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Sample records for complex regional pain

  1. Complex Regional Pain Syndrome

    Science.gov (United States)

    Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. It may happen ... move the affected body part The cause of CRPS is unknown. There is no specific diagnostic test. ...

  2. Complex Regional Pain Syndrome and Treatment Approaches

    Directory of Open Access Journals (Sweden)

    Neslihan Gokcen

    2013-08-01

    Full Text Available Complex Regional Pain Syndrome is a symptom complex including severe pain which is disproportioned by the initiating event. Formerly, it was known as reflex sympathetic dystropy, Sudeck’s atrophy and algoneurodystrophy. There are two types of complex regional pain syndrome (CPRS. CRPS type 1 (Reflex sympathetic dystropy occurs after a minor trauma of the extremities, CRPS type 2 (Causalgia occurs following peripheral nevre injury. Diagnosis is made according to the history, symptoms and physical findings of the patients. Patient education, physical therapy and medical treatment are the most common treatment approaches of complex regional pain syndrome. The aim of this review is to revise the treatment options ofcomplex regional pain syndrome, as well as to overview the new treatment approaches and options for the refractory complex regional pain syndrome cases. [Archives Medical Review Journal 2013; 22(4.000: 514-531

  3. Brain in complex regional pain syndrome

    OpenAIRE

    Hotta, Jaakko

    2017-01-01

    Complex regional pain syndrome (CRPS) causes disabling and severe limb pain that is difficult to treat. The pain typically increases during motor actions, but is present also at rest. The pathophysiology of CRPS is incompletely understood. Some of the symptoms suggest involvement of the central nervous system, and accordingly, patients have been shown to display alterations in, for instance, the primary sensorimotor cortex (SM1) and indications of neuroinflammation. More thorough pathophysiol...

  4. Complex Regional Pain Syndrome: An inflammatory disease

    NARCIS (Netherlands)

    M. Dirckx (Maaike)

    2015-01-01

    markdownabstractThe pathophysiology of Complex Regional Pain Syndrome (CRPS) is complex and still not completely understood. In addition to a convincing role of inflammation, there are a number of arguments why an involvement of the immune system has been suggested in the pathophysiology of CRPS.

  5. COMPLEX REGIONAL PAIN SYNDROME: AN UPDATE

    Directory of Open Access Journals (Sweden)

    Patta

    2015-10-01

    Full Text Available Complex Regional Pain Syndrome or CRPS is a chronic disabling heterogenous pain disorder due to trauma, resulting in sensory changes, motor function impairment, psychological changes. Diagnosis is based on clinical features and investigations. The patho - physiology is not clearly known. There is no single drug therapy, only combinations work. Treatment is multidisplinary involving medical, psychological and rehabi li tation. Newer modes of spinal cord stimulations, neuraxial mode of analgesics and newe r drugs are promising

  6. Spontaneous onset of Complex Regional Pain Syndrome

    NARCIS (Netherlands)

    de Rooij, A.M.; Perez, R.S.G.M.; Huygen, F.J.; van Eijs, F.; van Kleef, M.; Bauer, M.C.R.; van Hilten, J.J.; Marinus, J.

    2010-01-01

    Complex Regional Pain Syndrome (CRPS) usually develops after a noxious event, but spontaneous onsets have been described in 3-11% of the cases. The existence of spontaneous-onset CRPS is highly debated and the aim of the present study was therefore to compare the phenotypic characteristics of CRPS

  7. [Complex regional pain syndrome (CRPS) : An update].

    Science.gov (United States)

    Dimova, V; Birklein, F

    2018-04-17

    The acute phase of complex regional pain syndrome (CRPS) is pathophysiologically characterized by an activation of the immune system and its associated inflammatory response. During the course of CRPS, central nervous symptoms like mechanical hyperalgesia, loss of sensation, and body perception disorders develop. Psychological factors such as pain-related anxiety and traumatic events might have a negative effect on the treatment outcome. While the visible inflammatory symptoms improve, the pain often persists. A stage adapted, targeted treatment could improve the prognosis. Effective multidisciplinary treatment includes the following: pharmacotherapy with steroids, bisphosphonates, or dimethylsulfoxide cream (acute phase), and antineuropathic analgesics (all phases); physiotherapy and behavioral therapy for pain-related anxiety and avoidance of movement; and interventional treatment like spinal cord or dorsal root ganglion stimulation if noninvasive options failed.

  8. New Concepts in Complex Regional Pain Syndrome

    Science.gov (United States)

    Tajerian, Maral; Clark, J David

    2015-01-01

    SYNOPSIS Despite the severe pain and disability associated with Complex Regional Pain Syndrome (CRPS), our lack of understanding of the pathophysiological mechanisms supporting this enigmatic condition prevents the rational design of new therapies, a situation that is frustrating both to the physician and the patient. The following review will highlight some of the mechanisms thought to be involved in the pathophysiology of CRPS in preclinical models and CRPS patients, with the ultimate goal that understanding these mechanisms will lead to the design of efficacious, mechanism-based treatments available to the clinic. PMID:26611388

  9. Rethinking the Psychogenic Model of Complex Regional Pain Syndrome: Somatoform Disorders and Complex Regional Pain Syndrome

    Science.gov (United States)

    Hill, Renee J.; Chopra, Pradeep; Richardi, Toni

    2012-01-01

    Abstract Explaining the etiology of Complex Regional Pain Syndrome (CRPS) from the psychogenic model is exceedingly unsophisticated, because neurocognitive deficits, neuroanatomical abnormalities, and distortions in cognitive mapping are features of CRPS pathology. More importantly, many people who have developed CRPS have no history of mental illness. The psychogenic model offers comfort to physicians and mental health practitioners (MHPs) who have difficulty understanding pain maintained by newly uncovered neuro inflammatory processes. With increased education about CRPS through a biopsychosocial perspective, both physicians and MHPs can better diagnose, treat, and manage CRPS symptomatology. PMID:24223338

  10. Fear of pain in children and adolescents with neuropathic pain and complex regional pain syndrome.

    Science.gov (United States)

    Simons, Laura E

    2016-02-01

    A significant proportion of children and adolescents with chronic pain endorse elevated pain-related fear. Pain-related fear is associated with high levels of disability, depressive symptoms, and school impairment. Because of faulty nerve signaling, individuals with neuropathic pain and complex regional pain syndrome may be more prone to develop pain-related fear as they avoid use of and neglect the affected body area(s), resulting in exacerbated symptoms, muscle atrophy, maintenance of pain signaling, and ongoing pain-related disability. Not surprisingly, effective treatments for elevated pain-related fears involve exposure to previously avoided activities to downregulate incorrect pain signaling. In the context of intensive interdisciplinary pain treatment of youth with neuropathic pain, decreasing pain-related fear is associated with improved physical and psychological functioning, whereas high initial pain-related fear is a risk factor for less treatment responsiveness. An innovative approach to targeting pain-related fear and evidence of a neural response to treatment involving decoupling of the amygdala with key fear circuits in youth with complex regional pain syndrome suggest breakthroughs in our ability to ameliorate these issues.

  11. COMPLEX REGIONAL PAIN SYNDROME – CLINIC, DIAGNOSTICS, TREATMENT

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2014-07-01

    Full Text Available The problem of pain today remains one of the fundamental issues of medical care. It is known that the pain is the leading cause of treatmentto the doctor. Among pain syndromes, a special place belongs to the complex regional pain syndromes. They are distinguished by the multidisciplinary problem, the presence of explicit nature of the pain, difficulty of diagnosis and nature of the treatment. The article presentsmodern data on the diagnosis and treatment of the complex regional pain syndromes.

  12. COMPLEX REGIONAL PAIN SYNDROME – CLINIC, DIAGNOSTICS, TREATMENT

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2013-01-01

    Full Text Available The problem of pain today remains one of the fundamental issues of medical care. It is known that the pain is the leading cause of treatmentto the doctor. Among pain syndromes, a special place belongs to the complex regional pain syndromes. They are distinguished by the multidisciplinary problem, the presence of explicit nature of the pain, difficulty of diagnosis and nature of the treatment. The article presentsmodern data on the diagnosis and treatment of the complex regional pain syndromes.

  13. Inflammation in complex regional pain syndrome

    Science.gov (United States)

    Parkitny, Luke; McAuley, James H.; Di Pietro, Flavia; Stanton, Tasha R.; O’Connell, Neil E.; Marinus, Johan; van Hilten, Jacobus J.

    2013-01-01

    Objectives: We conducted a systematic review of the literature with meta-analysis to determine whether complex regional pain syndrome (CRPS) is associated with a specific inflammatory profile and whether this is dependent on the duration of the condition. Methods: Comprehensive searches of the literature using MEDLINE, Embase, Scopus, Web of Science, and reference lists from published reviews identified articles that measured inflammatory factors in CRPS. Two independent investigators screened titles and abstracts, and performed data extraction and risk of bias assessments. Studies were subgrouped by medium (blood, blister fluid, and CSF) and duration (acute and chronic CRPS). Where possible, meta-analyses of inflammatory factor concentrations were performed and pooled effect sizes were calculated using random-effects models. Results: Twenty-two studies were included in the systematic review and 15 in the meta-analysis. In acute CRPS, the concentrations of interleukin (IL)-8 and soluble tumor necrosis factor receptors I (sTNF-RI) and II (sTNF-RII) were significantly increased in blood. In chronic CRPS, significant increases were found in 1) TNFα, bradykinin, sIL-1RI, IL-1Ra, IL-2, sIL-2Ra, IL-4, IL-7, interferon-γ, monocyte chemoattractant protein-1 (MCP-1), and sRAGE (soluble receptor for advanced glycation end products) in blood; 2) IL-1Ra, MCP-1, MIP-1β, and IL-6 in blister fluid; and 3) IL-1β and IL-6 in CSF. Chronic CRPS was also associated with significantly decreased 1) substance P, sE-selectin, sL-selectin, sP-selectin, and sGP130 in blood; and 2) soluble intercellular adhesion molecule-1 (sICAM-1) in CSF. Most studies failed to meet 3 or more of our quality criteria. Conclusion: CRPS is associated with the presence of a proinflammatory state in the blood, blister fluid, and CSF. Different inflammatory profiles were found for acute and chronic cases. PMID:23267031

  14. Complex Regional Pain Syndrome in Children: Asking the Right Questions

    Directory of Open Access Journals (Sweden)

    Kenneth R Goldschneider

    2012-01-01

    Full Text Available BACKGROUND: Complex regional pain syndrome (CRPS is a painful disorder without a known unifying mechanism. There are little data on which to base evaluation and treatment decisions, and what data are available come from studies involving adults; however, even that literature is relatively sparse. Developing robust research for CRPS in children is essential for the progress toward optimal treatment.

  15. Genetic and epidemiological aspect of Complex Regional Pain Syndrome

    NARCIS (Netherlands)

    Rooij, Annetje Monique de

    2010-01-01

    Complex Regional Pain Syndrome (CRPS) is a painful disorder affecting one or more extremities. CRPS is characterized by various combinations of sensory, autonomic and motor disturbances. Genetic factors are suggested to play a role in CRPS, but this has not been extensively studied. Therefore the

  16. Neuroimmune Alterations in the Complex Regional Pain Syndrome

    NARCIS (Netherlands)

    F.J.P.M. Huygen (Frank)

    2004-01-01

    textabstractComplex Regional Pain Syndrome (CRPS) is a disease which occurs as a complication after surgery or trauma, although spontaneous development is described. CRPS is characterized by continuing pain, sensory and vasomotor, sudomotor, motor and trophic disturbances. Many of these symptoms are

  17. What is Complex Regional Pain Syndrome?

    Science.gov (United States)

    ... muscle diseases, a clotted vein, or small fiber polyneuropathies, because these require different treatment. The distinguishing feature ... CRPS treated? The following therapies are often used: Rehabilitation and physical therapy . An exercise program to keep the painful limb or body ...

  18. Orofacial complex regional pain syndrome: pathophysiologic mechanisms and functional MRI.

    Science.gov (United States)

    Lee, Yeon-Hee; Lee, Kyung Mi; Kim, Hyug-Gi; Kang, Soo-Kyung; Auh, Q-Schick; Hong, Jyung-Pyo; Chun, Yang-Hyun

    2017-08-01

    Complex regional pain syndrome (CRPS) is one of the most challenging chronic pain conditions and is characterized by burning pain, allodynia, hyperalgesia, autonomic changes, trophic changes, edema, and functional loss involving mainly the extremities. Until recently, very few reports have been published concerning CRPS involving the orofacial area. We report on a 50-year-old female patient who presented with unbearable pain in all of her teeth and hypersensitivity of the facial skin. She also reported intractable pain in both extremities accompanied by temperature changes and orofacial pain that increased when the other pains were aggravated. In the case of CRPS with trigeminal neuropathic pain, protocols for proper diagnosis and prompt treatment have yet to be established in academia or in the clinical field. We performed functional magnetic resonance imaging for a thorough analysis of the cortical representation of the affected orofacial area immediately before and immediately after isolated light stimulus of the affected hand and foot and concluded that CRPS can be correlated with trigeminal neuropathy in the orofacial area. Furthermore, the patient was treated with carbamazepine administration and stellate ganglion block, which can result in a rapid improvement of pain in the trigeminal region. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Reflex sympathetic dystrophy/complex regional pain syndrome, type 1

    African Journals Online (AJOL)

    Enrique

    with MRI every 3 months and the bone marrow oedema disappeared after 6 months. Introduction ... SA JOURNAL OF RADIOLOGY • August 2004. Reflex sympathetic dystrophy/complex regional pain syndrome, type 1 ... may be either trauma of external origin or iatrogenic, post surgery. In some patients particularly children ...

  20. [Complex regional pain syndrome type 1: negating the myth

    NARCIS (Netherlands)

    Frolke, J.P.M.; Dongen, R.T.M. van; Meent, H. van de

    2015-01-01

    Complex regional pain syndrome type 1 (CRPS-1) was identified in the Netherlands more than 30 years ago, but since then the arguments supporting this diagnosis have become weaker. Incidence has decreased, it is often not possible to make a definite diagnosis, the pathophysiology remains unclear and

  1. Evidence based guidelines for complex regional pain syndrome type 1

    NARCIS (Netherlands)

    Perez, R.S.G.M.; Zollinger, P.E.; Dijkstra, P.U.; Thomassen-Hilgersom, I.L.; Zuurmond, W.W.A.; Rosenbrand, C.J.G.M.; Geerzen, J.H.B.

    2010-01-01

    Background: Treatment of complex regional pain syndrome type I (CRPS-I) is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I.Method: A multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according

  2. Evidence based guidelines for complex regional pain syndrome type 1

    NARCIS (Netherlands)

    Perez, Roberto S.; Zollinger, Paul E.; Dijkstra, Pieter U.; Thomassen-Hilgersom, Ilona L.; Zuurmond, Wouter W.; Rosenbrand, Kitty C. J.; Geertzen, Jan H.

    2010-01-01

    Background: Treatment of complex regional pain syndrome type I (CRPS-I) is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I. Method: A multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according

  3. Complex Regional Pain Syndrome (CRPS/RSD and Neuropathic Pain: Role of Intravenous Bisphosphonates as Analgesics

    Directory of Open Access Journals (Sweden)

    Jennifer Yanow

    2008-01-01

    Full Text Available Neuropathic pain is a sequela of dysfunction, injuries, or diseases of the peripheral and/or central nervous system pain pathways, which has historically been extremely difficult to treat. Complex regional pain syndrome (CRPS types 1 and 2 are neuropathic pain conditions that have a long history in the medical literature but whose pathophysiology remains elusive and whose available treatment options remain few. While an exact animal model for CRPS doesn't yet exist, there are several animal models of neuropathic pain that develop behaviors of hypersensitivity, one of the hallmark signs of neuropathic pain in humans.

  4. Genome-Wide Expression Profiling of Complex Regional Pain Syndrome

    Science.gov (United States)

    Jin, Eun-Heui; Zhang, Enji; Ko, Youngkwon; Sim, Woo Seog; Moon, Dong Eon; Yoon, Keon Jung; Hong, Jang Hee; Lee, Won Hyung

    2013-01-01

    Complex regional pain syndrome (CRPS) is a chronic, progressive, and devastating pain syndrome characterized by spontaneous pain, hyperalgesia, allodynia, altered skin temperature, and motor dysfunction. Although previous gene expression profiling studies have been conducted in animal pain models, there genome-wide expression profiling in the whole blood of CRPS patients has not been reported yet. Here, we successfully identified certain pain-related genes through genome-wide expression profiling in the blood from CRPS patients. We found that 80 genes were differentially expressed between 4 CRPS patients (2 CRPS I and 2 CRPS II) and 5 controls (cut-off value: 1.5-fold change and pCRPS patients and 18 controls by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). We focused on the MMP9 gene that, by qRT-PCR, showed a statistically significant difference in expression in CRPS patients compared to controls with the highest relative fold change (4.0±1.23 times and p = 1.4×10−4). The up-regulation of MMP9 gene in the blood may be related to the pain progression in CRPS patients. Our findings, which offer a valuable contribution to the understanding of the differential gene expression in CRPS may help in the understanding of the pathophysiology of CRPS pain progression. PMID:24244504

  5. Sensitization of the Nociceptive System in Complex Regional Pain Syndrome

    Science.gov (United States)

    Diedrichs, Carolina; Baron, Ralf; Gierthmühlen, Janne

    2016-01-01

    Background Complex regional pain syndrome type I (CRPS-I) is characterized by sensory, motor and autonomic abnormalities without electrophysiological evidence of a nerve lesion. Objective Aims were to investigate how sensory, autonomic and motor function change in the course of the disease. Methods 19 CRPS-I patients (17 with acute, 2 with chronic CRPS, mean duration of disease 5.7±8.3, range 1–33 months) were examined with questionnaires (LANSS, NPS, MPI, Quick DASH, multiple choice list of descriptors for sensory, motor, autonomic symptoms), motor and autonomic tests as well as quantitative sensory testing according to the German Research Network on Neuropathic Pain at two visits (baseline and 36±10.6, range 16–53 months later). Results CRPS-I patients had an improvement of sudomotor and vasomotor function, but still a great impairment of sensory and motor function upon follow-up. Although pain and mechanical detection improved upon follow-up, thermal and mechanical pain sensitivity increased, including the contralateral side. Increase in mechanical pain sensitivity and loss of mechanical detection were associated with presence of ongoing pain. Conclusions The results demonstrate that patients with CRPS-I show a sensitization of the nociceptive system in the course of the disease, for which ongoing pain seems to be the most important trigger. They further suggest that measured loss of function in CRPS-I is due to pain-induced hypoesthesia rather than a minimal nerve lesion. In conclusion, this article gives evidence for a pronociceptive pain modulation profile developing in the course of CRPS and thus helps to assess underlying mechanisms of CRPS that contribute to the maintenance of patients’ pain and disability. PMID:27149519

  6. Sensitization of the Nociceptive System in Complex Regional Pain Syndrome.

    Directory of Open Access Journals (Sweden)

    Maren Reimer

    Full Text Available Complex regional pain syndrome type I (CRPS-I is characterized by sensory, motor and autonomic abnormalities without electrophysiological evidence of a nerve lesion.Aims were to investigate how sensory, autonomic and motor function change in the course of the disease.19 CRPS-I patients (17 with acute, 2 with chronic CRPS, mean duration of disease 5.7±8.3, range 1-33 months were examined with questionnaires (LANSS, NPS, MPI, Quick DASH, multiple choice list of descriptors for sensory, motor, autonomic symptoms, motor and autonomic tests as well as quantitative sensory testing according to the German Research Network on Neuropathic Pain at two visits (baseline and 36±10.6, range 16-53 months later.CRPS-I patients had an improvement of sudomotor and vasomotor function, but still a great impairment of sensory and motor function upon follow-up. Although pain and mechanical detection improved upon follow-up, thermal and mechanical pain sensitivity increased, including the contralateral side. Increase in mechanical pain sensitivity and loss of mechanical detection were associated with presence of ongoing pain.The results demonstrate that patients with CRPS-I show a sensitization of the nociceptive system in the course of the disease, for which ongoing pain seems to be the most important trigger. They further suggest that measured loss of function in CRPS-I is due to pain-induced hypoesthesia rather than a minimal nerve lesion. In conclusion, this article gives evidence for a pronociceptive pain modulation profile developing in the course of CRPS and thus helps to assess underlying mechanisms of CRPS that contribute to the maintenance of patients' pain and disability.

  7. Complex regional pain syndrome 1 : a study on pain and motor impairments

    NARCIS (Netherlands)

    G.M. Ribbers (Gerard)

    2001-01-01

    textabstractThis thesis, is compiled of publications on reflex sympathetic dystrophy (RSD) or Complex Regional Pain Syndrome type 1 (CRPS 1), as it was renamed by the committee on taxonomy of the International Association for the Study of Pain (IASP). It is a puzzling syndrome both from a clinical

  8. Optokinetic stimulation increases limb pain and forehead hyperalgesia in complex regional pain syndrome

    DEFF Research Database (Denmark)

    Knudsen, Lone F.; Drummond, Peter D.

    2015-01-01

    BACKGROUND: Ambiguous visual stimuli increase limb pain in patients with complex regional pain syndrome (CRPS), possibly due to afferent sensory feedback conflicts. Conflicting sensory stimuli can also generate unpleasant sensations in healthy people such as during motion sickness. We wanted to i...

  9. Genome-wide expression profiling of complex regional pain syndrome.

    Directory of Open Access Journals (Sweden)

    Eun-Heui Jin

    Full Text Available Complex regional pain syndrome (CRPS is a chronic, progressive, and devastating pain syndrome characterized by spontaneous pain, hyperalgesia, allodynia, altered skin temperature, and motor dysfunction. Although previous gene expression profiling studies have been conducted in animal pain models, there genome-wide expression profiling in the whole blood of CRPS patients has not been reported yet. Here, we successfully identified certain pain-related genes through genome-wide expression profiling in the blood from CRPS patients. We found that 80 genes were differentially expressed between 4 CRPS patients (2 CRPS I and 2 CRPS II and 5 controls (cut-off value: 1.5-fold change and p<0.05. Most of those genes were associated with signal transduction, developmental processes, cell structure and motility, and immunity and defense. The expression levels of major histocompatibility complex class I A subtype (HLA-A29.1, matrix metalloproteinase 9 (MMP9, alanine aminopeptidase N (ANPEP, l-histidine decarboxylase (HDC, granulocyte colony-stimulating factor 3 receptor (G-CSF3R, and signal transducer and activator of transcription 3 (STAT3 genes selected from the microarray were confirmed in 24 CRPS patients and 18 controls by quantitative reverse transcription-polymerase chain reaction (qRT-PCR. We focused on the MMP9 gene that, by qRT-PCR, showed a statistically significant difference in expression in CRPS patients compared to controls with the highest relative fold change (4.0±1.23 times and p = 1.4×10(-4. The up-regulation of MMP9 gene in the blood may be related to the pain progression in CRPS patients. Our findings, which offer a valuable contribution to the understanding of the differential gene expression in CRPS may help in the understanding of the pathophysiology of CRPS pain progression.

  10. Complex regional pain syndrome–up-to-date

    Science.gov (United States)

    Birklein, Frank; Dimova, Violeta

    2017-01-01

    Abstract Complex regional pain syndrome (CRPS) was described for the first time in the 19th century by Silas Weir Mitchell. After the exclusion of other causes, CRPS is characterised by a typical clinical constellation of pain, sensory, autonomic, motor, or trophic symptoms which can no longer be explained by the initial trauma. These symptoms spread distally and are not limited to innervation territories. If CRPS is not improved in the acute phase and becomes chronic, the visible symptoms change throughout because of the changing pathophysiology; the pain, however, remains. The diagnosis is primarily clinical, although in complex cases further technical examination mainly for exclusion of alternative diagnoses is warranted. In the initial phase, the pathophysiology is dominated by a posttraumatic inflammatory reaction by the activation of the innate and adaptive immune system. In particular, without adequate treatment, central nociceptive sensitization, reorganisation, and implicit learning processes develop, whereas the inflammation moderates. The main symptoms then include movement disorders, alternating skin temperature, sensory loss, hyperalgesia, and body perception disturbances. Psychological factors such as posttraumatic stress or pain-related fear may impact the course and the treatability of CRPS. The treatment should be ideally adjusted to the pathophysiology. Pharmacological treatment maybe particularly effective in acute stages and includes steroids, bisphosphonates, and dimethylsulfoxide cream. Common anti-neuropathic pain drugs can be recommended empirically. Intravenous long-term ketamine administration has shown efficacy in randomised controlled trials, but its repeated application is demanding and has side effects. Important components of the treatment include physio- and occupational therapy including behavioural therapy (eg, graded exposure in vivo and graded motor imaging). If psychosocial comorbidities exist, patients should be appropriately

  11. Complex regional pain syndrome–up-to-date

    Directory of Open Access Journals (Sweden)

    Frank Birklein

    2017-12-01

    Full Text Available Abstract. Complex regional pain syndrome (CRPS was described for the first time in the 19th century by Silas Weir Mitchell. After the exclusion of other causes, CRPS is characterised by a typical clinical constellation of pain, sensory, autonomic, motor, or trophic symptoms which can no longer be explained by the initial trauma. These symptoms spread distally and are not limited to innervation territories. If CRPS is not improved in the acute phase and becomes chronic, the visible symptoms change throughout because of the changing pathophysiology; the pain, however, remains. The diagnosis is primarily clinical, although in complex cases further technical examination mainly for exclusion of alternative diagnoses is warranted. In the initial phase, the pathophysiology is dominated by a posttraumatic inflammatory reaction by the activation of the innate and adaptive immune system. In particular, without adequate treatment, central nociceptive sensitization, reorganisation, and implicit learning processes develop, whereas the inflammation moderates. The main symptoms then include movement disorders, alternating skin temperature, sensory loss, hyperalgesia, and body perception disturbances. Psychological factors such as posttraumatic stress or pain-related fear may impact the course and the treatability of CRPS. The treatment should be ideally adjusted to the pathophysiology. Pharmacological treatment maybe particularly effective in acute stages and includes steroids, bisphosphonates, and dimethylsulfoxide cream. Common anti-neuropathic pain drugs can be recommended empirically. Intravenous long-term ketamine administration has shown efficacy in randomised controlled trials, but its repeated application is demanding and has side effects. Important components of the treatment include physio- and occupational therapy including behavioural therapy (eg, graded exposure in vivo and graded motor imaging. If psychosocial comorbidities exist, patients should

  12. Children and adolescents with complex regional pain syndrome: More psychologically distressed than other children in pain?

    Science.gov (United States)

    Logan, Deirdre E; Williams, Sara E; Carullo, Veronica P; Claar, Robyn Lewis; Bruehl, Stephen; Berde, Charles B

    2013-01-01

    BACKGROUND Historically, in both adult and pediatric populations, a lack of knowledge regarding complex regional pain syndrome (CRPS) and absence of clear diagnostic criteria have contributed to the view that this is a primarily psychiatric condition. OBJECTIVE: To test the hypothesis that children with CRPS are more functionally disabled, have more pain and are more psychologically distressed than children with other pain conditions. METHODS: A total of 101 children evaluated in a tertiary care pediatric pain clinic who met the International Association for the Study of Pain consensus diagnostic criteria for CRPS participated in the present retrospective study. Comparison groups included 103 children with abdominal pain, 291 with headache and 119 with back pain. Children and parents completed self-report questionnaires assessing disability, somatization, pain coping, depression, anxiety and school attendance. RESULTS: Children with CRPS reported higher pain intensity and more recent onset of pain at the initial tertiary pain clinic evaluation compared with children with other chronic pain conditions. They reported greater functional disability and more somatic symptoms than children with headaches or back pain. Scores on measures of depression and anxiety were within normal limits and similar to those of children in other pain diagnostic groups. CONCLUSIONS: As a group, clinic-referred children with CRPS may be more functionally impaired and experience more somatic symptoms compared with children with other pain conditions. However, overall psychological functioning as assessed by self-report appears to be similar to that of children with other chronic pain diagnoses. Comprehensive assessment using a biopsychosocial framework is essential to understanding and appropriately treating children with symptoms of CRPS. PMID:23662291

  13. Complex regional pain syndrome type I following pacemaker implantation

    Directory of Open Access Journals (Sweden)

    Sangita Kamath

    2015-12-01

    Full Text Available A 70-year-old woman presented with burning pain and swelling over dorsum of right hand and small joints of the fingers, associated with redness, feeling of warmth, and stiffness of the fingers, with inability to bend the fingers since 2 months. The symptoms were progressively increasing in intensity for the past 1 month. There was no history of fever or trauma to the hand. Two months before her symptoms started, she had permanent pacemaker implanted for complete heart block with syncope. She was hypertensive and was on regular medication. Her X-ray of right hand showed decreased bone density (demineralisation, suggestive of osteopenia. A diagnosis of reflex sympathetic dystrophy syndrome or complex regional pain syndrome type I induced by pacemaker insertion was made. She was treated with amitriptyline and steroids, after which her symptoms improved dramatically.

  14. Immunological aspects of the complex regional pain syndrome (CRPS).

    Science.gov (United States)

    Krämer, Heidrun H

    2012-01-01

    Limb trauma can lead to the development of a complex regional pain syndrome (CRPS). CRPS is a descriptive term of a variety of different symptoms. According to the current IASP-approved criteria, human CRPS can be diagnosed if a combination of signs is present: continuing pain and hyperalgesia, disproportionate to the initial trauma, skin temperature and colour asymmetry, sweating asymmetry, edema, decreased range of motion, and trophic changes. The diagnosis and treatment of human CRPS can be demanding and the pathophysiology underlying the disease is still under investigation. Immunological aspects are considered to play an important role in the development of CRPS. The impact of elevated pro-inflammatory cytokines systemically as well as locally, increased neurogenic inflammation and auto-antibodies in the pathophysiological development of CRPS are discussed in this review.

  15. Evidence based guidelines for complex regional pain syndrome type 1

    Directory of Open Access Journals (Sweden)

    Thomassen-Hilgersom Ilona L

    2010-03-01

    Full Text Available Abstract Background Treatment of complex regional pain syndrome type I (CRPS-I is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I. Method A multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according to their strength of evidence, published between 1980 to June 2005. Treatment recommendations based on the literature findings were formulated and formally approved by all Dutch professional associations involved in CRPS-I treatment. Results For pain treatment, the WHO analgesic ladder is advised with the exception of strong opioids. For neuropathic pain, anticonvulsants and tricyclic antidepressants may be considered. For inflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine are advised. To promote peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used to increase blood flow in case vasodilatory medication has insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, vitamin C is recommended. Adequate perioperative analgesia, limitation of operating time, limited use of tourniquet, and use of regional anaesthetic techniques are recommended for secondary prevention of CRPS-I. Conclusions Based on the literature identified and the extent of evidence found for therapeutic interventions for CRPS-I, we conclude that further research is needed into each of the therapeutic modalities discussed in the guidelines.

  16. Impaired insula functional connectivity associated with persistent pain perception in patients with complex regional pain syndrome

    Science.gov (United States)

    Jang, Joon Hwan; Lee, Do-Hyeong; Lee, Kyung-Jun; Lee, Won Joon; Moon, Jee Youn; Kim, Yong Chul

    2017-01-01

    Given that the insula plays a contributory role in the perception of chronic pain, we examined the resting-state functional connectivity between the insular cortex and other brain regions to investigate neural underpinnings of persisting perception of background pain in patients with complex regional pain syndrome (CRPS). A total of 25 patients with CRPS and 25 matched healthy controls underwent functional magnetic resonance imaging at rest. With the anterior and posterior insular cortices as seed regions, we compared the strength of the resting-state functional connectivity between the two groups. Functional connectivity between the anterior and posterior insular cortices and the postcentral and inferior frontal gyri, cingulate cortices was reduced in patients with CRPS compared with controls. Additionally, greater reductions in functional connectivity between the anterior insula and right postcentral gyrus were associated with more severe sensory pain in patients with CRPS (short-form McGill Pain Questionnaire sensory subscores, r = -.517, P = .023). The present results imply a possible role of the insula in aberrant processing of pain information in patients with CRPS. The findings suggest that a functional derangement of the connection between one of the somatosensory cortical functions of perception and one of the insular functions of awareness can play a significant role in the persistent experience of regional pain that is not confined to a specific nerve territory. PMID:28692702

  17. Complex regional pain syndrome 1 – the Swiss cohort study

    Directory of Open Access Journals (Sweden)

    Perez Roberto SGM

    2008-06-01

    Full Text Available Abstract Background Little is known about the course of Complex Regional Pain Syndrome 1 and potential factors influencing the course of this disorder over time. The goal of this study is a to set up a database with patients suffering from suspected CRPS 1 in an initial stadium, b to perform investigations on epidemiology, diagnosis, prognosis, and socioeconomics within the database and c to develop a prognostic risk assessment tool for patients with CRPS 1 taking into account symptomatology and specific therapies. Methods/design Prospective cohort study. Patients suffering from a painful swelling of the hand or foot which appeared within 8 weeks after a trauma or a surgery and which cannot be explained by conditions that would otherwise account for the degree of pain and dysfunction will be included. In accordance with the recommendations of International Classification of Functioning, Disability and Health (ICF model, standardised and validated questionnaires will be used. Patients will be monitored over a period of 2 years at 6 scheduled visits (0 and 6 weeks, 3, 6, 12, and 24 months. Each visit involves a physical examination, registration of therapeutic interventions, and completion of the various study questionnaires. Outcomes involve changes in health status, quality of life and costs/utility. Discussion This paper describes the rationale and design of patients with CRPS 1. Ideally, potential risk factors may be identified at an early stage in order to initiate an early and adequate treatment in patients with increased risk for delayed recovery. Trial registration Not applicable

  18. Complex regional pain syndromes (CRPS type 1 validating case histories

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    P. Berger

    2003-01-01

    Full Text Available The treatment of patients with complex regional pain syndrome (CRPS type 1 is challenging and unpredictable as the condition presents with vascular and neuropathic symptoms after nil or even minor injury to a peripheral nerve. The condition is one of a pain and motor dysfunction. The pathophysiology is not well understood and the relief of symptoms may change from being sympathetically mediated to sympathetically independent during  the course of the disease. At any stage physiotherapy has been advocated as the corner stone and most important aspect of treatment in the rehabilitation of these individuals but unfortunately it has been difficult to execute when pain is exacerbated due to allodynia (unbearable to touch or move and hyperalgesia. Best results have been obtained if the patients are recognised and treated in the early or acute phase and it has been found that through careful assessment and analysis these patients can be recognised by previous events that have occurred in their initial case history. The treatment in the acute stage with physiotherapy modalities such as electrical stimulation and acupuncture will produce an early cessation of the symptoms and prevention of the disease developing into the fully blown CRPS type 1 with irreversible and possibly atrophic consequences. Case histories have been presented that illustrate these important aspects and demonstrate  the value of early and the appropriate physiotherapy that may be more successful than other pharmacological and physical interventions in this disease.

  19. Reflex sympathetic dystrophy/complex regional pain syndrome, type 1

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    S.H. Botha

    2004-06-01

    Full Text Available Complex regional pain syndrome (CPRS, type 1 is a pain disorder that develops unpredictably and can follow a minor injury. A 12-year-old boy presented with severe pain in the feet and could not walk or stand weight bearing. Normal X-rays showed osteopenic changes and radiolucent lines, which appeared to be stress fractures. Three-phase bone scintigraphy showed no uptake in the left lower leg on the blood pool phase or on the immediate or delayed images. This indicated typical CPRS type 1 in children. The uptake in the right foot was increased and the stress fracture and other illness could not be differentiated. Computed tomography was done to exclude stress fractures. Only osteopenic changes in both calcaneus bones were found and there was no evidence of cortical stress fractures. Magnetic resonance images revealed oedema in the calcaneus and talus bones of both feet. The patient received epidural narcotic infusion with sympathetic blockage for 1 week combined with extensive physiotherapy. The blood pool phase of the bone scan became normal within 2 weeks, and increased uptake in both feet was noticed. The patient was followed up with MRI every 3 months and the bone marrow oedema disappeared after 6 months.

  20. Complex Regional Pain Syndrome after Transradial Cardiac Catheterization

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    Chih-Jou Lai

    2006-04-01

    Full Text Available Complex regional pain syndrome (CRPS is a disease with unclear pathophysiology. The condition is characterized by pain, soft tissue change, vasomotor change, and even psychosocial disturbance. It may affect the upper more than the lower extremities, and the distal more than the proximal. The trigger factors include carpal tunnel release, Dupuytren's repair, tendon release procedures, knee surgery, crush injury, ankle arthrodesis, amputation, and hip arthroplasty. Rarely, it has been associated with stroke, mastectomy, pregnancy, and osteogenesis imperfecta. Herein, we present a rare case of a patient who was diagnosed with CRPS after transradial cardiac catheterization. CRPS was first diagnosed due to hand swelling, allodynia, paresthesia, and the limited range of motion of interphalangeal, metacarpophalangeal, and wrist joints, with the preceding factor of transradial cardiac catheterization, and was then confirmed by a three-phase bone scan. After intensive physical therapy with hydrotherapy, manual soft tissue release, and occupational therapy for the hand function, there was much improvement in range of motion and hand function. There was no allodynia or painful sensation in the follow-up. After training, the functional status of this patient was adequate for daily activity.

  1. Are Pain-Related Fears Mediators for Reducing Disability and Pain in Patients with Complex Regional Pain Syndrome Type 1? An Explorative Analysis on Pain Exposure Physical Therapy

    Science.gov (United States)

    Barnhoorn, Karlijn J.; Staal, J. Bart; van Dongen, Robert T. M.; Frölke, Jan Paul M.; Klomp, Frank P.; van de Meent, Henk; Samwel, Han; Nijhuis-van der Sanden, Maria W. G.

    2015-01-01

    Objective To investigate whether pain-related fears are mediators for reducing disability and pain in patients with Complex Regional Pain Syndrome type 1 when treating with Pain Exposure Physical Therapy. Design An explorative secondary analysis of a randomised controlled trial. Participants Fifty-six patients with Complex Regional Pain Syndrome type 1. Interventions The experimental group received Pain Exposure Physical Therapy in a maximum of five treatment sessions; the control group received conventional treatment following the Dutch multidisciplinary guideline. Outcome measures Levels of disability, pain, and pain-related fears (fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were measured at baseline and after 3, 6, and 9 months follow-up. Results The experimental group had a significantly larger decrease in disability of 7.77 points (95% CI 1.09 to 14.45) and in pain of 1.83 points (95% CI 0.44 to 3.23) over nine months than the control group. The potential mediators pain-related fears decreased significantly in both groups, but there were no significant differences between groups, which indicated that there was no mediation. Conclusion The reduction of pain-related fears was comparable in both groups. We found no indication that pain-related fears mediate the larger reduction of disability and pain in patients with Complex Regional Pain Syndrome type 1 treated with Pain Exposure Physical Therapy compared to conventional treatment. Trial registration International Clinical Trials Registry NCT00817128 PMID:25919011

  2. Activation of cutaneous immune responses in complex regional pain syndrome

    Science.gov (United States)

    Birklein, Frank; Drummond, Peter D.; Li, Wenwu; Schlereth, Tanja; Albrecht, Nahid; Finch, Philip M.; Dawson, Linda F.; Clark, J. David; Kingery, Wade S.

    2014-01-01

    The pathogenesis of complex regional pain syndrome (CRPS) is unresolved, but TNF-α and IL-6 are elevated in experimental skin blister fluid from CRPS affected limbs, as is tryptase, a marker for mast cells. In the rat fracture model of CRPS exaggerated sensory and sympathetic neural signaling stimulate keratinocyte and mast cell proliferation, causing the local production of high levels of inflammatory cytokines leading to pain behavior. The current investigation used CRPS patient skin biopsies to determine whether keratinocyte and mast cell proliferation occur in CRPS skin and to identify the cellular source of the up-regulated TNF-α, IL-6, and tryptase observed in CRPS experimental skin blister fluid. Skin biopsies were collected from the affected skin and the contralateral mirror site in 55 CRPS patients and the biopsy sections were immunostained for keratinocyte, cell proliferation, mast cell markers, TNF-α, and IL-6. In early CRPS keratinocytes were activated in the affected skin, resulting in proliferation, epidermal thickening, and up-regulated TNF-α and IL-6 expression. In chronic CRPS there was reduced keratinocyte proliferation with epidermal thinning in the affected skin. Acute CRPS patients also had increased mast cell accumulation in the affected skin, but there was no increase in mast cell numbers in chronic CRPS. PMID:24462502

  3. MicroRNA modulation in complex regional pain syndrome

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    Orlova Irina A

    2011-11-01

    Full Text Available Abstract Background Aberrant expression of small noncoding RNAs called microRNAs (miRNAs is a common feature of several human diseases. The objective of the study was to identify miRNA modulation in patients with complex regional pain syndrome (CRPS a chronic pain condition resulting from dysfunction in the central and/or peripheral nervous systems. Due to a multitude of inciting pathologies, symptoms and treatment conditions, the CRPS patient population is very heterogeneous. Our goal was to identify differentially expressed miRNAs in blood and explore their utility in patient stratification. Methods We profiled miRNAs in whole blood from 41 patients with CRPS and 20 controls using TaqMan low density array cards. Since neurogenic inflammation is known to play a significant role in CRPS we measured inflammatory markers including chemokines, cytokines, and their soluble receptors in blood from the same individuals. Correlation analyses were performed for miRNAs, inflammatory markers and other parameters including disease symptoms, medication, and comorbid conditions. Results Three different groups emerged from miRNA profiling. One group was comprised of 60% of CRPS patients and contained no control subjects. miRNA profiles from the remaining patients were interspersed among control samples in the other two groups. We identified differential expression of 18 miRNAs in CRPS patients. Analysis of inflammatory markers showed that vascular endothelial growth factor (VEGF, interleukin1 receptor antagonist (IL1Ra and monocyte chemotactic protein-1 (MCP1 were significantly elevated in CRPS patients. VEGF and IL1Ra showed significant correlation with the patients reported pain levels. Analysis of the patients who were clustered according to their miRNA profile revealed correlations that were not significant in the total patient population. Correlation analysis of miRNAs detected in blood with additional parameters identified miRNAs associated with

  4. Estrogens and the risk of complex regional pain syndrome (CRPS).

    Science.gov (United States)

    de Mos, M; Huygen, F J P M; Stricker, B H Ch; Dieleman, J P; Sturkenboom, M C J M

    2009-01-01

    Since complex regional pain syndrome (CRPS) shows a clear female predominance, we investigated the association between the cumulative as well as current exposure to estrogens, and CRPS. A population-based case-control study was conducted in the Integrated Primary Care Information (IPCI) project in the Netherlands. Cases were identified from electronic records (1996-2005) and included if they were confirmed during a visit (using International Association for the Study of Pain Criteria), or had been diagnosed by a specialist. Controls were matched to cases on gender, age, calendar time, and injury. Measures of cumulative endogenous estrogen exposure were obtained by questionnaire and included age of menarche and menopause, menstrual life, and cumulative months of pregnancy and breast-feeding. Current estrogen exposure at CRPS onset was retrieved from the electronic medical records and determined by current pregnancy or by the use of oral contraceptive (OC) drugs or hormonal replacement therapy (HRT). Hundred and forty-three female cases (1493 controls) were included in analyses on drug use and pregnancies, while cumulative endogenous estrogen exposure was studied in 53 cases (58 controls) for whom questionnaire data were available. There was no association between CRPS and either cumulative endogenous estrogen exposure, OC, or HRT use. CRPS onset was increased during the first 6 months after pregnancy (OR: 5.6, 95%CI: 1.0-32.4), although based on small numbers. We did not find an association between CRPS onset and cumulative endogenous estrogen exposure or current OC or HRT use, but more powered studies are needed to exclude potential minor associations.

  5. Pain increases during sympathetic arousal in patients with complex regional pain syndrome.

    Science.gov (United States)

    Drummond, P D; Finch, P M; Skipworth, S; Blockey, P

    2001-10-09

    To investigate the effect of sympathetic arousal on pain and vasomotor responses in healthy control subjects and patients with complex regional pain syndrome (CRPS), and to determine whether pain increases in patients with particular symptoms. In experiments 1 and 2, capsaicin was applied to the forearm of 24 healthy subjects to induce thermal hyperalgesia. Vascular responses were monitored and subjects rated thermal hyperalgesia before and after being startled (experiment 1), and before, during, and after mental arithmetic, breath holding, forehead cooling, the Valsalva maneuver, and a cold pressor test in experiment 2. In a third experiment, sensitivity to heat, cold, and mechanical stimulation was investigated in 61 patients with CRPS. Pain ratings and vascular and electrodermal responses were recorded after patients were startled and during forehead cooling. In experiment 1, thermal hyperalgesia decreased in healthy control subjects after they were startled, and digital blood vessels constricted symmetrically. In experiment 2, thermal hyperalgesia decreased during and after other forms of sympathetic arousal. However, in experiment 3, ratings of clinical pain increased during forehead cooling or after being startled in over 70% of patients with CRPS. Pain increased most consistently during forehead cooling in patients with cold allodynia or punctate allodynia. Digital blood vessels constricted more intensely on the symptomatic than the nonsymptomatic side in patients with CRPS during sympathetic arousal. Normal inhibitory influences on pain during sympathetic arousal are compromised in the majority of patients with CRPS. The augmented vasoconstrictor response in the symptomatic limb during sympathetic arousal is consistent with adrenergic supersensitivity. An adrenergic sensitivity in nociceptive afferents might contribute to pain and hyperalgesia during sympathetic arousal in certain patients with CRPS.

  6. Demographic Features in Patients with Complex Regional Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Berat Meryem Alkan

    2011-12-01

    Full Text Available Summary Özet Orijinal Araştırma / Original Investigation 77 Aim: Complex regional pain syndrome (CRPS is characterized by pain, vasomotor and sudomotor changes and trophic disturbances. It may develop as a result of trauma, especially extremity fractures and surgery. Although the pathogenesis of CRPS is not exactly clear explained, it has been suggested that central and periferal mechanisms play role and neurogenic inflamatuar and microvasculer functional impairmensts are accompanying to the process. Not all but some of the patients with past trauma or with other possible etiological factors develop CRPS. This suggests the presence of an individual predisposition. In this article, we searched post fractüred CRPS-I patients demographic characteristics, current systemic diseases and symptoms that accompany a CRPS in our records. Materials and Methods: In this retrospective study conducted in Ankara Atatürk Education and Research Hospital, medical records of 356 patients admitted to physical medicine and rehabilitation outpatient clinics with fractures between January 2011 and June 2011 were evaluated and 34 patients diagnosed as CRPS-1 were included in the study. Results: 34 of 356 patients (9.56% with fractures were diagnosed as CRPS-1 in our outpatient clinics. Mean age of the patients was 46.05 years and 10 patients were females (29.4% and 24 patients (70.6% were males. Fractures were in upper extremities in 18 patients (52.9% and in lower extremities in 16 (47.1% patients. Neuropsychiatric disorders and other systemic diseases that may have a role in etiology of CRPS were found in lower rates in medical records of our patients. Conclusion: CRPS does not develop in every patients after travma who has etiologic risk factors, so it reminds that there exists a tendency to CRPS. We have observed that CRPS-1 risk was increased in male patients and in upper extremity fractures. We did not observe any other impertant factor which increases

  7. Rational pain management in complex regional pain syndrome 1 (CRPS 1)--a network meta-analysis.

    Science.gov (United States)

    Wertli, Maria M; Kessels, Alphons G H; Perez, Roberto S G M; Bachmann, Lucas M; Brunner, Florian

    2014-09-01

    Guidelines for complex regional pain syndrome (CRPS) 1 advocate several substance classes to reduce pain and support physical rehabilitation, but guidance about which agent should be prioritized when designing a therapeutic regimen is not provided. Using a network meta-analytic approach, we examined the efficacy of all agent classes investigated in randomized clinical trials of CRPS 1 and provide a rank order of various substances stratified by length of illness duration. In this study a network meta-analysis was conducted. The participants of this study were patients with CRPS 1. Searches in electronic, previous systematic reviews, conference abstracts, book chapters, and the reference lists of relevant articles were performed. Eligible studies were randomized controlled trials comparing at least one analgesic agent with placebo or with another analgesic and reporting efficacy in reducing pain. Summary efficacy stratified by symptom duration and length of follow-up was computed across all substance classes. Two authors independently extracted data. In total, 16 studies were included in the analysis. Bisphosphonates appear to be the treatment of choice in early stages of CRPS 1. The effects of calcitonin surpass that of bisphosphonates and other substances as a short-term medication in more chronic stages of the illness. While most medications showed some efficacy on short-term follow-up, only bisphosphonates, NMDA analogs, and vasodilators showed better long-term pain reduction than placebo. For some drug classes, only a few studies were available and many studies included a small group of patients. Insufficient data were available to analyze efficacy on disability. This network meta-analysis indicates that a rational pharmacological treatment strategy of pain management should consider bisphosphonates in early CRPS 1 and a short-term course of calcitonin in later stages. While most medications showed some efficacy on short-term follow-up, only bisphosphonates

  8. Chronic pain and evoked responses in the brain: A magnetoencephalographic study in Complex Regional Pain Syndrome I and II

    NARCIS (Netherlands)

    Theuvenet, P.J.

    2012-01-01

    Complex Regional Pain Syndrome (CRPS) type I and II are chronic pain syndromes with comparable symptoms, only in CRPS II a peripheral nerve injury is present. No objective tests are currently available to differentiate the two types which hampers diagnosis and treatment. Non-invasive brain imaging

  9. Incidence of Complex Regional Pain Syndrome I Following Foot and Ankle Fractures Using the Budapest Criteria.

    Science.gov (United States)

    Bullen, Michael; Lang, Coran; Tran, Phong

    2016-12-01

    OBJECTIVE : Fractures are a well-recognized inciting event in the development of complex regional pain syndrome. This study aimed to prospectively determine the incidence of complex regional pain syndrome following foot and ankle fractures. METHODS : A prospective study was conducted of patients presenting to two metropolitan hospitals with plain radiograph diagnosis of fractures to the foot or ankle. Patients were initially screened by phone 3 months after injury using the validated International Association for the Study of Pain Budapest criteria. Patients who fulfilled the screening criteria were then physically examined by a pain specialist to assess clinical signs as part of the Budapest criteria. RESULTS : A total of 306 consecutive eligible patients were included. One hundred and ten patients reported at least one symptom of complex regional pain syndrome; however, only three fulfilled the minimum requirements to necessitate clinical review. Of these three, only one patient fulfilled the combination of symptom and sign criteria for a positive diagnosis according to the validated Budapest criteria. The incidence of complex regional pain syndrome following foot and ankle fracture in this study was 0.3%. CONCLUSION : Although many patients may experience vasomotor, sensory, and sudomotor disturbance following a fracture to the foot and ankle, the observed incidence of complex regional pain syndrome using a prospectively collected validated criteria is significantly lower than previously published. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Can complex regional pain syndrome type 1 be circumvented? A ...

    African Journals Online (AJOL)

    Adele

    stressful life events may have some significance in patients with CRPS 1.4. It is intended .... disciplinary approach with the main goal of all therapeutic interventions being .... into the pain cycle. .... of learning processes resulting from increased physiological .... PHTG. The role of fear of movement/(re)injury in pain disability. J.

  11. Complex regional pain syndrome related movement disorders : studies on pathophysiology and therapy.

    NARCIS (Netherlands)

    Munts, Alexander Gerard

    2011-01-01

    Complex regional pain syndrome (CRPS) may occur after trauma, usually to one limb, and is characterised by pain and disturbed blood flow, temperature regulation and motor control. Knowledge on CRPS and its movement disorders is scarce. Dysfunction in small nerve fiber processing was found in CRPS

  12. Evidence for local inflammation in complex regional pain syndrome type 1

    Directory of Open Access Journals (Sweden)

    Frank J. P. M. Huygen

    2002-01-01

    Full Text Available Background: The pathophysiology of complex regional pain syndrome type 1 (CRPS 1 is still a matter of debate. Peripheral afferent, efferent and central mechanisms are supposed. Based on clinical signs and symptoms (e.g. oedema, local temperature changes and chronic pain local inflammation is suspected.

  13. Dystonia in complex regional pain syndrome : clinical, pathophysiological and therapeutic aspects

    NARCIS (Netherlands)

    Rijn, Monica Adriana van

    2010-01-01

    The clinical characteristics of Complex Regional Pain Syndrome (CRPS) are defined by pain and various combinations of sensory disturbances, autonomic features, and sudomotor and trophic changes. Furthermore, patients with CRPS may suffer from movement disorders, of which dystonia is the most

  14. Resilience in patients with amputation because of Complex Regional Pain Syndrome type I

    NARCIS (Netherlands)

    Bodde, Marlies I.; Schrier, Ernst; Krans, Hilde K.; Geertzen, J.H.B.; Dijkstra, Pieter U.

    2014-01-01

    Purpose: Although controversial, an amputation for longstanding and therapy-resistant Complex Regional Pain Syndrome Type I (CRPS-I) may improve quality of life and pain intensity. Resilience, the way people deal with adversity in a positive way may be related to these positive outcomes. This study

  15. The sodium pentothal hypnosis interview with follow-up treatment for complex regional pain syndrome.

    Science.gov (United States)

    Simon, E P; Dahl, L F

    1999-08-01

    A patient who was unresponsive to multiple conservative medical treatments for complex regional pain syndrome was assessed using a novel approach--the sodium pentothal hypnosis interview. The interview suggested that his pain was centrally generated. The patient's pain symptoms resolved with hypnotherapeutic treatment. Indications for this procedure and implications for assessment and treatment are discussed. This case raises more questions than it answers, and leaves the reader to struggle with current difficulties in diagnostic decision-making.

  16. Use of sequential diagnostic pain blocks in a patient of posttraumatic complex regional pain syndrome-not otherwise specified complicated by myofascial trigger points and thoracolumbar pain syndrome

    Directory of Open Access Journals (Sweden)

    Kailash Kothari

    2017-01-01

    Full Text Available We are presenting a case of posttraumatic lower limb Complex regional pain syndrome – Not otherwise specified (CRPS – NOS. As it was not treated in acute phase, the pain became chronic and got complicated by myofascial and thoracolumbar pain syndrome. This case posed us a diagnostic challenge. We used sequential diagnostic pain blocks to identify the pain generators and successfully treat the patient. We used diagnostic blocks step by step to identify and treat pain generators – T12,L1 and L2 Facet joints, Lumbar sympathetic block for CRPS NOS and Trigger point injection with dry needling for myofascial pain syndrome. This case highlights the facet that additional pain generators unrelated to original pain may complicate the presentation. Identifying these pain generators requires out of box thinking and high index of suspicion.

  17. Radiofrequency therapy in back pain and complex regional pain syndrome (CRPS

    Directory of Open Access Journals (Sweden)

    Norina Bergamin

    2011-01-01

    Full Text Available Percutaneous radiofrequency procedures are frequently used in the management of chronic pain. Continuous radiofrequency (CRF has been established as a safe and effective treatment for pain originating from facet and sacroiliac joints by way of co-agulation of their nerve supply. Different methods have been proposed to account for the complex nerve supply of the sacroiliac joint. Due to its neurodestructive property, CRF was limited to the treatment of neuropathic pain. When applied to the dorsal root ganglion (DRG for spinal pain or to the sympathetic ganglia in treatment of CRPS, heat related side effects have been reported. With the development of pulsed radiofrequency (PRF, a less destructive alternative to CRF became available, that is more suitable to treat neuropathic pain. PRF was adopted in the treatment of several pain conditions with different success. The results with PRF adjacent to the DRG are promising, whereas for facet and sacroiliac joint pain PRF could not yet be proven equally effective as CRF. As for PRF in CRPS there is almost no evidence available. The potential of PRF seems to lie in those areas where CRF is of limited value. Con-versely, it is questionable if PRF will ever be equally effective in indications, where CRF is already well established. Despite its active use in clinical practice, PRF is not validated yet nor is its mode of action. The literature in both cases is accumulating but further studies are urgently needed.

  18. The Responsive Amygdala: Treatment-induced Alterations in Functional Connectivity in Pediatric Complex Regional Pain Syndrome

    Science.gov (United States)

    Simons, LE; Pielech, M; Erpelding, N; Linnman, C; Moulton, E; Sava, S; Lebel, A; Serrano, P; Sethna, N; Berde, C; Becerra, L; Borsook, D

    2014-01-01

    The amygdala is a key brain region with efferent and afferent neural connections that involve complex behaviors such as pain, reward, fear and anxiety. This study evaluated resting state functional connectivity of the amygdala with cortical and subcortical regions in a group of chronic pain patients (pediatric complex regional pain syndrome) with age-gender matched controls before and after intensive physical-biobehavioral pain treatment. Our main findings include (1) enhanced functional connectivity from the amygdala to multiple cortical, subcortical, and cerebellar regions in patients compared to controls, with differences predominantly in the left amygdala in the pre-treated condition (disease state); (2) dampened hyperconnectivity from the left amygdala to the motor cortex, parietal lobe, and cingulate cortex after intensive pain rehabilitation treatment within patients with nominal differences observed among healthy controls from Time 1 to Time 2 (treatment effects); (3) functional connectivity to several regions key to fear circuitry (prefrontal cortex, bilateral middle temporal lobe, bilateral cingulate, hippocampus) correlated with higher pain-related fear scores and (4) decreases in pain-related fear associated with decreased connectivity between the amygdala and the motor and somatosensory cortex, cingulate, and frontal areas. Our data suggest that there are rapid changes in amygdala connectivity following an aggressive treatment program in children with chronic pain and intrinsic amygdala functional connectivity activity serving as a potential indicator of treatment response. PMID:24861582

  19. Pulsed Radiofrequency Treatment of Complex Regional Pain Syndrome: A Case Series

    Directory of Open Access Journals (Sweden)

    Vlad Djuric

    2014-01-01

    Full Text Available BACKGROUND: Various forms of sympathetic chain neurolysis (sympathectomy have, at one time or another, held promise as effective treatment options for complex regional pain syndrome (CRPS. Complications, such as worsening pain and the development of new pain syndromes, have prevented sympathectomy from emerging as a standard intervention. In an effort to avoid poor outcomes associated with neurolysis, pulsed radiofrequency (PRF has been proposed as a potential treatment alternative for a number of chronic neuropathic pain states, including some forms of CRPS.

  20. Complex Regional Pain Syndrome (CRPS Type II After Carpal Tunnel Release Surgery: Case Report

    Directory of Open Access Journals (Sweden)

    Hakan Tunç

    2010-08-01

    Full Text Available Summary Complex regional pain syndrome is a chronic syndrome characterised with dystrophic changes and neurovascular disordes of bone and skin of extremities. The most common etiological factors are trauma, ischemic heart disease, cerebral lesions, servical region disorders, infections, and surgical treatments. Carpal tunnel syndrome is the most common compressive neuropaty of the upper extremity. There are various surgical and conservative alternatives in the treatment of carpal tunnel syndrome. Complex regional pain syndrome has been reported as a complication of surgical carpal tunnel release in 2-5% of patients. In this case report clinical characteristics and rehabilitation outcomes of a patient with complex regional pain syndrome after carpal tunnel release surgery is presented. (Osteoporoz Dünyasından 2010;16:41-3

  1. Venipuncture-Induced Complex Regional Pain Syndrome: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Foad Elahi

    2014-01-01

    Full Text Available Venipuncture, the most frequently performed invasive medical procedure, is usually benign. Generally it produces only transitory mild discomfort. Venipuncture-induced neuropathic pain is hard to recognize at an early stage. Medical literature reviews show that there is not adequate medical knowledge about this important subject. The inciting incident in complex regional pain syndrome (CRPS can often seem far too trivial to result in a condition with such severe pathophysiologic effects. The practicing physician has little information available to enable early recognition of the condition, initiation of multidisciplinary treatment modalities, and proper referral to pain specialists. We encountered a unique case of venipuncture-induced complex regional pain syndrome (CRPS. The patient is a 52-year-old school teacher with no significant past medical history, who presented initially to the Center of Pain Medicine with left upper extremity pain. The pain started while phlebotomy was performed in the patient’s left antecubital area for routine blood check. The patient’s pain did not improve with multiple medications, physical therapy, or several nerve blocks. The patient demonstrated all the signs and symptoms of chronic neuropathic pain of CRPS in the upper extremity with minimal response to the continuous pain management. We decided to proceed with cervical spinal cord nerve stimulation along with continuing other modalities. The patient responded to this combination. During the follow-up, we noticed that the patient’s pain course was complicated by extension of the CRPS to her lower extremity. We will describe the course of treatment for the patient in this paper. In this paper we will discuss the electrical neuromodulation as an important modality in addition to the multidisciplinary pain management for a patient with venipuncture-induced chronic neuropathic pain.

  2. Ipsilateral sensory disturbances in Complex Regional Pain Syndrome (CRPS)

    DEFF Research Database (Denmark)

    Knudsen, Lone

    Aim of investigation: CRPS may spread from the primary affected limb to other body parts [1]. Even without subjective reports of a spread of CRPS, a spread of pressure hyperalgesia from the affected limb to the ipsilateral forehead is present in the majority of patients [2-4]. This may indicate...... of this study was to investigate sensitivity to pressure and pinprick at multiple body sites remote from the CRPS limb. Methods: Preliminary results from 10 CRPS patients (F/M: 8/2; mean age 43.2, range 24-61) with lower (n=2) or upper (n=8) limb affection and 10 age and sex matched healthy controls...... sites in controls. Patients also rated spontaneous pain on a numeric rating scale (0-10). Results: Mean of all PPTs were lower in CRPS patients (119 ± 15 kPa) than in controls (166 ± 15 kPa; p = 0.04), and PPTs were in general lower on the body side ipsilateral to pain in the CRPS patients (107 ± 13 k...

  3. Association of Neglect-Like Symptoms with Anxiety, Somatization, and Depersonalization in Complex Regional Pain Syndrome.

    Science.gov (United States)

    Michal, Matthias; Adler, Julia; Reiner, Iris; Wermke, Andreas; Ackermann, Tatiana; Schlereth, Tanja; Birklein, Frank

    2017-04-01

    Many patients with complex regional pain syndrome (CRPS) report some foreignness of the affected limb, which is referred to as "neglect-like symptoms" (NLS). Despite similarities of the NLS reports to symptoms of body image disturbances in mental disorders, no study has been conducted to examine such associations. We investigated 50 patients with CRPS and 45 pain control patients (N = 27, chronic limb pain; N = 18, migraine headache). NLS, anxiety, depression, depersonalization, and somatization were assessed using validated questionnaires. Seventy-two percent of the CRPS patients reported at least one NLS vs 29.6% and 33.3% in the two patient control groups. In limb pain controls, NLS correlated with pain intensity. In CRPS patients, NLS correlated with anxiety (rho = 0.658, P  psychological studies. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  4. Child Abuse and Dissociation in Patients with Complex Regional Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Michael Williams

    1999-01-01

    Full Text Available >OBJECTIVE: In the absence of a proven medical explanation for the chronic pain syndrome Complex Regional Pain Syndrome type I (CRPS I, this study explored a hypothetical link between childhood physical and sexual abuse, and the subsequent development of CRPS I. The hypothesis predicts the existence of a subpopulation of CRPS I patients with a high frequency of dissociative experiences corresponding to a history of childhood trauma.

  5. Electroencephalographic evoked pain response is suppressed by spinal cord stimulation in complex regional pain syndrome: a case report.

    Science.gov (United States)

    Hylands-White, Nicholas; Duarte, Rui V; Beeson, Paul; Mayhew, Stephen D; Raphael, Jon H

    2016-12-01

    Pain is a subjective response that limits assessment. The purpose of this case report was to explore how the objectivity of the electroencephalographic response to thermal stimuli would be affected by concurrent spinal cord stimulation. A patient had been implanted with a spinal cord stimulator for the management of complex regional pain syndrome of both hands for 8 years. Following ethical approval and written informed consent we induced thermal stimuli using the Medoc PATHWAY Pain & Sensory Evaluation System on the right hand of the patient with the spinal cord stimulator switched off and with the spinal cord stimulator switched on. The patient reported a clinically significant reduction in thermal induced pain using the numerical rating scale (71.4 % reduction) with spinal cord stimulator switched on. Analysis of electroencephalogram recordings indicated the occurrence of contact heat evoked potentials (N2-P2) with spinal cord stimulator off, but not with spinal cord stimulator on. This case report suggests that thermal pain can be reduced in complex regional pain syndrome patients with the use of spinal cord stimulation and offers objective validation of the reported outcomes with this treatment.

  6. Complex regional pain syndrome type 1 mimicking Raynaud’s phenomenon

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    Serpil Tuna

    2014-09-01

    Full Text Available Complex regional pain syndrome type 1 (CRPS-1 is a chronic pain syndrome characterized by severe pain, swelling, autonomic dysfunction and dystrophic changes in affected extremity. RSDS is a rare disease in children and usually occurs after trauma, however, without trauma may also occur. We were detected CRPS-1 activated by cold and stress and characterized by recurrent attacks in the bilateral upper extremities in 14 year-old girl, which is similar to Raynaud’s phenomenon. We present this case with the literature because of its rarity and atypical course.

  7. Neuropeptides, neurogenic inflammation and complex regional pain syndrome (CRPS).

    Science.gov (United States)

    Birklein, Frank; Schmelz, Martin

    2008-06-06

    This review explains symptoms and nature of neuropeptide signaling and its importance for clinical symptoms of CRPS. Neurogenic inflammation regularly accompanies excitation of primary afferent nociceptors. It has two major components-plasma extravasation and vasodilatation. The most important mediators are the calcitonin gene-related peptide (CGRP) and substance P (SP). After peripheral trauma immune reaction (e.g. cytokines) and the attempts of the tissue to regenerate (e.g. growth factors) sensitize nociceptors and amplify neurogenic inflammation. This cascade of events has been demonstrated in rat models of CRPS. Clinical findings in these animals strongly resemble clinical findings in CRPS, and can be prevented by anti-cytokine and anti-neuropeptide treatment. In CRPS patients, there is meanwhile also plenty of evidence that neurogenic inflammation contributes to clinical presentation. Increased cytokine production was demonstrated, as well as facilitated neurogenic inflammation. Very recently even "non-inflammatory" signs of CRPS (hyperhidrosis, cold skin) have been linked to neuropeptide signaling. Surprisingly, there was even moderately increased neurogenic inflammation in unaffected body regions. This favors the possibility that CRPS patients share genetic similarities. The future search for genetic commonalities will help us to further unravel the "mystery" CRPS.

  8. Regulation of peripheral blood flow in Complex Regional Pain Syndrome: clinical implication for symptomatic relief and pain management

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    Coderre Terence J

    2009-09-01

    Full Text Available Abstract Background During the chronic stage of Complex Regional Pain Syndrome (CRPS, impaired microcirculation is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Several mechanisms may be responsible for the ischemia and pain in chronic cold CPRS. Discussion The diminished blood flow may be caused by either sympathetic dysfunction, hypersensitivity to circulating catecholamines, or endothelial dysfunction. The pain may be of neuropathic, inflammatory, nociceptive, or functional nature, or of mixed origin. Summary The origin of the pain should be the basis of the symptomatic therapy. Since the difference in temperature between both hands fluctuates over time in cold CRPS, when in doubt, the clinician should prioritize the patient's report of a persistent cold extremity over clinical tests that show no difference. Future research should focus on developing easily applied methods for clinical use to differentiate between central and peripheral blood flow regulation disorders in individual patients.

  9. Psychological distress and stressful life events in pediatric complex regional pain syndrome

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    Wager, Julia; Brehmer, Hannah; Hirschfeld, Gerrit; Zernikow, Boris

    2015-01-01

    BACKGROUND: There is little knowledge regarding the association between psychological factors and complex regional pain syndrome (CRPS) in children. Specifically, it is not known which factors precipitate CRPS and which result from the ongoing painful disease. OBJECTIVES: To examine symptoms of depression and anxiety as well as the experience of stressful life events in children with CRPS compared with children with chronic primary headaches and functional abdominal pain. METHODS: A retrospective chart study examined children with CRPS (n=37) who received intensive inpatient pain treatment between 2004 and 2010. They were compared with two control groups (chronic primary headaches and functional abdominal pain; each n=37), who also received intensive inpatient pain treatment. Control groups were matched with the CRPS group with regard to admission date, age and sex. Groups were compared on symptoms of depression and anxiety as well as stressful life events. RESULTS: Children with CRPS reported lower anxiety and depression scores compared with children with abdominal pain. A higher number of stressful life events before and after the onset of the pain condition was observed for children with CRPS. CONCLUSIONS: Children with CRPS are not particularly prone to symptoms of anxiety or depression. Importantly, children with CRPS experienced more stressful life events than children with chronic headaches or abdominal pain. Prospective long-term studies are needed to further explore the potential role of stressful life events in the etiology of CRPS. PMID:26035287

  10. Mitochondrial dysfunction in muscle tissue of complex regional pain syndrome type I patients

    NARCIS (Netherlands)

    Tan, E.C.T.H.; Janssen, A.J.W.M.; Roestenberg, P.M.H.; Heuvel, L.P.W.J. van den; Goris, R.J.A.; Rodenburg, R.J.T.

    2011-01-01

    Reactive oxygen species (ROS) are known to be involved in the pathophysiology of complex regional pain syndrome type I (CRPS I). Since the mitochondrial respiratory chain is a major source of ROS, we hypothesized that mitochondria play a role in the pathophysiology of CRPS I. The hypothesis was

  11. Mannitol as salvage treatment for Complex Regional Pain Syndrome Type I.

    NARCIS (Netherlands)

    Tan, E.C.T.H.; Tacken, M.C.; Groenewoud, J.M.M.; Goor, H. van; Frolke, J.P.M.

    2010-01-01

    INTRODUCTION: Complex Regional Pain Syndrome Type I (CRPS I) is a continuation of symptoms and signs due to a pathological exaggerated reaction in an extremity of the human body after an injury or operation. Although the clinical picture of CRPS I in the majority of patients is well known, the

  12. Muscle Hyperalgesia Correlates With Motor Function in Complex Regional Pain Syndrome Type 1

    NARCIS (Netherlands)

    van Rooijen, Diana E.; Marinus, Johan; Schouten, Alfred Christiaan; Noldus, Lucas P.J.J.; van Hilten, Jacobus J.

    2013-01-01

    At present it is unclear if disturbed sensory processing plays a role in the development of the commonly observed motor impairments in patients with complex regional pain syndrome (CRPS). This study aims to investigate the relation between sensory and motor functioning in CRPS patients with and

  13. Genetic HLA Associations in Complex Regional Pain Syndrome With and Without Dystonia

    NARCIS (Netherlands)

    van Rooijen, D.E.; Roelen, D.L.; Verduijn, W.; Haasnoot, G.W.; Huygen, F.J.P.M.; Perez, R.S.G.M.; Claas, F.H.J.; Marinus, J.; van Hilten, J.J.; van den Maagdenberg, A.M.J.M.

    2012-01-01

    We previously showed evidence for a genetic association of the human leukocyte antigen (HLA) system and complex regional pain syndrome (CRPS) with dystonia. Involvement of the HLA system suggests that CRPS has a genetic component with perturbed regulation of inflammation and neuroplasticity as

  14. Informed Decision-Making Regarding Amputation for Complex Regional Pain Syndrome Type I

    NARCIS (Netherlands)

    Bodde, Marlies I.; Dijkstra, Pieter U.; Schrier, Michiel; van den Dungen, Johannes; den Dunnen, Wilfred E.; Geertzen, Joannes

    2014-01-01

    Background: Literature on complex regional pain syndrome type I (CRPS-I) discussing the decision to amputate or not, the level of amputation, or the timing of the amputation is scarce: We evaluated informed decision-making regarding amputation for CRPS-I. Methods: We describe our findings in a

  15. Cerebral activation during motor imagery in complex regional pain syndrome type 1 with dystonia

    NARCIS (Netherlands)

    Gieteling, Esther W.; van Rijn, Monique A.; de Jong, Bauke M.; Hoogduin, Johannes M.; Renken, Remco; van Hilten, Jacobus J.; Leenders, Klaus L.

    The pathogenesis of dystonia in Complex Regional Pain Syndrome type 1 (CRPS-1) is unclear. In primary dystonia, functional magnetic resonance imaging (fMRI) has revealed changes in cerebral networks during execution of movement. The aim of this study was to determine cerebral network function in

  16. Stressful life events and psychological dysfunction in complex regional pain syndrome type I

    NARCIS (Netherlands)

    Geertzen, JHB; de Bruijn-Kofman, AT; de Bruijn, HP; van de Wiel, HBM; Dijkstra, PU

    Objective: To determine to what extent stressful life events and psychological dysfunction play a role in the pathogenesis of Complex Regional Pain Syndrome type I (CRPS). Design: A comparative study between a CRPS group and a control group. Stressful life events and psychological dysfunction

  17. Enhanced pain and autonomic responses to ambiguous visual stimuli in chronic Complex Regional Pain Syndrome (CRPS) type I.

    Science.gov (United States)

    Cohen, H E; Hall, J; Harris, N; McCabe, C S; Blake, D R; Jänig, W

    2012-02-01

    Cortical reorganisation of sensory, motor and autonomic systems can lead to dysfunctional central integrative control. This may contribute to signs and symptoms of Complex Regional Pain Syndrome (CRPS), including pain. It has been hypothesised that central neuroplastic changes may cause afferent sensory feedback conflicts and produce pain. We investigated autonomic responses produced by ambiguous visual stimuli (AVS) in CRPS, and their relationship to pain. Thirty CRPS patients with upper limb involvement and 30 age and sex matched healthy controls had sympathetic autonomic function assessed using laser Doppler flowmetry of the finger pulp at baseline and while viewing a control figure or AVS. Compared to controls, there were diminished vasoconstrictor responses and a significant difference in the ratio of response between affected and unaffected limbs (symmetry ratio) to a deep breath and viewing AVS. While viewing visual stimuli, 33.5% of patients had asymmetric vasomotor responses and all healthy controls had a homologous symmetric pattern of response. Nineteen (61%) CRPS patients had enhanced pain within seconds of viewing the AVS. All the asymmetric vasomotor responses were in this group, and were not predictable from baseline autonomic function. Ten patients had accompanying dystonic reactions in their affected limb: 50% were in the asymmetric sub-group. In conclusion, there is a group of CRPS patients that demonstrate abnormal pain networks interacting with central somatomotor and autonomic integrational pathways. © 2011 European Federation of International Association for the Study of Pain Chapters.

  18. Bee Venom Pharmacopuncture: An Effective Treatment for Complex Regional Pain Syndrome

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    Jong-Min Kim

    2014-12-01

    Full Text Available Objectives: Treating complex regional pain syndrome (CRPS is difficult because it still does not have a recommended therapy. A 29-year-old man was diagnosed with CRPS after surgery on his 4th and 5th left toes 7 years ago. Though he had undergone diverse pain treatment, the symptoms persisted, so he visited Dunsan Korean Medicine Hospital of Daejeon University. This case report presents results on the effect of bee venom pharmacopuncture in treating patient with CRPS. Methods: Bee venom pharmacopuncture (BVP, 0.15 to 0.4 mL dosage, was administered at GB43. The treatment was applied each week for a total 14 times. The symptoms were evaluated using a numeric rating scale (NRS and the dosage of pain medicine. Results: On the first visit, he was taking an anticonvulsant, a trycyclic antidepressant, and an analgesic. On the NRS the worst pain in the toes received a score of 8. He also complained of severe pain and hypersensitivity when the 4th and the 5th toes were touched just slightly. Other complaint included dyspepsia, rash, and depression. After treatment, on the NRS, the score for toe pain was 0, and he no longer needed to take pain medication. During the 4-months follow-up period, he has remained without pain; neither have additional symptoms appeared nor adverse events occurred. Conclusion: BVP may have potential benefits for treating patients with CRPS.

  19. Motor imagery and its effect on complex regional pain syndrome: an integrative review

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    Nélio Silva de Souza

    2015-12-01

    Full Text Available The motor imagery (MI has been proposed as a treatment in the complex regional pain syndrome type 1 (CRPS-1, since it seems to promote a brain reorganization effect on sensory- motor areas of pain perception. The aim of this paper is to investigate, through an integrative critical review, the influence of MI on the CRPS-1, correlating their evidence to clinical practice. Research in PEDro, Medline, Bireme and Google Scholar databases was conducted. Nine randomized controlled trials (level 2, 1 non-controlled clinical study (level 3, 1 case study (level 4, 1 systematic review (level 1, 2 review articles and 1 comment (level 5 were found. We can conclude that MI has shown effect in reducing pain and functionality that remains after 6 months of treatment. However, the difference between the MI strategies for CRPS-1 is unknown as well as the intensity of mental stress influences the painful response or effect of MI or other peripheral neuropathies.

  20. Impaired recognition of social emotion in patients with complex regional pain syndrome.

    Science.gov (United States)

    Shin, Na Young; Kang, Do-Hyung; Jang, Joon Hwan; Park, Soo Young; Hwang, Jae Yeon; Kim, Sung Nyun; Byun, Min Soo; Park, Hye Youn; Kim, Yong Chul

    2013-11-01

    Multiple brain areas involved in nociceptive, autonomic, and social-emotional processing are disproportionally changed in patients with complex regional pain syndrome (CRPS). Little empirical evidence is available involving social cognitive functioning in patients with chronic pain conditions. We investigated the ability of patients with CRPS to recognize the mental/emotional states of other people. Forty-three patients with CRPS and 30 healthy controls performed the Reading Mind in the Eyes Test, which consists of photos in which human eyes express various emotional and mental states. Neuropsychological tests, including the Wisconsin Card Sorting Test, the stop-signal test, and the reaction time test, were administered to evaluate other cognitive functions. Patients with CRPS were significantly less accurate at recognizing emotional states in other persons, but not on other cognitive tests, compared with control subjects. We found a significant association between the deficit in social-emotion recognition and the affective dimension of pain, whereas this deficit was not related to the sensory dimension of pain. Our findings suggest a disrupted ability to recognize others' mental/emotional states in patients with CRPS. This article demonstrated a deficit in inferring mental/emotional states of others in patients with CRPS that was related to pain affect. Our study suggests that additional interventions directed toward reducing distressful affective pain may be helpful to restore social cognitive processing in patients with CRPS. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

  1. Inflammatory arthritis mimicking Complex Regional Pain Syndrome (CRPS) in a child: A case report.

    Science.gov (United States)

    Egilmez, Zeliha; Turgut, Selin Turan; Icagasioglu, Afitap; Bicakci, Irem

    2016-01-01

    Joint complaints in childhood are seen frequently and differential diagnosis can be difficult. Juvenile idiopathic arthritis (JIA) is the most common rheumatological disease of childhood. It involves peripheral joint arthritis, chronic synovitis, and extra-articular manifestations. Accurate diagnosis can take a long time and sometimes multiple diagnoses are used while following the patient until a final diagnosis can be reached. Arthritis may be triggered by trauma and confused with other diseases like complex regional pain syndrome (CRPS), in which trauma plays a role in the etiology. In the present case, ankle pain in an 8-year-old girl was misdiagnosed as CRPS.

  2. Clinical features and pathophysiology of Complex Regional Pain Syndrome – current state of the art

    Science.gov (United States)

    Marinus, Johan; Moseley, G. Lorimer; Birklein, Frank; Baron, Ralf; Maihöfner, Christian; Kingery, Wade S.; van Hilten, Jacobus J.

    2017-01-01

    That a minor injury can trigger a complex regional pain syndrome (CRPS) - multiple system dysfunction, severe and often chronic pain and disability - has fascinated scientists and perplexed clinicians for decades. However, substantial advances across several medical disciplines have recently increased our understanding of CRPS. Compelling evidence implicates biological pathways that underlie aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity in the clinical features of CRPS. Collectively, the evidence points to CRPS being a multifactorial disorder that is associated with an aberrant host response to tissue injury. Varying susceptibility to perturbed regulation of any of the underlying biological pathways probably accounts for the clinical heterogeneity of CRPS. PMID:21683929

  3. Treatment of Complex Regional Pain Syndrome (CRPS) using low dose naltrexone (LDN).

    Science.gov (United States)

    Chopra, Pradeep; Cooper, Mark S

    2013-06-01

    Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome, which involves glial activation and central sensitization in the central nervous system. Here, we describe positive outcomes of two CRPS patients, after they were treated with low-dose naltrexone (a glial attenuator), in combination with other CRPS therapies. Prominent CRPS symptoms remitted in these two patients, including dystonic spasms and fixed dystonia (respectively), following treatment with low-dose naltrexone (LDN). LDN, which is known to antagonize the Toll-like Receptor 4 pathway and attenuate activated microglia, was utilized in these patients after conventional CRPS pharmacotherapy failed to suppress their recalcitrant CRPS symptoms.

  4. Post-traumatic complex regional pain syndrome: clinical features and epidemiology

    Science.gov (United States)

    Ratti, Chiara; Nordio, Andrea; Resmini, Giuseppina; Murena, Luigi

    2015-01-01

    Summary Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that occurs after a tissue injury (fractures, sprain, surgery) of the upper or lower extremities. A clear pathophysiological mechanism has not been established yet and different patterns are considered to play a role in the genesis of the disease. The diagnosis is made by different diagnosis criteria and a gold standard has not been established yet. Incidence of CRPS is unclear and large prospective studies on the incidence and prevalence of CRPS are scarce. The aim of this review is to give an overview on the prevalent data regarding this chronic syndrome. PMID:27134626

  5. Bilateral Complex Regional Pain Syndrome after Fracture of Bilateral Tibia and Fibula

    Directory of Open Access Journals (Sweden)

    Senem Şaş

    2017-04-01

    Full Text Available Complex regional syndrome type 1 (CRPS-1 is a painful clinical condition. It occurs after a painful event and characterized by allodynia, hyperalgesia, edema, abnormalities in skin blood flow and abnormal sudomotor activity. When CRPS-1 is associated with nerve injury, it is defined as CRPS-2. Central and peripheral theory are responsible in etiopathogenesis of CRPS-1. Generally it occurs in the injured limb. But, it may ocur in the opposite extremities. In this article, we present a case developing bilateral CRPS-1 after bilateral tibia and fibula fracture by reviewing current literatüre.

  6. Imaging of Posttraumatic Arthritis, Avascular Necrosis, Septic Arthritis, Complex Regional Pain Syndrome, and Cancer Mimicking Arthritis.

    Science.gov (United States)

    Rupasov, Andrey; Cain, Usa; Montoya, Simone; Blickman, Johan G

    2017-09-01

    This article focuses on the imaging of 5 discrete entities with a common end result of disability: posttraumatic arthritis, a common form of secondary osteoarthritis that results from a prior insult to the joint; avascular necrosis, a disease of impaired osseous blood flow, leading to cellular death and subsequent osseous collapse; septic arthritis, an infectious process leading to destructive changes within the joint; complex regional pain syndrome, a chronic limb-confined painful condition arising after injury; and cases of cancer mimicking arthritis, in which the initial findings seem to represent arthritis, despite a more insidious cause. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Objective sensory evaluation of the spread of complex regional pain syndrome.

    Science.gov (United States)

    Edinger, Lara; Schwartzman, Robert J; Ahmad, Ayesha; Erwin, Kirsten; Alexander, Guillermo M

    2013-01-01

    The spread of complex regional pain syndrome (CRPS) has been well documented. Many severe refractory long-standing patients have total body pain (TBP) that evolved from a single extremity injury. The purpose of this study was to document by objective sensory threshold testing the extent of body area involvement in 20 long-standing patients with CRPS who have TBP. A comparison of sensory threshold testing parameters between 20 long-standing refractory patients with CRPS who have TBP versus 10 healthy participants. Twenty patients with CRPS who stated that they suffered from total body pain were chosen from the Drexel University College of Medicine CRPS database. They were compared to 10 healthy participants that were age and gender matched to the patients with CRPS. The sensory parameters tested were: skin temperature; static and mechanical allodynia; thermal allodynia; mechanical hyperalgesia; after sensations following all sensory tests. The sites chosen for testing in the patients with CRPS were the most painful area in each of 8 body regions that comprised the total body area. Five patients with CRPS had signs of CRPS over 100% of their body (20%). One patient had pain over 87% and another had pain over 90% of their body area. The average percentage of body involvement was 62% (range 37% - 100%). All patients with CRPS had at least one sensory parameter abnormality in all body regions. All patients with CRPS had lower pain thresholds for static allodynia in all body areas, while 50% demonstrated a lower threshold for dynamic allodynia in all body regions compared to the healthy participants. Cold allodynia had a higher median pain rating on the Likert pain scale in all body areas versus healthy participants except for the chest, abdomen, and back. Eighty-five percent of the patients with CRPS had a significantly lower pain threshold for mechanical hyperalgesia in all body areas compared to the healthy participants. After sensations occurred after all sensory

  8. Bilateral complex regional pain syndrome following spinal cord injury and bilateral calcaneus fracture

    Directory of Open Access Journals (Sweden)

    Ahmet Boyacı

    2013-09-01

    Full Text Available Complex regional pain syndrome (CRPS is a disease affectingone or more extremities, characterized by spontaneouspain, allodynia, hyperpathia and hyperalgesia.CRPS is separated into Type 1 and Type 2. CRPS whichdevelops after a nociceptive event is labeled as Type 1and when it develops following peripheral nerve damage,Type 2. Although the pathogenesis is not fully understood,peripheral and central sensitivity are held responsible.Bilateral lower extremity involvement is extremely rare.However, it should be borne in mind that it can develop intraumatic injuries which occur in more than one area anddiagnosis and commencement of a rehabilitation programshould be made in the early period. The case is presentedhere of bilateral Type 1 CRPS developing after incompletespinal cord injury and bilateral calcaneus fracture. JClin Exp Invest 2013; 4 (3: 360-363Key words: complex regional pain syndrome, calcaneusfracture, spinal cord injury

  9. Personality assessment of patients with complex regional pain syndrome type I.

    Science.gov (United States)

    Monti, D A; Herring, C L; Schwartzman, R J; Marchese, M

    1998-12-01

    There is controversy regarding the importance of psychological/psychiatric factors in the development of the Complex Regional Pain Syndrome (CRPS). Our objective was to determine whether CRPS type I patients were psychiatrically different from other chronic pain patients, with particular attention to personality pathology. A standardized clinical assessment of all major psychiatric categories, including personality disorders, was performed on 25 CRPS type I patients and a control group of 25 patients with chronic low back pain from disc-related radiculopathy. Both sections of the Structured Clinical Interview for the Diagnostic and Statistical Manual (3rd ed., rev.) and the visual analog scale. Both groups were similar in terms of pain intensity and duration. Statistical analysis showed both groups to have a significant amount of major psychiatric comorbidity, in particular major depressive disorder, and a high incidence of personality disorders. Therefore, intense chronic pain was associated with significant psychiatric comorbidity in both groups and in similar proportions. The high incidence of personality pathology in both groups may represent an exaggeration of maladaptive personality traits and coping styles as a result of a chronic, intense, state of pain.

  10. Correlates and importance of neglect-like symptoms in complex regional pain syndrome.

    Science.gov (United States)

    Wittayer, Matthias; Dimova, Violeta; Birklein, Frank; Schlereth, Tanja

    2018-05-01

    Neglect-like symptoms (NLS) are frequently observed in complex regional pain syndrome (CRPS). The clinical meaning of NLS, however, is largely unknown. Therefore, this study sets out to assess the importance of NLS for patient outcome and to explore their clinical correlates. We assessed NLS in a group of 53 patients with CRPS and compared the results to 28 healthy volunteers. To define the origin of the NLS reports, we tested the subjective visual midline, performed a limb-laterality recognition test, and quantitative sensory testing. In addition, psychological and pain assessment scales were completed. Tests were analyzed with univariate and multivariate approaches. After 6 months, patients were reassessed and the influence of NLS on pain outcome was determined. Most patients reported NLS in the questionnaire, whereas subjective visual midline and limb-laterality recognition test in contrast to previous studies did not reveal perceptual disturbances. Neglect-like symptom scores were associated with pain and pain catastrophizing in acute CRPS and anxiety and thermal sensory loss in chronic CRPS. Furthermore, high NLS scores had a negative impact on pain outcome after 6 months. Our results indicate that NLS have a different meaning in acute and chronic CRPS and might be of prognostic value. Possibly, treatment should focus on reducing NLS.

  11. A Novel Compound Analgesic Cream (Ketamine, Pentoxifylline, Clonidine, DMSO) for Complex Regional Pain Syndrome Patients.

    Science.gov (United States)

    Russo, Marc A; Santarelli, Danielle M

    2016-01-01

    Evidence suggests that complex regional pain syndrome (CRPS) is a manifestation of microvascular dysfunction. Topical combinations of α2-adrenergic receptor agonists or nitric oxide donors with phosphodiesterase or phosphatidic acid inhibitors formulated to treat microvascular dysfunction have been shown to reduce allodynia in a rat model of CRPS-I. Driven by these findings, we assessed the outcomes of CRPS patients treated with a compound analgesic cream (CAC) consisting of ketamine 10%, pentoxifylline 6%, clonidine 0.2%, and dimethyl sulfoxide 6% to 10%. An audit was conducted on 13 CRPS patients who trialed the CAC. A detailed report was compiled for each patient which comprised baseline characteristics, including CRPS description, previous treatments, and pain scores (numerical pain rating scale; 0 to 10). Recorded outcomes consisted of pain scores, descriptive outcomes, and concurrent medications/treatments, for which basic analysis was performed to determine the effectiveness of the CAC. Case reports are presented for 3 patients with varying outcomes. Nine patients (69%) reported pain/symptom reduction (4.4 ± 2.1 vs. 6.3 ± 1.9) with use of the CAC. Six patients reported sustained benefits after 2 months of CAC use, and 2 patients reported complete resolution of pain/symptoms: one had early CRPS-I and the other received a partial CRPS diagnosis. An otherwise medication refractory and intolerant patient found partial benefit with the CAC. These results demonstrate promise for this topical combination as a useful treatment in multimodal therapy for patients with CRPS, with the potential to resolve pain/symptoms in early CRPS patients. © 2015 World Institute of Pain.

  12. Sex differences in complex regional pain syndrome type I (CRPS-I) in mice.

    Science.gov (United States)

    Tang, Chaoliang; Li, Juan; Tai, Wai Lydia; Yao, Weifeng; Zhao, Bo; Hong, Junmou; Shi, Si; Wang, Song; Xia, Zhongyuan

    2017-01-01

    Sex differences have been increasingly highlighted in complex regional pain syndrome (CRPS) in clinical practice. In CRPS type I (CRPS-I), although inflammation and oxidative stress have been implicated in its pathogenesis, whether pain behavior and the underlying mechanism are sex-specific is unclear. In the present study, we sought to explore whether sex differences have an impact on inflammation, oxidative stress, and pain sensitivity in CRPS-I. Chronic post-ischemia pain (CPIP) was established in both male and female mice as an animal model of CRPS-I. Edema and mechanical allodynia of bilateral hind paws were assessed after reperfusion. Blood samples were analyzed for serum levels of oxidative stress markers and inflammatory cytokines. Both male and female mice developed edema. Male mice developed CPIP at day 3 after reperfusion; female mice developed CPIP at day 2 after reperfusion. Female mice displayed significantly earlier and higher mechanical allodynia in the ischemic hind paw, which was associated with higher serum levels of IL-2, TNF-α, isoprostanes, 8 OhdG, and malondialdehyde at day 2 after reperfusion. Moreover, female mice showed significantly lower SOD and IL-4 compared to male mice at day 2 after reperfusion. Our results indicate that sex differences in inflammatory and oxidative stress states may play a central role in the sex-specific nociceptive hypersensitivity in CRPS-I, and offer a new insight into pharmacology treatments to improve pain management with CRPS.

  13. Abnormal Brain Responses to Action Observation in Complex Regional Pain Syndrome.

    Science.gov (United States)

    Hotta, Jaakko; Saari, Jukka; Koskinen, Miika; Hlushchuk, Yevhen; Forss, Nina; Hari, Riitta

    2017-03-01

    Patients with complex regional pain syndrome (CRPS) display various abnormalities in central motor function, and their pain is intensified when they perform or just observe motor actions. In this study, we examined the abnormalities of brain responses to action observation in CRPS. We analyzed 3-T functional magnetic resonance images from 13 upper limb CRPS patients (all female, ages 31-58 years) and 13 healthy, age- and sex-matched control subjects. The functional magnetic resonance imaging data were acquired while the subjects viewed brief videos of hand actions shown in the first-person perspective. A pattern-classification analysis was applied to characterize brain areas where the activation pattern differed between CRPS patients and healthy subjects. Brain areas with statistically significant group differences (q frontal gyrus, secondary somatosensory cortex, inferior parietal lobule, orbitofrontal cortex, and thalamus. Our findings indicate that CRPS impairs action observation by affecting brain areas related to pain processing and motor control. This article shows that in CRPS, the observation of others' motor actions induces abnormal neural activity in brain areas essential for sensorimotor functions and pain. These results build the cerebral basis for action-observation impairments in CRPS. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

  14. Impaired spatial body representation in complex regional pain syndrome type 1 (CRPS I).

    Science.gov (United States)

    Reinersmann, Annika; Landwehrt, Julia; Krumova, Elena K; Ocklenburg, Sebastian; Güntürkün, Onur; Maier, Christoph

    2012-11-01

    Recently, a shift of the visual subjective body midline (vSM), a correlate of the egocentric reference frame, towards the affected side was reported in patients with complex regional pain syndrome (CRPS). However, the specificity of this finding is as yet unclear. This study compares 24 CRPS patients to 21 patients with upper limb pain of other origin (pain control) and to 24 healthy subjects using a comprehensive test battery, including assessment of the vSM in light and dark, line bisection, hand laterality recognition, neglect-like severity symptoms, and motor impairment (disability of the arm, shoulder, and hand). 1-way analysis of variance, t-tests, significance level: 0.05. In the dark, CRPS patients displayed a significantly larger leftward spatial bias when estimating their vSM, compared to pain controls and healthy subjects, and also reported lower motor function than pain controls. For right-affected CRPS patients only, the deviation of the vSM correlated significantly with the severity of distorted body perception. Results confirm previous findings of impaired visuospatial perception in CRPS patients, which might be the result of the involvement of supraspinal mechanisms in this pain syndrome. These mechanisms might accentuate the leftward bias that results from a right-hemispheric dominance in visuospatial processing and is known as pseudoneglect. Pseudoneglect reveals itself in the tendency to perceive the midpoint of horizontal lines or the subjective body midline left of the centre. It was observable in all 3 groups, but most pronounced in CRPS patients, which might be due to the cortical reorganisation processes associated with this syndrome. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  15. Concurrent Peripheral Pathologies and Complex Regional Pain Syndrome Type 1 as Contributors to Acute Post-Stroke Shoulder Pain: A Case Report

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    Seyed Majid Akhavan Hejazi

    2012-04-01

    Full Text Available Post-stroke shoulder pain is associated with either a peripheral or central pathology. However, most of the time, it is challenging to establish a cause-and-effect relationship between the suggested pathology and shoulder pain reported. We report a 66 year-old man who developed a right hemiplegic shoulder pain two months post stroke with initial investigations suggestive of peripheral pathologies. Pharmacological and non-pharmacological treatment did not improve his shoulder pain. Later he developed complex regional pain syndrome (CRPS of the right hand and the initial shoulder pain subsequently relieved following resolution of the CRPS.

  16. Intravenous regional block is similar to sympathetic ganglion block for pain management in patients with complex regional pain syndrome type I

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    M.S.A. Nascimento

    2010-12-01

    Full Text Available Sympathetic ganglion block (SGB or intravenous regional block (IVRB has been recommended for pain management in patients with complex regional pain syndrome type I (CRPS-I. Forty-five patients were initially selected but only 43 were accepted for the study. The present study evaluated the efficacy of IVRB produced by combining 70 mg lidocaine with 30 µg clonidine (14 patients, 1 male/13 females, age range: 27-50 years versus SGB produced by the injection of 70 mg lidocaine alone (14 patients, 1 male/13 females, age range: 27-54 years or combined with 30 µg clonidine (15 patients, 1 male/14 females, age range: 25-50 years into the stellate ganglion for pain management in patients with upper extremity CRPS-I. Each procedure was repeated five times at 7-day intervals, and pain intensity and duration were measured using a visual analog scale immediately before each procedure. A progressive and significant reduction in pain scores and a significant increase in the duration of analgesia were observed in all groups following the first three blocks, but no further improvement was obtained following the last two blocks. Drowsiness, the most frequent side effect, and dry mouth occurred only in patients submitted to SGB with lidocaine combined with clonidine. The three methods were similar regarding changes in pain intensity and duration of analgesia. However, IVRB seems to be preferable to SGB due to its easier execution and lower risk of undesirable effects.

  17. Are you better? A multi-centre study of patient-defined recovery from Complex Regional Pain Syndrome

    DEFF Research Database (Denmark)

    Llewellyn, A; McCabe, CS; Hibberd, Y

    2018-01-01

    Background: Complex Regional Pain Syndrome (CRPS) symptoms can significantly differ between patients, fluctuate over time, disappear or persist. This leads to problems in defining recovery and in evaluating the efficacy of therapeutic interventions. Objectives: To define recovery from the patient...

  18. Complex regional pain syndrome with associated chest wall dystonia: a case report

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    Schwartzman Robert J

    2011-09-01

    Full Text Available Abstract Patients with complex regional pain syndrome (CRPS often suffer from an array of associated movement disorders, including dystonia of an affected limb. We present a case of a patient with long standing CRPS after a brachial plexus injury, who after displaying several features of the movement disorder previously, developed painful dystonia of chest wall musculature. Detailed neurologic examination found palpable sustained contractions of the pectoral and intercostal muscles in addition to surface allodynia. Needle electromyography of the intercostal and paraspinal muscles supported the diagnosis of dystonia. In addition, pulmonary function testing showed both restrictive and obstructive features in the absence of a clear cardiopulmonary etiology. Treatment was initiated with intrathecal baclofen and the patient had symptomatic relief and improvement of dystonia. This case illustrates a novel form of the movement disorder associated with CRPS with response to intrathecal baclofen treatment.

  19. Molecular signature of complex regional pain syndrome (CRPS) and its analysis.

    Science.gov (United States)

    König, Simone; Schlereth, Tanja; Birklein, Frank

    2017-10-01

    Complex Regional Pain Syndrome (CRPS) is a rare, but often disabling pain disease. Biomarkers are lacking, but several inflammatory substances have been associated with the pathophysiology. This review outlines the current knowledge with respect to target biomolecules and the analytical tools available to measure them. Areas covered: Targets include cytokines, neuropeptides and resolvins; analysis strategies are thus needed for different classes of substances such as proteins, peptides, lipids and small molecules. Traditional methods like immunoassays are of importance next to state-of-the art high-resolution mass spectrometry techniques and 'omics' approaches. Expert commentary: Future biomarker studies need larger cohorts, which improve subgrouping of patients due to their presumed pathophysiology, and highly standardized workflows from sampling to analysis.

  20. Continuous Thoracic Sympathetic Ganglion Block in Complex Regional Pain Syndrome Patients with Spinal Cord Stimulation Implantation

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    EungDon Kim

    2016-01-01

    Full Text Available The sympathetic block is widely used for treating neuropathic pain such as complex regional pain syndrome (CRPS. However, single sympathetic block often provides only short-term effect. Moreover, frequent procedures for sympathetic block may increase the risk of complications. The use of epidural route may be limited by concern of infection in case of previous implantation of the spinal cord stimulation (SCS. In contrast, a continuous sympathetic block can be administered without such concerns. The continuous thoracic sympathetic block (TSGB has been used to treat the ischemic disease and other neuropathic conditions such as postherpetic neuralgia. We administered continuous thoracic sympathetic block using catheter in CRPS patients who underwent SCS implantations and achieved desirable outcomes. We believe a continuous sympathetic block is a considerable option before performing neurolysis or radiofrequency rhizotomy and even after SCS implantation.

  1. Abnormal thalamocortical activity in patients with Complex Regional Pain Syndrome (CRPS) type I.

    Science.gov (United States)

    Walton, K D; Dubois, M; Llinás, R R

    2010-07-01

    Complex Regional Pain Syndrome (CRPS) is a neuropathic disease that presents a continuing challenge in terms of pathophysiology, diagnosis, and treatment. Recent studies of neuropathic pain, in both animals and patients, have established a direct relationship between abnormal thalamic rhythmicity related to Thalamo-cortical Dysrhythmia (TCD) and the occurrence of central pain. Here, this relationship has been examined using magneto-encephalographic (MEG) imaging in CRPS Type I, characterized by the absence of nerve lesions. The study addresses spontaneous MEG activity from 13 awake, adult patients (2 men, 11 women; age 15-62), with CRPS Type I of one extremity (duration range: 3months to 10years) and from 13 control subjects. All CRPS I patients demonstrated peaks in power spectrum in the delta (CRPS Type I patients presented abnormal brain activity typical of TCD, which has both diagnostic value indicating a central origin for this ailment and a potential treatment interest involving pharmacological and electrical stimulation therapies. Copyright 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  2. Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome

    Science.gov (United States)

    Becerra, Lino; Sava, Simona; Simons, Laura E.; Drosos, Athena M.; Sethna, Navil; Berde, Charles; Lebel, Alyssa A.; Borsook, David

    2014-01-01

    Pediatric complex regional pain syndrome (P-CRPS) offers a unique model of chronic neuropathic pain as it either resolves spontaneously or through therapeutic interventions in most patients. Here we evaluated brain changes in well-characterized children and adolescents with P-CRPS by measuring resting state networks before and following a brief (median = 3 weeks) but intensive physical and psychological treatment program, and compared them to matched healthy controls. Differences in intrinsic brain networks were observed in P-CRPS compared to controls before treatment (disease state) with the most prominent differences in the fronto-parietal, salience, default mode, central executive, and sensorimotor networks. Following treatment, behavioral measures demonstrated a reduction of symptoms and improvement of physical state (pain levels and motor functioning). Correlation of network connectivities with spontaneous pain measures pre- and post-treatment indicated concomitant reductions in connectivity in salience, central executive, default mode and sensorimotor networks (treatment effects). These results suggest a rapid alteration in global brain networks with treatment and provide a venue to assess brain changes in CRPS pre- and post-treatment, and to evaluate therapeutic effects. PMID:25379449

  3. Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome

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    Lino Becerra

    2014-01-01

    Full Text Available Pediatric complex regional pain syndrome (P-CRPS offers a unique model of chronic neuropathic pain as it either resolves spontaneously or through therapeutic interventions in most patients. Here we evaluated brain changes in well-characterized children and adolescents with P-CRPS by measuring resting state networks before and following a brief (median = 3 weeks but intensive physical and psychological treatment program, and compared them to matched healthy controls. Differences in intrinsic brain networks were observed in P-CRPS compared to controls before treatment (disease state with the most prominent differences in the fronto-parietal, salience, default mode, central executive, and sensorimotor networks. Following treatment, behavioral measures demonstrated a reduction of symptoms and improvement of physical state (pain levels and motor functioning. Correlation of network connectivities with spontaneous pain measures pre- and post-treatment indicated concomitant reductions in connectivity in salience, central executive, default mode and sensorimotor networks (treatment effects. These results suggest a rapid alteration in global brain networks with treatment and provide a venue to assess brain changes in CRPS pre- and post-treatment, and to evaluate therapeutic effects.

  4. Evaluation of brain metabolite in patients with complex regional pain syndrome by MR spectroscopy

    International Nuclear Information System (INIS)

    Iwashita, Narihito; Fukui, Mikio; Nitta, Kazuhito; Anzawa, Noriyuki; Tomie, Hisashi; Nakanishi, Miho; Matsumoto, Tomikichi; Nosaka, Shuichi

    2010-01-01

    Recently brain imaging studies have shown that patients with chronic pain have an altered cortical processing of nociceptive inputs. We evaluated brain metabolites in patients with complex regional pain syndrome (CRPS) using MR spectroscopy. Absolute concentrations of N-acetylaspartate (NAA) and choline (Cho) were measured in anterior cingulate (ACC) and prefrontal cortices (PFC) of patients and volunteers as matched control. Psychological aspects of patients were also evaluated with Hospital Anxiety and Depression (HAD) scale, in addition to the intensity of pain by visual analog scale. In the ACC, CRPS patients had a significant decrease of NAA and a significant increase of Cho compared to the control. Furthermore, patients with anxiety scored by HAD scale had reduced NAA concentration in ACC compared to the patients without anxiety. In the PFC, there was a reduction of NAA in the patients compared with that in control. No correlation was observed between intensity of pain and these metabolites. These results suggest that metabolite changes in ACC and PFC could reflect the pathogenesis of CRPS. (author)

  5. Cerebral glucose metabolism change in patients with complex regional pain syndrome. A PET study

    International Nuclear Information System (INIS)

    Shiraishi, Satoe; Kobayashi, Hidetoshi; Nihashi, Takashi

    2006-01-01

    The aim of this study was to examine abnormalities of the central nervous system in patients with chronic pain who were diagnosed with complex regional pain syndrome (CRPS). Brain activity was assessed using 18 F-fluorodeoxyglucose positron emission tomography. The data collected from 18 patients were compared with data obtained from 13 normal age-matched controls. Our results showed that glucose metabolism was bilaterally increased in the secondary somatosensory cortex, mid-anterior cingulated cortex (ACC) or posterior cingulated cortex (PCC) (or both), parietal cortex, posterior parietal cortex (PPC), and cerebellum as well as in the right posterior insula and right thalamus in our patients. In contrast, glucose metabolism was reduced contralaterally in the dorsal prefrontal cortex and primary motor cortex. Glucose metabolism was bilaterally elevated in the mid-ACC/PCC and the PPC, which correlated with pain duration. These data suggested that glucose metabolism in the brains of patients with CRPS changes dramatically at each location. In particular, glucose metabolism was increased in the areas concerned with somatosensory perception, possibly due to continuous painful stimulation. (author)

  6. Risk Factors for Post-treatment Complex Regional Pain Syndrome (CRPS)

    DEFF Research Database (Denmark)

    Petersen, Pelle B; Mikkelsen, Kim Lyngby; Lauritzen, Jes B

    2018-01-01

    OBJECTIVES: Complex regional pain syndrome is a challenging condition that includes a broad spectrum of sensory, autonomic, and motor features predominantly in extremities recovering from a trauma. Few large-scale studies have addressed occurrence of and factors associated with complex regional......, gender, initial diagnosis, treatment, and amount of compensation were extracted. Multivariate logistic regressions were performed to identify variables associated with approval of the claim. For carpal tunnel syndrome (CTS) patients, we registered whether symptoms were bilateral or unilateral...... normal neurophysiology. CONCLUSIONS: Female gender, surgical treatment, and treatment to the upper limb were risk factors. Elective surgery accounted for a large number of post-treatment CRPS patients. In CTS patients developing CRPS, normal neurophysiological examination findings were common...

  7. Delayed diagnosis and worsening of pain following orthopedic surgery in patients with complex regional pain syndrome (CRPS).

    Science.gov (United States)

    Lunden, Lars K; Kleggetveit, Inge P; Jørum, Ellen

    2016-04-01

    Complex regional pain syndrome (CRPS) is a serious and disabling chronic pain condition, usually occurring in a limb. There are two main types, CRPS 1 with no definite nerve lesion and CRPS 2 with an identified nerve lesion. CRPS 1 and 2 may occur following an injury (frequently following fractures), surgery or without known cause. An early diagnosis and start of adequate treatment is considered desirable for patients with CRPS. From the clinical experience of the principal investigator, it became apparent that CRPS often remained undiagnosed and that the clinical conditions of many patients seemed to be worsened following orthopedic surgery subsequent to the initial eliciting event. The aim of the present retrospective study of 55 patients, all diagnosed with either CRPS 1 or 2, was to evaluate the time from injury until diagnosis of CRPS and the effect on pain of orthopedic surgical intervention subsequent to the original injury/surgery. Clinical symptoms with an emphasis on pain were assessed by going through the patients' records and by information given during the investigation at Oslo University Hospital, where the patients also were examined clinically and with EMG/neurography. Alteration in pain was evaluated in 27 patients who underwent orthopedic surgery subsequent to the eliciting injury. Of a total of 55 patients, 28 women and 27 men (mean age 38.7 (SD 12.3), 38 patients were diagnosed with CRPS type 1, and 17 with CRPS type 2. Mean time before diagnosis was confirmed was 3.9 years (SD1.42, range 6 months-10 years). The eliciting injuries for both CRPS type 1 and type 2 were fractures, squeeze injuries, blunt injuries, stretch accidents and surgery. A total of 27 patients (14 men and 13 women) were operated from one to 12 times at a later stage (from 6 months to several years) following the initial injury or any primary operation because of fracture. A total of 22 patients reported a worsening of pain following secondary surgical events, while four

  8. Radiofrequency ablation of stellate ganglion in a patient with complex regional pain syndrome

    Directory of Open Access Journals (Sweden)

    Chinmoy Roy

    2014-01-01

    Full Text Available Complex regional pain syndrome (CRPS is characterized by a combination of sensory, motor, vasomotor, pseudomotor dysfunctions and trophic signs. We describe the use of radiofrequency (RF ablation of Stellate ganglion (SG under fluoroscopy, for long-term suppression of sympathetic nervous system, in a patient having CRPS-not otherwise specified. Although the effects of thermal RF neurolysis may be partial or temporary, they may promote better conditions toward rehabilitation. The beneficial effect obtained by the RF neurolysis of SG in this particular patient strongly advocates the use of this mode of therapy in patients with CRPS.

  9. Comparison of muscle and joint pressure-pain thresholds in patients with complex regional pain syndrome and upper limb pain of other origin.

    Science.gov (United States)

    Mainka, Tina; Bischoff, Florian S; Baron, Ralf; Krumova, Elena K; Nicolas, Volkmar; Pennekamp, Werner; Treede, Rolf-Detlef; Vollert, Jan; Westermann, Andrea; Maier, Christoph

    2014-03-01

    Pain localized in the deep tissues occurs frequently in complex regional pain syndrome (CRPS). In addition, hyperalgesia to blunt pressure over muscles is common in CRPS, but it often appears in limb pain of other origin as well. Considering that 3-phase bone scintigraphy (TPBS) reveals periarticular enhanced bone metabolism in CRPS, joint-associated hyperalgesia to blunt pressure might be a more specific finding than hyperalgesia over muscles. In 34 patients with upper limb pain (18 CRPS, 16 non-CRPS; diagnosed in accordance to the Budapest criteria) and in 18 healthy controls, pressure-pain thresholds (PPT) were assessed bilaterally over the thenar (PPTThenar), the metacarpophalangeal (PPTMCP), and the proximal interphalangeal (PPTPIP) joints using a pressure algometer (Somedic, Sweden). Beforehand, all patients had received TPBS for diagnostic purposes independently of the study. Region-of-interest (ROI) ratios (mineralization phase) for the MCP and PIP, excluding fracture sites, were correlated with the PPT. In CRPS, all ROI ratios were significantly increased and all PPT of the affected hand were decreased compared to non-CRPS (PPTThenar: 243±150kPa vs 358±197kPa, PPTMCP: 80±67kPa vs 159±93kPa, PPTPIP: 80±56kPa vs 184±110kPa; PPain. Published by Elsevier B.V. All rights reserved.

  10. Investigating Reports of Complex Regional Pain Syndrome: An Analysis of HPV-16/18-Adjuvanted Vaccine Post-Licensure Data

    NARCIS (Netherlands)

    F.J.P.M. Huygen (Frank); K. Verschueren (Kristin); C. McCabe (Candida); J.-U. Stegmann (Jens-Ulrich); J. Zima (Julia); O. Mahaux (Olivia); L. Van Holle (Lionel); M.-G. Angelo (Maria-Genalin)

    2015-01-01

    textabstractComplex regional pain syndrome (CRPS) is a chronic pain disorder that typically follows trauma or surgery. Suspected CRPS reported after vaccination with human papillomavirus (HPV) vaccines led to temporary suspension of proactive recommendation of HPV vaccination in Japan. We

  11. Impact of spinal cord stimulation on sensory characteristics in complex regional pain syndrome type I - A randomized trial

    NARCIS (Netherlands)

    Kemler, MA; Reulen, JPH; Barendse, GAM; van Kleef, M; de Vet, HCW; van den Wildenberg, FAJM

    Background: A randomized trial was performed to assess the effect of spinal cord stimulation (SCS) on detection and pain thresholds for pressure, warmth, and cold and on the extent of mechanical hyperalgesia in patients with chronic complex regional pain syndrome type I. Methods: Fifty-four chronic

  12. Selective Fiber Degeneration in the Peripheral Nerve of a Patient With Severe Complex Regional Pain Syndrome

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    Adrien Yvon

    2018-04-01

    Full Text Available Aims: Complex regional pain syndrome (CRPS is characterized by chronic debilitating pain disproportional to the inciting event and accompanied by motor, sensory, and autonomic disturbances. The pathophysiology of CRPS remains elusive. An exceptional case of severe CRPS leading to forearm amputation provided the opportunity to examine nerve histopathological features of the peripheral nerves.Methods: A 35-year-old female developed CRPS secondary to low voltage electrical injury. The CRPS was refractory to medical therapy and led to functional loss of the forelimb, repeated cutaneous wound infections leading to hospitalization. Specifically, the patient had exhausted a targeted conservative pain management programme prior to forearm amputation. Radial, median, and ulnar nerve specimens were obtained from the amputated limb and analyzed by light and transmission electron microscopy (TEM.Results: All samples showed features of selective myelinated nerve fiber degeneration (47–58% of fibers on electron microscopy. Degenerating myelinated fibers were significantly larger than healthy fibers (p < 0.05, and corresponded to the larger Aα fibers (motor/proprioception whilst smaller Aδ (pain/temperature fibers were spared. Groups of small unmyelinated C fibers (Remak bundles also showed evidence of degeneration in all samples.Conclusions: We are the first to show large fiber degeneration in CRPS using TEM. Degeneration of Aα fibers may lead to an imbalance in nerve signaling, inappropriately triggering the smaller healthy Aδ fibers, which transmit pain and temperature. These findings suggest peripheral nerve degeneration may play a key role in CRPS. Improved knowledge of pathogenesis will help develop more targeted treatments.

  13. Complex regional pain syndrome type I : Use of the International Association for the Study of Pain diagnostic criteria defined in 1994

    NARCIS (Netherlands)

    Reinders, M.F.; Geertzen, J.H.B.; Dijkstra, P.U.

    2002-01-01

    Objectives: The objective was to assess the reported use in recent publications of the diagnostic criteria for complex regional pain syndrome type I (CRPS 1) proposed by the International Association for the Study of Pain (IASP) in 1994. Methods: A literature search of MEDLINE (January 1996 to July

  14. Lack of genetic association of neutral endopeptidase (NEP) with complex regional pain syndrome (CRPS).

    Science.gov (United States)

    Huehne, Kathrin; Schaal, Ute; Leis, Stefan; Uebe, Steffen; Gosso, M Florencia; van den Maagdenberg, Arn M J M; Maihöfner, Christian; Birklein, Frank; Rautenstrauss, Bernd; Winterpacht, Andreas

    2010-03-12

    Complex regional pain syndrome (CRPS) is a condition that is characterized by severe pain and exaggerated neurogenic inflammation, which may develop after injury or surgery. Neurogenic inflammation is mediated by neuropeptides, such as calcitonin gene-related peptide (CGRP) and substance P (SP) that are released from nociceptors. Genetic factors may play a role in CRPS as was suggested by the occurrence of familial cases and several genetic association studies investigating mainly the human leukocyte antigen (HLA) system. Here we investigated the role of neutral endopeptidase (NEP), a key enzyme in neuropeptide catabolism. NEP dysfunction resulting in reduced inactivation of neuropeptides may be a possible pathomechanism in CRPS. To this end, we tested a GT-repeat polymorphism in the NEP promoter region as well as 18 tag-SNPs in six linkage disequilibrium (LD) blocks in the NEP gene region in 320 CRPS patients and 376 controls. No significant genetic association was observed. Thus, we conclude that the NEP gene does not seem to be a major risk factor for CRPS. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  15. Proteomic identification of altered cerebral proteins in the complex regional pain syndrome animal model.

    Science.gov (United States)

    Nahm, Francis Sahngun; Park, Zee-Yong; Nahm, Sang-Soep; Kim, Yong Chul; Lee, Pyung Bok

    2014-01-01

    Complex regional pain syndrome (CRPS) is a rare but debilitating pain disorder. Although the exact pathophysiology of CRPS is not fully understood, central and peripheral mechanisms might be involved in the development of this disorder. To reveal the central mechanism of CRPS, we conducted a proteomic analysis of rat cerebrum using the chronic postischemia pain (CPIP) model, a novel experimental model of CRPS. After generating the CPIP animal model, we performed a proteomic analysis of the rat cerebrum using a multidimensional protein identification technology, and screened the proteins differentially expressed between the CPIP and control groups. Results. A total of 155 proteins were differentially expressed between the CPIP and control groups: 125 increased and 30 decreased; expressions of proteins related to cell signaling, synaptic plasticity, regulation of cell proliferation, and cytoskeletal formation were increased in the CPIP group. However, proenkephalin A, cereblon, and neuroserpin were decreased in CPIP group. Altered expression of cerebral proteins in the CPIP model indicates cerebral involvement in the pathogenesis of CRPS. Further study is required to elucidate the roles of these proteins in the development and maintenance of CRPS.

  16. Proteomic Identification of Altered Cerebral Proteins in the Complex Regional Pain Syndrome Animal Model

    Directory of Open Access Journals (Sweden)

    Francis Sahngun Nahm

    2014-01-01

    Full Text Available Background. Complex regional pain syndrome (CRPS is a rare but debilitating pain disorder. Although the exact pathophysiology of CRPS is not fully understood, central and peripheral mechanisms might be involved in the development of this disorder. To reveal the central mechanism of CRPS, we conducted a proteomic analysis of rat cerebrum using the chronic postischemia pain (CPIP model, a novel experimental model of CRPS. Materials and Methods. After generating the CPIP animal model, we performed a proteomic analysis of the rat cerebrum using a multidimensional protein identification technology, and screened the proteins differentially expressed between the CPIP and control groups. Results. A total of 155 proteins were differentially expressed between the CPIP and control groups: 125 increased and 30 decreased; expressions of proteins related to cell signaling, synaptic plasticity, regulation of cell proliferation, and cytoskeletal formation were increased in the CPIP group. However, proenkephalin A, cereblon, and neuroserpin were decreased in CPIP group. Conclusion. Altered expression of cerebral proteins in the CPIP model indicates cerebral involvement in the pathogenesis of CRPS. Further study is required to elucidate the roles of these proteins in the development and maintenance of CRPS.

  17. Local cytokine changes in complex regional pain syndrome type I (CRPS I) resolve after 6 months.

    Science.gov (United States)

    Lenz, Melanie; Uçeyler, Nurcan; Frettlöh, Jule; Höffken, Oliver; Krumova, Elena K; Lissek, Silke; Reinersmann, Annika; Sommer, Claudia; Stude, Philipp; Waaga-Gasser, Ana M; Tegenthoff, Martin; Maier, Christoph

    2013-10-01

    There is evidence that inflammatory processes are involved in at least the early phase of complex regional pain syndrome (CRPS). We compared a panel of pro- and antiinflammatory cytokines in skin blister fluids and serum from patients with CRPS and patients with upper-limb pain of other origin (non-CRPS) in the early stage (CRPS patients compared to non-CRPS patients. Neither group showed side differences. After 6 months under analgesic treatment, protein levels of all measured cytokines in CRPS patients, except for IL-6, significantly changed bilaterally to the level of non-CRPS patients. These changes were not related to treatment outcome. In serum, only IL-8, TNF-α, eotaxin, MCP-1, and MIP-1β were detectable without intergroup differences. Blister fluid of CRPS patients showed a bilateral proinflammatory cytokine profile. This profile seems to be relevant only at the early stage of CRPS. Almost all measured cytokine levels were comparable to those of non-CRPS patients after 6 months of analgesic treatment and were not related to treatment outcome. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  18. [Comparable disorder of the body schema in patients with complex regional pain syndrome (CRPS) and phantom pain].

    Science.gov (United States)

    Reinersmann, A; Haarmeyer, G S; Blankenburg, M; Frettlöh, J; Krumova, E K; Ocklenburg, S; Maier, C

    2011-09-01

    In patients with complex regional pain syndrome (CRPS) a disruption of the body schema has been shown in an altered cortical representation of the hand and in delayed reaction times (RT) in the hand laterality recognition task. However, the role of attentional processes or the effect of isolated limb laterality training has not yet been clarified. The performance of healthy subjects (n = 38), CRPS patients (n = 12) and phantom limb pain (PLP) patients (n = 12) in a test battery of attentional performance (TAP) and in a limb laterality recognition task was compared and the effect of limb laterality training in CRPS patients and healthy subjects evaluated. The RTs of both CRPS and PLP patients were significantly slower than those of healthy subjects despite normal TAP values. The CRPS and PLP patients showed bilaterally delayed RTs. Through training RTs improved significantly but the RTs of CRPS patients remained slower than those of healthy subjects. In this study an equal disruption of the body schema was found in both CRPS and PLP patients which cannot be accounted for by attentional processes. For CRPS patients this disorder cannot be fully reversed by isolated limb laterality recognition training.

  19. Complex Regional Pain Syndrome following an Episode of Herpes Zoster: A Case Report.

    Science.gov (United States)

    Marrero, Christopher E; Mclean, Neuyen; Varnado, Keyana

    2017-01-01

    Complex regional pain syndrome (CRPS) is characterized by searing pain, hyperalgesia, edema, allodynia, and skin changes. CRPS may be difficult to diagnose and to treat given poorly understood mechanisms as well as its presentation of symptoms that may mimic common conditions such as joint stiffness in this condition as well as rheumatoid arthritis. A 71-year-old female presented to our clinic post shingles of the right upper extremity. We diagnosed her with CRPS based on the Budapest diagnostic criteria and the clinical findings of pain and decreased the range of motion along with edema, hypersensitivity, discoloration and allodynia of the right thumb and index finger. She was treated with vitamin C as well as gabapentin and physical therapy. The patient was unable to go consistently to physical therapy due to insurance limitations, and we found no clinical benefit of vitamin C in reducing her symptoms. She was lost to follow-up during her treatment but re-emerged at 21 months. At that time she reported, she was largely unchanged in regards to her right-hand symptoms but did believe the gabapentin was helpful and still continued to take 300 mg daily. This case report highlights the usefulness of the Budapest diagnostic criteria to make the diagnosis of CRPS when associated with shingles, which can cause long-term pain and mimic some findings. Prompt diagnosis is important, as recovery typically extends beyond 6 months; our patient still reported continued symptoms at 21 months post initial presentation. Our primary treatment plan was physical therapy, which she discontinued due to insurance limitations. We recommend that patients, physicians, and third-party payers work together to extend access to physical therapy. More investigation is warranted regarding symptomatic treatment, as we found limited clinical benefit of gabapentin and vitamin C.

  20. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II.

    Science.gov (United States)

    Smart, Keith M; Wand, Benedict M; O'Connell, Neil E

    2016-02-24

    Complex regional pain syndrome (CRPS) is a painful and disabling condition that usually manifests in response to trauma or surgery. When it occurs, it is associated with significant pain and disability. It is thought to arise and persist as a consequence of a maladaptive pro-inflammatory response and disturbances in sympathetically-mediated vasomotor control, together with maladaptive peripheral and central neuronal plasticity. CRPS can be classified into two types: type I (CRPS I) in which a specific nerve lesion has not been identified, and type II (CRPS II) where there is an identifiable nerve lesion. Guidelines recommend the inclusion of a variety of physiotherapy interventions as part of the multimodal treatment of people with CRPS, although their effectiveness is not known. To determine the effectiveness of physiotherapy interventions for treating the pain and disability associated with CRPS types I and II. We searched the following databases from inception up to 12 February 2015: CENTRAL (the Cochrane Library), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, PEDro, Web of Science, DARE and Health Technology Assessments, without language restrictions, for randomised controlled trials (RCTs) of physiotherapy interventions for treating pain and disability in people CRPS. We also searched additional online sources for unpublished trials and trials in progress. We included RCTs of physiotherapy interventions (including manual therapy, therapeutic exercise, electrotherapy, physiotherapist-administered education and cortically directed sensory-motor rehabilitation strategies) employed in either a stand-alone fashion or in combination, compared with placebo, no treatment, another intervention or usual care, or of varying physiotherapy interventions compared with each other in adults with CRPS I and II. Our primary outcomes of interest were patient-centred outcomes of pain intensity and functional disability. Two review authors independently evaluated those studies

  1. Prevalence and Cost Analysis of Complex Regional Pain Syndrome (CRPS): A Role for Neuromodulation.

    Science.gov (United States)

    Elsamadicy, Aladine A; Yang, Siyun; Sergesketter, Amanda R; Ashraf, Bilal; Charalambous, Lefko; Kemeny, Hanna; Ejikeme, Tiffany; Ren, Xinru; Pagadala, Promila; Parente, Beth; Xie, Jichun; Lad, Shivanand P

    2017-09-29

    The diagnosis and treatment of complex regional pain syndrome (CRPS) is challenging and there is a paucity of data describing its overall cost burden and quantifying its impact on the US healthcare system. The aim of this study was to assess the prevalence and healthcare utilization costs associated with CRPS. A retrospective longitudinal study was performed using the Truven MarketScan® database to identify patients with a new indexed diagnosis of CRPS (Type I, II, or both) from 2001 to 2012. We collected total, outpatient, and pain prescription costs three years prior to CRPS diagnosis (baseline), at year of CRPS diagnosis, and eight-year post-CRPS diagnosis. A longitudinal multivariate analysis was used to model the estimated total and pain prescription cost ratios comparing patients diagnosed before and after CRPS. We included 35,316 patients with a newly indexed diagnosis of CRPS (Type I: n = 18,703, Type II: n = 14,599, Unspecified: n = 2014). Baseline characteristics were similar between the CRPS cohorts. Compared to two- and three-year baseline costs, one-year prior to diagnosis for all CRPS patients yielded the highest interquartile median [IQR] costs: total costs $7904[$3469, $16,084]; outpatient costs $6706[$3119, $12,715]; and pain prescription costs $1862[$147, $7649]. At the year of CRPS diagnosis, the median [IQR] costs were significantly higher than baseline costs: total costs $8508[$3943, $16,666]; outpatient costs $7251[$3527, $13,568]; and pain prescription costs $2077[$140, $8856]. Over the eight-year period after CRPS diagnosis, costs between all the years were similar, ranging from the highest (one-year) to lowest (seven-years), $4845 to $3888. The median total cumulative cost 8-years after CRPS diagnosis was $43,026 and $12,037 for pain prescription costs. [Correction added on 06 November 2017 after first online publication: the preceding sentence has been updated to demonstrate the median cumulative cost in replacement of the

  2. [11C]-(R)-PK11195 positron emission tomography in patients with complex regional pain syndrome

    Science.gov (United States)

    Jeon, So Yeon; Seo, Seongho; Lee, Jae Sung; Choi, Soo-Hee; Lee, Do-Hyeong; Jung, Ye-Ha; Song, Man-Kyu; Lee, Kyung-Jun; Kim, Yong Chul; Kwon, Hyun Woo; Im, Hyung-Jun; Lee, Dong Soo; Cheon, Gi Jeong; Kang, Do-Hyung

    2017-01-01

    Abstract Complex regional pain syndrome (CRPS) is characterized by severe and chronic pain, but the pathophysiology of this disease are not clearly understood. The primary aim of our case–control study was to explore neuroinflammation in patients with CRPS using positron emission tomography (PET), with an 18-kDa translocator protein specific radioligand [11C]-(R)-PK11195. [11C]-(R)-PK11195 PET scans were acquired for 11 patients with CRPS (30–55 years) and 12 control subjects (30–52 years). Parametric image of distribution volume ratio (DVR) for each participant was generated by applying a relative equilibrium-based graphical analysis. The DVR of [11C]-(R)-PK11195 in the caudate nucleus (t(21) = −3.209, P = 0.004), putamen (t(21) = −2.492, P = 0.022), nucleus accumbens (t(21) = −2.218, P = 0.040), and thalamus (t(21) = −2.395, P = 0.026) were significantly higher in CRPS patients than in healthy controls. Those of globus pallidus (t(21) = −2.045, P = 0.054) tended to be higher in CRPS patients than in healthy controls. In patients with CRPS, there was a positive correlation between the DVR of [11C]-(R)-PK11195 in the caudate nucleus and the pain score, the visual analog scale (r = 0.661, P = 0.026, R2 = 0.408) and affective subscales of McGill Pain Questionnaire (r = 0.604, P = 0.049, R2 = 0.364). We demonstrated that neuroinflammation of CRPS patients in basal ganglia. Our results suggest that microglial pathology can be an important pathophysiology of CRPS. Association between the level of caudate nucleus and pain severity indicated that neuroinflammation in this region might play a key role. These results may be essential for developing effective medical treatments. PMID:28072713

  3. Bisphosphonates Inhibit Pain, Bone Loss, and Inflammation in a Rat Tibia Fracture Model of Complex Regional Pain Syndrome.

    Science.gov (United States)

    Wang, Liping; Guo, Tian-Zhi; Hou, Saiyun; Wei, Tzuping; Li, Wen-Wu; Shi, Xiaoyou; Clark, J David; Kingery, Wade S

    2016-10-01

    Bisphosphonates are used to prevent the bone loss and fractures associated with osteoporosis, bone metastases, multiple myeloma, and osteogenesis deformans. Distal limb fractures cause regional bone loss with cutaneous inflammation and pain in the injured limb that can develop into complex regional pain syndrome (CRPS). Clinical trials have reported that antiresorptive bisphosphonates can prevent fracture-induced bone loss, inhibit serum inflammatory cytokine levels, and alleviate CRPS pain. Previously, we observed that the inhibition of inflammatory cytokines or adaptive immune responses attenuated the development of pain behavior in a rat fracture model of CRPS, and we hypothesized that bisphosphonates could prevent pain behavior, trabecular bone loss, postfracture cutaneous cytokine upregulation, and adaptive immune responses in this CRPS model. Rats underwent tibia fracture and cast immobilization for 4 weeks and were chronically administered either subcutaneously perfused alendronate or oral zoledronate. Behavioral measurements included hindpaw von Frey allodynia, unweighting, warmth, and edema. Bone microarchitecture was measured by microcomputed tomography, and bone cellular activity was evaluated by static and dynamic histomorphometry. Spinal cord Fos immunostaining was performed, and skin cytokine (tumor necrosis factor, interleukin [IL]-1, IL-6) and nerve growth factor (NGF) levels were determined by enzyme immunoassay. Skin and sciatic nerve immunoglobulin levels were determined by enzyme immunoassay. Rats with tibia fractures developed hindpaw allodynia, unweighting, warmth, and edema, increased spinal Fos expression and trabecular bone loss in the lumbar vertebra and bilateral distal femurs as measured by microcomputed tomography, increased trabecular bone resorption and osteoclast surface with decreased bone formation rates, increased cutaneous inflammatory cytokine and NGF expression, and elevated immunocomplex deposition in skin and nerve

  4. Complex Regional Pain Syndrome Type I Affects Brain Structure in Prefrontal and Motor Cortex

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    Pleger, Burkhard; Draganski, Bogdan; Schwenkreis, Peter; Lenz, Melanie; Nicolas, Volkmar; Maier, Christoph; Tegenthoff, Martin

    2014-01-01

    The complex regional pain syndrome (CRPS) is a rare but debilitating pain disorder that mostly occurs after injuries to the upper limb. A number of studies indicated altered brain function in CRPS, whereas possible influences on brain structure remain poorly investigated. We acquired structural magnetic resonance imaging data from CRPS type I patients and applied voxel-by-voxel statistics to compare white and gray matter brain segments of CRPS patients with matched controls. Patients and controls were statistically compared in two different ways: First, we applied a 2-sample ttest to compare whole brain white and gray matter structure between patients and controls. Second, we aimed to assess structural alterations specifically of the primary somatosensory (S1) and motor cortex (M1) contralateral to the CRPS affected side. To this end, MRI scans of patients with left-sided CRPS (and matched controls) were horizontally flipped before preprocessing and region-of-interest-based group comparison. The unpaired ttest of the “non-flipped” data revealed that CRPS patients presented increased gray matter density in the dorsomedial prefrontal cortex. The same test applied to the “flipped” data showed further increases in gray matter density, not in the S1, but in the M1 contralateral to the CRPS-affected limb which were inversely related to decreased white matter density of the internal capsule within the ipsilateral brain hemisphere. The gray-white matter interaction between motor cortex and internal capsule suggests compensatory mechanisms within the central motor system possibly due to motor dysfunction. Altered gray matter structure in dorsomedial prefrontal cortex may occur in response to emotional processes such as pain-related suffering or elevated analgesic top-down control. PMID:24416397

  5. Complex regional pain syndrome type I affects brain structure in prefrontal and motor cortex.

    Directory of Open Access Journals (Sweden)

    Burkhard Pleger

    Full Text Available The complex regional pain syndrome (CRPS is a rare but debilitating pain disorder that mostly occurs after injuries to the upper limb. A number of studies indicated altered brain function in CRPS, whereas possible influences on brain structure remain poorly investigated. We acquired structural magnetic resonance imaging data from CRPS type I patients and applied voxel-by-voxel statistics to compare white and gray matter brain segments of CRPS patients with matched controls. Patients and controls were statistically compared in two different ways: First, we applied a 2-sample ttest to compare whole brain white and gray matter structure between patients and controls. Second, we aimed to assess structural alterations specifically of the primary somatosensory (S1 and motor cortex (M1 contralateral to the CRPS affected side. To this end, MRI scans of patients with left-sided CRPS (and matched controls were horizontally flipped before preprocessing and region-of-interest-based group comparison. The unpaired ttest of the "non-flipped" data revealed that CRPS patients presented increased gray matter density in the dorsomedial prefrontal cortex. The same test applied to the "flipped" data showed further increases in gray matter density, not in the S1, but in the M1 contralateral to the CRPS-affected limb which were inversely related to decreased white matter density of the internal capsule within the ipsilateral brain hemisphere. The gray-white matter interaction between motor cortex and internal capsule suggests compensatory mechanisms within the central motor system possibly due to motor dysfunction. Altered gray matter structure in dorsomedial prefrontal cortex may occur in response to emotional processes such as pain-related suffering or elevated analgesic top-down control.

  6. Interaction of hyperalgesia and sensory loss in complex regional pain syndrome type I (CRPS I.

    Directory of Open Access Journals (Sweden)

    Volker Huge

    Full Text Available BACKGROUND: Sensory abnormalities are a key feature of Complex Regional Pain Syndrome (CRPS. In order to characterise these changes in patients suffering from acute or chronic CRPS I, we used Quantitative Sensory Testing (QST in comparison to an age and gender matched control group. METHODS: 61 patients presenting with CRPS I of the upper extremity and 56 healthy subjects were prospectively assessed using QST. The patients' warm and cold detection thresholds (WDT; CDT, the heat and cold pain thresholds (HPT; CPT and the occurrence of paradoxical heat sensation (PHS were observed. RESULTS: In acute CRPS I, patients showed warm and cold hyperalgesia, indicated by significant changes in HPT and CPT. WDT and CDT were significantly increased as well, indicating warm and cold hypoaesthesia. In chronic CRPS, thermal hyperalgesia declined, but CDT as well as WDT further deteriorated. Solely patients with acute CRPS displayed PHS. To a minor degree, all QST changes were also present on the contralateral limb. CONCLUSIONS: We propose three pathomechanisms of CRPS I, which follow a distinct time course: Thermal hyperalgesia, observed in acute CRPS, indicates an ongoing aseptic peripheral inflammation. Thermal hypoaesthesia, as detected in acute and chronic CRPS, signals a degeneration of A-delta and C-fibres, which further deteriorates in chronic CRPS. PHS in acute CRPS I indicates that both inflammation and degeneration are present, whilst in chronic CRPS I, the pathomechanism of degeneration dominates, signalled by the absence of PHS. The contralateral changes observed strongly suggest the involvement of the central nervous system.

  7. Interaction of hyperalgesia and sensory loss in complex regional pain syndrome type I (CRPS I).

    Science.gov (United States)

    Huge, Volker; Lauchart, Meike; Förderreuther, Stefanie; Kaufhold, Wibke; Valet, Michael; Azad, Shahnaz Christina; Beyer, Antje; Magerl, Walter

    2008-07-23

    Sensory abnormalities are a key feature of Complex Regional Pain Syndrome (CRPS). In order to characterise these changes in patients suffering from acute or chronic CRPS I, we used Quantitative Sensory Testing (QST) in comparison to an age and gender matched control group. 61 patients presenting with CRPS I of the upper extremity and 56 healthy subjects were prospectively assessed using QST. The patients' warm and cold detection thresholds (WDT; CDT), the heat and cold pain thresholds (HPT; CPT) and the occurrence of paradoxical heat sensation (PHS) were observed. In acute CRPS I, patients showed warm and cold hyperalgesia, indicated by significant changes in HPT and CPT. WDT and CDT were significantly increased as well, indicating warm and cold hypoaesthesia. In chronic CRPS, thermal hyperalgesia declined, but CDT as well as WDT further deteriorated. Solely patients with acute CRPS displayed PHS. To a minor degree, all QST changes were also present on the contralateral limb. We propose three pathomechanisms of CRPS I, which follow a distinct time course: Thermal hyperalgesia, observed in acute CRPS, indicates an ongoing aseptic peripheral inflammation. Thermal hypoaesthesia, as detected in acute and chronic CRPS, signals a degeneration of A-delta and C-fibres, which further deteriorates in chronic CRPS. PHS in acute CRPS I indicates that both inflammation and degeneration are present, whilst in chronic CRPS I, the pathomechanism of degeneration dominates, signalled by the absence of PHS. The contralateral changes observed strongly suggest the involvement of the central nervous system.

  8. A prospective, multisite, international validation of the Complex Regional Pain Syndrome Severity Score.

    Science.gov (United States)

    Harden, R Norman; Maihofner, Christian; Abousaad, Elias; Vatine, Jean-Jacques; Kirsling, Amy; Perez, Roberto S G M; Kuroda, Maxine; Brunner, Florian; Stanton-Hicks, Michael; Marinus, Johan; van Hilten, Jacobus J; Mackey, Sean; Birklein, Frank; Schlereth, Tanja; Mailis-Gagnon, Angela; Graciosa, Joe; Connoly, Sara B; Dayanim, David; Massey, Michael; Frank, Hadas; Livshitz, Anatoly; Bruehl, Stephen

    2017-08-01

    Clinical diagnosis of complex regional pain syndrome (CRPS) is a dichotomous (yes/no) categorization, a format necessary for clinical decision making. Such dichotomous diagnostic categories do not convey an individual's subtle gradations in the severity of the condition over time and have poor statistical power when used as an outcome measure in research. This prospective, international, multicenter study slightly modified and further evaluated the validity of the CRPS Severity Score (CSS), a continuous index of CRPS severity. Using a prospective design, medical evaluations were conducted in 156 patients with CRPS to compare changes over time in CSS scores between patients initiating a new treatment program and patients on stable treatment regimens. New vs stable categorizations were supported by greater changes in pain and function in the former. Results indicated that CSS values in the stable CRPS treatment group exhibited much less change over time relative to the new treatment group, with intraclass correlations nearly twice as large in the former. A calculated smallest real difference value revealed that a change in the CSS of ≥4.9 scale points would indicate real differences in CRPS symptomatology (with 95% confidence). Across groups, larger changes in CRPS features on the CSS over time were associated in the expected direction with greater changes in pain intensity, fatigue, social functioning, ability to engage in physical roles, and general well-being. The overall pattern of findings further supports the validity of the CSS as a measure of CRPS severity and suggests it may prove useful in clinical monitoring and outcomes research.

  9. Changes in plasma cytokines and their soluble receptors in complex regional pain syndrome.

    Science.gov (United States)

    Alexander, Guillermo M; Peterlin, B Lee; Perreault, Marielle J; Grothusen, John R; Schwartzman, Robert J

    2012-01-01

    Complex Regional Pain Syndrome (CRPS) is a chronic and often disabling pain disorder. There is evidence demonstrating that neurogenic inflammation and activation of the immune system play a significant role in the pathophysiology of CRPS. This study evaluated the plasma levels of cytokines, chemokines, and their soluble receptors in 148 subjects afflicted with CRPS and in 60 gender- and age-matched healthy controls. Significant changes in plasma cytokines, chemokines, and their soluble receptors were found in subjects with CRPS as compared with healthy controls. For most analytes, these changes resulted from a distinct subset of the CRPS subjects. When the plasma data from the CRPS subjects was subjected to cluster analysis, it revealed 2 clusters within the CRPS population. The category identified as most important for cluster separation by the clustering algorithm was TNFα. Cluster 1 consisted of 64% of CRPS subjects and demonstrated analyte values similar to the healthy control individuals. Cluster 2 consisted of 36% of the CRPS subjects and demonstrated significantly elevated levels of most analytes and in addition, it showed that the increased plasma analyte levels in this cluster were correlated with disease duration and severity. The identification of biomarkers that define disease subgroups can be of great value in the design of specific therapies and of great benefit to the design of clinical trials. It may also aid in advancing our understanding of the mechanisms involved in the pathophysiology of CRPS, which may lead to novel treatments for this very severe condition. Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

  10. Mirror box therapy added to cognitive behavioural therapy in three chronic complex regional pain syndrome type I patients : a pilot study

    NARCIS (Netherlands)

    Tichelaar, Y. I. G. Vladimir; Geertzen, Jan H. B.; Keizer, Doeke; van Wilgen, C. Paul

    Complex regional pain syndrome type I is a disorder of the extremities with disability and pain as the most prominent features. This paper describes the results of cognitive behavioural therapy combined with mirror box therapy in three patients with chronic complex regional pain syndrome type I.

  11. The semiquantitative three-phase bone scintigraphy on hemiplegic patients with earlier complex regional pain syndrome

    International Nuclear Information System (INIS)

    Li Fang; Liu Xingdang; Lu Zhihui; Liu Congjin

    2010-01-01

    Objective: To investigate the difference between the early phases and delay phase of three-phase bone scintigraphy on hemiplegic patients with earlier complex regional pain syndrome (CRPS). Methods: Twenty-nine stroke patients with hemiplegia complicating CRPS received three-phase bone scintigraphy after intravenous injection of 99 Tc m -methylene diphosphonate (MDP). The region of interest (ROI) technique was used to obtain the radioactive counts of involved joints and contralateral sites on wrists, metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints. The total counts of these four sites in each patient were then obtained and the total uptake ratios of involved joints/contralateral joints for each phase were calculated to compare the difference among the three phases. Wilcoxon test and ANOVA were used in data analyses. Results: The involved joints of hemiplegic side displayed higher tracer uptake. There were significant differences of the radioactive counts between involved joints and uninvolved ones in the perfusion, pool and delay phase (Wilcoxon test, Z: -4.73 to -2.10, P<0.05). There was no significant difference of total uptake ratios of involved joints/contralateral joints among the three phases (ANOVA, F = 0. 807, P < 0.05). Conclusions: Due to higher bone seeking agent accumulation on three-phase bone scintigraphy, both early phases and delay phase imaging showed similar value in stroke patients with hemiplegia complicating earlier CRPS. (authors)

  12. Motor dysfunction of complex regional pain syndrome is related to impaired central processing of proprioceptive information.

    Science.gov (United States)

    Bank, Paulina J M; Peper, C Lieke E; Marinus, Johan; Beek, Peter J; van Hilten, Jacobus J

    2013-11-01

    Our understanding of proprioceptive deficits in complex regional pain syndrome (CRPS) and its potential contribution to impaired motor function is still limited. To gain more insight into these issues, we evaluated accuracy and precision of joint position sense over a range of flexion-extension angles of the wrist of the affected and unaffected sides in 25 chronic CRPS patients and in 50 healthy controls. The results revealed proprioceptive impairment at both the patients' affected and unaffected sides, characterized predominantly by overestimation of wrist extension angles. Precision of the position estimates was more prominently reduced at the affected side. Importantly, group differences in proprioceptive performance were observed not only for tests at identical percentages of each individual's range of wrist motion but also when controls were tested at wrist angles that corresponded to those of the patient's affected side. More severe motor impairment of the affected side was associated with poorer proprioceptive performance. Based on additional sensory tests, variations in proprioceptive performance over the range of wrist angles, and comparisons between active and passive displacements, the disturbances of proprioceptive performance most likely resulted from altered processing of afferent (and not efferent) information and its subsequent interpretation in the context of a distorted "body schema." The present results point at a significant role for impaired central processing of proprioceptive information in the motor dysfunction of CRPS and suggest that therapeutic strategies aimed at identification of proprioceptive impairments and their restoration may promote the recovery of motor function in CRPS patients. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

  13. Novel Signs and Their Clinical Utility in Diagnosing Complex Regional Pain Syndrome (CRPS): A Prospective Observational Cohort Study.

    Science.gov (United States)

    Kuttikat, Anoop; Shaikh, Maliha; Oomatia, Amin; Parker, Richard; Shenker, Nicholas

    2017-06-01

    Delays in diagnosis occur with complex regional pain syndrome (CRPS). We define and prospectively demonstrate that novel bedside tests measuring body perception disruption can identify patients with CRPS postfracture. The objectives of our study were to define and validate 4 bedside tests, to identify the prevalence of positive tests in patients with CRPS and other chronic pain conditions, and to assess the clinical utility (sensitivity, specificity, positive predictive value, negative predictive value) for identifying CRPS within a Fracture cohort. This was a single UK teaching hospital prospective cohort study with 313 recruits from pain-free volunteers and patients with chronic pain conditions.Four novel tests were Finger Perception (FP), Hand Laterality identification (HL), Astereognosis (AS), and Body Scheme (BS) report. Five questionnaires (Brief Pain Inventory, Upper Extremity Functional Index, Lower Extremity Functional Index, Neglect-like Symptom Questionnaire, Hospital Anxiety and Depression Score) assessed the multidimensional pain experience. FP and BS were the best performing tests. Prospective monitoring of fracture patients showed that out of 7 fracture patients (total n=47) who had both finger misperception and abnormal BS report at initial testing, 3 developed persistent pain with 1 having a formal diagnosis of CRPS. Novel signs are reliable, easy to perform, and present in chronic pain patients. FP and BS have significant clinical utility in predicting persistent pain in a fracture group thereby allowing targeted early intervention.

  14. Intravenous magnesium for chronic complex regional pain syndrome type 1 (CRPS-1).

    Science.gov (United States)

    Fischer, Sigrid G L; Collins, Susan; Boogaard, Sabine; Loer, Stephan A; Zuurmond, Wouter W A; Perez, Roberto S G M

    2013-09-01

    To assess the effects of intravenous administration of magnesium on complex regional pain syndrome type 1 (CRPS-1), a randomized double-blind placebo-controlled trial was performed. Fifty-six patients with CRPS-1 (International Association for the Study of Pain Orlando criteria) received MgSO(4) 70 mg/kg or placebo (NaCl 0.9%) in 4 hours over 5 consecutive days. Pain (BOX-11 and McGill), the level of impairment (Impairment level Sum Score [ISS]), functional limitations (Radboud Skills Questionnaire, Walking Skills Questionnaire/questionnaire rising and sitting down), participation (Impact on Participation and Autonomy [IPA]), and quality of life (Short Form-36, EuroQol, IPA) were evaluated at baseline and at 1, 3, 6, and 12 weeks. No significant differences were found between MgSO(4) and placebo on the BOX-11 and ISS at different time points during the trial on intention-to-treat and per-protocol analysis. A significant improvement on the BOX-11 was found after the first week of the trial in both groups (mean 0.7; standard deviation 1.1). For the MgSO(4) group, a clinically relevant and statistically significant improvement on the ISS at 1 week (median 5, interquartile range [IQR] -1 to 8) and a significant improvement on the McGill up to 6 weeks (median 2 words, IQR 0-4.5) were found compared with baseline, which were not found in the placebo group. Significant improvement in perceived job participation was found for the MgSO(4) group at 12 weeks (median improvement 1.44-1.17; P = 0.01). ISS improved significantly more in patients with a low Hospital Anxiety and Depression Scale (HADS) score (≤10) in the MgSO(4) group (mean 4.4 vs mean -3.1; P = 0.02). Administration of the physiological competitive N-methyl-D-aspartate receptor antagonist magnesium in chronic CRPS provides insufficient benefit over placebo. Future research should focus on patients with acute CRPS and early signs and symptoms of central sensitization. Wiley Periodicals, Inc.

  15. Motor dysfunction in complex regional pain syndrome : the role of sensory processing and sensory-motor integration

    NARCIS (Netherlands)

    Bank, Paulina Johanna Maria

    2014-01-01

    In the chronic stage of Complex Regional Pain Syndrome (CRPS), motor disturbances are common and cause significant disability. The motor dysfunction of CRPS is a poorly understood phenomenon that is characterized predominantly by a decrease or loss of voluntary muscle control. This thesis aims to

  16. fMRI Reveals Distinct CNS Processing during Symptomatic and Recovered Complex Regional Pain Syndrome in Children

    Science.gov (United States)

    Lebel, A.; Becerra, L.; Wallin, D.; Moulton, E. A.; Morris, S.; Pendse, G.; Jasciewicz, J.; Stein, M.; Aiello-Lammens, M.; Grant, E.; Berde, C.; Borsook, D.

    2008-01-01

    Complex regional pain syndrome (CRPS) in paediatric patients is clinically distinct from the adult condition in which there is often complete resolution of its signs and symptoms within several months to a few years. The ability to compare the symptomatic and asymptomatic condition in the same individuals makes this population interesting for the…

  17. A case of complex regional pain syndrome with agnosia for object orientation.

    Science.gov (United States)

    Robinson, Gail; Cohen, Helen; Goebel, Andreas

    2011-07-01

    This systematic investigation of the neurocognitive correlates of complex regional pain syndrome (CRPS) in a single case also reports agnosia for object orientation in the context of persistent CRPS. We report a patient (JW) with severe long-standing CRPS who had no difficulty identifying and naming line drawings of objects presented in 1 of 4 cardinal orientations. In contrast, he was extremely poor at reorienting these objects into the correct upright orientation and in judging whether an object was upright or not. Moreover, JW made orientation errors when copying drawings of objects, and he also showed features of mirror reversal in writing single words and reading single letters. The findings are discussed in relation to accounts of visual processing. Agnosia for object orientation is the term for impaired knowledge of an object's orientation despite good recognition and naming of the same misoriented object. This defect has previously only been reported in patients with major structural brain lesions. The neuroanatomical correlates are discussed. The patient had no structural brain lesion, raising the possibility that nonstructural reorganisation of cortical networks may be responsible for his deficits. Other patients with CRPS may have related neurocognitive defects. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

  18. Complex regional pain syndrome (CRPS) or continuous unilateral distal experimental pain stimulation in healthy subjects does not bias visual attention towards one hemifield.

    Science.gov (United States)

    Filippopulos, Filipp M; Grafenstein, Jessica; Straube, Andreas; Eggert, Thomas

    2015-11-01

    In natural life pain automatically draws attention towards the painful body part suggesting that it interacts with different attentional mechanisms such as visual attention. Complex regional pain syndrome (CRPS) patients who typically report on chronic distally located pain of one extremity may suffer from so-called neglect-like symptoms, which have also been linked to attentional mechanisms. The purpose of the study was to further evaluate how continuous pain conditions influence visual attention. Saccade latencies were recorded in two experiments using a common visual attention paradigm whereby orientating saccades to cued or uncued lateral visual targets had to be performed. In the first experiment saccade latencies of healthy subjects were measured under two conditions: one in which continuous experimental pain stimulation was applied to the index finger to imitate a continuous pain situation, and one without pain stimulation. In the second experiment saccade latencies of patients suffering from CRPS were compared to controls. The results showed that neither the continuous experimental pain stimulation during the experiment nor the chronic pain in CRPS led to an unilateral increase of saccade latencies or to a unilateral increase of the cue effect on latency. The results show that unilateral, continuously applied pain stimuli or chronic pain have no or only very limited influence on visual attention. Differently from patients with visual neglect, patients with CRPS did not show strong side asymmetries of saccade latencies or of cue effects on saccade latencies. Thus, neglect-like clinical symptoms of CRPS patients do not involve the allocation of visual attention.

  19. Analysis of gene expression profile microarray data in complex regional pain syndrome.

    Science.gov (United States)

    Tan, Wulin; Song, Yiyan; Mo, Chengqiang; Jiang, Shuangjian; Wang, Zhongxing

    2017-09-01

    The aim of the present study was to predict key genes and proteins associated with complex regional pain syndrome (CRPS) using bioinformatics analysis. The gene expression profiling microarray data, GSE47603, which included peripheral blood samples from 4 patients with CRPS and 5 healthy controls, was obtained from the Gene Expression Omnibus (GEO) database. The differentially expressed genes (DEGs) in CRPS patients compared with healthy controls were identified using the GEO2R online tool. Functional enrichment analysis was then performed using The Database for Annotation Visualization and Integrated Discovery online tool. Protein‑protein interaction (PPI) network analysis was subsequently performed using Search Tool for the Retrieval of Interaction Genes database and analyzed with Cytoscape software. A total of 257 DEGs were identified, including 243 upregulated genes and 14 downregulated ones. Genes in the human leukocyte antigen (HLA) family were most significantly differentially expressed. Enrichment analysis demonstrated that signaling pathways, including immune response, cell motion, adhesion and angiogenesis were associated with CRPS. PPI network analysis revealed that key genes, including early region 1A binding protein p300 (EP300), CREB‑binding protein (CREBBP), signal transducer and activator of transcription (STAT)3, STAT5A and integrin α M were associated with CRPS. The results suggest that the immune response may therefore serve an important role in CRPS development. In addition, genes in the HLA family, such as HLA‑DQB1 and HLA‑DRB1, may present potential biomarkers for the diagnosis of CRPS. Furthermore, EP300, its paralog CREBBP, and the STAT family genes, STAT3 and STAT5 may be important in the development of CRPS.

  20. Treatment of complex regional pain syndrome type 1 in a pediatric patient using the lidocaine patch 5%: a case report

    Directory of Open Access Journals (Sweden)

    Steven G Frost, MD

    2003-09-01

    Full Text Available Background: Successful treatment of complex regional pain syndrome type 1 (CRPS-1 requires a coordinated, multidisciplinary approach. Physical rehabilitation is an important component of long-term treatment. Unfortunately, patients with significant allodynia or hyperalgesia characteristic of CRPS-1 often have difficulty progressing through a physical therapy (PT regimen. In most adults with CRPS-1, the treatment of choice is PO opioids. Objective: This article presents a case report of the use of the lidocaine patch 5%, a targeted peripheral analgesic, in a pediatric patient and its effects on reducing pain, improving the patient's overall attitude, and facilitating compliance with ongoing PT. Results: A 10-year-old girl developed CRPS-1 after arthroscopic surgery for a sprained ankle. Attempts at PT were unsuccessful due to inadequate pain relief from various treatment modalities. Therapy with the lidocaine patch 5% was initiated and resulted in significant pain relief, improvements in the patient's attitude, and progress with PT. Conclusion: This case report of a child with CRPS-1 showed that therapy with lidocaine patch 5% may be efficacious in treating children with pain resulting from CRPS-1, thereby increasing the success of PT. Keywords: complex regional pain syndrome, lidocaine patch 5%, targeted peripheral analgesic, pediatrics

  1. Case Study of High-Dose Ketamine for Treatment of Complex Regional Pain Syndrome in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Pasek, Tracy Ann; Crowley, Kelli; Campese, Catherine; Lauer, Rachel; Yang, Charles

    2017-06-01

    Complex regional pain syndrome (CRPS) is a life-altering and debilitating chronic pain condition. The authors are presenting a case study of a female who received high-dose ketamine for the management of her CRPS. The innovative treatment lies not only within the pharmacologic management of her pain, but also in the fact that she was the first patient to be admitted to our pediatric intensive care unit solely for pain control. The primary component of the pharmacotherapy treatment strategy plan was escalating-dose ketamine infusion via patient-controlled-analgesia approved by the pharmacy and therapeutics committee guided therapy for this patient. The expertise of advanced practice nurses blended exquisitely to ensure patient and family-centered care and the coordination of care across the illness trajectory. The patient experienced positive outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Medical history and the onset of complex regional pain syndrome (CRPS).

    Science.gov (United States)

    de Mos, M; Huygen, F J P M; Dieleman, J P; Koopman, J S H A; Stricker, B H Ch; Sturkenboom, M C J M

    2008-10-15

    Knowledge concerning the medical history prior to the onset of complex regional pain syndrome (CRPS) might provide insight into its risk factors and potential underlying disease mechanisms. To evaluate prior to CRPS medical conditions, a case-control study was conducted in the Integrated Primary Care Information (IPCI) project, a general practice (GP) database in the Netherlands. CRPS patients were identified from the records and validated through examination by the investigator (IASP criteria) or through specialist confirmation. Cases were matched to controls on age, gender and injury type. All diagnoses prior to the index date were assessed by manual review of the medical records. Some pre-specified medical conditions were studied for their association with CRPS, whereas all other diagnoses, grouped by pathogenesis, were tested in a hypothesis-generating approach. Of the identified 259 CRPS patients, 186 cases (697 controls) were included, based on validation by the investigator during a visit (102 of 134 visited patients) or on specialist confirmation (84 of 125 unvisited patients). A medical history of migraine (OR: 2.43, 95% CI: 1.18-5.02) and osteoporosis (OR: 2.44, 95% CI: 1.17-5.14) was associated with CRPS. In a recent history (1-year before CRPS), cases had more menstrual cycle-related problems (OR: 2.60, 95% CI: 1.16-5.83) and neuropathies (OR: 5.7; 95% CI: 1.8-18.7). In a sensitivity analysis, including only visited cases, asthma (OR: 3.0; 95% CI: 1.3-6.9) and CRPS were related. Psychological factors were not associated with CRPS onset. Because of the hypothesis-generating character of this study, the findings should be confirmed by other studies.

  3. Is physiotherapy effective for children with complex regional pain syndrome type 1?

    Science.gov (United States)

    Bialocerkowski, Andrea E; Daly, Anne

    2012-01-01

    This study synthesized current research evidence on the effectiveness of physiotherapy for the management of children diagnosed with complex regional pain syndrome type 1 (CRPS-1), to provide up-to-date physiotherapy treatment recommendations, and to identify areas that require further investigation. Nine electronic databases were searched for quantitative studies that evaluated the effect of physiotherapy on children with CRPS-1. The methodological quality of the studies was evaluated using the Critical Review Form. Data were extracted regarding the study design, participant characteristics, types of outcome measures used, and physiotherapy technique used and its effectiveness. The search strategy identified 303 potential studies, of which 12 met the inclusion criteria (1 randomized controlled trial, 1 comparative study, 10 case series). The methodological quality of all studies was rated as poor to fair. The "stand-alone" value of physiotherapy could not be determined as physiotherapy was prescribed in conjunction with psychological and medical interventions. There is low volume and poor-to-fair quality evidence which suggests that physiotherapy prescribed with other interventions may lead to short-term improvement in the signs and symptoms of CRPS-1 or functional ability in children with CRPS-1, and the relapse rate may be moderately high. High-quality studies are required in this area. These studies should evaluate a package of care (which includes physiotherapy); they should investigate the effects of physiotherapy treatments that have proven effectiveness in adults with CRPS-1; they should use psychometrically sound measures to evaluate outcome; and the nature of physiotherapy should be detailed in future publications to enable replication in the clinical setting.

  4. Association of non-traumatic complex regional pain syndrome with adenocarcinoma lung on 99mTc-MDP bone scan

    International Nuclear Information System (INIS)

    Damle, Nishikant A.; Tripathi, Madhavi; Singhal, Abhinav; Bal, Chandrasekhar; Praveen Kumar; Kandasamy, Devasenathipathi; Jana, Manisha

    2012-01-01

    Complex regional pain syndrome (CRPS) is usually associated with trauma. Rarely, it may be seen in association with malignancies. We present here the bone scan and X-ray findings in the case of a 56-year-male-patient with adenocarcinoma lung who also had non-traumatic CRPS without involvement of the stellate ganglion. The case highlights the fact that spontaneous development of reflex sympathetic dystrophy may be associated with a neoplastic etiology. (author)

  5. Potential Risk Factors for the Onset of Complex Regional Pain Syndrome Type 1: A Systematic Literature Review

    Directory of Open Access Journals (Sweden)

    Tracey Pons

    2015-01-01

    Full Text Available Anaesthetists in the acute and chronic pain teams are often involved in treating Complex Regional Pain Syndromes. Current literature about the risk factors for the onset of Complex Regional Pain Syndrome Type 1 (CRPS 1 remains sparse. This syndrome has a low prevalence, a highly variable presentation, and no gold standard for diagnosis. In the research setting, the pathogenesis of the syndrome continues to be elusive. There is a growing body of literature that addresses efficacy of a wide range of interventions as well as the likely mechanisms that contribute to the onset of CRPS 1. The objective for this systematic search of the literature focuses on determining the potential risk factors for the onset of CRPS 1. Eligible articles were analysed, dated 1996 to April 2014, and potential risk factors for the onset of CRPS 1 were identified from 10 prospective and 6 retrospective studies. Potential risk factors for the onset of CRPS 1 were found to include being female, particularly postmenopausal female, ankle dislocation or intra-articular fracture, immobilisation, and a report of higher than usual levels of pain in the early phases of trauma. It is not possible to draw definite conclusions as this evidence is heterogeneous and of mixed quality, relevance, and weighting strength against bias and has not been confirmed across multiple trials or in homogenous studies.

  6. Antiallodynic Effects of Bee Venom in an Animal Model of Complex Regional Pain Syndrome Type 1 (CRPS-I).

    Science.gov (United States)

    Lee, Sung Hyun; Lee, Jae Min; Kim, Yun Hong; Choi, Jung Hyun; Jeon, Seung Hwan; Kim, Dong Kyu; Jeong, Hyeon Do; Lee, You Jung; Park, Hue Jung

    2017-09-15

    Neuropathic pain in a chronic post-ischaemic pain (CPIP) model mimics the symptoms of complex regional pain syndrome type I (CRPS I). The administration of bee venom (BV) has been utilized in Eastern medicine to treat chronic inflammatory diseases accompanying pain. However, the analgesic effect of BV in a CPIP model remains unknown. The application of a tight-fitting O-ring around the left ankle for a period of 3 h generated CPIP in C57/Bl6 male adult mice. BV (1 mg/kg ; 1, 2, and 3 times) was administered into the SC layer of the hind paw, and the antiallodynic effects were investigated using the von Frey test and by measuring the expression of neurokinin type 1 (NK-1) receptors in dorsal root ganglia (DRG). The administration of BV dose-dependently reduced the pain withdrawal threshold to mechanical stimuli compared with the pre-administration value and with that of the control group. After the development of the CPIP model, the expression of NK-1 receptors in DRG increased and then decreased following the administration of BV. SC administration of BV results in the attenuation of allodynia in a mouse model of CPIP. The antiallodynic effect was objectively proven through a reduction in the increased expression of NK-1 receptors in DRG.

  7. High-Frequency Repetitive Sensory Stimulation as Intervention to Improve Sensory Loss in Patients with Complex Regional Pain Syndrome I.

    Science.gov (United States)

    David, Marianne; Dinse, Hubert R; Mainka, Tina; Tegenthoff, Martin; Maier, Christoph

    2015-01-01

    Achieving perceptual gains in healthy individuals or facilitating rehabilitation in patients is generally considered to require intense training to engage neuronal plasticity mechanisms. Recent work, however, suggested that beneficial outcome similar to training can be effectively acquired by a complementary approach in which the learning occurs in response to mere exposure to repetitive sensory stimulation (rSS). For example, high-frequency repetitive sensory stimulation (HF-rSS) enhances tactile performance and induces cortical reorganization in healthy subjects and patients after stroke. Patients with complex regional pain syndrome (CRPS) show impaired tactile performance associated with shrinkage of cortical maps. We here investigated the feasibility and efficacy of HF-rSS, and low-frequency rSS (LF-rSS) to enhance tactile performance and reduce pain intensity in 20 patients with CRPS type I. Intermittent high- or low-frequency electrical stimuli were applied for 45 min/day to all fingertips of the affected hand for 5 days. Main outcome measures were spatial two-point-discrimination thresholds and mechanical detection thresholds measured on the tip of the index finger bilaterally. Secondary endpoint was current pain intensity. All measures were assessed before and on day 5 after the last stimulation session. HF-rSS applied in 16 patients improved tactile discrimination on the affected hand significantly without changes contralaterally. Current pain intensity remained unchanged on average, but decreased in four patients by ≥30%. This limited pain relief might be due to the short stimulation period of 5 days only. In contrast, after LF-rSS, tactile discrimination was impaired in all four patients, while detection thresholds and pain were not affected. Our data suggest that HF-rSS could be used as a novel approach in CRPS treatment to improve sensory loss. Longer treatment periods might be required to induce consistent pain relief.

  8. High frequency repetitive sensory stimulation as intervention to improve sensory loss in patients with complex regional pain syndrome (CRPS I

    Directory of Open Access Journals (Sweden)

    Marianne eDavid

    2015-11-01

    Full Text Available Achieving perceptual gains in healthy individuals, or facilitating rehabilitation in patients is generally considered to require intense training to engage neuronal plasticity mechanisms. Recent work, however, suggested that beneficial outcome similar to training can be effectively acquired by a complementary approach in which the learning occurs in response to mere exposure to repetitive sensory stimulation (rSS. For example, high-frequency repetitive sensory stimulation (HF-rSS enhances tactile performance and induces cortical reorganization in healthy subjects and patients after stroke. Patients with complex regional pain syndrome (CRPS show impaired tactile performance associated with shrinkage of cortical maps. We here investigated the feasibility and efficacy of HF-rSS, and low-frequency rSS (LF-rSS to enhance tactile performance and reduce pain intensity in 20 patients with CRPS type I. Intermittent high or low frequency electrical stimuli were applied for 45min/day to all fingertips of the affected hand for 5 days. Main outcome measures were spatial 2-point-discrimination thresholds and mechanical detection thresholds measured on the tip of the index finger bilaterally. Secondary endpoint was current pain intensity. All measures were assessed before and on day 5 after the last stimulation session. HF-rSS applied in 16 patients improved tactile discrimination on the affected hand significantly without changes contralaterally. Current pain intensity remained unchanged on average, but decreased in 4 patients by 30%. This limited pain relief might be due to the short stimulation period of 5 days only. In contrast, after LF-rSS, tactile discrimination was impaired in all 4 patients, while detection thresholds and pain were not affected. Our data suggest that HF-rSS could be used as a novel approach in CRPS treatment to improve sensory loss. Longer treatment periods might be required to induce consistent pain relief.

  9. Intrathecal Bupivacaine Monotherapy with a Retrograde Catheter for the Management of Complex Regional Pain Syndrome of the Lower Extremity.

    Science.gov (United States)

    McRoberts, W Porter; Apostol, Catalina; Haleem, Abdul

    2016-01-01

    Complex regional pain syndrome (CRPS) presents a therapeutic challenge due to its many presentations and multifaceted pathophysiology. There is no approved treatment algorithm and clinical interventions are often applied empirically. In cases of CRPS where symptoms are localized to an extremity, a targeted treatment is indicated. We describe the use of intrathecal bupivacaine monotherapy, delivered through a retrograde catheter, in the treatment of CRPS affecting the lower extremity. The patient, a 57-year-old woman with a history of failed foot surgery, was seen in our office after 2 years of ineffective treatments with local blocks and neurolytic procedures. We advanced therapy to moderately invasive procedures with an emphasis on neuromodulation. A combined central and peripheral stimulation technique that initially provided 75% pain relief, failed to provide lasting analgesia. We proceeded with an intrathecal pump implant. Based on the results of dorsal root ganglion (DRG) mapping, L5-S1 was identified as the optimal target for therapy and a retrograde catheter was placed at this level. Various intrathecal medications were tested individually. An intrathecal morphine trial was ineffective (visual analog scale [VAS] 7), while intrathecal clonidine provided excellent pain relief (VAS 0) that was limited by severe side effects. Bupivacaine provided 100% analgesia with tolerable side effects (lower extremity weakness and minor bladder incontinence) and was selected for intrathecal infusion. After 14 months, bupivacaine treatment continued to control pain exacerbations. We conclude that CRPS patients benefit from early identification of the predominant underlying symptoms and a targeted treatment with moderately invasive techniques when less invasive techniques fail. Intrathecal bupivacaine, bupivacaine monotherapy, retrograde catheter, complex regional pain syndrome (CRPS), dual stimulation, dosal root ganglion (DRG) testing.

  10. The effectiveness and cost evaluation of pain exposure physical therapy and conventional therapy in patients with complex regional pain syndrome type 1. Rationale and design of a randomized controlled trial

    NARCIS (Netherlands)

    Barnhoorn, K.J.; Oostendorp, R.A.B.; van Dongen, R.T.M.; Klomp, F.P.; Samwel, H.; van der Wilt, G.J.; Adang, E.M.M.; Groenewoud, H.; van de Meent, H.; Frolke, J.P.M.

    2012-01-01

    Background: Pain Exposure Physical Therapy is a new treatment option for patients with Complex Regional Pain Syndrome type 1. It has been evaluated in retrospective as well as in prospective studies and proven to be safe and possibly effective. This indicates that Pain Exposure Physical Therapy is

  11. Low-Dose Intravenous Immunoglobulin Treatment for Long-Standing Complex Regional Pain Syndrome: A Randomized Trial.

    Science.gov (United States)

    Goebel, Andreas; Bisla, Jatinder; Carganillo, Roy; Frank, Bernhard; Gupta, Rima; Kelly, Joanna; McCabe, Candy; Murphy, Caroline; Padfield, Nick; Phillips, Ceri; Sanders, Mark; Serpell, Mick; Shenker, Nick; Shoukrey, Karim; Wyatt, Lynne; Ambler, Gareth

    2017-10-03

    Two small trials suggest that low-dose intravenous immunoglobulin (IVIg) may improve the symptoms of complex regional pain syndrome (CRPS), a rare posttraumatic pain condition. To confirm the efficacy of low-dose IVIg compared with placebo in reducing pain during a 6-week period in adult patients who had CRPS from 1 to 5 years. 1:1 parallel, randomized, placebo-controlled, multicenter trial for 6 weeks, with an optional 6-week open extension. Patients were randomly assigned to 1 of 2 study groups between 27 August 2013 and 28 October 2015; the last patient completed follow-up on 21 March 2016. Patients, providers, researchers, and outcome assessors were blinded to treatment assignment. (ISRCTN42179756). 7 secondary and tertiary care pain management centers in the United Kingdom. 111 patients with moderate or severe CRPS of 1 to 5 years' duration. IVIg, 0.5 g/kg of body weight, or visually indistinguishable placebo of 0.1% albumin in saline on days 1 and 22 after randomization. The primary outcome was 24-hour average pain intensity, measured daily between days 6 and 42, on an 11-point (0- to 10-point) rating scale. Secondary outcomes were pain interference and quality of life. The primary analysis sample consisted of 108 eligible patients, 103 of whom had outcome data. Mean (average) pain scores were 6.9 points (SD, 1.5) for placebo and 7.2 points (SD, 1.3) for IVIg. The adjusted difference in means was 0.27 (95% CI, -0.25 to 0.80; P = 0.30), which excluded the prespecified, clinically important difference of -1.2. No statistically significant differences in secondary outcomes were found between the groups. In the open extension, 12 of the 67 patients (18%) who received 2 IVIg infusions had pain reduction of at least 2 points compared with their baseline score. Two patients in the blinded phase (1 in the placebo and 1 in the IVIg group) and 4 in the open IVIg phase had serious events. Results do not apply to patients who have had CRPS for less than 1 year or more

  12. Complex Regional Pain Syndrome Revived by Epileptic Seizure Then Disappeared Soon during Treatment with Regional Intravenous Nerve Blockade: A Case Report

    Directory of Open Access Journals (Sweden)

    Masahiko Sumitani

    2011-01-01

    Full Text Available We present a case of complex regional pain syndrome (CRPS, in which symptoms, including burning pain and severe allodynia, were alleviated by using a regional intravenous nerve blockade (Bier block combined with physiotherapy, but reappeared following an epileptic seizure. Symptoms disappeared again following control of epileptic discharges, as revealed by single-photon emission computed tomography (SPECT and electroencephalography (EEG results. Although systemic toxicity of a local anesthetic applied by Bier block was suspected as a cause of the first seizure, the patient did not present any other toxic symptoms, and seizures repeatedly occurred after Bier block cessation; the patient was then diagnosed as having temporal symptomatic epilepsy. This case suggests that symptoms of CRPS may be sustained by abnormal brain conditions, and our findings contribute to the understanding of how the central nervous system participates in maintaining pain and allodynia associated with CRPS.

  13. Use of a medication quantification scale for comparison of pain medication usage in patients with complex regional pain syndrome (CRPS).

    Science.gov (United States)

    Gallizzi, Michael A; Khazai, Ravand S; Gagnon, Christine M; Bruehl, Stephen; Harden, R Norman

    2015-03-01

    To correlate the amount and types of pain medications prescribed to CRPS patients, using the Medication Quantification Scale, and patients' subjective pain levels. An international, multisite, retrospective review. University medical centers in the United States, Israel, Germany, and the Netherlands. A total of 89 subjects were enrolled from four different countries: 27 from the United States, 20 Germany, 18 Netherlands, and 24 Israel. The main outcome measures used were the Medication Quantification Scale III and numerical analog pain scale. There was no statistically significant correlation noted between the medication quantification scale and the visual analog scale for any site except for a moderate positive correlation at German sites. The medication quantification scale mean differences between the United States and Germany, the Netherlands, and Israel were 9.793 (P CRPS patients and would be useful in further prospective studies of pain medication prescription practices in the CRPS population worldwide. Wiley Periodicals, Inc.

  14. Bodily Sensory Inputs and Anomalous Bodily Experiences in Complex Regional Pain Syndrome: Evaluation of the Potential Effects of Sound Feedback

    Directory of Open Access Journals (Sweden)

    Ana Tajadura-Jiménez

    2017-07-01

    Full Text Available Neuroscientific studies have shown that human's mental body representations are not fixed but are constantly updated through sensory feedback, including sound feedback. This suggests potential new therapeutic sensory approaches for patients experiencing body-perception disturbances (BPD. BPD can occur in association with chronic pain, for example in Complex Regional Pain Syndrome (CRPS. BPD often impacts on emotional, social, and motor functioning. Here we present the results from a proof-of-principle pilot study investigating the potential value of using sound feedback for altering BPD and its related emotional state and motor behavior in those with CRPS. We build on previous findings that real-time alteration of the sounds produced by walking can alter healthy people's perception of their own body size, while also resulting in more active gait patterns and a more positive emotional state. In the present study we quantified the emotional state, BPD, pain levels and gait of twelve people with CRPS Type 1, who were exposed to real-time alteration of their walking sounds. Results confirm previous reports of the complexity of the BPD linked to CRPS, as participants could be classified into four BPD subgroups according to how they mentally visualize their body. Further, results suggest that sound feedback may affect the perceived size of the CRPS affected limb and the pain experienced, but that the effects may differ according to the type of BPD. Sound feedback affected CRPS descriptors and other bodily feelings and emotions including feelings of emotional dominance, limb detachment, position awareness, attention and negative feelings toward the limb. Gait also varied with sound feedback, affecting the foot contact time with the ground in a way consistent with experienced changes in body weight. Although, findings from this small pilot study should be interpreted with caution, they suggest potential applications for regenerating BDP and its related

  15. Bodily Sensory Inputs and Anomalous Bodily Experiences in Complex Regional Pain Syndrome: Evaluation of the Potential Effects of Sound Feedback

    Science.gov (United States)

    Tajadura-Jiménez, Ana; Cohen, Helen; Bianchi-Berthouze, Nadia

    2017-01-01

    Neuroscientific studies have shown that human's mental body representations are not fixed but are constantly updated through sensory feedback, including sound feedback. This suggests potential new therapeutic sensory approaches for patients experiencing body-perception disturbances (BPD). BPD can occur in association with chronic pain, for example in Complex Regional Pain Syndrome (CRPS). BPD often impacts on emotional, social, and motor functioning. Here we present the results from a proof-of-principle pilot study investigating the potential value of using sound feedback for altering BPD and its related emotional state and motor behavior in those with CRPS. We build on previous findings that real-time alteration of the sounds produced by walking can alter healthy people's perception of their own body size, while also resulting in more active gait patterns and a more positive emotional state. In the present study we quantified the emotional state, BPD, pain levels and gait of twelve people with CRPS Type 1, who were exposed to real-time alteration of their walking sounds. Results confirm previous reports of the complexity of the BPD linked to CRPS, as participants could be classified into four BPD subgroups according to how they mentally visualize their body. Further, results suggest that sound feedback may affect the perceived size of the CRPS affected limb and the pain experienced, but that the effects may differ according to the type of BPD. Sound feedback affected CRPS descriptors and other bodily feelings and emotions including feelings of emotional dominance, limb detachment, position awareness, attention and negative feelings toward the limb. Gait also varied with sound feedback, affecting the foot contact time with the ground in a way consistent with experienced changes in body weight. Although, findings from this small pilot study should be interpreted with caution, they suggest potential applications for regenerating BDP and its related bodily feelings in

  16. Photoacoustic microscopy of complex regional pain syndrome type I (CRPS-1) after stellate ganglion blocks in vivo

    Science.gov (United States)

    Zhou, Yong; Yi, Xiaobin; Xing, Wenxin; Hu, Song; Maslov, Konstantin I.; Wang, Lihong V.

    2015-03-01

    We used photoacoustic microscopy (PAM) to assist diagnoses and monitor the progress and treatment outcome of complex regional pain syndrome type 1 (CRPS-1). Blood vasculature and oxygen saturation (sO2) were imaged by PAM in eight adult patients with CRPS-1. Patients' hands and cuticles were imaged both before and after stellate ganglion block (SGB) for comparison. For all patients, both the vascular structure and sO2 could be assessed by PAM. In addition, more vessels and stronger signals were observed after SGB.

  17. Modified Graded Motor Imagery for Complex Regional Pain Syndrome Type 1 of the Upper Extremity in the Acute Phase: A Patient Series

    Science.gov (United States)

    Lagueux, Emilie; Charest, Joelle; Lefrancois-Caron, Eve; Mauger, Marie-Eve; Mercier, Emilie; Savard, Kim; Tousignant-Laflamme, Yannick

    2012-01-01

    Complex regional pain syndrome (CRPS) is a pathologic condition in which the painful experience is disproportionate in time and intensity in comparison with the inciting event. At present, the pathophysiology of CRPS is not well understood. Several studies have indicated that cortical reorganization plays a role in the persistence of the symptoms.…

  18. Anti tumor necrosis factor - alpha adalimumab for complex regional pain syndrome type 1 (CRPS-I): a case series.

    Science.gov (United States)

    Eisenberg, Elon; Sandler, Ifat; Treister, Roi; Suzan, Erica; Haddad, May

    2013-11-01

    Evidence suggests tumor necrosis factor-alpha (TNF-α) mediates, at least in part, symptoms and signs in complex regional pain syndrome (CRPS). Here, we present a case series of patients with CRPS type 1, in whom the response to the anti-TNF-α adalimumab was assessed. Ten patients with CRPS type 1 were recruited. Assessments were performed before treatment, at 1 week, and 1, 3, and 6 months following 3 biweekly subcutaneous injections (40 mg/0.8 mL) adalimumab (Humira(®) ) and included the followings: Pain intensity using a 0-10 cm visual analog scale; the Short Form of the McGill Pain Questionnaire; the Beck Depression Inventory; the SF-36 questionnaire and mechanical and thermal thresholds (Von frey hair and Thermal Sensory Analyzer, respectively). In addition to the description of individual patient responses, both intention to treat (ITT) and per-protocol (PP) analyses were performed for the entire group. Three subgroups of patients were identified (3 patients in each): "nonresponders", "partial responders", and "robust responders" in whom improvement in almost all parameters was noted. Both the ITT and PP analyses demonstrated only a trend toward improvement in mechanical pain thresholds following treatment (ITT χ² = 13.83, P = 0.008; PP χ² = 10.29, P = 0.036). These results suggest adalimumab, and possibly other anti-TNF-α, can be potentially useful in some (although not in all) patients with CRPS type 1. These preliminary results along with the growing body of evidence which points to the involvement of TNF-α in the pathogenesis of CRPS justify further studies in this area. © 2013 World Institute of Pain.

  19. Characteristics of complex regional pain syndrome in patients referred to a tertiary pain clinic by community physicians, assessed by the Budapest clinical diagnostic criteria.

    Science.gov (United States)

    Mailis-Gagnon, Angela; Lakha, Shehnaz Fatima; Allen, Matti D; Deshpande, Amol; Harden, Robert Norman

    2014-11-01

    The aim of this study was to describe the characteristics of patients referred with complex regional pain syndrome (CRPS) diagnosis to a tertiary care pain center. Descriptive chart review study of all patients referred by family physicians or community specialists as having CRPS (2006-2010). Data extraction included demographics, pain ratings, and diagnosis utilizing the Budapest CRPS criteria. The study population consisted of 54 subjects (male [M] =7, female [F] =47). Only 27.7% were classified as CRPS by the clinical expert. Four additional subjects carrying other diagnoses but found to have CRPS were added to the analysis. The non-CRPS group consisted of 39 subjects (M=8, F=31) and the CRPS group of 19 (M=2, F=17). CRPS patients were statistically significantly more likely to 1) have suffered a fracture; 2) report symptoms in each of the four symptom categories, as well as signs in three or four categories collectively; and 3) have allodynia/hyperalgesia alone or in combination (85/90%) as compared with the non-CRPS group (23/25%, respectively). The non-CRPS group was much more likely to report no symptoms or signs at all in the different symptom and sign categories. Of the 39 non-CRPS patients, 74% had other diagnosable entities (1/3 suffering from specific neuropathic pain conditions, e.g., radiculopathy, diabetic neuropathy, etc. and 2/3 from discreet musculoskeletal entities), while 18% were diagnosed with psychogenic pain disorders including conversion reaction associated with immobility or paralysis. Besides fulfilling the Budapest CRPS diagnostic criteria, the most important other factor for diagnosing CRPS is the exclusion of a neuropathic, musculoskeletal, or non-biomedical condition accounting for the presentation. Wiley Periodicals, Inc.

  20. A CRPS-IgG-transfer-trauma model reproducing inflammatory and positive sensory signs associated with complex regional pain syndrome.

    Science.gov (United States)

    Tékus, Valéria; Hajna, Zsófia; Borbély, Éva; Markovics, Adrienn; Bagoly, Teréz; Szolcsányi, János; Thompson, Victoria; Kemény, Ágnes; Helyes, Zsuzsanna; Goebel, Andreas

    2014-02-01

    The aetiology of complex regional pain syndrome (CRPS), a highly painful, usually post-traumatic condition affecting the limbs, is unknown, but recent results have suggested an autoimmune contribution. To confirm a role for pathogenic autoantibodies, we established a passive-transfer trauma model. Prior to undergoing incision of hind limb plantar skin and muscle, mice were injected either with serum IgG obtained from chronic CRPS patients or matched healthy volunteers, or with saline. Unilateral hind limb plantar skin and muscle incision was performed to induce typical, mild tissue injury. Mechanical hyperalgesia, paw swelling, heat and cold sensitivity, weight-bearing ability, locomotor activity, motor coordination, paw temperature, and body weight were investigated for 8days. After sacrifice, proinflammatory sensory neuropeptides and cytokines were measured in paw tissues. CRPS patient IgG treatment significantly increased hind limb mechanical hyperalgesia and oedema in the incised paw compared with IgG from healthy subjects or saline. Plantar incision induced a remarkable elevation of substance P immunoreactivity on day 8, which was significantly increased by CRPS-IgG. In this IgG-transfer-trauma model for CRPS, serum IgG from chronic CRPS patients induced clinical and laboratory features resembling the human disease. These results support the hypothesis that autoantibodies may contribute to the pathophysiology of CRPS, and that autoantibody-removing therapies may be effective treatments for long-standing CRPS. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  1. Predictive value of symptom level measurements for complex regional pain syndrome type I

    NARCIS (Netherlands)

    Perez, R. S. G. M.; Keijzer, C.; Bezemer, P. D.; Zuurmond, W. W. A.; de Lange, J. J.

    2005-01-01

    The validity with respect to presence or absence of CRPS I according to Veldman's criteria was assessed for measured pain, temperature, volume differences and limitations in range of motion. Evaluated were 155 assessments of 66 outpatients, initially diagnosed with CRPS I, but many of them not so on

  2. The place of occupational therapy in rehabilitation strategies of complex regional pain syndrome: Comparative study of 60 cases.

    Science.gov (United States)

    Rome, L

    2016-10-01

    The purpose of the study was to assess the value of combining occupational therapy (OT) with physical therapy (PT) for the rehabilitation of complex regional pain syndrome (CRPS) and to measure its effectiveness on activities of daily life. Sixty patients with CRPS type 1 were recruited and interviewed between September 1, 2014 and February 1, 2015. Thirty patients had undergone PT and thirty had undergone PT+OT. They were administered the short-form of the "Assessment of Life Habits" questionnaire (v.3.0 LIFE-H) created in Canada. This questionnaire consists of 16 items exploring activities of daily living, which were used to compare the effectiveness of the two rehabilitation protocols. The results of each test were submitted to the Wilcoxon test. After confirming the complexity of CRPS in terms of its etiology, clinical signs and progression, rehabilitation was effective, especially for pain. The patients who received PT+OT had on average 10% better dressing and undressing function, 25% better for meal preparation, and 20% better on personal care than those who underwent PT only. In CRPS, OT combined with PT brings a real benefit in restoring the essential activities of daily life. This strategy could be implemented as soon the diagnosis confirmed and continued for a very long time. It helps to avoid the risk of dependence on third parties. Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  3. The rubber hand illusion in complex regional pain syndrome: preserved ability to integrate a rubber hand indicates intact multisensory integration.

    Science.gov (United States)

    Reinersmann, Annika; Landwehrt, Julia; Krumova, Elena K; Peterburs, Jutta; Ocklenburg, Sebastian; Güntürkün, Onur; Maier, Christoph

    2013-09-01

    In patients with complex regional pain syndrome (CRPS) type 1, processing of static tactile stimuli is impaired, whereas more complex sensory integration functions appear preserved. This study investigated higher order multisensory integration of body-relevant stimuli using the rubber hand illusion in CRPS patients. Subjective self-reports and skin conductance responses to watching the rubber hand being harmed were compared among CRPS patients (N=24), patients with upper limb pain of other origin (N=21, clinical control group), and healthy subjects (N=24). Additionally, the influence of body representation (body plasticity [Trinity Assessment of Body Plasticity], neglect-like severity symptoms), and clinical signs of illusion strength were investigated. For statistical analysis, 1-way analysis of variance, t test, Pearson correlation, with α=0.05 were used. CRPS patients did not differ from healthy subjects and the control group with regard to their illusion strength as assessed by subjective reports or skin conductance response values. Stronger left-sided rubber hand illusions were reported by healthy subjects and left-side-affected CRPS patients. Moreover, for this subgroup, illness duration and illusion strength were negatively correlated. Overall, severity of neglect-like symptoms and clinical signs were not related to illusion strength. However, patients with CRPS of the right hand reported significantly stronger neglect-like symptoms and significantly lower illusion strength of the affected hand than patients with CRPS of the left hand. The weaker illusion of CRPS patients with strong neglect-like symptoms on the affected hand supports the role of top-down processes modulating body ownership. Moreover, the intact ability to perceive illusory ownership confirms the notion that, despite impaired processing of proprioceptive or tactile input, higher order multisensory integration is unaffected in CRPS. Copyright © 2013 International Association for the Study

  4. Pain Relief Is Associated With Improvement in Motor Function in Complex Regional Pain Syndrome Type 1: Secondary Analysis of a Placebo-Controlled Study on the Effects of Ketamine

    NARCIS (Netherlands)

    Schilder, J.C.M.; Sigtermans, M.J.; Schouten, Alfred Christiaan; Putter, H.; Dahan, A.; Noldus, L.P.J.J.; Marinus, J.; van Hilten, J.J.

    2013-01-01

    There are indications of motor circuit changes in patients with complex regional pain syndrome (CRPS). Nevertheless, although several studies have analyzed motor behavior in CRPS, a relation with pain could not be detected. This might be explained by the use of cross-sectional designs in these

  5. Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome.

    Science.gov (United States)

    Harden, R Norman; Bruehl, Stephen; Perez, Roberto S G M; Birklein, Frank; Marinus, Johan; Maihofner, Christian; Lubenow, Timothy; Buvanendran, Asokumar; Mackey, Sean; Graciosa, Joseph; Mogilevski, Mila; Ramsden, Christopher; Chont, Melissa; Vatine, Jean-Jacques

    2010-08-01

    Current IASP diagnostic criteria for CRPS have low specificity, potentially leading to overdiagnosis. This validation study compared current IASP diagnostic criteria for CRPS to proposed new diagnostic criteria (the "Budapest Criteria") regarding diagnostic accuracy. Structured evaluations of CRPS-related signs and symptoms were conducted in 113 CRPS-I and 47 non-CRPS neuropathic pain patients. Discriminating between diagnostic groups based on presence of signs or symptoms meeting IASP criteria showed high diagnostic sensitivity (1.00), but poor specificity (0.41), replicating prior work. In comparison, the Budapest clinical criteria retained the exceptional sensitivity of the IASP criteria (0.99), but greatly improved upon the specificity (0.68). As designed, the Budapest research criteria resulted in the highest specificity (0.79), again replicating prior work. Analyses indicated that inclusion of four distinct CRPS components in the Budapest Criteria contributed to enhanced specificity. Overall, results corroborate the validity of the Budapest Criteria and suggest they improve upon existing IASP diagnostic criteria for CRPS. Copyright (c) 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  6. [Prevalence and Co-prevalence of Complex Regional Pain Syndrome (CRPS) and Carpal Tunnel Syndrome (CTS) in Hand Rehabilitation].

    Science.gov (United States)

    Neubrech, F; Gentzsch, T; Kotsougiani, D; Bickert, B; Kneser, U; Harhaus, L

    2016-06-01

    In the current literature, there are reports of associations between complex regional pain syndromes (CRPS) and carpal tunnel syndromes (CTS). The aim of this study was to determine the prevalence of both disease patterns in hand rehabilitation patients and to investigate whether there is a correlation between CTS and CRPS. Furthermore, differences in the healing process of patients with and without additional CTS, and the effectiveness of the rehabilitative therapy for both diseases, were investigated. The computerised medical records of 791 patients in the years 2009-2015 who had been in hand rehabilitation were retrospectively analysed. At the beginning and end of rehabilitation, measurements were made of pain by visual analogue scales (VAS, 0-10), grip strength and finger mobility (mean distance from finger pulp to palmar D2-D5). The clinical course was statistically analysed. CRPS diagnosis was confirmed clinically by a pain therapist, CTS diagnosis was confirmed by neurological and neurophysiological examination. Surgical therapy was performed despite CRPS diagnosis. The prevalence of CRPS was 161/1000 and of CTS 62/1000; the co-prevalence of the 2 diagnoses was 24/1000 (pCRPS group, after a mean of 8 (1-21) weeks of rehabilitative therapy, mean pain was reduced from 5 (1-10) to 3 (0-9), grip strength improved from 10 (0-39)kg to 18.5 (2.5-45.5)kg and finger mobility increased from 2.9 (0-7.6)cm to 1.8 (0-7.8)cm. In the CRPS+CTS group, after a mean of 6.8 (3-23) weeks of rehabilitative therapy, mean pain was reduced from 5 (0-8) to 2.6 (0-5), grip strength improved from 9.7 (2.4-25.5)kg to 17.4 (0.9-47.4)kg and finger mobility increased from 2.7 (0-5.3)cm to 1.7 (0-5.3)cm. Improvement over the period of rehabilitation was significant in both groups, though the period of therapy was significantly shorter in the CRPS+CTS group. CRPS and CTS are often associated. Rehabilitative therapy was effective for CRPS- and CRPS+CTS patients. © Georg Thieme Verlag KG

  7. Bisphosphonates for treatment of Complex Regional Pain Syndrome type 1: A systematic literature review and meta-analysis of randomized controlled trials versus placebo.

    Science.gov (United States)

    Chevreau, Maxime; Romand, Xavier; Gaudin, Philippe; Juvin, Robert; Baillet, Athan

    2017-07-01

    Complex Regional Pain Syndrome Type 1 is a severely disabling pain syndrome with no definite established treatment. We have performed a systematic literature review and meta-analysis of all randomized controlled trials to assess the benefit of bisphosphonates on pain and function in patients with Complex Regional Pain Syndrome Type 1. A systematic literature search was performed in the Medline, Embase and Cochrane databases. Two authors selected independently blinded randomized trials comparing bisphosphonates to placebo on short-term (J30 to J40) and medium term pain (M2-M3), safety and function in patients with CRPS 1. The methodological quality of the studies was analyzed. Data were aggregated using the method of the inverse of the variance. 258 articles were identified. Four trials of moderate to good quality comprising 181 patients (90 in the bisphosphonate group and 91 in the placebo group) were included in this meta-analysis. Short-term pain Visual Analog Scale was significantly lower in the bisphosphonate group versus the placebo group (SMD=-2.6, 95%CI [-1.8, -3.4], Ppain (SMD=-2.5, 95%CI [-1.4, -3.6], Ppain in patients with Complex Regional Pain Syndrome type 1. Other studies are needed to determine their effectiveness. Copyright © 2017. Published by Elsevier SAS.

  8. Investigating Reports of Complex Regional Pain Syndrome: An Analysis of HPV-16/18-Adjuvanted Vaccine Post-Licensure Data

    Science.gov (United States)

    Huygen, Frank; Verschueren, Kristin; McCabe, Candida; Stegmann, Jens-Ulrich; Zima, Julia; Mahaux, Olivia; Van Holle, Lionel; Angelo, Maria-Genalin

    2015-01-01

    Complex regional pain syndrome (CRPS) is a chronic pain disorder that typically follows trauma or surgery. Suspected CRPS reported after vaccination with human papillomavirus (HPV) vaccines led to temporary suspension of proactive recommendation of HPV vaccination in Japan. We investigated the potential CRPS signal in relation to HPV-16/18-adjuvanted vaccine (Cervarix®) by database review of CRPS cases with independent expert confirmation; a disproportionality analysis and analyses of temporality; an observed versus expected analysis using published background incidence rates; systematic reviews of aggregate safety data, and a literature review. The analysis included 17 case reports of CRPS: 10 from Japan (0.14/100,000 doses distributed) and seven from the United Kingdom (0.08/100,000). Five cases were considered by independent experts to be confirmed CRPS. Quantitative analyses did not suggest an association between CRPS and HPV-16/18-adjuvanted vaccine. Observed CRPS incidence after HPV-16/18 vaccination was statistically significantly below expected rates. Systematic database reviews using search terms varying in specificity and sensitivity did not identify new cases. No CRPS was reported during clinical development and no unexpected results found in the literature. There is not sufficient evidence to suggest an increased risk of developing CRPS following vaccination with HPV-16/18-adjuvanted vaccine. Post-licensure safety surveillance confirms the acceptable benefit-risk of HPV-16/18 vaccination. PMID:26501109

  9. Evaluation of low level laser and interferential current in the therapy of complex regional pain syndrome by infrared thermographic camera

    Directory of Open Access Journals (Sweden)

    Kocić Mirjana

    2010-01-01

    Full Text Available Background/Aim. Complex regional pain syndrome type I (CRPS I is characterized by continuous regional pain, disproportional according to duration and intensity and to the sort of trauma or other lesion it was caused by. The aim of the study was to evaluate and compare, by using thermovison, the effects of low level laser therapy and therapy with interferential current in treatment of CRPS I. Methods. The prospective randomized controlled clinical study included 45 patients with unilateral CRPS I, after a fracture of the distal end of the radius, of the tibia and/or the fibula, treated in the Clinical Centre in Nis from 2004 to 2007. The group A consisted of 20 patients treated by low level laser therapy and kinesy-therapy, while the patients in the group B (n = 25 were treated by interferential current and kinesy-therapy. The regions of interest were filmed by a thermovision camera on both sides, before and after the 20 therapeutic procedures had been applied. Afterwards, the quantitative analysis and the comparing of thermograms taken before and after the applied therapy were performed. Results. There was statistically significant decrease of the mean maximum temperature difference between the injured and the contralateral extremity after the therapy in comparison to the status before the therapy, with the patients of the group A (p < 0.001 as well as those of the group B (p < 0.001. The decrease was statistically significantly higher in the group A than in the group B (p < 0.05. Conclusions. By the use of the infrared thermovision we showed that in the treatment of CRPS I both physical medicine methods were effective, but the effectiveness of laser therapy was statistically significantly higher compared to that of the interferential current therapy.

  10. Differential Efficacy of Ketamine in the Acute versus Chronic Stages of Complex Regional Pain Syndrome in Mice

    Science.gov (United States)

    Tajerian, Maral; Leu, David; Yang, Phillip; Huang, Ting Ting; Kingery, Wade S; Clark, J David

    2015-01-01

    Background Complex regional pain syndrome (CRPS) is a painful, disabling and often chronic condition, where many patients transition from an acute phase with prominent peripheral neurogenic inflammation to a chronic phase with evident central nervous system (CNS) changes. Ketamine is a centrally-acting agent believed to work through blockade of N-methyl-D-aspartate (NMDA) receptors and is being increasingly used for the treatment of refractory CRPS, although the basis for the drug’s effects and efficacy at different stages of the syndrome remain unclear. Methods We used a mouse model of CRPS (n=8–12/group) involving tibia fracture/cast immobilization to test the efficacy of ketamine (2 mg/kg/day; 7 days) or vehicle infusion during acute (3weeks [3w] post-fracture) and chronic (7w post-fracture) stages. Results Acute phase fracture mice displayed elevated limb temperature, edema and nociceptive sensitization that were not reduced by ketamine. Fracture mice treated with ketamine during the chronic phase showed reduced nociceptive sensitization that persisted beyond completion of the infusion. During this chronic phase, ketamine also reduced latent nociceptive sensitization and improved motor function at 18 weeks post-fracture. No side effects of the infusions were identified. These behavioral changes were associated with altered spinal astrocyte activation and expression of pain-related proteins including NMDA receptor 2b (NR2b), Ca2+/calmodulin-dependent protein kinase ii (CaMK2), and brain-derived neurotrophic factor (BNDF). Conclusions Collectively, these results demonstrate that ketamine is efficacious in the chronic, but not acute stages of CRPS, suggesting that the centrally-acting drug is relatively ineffective in early CRPS when peripheral mechanisms are more critical for supporting nociceptive sensitization. PMID:26492479

  11. Complete recovery from intractable complex regional pain syndrome, CRPS-type I, following anesthetic ketamine and midazolam.

    Science.gov (United States)

    Kiefer, Ralph-Thomas; Rohr, Peter; Ploppa, Annette; Altemeyer, Karl-Heinz; Schwartzman, Robert Jay

    2007-06-01

    To describe the treatment of an intractable complex regional pain syndrome I (CRPS-I) patient with anesthetic doses of ketamine supplemented with midazolam. A patient presented with a rapidly progressing contiguous spread of CRPS from a severe ligamentous wrist injury. Standard pharmacological and interventional therapy successively failed to halt the spread of CRPS from the wrist to the entire right arm. Her pain was unmanageable with all standard therapy. As a last treatment option, the patient was transferred to the intensive care unit and treated on a compassionate care basis with anesthetic doses of ketamine in gradually increasing (3-5 mg/kg/h) doses in conjunction with midazolam over a period of 5 days. On the second day of the ketamine and midazolam infusion, edema, and discoloration began to resolve and increased spontaneous movement was noted. On day 6, symptoms completely resolved and infusions were tapered. The patient emerged from anesthesia completely free of pain and associated CRPS signs and symptoms. The patient has maintained this complete remission from CRPS for 8 years now. In a patient with severe spreading and refractory CRPS, a complete and long-term remission from CRPS has been obtained utilizing ketamine and midazolam in anesthetic doses. This intensive care procedure has very serious risks but no severe complications occurred. The psychiatric side effects of ketamine were successfully managed with the concomitant use of midazolam and resolved within 1 month of treatment. This case report illustrates the effectiveness and safety of high-dose ketamine in a patient with generalized, refractory CRPS.

  12. Recommendations for a first Core Outcome Measurement set for complex regional PAin syndrome Clinical sTudies (COMPACT)

    Science.gov (United States)

    Grieve, Sharon; Perez, Roberto SGM; Birklein, Frank; Brunner, Florian; Bruehl, Stephen; Harden R, Norman; Packham, Tara; Gobeil, Francois; Haigh, Richard; Holly, Janet; Terkelsen, Astrid; Davies, Lindsay; Lewis, Jennifer; Thomassen, Ilona; Connett, Robyn; Worth, Tina; Vatine, Jean-Jacques; McCabe, Candida S

    2017-01-01

    Complex Regional Pain Syndrome (CRPS) is a persistent pain condition that remains incompletely understood and challenging to treat. Historically, a wide range of different outcome measures have been used to capture the multidimensional nature of CRPS. This has been a significant limiting factor in the advancement of our understanding of the mechanisms and management of CRPS. In 2013, an international consortium of patients, clinicians, researchers and industry representatives was established, to develop and agree on a minimum core set of standardised outcome measures for use in future CRPS clinical research, including but not limited to clinical trials within adult populations The development of a core measurement set was informed through workshops and supplementary work, using an iterative consensus process. ‘What is the clinical presentation and course of CRPS, and what factors influence it?’ was agreed as the most pertinent research question that our standardised set of patient-reported outcome measures should be selected to answer. The domains encompassing the key concepts necessary to answer the research question were agreed as: pain, disease severity, participation and physical function, emotional and psychological function, self efficacy, catastrophizing and patient's global impression of change. The final core measurement set included the optimum generic or condition-specific patient-reported questionnaire outcome measures, which captured the essence of each domain, and one clinician reported outcome measure to capture the degree of severity of CRPS. The next step is to test the feasibility and acceptability of collecting outcome measure data using the core measurement set in the CRPS population internationally. PMID:28178071

  13. Advances in translational neuropathic research: example of enantioselective pharmacokinetic-pharmacodynamic modeling of ketamine-induced pain relief in complex regional pain syndrome.

    Science.gov (United States)

    Sabia, Michael; Hirsh, Robert A; Torjman, Marc C; Wainer, Irving W; Cooper, Niti; Domsky, Richard; Goldberg, Michael E

    2011-06-01

    Historically, complex regional pain syndrome (CRPS) was poorly defined, which meant that scientists and clinicians faced much uncertainty in the study, diagnosis, and treatment of the syndrome. The problem could be attributed to a nonspecific diagnostic criteria, unknown pathophysiologic causes, and limited treatment options. The two forms of CRPS still are painful, debilitating disorders whose sufferers carry heavy emotional burdens. Current research has shown that CRPS I and CRPS II are distinctive processes, and the presence or absence of a partial nerve lesion distinguishes them apart. Ketamine has been the focus of various studies involving the treatment of CRPS; however, currently, there is incomplete data from evidence-based studies. The question as to why ketamine is effective in controlling the symptoms of a subset of patients with CRPS and not others remains to be answered. A possible explanation to this phenomenon is pharmacogenetic differences that may exist in different patient populations. This review summarizes important translational work recently published on the treatment of CRPS using ketamine. © Springer Science+Business Media, LLC 2011

  14. [Prophylactic plexus catheter treatment in operations following complex regional pain syndrome (CRPS)].

    Science.gov (United States)

    Neubrech, Florian; Pronk, Roderick Franciscus; Bigdeli, Amir Khosrow; Tapking, Christian; Kneser, Ulrich; Harhaus, Leila

    2017-08-01

    Background  This paper investigates and discusses the effect of perioperative plexus catheter treatment in former CRPS patients. Patients and Methods A retrospective matched-pair analysis was conducted on 10 CRPS patients with comparable injuries, who underwent surgery in the disease-free interval. In 10 cases, the procedure was performed with perioperative plexus catheter treatment (intervention group), whereas 10 patients did not receive perioperative plexus catheter treatment (control group). Results  In the intervention group, after a follow-up time of 105 (20-184) days after the last surgical procedure, pain intensity on the visual analogue scale (VAS; 0 to 10) was 6.4 (4-8), fingertip-to-palm distance averaged 3.2 (0-7.6) cm, active range of wrist motion was 47.5 (0-95), and grip strength was 9.2 (2.1-16.6) kg. In the control group, after a follow-up time of 129 (19-410) days since the last surgical procedure, pain intensity on the visual analogue scale was 6 (3-10), fingertip-to-palm distance averaged 2.7 (0-4.5) cm, active range of wrist-motion was 64 (0-125), and grip strength was 12.4 (0.8-23.8) kg. There was no significant difference between the groups. There was no recurrence of CRPS disease in either group after surgery. Conclusion  There is no evidence so far for perioperative plexus catheter treatment to prevent recurrence in former CRPS patients. Georg Thieme Verlag KG Stuttgart · New York.

  15. Different activation of opercular and posterior cingulate cortex (PCC) in patients with complex regional pain syndrome (CRPS I) compared with healthy controls during perception of electrically induced pain: a functional MRI study.

    Science.gov (United States)

    Freund, Wolfgang; Wunderlich, Arthur P; Stuber, Gregor; Mayer, Florian; Steffen, Peter; Mentzel, Martin; Weber, Frank; Schmitz, Bernd

    2010-05-01

    Although the etiology of complex regional pain syndrome type 1 (CRPS 1) is still debated, many arguments favor central maladaptive changes in pain processing as an important causative factor. To look for the suspected alterations, 10 patients with CRPS affecting the left hand were explored with functional magnetic resonance imaging during graded electrical painful stimulation of both hands subsequently and compared with healthy participants. Activation of the anterior insula, posterior cingulate cortex (PCC), and caudate nucleus was seen in patients during painful stimulation. Compared with controls, CRPS patients had stronger activation of the PCC during painful stimulation of the symptomatic hand. The comparison of insular/opercular activation between controls and patients with CRPS I during painful stimulation showed stronger (posterior) opercular activation in controls than in patients. Stronger PCC activation during painful stimulation may be interpreted as a correlate of motor inhibition during painful stimuli different from controls. Also, the decreased opercular activation in CRPS patients shows less sensory-discriminative processing of painful stimuli.These results show that changed cerebral pain processing in CRPS patients is less sensory-discriminative but more motor inhibition during painful stimuli. These changes are not limited to the diseased side but show generalized alterations of cerebral pain processing in chronic pain patients.

  16. Complex regional pain syndrome related dystonia : exploratory metabolomics and therapeutic studies

    NARCIS (Netherlands)

    Plas, Anton Adriaan van der

    2013-01-01

    Dit proefschrift beschrijft de resultaten van aan aantal studies naar bewegingsstoornissen en pijn bij patiënten met complex regionaal pijnsyndroom (CRPS). Ten eerste werd het effect onderzocht van intrathecaal baclofen op verschillende pijnkwaliteiten bij CRPS-patiënten, de invloed bestudeerd van

  17. Complex regional pain syndrome type I in the upper extremity - how efficient physical therapy and rehabilitation are.

    Science.gov (United States)

    Zečević Luković, Tanja; Ristić, Branko; Jovanović, Zorica; Rančić, Nemanja; Ignjatović Ristić, Dragana; Cuković, Saša

    2012-08-01

    To evaluate the effects of early started combined therapy in Complex Regional Pain Syndrome-1 (CRPS-1) on the upper extremities. The study included 36 patients in the first stadium of CRPS-1 on the upper extremities The mean age of patients was 42.6±14.6, the majority of them (26 of 36) were females. The right side of the upper extremity was affected much more then the left side. They were treated by combined therapy including analgetics, electrotherapy, magneto therapy and kinesitherapy. The average length of observation was 172.1 days (from 90 to 250 days). The average length of treatment was 91.5±42.16 days. Intensity of pain, swelling of the extremity, the change in skin coloration and cutaneous manifestations were assessed three times, at the beginning of the treatment, after 6 weeks and at the end of the treatment. The pain was registered in all patients at visit 1 (average pain intensity was 5.70 ±1.44 on 100 mm visual analogue scale), and it was progressively decreased during the treatment from 3.60±1.22 at the second visit to 0.34±0.68 at the third visit. Vasodilatation was registered in 30 (83.33%) patients and skin temperature asymmetries was found in 21 (58.33%) patients. The difference of size was detected in 30 (83.33%) patients at the first visit compared to four (11.11%) patients at the end of the treatment. There were six (16.66%) patients without swelling at the beginning compared to 26 (72.22%) at the end of the treatment (p less than 0.000). Complete healing was achieved in 32 patients (88.88%). The carefully chosen physical agents in combination with analgesic and non-steroidal anti-inflammatory drugs may benefit in patients with CRPS-1 on the upper extremity if the treatment starts as soon as possible.

  18. Role of NFkappaB in an animal model of complex regional pain syndrome-type I (CRPS-I).

    Science.gov (United States)

    de Mos, Marissa; Laferrière, André; Millecamps, Magali; Pilkington, Mercedes; Sturkenboom, Miriam C J M; Huygen, Frank J P M; Coderre, Terence J

    2009-11-01

    NFkappaB is involved in several pathogenic mechanisms that are believed to underlie the complex regional pain syndrome (CRPS), including ischemia, inflammation and sensitization. Chronic postischemia pain (CPIP) has been developed as an animal model that mimics the symptoms of CRPS-I. The possible involvement of NFkappaB in CRPS-I was studied using CPIP rats. Under sodium pentobarbital anesthesia, a tourniquet was placed around the rat left ankle joint, producing 3 hours of ischemia, followed by rapid reperfusion (IR injury). NFkappaB was measured in nuclear extracts of muscle and spinal cord tissue using ELISA. Moreover, the anti-allodynic (mechanical and cold) effect was tested for systemic, intrathecal, or intraplantar treatment with the NFkappaB inhibitor pyrrolidine dithiocarbamate (PDTC). At 2 and 48 hours after IR injury, NFkappaB was elevated in muscle and spinal cord of CPIP rats compared to shams. At 7 days, NFkappaB levels were normalized in muscle, but still elevated in spinal cord tissue. Systemic PDTC treatment relieved mechanical and cold allodynia in a dose-dependent manner, lasting for at least 3 hours. Intrathecal-but not intraplantar-administration also relieved mechanical allodynia. The results suggest that muscle and spinal NFkappaB plays a role in the pathogenesis of CPIP and potentially of human CRPS. Using the CPIP model, we demonstrate that NFkappaB is involved in the development of allodynia after a physical injury (ischemia and reperfusion) without direct nerve trauma. Since CPIP animals exhibit many features of human CRPS-I, this observation indicates a potential role for NFkappaB in human CRPS.

  19. Treatment of Patients With Complex Regional Pain Syndrome Type I With Mannitol: A Prospective, Randomized, Placebo-Controlled, Double-Blinded Study

    NARCIS (Netherlands)

    Perez, R.S.G.M.; Pragt, E.; Geurts, J.J.G.; Zuurmond, W.W.A.; Patijn, J.; van Kleef, M.

    2008-01-01

    To assess the effects of intravenous administration of the free radical scavenger mannitol 10% on complaints associated with complex regional pain syndrome Type I (CRPS I), a randomized, placebo-controlled, double-blinded trial was performed. Forty-one CRPS I patients according to the Bruehl et al

  20. Oxidative Stress in Complex Regional Pain Syndrome (CRPS): No Systemically Elevated Levels of Malondialdehyde, F2-Isoprostanes and 8OHdG in a Selected Sample of Patients

    NARCIS (Netherlands)

    Fischer, S.G.L.; Perez, R.S.G.M.; Nouta, J.; Zuurmond, W.W.A.; Scheffer, P.G.

    2013-01-01

    Exaggerated inflammation and oxidative stress are involved in the pathogenesis of Complex Regional Pain Syndrome (CRPS). However, studies assessing markers for oxidative stress in CRPS patients are limited. In this study, markers for lipid peroxidation (malondialdehyde and F2-isoprostanes) and DNA

  1. Human papillomavirus vaccines, complex regional pain syndrome, postural orthostatic tachycardia syndrome, and autonomic dysfunction - a review of the regulatory evidence from the European Medicines Agency

    DEFF Research Database (Denmark)

    Jefferson, Tom; Jørgensen, Lars

    2017-01-01

    Recent concerns about a possible association between exposure of young women to human papillomavirus (HPV) vaccines and two "dysautonomic syndromes" (a collection of signs and symptoms thought to be caused by autoimmunity) - complex regional pain syndrome (CRPS) and postural orthostatic tachycardia...

  2. Development of a symptoms questionnaire for complex regional pain syndrome and potentially related illnesses: the Trauma Related Neuronal Dysfunction Symptoms Inventory

    NARCIS (Netherlands)

    Collins, S.; van Hilten, J.J.; Marinus, J.J.; Zuurmond, W.W.A.; de Lange, J.J.; Perez, R.S.G.M.

    2008-01-01

    Collins S, van Hilten JJ, Marinus J, Zuurmond WW, de Lange JJ, Perez RS. Development of a symptoms questionnaire for complex regional pain syndrome and potentially related illnesses: the Trauma Related Neuronal Dysfunction Symptoms Inventory. Objective: To develop a questionnaire to evaluate

  3. Usefulness of asymmetry score on quantitative three-phase bone scintigraphy in the evaluation of complex regional pain syndrome

    International Nuclear Information System (INIS)

    Sampath, Santhosh; Mittal, Bhagwant Rai; Arun, Sasikumar; Sood, Ashwani; Bhattacharya, Anish; Sharma, Aman

    2013-01-01

    Complex regional pain syndrome (CRPS) is primarily a clinical diagnosis. Diagnostic imaging in CRPS can be used, especially to exclude other disorders. The sensitivity and specificity of three phase bone scintigraphy (TPBS) for the diagnosis of CRPS is variable throughout the literature. To establish a simple and effective quantitative approach to help in the diagnosis of CRPS by TPBS. TPBS done in patients (n = 68) with suspected CRPS was analyzed retrospectively. They were classified into bone scan positive group (BSP), bone scan negative group (BSN) and non-CRPS group based on diffusely increased periarticular uptake, symmetrical uptake, and focal uptake respectively. Asymmetry score (AS) was also measured between the affected and unaffected side. 16 patients showed focal uptake, 37 were in BSP group with mean AS score of 1.57 ± 0.5 and 15 were in BSN group with mean AS score of 1.01 ± 0.05. The mean AS was significantly different (P < 0.0001). AS of 1.06 had sensitivity and specificity of 96.43% and 100% respectively (P = 0.0001). There was a trend of negative correlation between the AS and the duration, r = −0.21; however, it was not statistically significant (P = 0.28). TPBS should be considered in the evaluation of CRPS to rule out patients who have focal involvement, not diagnostic of CRPS (~24% in this study). Quantitative AS of 1.06 can be included to support visual interpretation in the delayed phase

  4. Establishing the characteristics for patients with chronic Complex Regional Pain Syndrome: the value of the CRPS-UK Registry.

    Science.gov (United States)

    Shenker, Nicholas; Goebel, Andreas; Rockett, Mark; Batchelor, James; Jones, Gareth T; Parker, Richard; de C Williams, Amanda C; McCabe, Candida

    2015-05-01

    The long-term prognosis of patients with Complex Regional Pain Syndrome (CRPS) is unknown with no reported prospective studies from the United Kingdom longer than 18 months. The CRPS-UK Network aims to study this by use of a Registry. The aims of this article are, to outline the CRPS-UK Registry, assess the validity of the data and to describe the characteristics of a sample of the UK CRPS population. A web-based CRPS-UK Registry was developed and made accessible to centres experienced in diagnosing and managing patients with CRPS. Pragmatic annual follow-up questions were agreed. Up until July 2013, the Registry has recruited 240 patients. A blinded, validation study of 20 consecutive patients from two centres (10 each) demonstrated 95.6% completion and 99.4% accuracy of a random sample of the recorded data. These patients had chronic disease (median duration: 29 months); 72.5% were female (2.6:1), with a mean age at symptoms onset of 43 years, and were left-handed more than expected (21.8% versus 10% in the general population). Patients reported a delayed diagnosis, with the median time between symptom onset and diagnosis of 6 months. In all, 30 patients (12.5%) had multiple limb involvement and (83.3%) had a contiguous spread of CRPS. CRPS-UK Registry is a validated method for actively recruiting well-characterised patients with CRPS to provide further information on the long-term outcome.

  5. [Spinal cord stimulation (SCS) as a treatment for the spread phenomenon related to complex regional pain syndrome type- I (CRPS-I )].

    Science.gov (United States)

    Goto, Shinichi; Taira, Takaomi; Hori, Tomokatsu

    2009-09-01

    The authors describe an experience of spinal cord stimulation (SCS) in a 30-year-old woman who developed complex regional pain syndrome type-I (CRPS-I) with spread phenomenon. She had received lumbar SCS under a diagnosis of CRPS-I in her left leg for 8 years. She had refractory pain in her right arm for the recent two years. There was no new lesion explaining her refractory pain on physical or radiological examination. Thus, the pain in her right upper arm was considered as spread phenomenon of CRPS-I. Test stimulation with cervical epidural spinal electrode showed good results and the pulse generator was implanted. It is suggested that the symptom of CRPS-I involving spread phenomenon was possibly due to a cortical reorganization. But a certain effect of SCS may be contributing to the favorable results of test stimulation for the treatment of CRPS-I with spread phenomenon in this case.

  6. An atypical case of postsurgical complex regional pain syndrome in a patient having nonhealing varicose venous ulcer treated by lumbar sympathectomy

    Directory of Open Access Journals (Sweden)

    Kailash Kothari

    2017-01-01

    Full Text Available Complex regional pain syndrome (CRPS of the lower limb is a relatively uncommon entity as compared to CRPS of the upper extremity. Literature search has revealed only 2 retrospective case series and a single case report of lower extremity CRPS type I from 1975 to 2014 on Pubmed, isolated cases of CRPS type I of lower extremity have also been reported following knee surgeries and arthroscopies. This report presents a case of lower limb CRPS type I, following surgery for varicose vein ulcer. Pain was not relieved with medications. Diagnostic lumbar sympathectomy was done and patient had tremendous relief of pain following that, proving sympathetic mediated pain of the involved limb.

  7. Relationship Between HbA1c and Complex Regional Pain Syndrome in Stroke Patients With Type 2 Diabetes Mellitus

    Science.gov (United States)

    2016-01-01

    Objective To investigate the relationship between glycosylated hemoglobin A (HbA1c) and complex regional pain syndrome (CRPS) in stroke patients with type 2 diabetes mellitus (T2DM). Methods A retrospective chart review was performed of stroke patients from January 2012 to December 2013. We reviewed 331 patients and included 200 in the analysis. We divided them into CRPS and non-CRPS groups and compared them by age, gender, stroke lesion, cause of stroke, duration of T2DM, HbA1c (%), National Institutes of Health Stroke Scale score, affected shoulder flexor muscle strength, Fugl-Meyer Assessment score, motricity index, Functional Independence Measure, Korean version of Modified Barthel Index, blood glucose level on admission day, duration from stroke onset to HbA1c check, and duration from stroke onset to three-phase bone scan for CRPS diagnosis. Thereafter, we classified the patients into five groups by HbA1c level (group 1, 5.0%–5.9%; group 2, 6.0%–6.9%; group 3, 7.0%–7.9%; group 4, 8.0%–8.9%; and group 5, 9.0%–9.9%) and we investigated the difference in CRPS prevalence between the two groups. Results Of the 200 patients, 108 were in the CRPS group and 92 were in the non-CRPS group. There were significant differences in HbA1c (pCRPS prevalence (pCRPS prevalence and thus that uncontrolled blood glucose can affect CRPS occurrence in stroke patients with diabetes. PMID:27847707

  8. Diagnostic Performance of Three Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria

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    Kwon, Hyun Woo; Paeng, Jin Chul; Nahm, Francins Sahngun; Kim, Seog Gyun; Zehra, Tanzeel; Oh, So Won; Lee, Hyo Sang; Kang, Keon Wook; Chung, June Key; Lee, Myung Chul; Lee, Dong Soo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    Although the three phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type 1 (CRPS 1), there is some controversy regarding the TPBS image criteria for CRPS 1. In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria. The study included 140 patients with suspected CRPS 1 (CRPS 1, n=79; non CRPS, n=61; mean age 39{+-}15 years) who underwent TPBS. The clinical diagnostic criteria for CRPS 1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS (TI{sup eventscan)}. Quantitative analysis for lesion to contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance. Both increased and decreased periarticular DU were significant image findings for CRPS 1 (CRPS 1 positive rate=73% in the increased DU group, 75% in the decreased DU group). The TI{sup eventscand}id not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS 1 and diagnostic performance was significantly improved in the increased DU group (area under the curve=0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS 1 were 80% and 72%, respectively. Optimally modified TPBS image criteria for CRPS 1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS 1 even with the most recent consensus clinical diagnostic criteria.

  9. The association between ACE inhibitors and the complex regional pain syndrome: Suggestions for a neuro-inflammatory pathogenesis of CRPS.

    Science.gov (United States)

    de Mos, M; Huygen, F J P M; Stricker, B H Ch; Dieleman, J P; Sturkenboom, M C J M

    2009-04-01

    Antihypertensive drugs interact with mediators that are also involved in complex regional pain syndrome (CRPS), such a neuropeptides, adrenergic receptors, and vascular tone modulators. Therefore, we aimed to study the association between the use of antihypertensive drugs and CRPS onset. We conducted a population-based case-control study in the Integrated Primary Care Information (IPCI) database in the Netherlands. Cases were identified from electronic records (1996-2005) and included if they were confirmed during an expert visit (using IASP criteria), or if they had been diagnosed by a medical specialist. Up to four controls per cases were selected, matched on gender, age, calendar time, and injury. Exposure to angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, beta-blockers, calcium channel blockers, and diuretics was assessed from the automated prescription records. Data were analyzed using multivariate conditional logistic regression. A total of 186 cases were matched to 697 controls (102 confirmed during an expert visit plus 84 with a specialist diagnosis). Current use of ACE inhibitors was associated with an increased risk of CRPS (OR(adjusted): 2.7, 95% CI: 1.1-6.8). The association was stronger if ACE inhibitors were used for a longer time period (OR(adjusted): 3.0, 95% CI: 1.1-8.1) and in higher dosages (OR(adjusted): 4.3, 95% CI: 1.4-13.7). None of the other antihypertensive drug classes was significantly associated with CRPS. We conclude that ACE inhibitor use is associated with CRPS onset and hypothesize that ACE inhibitors influence the neuro-inflammatory mechanisms that underlie CRPS by their interaction with the catabolism of substance P and bradykinin.

  10. Diagnostic Performance of Three Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria

    International Nuclear Information System (INIS)

    Kwon, Hyun Woo; Paeng, Jin Chul; Nahm, Francins Sahngun; Kim, Seog Gyun; Zehra, Tanzeel; Oh, So Won; Lee, Hyo Sang; Kang, Keon Wook; Chung, June Key; Lee, Myung Chul; Lee, Dong Soo

    2011-01-01

    Although the three phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type 1 (CRPS 1), there is some controversy regarding the TPBS image criteria for CRPS 1. In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria. The study included 140 patients with suspected CRPS 1 (CRPS 1, n=79; non CRPS, n=61; mean age 39±15 years) who underwent TPBS. The clinical diagnostic criteria for CRPS 1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS (TI eventscan) . Quantitative analysis for lesion to contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance. Both increased and decreased periarticular DU were significant image findings for CRPS 1 (CRPS 1 positive rate=73% in the increased DU group, 75% in the decreased DU group). The TI eventscand id not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS 1 and diagnostic performance was significantly improved in the increased DU group (area under the curve=0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS 1 were 80% and 72%, respectively. Optimally modified TPBS image criteria for CRPS 1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS 1 even with the most recent consensus clinical diagnostic criteria.

  11. Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome (CRPS) Recurrence after Amputation for CRPS, and Failure of Conventional Spinal Cord Stimulation.

    Science.gov (United States)

    Goebel, Andreas; Lewis, Sarah; Phillip, Rhodri; Sharma, Manohar

    2018-01-01

    Limb amputation is sometimes being performed in long-standing complex regional pain syndrome (CRPS), although little evidence is available guiding management decisions, including how CRPS recurrence should be managed. This report details the management of a young soldier with CRPS recurrence 2 years after midtibial amputation for CRPS. Conventional spinal cord stimulation did not achieve paraesthetic coverage, or pain relief in the stump, whereas L4 dorsal root ganglion stimulation achieved both coverage and initially modest pain relief, and over time, substantial pain relief. Current evidence does not support the use of amputation to improve either pain or function in CRPS. Before a decision is made, in exceptional cases, about referral for amputation, dorsal root ganglion stimulation should be considered as a potentially effective treatment, even where conventional spinal cord stimulator treatment has failed to achieve reliable paraesthetic cover. Furthermore, this treatment may provide pain relief in those patients with CRPS recurrence in the stump after amputation. © 2017 World Institute of Pain.

  12. Ultrasound-guided stellate ganglion blocks combined with pharmacological and occupational therapy in Complex Regional Pain Syndrome (CRPS): a pilot case series ad interim.

    Science.gov (United States)

    Wei, Karin; Feldmann, Robert E; Brascher, Anne-Kathrin; Benrath, Justus

    2014-12-01

    This preliminary and retrospective pilot case series examines a treatment concept consisting of ultrasound-guided stellate ganglion blocks (SGBs) combined with pharmacological and occupational therapy in patients with complex regional pain syndrome (CRPS) of the hand. Efficacy of combined treatment concepts and safety of ultrasound-guided SGB have not been sufficiently investigated yet. A total number of 156 blocks were evaluated in 16 patients with CRPS in a retrospective analysis. All patients received pharmacotherapy and a standard regimen of occupational therapy offered simultaneously to the SGBs. Changes in both spontaneous and evoked pain levels were assessed by numerical pain rating score before and after the last blockade of a series. Side effects were documented. The overall mean pain reduction was 63.2% regarding spontaneous and 45.3% regarding evoked pain. Mild complications, such as hoarseness or dysphagia, occurred in 13.5% of the blocks (21 SGBs). Serious complications, such as plexus paresis or accidental puncture of vessels or other structures, did not occur. Time between symptom onset and start of treatment did not affect the extent of pain reduction. The combination of ultrasound-guided SGB and simultaneous pharmacological and occupational therapy showed encouraging treatment results under conditions of this pilot case series. Assessment of efficacy of this combined treatment concept and safety of ultrasound-guided SGB require further prospective clinical studies with larger number of participants. Wiley Periodicals, Inc.

  13. Immediate Return to Ambulation and Improved Functional Capacity for Rehabilitation in Complex Regional Pain Syndrome following Early Implantation of a Spinal Cord Stimulation System

    Directory of Open Access Journals (Sweden)

    Brandon Jesse Goff

    2014-01-01

    Full Text Available Complex regional pain syndrome (CRPS is a neuropathic pain condition that is characterized by vasomotor, sensory, sudomotor, and motor symptoms. Spinal cord stimulation (SCS has been successfully utilized for the treatment of pain refractory to conventional therapies. We present a case of a previously highly functioning 54-year-old female who developed a rarely reported case of idiopathic CRPS of the right ankle which spontaneously occurred four months after an uncomplicated anterior cervical disc fusion. This condition resulted in severe pain and functional impairment that was unresponsive to pharmacological management. The patient’s rehabilitation was severely stymied by her excruciating pain. However, with the initiation of spinal cord stimulation, her pain was adequately controlled allowing for progression to full unassisted ambulation, advancing functional capacity, and improving quality of life. This case report supports the concept that rapid progression to neuromodulation, rather than delays that occur due to attempts at serial sympathetic blocks, may better control symptoms leading allowing for a more meaningful recovery.

  14. Systemic inflammatory mediators in post-traumatic complex regional pain syndrome (CRPS I) - longitudinal investigations and differences to control groups.

    Science.gov (United States)

    Schinkel, Christian; Scherens, A; Köller, M; Roellecke, G; Muhr, G; Maier, C

    2009-03-17

    The Complex Regional Pain Syndrome I (CRPS I) is a disease that might affect an extremity after trauma or operation. The pathogenesis remains yet unclear. It has clinical signs of severe local inflammation as a result of an exaggerated inflammatory response but neurogenic dysregulation also contributes to it. Some studies investigated the role inflammatory mediators and cytokines; however, few longitudinal studies exist and control groups except healthy controls were not investigated yet. To get further insights into the role of systemic inflammatory mediators in CRPS I, we investigated a variety of pro-, anti-, or neuro-inflammatory mediators such as C-Reactive Protein (CRP), White Blood Cell Count (WBC), Interleukins 4, 6, 8, 10, 11, 12 (p70), Interferon gamma, Tumor-Necrosis-Factor alpha (TNF-a) and its soluble Receptors I/II, soluble Selectins (E,L,P), Substance-P (SP), and Calcitonin Gene-Related Peptide (CGRP) at different time points in venous blood from patients with acute (AC) and chronic (CC) CRPS I, patients with forearm fractures (FR), with neuralgia (NE), and from healthy volunteers (C). No significant changes for serum parameters investigated in CRPS compared to control groups were found except for CC/C (CGRP p = 0.007), FR/C (CGRP p = 0.048) and AC/CC (IL-12 p = 0.02; TNFRI/II p = 0.01; SP p = 0.049). High interindividual variations were observed. No intra- or interindividual correlation of parameters with clinical course (e.g. chronification) or outcome was detectable. Although clinically appearing as inflammation in acute stages, local rather than systemic inflammatory responses seem to be relevant in CRPS. Variable results from different studies might be explained by unpredictable intermittent release of mediators from local inflammatory processes into the blood combined with high interindividual variabilities. A clinically relevant difference to various control groups was not notable in this pilot study. Determination of systemic inflammatory

  15. Systemic inflammatory mediators in post-traumatic Complex Regional Pain Syndrome (CRPS I - longitudinal investigations and differences to control groups

    Directory of Open Access Journals (Sweden)

    Schinkel Ch

    2009-03-01

    Full Text Available Abstract Objectives The Complex Regional Pain Syndrome I (CRPS I is a disease that might affect an extremity after trauma or operation. The pathogenesis remains yet unclear. It has clinical signs of severe local inflammation as a result of an exaggerated inflammatory response but neurogenic dysregulation also contributes to it. Some studies investigated the role inflammatory mediators and cytokines; however, few longitudinal studies exist and control groups except healthy controls were not investigated yet. Methods To get further insights into the role of systemic inflammatory mediators in CRPS I, we investigated a variety of pro-, anti-, or neuro-inflammatory mediators such as C-Reactive Protein (CRP, White Blood Cell Count (WBC, Interleukins 4, 6, 8, 10, 11, 12 (p70, Interferon gamma, Tumor-Necrosis-Factor alpha (TNF-α and its soluble Receptors I/II, soluble Selectins (E, L, P, Substance-P (SP, and Calcitonin Gene-Related Peptide (CGRP at different time points in venous blood from patients with acute (AC and chronic (CC CRPS I, patients with forearm fractures (FR, with neuralgia (NE, and from healthy volunteers (C. Results No significant changes for serum parameters investigated in CRPS compared to control groups were found except for CC/C (CGRP p = 0.007, FR/C (CGRP p = 0.048 and AC/CC (IL-12 p = 0.02; TNFRI/II p = 0.01; SP p = 0.049. High interindividual variations were observed. No intra-or interindividual correlation of parameters with clinical course (e.g. chronification or outcome was detectable. Conclusion Although clinically appearing as inflammation in acute stages, local rather than systemic inflammatory responses seem to be relevant in CRPS. Variable results from different studies might be explained by unpredictable intermittent release of mediators from local inflammatory processes into the blood combined with high interindividual variabilities. A clinically relevant difference to various control groups was not notable in this

  16. Utilization of manual therapy to the lumbar spine in conjunction with traditional conservative care for individuals with bilateral lower extremity complex regional pain syndrome: A case series.

    Science.gov (United States)

    Walston, Zachary; Hernandez, Luis; Yake, Dale

    2018-06-06

    Conservative therapies for complex regional pain syndrome (CRPS) have traditionally focused on exercise and desensitization techniques targeted at the involved extremity. The primary purpose of this case series is to report on the potential benefit of utilizing manual therapy to the lumbar spine in conjunction with traditional conservative care when treating patients with lower extremity CRPS. Two patients with the diagnosis of lower extremity CRPS were treated with manual therapy to the lumbar spine in conjunction with education, exercise, desensitization, and soft tissue techniques for the extremity. Patient 1 received 13 sessions over 6 weeks resulting in a 34-point improvement in oswestry disability index (ODI) and 35-point improvement in lower extremity functional scale (LEFS). Patient 2 received 21 sessions over 12 weeks resulting in a 28-point improvement in ODI and a 41-point improvement in LEFS. Both patients exhibited reductions in pain and clinically meaningful improvements in function. Manual therapies when applied to the lumbar spine in these patients as part of a comprehensive treatment plan resulted in improved spinal mobility, decreased pain, and reduction is distal referred symptoms. Although one cannot infer a cause and effect relationship from a case series, this report identifies meaningful clinical outcomes potentially associated with manual physical therapy to the lumbar spine for two patients with complex regional pain syndrome type 1.

  17. Fear of movement modulates the feedforward motor control of the affected limb in complex regional pain syndrome (CRPS): A single-case study.

    Science.gov (United States)

    Osumi, Michihiro; Sumitani, Masahiko; Otake, Yuko; Morioka, Shu

    2018-01-01

    Pain-related fear can exacerbate physical disability and pathological pain in complex regional pain syndrome (CRPS) patients. We conducted a kinematic analysis of grasping movements with a pediatric patient suffering from CRPS in an upper limb to investigate how pain-related fear affects motor control. Using a three-dimensional measurement system, we recorded the patient's movement while grasping three vertical bars of different diameters (thin, middle, thick) with the affected and intact hands. We analyzed the maximum grasp distance between the thumb and the index finger (MGD), the peak velocity of the grasp movement (PV), and the time required for the finger opening phase (TOP) and closing phase (TCP). Consequently, the MGD and PV of grasp movements in the affected hand were significantly smaller than those of the intact hand when grasping the middle and thick bars. This might reflect pain-related fear against visual information of the target size which evokes sensation of difficulty in opening fingers widely to grasp the middle and thick bars. Although MGD and PV increased with target size, the TOP was longer in the affected hand when grasping the thick bar. These findings indicate that pain-related fear impairs motor commands that are sent to the musculoskeletal system, subsequently disrupting executed movements and their sensory feedback. Using kinematic analysis, we objectively demonstrated that pain-related fear affects the process of sending motor commands towards the musculoskeletal system in the CRPS-affected hand, providing a possible explanatory model of pathological pain. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Complex regional pain syndrome (CRPS) impairs visuospatial perception,whereas post-herpetic neuralgia does not: possible implications for supraspinal mechanism of CRPS.

    Science.gov (United States)

    Uematsu, Hironobu; Sumitani, Masahiko; Yozu, Arito; Otake, Yuko; Shibata, Masahiko; Mashimo, Takashi; Miyauchi, Satoru

    2009-11-01

    Complex regional pain syndrome (CRPS) patients show impaired visuospatial perception in the dark, as compared to normal patients with acute nociceptive pain. The purpose of this study is 2-fold: (i) to ascertain whether this distorted visuospatial perception is related to the chronicity of pain, and (ii) to analyse visuospatial perception of CRPS in comparison with another neuropathic pain condition. We evaluated visual subjective body-midline (vSM) representation in 27 patients with post-herpetic neuralgia (PHN) and 22 with CRPS under light and dark conditions. A red laser dot was projected onto a screen and moved horizontally towards the sagittal plane of the objective body-midline (OM). Each participant was asked to direct the dot to a position where it crossed their vSM. The distance between the vSM and OM was analysed to determine how and in which direction the vSM deviated. Under light condition, all vSM judgments approximately matched the OM. However, in the dark, CRPS patients, but not PHN patients, showed a shifted vSM towards the affected side. We demonstrated that chronic pain does not always impair visuospatial perception. The aetiology of PHN is limited to the peripheral nervous system, whereas the distorted visuospatial perception suggests a supraspinal aetiology of CRPS.

  19. Complex Regional Pain Syndrome (CRPS type-1) in an Adolescent Following Extravasation of Dextrose Containing Fluid-an Underdiagnosed Case.

    Science.gov (United States)

    Subedi, Asish; Bhattarai, Balkrishna; Biswas, Binay K; Khatiwada, Sindhu

    2011-06-01

    Due to its complex pathophysiology and wide spectrum of clinical manifestations, the diagnosis of CRPS is often missed in the early stage by primary care physicians. After being treated by a primary care physician for 5 months for chronic cellulitis, a 16-year-old girl was referred to our hospital with features of type-1 CRPS of the right upper extremity. Inability to diagnose early caused prolonged suffering to the girl with all the consequence of CRPS. The patient responded well with marked functional recovery from multimodal therapy. Ability to distinguish CRPS from other pain conditions, referral for specialty care at the appropriate time and full awareness of this condition and its clinical features among various healthcare professionals are essential in reducing patient suffering and stopping its progression towards difficult-to-treat situations.

  20. Adolescents' experience of complex persistent pain.

    Science.gov (United States)

    Sørensen, Kari; Christiansen, Bjørg

    2017-04-01

    Persistent (chronic) pain is a common phenomenon in adolescents. When young people are referred to a pain clinic, they usually have amplified pain signals, with pain syndromes of unconfirmed ethology, such as fibromyalgia and complex regional pain syndrome (CRPS). Pain is complex and seems to be related to a combination of illness, injury, psychological distress, and environmental factors. These young people are found to have higher levels of distress, anxiety, sleep disturbance, and lower mood than their peers and may be in danger of entering adulthood with mental and physical problems. In order to understand the complexity of persistent pain in adolescents, there seems to be a need for further qualitative research into their lived experiences. The aim of this study was to explore adolescents' experiences of complex persistent pain and its impact on everyday life. The study has an exploratory design with individual in-depth interviews with six youths aged 12-19, recruited from a pain clinic at a main referral hospital in Norway. A narrative approach allowed the informants to give voice to their experiences concerning complex persistent pain. A hermeneutic analysis was used, where the research question was the basis for a reflective interpretation. Three main themes were identified: (1) a life with pain and unpleasant bodily expressions; (2) an altered emotional wellbeing; and (3) the struggle to keep up with everyday life. The pain was experienced as extremely strong, emerging from a minor injury or without any obvious causation, and not always being recognised by healthcare providers. The pain intensity increased as the suffering got worse, and the sensation was hard to describe with words. Parts of their body could change in appearance, and some described having pain-attacks or fainting. The feeling of anxiety was strongly connected to the pain. Despair and uncertainty contributed to physical disability, major sleep problems, school absence, and withdrawal from

  1. Autonomic components of Complex Regional Pain Syndrome (CRPS) are favourably affected by Electrical Twitch-Obtaining Intramuscular Stimulation (ETOIMS): effects on blood pressure and heart rate.

    Science.gov (United States)

    Chu, Jennifer; Bruyninckx, Frans; Neuhauser, Duncan V

    2017-07-01

    Favourable pain relief results on evoking autonomous twitches at myofascial trigger points with Electrical Twitch Obtaining Intramuscular Stimulation (ETOIMS). To document autonomic nervous system (ANS) dysfunction in Complex Regional Pain Syndrome (CRPS) from blood pressure (BP) and pulse/heart rate changes with ETOIMS. A patient with persistent pain regularly received serial ETOIMS sessions of 60, 90, 120 or ≥150 min over 24 months. Outcome measures include BP: systolic, diastolic, pulse pressure and pulse/heart rate, pre-session/immediate-post-session summed differences (SDPPP index), and pain reduction. His results were compared with that of two other patients and one normal control. Each individual represented the following maximal elicitable twitch forces (TWF) graded 1-5: maximum TWF2: control subject; maximum TWF3: CRPS patient with suspected ANS dysfunction; and maximum TWF4 and TWF5: two patients with respective slow-fatigue and fast-fatigue twitches who during ETOIMS had autonomous twitching at local and remote myotomes simultaneously from denervation supersensitivity. ETOIMS results between TWFs were compared using one-way analysis of variance test. The patients showed immediate significant pain reduction, BP and pulse/heart rate changes/reduction(s) except for diastolic BP in the TWF5 patient. TWF2 control subject had diastolic BP reduction with ETOIMS but not with rest. Linear regression showed TWF grade to be the most significant variable in pain reduction, more so than the number of treatments, session duration and treatment interval. TWF grade was the most important variable in significantly reducing outcome measures, especially pulse/heart rate. Unlike others, the TWF3 patient had distinctive reductions in SDPPP index. Measuring BP and pulse/heart rate is clinically practical for alerting ANS dysfunction maintained CRPS. SDPPP index (≥26) and pulse/heart rate (≥8) reductions with almost every ETOIMS treatment, plus inability to evoke

  2. Effects of Simvastatin Beyond Dyslipidemia: Exploring Its Antinociceptive Action in an Animal Model of Complex Regional Pain Syndrome-Type I

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    Graziela Vieira

    2017-09-01

    Full Text Available Simvastatin is a lipid-lowering agent that blocks the production of cholesterol through inhibition of 3-hydroxy-methyl-glutaryl coenzyme A (HMG-CoA reductase. In addition, recent evidence has suggested its anti-inflammatory and antinociceptive actions during inflammatory and pain disorders. Herein, we investigated the effects of simvastatin in an animal model of complex regional pain syndrome-type I, and its underlying mechanisms. Chronic post-ischemia pain (CPIP was induced by ischemia and reperfusion (IR injury of the left hind paw. Our findings showed that simvastatin inhibited mechanical hyperalgesia induced by CPIP model in single and repeated treatment schedules, respectively; however simvastatin did not alter inflammatory signs during CPIP model. The mechanisms underlying those actions are related to modulation of transient receptor potential (TRP channels, especially TRMP8. Moreover, simvastatin oral treatment was able to reduce the nociception induced by acidified saline [an acid-sensing ion channels (ASICs activator] and bradykinin (BK stimulus, but not by TRPA1, TRPV1 or prostaglandin-E2 (PGE2. Relevantly, the antinociceptive effects of simvastatin did not seem to be associated with modulation of the descending pain circuits, especially noradrenergic, serotoninergic and dopaminergic systems. These results indicate that simvastatin consistently inhibits mechanical hyperalgesia during neuropathic and inflammatory disorders, possibly by modulating the ascending pain signaling (TRPM8/ASIC/BK pathways expressed in the primary sensory neuron. Thus, simvastatin open-up new standpoint in the development of innovative analgesic drugs for treatment of persistent pain, including CRPS-I.

  3. A curative treatment option for Complex Regional Pain Syndrome (CRPS) Type I: dorsal root entry zone operation (report of two cases).

    Science.gov (United States)

    Kanpolat, Yucel; Al-Beyati, Eyyub; Ugur, Hasan Caglar; Akpinar, Gokhan; Kahilogullari, Gokmen; Bozkurt, Melih

    2014-01-01

    Complex Regional Pain Syndrome Type I (CRPS-I) is a debated health problem concerning its pathophysiology and treatment strategies. A 12-year-old boy and a 35-year-old woman were diagnosed with CRPS-I at different times. They had previously undergone various types of interventions with no success. After one year of follow-up and observation, DREZ lesioning operation was performed. Afterwards, both cases had transient lower extremity ataxia. The first case was followed for 60 months with no recurrence and total cure. The second case was pain-free until the 6th month, when she required psychological support; she was followed for 33 months with partial satisfactory outcome. Although not a first-line option, DREZ lesioning procedure can be chosen and may be a curative option in selected cases of CRPS-I who are unresponsive to conventional therapies.

  4. Pulsed Radiofrequency of Dorsal Root Ganglia for the Treatment of Complex Regional Pain Syndrome in an Adolescent with Poliomyelitis Sequel: A Case Report.

    Science.gov (United States)

    Apiliogullari, Seza; Aydin, Bahattin Kerem; Onal, Ozkan; Kirac, Yunus; Celik, Jale Bengi

    2015-07-01

    Complex regional pain syndrome (CRPS) is a painful and disabling syndrome in which the patient presents with neuropathic pain, edema, or vasomotor or pseudomotor abnormalities that are often refractory to treatment. Polio paralysis is caused by the damage or destruction of motor neurons in the spine, which lead to corresponding muscle paralysis. This report is a case report on the application of a pulsed radiofrequency (PRF) current to dorsal root ganglia (DRG) for the treatment of CRPS type 1 in an adolescent patient. Single case report. Selcuk University Hospital. A 16-year-old girl who suffered from CRPS type 1 secondary to surgeries for the sequelae of poliomyelitis. PRF current application to the lumbar 4 and lumbar 5 DRG. Pain reduction. The patient had complete resolution of her symptoms, which was maintained at a 6-month follow-up. This case illustrates that PRF applied to lumbar 4 and lumbar 5 DRG may play a significant role in CRPS type 1 management after the surgical treatment of poliomyelitis sequelae in adolescent patients. Further randomized, controlled studies are needed to support this argument. Wiley Periodicals, Inc.

  5. Complex Regional Pain Syndrome type I of the upper limb - treatment based on Stress Loading Program: a case study

    Directory of Open Access Journals (Sweden)

    Aline Sarturi Ponte

    2015-03-01

    Full Text Available The daily life of an individual suffering from Complex Regional Pain Syndrome type I (CPRS I becomes limited, because this syndrome causes signs and symptoms located in the affected limb, and may occur in other parts. From this premise, this study aims to present the contributions of Occupational Therapy and the Rehabilitation Stress Loading Program for a subject with CRPS I in the upper limb, attended by the Group of Pain from the University Hospital of Santa Maria (HUSM, Rio Grande do Sul state. This research is characterized as a case study, experimental, which deals with pre and post occupational therapy intervention. The instruments used for data collection were the protocols of Disabilities of the Arm, Shoulder and Hand (DASH, the International Classification of Disability, Functioning and Health (ICF, the Canadian Occupational Performance Measure (COPM, the Visual Analogue Scale, and goniometry (EVA. After assessment, the subject was exposed to the treatment of compressive active resistive exercises; after this treatment was completed, the subject was reassessed. It was observed that the treatment applied has contributed to the reduction of the pain and to the improvement in the Range of Motion (ROM of the subject. The use of the stress protocol and active compression contributed significantly to the reduction of pain, ADM gain and occupational performance improvement.

  6. Risk Factors for Post-treatment Complex Regional Pain Syndrome (CRPS): An Analysis of 647 Cases of CRPS from the Danish Patient Compensation Association.

    Science.gov (United States)

    Petersen, Pelle B; Mikkelsen, Kim L; Lauritzen, Jes B; Krogsgaard, Michael R

    2018-03-01

    Complex regional pain syndrome is a challenging condition that includes a broad spectrum of sensory, autonomic, and motor features predominantly in extremities recovering from a trauma. Few large-scale studies have addressed occurrence of and factors associated with complex regional pain syndrome (CRPS) following orthopedic treatment. The present study aimed to identify factors associated with post-treatment development of CRPS. Using the Danish Patient Compensation Association's database, we identified 647 patients claiming post-treatment CRPS between 1992 and 2015. Age, gender, initial diagnosis, treatment, and amount of compensation were extracted. Multivariate logistic regressions were performed to identify variables associated with approval of the claim. For carpal tunnel syndrome (CTS) patients, we registered whether symptoms were bilateral or unilateral and if neurophysiology prior to treatment was pathologic. The following ratios were found: women:men was 4:1, primary diagnosis to the upper limb:lower limb was 2.5:1, and surgical:nonsurgical treatment was 3:1. Mean age was 47.5 ± 13.7 years, and no intergender difference was detected. Antebrachial fracture (23%) and CTS (9%) were the most common primary conditions. Surgical treatment was associated with approval of the claim (odds ratio 3.5, 95% confidence interval 2.3 to 5.3; P CRPS patients. In CTS patients developing CRPS, normal neurophysiological examination findings were common, and it could be suspected that these patients were suffering from an pre-clinical stage of CRPS, not CTS. © 2017 World Institute of Pain.

  7. CT-guided stellate ganglion blockade vs. radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb

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    Kastler, Adrian [University Hospital CHU Gabriel Montpied, Radiology Department, Clermont-Ferrand (France); Franche Comte University, I4S Laboratory-EA 4268-IFR 133, Besancon (France); CHU Clermont-Ferrand, Hopital Gabriel Montpied, Clermont-Ferrand (France); Aubry, Sebastien; Kastler, Bruno [University Hospital CHU Jean Minjoz, Radiology and Interventional Pain Unit, Besancon (France); Franche Comte University, I4S Laboratory-EA 4268-IFR 133, Besancon (France); Sailley, Nicolas; Michalakis, Demosthene [University Hospital CHU Jean Minjoz, Radiology and Interventional Pain Unit, Besancon (France); Siliman, Gaye [University Hospital CHU St Jacques, Clinical Investigation Center, Besancon (France); Gory, Guillaume [Franche Comte University, I4S Laboratory-EA 4268-IFR 133, Besancon (France); Lajoie, Jean-Louis [University Hospital CHU Jean Minjoz, Pain evaluation and Management Unit, Besancon (France)

    2013-05-15

    To describe and evaluate the feasibility and efficacy of CT-guided radiofrequency neurolysis (RFN) vs. local blockade of the stellate ganglion in the management of chronic refractory type I complex regional pain syndrome (CRPS) of the upper limb. Sixty-seven patients were included in this retrospective study between 2000 and 2011. All suffered from chronic upper limb type I CRPS refractory to conventional pain therapies. Thirty-three patients underwent stellate ganglion blockade and 34 benefited from radiofrequency neurolysis of the stellate ganglion. CT guidance was used in both groups. The procedure was considered effective when pain relief was {>=}50 %, lasting for at least 2 years. Thirty-nine women (58.2 %) and 28 men (41.8 %) with a mean age of 49.5 years were included in the study. Univariate analysis performed on the blockade and RFN groups showed a significantly (P < 0.0001) higher success rate in the RFN group (67.6 %, 23/34) compared with the blockade group (21.2 %, 7/33) with an odds ratio of 7.76. CT-guided radiofrequency neurolysis of the stellate ganglion is a safe and successful treatment of chronic refractory type I CRPS of the upper limb. It appears to be more effective than stellate ganglion blockade. (orig.)

  8. Cutaneous noradrenaline measured by microdialysis in complex regional pain syndrome during whole-body cooling and heating

    DEFF Research Database (Denmark)

    Terkelsen, Astrid Juhl; Gierthmühlen, Janne; Petersen, Lars J.

    2013-01-01

    and in healthy volunteers. Seven patients and nine controls completed whole-body cooling (sympathetic activation) and heating (sympathetic inhibition) induced by a whole-body thermal suit with simultaneous measurement of the skin temperature, skin blood flow, and release of dermal noradrenaline. CRPS pain...

  9. CONTINUOUS SENSORY ANALGESIA HELPS THE DIFFERENTIAL DIAGNOSIS AND THE TREATMENT OF COMPLEX REGIONAL PAIN SYNDROME (CRPS/RSD

    Directory of Open Access Journals (Sweden)

    Krunoslav Margić

    2001-11-01

    Full Text Available Background. CRPS/RSD still offers more questionsthen answers. The initial events and pathophysiology are unknown,the treatment is unsuccessful and the results are poor.The authors have transmitted their experiences with continuoussensory analgesia of brachial plexus in the treatment ofheavy injured hands to the treatment of CRPS. Efficient analgesia,control of vegetative nerve system and painless exercisesare of outmost importance in the treatment of CRPS.Patients and methods. From 1996 to 1998 we have used continuoussensory analgesia in the treatment of 8 patients withCRPS of the upper extremity. All of them were treated fewmonths after injury.Results. Two to four years after treatment six of eight havebeen ranged as good result (only temporary pain judged onsubjective pain scale as 2; ROM of wrist higher than 50%of normal, lack of 30° of ROM of fingers; hand and key gripgreater than 50% of normal hand.

  10. Effects of serum immunoglobulins from patients with complex regional pain syndrome (CRPS) on depolarisation-induced calcium transients in isolated dorsal root ganglion (DRG) neurons.

    Science.gov (United States)

    Reilly, Joanne M; Dharmalingam, Backialakshmi; Marsh, Stephen J; Thompson, Victoria; Goebel, Andreas; Brown, David A

    2016-03-01

    Complex regional pain syndrome (CRPS) is thought to have an auto-immune component. One such target recently proposed from the effects of auto-immune IgGs on Ca(2+) transients in cardiac myocytes and cell lines is the α1-adrenoceptor. We have tested whether such IgGs exerted comparable effects on nociceptive sensory neurons isolated from rat dorsal root ganglia. Depolarisation-induced [Ca(2+)]i transients were generated by applying 30 mM KCl for 2 min and monitored by Fura-2 fluorescence imaging. No IgGs tested (including 3 from CRPS patients) had any significant effect on these [Ca(2+)]i transients. However, IgG from one CRPS patient consistently and significantly reduced the K(+)-induced response of cells that had been pre-incubated for 24h with a mixture of inflammatory mediators (1 μM histamine, 5-hydroxytryptamine, bradykinin and PGE2). Since this pre-incubation also appeared to induce a comparable inhibitory response to the α1-agonist phenylephrine, this is compatible with the α1-adrenoceptor as a target for CRPS auto-immunity. A mechanism whereby this might enhance pain is suggested. Copyright © 2015. Published by Elsevier Inc.

  11. Co-creation of information leaflets to meet the support needs of people living with complex regional pain syndrome (CRPS) through innovative use of wiki technology.

    Science.gov (United States)

    Rodham, Karen; Gavin, Jeff; Coulson, Neil; Watts, Leon

    2016-01-01

    People living with complex regional pain syndrome (CRPS) experience frustration with the lack of knowledge and understanding of CRPS as a pain condition. We report on our attempt to address this issue. People living with CRPS taking part in a larger study were invited to co-construct a CRPS wiki page that addressed the areas in which they had experienced the most difficulty. A blank wiki page was set up for participants to populate with issues they felt needed to be raised and addressed. Participants failed to engage with the wiki technology. We modified our procedure and completed an inductive analysis of a sister-forum which participants were using as part of the larger study. Six issues of importance were identified. We used the discussion forum threads to populate the themes. Due to a continued lack of engagement with the wiki technology, the team decided to create a suite of leaflets which were piloted with delegates at a CRPS patient conference. Future work should be mindful of the extent to which patients are able and willing to share their experiences through such technology. Striking the balance between patient-endorsed and researcher-driven co-creation of such material is imperative.

  12. Effect of a new formulation of micronized and ultramicronized N-palmitoylethanolamine in a tibia fracture mouse model of complex regional pain syndrome.

    Directory of Open Access Journals (Sweden)

    Roberta Fusco

    Full Text Available Complex regional pain syndrome type 1 (CRPS-I is a disabling and frequently chronic condition. It involves the extremities and is a frequent consequence of distal tibia and radius fractures. The inflamed appearance of the affected CRPS-I limb suggests that local production of inflammatory mediators may be implicated in the ensuing etiology. A rodent tibia fracture model, characterized by inflammation, chronic unilateral hindlimb warmth, edema, protein extravasation, allodynia and hyperalgesia resembles the clinical features of patients with acute CRPS-I. N-palmitoylethanolamine (PEA, a member of the family of naturally-occurring N-acylethanolamines, is well-known for its ability to modulate inflammatory processes and regulate pain sensitivity. However, the large particle size and lipidic nature of PEA may limit its bioavailability and solubility when given orally. Micronized formulations are frequently used to enhance the dissolution rate of drug and reduce its variability of absorption when orally administered. The aim of this study was to assess the effects of a formulation of micronized and ultramicronized PEA (PEA-MPS, given orally in a mouse model of CRPS-I. CD-1 male mice were subjected to distal tibia fracture and divided into two groups: control and treated with PEA-MPS (PEA micronized 300 mg/kg and ultramicronized 600 mg/kg. Sensibility to pain was monitored in all mice throughout the course of the experiment. Twenty-eight days after tibia fracture induction animals were sacrificed and biochemical parameters evaluated. The PEA-MPS-treated group showed an improved healing process, fracture recovery and fibrosis score. PEA-MPS administration decreased mast cell density, nerve growth factor, matrix metalloproteinase 9 and cytokine expression. This treatment also reduced (poly-ADPribose polymerase activation, peroxynitrite formation and apoptosis. Our results suggest that PEA-MPS may be a new therapeutic strategy in the treatment of CRPS-I.

  13. 'Pseudofailure' of spinal cord stimulation for neuropathic pain following a new severe noxious stimulus: learning points from a case series of failed spinal cord stimulation for complex regional pain syndrome and failed back surgery syndrome.

    Science.gov (United States)

    Muquit, Samiul; Moussa, Ahmad Abdelhai; Basu, Surajit

    2016-05-01

    Failure of spinal cord stimulation (SCS) may be due to hardware problems, migration of electrodes and, in the long-term, plasticity in the spinal cord with habituation to the stimulation current. We describe a series of seven patients who experienced acute therapeutic loss of SCS effects following an acute nociceptive event unrelated to primary pathology. There were no hardware problems. We called this 'Pseudofailure', as the effective stimulation returned in all patients following a period off stimulation or reprogramming. This phenomenon has not been reported previously in the literature. Over a 4-year period, we managed seven patients with this feature: four had received SCS for complex regional pain syndrome and three for failed back surgery syndrome. In all seven cases, there was cessation of the pain relief afforded by SCS following an acute painful event: four patients had trauma, two patients had domestic electric shock and one patient suffered shingles (varicella zoster infection). We excluded hardware-related problems in all cases. In two patients, SCS effects could be regained by an initial attempt at reprogramming. In the remaining five cases reprogramming was unsuccessful, and stimulation was switched off for several months before recommencing, when we discovered a return of good therapeutic effect. We conclude that SCS may seem to fail following a separate strong nociceptive stimulus. Stimulation may be regained with reprogramming or following a period with stimulation switched off. We would, therefore, advise against removal of SCS hardware in the first instance.

  14. Study for Reliability of Interpretation of the Three Phase Bone Scintigraphy in Patients with Post-traumatic Complex Regional Pain Syndrome

    International Nuclear Information System (INIS)

    Park, Jung Mi; Kim, Seon Jung; Chung, Seung Hyun; Lee, Yong Taek

    2008-01-01

    We performed this study to evaluate reliability on interpretation of three phase bone scintigraphy (TPBS) in patients with post-traumatic complex regional pain syndrome (PT-CRPS). Based on International Association for the Study of Pain guideline in 1994, 34 patients with PT-CRPS were selected for this study. Two nuclear medicine physicians evaluated identical TPBS according to the uptake pattern, extent and intensity of the lesion, and their agreements (kappa values) were analysed. The final diagnosis based on arbitrary criteria of each physician were compared with those obtained by the criteria for PT-CRPS established in this study, which are hyperactivity on all phases (criteria 1), hyperactivity of whole joints on delayed phase (criteria 2), and hyperactivity of either whole or focal joints on delayed phase (criteria 3). Intra-observer agreements were good for uptake pattern, intensity, and extent on TPBS. Inter-observer agreements were also good, except extent on blood pool phase (0.55). The inter-observer agreements on final diagnosis improved when criteria 1-3 were applied (0.77-0.88), compared to when physician's own criteria were used (0.63). Those also improved from 0.29 to 0.47-0.82 for acute stage, and from 0.37 to 1.0 for chronic stage. The sensitivities of chronic stage were relatively lower to those of acute stage. Inter-observer's variations in diagnosis of the patients with PT-CRPS using TPBS were observed. These results were attributed to different criteria set by observers. In order to improve agreement on interpretation of TPBS, common positive criteria should be established, especially considering uptake pattern and clinical stages

  15. Study for Reliability of Interpretation of the Three Phase Bone Scintigraphy in Patients with Post-traumatic Complex Regional Pain Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jung Mi [Bucheon Hospital Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of); Kim, Seon Jung [National Health Insurance Corporation Ilsan Hospital, Koyang (Korea, Republic of); Chung, Seung Hyun [National Cancer Center, Koyang (Korea, Republic of); Lee, Yong Taek [Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2008-02-15

    We performed this study to evaluate reliability on interpretation of three phase bone scintigraphy (TPBS) in patients with post-traumatic complex regional pain syndrome (PT-CRPS). Based on International Association for the Study of Pain guideline in 1994, 34 patients with PT-CRPS were selected for this study. Two nuclear medicine physicians evaluated identical TPBS according to the uptake pattern, extent and intensity of the lesion, and their agreements (kappa values) were analysed. The final diagnosis based on arbitrary criteria of each physician were compared with those obtained by the criteria for PT-CRPS established in this study, which are hyperactivity on all phases (criteria 1), hyperactivity of whole joints on delayed phase (criteria 2), and hyperactivity of either whole or focal joints on delayed phase (criteria 3). Intra-observer agreements were good for uptake pattern, intensity, and extent on TPBS. Inter-observer agreements were also good, except extent on blood pool phase (0.55). The inter-observer agreements on final diagnosis improved when criteria 1-3 were applied (0.77-0.88), compared to when physician's own criteria were used (0.63). Those also improved from 0.29 to 0.47-0.82 for acute stage, and from 0.37 to 1.0 for chronic stage. The sensitivities of chronic stage were relatively lower to those of acute stage. Inter-observer's variations in diagnosis of the patients with PT-CRPS using TPBS were observed. These results were attributed to different criteria set by observers. In order to improve agreement on interpretation of TPBS, common positive criteria should be established, especially considering uptake pattern and clinical stages.

  16. Wireless peripheral nerve stimulation for complex regional pain syndrome type I of the upper extremity: a case illustration introducing a novel technology.

    Science.gov (United States)

    Herschkowitz, Daniel; Kubias, Jana

    2018-04-13

    Complex regional pain syndrome (CRPS) is a debilitating painful disorder, cryptic in its pathophysiology and refractory condition with limited therapeutic options. Type I CRPS with its variable relationship to trauma has often no discernible fractures or nerve injuries and remains enigmatic in its response to conservative treatment as well as the other limited interventional therapies. Neuromodulation in the form of spinal cord and dorsal root ganglion stimulation (SCS, DRGS) has shown encouraging results, especially of causalgia or CRPS I of lower extremities. Upper extremity CRPS I is far more difficult. To report a case of upper extremity CRPS I treated by wireless peripheral nerve stimulation (WPNS) for its unique features and minimally invasive technique. The system does not involve implantation of battery or its connections. A 47 year old female patient presented with refractory CRPS I following a blunt trauma to her right forearm. As interventional treatment in the form of local anesthetics (Anesthesia of peripheral branches of radial nerve) and combined infusions of ketamine/lidocaine failed to provide any significant relief she opted for WPNS treatment. Based on the topographic distribution, two electrodes (Stimwave Leads: FR4A-RCV-A0 with tines, Generation 1 and FR4A-RCV-B0 with tines, Generation 1), were placed along the course of radial and median nerves under ultrasonography monitoring and guided by intraoperative stimulation. This procedure did not involve implantation of extension cables or the power source. At a frequency of 60 Hz and 300 μs the stimulation induced paresthesia along the distribution of the nerves. Therapeutic relief was observed with high frequency (HF) stimulation (HF 10 kHz/32 μs, 2.0 mA) reducing her pain from a visual analogue scale (VAS) score of 7-4 postoperatively. Three HF stimulations programs were provided at the time of discharge, as she improved in her sensory impairment to touch, pressure and temperature at her first

  17. Perioperative factors affecting the occurrence of acute complex regional pain syndrome following limb bone fracture surgery: data from the Japanese Diagnosis Procedure Combination database.

    Science.gov (United States)

    Sumitani, Masahiko; Yasunaga, Hideo; Uchida, Kanji; Horiguchi, Hiromasa; Nakamura, Masaya; Ohe, Kazuhiko; Fushimi, Kiyohide; Matsuda, Shinya; Yamada, Yoshitsugu

    2014-07-01

    Complex regional pain syndrome (CRPS) describes a broad spectrum of symptoms that predominantly localize to the extremities. Although limb fracture is one of the most frequently reported triggering events, few large-scale studies have shown the occurrence of and factors associated with CRPS following limb fracture. This study aimed to show the occurrence and identify of those factors. Using the Japanese Diagnosis Procedure Combination database, we identified 39 patients diagnosed with CRPS immediately after open reduction and internal fixation (ORIF) for limb fracture from a cohort of 185 378 inpatients treated with ORIF between 1 July and 31 December of each year between 2007 and 2010. Patient and clinical characteristics such as age, gender, fracture site, duration of anaesthesia and use of regional anaesthesia were investigated by logistic regression analyses to examine associations between these factors and the in-hospital occurrence of CRPS after ORIF. The occurrence of CRPS was relatively high in fractures of the distal forearm, but low in fractures of the lower limb and in patients with multiple fractures. Generally females are considered to be at high risk of CRPS; however, we found a comparable number of male and female patients suffering from CRPS after ORIF for limb fracture. In terms of perioperative factors, a longer duration of anaesthesia, but not regional anaesthesia, was significantly associated with a higher incidence of CRPS. Although a limited number of CRPS patients were analysed in this study, reduced operative time might help to prevent the development of acute CRPS following limb fracture. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. A contribution to genetic etiology of complex regional pain syndrome type I (algodystropy syndrome) based on quantitative analysis of digitopalmar dermatoglyphics in sixty men.

    Science.gov (United States)

    Cvjeticanin, Miljenko; Jajić, Zrinka; Jajić, Ivo

    2005-01-01

    The patterns of the ridges of the skin of the fingers and palms were determined in sixty men with complex regional pain syndrome (type I) as a measure of disease prevention. The study included 25 dermatoglyphic traits: number of epidermal ridges on all ten fingers; their sum for five and ten fingers; four traits on both palms, i.e. between a-b, b-c and c-d triradii; atd angles: and their bilateral sum. The data obtained were compared with those recorded in a control group of 200 pairs of imprints of phenotipycally healthy male adults from the Zagreb area. Statistically significant difference from control values were found in 12 dermatoglyphic variables, including an increased sum of ridges on nine fingers (except for left second finger pad), and total sum for five and ten fingers. These findings suggested the polygenic system responsible for development of dermatoglyphics to be identical with some polygenic loci for the onset of algodystrophy syndrome, which might prove useful in disease prevention (e.g., taking fingerprints following a trauma and before rehabilitation), and to facilitate identification of risk groups, and thus the treatment for this longterm and yet obscure syndrome.

  19. Thermography imaging during static and controlled thermoregulation in complex regional pain syndrome type 1: diagnostic value and involvement of the central sympathetic system

    Directory of Open Access Journals (Sweden)

    Westra Mirjam

    2006-05-01

    Full Text Available Abstract Background Complex Regional Pain Syndrome type 1 (CRPS1 is a clinical diagnosis based on criteria describing symptoms of the disease. The main aim of the present study was to compare the sensitivity and specificity of calculation methods used to assess thermographic images (infrared imaging obtained during temperature provocation. The secondary objective was to obtain information about the involvement of the sympathetic system in CRPS1. Methods We studied 12 patients in whom CRPS1 was diagnosed according to the criteria of Bruehl. High and low whole body cooling and warming induced and reduced sympathetic vasoconstrictor activity. The degree of vasoconstrictor activity in both hands was monitored using a videothermograph. The sensitivity and specificity of the calculation methods used to assess the thermographic images were calculated. Results The temperature difference between the hands in the CRPS patients increases significantly when the sympathetic system is provoked. At both the maximum and minimum vasoconstriction no significant differences were found in fingertip temperatures between both hands. Conclusion The majority of CRPS1 patients do not show maximal obtainable temperature differences between the involved and contralateral extremity at room temperature (static measurement. During cold and warm temperature challenges this temperature difference increases significantly. As a result a higher sensitivity and specificity could be achieved in the diagnosis of CRPS1. These findings suggest that the sympathetic efferent system is involved in CRPS1.

  20. Elevated Plasma Levels of sIL-2R in Complex Regional Pain Syndrome: A Pathogenic Role for T-Lymphocytes?

    Science.gov (United States)

    Stronks, Dirk L.; Dik, Willem A.; Schreurs, Marco W. J.

    2017-01-01

    The immune system has long been thought to be involved in the pathophysiology of complex regional pain syndrome (CRPS). However, not much is known about the role of the immune system and specifically T-cells in the onset and maintenance of this disease. In this study, we aimed to evaluate T-cell activity in CRPS by comparing blood soluble interleukin-2 receptor (sIL-2R) levels between CRPS patients and healthy controls. CRPS patients had statistically significant elevated levels of sIL-2R as compared to healthy controls (median sIL-2R levels: 4151 pg/ml (Q3 − Q1 = 5731 pg/ml − 3546 pg/ml) versus 1907 pg/ml (Q3 − Q1: 2206 pg/ml − 1374 pg/ml), p CRPS patients and healthy controls with a high sensitivity (90%) and specificity (89.5%). Our finding indicates increased T-cell activity in patients with CRPS. This finding is of considerable relevance as it could point towards a T-cell-mediated inflammatory process in this disease. This could pave the way for new anti-inflammatory therapies in the treatment of CRPS. Furthermore, sIL-2R could be a promising new marker for determining inflammatory disease activity in CRPS. PMID:28634419

  1. Impact of three-phase bone scintigraphy on the diagnosis and treatment of complex regional pain syndrome type I or reflex sympathetic dystrophy.

    Science.gov (United States)

    Shehab, Dia; Elgazzar, Abdelhamid; Collier, B David; Naddaf, Sleiman; Al-Jarallah, Khalid; Omar, Abdelmoneim; Al-Mutairy, Moudi

    2006-01-01

    To determine the impact of three-phase bone scintigraphy (TPBS) on the diagnosis and management of complex regional pain syndrome type I (CRPSI) or reflex sympathetic dystrophy (RSD). Twenty consecutive patients with a recent clinical evidence of CRPSI were referred for TPBS as part of their routine management plan. All patients underwent neurological examinations with special attention to the evaluation of clinical features of vasomotor, sudomotor, motor and sensory dysfunction. Patients were followed prospectively. When both the clinical and TPBS results supported the diagnosis of CRPSI, patients were started on treatment. Of the 20 patients, TPBS supported the diagnosis of RSD in 9 who were treated with steroids and physiotherapy. Complete follow-up was available for 7 of them and all had a satisfactory response to treatment. For the remaining 11 patients RSD was diagnosed clinically but not confirmed by TPBS. On follow-up there was no evidence that TPBS failed to identify RSD in these 11 patients. The results indicate that TPBS confirmed the clinical diagnosis of RSD, and, more importantly, had a significant impact on its management.

  2. Increased endothelin-1 and diminished nitric oxide levels in blister fluids of patients with intermediate cold type complex regional pain syndrome type 1

    Directory of Open Access Journals (Sweden)

    Niehof Sjoerd

    2006-11-01

    Full Text Available Abstract Background In complex regional pain syndrome type 1 (CRPS1 pro-inflammatory mediators and vascular changes play an important role in the sustained development and outcome of the disease. The aim of this study was to determine the involvement of vasoactive substances endothelin-1 (ET-1 and nitric oxide (NO during early chronic CRPS1. Methods Included were 29 patients with CRPS 1 who were diagnosed during the acute stage of their disease and observed during follow-up visits. Disease activity and impairment were determined and artificial suction blisters were made on the CRPS1 and the contralateral extremities for measurements of IL-6, TNF-α, ET-1 and nitrate/nitrite (NOx. Results The levels of IL-6, TNF-α and ET-1 in blister fluid in the CRPS1 extremity versus the contralateral extremity were significantly increased and correlated with each other, whereas NOx levels were decreased. Conclusion The NOx/ET-1 ratio appears to be disturbed in the intermediate stage of CRPS, resulting in vasoconstriction and consequently in a diminished tissue blood distribution.

  3. Elevated Plasma Levels of sIL-2R in Complex Regional Pain Syndrome: A Pathogenic Role for T-Lymphocytes?

    Directory of Open Access Journals (Sweden)

    Krishna D. Bharwani

    2017-01-01

    Full Text Available The immune system has long been thought to be involved in the pathophysiology of complex regional pain syndrome (CRPS. However, not much is known about the role of the immune system and specifically T-cells in the onset and maintenance of this disease. In this study, we aimed to evaluate T-cell activity in CRPS by comparing blood soluble interleukin-2 receptor (sIL-2R levels between CRPS patients and healthy controls. CRPS patients had statistically significant elevated levels of sIL-2R as compared to healthy controls (median sIL-2R levels: 4151 pg/ml (Q3 − Q1 = 5731 pg/ml − 3546 pg/ml versus 1907 pg/ml (Q3 − Q1: 2206 pg/ml − 1374 pg/ml, p<0.001, resp.. Furthermore, sIL-2R level seems to be a good discriminator between CRPS patients and healthy controls with a high sensitivity (90% and specificity (89.5%. Our finding indicates increased T-cell activity in patients with CRPS. This finding is of considerable relevance as it could point towards a T-cell-mediated inflammatory process in this disease. This could pave the way for new anti-inflammatory therapies in the treatment of CRPS. Furthermore, sIL-2R could be a promising new marker for determining inflammatory disease activity in CRPS.

  4. Oxidative stress in Complex Regional Pain Syndrome (CRPS): no systemically elevated levels of malondialdehyde, F2-isoprostanes and 8OHdG in a selected sample of patients.

    Science.gov (United States)

    Fischer, Sigrid G L; Perez, Roberto S G M; Nouta, Jan; Zuurmond, Wouter W A; Scheffer, Peter G

    2013-04-10

    Exaggerated inflammation and oxidative stress are involved in the pathogenesis of Complex Regional Pain Syndrome (CRPS). However, studies assessing markers for oxidative stress in CRPS patients are limited. In this study, markers for lipid peroxidation (malondialdehyde and F2-isoprostanes) and DNA damage (8-hydroxy-2-deoxyguanosine) were measured in nine patients (mean age 50.1 ± 17.1 years) with short term CRPS-1 (median 3 months) and nine age and sex matched healthy volunteers (mean age 49.3 ± 16.8 years) to assess and compare the level of oxidative stress. No differences were found in plasma between CRPS patients and healthy volunteers for malondialdehyde (5.2 ± 0.9 µmol/L vs. 5.4 ± 0.5 µmol/L) F2-isoprostanes (83.9 ± 18.7 pg/mL vs. 80.5 ± 12.3 pg/mL) and 8-hydroxy-2-deoxyguanosine (92.6 ± 25.5 pmol/L vs. 86.9 ± 19.0 pmol/L). Likewise, in urine, no differences were observed between CRPS patients and healthy volunteers for F2-isoprostanes (117 ng/mmol, IQR 54.5-124.3 vs. 85 ng/mmol, IQR 55.5-110) and 8-hydroxy-2-deoxyguanosine (1.4 ± 0.7 nmol/mmol vs. 1.4 ± 0.5 nmol/mmol). Our data show no elevation of systemic markers of oxidative stress in CRPS patients compared to matched healthy volunteers. Future research should focus on local sampling methods of oxidative stress with adequate patient selection based on CRPS phenotype and lifestyle.

  5. Analysis of patterns of three-phase bone scintigraphy for patients with complex regional pain syndrome diagnosed using the proposed research criteria (the 'Budapest Criteria').

    Science.gov (United States)

    Moon, J Y; Park, S Y; Kim, Y C; Lee, S C; Nahm, F S; Kim, J H; Kim, H; Oh, S W

    2012-04-01

    Three-phase bone scintigraphy (TPBS) is an established objective diagnostic method for complex regional pain syndrome (CRPS), but its validity remains controversial. The aims of this study were: (i) to re-evaluate the diagnostic performance of TPBS, and (ii) to suggest new TPBS criteria based on the proposed research criteria for CPRS in Budapest (the 2003 Budapest research criteria). The medical records of 228 consecutive patients, evaluated using the Budapest research criteria, were retrospectively analysed. Of these, 116 patients were included in the present study, and 69 of 116 were diagnosed to have CRPS based on these criteria. The diagnostic performance of TPBS was assessed by determining its sensitivity, specificity, and positive and negative likelihood ratios, and new criteria for TPBS were identified by pattern analysis using the Budapest research criteria. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of TPBS for the diagnosis of CRPS according to the Budapest research criteria were 40.0, 76.5, 1.73, and 0.78, respectively. Furthermore, D-D-D, D-D-S, and D-D-I patterns [i.e. according to decreased (D), symmetrical (S), or increased (I) tracer uptake during Phases I, II, and III] of TPBS were found to be positively predictive for CRPS. The diagnostic value of a positive TPBS for CRPS is low from the view point of the Budapest research criteria. Our findings suggest that a diagnosis of CRPS using the Budapest research criteria should be considered when decreased patterns of TPBS are observed during Phases I and II.

  6. [The German version of the Bath Body Perception Disturbance Scale (BBPDS-D) : Translation, cultural adaptation and linguistic validation on patients with complex regional pain syndrome].

    Science.gov (United States)

    Tschopp, M; Swanenburg, J; Wertli, M W; Langenfeld, A; McCabe, C S; Lewis, J; Baertschi, E; Brunner, F

    2018-05-07

    Besides the classical clinical manifestations, body perception disturbances are common among patients with complex regional pain syndrome (CRPS). The Bath Body Perception Disturbance Scale (BBPDS) represents a useful tool to assess these changes in CRPS patients; however, to date no validated German version is available. The aim of this study was to translate the BBPDS into German, to perform a cross-cultural adaptation and linguistic validation in patients with acute (symptoms German according to published guidelines (translation and back translation) and tested on 56 patients (mean age 50.9 ± 13.1 years) with acute (n = 28) or stable (n = 28) CRPS. The relative reliability, intraclass correlation and test-retest reliability were excellent overall and in the groups with acute and stable CRPS. The smallest detectable change was at 10 points. In the test-retest 48 points lay within the 95% confidence interval and visual inspection showed no tendency towards heteroscedasticity. Spearman's ρ‑coefficient values showed no correlation between the total score of the BBPDS-D with the numerical rating scale (NRS, ρ = -0.19) and the EuroQol-5 D (ρ = 0.16). There were no significant differences between patients with acute and stable CRPS (p = 0.412). There were also no floor or ceiling effects. This German translation and cross-cultural adaptation of the original English version of the BBPDS is a valid instrument to assess body perception disturbances in German speaking CRPS patients. Future research should further assess the impact of body perception disturbance on treatment outcome and prognosis.

  7. Ethnographies of pain: culture, context and complexity

    Science.gov (United States)

    2015-01-01

    This article briefly introduces and discusses the value of ethnographic research, particularly research hailing from the discipline of social and cultural anthropology. After an introduction to ethnography in general, key ethnographic studies of pain are described. These show that ethnography provides a set of techniques for data collection and analysis, as well as a way of thinking about pain as socially and culturally embedded. Modern ethnographic writing is far removed from the literature of the past that sometimes described stereotypes rather than process and complexity. Ethnography provides the chance to describe the complexity and nuance of culture, which serves to counter stereotypes. The article concludes with an example from pain research conducted in a clinical setting. Through the use of ethnographic techniques, the research study provided greater insight than other methods alone might have achieved. The article includes references for further reading should readers be interested in developing their engagement with ethnographic method and interpretation. PMID:26516554

  8. A parallel chiral-achiral liquid chromatographic method for the determination of the stereoisomers of ketamine and ketamine metabolites in the plasma and urine of patients with complex regional pain syndrome

    OpenAIRE

    Moaddel, Ruin; Venkata, Swarajya Lakshmi Vattem; Tanga, Mary J.; Bupp, James E.; Green, Carol E.; Iyer, Lalitha; Furimsky, Anna; Goldberg, Michael E.; Torjman, Marc C.; Wainer, Irving W.

    2010-01-01

    A parallel chiral/achiral LC-MS/MS assay has been developed and validated to measure the plasma and urine concentrations of the enantiomers of ketamine, (R)- and (S)-Ket, in Complex Regional Pain Syndrome (CRPS) patients receiving a 5-day continuous infusion of a sub-anesthetic dose of (R,S)-Ket. The method was also validated for the determination of the enantiomers of the Ket metabolites norketamine, (R)-and (S)-norKet and dehydronorketamine, (R)- and (S)-DHNK, as well as the diastereomeric ...

  9. Perspectives on Music Imagery and complex chronic pain

    OpenAIRE

    Sanfi, Ilan; Christensen, Erik

    2017-01-01

    The aim of the article is to examine the concept of chronic pain as a complex phenomenon and to highlight the potential role of music therapy – in particular, music imagery – in the treatment of chronic pain. Theories of pain, along with research on pain pathways and pain control in the nervous system, support the evidence from clinical practice that music interventions can alleviate the sensation of pain whilst also offering a pleasant aesthetic experience. Music therapy provides opportuniti...

  10. Chronic pain as a manifestation of potassium channel-complex autoimmunity.

    Science.gov (United States)

    Klein, Christopher J; Lennon, Vanda A; Aston, Paula A; McKeon, Andrew; Pittock, Sean J

    2012-09-11

    Autoantibodies targeting voltage-gated potassium channel (VGKC) complexes cause a spectrum of neuronal hyperexcitability disorders. We investigated pain as a manifestation of VGKC-complex autoimmunity. We reviewed the prevalence and characteristics of pain in VGKC-complex-immunoglobulin G (IgG)-seropositive patients in 25 months of comprehensive service testing for neural autoantibodies, subtyped positive sera for LGI1-IgG and CASPR2-IgG specificities, and reviewed pain prevalence in autoimmune control patients. VGKC-complex-IgG was identified in 1,992 patients of 54,853 tested (4%). Of 316 evaluated neurologically at Mayo Clinic, 159 (50%) had pain, in isolation (28%) or with accompanying neurologic manifestations (72%), and not attributable to alternative cause. Pain was subacute in onset, chronic in course, neuropathic, nociceptive, regional, or diffuse and sometimes attributed to fibromyalgia (6%) or psychogenic cause (13%). Most patients had normal peripheral nervous system function, measured by neuropathy impairment scores and nerve conduction. Evidence of neuronal hyperexcitability (hyperhidrosis, quantitative heat-pain hyperalgesia, or electromyographic excitability) was 25-fold more common in pain patients. Pain management required multiple medications in 70% (narcotics, 30%); 13 of 16 patients reported pain relief with immunotherapy. Pain was significantly associated with CASPR2-IgG-positivity (16% positive with pain, 7% without pain; p = 0.014) but not with LGI1-IgG. Less than 10% of 167 patients with neural autoantibodies other than VGKC-complex-IgG reported pain. Chronic idiopathic pain is a syndromic manifestation of VGKC-complex autoimmunity. Hyperexcitability of nociceptive pathways is implicated. CASPR2-IgG significantly associates with pain, but in most patients the antigenic VGKC-complex molecule remains to be determined. VGKC-complex autoimmunity represents an important new direction for pain research and therapy.

  11. Motor cortex stimulation(MCS) for intractable complex regional pain syndrome (CRPS) type II: PSM analysis of Tc-99m ECD brain perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Y. A.; Son, B. C.; Yoo, I. R.; Kim, S. H.; Kim, E. N.; Park, Y. H.; Lee, S. Y.; Sohn, H. S.; Chung, S. K. [College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2001-07-01

    We had experienced a patient with intractable CRPS in whom statistical parametric mapping (SPM) analysis of cerebral perfusion explained the mechanism of pain control by MCS. A 43-year-old man presented spontaneous severe burning pain in his left hand and forearm and allodynia over the left arm and left hemibody. After the electrodes for neuromodulation therapy were inserted in the central sulcus, the baseline and stimulation brain perfusion SPECT using Tc-99m ECD were obtained within two days. The differences between the baseline and stimulation SPECT images, estimated at every voxel using t-statistics using SPM-99 software, were considered significant at a threshold of uncorrected P values less than 0.01. Among several areas significantly activated following pain relief with MCS, ipsilateral pyramidal tract in the cerebral peduncle might be related to the mechanism of pain control with MCS through efferent motor pathway. The result suggested that corticospinal neurons themselves or motor cortex efferent pathway maintained by the presence of intact corticospinal neurons could play an important role in producing pain control after MCS. This study would helpful in understanding of neurophysiology.

  12. Motor cortex stimulation(MCS) for intractable complex regional pain syndrome (CRPS) type II: PSM analysis of Tc-99m ECD brain perfusion SPECT

    International Nuclear Information System (INIS)

    Chung, Y. A.; Son, B. C.; Yoo, I. R.; Kim, S. H.; Kim, E. N.; Park, Y. H.; Lee, S. Y.; Sohn, H. S.; Chung, S. K.

    2001-01-01

    We had experienced a patient with intractable CRPS in whom statistical parametric mapping (SPM) analysis of cerebral perfusion explained the mechanism of pain control by MCS. A 43-year-old man presented spontaneous severe burning pain in his left hand and forearm and allodynia over the left arm and left hemibody. After the electrodes for neuromodulation therapy were inserted in the central sulcus, the baseline and stimulation brain perfusion SPECT using Tc-99m ECD were obtained within two days. The differences between the baseline and stimulation SPECT images, estimated at every voxel using t-statistics using SPM-99 software, were considered significant at a threshold of uncorrected P values less than 0.01. Among several areas significantly activated following pain relief with MCS, ipsilateral pyramidal tract in the cerebral peduncle might be related to the mechanism of pain control with MCS through efferent motor pathway. The result suggested that corticospinal neurons themselves or motor cortex efferent pathway maintained by the presence of intact corticospinal neurons could play an important role in producing pain control after MCS. This study would helpful in understanding of neurophysiology

  13. Quantifying China's regional economic complexity

    Science.gov (United States)

    Gao, Jian; Zhou, Tao

    2018-02-01

    China has experienced an outstanding economic expansion during the past decades, however, literature on non-monetary metrics that reveal the status of China's regional economic development are still lacking. In this paper, we fill this gap by quantifying the economic complexity of China's provinces through analyzing 25 years' firm data. First, we estimate the regional economic complexity index (ECI), and show that the overall time evolution of provinces' ECI is relatively stable and slow. Then, after linking ECI to the economic development and the income inequality, we find that the explanatory power of ECI is positive for the former but negative for the latter. Next, we compare different measures of economic diversity and explore their relationships with monetary macroeconomic indicators. Results show that the ECI index and the non-linear iteration based Fitness index are comparative, and they both have stronger explanatory power than other benchmark measures. Further multivariate regressions suggest the robustness of our results after controlling other socioeconomic factors. Our work moves forward a step towards better understanding China's regional economic development and non-monetary macroeconomic indicators.

  14. Personality disparity in chronic regional and widespread pain.

    Science.gov (United States)

    Chang, Mei-Chung; Chen, Po-Fei; Lung, For-Wey

    2017-08-01

    Chronic pain has high comorbidity with psychiatric disorders, therefore, better understanding of the relationship between chronic pain and mental illness is needed. This study aimed to investigate the pathway relationships among parental attachment, personality characteristics, alexithymic trait and mental health in patients with chronic widespread pain, those with chronic regional pain, and controls. Two hundred and thirty participants were recruited. The parental Bonding Inventory, Eysenck Personality Inventory (EPI), 20-item Toronto Alexithymia Scale (TAS-20), Chinese Health Questionnaire, and Short-Form 36 were filled out. The pathway relationships revealed that patients of mothers who were more protective were more neurotic, had more difficulty identifying feelings (DIF), worse mental health, and a higher association with chronic widespread pain. No differences were found between patients with chronic regional pain and the controls. The predisposing factors for chronic widespread pain, when compared with chronic regional pain, may be more closely related to psychiatric disorders. The pathways to chronic regional pain and chronic widespread pain differ, with neuroticism and the alexithymic DIF trait being the main factors defining chronic widespread pain. Therefore, besides therapies targeting pain symptoms, psychiatric consultation, medication and psychotherapy are also recommended for those with chronic widespread pain to alleviate their mental health conditions. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  15. Perspectives on Music Imagery and complex chronic pain

    DEFF Research Database (Denmark)

    Sanfi, Ilan; Christensen, Erik

    2017-01-01

    The aim of the article is to examine the concept of chronic pain as a complex phenomenon and to highlight the potential role of music therapy – in particular, music imagery – in the treatment of chronic pain. Theories of pain, along with research on pain pathways and pain control in the nervous...... system, support the evidence from clinical practice that music interventions can alleviate the sensation of pain whilst also offering a pleasant aesthetic experience. Music therapy provides opportunities for processing psychological and existential issues and enables patients to better cope with chronic...... pain. Related research in neuroscience and music medicine provides supplementary evidence that music can have a considerable impact on the physiological and psychological aspects of pain. This article summarises selected theoretical, clinical, and research–based knowledge relevant for music therapy...

  16. Rehabilitation of a female dancer with patellofemoral pain syndrome: applying concepts of regional interdependence in practice.

    Science.gov (United States)

    Welsh, Caitlyn; Hanney, William J; Podschun, Laura; Kolber, Morey J

    2010-06-01

    Due to complex movements and high physical demands, dance is often associated with a multitude of impairments including pain of the low back, pelvis, leg, knee, and foot. This case report provides an exercise progression, emphasizing enhancement of strength and neuromuscular performance using the concept of regional interdependence in a 17 year old female dancer with patellofemoral pain syndrome.

  17. A parallel chiral-achiral liquid chromatographic method for the determination of the stereoisomers of ketamine and ketamine metabolites in the plasma and urine of patients with complex regional pain syndrome.

    Science.gov (United States)

    Moaddel, Ruin; Venkata, Swarajya Lakshmi Vattem; Tanga, Mary J; Bupp, James E; Green, Carol E; Iyer, Lalitha; Furimsky, Anna; Goldberg, Michael E; Torjman, Marc C; Wainer, Irving W

    2010-10-15

    A parallel chiral/achiral LC-MS/MS assay has been developed and validated to measure the plasma and urine concentrations of the enantiomers of ketamine, (R)- and (S)-Ket, in complex regional pain syndrome (CRPS) patients receiving a 5-day continuous infusion of a sub-anesthetic dose of (R,S)-Ket. The method was also validated for the determination of the enantiomers of the Ket metabolites norketamine, (R)- and (S)-norKet and dehydronorketamine, (R)- and (S)-DHNK, as well as the diastereomeric metabolites hydroxynorketamine, (2S,6S)-/(2R,6R)-HNK and two hydroxyketamines, (2S,6S)-HKet and (2S,6R)-Hket. In this method, (R,S)-Ket, (R,S)-norKet and (R,S)-DHNK and the diastereomeric hydroxyl-metabolites were separated and quantified using a C(18) stationary phase and the relative enantiomeric concentrations of (R,S)-Ket, (R,S)-norKet and (R,S)-DHNK were determined using an AGP-CSP. The analysis of the results of microsomal incubations of (R)- and (S)-Ket and a plasma and urine sample from a CRPS patient indicated the presence of 10 additional compounds and glucuronides. The data from the analysis of the patient sample also demonstrated that a series of HNK metabolites were the primary metabolites in plasma and (R)- and (S)-DHNK were the major metabolites found in urine. The results suggest that norKet is the initial, but not the primary metabolite and that downstream norKet metabolites play a role in (R,S)-Ket-related pain relief in CRPS patients. Published by Elsevier B.V.

  18. Neuropathic pain in the orofacial region: The role of pain history. A retrospective study.

    Science.gov (United States)

    Dieb, W; Moreau, N; Chemla, I; Descroix, V; Boucher, Y

    2017-06-01

    Orofacial neuropathic pain is often difficult to treat, mostly because of still unclear underlying mechanisms. The occurrence of such neuropathic pain varies depending on different factors, of which preexisting preoperative pain seems to be of high importance. The aim of this study was thus to test the hypothesis that prior history of pain could indeed be considered a risk factor for the development of orofacial neuropathic pain in the same region. The study was performed in the dental department of the Groupe Hospitalier Pitié-Salpêtrière (GHPS) in Paris, France. We investigated the presence of prior inflammatory pain before development of orofacial neuropathic pain in 56 patients. For each patient file, the following items were collected: age, gender; medical history; diagnosis; description of the pain (at time of consultation); presence or absence of prior dental treatment; date and type of dental treatment received. 41 patients (73%) of orofacial neuropathic pain patients had a history of pain compatible with an inflammatory condition; 4% (n=2) did not report any prior pain and 23% (n=13) could not remember. Among the patients with documented history of pain prior to neuropathy, 88% (n=36) received surgical treatment; 61%, (n=25) endodontic treatment and 22%, (n=9) restorative treatment. All eventually received endodontic treatment or tooth extraction. These dental treatments are compatible with the hypothesis of prior inflammatory pain in these patients. These results support the hypothesis that prior inflammatory pain could favor the development of orofacial neuropathic pain. Prevention and treatment of inflammatory trigeminal pain may therefore play a key role in preventing future neuropathic pain development. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. A report from the first regional pain medicine symposia in East ...

    African Journals Online (AJOL)

    A report from the first regional pain medicine symposia in East, Central and Southern African ... Definition and concept of the Rhino model in pain education in Africa ... pain medicine among residents to stimulate their ideas for pain research ...

  20. Rising prevalence of back pain in Austria: considering regional disparities.

    Science.gov (United States)

    Großschädl, Franziska; Stolz, Erwin; Mayerl, Hannes; Rásky, Éva; Freidl, Wolfgang; Stronegger, Willibald J

    2016-01-01

    Back pain is the most common form of musculoskeletal conditions and leads to high health care costs. Information about geographic variations in highly prevalent diseases/disorders represents important implications for public health planning to face structural challenges. The present study aims to investigate regional trends in the prevalence of back pain and the role of obesity and social inequalities among Austrian adults. A secondary data analysis based on five nationally representative cross-sectional surveys (1973-2007) was carried out (N = 178,818). Back pain was measured as self-reported presence. Obesity (BMI ≥ 30 kg/m²) was adjusted for self-report bias. For the regional analyses, Austria was divided into Western, Central and Eastern Austria. A relative index of inequality (RII) was computed to quantify the extent of social inequality. A continuous rise in back pain prevalence was observed in the three regions and among all investigated subgroups. In 2007 the age-standardised prevalence was similar in Central (36.9 %), Western (35.2 %) and Eastern Austria (34.3 %). The absolute change in back pain prevalence was highest among obese subjects in Central Austria (women: + 29.8 %, men: + 32.5 %). RIIs were unstable during the study period and in 2007 highest in Eastern Austria. Variation and trends in back pain are not attributable to geographic variation in Austria: an assumed East-West gradient in Austria has not been confirmed. Nevertheless our study confirms that back pain dramatically increased in all Austrian regions and investigated subgroups. This worrying trend should be further monitored and public health interventions should be implemented increasingly, especially among obese women and men.

  1. The American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies Joint Committee recommendations for education and training in ultrasound-guided interventional pain procedures.

    Science.gov (United States)

    Narouze, Samer N; Provenzano, David; Peng, Philip; Eichenberger, Urs; Lee, Sang Chul; Nicholls, Barry; Moriggl, Bernhard

    2012-01-01

    The use of ultrasound in pain medicine for interventional axial, nonaxial, and musculoskeletal pain procedures is rapidly evolving and growing. Because of the lack of specialty-specific guidelines for ultrasonography in pain medicine, an international collaborative effort consisting of members of the Special Interest Group on Ultrasonography in Pain Medicine from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies developed the following recommendations for education and training in ultrasound-guided interventional pain procedures. The purpose of these recommendations is to define the required skills for performing ultrasound-guided pain procedures, the processes for appropriate education, and training and quality improvement. Training algorithms are outlined for practice- and fellowship-based pathways. The previously published American Society of Regional Anesthesia and Pain Medicine and European Society of Regional Anaesthesia and Pain Therapy education and teaching recommendations for ultrasound-guided regional anesthesia served as a foundation for the pain medicine recommendations. Although the decision to grant ultrasound privileges occurs at the institutional level, the committee recommends that the training guidelines outlined in this document serve as the foundation for educational training and the advancement of the practice of ultrasonography in pain medicine.

  2. Diphosphonic Acid (HEDP) Complex As A, Bone Pain Palliative Agent

    International Nuclear Information System (INIS)

    H G, Adang; Mutalib, A; Bagiawati, Sri; S, Evi; Aguawarini, Sri; Abidin

    2003-01-01

    Bone pain is a common complication for patient with bone metastases from prostate, breasts, lung and renal cancers. The systemic treatment of metastatic bone cancers can be done by using analgesic drug therapy, hormonal therapy, chemotherapy, narcotic (morphine) and radiopharmaceuticals. Samarium-153 EDTMP is one of the most widely used radiopharmaceutical for the treatment of metallics bone pain. Preparation and quality control of 186 Re-HEDP have been carried out. Radiochemical purity was analysed using paper chromatography and resulted in maximum yields more than 90 % . Complexes quite were stable for 3 days when stored at 4 o C. Rhenium-186 HEDP complex contents in the blood reach optimum activity after 5 minutes and decrease drastically at 24 hours post injection. The complex showed major renal clearance up to 41 % as perrhenate ion within 24 hours after injection, Biodistribution pattern of the injected complex in mice indicates that the accumulated optimum activity in the bone was obtained between 2 - 24 hours post injection, Sterility and pyrogenicity test indicated that the complex were sterile and pyrogen free

  3. Region Tourist and Recreation Complex Development

    Directory of Open Access Journals (Sweden)

    Elizaveta Oyusovna Tappaskhanova

    2015-06-01

    Full Text Available The subject matter of the research is the tourist and recreation complex of Kabardino-Balkar Republic. The purpose of the work is to provide solutions to problems of the republic tourist and recreation complex development. The results obtained from the study showed that in spite of the fact that in the region’s development certain positive steps are taken, according to the indicators of the tourism and recreation development, the region has not reach the level of the 1990th yet, the possibilities of this major sector of the republic economy remain not demanded. It is highlighted, that the most important factor in the tourist and recreation complex development is its infrastructure condition. It is recommended to use the model of the infrastructure management aimed at providing its effective functioning and development due to formation of interaction system at every power level through a network of the centers of the tourist and recreation complex development. In the article, the need for the use of the innovative approaches for the republic tourist and recreation complex development in the particular development of the new tourist directions are also found. For the purpose to improve the professional training of personnel for the tourism and recreation sphere, the need for a transition to multilevel training of personnel is proved. The main directions of the republic image development on the basis of designing and implementing of the regional program of its image development as the tourist territory and creation of the tourist information center are defined. Realization of all these problems allows to develop a highly effective and competitive tourist and recreation complex in Kabardino-Balkaria.

  4. Comorbidity negatively influences the outcomes of diagnostic tests for musculoskeletal pain in the orofacial region.

    Science.gov (United States)

    Koutris, Michail; Visscher, Corine M; Lobbezoo, Frank; Naeije, Machiel

    2013-06-01

    The aim of this study was to investigate whether diagnostic tests for musculoskeletal pain in the orofacial region [temporomandibular disorder (TMD) pain] are influenced by the presence of comorbid conditions, and to determine whether this influence decreases when the presence of "familiar pain" is used as outcome measure. In total, 117 patients (35 men, 82 women; 75 TMD-pain patients, 42 pain-free patients; mean age ± SD = 42.94 ± 14.17 years) were examined with palpation tests and dynamic/static tests. After each test, they were asked whether any pain was provoked and whether this pain response was familiar or not. For four clinical outcome measures (pain on palpation, familiar pain on palpation, pain on dynamic/static tests, and familiar pain on dynamic/static tests), multiple logistic regression analyses were performed with the presence of TMD pain as the primary predictor and regional (neck/shoulder) pain, widespread pain, depression, and somatization as comorbid factors. Pain on palpation was not associated with the primary predictor but with regional pain [P = 0.02, odds ratio (OR) = 4.59] and somatization (P = 0.011, OR = 8.47), whereas familiar pain on palpation was associated with the primary predictor (P = 0.003, OR = 5.23), but also with widespread pain (P = 0.001, OR = 2.02). Pain on dynamic/static tests was associated with the primary predictor (P pain on dynamic/static tests was only associated with the primary predictor (P diagnostic tests are negatively influenced by the presence of comorbidity. This influence decreases when the presence of familiar pain is used as outcome measure. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  5. Oral Ketamine in the Palliative Care Setting: A Review of the Literature and Case Report of a Patient With Neurofibromatosis Type 1 and Glomus Tumor-Associated Complex Regional Pain Syndrome

    Science.gov (United States)

    Soto, Eliezer; Stewart, Douglas R.; Mannes, Andrew J.; Ruppert, Sarah L.; Baker, Karen; Zlott, Daniel; Handel, Daniel; Berger, Ann M.

    2014-01-01

    Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to be effective not only for its anesthetic properties but also for the analgesic and opiate-sparing effects. However, data on efficacy and safety of oral ketamine for the treatment of neuropathic or cancer pain syndromes is limited with most of the evidence based on small clinical trials and anecdotal experiences. In this review, we will analyze the clinical data on oral ketamine in the palliative care setting. After an extensive search using five major databases, a total of 19 relevant articles were included. No official clinical guidelines for the use of oral ketamine in this patient population were found. Studies on oral ketamine for cancer and neuropathic pain have shown mixed results which could be partially due to significant differences in hepatic metabolism. In addition, we will include a case report of a 38-year-old female with neurofibromatosis type 1 (NF1) with history of chronic, severe pain in her fingertips secondary to multiple glomus tumors which evolved into CRPS resistant to multiple therapies but responsive to oral ketamine. Based on our experience with oral ketamine, this drug should be administered after an intravenous trial to monitor response and side effects in patients with an adequate functional status. However, patients in the palliative care and hospice setting, especially the one at the end of their lives, may also benefit from oral ketamine even if an intravenous trial is not feasible. PMID:21803784

  6. Combined glutamate and glutamine levels in pain-processing brain regions are associated with individual pain sensitivity.

    Science.gov (United States)

    Zunhammer, Matthias; Schweizer, Lauren M; Witte, Vanessa; Harris, Richard E; Bingel, Ulrike; Schmidt-Wilcke, Tobias

    2016-10-01

    The relationship between glutamate and γ-aminobutyric acid (GABA) levels in the living human brain and pain sensitivity is unknown. Combined glutamine/glutamate (Glx), as well as GABA levels can be measured in vivo with single-voxel proton magnetic resonance spectroscopy. In this cross-sectional study, we aimed at determining whether Glx and/or GABA levels in pain-related brain regions are associated with individual differences in pain sensitivity. Experimental heat, cold, and mechanical pain thresholds were obtained from 39 healthy, drug-free individuals (25 men) according to the quantitative sensory testing protocol and summarized into 1 composite measure of pain sensitivity. The Glx levels were measured using point-resolved spectroscopy at 3 T, within a network of pain-associated brain regions comprising the insula, the anterior cingulate cortex, the mid-cingulate cortex, the dorsolateral prefrontal cortex, and the thalamus. GABA levels were measured using GABA-edited spectroscopy (Mescher-Garwood point-resolved spectroscopy) within the insula, the anterior cingulate cortex, and the mid-cingulate cortex. Glx and/or GABA levels correlated positively across all brain regions. Gender, weekly alcohol consumption, and depressive symptoms were significantly associated with Glx and/or GABA levels. A linear regression analysis including all these factors indicated that Glx levels pooled across pain-related brain regions were positively associated with pain sensitivity, whereas no appreciable relationship with GABA was found. In sum, we show that the levels of the excitatory neurotransmitter glutamate and its precursor glutamine across pain-related brain regions are positively correlated with individual pain sensitivity. Future studies will have to determine whether our findings also apply to clinical populations.

  7. The disruptive effects of pain on complex cognitive performance and executive control.

    Directory of Open Access Journals (Sweden)

    Edmund Keogh

    Full Text Available Pain interferes and disrupts attention. What is less clear is how pain affects performance on complex tasks, and the strategies used to ensure optimal outcomes. The aim of the current study was to examine the effect of pain on higher-order executive control processes involved in managing complex tasks. Sixty-two adult volunteers (40 female completed two computer-based tasks: a breakfast making task and a word generation puzzle. Both were complex, involving executive control functions, including goal-directed planning and switching. Half of those recruited performed the tasks under conditions of thermal heat pain, and half with no accompanying pain. Whilst pain did not affect central performance on either task, it did have indirect effects. For the breakfast task, pain resulted in a decreased ability to multitask, with performance decrements found on the secondary task. However, no effects of pain were found on the processes thought to underpin this task. For the word generation puzzle, pain did not affect task performance, but did alter subjective accounts of the processes used to complete the task; pain affected the perceived allocation of time to the task, as well as switching perceptions. Sex differences were also found. When studying higher-order cognitive processes, pain-related interference effects are varied, and may result in subtle or indirect changes in cognition.

  8. The disruptive effects of pain on complex cognitive performance and executive control.

    Science.gov (United States)

    Keogh, Edmund; Moore, David J; Duggan, Geoffrey B; Payne, Stephen J; Eccleston, Christopher

    2013-01-01

    Pain interferes and disrupts attention. What is less clear is how pain affects performance on complex tasks, and the strategies used to ensure optimal outcomes. The aim of the current study was to examine the effect of pain on higher-order executive control processes involved in managing complex tasks. Sixty-two adult volunteers (40 female) completed two computer-based tasks: a breakfast making task and a word generation puzzle. Both were complex, involving executive control functions, including goal-directed planning and switching. Half of those recruited performed the tasks under conditions of thermal heat pain, and half with no accompanying pain. Whilst pain did not affect central performance on either task, it did have indirect effects. For the breakfast task, pain resulted in a decreased ability to multitask, with performance decrements found on the secondary task. However, no effects of pain were found on the processes thought to underpin this task. For the word generation puzzle, pain did not affect task performance, but did alter subjective accounts of the processes used to complete the task; pain affected the perceived allocation of time to the task, as well as switching perceptions. Sex differences were also found. When studying higher-order cognitive processes, pain-related interference effects are varied, and may result in subtle or indirect changes in cognition.

  9. Comorbidity negatively influences the outcomes of diagnostic tests for musculoskeletal pain in the orofacial region

    NARCIS (Netherlands)

    Koutris, M.; Visscher, C.M.; Lobbezoo, F.; Naeije, M.

    2013-01-01

    The aim of this study was to investigate whether diagnostic tests for musculoskeletal pain in the orofacial region [temporomandibular disorder (TMD) pain] are influenced by the presence of comorbid conditions, and to determine whether this influence decreases when the presence of "familiar pain" is

  10. Antidepressant therapy in complex treatment of painful diabetic polyneuropathy

    Directory of Open Access Journals (Sweden)

    Lidia Grigor'evna Turbina

    2012-09-01

    Full Text Available Aims. Comparative efficiency and safety analysis of antidepressant agents from different pharmacological classes (pipofezine and venlafaxinein combination with carbamazepine for treatment of neuropathic pain (NP in patients with diabetic polyneuropathy (DP. Materials and methods. We examined 21 male and 27 female patients with painful DP (mean age 54.3?14.2 years; mean duration ofdiabetes mellitus (DM 8.9?5.1 years; mean duration of DP - 3.8?2.1 years. DP was diagnosed clinically and by electromyographymethod. Pain syndrome was assessed with DN4 questionnaire, visual analogue scale (VAS and McGill Pain Questionnaire. Psycho-vegetative status was evaluated by Spielberger test with reactive and personal anxiety (RA and PA assessment and Beck depressioninventory. All patients received symptomatic pharmacotherapy with anticonvulsant and antidepressant agent. First group (DP-1included 23 patients on carbamazepin and pipofezine. Second group (DP-2 included 25 patients on carbamazepin and venlafaxine. Results. Following treatment, pain syndrome was completely compensated in 8.7% of patients from DP-1 group and 12.5% from DP-2.Decrease in pain intensity?50% from initial level was achieved in 73.9% (DP-1 and 75% (DP-2 of cases. Mean pain intensityaccording to VAS reduced from 5.2?2.1 points to 2.3?1.4 points (DP-1 and from 5.8?2.3 points (DP-2 with equal statistical significance(p

  11. [A reflective case report applied to pain management in a complex care situation].

    Science.gov (United States)

    Kinsperger, Laura; Mayrhofer, Stefanie Maria; Pichler, Birgit; Qin, Hong; Rheinfrank, Iris; Schrems, Berta

    2015-10-01

    This case report deals with the unsatisfying pain management of a 44 year old patient with cardiac arrest and subsequent cardiopulmonary resuscitation. The patient has (1) a reduced consciousness, (2) is isolated due to an infection with multi-resistant germs, (3) has a tracheotomy and (4) contractures of the muscles in fingers and hands. During nursing care he shows facial expressions and body postures that indicate pain which is insufficiently addressed. The case was processed according to the model of reflexive case report by Johns (1995) and interpreted by theoretical expertise and the change of the perspective. Therefore the following questions were answered: Which factors made the nurse who brought the case to the case deliberation feeling dissatisfied with the pain management? Insufficient pain management due to a lack of knowledge, no assessment of the state of consciousness, pain and isolation probably led to unnecessary burden of the patient, next of kin and nurses. Training, systematic pain management and multi-disciplinary case conferences might facilitate dealing with comparable complex situations of caring in the future. The present case report shows that pain can only be treated successfully if pain-triggering factors are recognized, systematically assessed and treated. An adequate external assessment of the pain situation is especially important when dealing with patients who suffer from disorders of consciousness. In complex cases, in which multiple factors influence the pain situation, interdisciplinary case conferences may help to improve the quality of pain management.

  12. Schur Stability Regions for Complex Quadratic Polynomials

    Science.gov (United States)

    Cheng, Sui Sun; Huang, Shao Yuan

    2010-01-01

    Given a quadratic polynomial with complex coefficients, necessary and sufficient conditions are found in terms of the coefficients such that all its roots have absolute values less than 1. (Contains 3 figures.)

  13. Síndrome dolorosa complexa regional: epidemiologia, fisiopatologia, manifestações clínicas, testes diagnósticos e propostas terapêuticas Síndrome dolorosa compleja regional: epidemiología, fisiopatología, manifestaciones clínicas, tests diagnósticos y propuestas terapéuticas Complex regional pain syndrome: epidemiology, pathophysiology, clinical manifestations, diagnostic tests and therapeutic proposals

    Directory of Open Access Journals (Sweden)

    Francisco Carlos Obata Cordon

    2002-09-01

    informaciones con la intuición de la mejor comprensión de esta importante síndrome dolorosa. CONTENIDO: Este es un trabajo de revisión de la literatura en los diversos aspectos de la SDCR, con énfasis en sus causas, definición y taxonomía, fisiopatología, características clínicas, tests diagnósticos y propuestas de tratamientos más recientes. CONCLUSIONES: Pocos son los estudios controlados adecuadamente, encubiertos y aleatorios, publicados con grandes muestras, habiendo muchas dudas sobre esta enfermedad. De esta forma, aun hay enorme empirismo en su terapéutica, y los resultados obtenidos son insatisfactorios.BACKGROUND AND OBJECTIVES: The term Complex Regional Pain Syndrome (CRPS was adopted as from 1994 by the International Association for Study of Pain (IASP Consensus. It previously referred to by several other names, such as Reflex Sympathetic Dystrophy, Causalgia, Algodystrophy or Sudeck’s Atrophy, and is a disease where the understanding of clinical limits, pathophysiology and pathogenic implications is still very poor. Thus resulting in disappointment both for patients and for health professionals with regard to currently available therapies. This study aimed at reviewing the literature and updating information to improve the understanding of this severe painful syndrome. CONTENTS: This study is a literature review of several CRPS aspects, with emphasis in its causes, definition and taxonomy, pathophysiology, clinical characteristics, diagnostic tests and most recent therapies. CONCLUSIONS: There are few well controlled, double blind and randomized CRPS studies with large samples, and there are still several questions about this disease. The treatment is usually empirical and the patient outcome is poor.

  14. The cost of chronic pain: an analysis of a regional pain management service in Ireland.

    Science.gov (United States)

    Gannon, Brenda; Finn, David P; O'Gorman, David; Ruane, Nancy; McGuire, Brian E

    2013-10-01

    The objective of the study was to collect data on the direct and indirect economic cost of chronic pain among patients attending a pain management clinic in Ireland. A tertiary pain management clinic serving a mixed urban and rural area in the West of Ireland. Data were collected from 100 patients using the Client Services Receipt Inventory and focused on direct and indirect costs of chronic pain. Patients were questioned about health service utilization, payment methods, and relevant sociodemographics. Unit costs were multiplied by resource use data to obtain full costs. Cost drivers were then estimated. Our study showed a cost per patient of US$24,043 over a 12-month period. Over half of this was attributable to wage replacement costs and lost productivity in those unable to work because of pain. Hospital stays and outpatient hospital services were the main drivers for health care utilization costs, together accounting for 63% of the direct medical costs per study participant attending the pain clinic. The cost of chronic pain among intensive service users is significant, and when extrapolated to a population level, these costs represent a very substantial economic burden. Wiley Periodicals, Inc.

  15. 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.

  16. Pain sensitivity is inversely related to regional grey matter density in the brain.

    Science.gov (United States)

    Emerson, Nichole M; Zeidan, Fadel; Lobanov, Oleg V; Hadsel, Morten S; Martucci, Katherine T; Quevedo, Alexandre S; Starr, Christopher J; Nahman-Averbuch, Hadas; Weissman-Fogel, Irit; Granovsky, Yelena; Yarnitsky, David; Coghill, Robert C

    2014-03-01

    Pain is a highly personal experience that varies substantially among individuals. In search of an anatomical correlate of pain sensitivity, we used voxel-based morphometry to investigate the relationship between grey matter density across the whole brain and interindividual differences in pain sensitivity in 116 healthy volunteers (62 women, 54 men). Structural magnetic resonance imaging (MRI) and psychophysical data from 10 previous functional MRI studies were used. Age, sex, unpleasantness ratings, scanner sequence, and sensory testing location were added to the model as covariates. Regression analysis of grey matter density across the whole brain and thermal pain intensity ratings at 49°C revealed a significant inverse relationship between pain sensitivity and grey matter density in bilateral regions of the posterior cingulate cortex, precuneus, intraparietal sulcus, and inferior parietal lobule. Unilateral regions of the left primary somatosensory cortex also exhibited this inverse relationship. No regions showed a positive relationship to pain sensitivity. These structural variations occurred in areas associated with the default mode network, attentional direction and shifting, as well as somatosensory processing. These findings underscore the potential importance of processes related to default mode thought and attention in shaping individual differences in pain sensitivity and indicate that pain sensitivity can potentially be predicted on the basis of brain structure. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  17. Chronic Pain, Chronic Opioid Addiction: a Complex Nexus.

    Science.gov (United States)

    Salsitz, Edwin A

    2016-03-01

    Over the past two decades, there has been a significant increase in the prescribing of opioids, with associated increases in opioid addiction and overdose deaths. This article reviews the evidence for the effectiveness and risk of developing an opioid use disorder (OUD) in those patients treated with chronic opioid therapy (COT) for chronic non-cancer pain (CNCP). Rates of development of OUD range from 0-50 %, and aberrant drug related behaviors (ADRBs) are reported to be 20 %. Health care providers must properly assess, screen, and carefully monitor patients on COT utilizing evidence-based tools.

  18. Pain and Disability in the Jaw and Neck Region following Whiplash Trauma.

    Science.gov (United States)

    Häggman-Henrikson, B; Lampa, E; Marklund, S; Wänman, A

    2016-09-01

    The relationship between whiplash trauma and chronic orofacial pain is unclear, especially with regard to the time elapsed from trauma to development of orofacial pain. The aim was to analyze prevalence of jaw pain and disability, as well as the relationship between pain and disability in the jaw and neck regions in the early nonchronic stage after whiplash trauma. In this case-control study, 70 individuals (40 women, 30 men, mean age 35.5 y) who visited an emergency department with neck pain following a car accident were examined within 3 wk of trauma (group 1) and compared with 70 individuals (42 women, 28 men, mean age 33.8 y), who declined to attend a clinical examination but agreed to fill in questionnaires (group 2). The 2 case groups were compared with a matched control group of 70 individuals (42 women, 28 men, mean age 37.6 y) without a history of neck trauma. All participants completed questionnaires regarding jaw pain and dysfunction, rating pain intensity in jaw and neck regions on the Numerical Rating Scale, the Neck Disability Index, and Jaw Disability Checklist. Compared with controls, individuals with a recent whiplash trauma reported more jaw pain and dysfunction. Furthermore, there was a moderate positive correlation between jaw and neck pain ratings for group 1 (r = 0.61, P whiplash trauma report more jaw pain and disability compared with controls without a history of neck trauma. Furthermore, the correlation between jaw and neck pain intensity implies that intensity of neck pain in the acute stage after whiplash trauma might be a possible risk factor also for development of chronic orofacial pain. © International & American Associations for Dental Research 2016.

  19. Effect of scapular function training on chronic pain in the neck/shoulder region

    DEFF Research Database (Denmark)

    Andersen, Christoffer H; Andersen, Lars L; Zebis, Mette K

    2014-01-01

    avoiding direct training of the painful area. Our study investigates the effect of the latter approach. The purpose of this study was in a randomised controlled trial to investigate if intensive scapular function training (SFT)-in terms of training of the lower trapezius and the serratus anterior muscle...... while minimizing direct training of the upper trapezius-is effective in reducing pain in adults with chronic non-specific pain in the neck/shoulder region. METHODS: 47 office workers with chronic non-specific pain in the neck/shoulder region were randomized to 10 weeks 3 × 20 min SFT with training......PURPOSE: Neck and shoulder complaints are common among employees in occupations characterized by intensive computer use. Treatment has varied from passive rest to active treatments and active treatments have often been divided into either training of the painful area or the surrounding musculature...

  20. Pharmacological treatment and regional anesthesia techniques for pain management after completion of both conservative and surgical treatment of endometriosis and pelvic adhesions in women with chronic pelvic pain as a mandated treatment strategy

    Directory of Open Access Journals (Sweden)

    Małgorzata Malec-Milewska

    2015-05-01

    Full Text Available Introduction. Chronic pelvic pain syndrome occurs in 4–14% of women. Pain pathomechanism in this syndrome is complex, as it is common to observe the features of nociceptive, inflammatory, neuropathic and psychogenic pain. The common findings in women with pelvic pain are endometriosis and pelvic adhesions. Objective. Aim of the study was to test the effectiveness of pharmacological treatment and regional anesthesia techniques for pain control as the next step of treatment after the lack of clinical results of surgical and pharmacological methods normally used in the management of endometriosis and pelvic adhesions. Materials and method. 18 women were treated between January 2010 – October 2013 in the Pain Clinic of the Department of Anaesthesiology and Intensive Care at the Centre for Postgraduate Education in Warsaw due to chronic pelvic pain syndrome related to either endometriosis or pelvic adhesions. During the previous step of management, both conservative and surgical treatments were completed without achieving satisfactory results. Initial constant pain severity was 3–9 points on the Numeric Rating Scale, while the reported paroxysmal pain level was 7–10. The pharmacological treatment implemented was based on oral gabapentinoids and antidepressants, aided by neurolytic block of ganglion of Walther, pudendal nerve blocks and topical treatment (5% lidocaine, 10% amitriptyline, 10% gabapentin. Results. In 17 women, a significant reduction of both constant and paroxysmal pain was achieved, of which complete and permanent cessation of pain occurred in 6 cases. One patient experienced no improvement in the severity of her symptoms. Conclusions. The combination of pain management with pharmacological treatment, pudendal nerve blocks, neurolysis of ganglion impar (Walther and topical preparations in cases of chronic pelvic pain syndrome seems to be adequate medical conduct after failed or otherwise ineffective causative therapy.

  1. Environmental management on the basis of Complex Regional Indicators Concept: case of the Murmansk region

    Science.gov (United States)

    Kozlov, A.; Gutman, S.; Zaychenko, I.; Rytova, E.; Nijinskaya, P.

    2015-09-01

    The article presents an approach to sustainable environmental development of the Murmansk region of the Russian Federation based on the complex regional indicators as a transformation of a balance scorecard method. The peculiarities of Murmansk region connected with sustainable environmental development are described. The complex regional indicators approach allows to elaborate the general concept of complex regional development taking into consideration economic and non-economic factors with the focus on environmental aspects, accumulated environmental damage in particular. General strategic chart of sustainable environmental development of the Murmansk region worked out on the basis of complex regional indicators concept is composed. The key target indicators of sustainable ecological development of the Murmansk region are presented for the following strategic chart components: regional finance; society and market; industry and entrepreneurship; training, development and innovations. These charts are to be integrated with international environmental monitoring systems.

  2. Postoperative pain in complex ophthalmic surgical procedures: comparing practice with guidelines.

    Science.gov (United States)

    Lesin, Mladen; Sundov, Zeljka Duplancic; Jukic, Marko; Puljak, Livia

    2014-06-01

    To analyze the management of postoperative pain after complex ophthalmic surgery and to compare it to the guidelines. A retrospective study. University Hospital Split, Croatia. Patients (N = 447) who underwent complex ophthalmic surgical procedures from 2008 to 2012. The following data were extracted from patient medical records: age, gender, type and dosage of premedication, preoperative patient's physical status, type of procedure, duration of procedure-surgical and anesthesia time, type and dosage of anesthesia, the type and dosage of postoperative analgesia for each postoperative day. None of the patients had information about pain intensity in their records. There were 90% patients who did not receive any medication the night before surgery, 54% did not receive any premedication immediately before surgery, 19% did not receive any pain medication after the surgery in the operating room and 46% of patients did not receive any analgesics after being released to the ophthalmology department. Among those who received analgesia after surgery, 98% received only one dose of an analgesic, and 93% of patients received analgesia only on the day of the surgery. Furthermore, patients were returned to the department immediately after surgery, without intensive monitoring. During the analyzed five years there were no educational session organized by anesthesiologist to the ophthalmic surgeons. Postoperative pain management and perioperative care of patients undergoing major ophthalmic surgery indicates lack of attention towards pain intensity and postoperative analgesia. Appropriate interventions should be employed to improve postoperative pain management, to facilitate patient recovery. Wiley Periodicals, Inc.

  3. Optimizing velocities and transports for complex coastal regions and archipelagos

    OpenAIRE

    Haley, Patrick; Agarwal, Arpit; Lermusiaux, Pierre

    2015-01-01

    We derive and apply a methodology for the initialization of velocity and transport fields in complex multiply-connected regions with multiscale dynamics. The result is initial fields that are consistent with observations, complex geometry and dynamics, and that can simulate the evolution of ocean processes without large spurious initial transients. A class of constrained weighted least squares optimizations is defined to best fit first-guess velocities while satisfying the complex bathymetry,...

  4. Estimation of Economic Efficiency of Regional Touristic Complex

    Directory of Open Access Journals (Sweden)

    Kurchenkov Vladimir Viktorovich

    2015-09-01

    Full Text Available The article describes the features of the development of the regional touristic complex in modern conditions and determines the direction of realizing the potential of the regional market of tourist services. The authors reveal the multiplicative interrelation for analyzing the interaction of the primary and secondary sectors of the regional market of tourist services. The key indicators of efficiency are outlined, the extent of their relevance for assessing the potential of international tourism in the region is revealed. The authors calculate the relative indicators reflecting the dynamics of incomes from inbound, outbound and domestic tourism in relation to the total income from tourism activities in the region during the reporting period, usually for one calendar year. On the basis of these parameters, the classification of the regions of the Southern Federal District in terms of tourist attraction is carried out. The authors determine the reasons of the low tourist attractiveness of the Volgograd region in comparison with other regions of the Southern Federal District. It is substantiated that the potential of expanding tourism activity is not fully realized today in the Volgograd region. The technique of analysis and evaluation of the effectiveness of regional touristic complex on the basis of cluster approach is suggested. For analyzing the effectiveness of regional tourism cluster the authors propose to use indicators that reflect the overall performance of the regional tourism cluster, characterizing the impact of cluster development of the area, or the regional market, as well as evaluating the performance of each of the companies cooperating in the framework of the cluster. The article contains recommendations to the regional authorities on improving the efficiency of regional touristic complex in the short- and long-term prospects.

  5. Extracting Neural Oscillation Signatures of Laser-Induced Nociception in Pain-Related Regions in Rats

    Directory of Open Access Journals (Sweden)

    Xuezhu Li

    2017-10-01

    Full Text Available Previous studies have shown that multiple brain regions are involved in pain perception and pain-related neural processes by forming a functionally connected pain network. It is still unclear how these pain-related brain areas actively work together to generate the experience of pain. To get a better insight into the pain network, we implanted electrodes in four pain-related areas of rats including the anterior cingulate cortex (ACC, orbitofrontal cortex (OFC, primary somatosensory cortex (S1 and periaqueductal gray (PAG. We analyzed the pattern of local field potential (LFP oscillations under noxious laser stimulations and innoxious laser stimulations. A high-dimensional feature matrix was built based on the LFP characters for both experimental conditions. Generalized linear models (GLMs were trained to classify recorded LFPs under noxious vs. innoxious condition. We found a general power decrease in α and β bands and power increase in γ band in the recorded areas under noxious condition. After noxious laser stimulation, there was a consistent change in LFP power and correlation in all four brain areas among all 13 rats. With GLM classifiers, noxious laser trials were distinguished from innoxious laser trials with high accuracy (86% using high-dimensional LFP features. This work provides a basis for further research to examine which aspects (e.g., sensory, motor or affective processes of noxious stimulation should drive distinct neural activity across the pain network.

  6. On synchronized regions of discrete-time complex dynamical networks

    International Nuclear Information System (INIS)

    Duan Zhisheng; Chen Guanrong

    2011-01-01

    In this paper, the local synchronization of discrete-time complex networks is studied. First, it is shown that for any natural number n, there exists a discrete-time network which has at least left floor n/2 right floor +1 disconnected synchronized regions for local synchronization, which implies the possibility of intermittent synchronization behaviors. Different from the continuous-time networks, the existence of an unbounded synchronized region is impossible for discrete-time networks. The convexity of the synchronized regions is also characterized based on the stability of a class of matrix pencils, which is useful for enlarging the stability region so as to improve the network synchronizability.

  7. Early Childhood Dental Caries, Mouth Pain, and Malnutrition in the Ecuadorian Amazon Region.

    Science.gov (United States)

    So, Marvin; Ellenikiotis, Yianni A; Husby, Hannah M; Paz, Cecilia Leonor; Seymour, Brittany; Sokal-Gutierrez, Karen

    2017-05-22

    Malnutrition and dental caries in early childhood remain persistent and intertwined global health challenges, particularly for indigenous and geographically-remote populations. To examine the prevalence and associations between early childhood dental caries, parent-reported mouth pain and malnutrition in the Amazonian region of Ecuador, we conducted a cross-sectional study of the oral health and nutrition status of 1407 children from birth through age 6 in the "Alli Kiru" program (2011-2013). We used multivariate regression analysis to examine relationships between severe caries, parent-reported mouth pain measures, and nutritional status. The prevalence of dental caries was 65.4%, with 44.7% of children having deep or severe caries, and 33.8% reporting mouth pain. The number of decayed, missing and filled teeth (dmft) increased dramatically with age. Malnutrition was prevalent, with 35.9% of children stunted, 1.1% wasted, 7.4% underweight, and 6.8% overweight. As mouth pain increased in frequency, odds for severe caries increased. For each unit increase in mouth pain frequency interfering with sleeping, children had increased odds for being underweight (Adjusted Odds Ratio (AOR): 1.27; 95% CI: 1.02-1.54) and decreased odds for being overweight (AOR: 0.76; 95% CI: 0.58-0.97). This relationship was most pronounced among 3-6 year-olds. Early childhood caries, mouth pain and malnutrition were prevalent in this sample of young children. Parent-reported mouth pain was associated with severe caries, and mouth pain interfering with sleeping was predictive of poor nutritional status. We demonstrate the utility of a parsimonious parent-reported measure of mouth pain to predict young children's risk for severe early childhood caries and malnutrition, which has implications for community health interventions.

  8. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.

    Science.gov (United States)

    Narouze, Samer; Benzon, Honorio T; Provenzano, David A; Buvanendran, Asokumar; De Andres, José; Deer, Timothy R; Rauck, Richard; Huntoon, Marc A

    2015-01-01

    Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures. In response, ASRA formed a guidelines committee. After preliminary review of published complication reports and studies, committee members stratified interventional spine and pain procedures according to potential bleeding risk as low-, intermediate-, and high-risk procedures. The ASRA guidelines were deemed largely appropriate for the low- and intermediate-risk categories, but it was agreed that the high-risk targets required an intensive look at issues specific to patient safety and optimal outcomes in pain medicine. The latest evidence was sought through extensive database search strategies and the recommendations were evidence-based when available and pharmacology-driven otherwise. We could not provide strength and grading of these recommendations as there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations.

  9. Neurochemical dynamics of acute orofacial pain in the human trigeminal brainstem nuclear complex.

    Science.gov (United States)

    de Matos, Nuno M P; Hock, Andreas; Wyss, Michael; Ettlin, Dominik A; Brügger, Mike

    2017-11-15

    The trigeminal brainstem sensory nuclear complex is the first central relay structure mediating orofacial somatosensory and nociceptive perception. Animal studies suggest a substantial involvement of neurochemical alterations at such basal CNS levels in acute and chronic pain processing. Translating this animal based knowledge to humans is challenging. Human related examining of brainstem functions are challenged by MR related peculiarities as well as applicability aspects of experimentally standardized paradigms. Based on our experience with an MR compatible human orofacial pain model, the aims of the present study were twofold: 1) from a technical perspective, the evaluation of proton magnetic resonance spectroscopy at 3 T regarding measurement accuracy of neurochemical profiles in this small brainstem nuclear complex and 2) the examination of possible neurochemical alterations induced by an experimental orofacial pain model. Data from 13 healthy volunteers aged 19-46 years were analyzed and revealed high quality spectra with significant reductions in total N-acetylaspartate (N-acetylaspartate + N-acetylaspartylglutamate) (-3.7%, p = 0.009) and GABA (-10.88%, p = 0.041) during the pain condition. These results might reflect contributions of N-acetylaspartate and N-acetylaspartylglutamate in neuronal activity-dependent physiologic processes and/or excitatory neurotransmission, whereas changes in GABA might indicate towards a reduction in tonic GABAergic functioning during nociceptive signaling. Summarized, the present study indicates the applicability of 1 H-MRS to obtain neurochemical dynamics within the human trigeminal brainstem sensory nuclear complex. Further developments are needed to pave the way towards bridging important animal based knowledge with human research to understand the neurochemistry of orofacial nociception and pain. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Effects of A Combined Treatment Protocol in Chronic Regional Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Ali Asghar Jameh-Bozorgi

    2011-01-01

    Full Text Available Objective: Chronic regional pain syndrome (CRPS is one of the most important and worst types of peripheral nervous system, especially in upper extremity. The aim of this study was determination of the effect of a combined rehabilitation program in the treatment of patients with CRPS type I. Materials & Methods: In this quasi-experimental and before-after study, 20 patients with chronic regional pain syndrome were selected simply and their pain, range of motion, edema and muscular strength were examined and recorded before intervention. Then, patients under went a combined treatment programs included some modalities from physical and occupation therapy. Patients attended at clinic for 20 therapeutic sessions with one day intervals. Finally, data were analyzed using paired–t test. Results: Post operatively, pain and edema were decreased and range of motion and grip strength was increased significantly (P>0.05. Conclusion: Current study demonstrated that early and combined physical and occupational therapy efficient in the treatment of patients suffering from CRPS type I. This combined program can relieve pain and edema and increase ROM and grip strength.

  11. Differential structural and resting state connectivity between insular subdivisions and other pain-related brain regions.

    Science.gov (United States)

    Wiech, K; Jbabdi, S; Lin, C S; Andersson, J; Tracey, I

    2014-10-01

    Functional neuroimaging studies suggest that the anterior, mid, and posterior division of the insula subserve different functions in the perception of pain. The anterior insula (AI) has predominantly been associated with cognitive-affective aspects of pain, while the mid and posterior divisions have been implicated in sensory-discriminative processing. We examined whether this functional segregation is paralleled by differences in (1) structural and (2) resting state connectivity and (3) in correlations with pain-relevant psychological traits. Analyses were restricted to the 3 insular subdivisions and other pain-related brain regions. Both type of analyses revealed largely overlapping results. The AI division was predominantly connected to the ventrolateral prefrontal cortex (structural and resting state connectivity) and orbitofrontal cortex (structural connectivity). In contrast, the posterior insula showed strong connections to the primary somatosensory cortex (SI; structural connectivity) and secondary somatosensory cortex (SII; structural and resting state connectivity). The mid insula displayed a hybrid connectivity pattern with strong connections with the ventrolateral prefrontal cortex, SII (structural and resting state connectivity) and SI (structural connectivity). Moreover, resting state connectivity revealed strong connectivity of all 3 subdivisions with the thalamus. On the behavioural level, AI structural connectivity was related to the individual degree of pain vigilance and awareness that showed a positive correlation with AI-amygdala connectivity and a negative correlation with AI-rostral anterior cingulate cortex connectivity. In sum, our findings show a differential structural and resting state connectivity for the anterior, mid, and posterior insula with other pain-relevant brain regions, which might at least partly explain their different functional profiles in pain processing. Copyright © 2014 The Authors. Published by Elsevier B.V. All

  12. Contribution of Large Region Joint Associations to Complex Traits Genetics

    Science.gov (United States)

    Paré, Guillaume; Asma, Senay; Deng, Wei Q.

    2015-01-01

    A polygenic model of inheritance, whereby hundreds or thousands of weakly associated variants contribute to a trait’s heritability, has been proposed to underlie the genetic architecture of complex traits. However, relatively few genetic variants have been positively identified so far and they collectively explain only a small fraction of the predicted heritability. We hypothesized that joint association of multiple weakly associated variants over large chromosomal regions contributes to complex traits variance. Confirmation of such regional associations can help identify new loci and lead to a better understanding of known ones. To test this hypothesis, we first characterized the ability of commonly used genetic association models to identify large region joint associations. Through theoretical derivation and simulation, we showed that multivariate linear models where multiple SNPs are included as independent predictors have the most favorable association profile. Based on these results, we tested for large region association with height in 3,740 European participants from the Health and Retirement Study (HRS) study. Adjusting for SNPs with known association with height, we demonstrated clustering of weak associations (p = 2x10-4) in regions extending up to 433.0 Kb from known height loci. The contribution of regional associations to phenotypic variance was estimated at 0.172 (95% CI 0.063-0.279; p < 0.001), which compared favorably to 0.129 explained by known height variants. Conversely, we showed that suggestively associated regions are enriched for known height loci. To extend our findings to other traits, we also tested BMI, HDLc and CRP for large region associations, with consistent results for CRP. Our results demonstrate the presence of large region joint associations and suggest these can be used to pinpoint weakly associated SNPs. PMID:25856144

  13. Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain

    Science.gov (United States)

    Davis, Matthew A.; Yakusheva, Olga; Gottlieb, Daniel J.; Bynum, Julie P.W.

    2015-01-01

    Background Whether availability of chiropractic care affects use of primary care physician (PCP) services is unknown. Methods We performed a cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to 2011. We examined the relationship between regional supply of chiropractic care and PCP services using Spearman correlation. Generalized linear models were used to examine the association between regional supply of chiropractic care and number of annual visits to PCPs for back and/or neck pain. Results We found a positive association between regional supply of chiropractic care and PCP services (rs = 0.52; P neck pain was apparent. The number of PCP visits for back and/or neck pain was 8% lower (rate ratio, 0.92; 95% confidence interval, 0.91–0.92) in the quintile with the highest supply of chiropractic care compared to the lowest quintile. We estimate chiropractic care is associated with a reduction of 0.37 million visits to PCPs nationally, at a cost of $83.5 million. Conclusions Greater availability of chiropractic care in some areas may be offsetting PCP services for back and/or neck pain among older adults. (J Am Board Fam Med 2015;28:000–000.) PMID:26152439

  14. The major histocompatibility complex genes impact pain response in DA and DA.1U rats.

    Science.gov (United States)

    Guo, Yuan; Yao, Fan-Rong; Cao, Dong-Yuan; Li, Li; Wang, Hui-Sheng; Xie, Wen; Zhao, Yan

    2015-08-01

    Our recent studies have shown that the difference in basal pain sensitivity to mechanical and thermal stimulation between Dark-Agouti (DA) rats and a novel congenic DA.1U rats is major histocompatibility complex (MHC) genes dependent. In the present study, we further used DA and DA.1U rats to investigate the role of MHC genes in formalin-induced pain model by behavioral, electrophysiological and immunohistochemical methods. Behavioral results showed biphasic nociceptive behaviors increased significantly following the intraplantar injection of formalin in the hindpaw of DA and DA.1U rats. The main nociceptive behaviors were lifting and licking, especially in DA rats (PDA rats were significantly higher than those in DA.1U rats in both phases of the formalin test (PDA rats was significantly higher than that of DA.1U rats (PDA was greater than that in DA.1U rats (PDA rats was significantly higher than that in DA.1U rats in the respective experimental group (PDA and DA.1U rats exhibited nociceptive responses in formalin-induced pain model and DA rats were more sensitive to noxious chemical stimulus than DA.1U rats, indicating that MHC genes might contribute to the difference in pain sensitivity. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.

    Science.gov (United States)

    Narouze, Samer; Benzon, Honorio T; Provenzano, David; Buvanendran, Asokumar; De Andres, José; Deer, Timothy; Rauck, Richard; Huntoon, Marc A

    2018-04-01

    The American Society of Regional Anesthesia and Pain Medicine (ASRA) 2012 survey of meeting attendees showed that existing ASRA anticoagulation guidelines for regional anesthesia were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures. In response, a guidelines committee was formed. After preliminary review of published complications reports and studies, the committee stratified interventional spine and pain procedures according to potential bleeding risk: low-, intermediate-, and high-risk procedures. The ASRA regional anesthesia anticoagulation guidelines were largely deemed appropriate for the low- and intermediate-risk categories, but the high-risk category required further investigation. The first guidelines specific to interventional spine and pain procedures were published in 2015. Recent reviews evaluating bleeding complications in patients undergoing specific interventional pain procedures, the development of new regional anesthesia and acute pain guidelines, and the development of new anticoagulants and antiplatelet medications necessitate complementary updated guidelines. The authors desired coordination with the authors of the recently updated regional and acute pain anticoagulation guidelines. The latest evidence was sought through extensive database search strategies and the recommendations were evidence based when available and pharmacology driven otherwise. We could not provide strength and grading of these recommendations because there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations. This publication is intended as a living document to be updated

  16. Spontaneous behavioral responses in the orofacial region: A model of trigeminal pain in mouse

    Science.gov (United States)

    Romero-Reyes, Marcela; Akerman, Simon; Nguyen, Elaine; Vijjeswarapu, Alice; Hom, Betty; Dong, Hong-Wei; Charles, Andrew C.

    2012-01-01

    OBJECTIVES To develop a translational mouse model for the study and measurement of non-evoked pain in the orofacial region by establishing markers of nociceptive-specific grooming behaviors in the mouse. BACKGROUND Some of the most prevalent and debilitating conditions involve pain in the trigeminal distribution. Although there are current therapies for these pain conditions, for many patients they are far from optimal. Understanding the pathophysiology of pain disorders arising from structures innervated by the trigeminal nerve is still limited and most animal behavioral models focus on the measurement of evoked pain. In patients, spontaneous (non-evoked) pain responses provide a more accurate representation of the pain experience than do responses that are evoked by an artificial stimulus. Therefore, the development of animal models that measure spontaneous nociceptive behaviors may provide a significant translational tool for a better understanding of pain neurobiology. METHODS C57BL/6 mice received either an injection of 0.9% Saline solution or complete Freund’s adjuvant (CFA) into the right masseter muscle. Animals were video recorded and then analyzed by an observer blind to the experiment group. The duration of different facial grooming patterns performed in the area of injection were measured. After 2 hrs, mice were euthanized, perfused and the brainstem was removed. Fos protein expression in the trigeminal nucleus caudalis was quantified using immunohistochemistry to investigate nociceptive-specific neuronal activation. A separate group of animals was treated with morphine sulfate, to determine the nociceptive-specific nature of their behaviors. RESULTS We characterized and quantified 3 distinct patterns of acute grooming behaviors: fore-paw rubbing, lower lip skin/cheek rubbing against enclosure floor and hind paw scratching. These behaviors occurred with a reproducible frequency and time course, and were inhibited by the analgesic morphine. CFA

  17. Optimizing velocities and transports for complex coastal regions and archipelagos

    Science.gov (United States)

    Haley, Patrick J.; Agarwal, Arpit; Lermusiaux, Pierre F. J.

    2015-05-01

    We derive and apply a methodology for the initialization of velocity and transport fields in complex multiply-connected regions with multiscale dynamics. The result is initial fields that are consistent with observations, complex geometry and dynamics, and that can simulate the evolution of ocean processes without large spurious initial transients. A class of constrained weighted least squares optimizations is defined to best fit first-guess velocities while satisfying the complex bathymetry, coastline and divergence strong constraints. A weak constraint towards the minimum inter-island transports that are in accord with the first-guess velocities provides important velocity corrections in complex archipelagos. In the optimization weights, the minimum distance and vertical area between pairs of coasts are computed using a Fast Marching Method. Additional information on velocity and transports are included as strong or weak constraints. We apply our methodology around the Hawaiian islands of Kauai/Niihau, in the Taiwan/Kuroshio region and in the Philippines Archipelago. Comparisons with other common initialization strategies, among hindcasts from these initial conditions (ICs), and with independent in situ observations show that our optimization corrects transports, satisfies boundary conditions and redirects currents. Differences between the hindcasts from these different ICs are found to grow for at least 2-3 weeks. When compared to independent in situ observations, simulations from our optimized ICs are shown to have the smallest errors.

  18. Reabilitação funcional e analgesia com uso de toxina botulínica A na síndrome dolorosa regional complexa tipo I do membro superior: relato de casos Rehabilitación funcional y analgesia con uso de toxina botulínica A en el síndrome doloroso regional compleja tipo I del miembro superior: relato de casos Functional rehabilitation and analgesia with botulinum toxin A in upper limb complex regional pain syndrome type I: case reports

    Directory of Open Access Journals (Sweden)

    Gabriela Rocha Lauretti

    2005-04-01

    acometido. Se relatan dos casos de SDRC donde la aplicación de toxina botulínica-A como fármaco coadyuvante contribuyó en la recuperación funcional motora del miembro acometido. RELATO DE LOS CASOS: Dos pacientes portadoras de SDRC tipo I fueron inicialmente evaluadas para control del dolor en miembro superior derecho. Ambas presentaban incapacidad para abrir la mano y dolor por la escala analógica numérica (EAN de 10 en reposo o cuando la mano o los dedos eran pasivamente manejados. Se inició secuencia de 5 bloqueos, del ganglio estrellado ipsilateral a intervalos semanales, con clonidina y lidocaína. Simultáneamente, durante la realización del tercer bloqueo del ganglio estrellado, fue administrado 75 UI de toxina botulínica A en los músculos flexores de las falanges y de la articulación del puño. Una semana después de aplicación de la toxina botulínica A, las pacientes presentaban relajamiento de las falanges y del puño, relataban facilidad para la ejecución de la fisioterapia pasiva y el dolor clasificado fue como 2 (EAN a la manipulación pasiva. Al término de la realización de la secuencia de bloqueos del ganglio estrellado, las pacientes fueron sometidas a 3 sesiones semanales de administración por vía venosa regional de clonidina, lidocaína y parecoxib. Después de 8 meses de evaluación las pacientes presentaron 70% y 80% de recuperación motora y funcional del miembro acometido. CONCLUSIONES: La aplicación por vía muscular de toxina botulínica A resultó en mejora del movimiento del miembro acometido, analgesia auxiliando en su recuperación funcional.BACKGROUND AND OBJECTIVES: Functional inability of the affected limb is often added to alodynia and hyperalgesia in Complex Regional Pain Syndrome (CRPS type I. Two CRPS cases are reported in which botulinum toxin A as coadjuvant drug has contributed to motor and functional recovery of the affected limb. CASE REPORTS: Two CRPS type I patients were initially evaluated for upper limb pain

  19. Results from 10 Years of a CBT Pain Self-Management Outpatient Program for Complex Chronic Conditions

    Directory of Open Access Journals (Sweden)

    Kathryn A. Boschen

    2016-01-01

    Full Text Available Background. Traditional unimodal interventions may be insufficient for treating complex pain, as they do not address cognitive and behavioural contributors to pain. Cognitive Behavioural Therapy (CBT and physical exercise (PE are empirically supported treatments that can reduce pain and improve quality of life. Objectives. To examine the outcomes of a pain self-management outpatient program based on CBT and PE at a rehabilitation hospital in Toronto, Ontario. Methods. The pain management group (PMG consisted of 20 sessions over 10 weeks. The intervention consisted of four components: education, cognitive behavioural skills, exercise, and self-management strategies. Outcome measures included the sensory, affective, and intensity of pain experience, depression, anxiety, pain disability, active and passive coping style, and general health functioning. Results. From 2002 to 2011, 36 PMGs were run. In total, 311 patients entered the program and 214 completed it. Paired t-tests showed significant pre- to posttreatment improvements in all outcomes measured. Patient outcomes did not differ according to the number or type of diagnoses. Both before and after treatment, women reported more active coping than men. Discussion. The PMGs improved pain self-management for patients with complex pain. Future research should use a randomized controlled design to better understand the outcomes of PMGs.

  20. Priority Directions of The Regional Food Complex Effectiveness Increase

    Directory of Open Access Journals (Sweden)

    Dmitry Andreyevich Karkh

    2015-06-01

    Full Text Available In the article, the modern trends of management integration as a solution of food and sectoral problems are considered. On the basis of national and foreign experience of development of integration, the classification of integration in economic systems is developed. On the basis of the given classification, the concept of integration is conducted. In the article, much attention is given to the food problem solution, which depends more on the agro-industrial complex based on metaintegration. The leading place of a food complex in the system of agro-industrial complex is caused by a role of food and food raw materials in life of the population of the country. The ratio of the sectors participating in the food production and consumer goods makes the sectoral structure of agro-industrial complex. In the conditions of the resource limitation necessary for the production and food delivery to the domestic market, the role of trade will increase not only in agro-industrial complex, but in all national economy. Also, in this article, the phenomenon of clusters is studied. The attention to clusters as to innovation systems reflects a rising tide of interest of economic science to the questions of economics functioning in regional level and understanding of a role of specific local resources in stimulation of innovative opportunities and competitiveness of small and medium business. Creating a cluster, participants develop the spatial and organizational integrated structure, in interaction of legal entities the status is saved and cooperation provides competitive advantages with other business entities. The role of the state in integration of cluster formations in the Russian Federation is more significant, than in any other country. The state represented by regional authorities actively participates in decision-making process by the business located in its catchment area not only through membership in governing bodies of large joint stock companies.

  1. Regional Anesthesia and Valproate Sodium for the Prevention of Chronic Post-Amputation Pain

    Science.gov (United States)

    2014-10-01

    undergone amputation: • Phantom, Residual Limb Pain, and Prosthesis Questions (from the patient interview) ANALYTIC TESTS Blood Sample Collections The...Exam: to be completed at study enrollment, 3 and 6 month visits The investigators will perform an exam of the affected limb by removing the prosthesis ...may feel dizzy and lightheaded but these are typically mild and self-limited. Thomas Buchheit, MD Regional Anesthesia & Valproate

  2. Clonidine versus ketamine to prevent tourniquet pain during intravenous regional anesthesia with lidocaine.

    Science.gov (United States)

    Gorgias, N K; Maidatsi, P G; Kyriakidis, A M; Karakoulas, K A; Alvanos, D N; Giala, M M

    2001-01-01

    Both clonidine and ketamine have been found to prolong the action of local anesthetics through a peripheral mechanism. Our study compares the efficacy of a low dose of clonidine or ketamine separately added to intravenous regional anesthesia (IVRA) with lidocaine to prevent tourniquet pain. We conducted a prospective randomized double-blinded study in 45 patients undergoing hand or forearm surgery, with anticipated duration exceeding 1 hour under IVRA. Proximal cuff inflation of a double tourniquet was followed by administration of 40 mL of lidocaine 0.5% and either saline, 1 microg/kg clonidine, or 0.1 mg/kg ketamine. When anesthesia was established, the inflation of the proximal and distal cuff was interchanged. Thereafter, tourniquet pain was rated on a visual analog scale (VAS) every 10 minutes. Intraoperatively, boluses of 25 microg fentanyl were provided for tourniquet pain treatment when required, and total fentanyl consumption was recorded. Patients receiving plain lidocaine persistently reported the highest pain scores among groups (P <.001) 20 minutes after distal cuff inflation. Differences between the groups with additional treatment were noted 50 minutes after distal cuff inflation and until the end of the observation, with significantly lower VAS ratings (P <.001 to P <.01) in ketamine-treated patients. Total fentanyl consumption was significantly decreased by ketamine (70.00 +/- 25.35 microg) or clonidine (136.67 +/- 39.94 microg) compared with the plain lidocaine group (215.33 +/- 52.33 microg) (P <.001 between all groups). The addition of clonidine 1 microg/kg or ketamine 0.1 mg/kg to lidocaine for IVRA delays the onset of unbearable tourniquet pain and decreases analgesic consumption for tourniquet pain relief, although ketamine has a more potent effect.

  3. Pain

    OpenAIRE

    H.W. Snyman

    1980-01-01

    The medical profession has always been under pressure to supply public explanations of the diseases with which it deals. On the other hand, it is an old characteristic of the profession to devise comprehensive and unifying theories on all sorts of medical problems. Both these statements apply to pain - one of the most important and clinically striking phenomena and expressions of man since his origin in the mists of time.

  4. Pain

    Directory of Open Access Journals (Sweden)

    H.W. Snyman

    1980-09-01

    Full Text Available The medical profession has always been under pressure to supply public explanations of the diseases with which it deals. On the other hand, it is an old characteristic of the profession to devise comprehensive and unifying theories on all sorts of medical problems. Both these statements apply to pain - one of the most important and clinically striking phenomena and expressions of man since his origin in the mists of time.

  5. Security Inequalities in North America: Reassessing Regional Security Complex Theory

    Directory of Open Access Journals (Sweden)

    Richard Kilroy

    2017-12-01

    Full Text Available This article re-evaluates earlier work done by the authors on Regional Security Complex Theory (RSCT in North America, using sectoral analysis initially developed by Buzan and Waever, but also adding the variables of institutions, identity, and interests. These variables are assessed qualitatively in the contemporary context on how they currently impress upon the process of securitization within sectoral relations between Canada, Mexico, and the United States. The article reviews the movement from bilateral security relations between these states to the development of a trilateral response to regional security challenges post- 9/11. It further addresses the present period and what appears to be a security process derailed by recent political changes and security inequalities, heightened by the election of Donald Trump in 2016. The article argues that while these three states initially evinced a convergence of regional security interests after 9/11, which did create new institutional responses, under the current conditions, divergence in political interests and security inequalities have reduced the explanatory power of RSCT in North America. Relations between states in North American are becoming less characterized by the role of institutions and interests and more by identity politics in the region.

  6. Women's preferences and received pain relief in childbirth - A prospective longitudinal study in a northern region of Sweden.

    Science.gov (United States)

    Lindholm, Annika; Hildingsson, Ingegerd

    2015-06-01

    A range of alternatives in pain management during childbirth are available in the western countries. Women's preferences for and use of pain relief methods during labour is not fully investigated. The aim of this study was to describe what pain relief methods pregnant women preferred when asked in late pregnancy and to identify factors associated with preferred and received pain relief methods. A prospective longitudinal study in a northern region of Sweden (n = 936). Data were collected by three questionnaires. Odds ratios with a 95% confidence interval were calculated between preferred and received pain relief methods for several explanatory variables. The most preferred pain relief methods were also the most common received pain relief methods; nitrous oxide, bathing, breathing techniques, epidural analgesia and massage. The strongest factors for using different pain relief methods were primiparity and preferences. Women who used epidural analgesia, regardless of preference, were two to four times more likely to have a less positive birth experience. Women's preferences for a certain pain relief method were largely met. Greater differences were seen between background factors and preferences than the received pain relief methods. Preferences and primiparity were the most important factors for actually using pain relief. Epidural analgesia was associated with a less positive birth experience. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Day case shoulder surgery: satisfactory pain control without regional anaesthesia. A prospective analysis of a perioperative protocol.

    LENUS (Irish Health Repository)

    Daruwalla, Z J

    2009-03-01

    Pain control is an issue which may limit patients\\' acceptance of day case shoulder surgery. This study prospectively examined the outcome of a protocol for day case shoulder surgery to determine if satisfactory pain relief could be achieved without regional anaesthesia.

  8. Cervical Epidural Anaesthesia for Radical Mastectomy and Chronic Regional Pain Syndrome of Upper Limb - A Case Report

    Directory of Open Access Journals (Sweden)

    Ashok Jadon

    2009-01-01

    Full Text Available A 47-yrs-female patient presented with carcinoma right breast, swelling and allodynia of right upper limb. radical mastectomy with axillary clearance and skin grafting was done under cervical epidural anaesthesia through 18G epidural catheter placed at C6/C7 level. Postoperative analgesia and rehabilitation of affected right upper limb was managed by continuous epidural infusion of 0.125% bupivacaine and 2.5 µg/ml -1 clonidine solution through epidu-ral catheter for 5 days and physiotherapy. This case report highlights the usefulness of cervical epidural analgesia in managing a complex situation of carcinoma breast with associated periarthitis of shoulder joint and chronic regional pain syndrome (CRPS of right upper limb.

  9. Central representation of muscle pain and mechanical hyperesthesia in the orofacial region: a positron emission tomography study

    DEFF Research Database (Denmark)

    Kupers, Rron; Svensson, Peter; Jensen, Troels Staehlin

    2004-01-01

    Functional neuroimaging studies of the human brain have revealed a network of brain regions involved in the processing of nociceptive information. However, little is known of the cerebral processing of pain originating from muscles. The aim of this study was to investigate the cerebral activation...... pattern evoked by experimental jaw-muscle pain and its interference by simultaneous mechanical stimuli, which has been shown to evoke hyperesthesia. Ten healthy subjects participated in a PET study and jaw-muscle pain was induced by bolus injections of 5% hypertonic saline into the right masseter muscle....... Repeated von Frey hair stimulation (0.5 Hz) of the skin above the masseter muscle was used as the mechanical stimulus. Hypertonic saline injections caused strong muscle pain spreading to adjacent areas. von Frey stimulation was rated as non-painful but produced hyperesthesia during jaw-muscle pain. Jaw...

  10. QUANTITATIVE CHANGES IN REGIONAL CEREBRAL BLOOD FLOW INDUCED BY COLD, HEAT AND ISCHEMIC PAIN: A CONTINUOUS ARTERIAL SPIN LABELING STUDY

    Science.gov (United States)

    Frölich, Michael A.; Deshpande, Hrishikesh; Ness, Timothy; Deutsch, Georg

    2012-01-01

    Background The development of arterial spin labeling methods, has allowed measuring regional cerebral blood flow (rCBF) quantitatively and to show the pattern of cerebral activity associated with any state such as a sustained pain state or changes due to a neurotropic drug. Methods We studied the differential effects of three pain conditions in ten healthy subjects on a 3T scanner during resting baseline, heat, cold and ischemic pain using continuous arterial spin labeling. Results Cold pain showed the greatest absolute rCBF increases in left anterior cingulate cortex, left amygdala, left angular gyrus, and Brodmann Area 6, and a significant rCBF decrease in the cerebellum. Changes in rCBF were characteristic of the type of pain condition: cold and heat pain showed increases, while the ischemic condition showed a reduction in mean absolute gray matter flow compared to rest. An association of subjects’ pain tolerance and cerebral blood flow was noted. Conclusions The observation that quantitative rCBF changes are characteristic of the pain task employed and that there is a consistent rCBF change in Brodman area 6, an area responsible for the integration of a motor response to pain, should provide extremely useful information in the quest to develop an imaging biomarker of pain. Conceivably, response in BA6 may serve as an objective measure of analgesic efficacy. PMID:22913924

  11. Quantitative changes in regional cerebral blood flow induced by cold, heat and ischemic pain: a continuous arterial spin labeling study.

    Science.gov (United States)

    Frölich, Michael A; Deshpande, Hrishikesh; Ness, Timothy; Deutsch, Georg

    2012-10-01

    The development of arterial spin labeling methods has allowed measuring regional cerebral blood flow (rCBF) quantitatively and to show the pattern of cerebral activity associated with any state such as a sustained pain state or changes due to a neurotropic drug. The authors studied the differential effects of three pain conditions in 10 healthy subjects on a 3 Tesla scanner during resting baseline, heat, cold, and ischemic pain using continuous arterial spin labeling. Cold pain showed the greatest absolute rCBF increases in left anterior cingulate cortex, left amygdala, left angular gyrus, and Brodmann area 6, and a significant rCBF decrease in the cerebellum. Changes in rCBF were characteristic of the type of pain condition: cold and heat pain showed increases, whereas the ischemic condition showed a reduction in mean absolute gray matter flow compared with rest. An association of subjects' pain tolerance and cerebral blood flow was noted. The observation that quantitative rCBF changes are characteristic of the pain task used and that there is a consistent rCBF change in Brodman area 6, an area responsible for the integration of a motor response to pain, should provide extremely useful information in the quest to develop an imaging biomarker of pain. Conceivably, response in BA6 may serve as an objective measure of analgesic efficacy.

  12. Regional socioeconomic disparities in outcomes for workers with low back pain in the United States.

    Science.gov (United States)

    Shraim, Mujahed; Cifuentes, Manuel; Willetts, Joanna L; Marucci-Wellman, Helen R; Pransky, Glenn

    2017-05-01

    Although regional socioeconomic (SE) factors have been associated with worse health outcomes, prior studies have not addressed important confounders or work disability. A national sample of 59 360 workers' compensation (WC) cases to evaluate impact of regional SE factors on medical costs and length of disability (LOD) in occupational low back pain (LBP). Lower neighborhood median household incomes (MHI) and higher state unemployment rates were associated with longer LOD. Medical costs were lower in states with more workers receiving Social Security Disability, and in areas with lower MHI, but this varied in magnitude and direction among neighborhoods. Medical costs were higher in more urban, more racially diverse, and lower education neighborhoods. Regional SE disparities in medical costs and LOD occur even when health insurance, health care availability, and indemnity benefits are similar. Results suggest opportunities to improve care and disability outcomes through targeted health care and disability interventions. © 2017 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.

  13. The Pain of Labour

    Science.gov (United States)

    Labor, Simona

    2008-01-01

    Labour is an emotional experience and involves both physiological and psychological mechanisms. The pain of labour is severe but despite this its memory diminishes with time. Labour pain has two components: visceral pain which occurs during the early first stage and the second stage of childbirth, and somatic pain which occurs during the late first stage and the second stage. The pain of labour in the first stage is mediated by T10 to L1 spinal segments, whereas that in the second stage is carried by T12 to L1, and S2 to S4 spinal segments. Pain relief in labour is complex and often challenging without regional analgesia. Effective management of labour pain plays a relatively minor role in a woman's satisfaction with childbirth. PMID:26526404

  14. Availability and Readability of Online Patient Education Materials Regarding Regional Anesthesia Techniques for Perioperative Pain Management.

    Science.gov (United States)

    Kumar, Gunjan; Howard, Steven K; Kou, Alex; Kim, T Edward; Butwick, Alexander J; Mariano, Edward R

    2017-10-01

    Patient education materials (PEM) should be written at a sixth-grade reading level or lower. We evaluated the availability and readability of online PEM related to regional anesthesia and compared the readability and content of online PEM produced by fellowship and nonfellowship institutions. With IRB exemption, we constructed a cohort of online regional anesthesia PEM by searching Websites from North American academic medical centers supporting a regional anesthesiology and acute pain medicine fellowships and used a standardized Internet search engine protocol to identify additional nonfellowship Websites with regional anesthesia PEM based on relevant keywords. Readability metrics were calculated from PEM using the TextStat 0.1.4 textual analysis package for Python 2.7 and compared between institutions with and without a fellowship program. The presence of specific descriptive PEM elements related to regional anesthesia was also compared between groups. PEM from 17 fellowship and 15 nonfellowship institutions were included in analyses. The mean (SD) Flesch-Kincaid Grade Level for PEM from the fellowship group was 13.8 (2.9) vs 10.8 (2.0) for the nonfellowship group (p = 0.002). We observed no other differences in readability metrics between fellowship and nonfellowship institutions. Fellowship-based PEM less commonly included descriptions of the following risks: local anesthetic systemic toxicity (p = 0.033) and injury due to an insensate extremity (p = 0.003). Available online PEM related to regional anesthesia are well above the recommended reading level. Further, fellowship-based PEM posted are at a higher reading level than PEM posted by nonfellowship institutions and are more likely to omit certain risk descriptions. 2016 American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.

  15. Multifractal analysis of forest fires in complex regions

    Science.gov (United States)

    Vega Orozco, C. D.; Kanevski, M.; Golay, J.; Tonini, M.; Conedera, M.

    2012-04-01

    Forest fires can be studied as point processes where the ignition points represent the set of locations of the observed events in a defined study region. Their spatial and temporal patterns can be characterized by their fractal properties; which quantify the global aspect of the geometry of the support data. However, a monofractal dimension can not completely describe the pattern structure and related scaling properties. Enhancements in fractal theory had developed the multifractal concept which describes the measures from which interlinked fractal sets can be retrieved and characterized by their fractal dimension and singularity strength [1, 2]. The spatial variability of forest fires is conditioned by an intermixture of human, topographic, meteorological and vegetation factors. This heterogeneity makes fire patterns complex scale-invariant processes difficult to be depicted by a single scale. Therefore, this study proposes an exploratory data analysis through a multifractal formalism to characterize and quantify the multiscaling behaviour of the spatial distribution pattern of this phenomenon in a complex region like the Swiss Alps. The studied dataset is represented by 2,401 georeferenced forest fire ignition points in canton Ticino, Switzerland, in a 40-years period from 1969 to 2008. Three multifractal analyses are performed: one assesses the multiscaling behaviour of fire occurrence probability of the support data (raw data) and four random patterns simulated within three different support domains; second analysis studies the multifractal behavior of patterns from anthropogenic and natural ignited fires (arson-, accident- and lightning-caused fires); and third analysis aims at detecting scale-dependency of the size of burned area. To calculate the generalized dimensions, Dq, a generalization of the box counting methods is carried out based on the generalization of Rényi information of the qth order moment of the probability distribution. For q > 0, Dq

  16. Regional differences in lumbar spinal posture and the influence of low back pain

    Directory of Open Access Journals (Sweden)

    Burnett Angus F

    2008-11-01

    Full Text Available Abstract Background Spinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP patients. However, the link between spinal posture and LBP is not fully understood. Recent evidence suggests that considering regional, rather than total lumbar spine posture is important. The purpose of this study was to determine; if there are regional differences in habitual lumbar spine posture and movement, and if these findings are influenced by LBP. Methods One hundred and seventy female undergraduate nursing students, with and without LBP, participated in this cross-sectional study. Lower lumbar (LLx, Upper lumbar (ULx and total lumbar (TLx spine angles were measured using an electromagnetic tracking system in static postures and across a range of functional tasks. Results Regional differences in lumbar posture and movement were found. Mean LLx posture did not correlate with ULx posture in sitting (r = 0.036, p = 0.638, but showed a moderate inverse correlation with ULx posture in usual standing (r = -0.505, p Conclusion This study supports the concept of regional differences within the lumbar spine during common postures and movements. Global lumbar spine kinematics do not reflect regional lumbar spine kinematics, which has implications for interpretation of measures of spinal posture, motion and loading. BMI influenced regional lumbar posture and movement, possibly representing adaptation due to load.

  17. An empirical application of regional security complex theory on eastern partnership region

    Directory of Open Access Journals (Sweden)

    Ludmila STUPARU

    2015-12-01

    Full Text Available Eastern Partnership (EaP is a very dynamic region. If a year ago the EaP was seen as an authentic and vibrant „laboratory” of democracy building, overcoming the remains of the totalitarian state and putting the basis of a free and pluralist society, nowadays the Eastern Partnership is seen as an „out-dated” approach of the EU. However, Eastern Partnership is visible on European political arena and the big powers (USA, Russia and the EU pay attention more and more to the evolution of EaP countries. Moreover, it seems to be a confrontation between Russia and Western powers regarding the political and geopolitical orientation of EaP countries. Kremlin tries actively to stop the efforts of the EaP to close to the EU and on the other side, the EU as well as the USA encourage EaP countries to implement reforms in order to build their democracy. This paper aims to analyse the Eastern Partnership in terms of security complex, trying to argue that Eastern Partnership countries at this phase don’t form a Regional Security Complex and the EU and USA should rethink its approach towards this region.

  18. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1993-01-01

    also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree......Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may...

  19. 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

  20. Diagnosis and treatment of posterior sacroiliac complex pain: a systematic review with comprehensive analysis of the published data.

    Science.gov (United States)

    King, Wade; Ahmed, Shihab U; Baisden, Jamie; Patel, Nileshkumar; Kennedy, David J; Duszynski, Belinda; MacVicar, John

    2015-02-01

    To assess the evidence on the validity of sacral lateral branch blocks and the effectiveness of sacral lateral branch thermal radiofrequency neurotomy in managing sacroiliac complex pain. Systematic review with comprehensive analysis of all published data. Six reviewers searched the literature on sacral lateral branch interventions. Each assessed the methodologies of studies found and the quality of the evidence presented. The outcomes assessed were diagnostic validity and effectiveness of treatment for sacroiliac complex pain. The evidence found was appraised in accordance with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system of evaluating scientific evidence. The searches yielded two primary publications on sacral lateral branch blocks and 15 studies of the effectiveness of sacral lateral branch thermal radiofrequency neurotomy. One study showed multisite, multidepth sacral lateral branch blocks can anesthetize the posterior sacroiliac ligaments. Therapeutic studies show sacral lateral branch thermal radiofrequency neurotomy can relieve sacroiliac complex pain to some extent. The evidence of the validity of these blocks and the effectiveness of this treatment were rated as moderate in accordance with the GRADE system. The literature on sacral lateral branch interventions is sparse. One study demonstrates the face validity of multisite, multidepth sacral lateral branch blocks for diagnosis of posterior sacroiliac complex pain. Some evidence of moderate quality exists on therapeutic procedures, but it is insufficient to determine the indications and effectiveness of sacral lateral branch thermal radiofrequency neurotomy, and more research is required. Wiley Periodicals, Inc.

  1. [Case of anti VGKC-complex antibody associated disorder presenting with severe pain and fasciculations predominant in unilateral upper extremity].

    Science.gov (United States)

    Hara, Kenju; Watanabe, Osamu; Shibano, Ken; Ishiguro, Hideaki

    2012-01-01

    A 21-year-old man complained of severe pain and muscle twitching localized in his right arm. Neurological examination showed muscle fasciculations in his right forearm but no myokymia or myotonia. Needle electromyography revealed fibrillation potentials in his biceps brachii muscle and extensor carpi radialis muscle at rest but no myokymic discharges. His serum anti-voltage-gated potassium channel (VGKC)-complex antibody level was significantly high (194.2pM; controls VGKC-complex antibody associated disorder.

  2. Future Directions in Painful Knee Osteoarthritis: Harnessing Complexity in a Heterogeneous Population

    Science.gov (United States)

    George, Steven Z.; Maluf, Katrina S.; Stevens-Lapsley, Jennifer E.

    2014-01-01

    This perspective article proposes a conceptual model for the pain experience for individuals diagnosed with knee osteoarthritis (OA). Pain in knee OA is likely a heterogeneous, multifactorial phenomenon that involves not only the OA disease process but also elements specific to patient psychology and pain neurophysiology. The relevant contributions to the pain experience for any individual patient remain difficult, if not impossible, to definitively determine, and the rationale for many clinical treatment decisions arises primarily from a mechanistic understanding of OA pathophysiology. The Osteoarthritis Research Society International (OARSI) recently identified “phenotyping” of OA pain as a research priority to “better target pain therapies to individual patients.” This perspective article proposes that contributions from 3 domains—knee pathology, psychological distress, and pain neurophysiology—should be considered equally important in future efforts to understand pain phenotypes in knee OA. Ultimately, characterization of pain phenotypes may aid in the understanding of the pain experience and the development of interventions specific to pain for individual patients. PMID:24179141

  3. Psychometric Properties of the Pain Numeric Rating Scale When Applied to Multiple Body Regions among Professional Musicians

    Science.gov (United States)

    2016-01-01

    Background Despite the broad popularity of a numeric rating scale (NRS) its psychometric properties are not well known. The objective was to determine if there is any difference in the discrimination ability of the NRS when used for measuring pain severity separately in different body regions. Methods Cross-sectional survey study of 630 professional musicians. Item Response Theory (IRT) was used to define the psychometric properties of the NRS. Results The discrimination ability of the pain NRS was dependent on the body area to which it was applied. The discrimination was low 0.5 (95% CI 0.4. to 0.7) for the hand region and perfect for the shoulder and upper part of the neck– 3.2 (95% CI 1.2 to 5.2) and 10.5 (95% CI 10.0 to 10.9), respectively. Both shoulder and neck NRSs showed a great shift towards higher levels of pain severity meaning that the ability of the NRS to discriminate low levels of pain is poor. NRS scores obtained from all other regions did not demonstrate any discrimination ability. Conclusions The pain NRS might have different psychometric properties depending on the body area to which it is applied. Overall, the modest discrimination ability of the pain NRS implies that it should be used in screening questionnaires with some reservations. PMID:27603011

  4. Interventional therapy for neuropathic pain

    Directory of Open Access Journals (Sweden)

    YANG Yang

    2013-10-01

    Full Text Available Neuropathic pain (NP is a common clinical refractory pain for which there are limited methods to treat. In this article, based on typical diseases, such as postherpetic neuralgia (PHN, trigeminal neuralgia, complex regional pain syndrome (CRPS, lower back pain with radiculopathy and failed back surgery syndrome (FBSS, phantom pain, the general treatment principle and method for NP are expatiated. Interventional methods for NP, including intraspinal block, radiofrequeney rhizotomy of trigeminal neuralgia, selective nerve root block, spinal cord stimulation (SCS and motor cortex stimulation (MCS are introduced, especially their indications, complications and matters needing attention.

  5. The α2δ-1-NMDA Receptor Complex Is Critically Involved in Neuropathic Pain Development and Gabapentin Therapeutic Actions

    Directory of Open Access Journals (Sweden)

    Jinjun Chen

    2018-02-01

    Full Text Available α2δ-1, commonly known as a voltage-activated Ca2+ channel subunit, is a binding site of gabapentinoids used to treat neuropathic pain and epilepsy. However, it is unclear how α2δ-1 contributes to neuropathic pain and gabapentinoid actions. Here, we show that Cacna2d1 overexpression potentiates presynaptic and postsynaptic NMDAR activity of spinal dorsal horn neurons to cause pain hypersensitivity. Conversely, Cacna2d1 knockdown or ablation normalizes synaptic NMDAR activity increased by nerve injury. α2δ-1 forms a heteromeric complex with NMDARs in rodent and human spinal cords. The α2δ-1-NMDAR interaction predominantly occurs through the C terminus of α2δ-1 and promotes surface trafficking and synaptic targeting of NMDARs. Gabapentin or an α2δ-1 C terminus-interfering peptide normalizes NMDAR synaptic targeting and activity increased by nerve injury. Thus, α2δ-1 is an NMDAR-interacting protein that increases NMDAR synaptic delivery in neuropathic pain. Gabapentinoids reduce neuropathic pain by inhibiting forward trafficking of α2δ-1-NMDAR complexes.

  6. The changes of regional cerebral blood flow: successful pain relief of intractable CRPS type II patients by motor cortex stimulation

    International Nuclear Information System (INIS)

    Jung, J. A.; Son, H. S.; Kim, S. H.; Jung, S. G

    2004-01-01

    Authors report the effectiveness of MCS in extraordinarily extended pain due to intractable CRPS type II and rCBF study result for mechanism of pain control by MCS. A 43-year-old male presented severe spontaneous burning pain in his left hand and forearm and allodynia over the left arm and left hemibody. Authors planned MCS as a neuromodulation therapy for this intractable peripheral neuropathic pain patient because further neurodestructive procedure did not work anymore and have a potential risk of further aggrevation of neuopathic pain. We performed baseline and stimulation brain perfusion SPECT using 20 mCi of Tc-99m ECD. The baseline CBD studies were done with stimulator 'off' state and stimulation studies were done after stimulator 'on' with satisfactory pain relief. For the stimulation study, the radioisotope was injected immediately after pain-relief and the images were taken about 50 minutes after injection of radioisotope. In resting rCBF in the patient was compared with normal control datas, we found significant increase in rCBF in the bilateral prefrontal cortex, right dorsolateral prefrontal cortex, right superior temporal gyrus, left temporooccipital area. When rCBF datas obtained after alleviation of pain with stimulator 'on' . there were significant increase in rCBF in bilateral prefrontal cortex and left temporoocipital area. After subtraction of ECD SPECT, we found significant increase in rCBF in the right premotor and supplementary motor cortex left sensorimotor cortex, right cingulated cortex, right posterior insular cortex, right anterior limb of internal capsule. left orbitofrontal cortex and right pyramidal tract in cerebral peduncle. Authors report exellent pain control by MCS in a case of severe CRPS type II with hemibody involvement and regional cerebral blood flow changes according to successful pain control

  7. The changes of regional cerebral blood flow: successful pain relief of intractable CRPS type II patients by motor cortex stimulation

    Energy Technology Data Exchange (ETDEWEB)

    Jung, J. A.; Son, H. S.; Kim, S. H.; Jung, S. G [The Catholic University of Korea, Seoul (Korea, Republic of)

    2004-07-01

    Authors report the effectiveness of MCS in extraordinarily extended pain due to intractable CRPS type II and rCBF study result for mechanism of pain control by MCS. A 43-year-old male presented severe spontaneous burning pain in his left hand and forearm and allodynia over the left arm and left hemibody. Authors planned MCS as a neuromodulation therapy for this intractable peripheral neuropathic pain patient because further neurodestructive procedure did not work anymore and have a potential risk of further aggrevation of neuopathic pain. We performed baseline and stimulation brain perfusion SPECT using 20 mCi of Tc-99m ECD. The baseline CBD studies were done with stimulator 'off' state and stimulation studies were done after stimulator 'on' with satisfactory pain relief. For the stimulation study, the radioisotope was injected immediately after pain-relief and the images were taken about 50 minutes after injection of radioisotope. In resting rCBF in the patient was compared with normal control datas, we found significant increase in rCBF in the bilateral prefrontal cortex, right dorsolateral prefrontal cortex, right superior temporal gyrus, left temporooccipital area. When rCBF datas obtained after alleviation of pain with stimulator 'on' . there were significant increase in rCBF in bilateral prefrontal cortex and left temporoocipital area. After subtraction of ECD SPECT, we found significant increase in rCBF in the right premotor and supplementary motor cortex left sensorimotor cortex, right cingulated cortex, right posterior insular cortex, right anterior limb of internal capsule. left orbitofrontal cortex and right pyramidal tract in cerebral peduncle. Authors report exellent pain control by MCS in a case of severe CRPS type II with hemibody involvement and regional cerebral blood flow changes according to successful pain control.

  8. An immunohistochemical study of the triangular fibrocartilage complex of the wrist: regional variations in cartilage phenotype

    Science.gov (United States)

    Milz, S; Sicking, B; Sprecher, C M; Putz, R; Benjamin, M

    2007-01-01

    The triangular fibrocartilage complex (TFCC) transmits load from the wrist to the ulna and stabilizes the distal radioulnar joint. Damage to it is a major cause of wrist pain. Although its basic structure is well established, little is known of its molecular composition. We have analysed the immunohistochemical labelling pattern of the extracellular matrix of the articular disc and the meniscal homologue of the TFCC in nine elderly individuals (age range 69–96 years), using a panel of monoclonal antibodies directed against collagens, glycosaminoglycans, proteoglycans and cartilage oligomeric matrix protein (COMP). Although many of the molecules (types I, III and VI collagen, chondroitin 4 sulphate, dermatan sulphate and keratan sulphate, the oversulphated epitope of chondroitin 6 sulphate, versican and COMP) were found in all parts of the TFCC, aggrecan, link protein and type II collagen were restricted to the articular disc and to entheses. They were thus not a feature of the meniscal homologue. The shift in tissue phenotype within the TFCC, from a fibrocartilaginous articular disc to a more fibrous meniscal homologue, correlates with biomechanical data suggesting that the radial region is stiff and subject to considerable stress concentration. The presence of aggrecan, link protein and type II collagen in the articular disc could explain why the TFCC is destroyed in rheumatoid arthritis, given that it has been suggested that autoimmunity to these antigens results in the destruction of articular cartilage. The differential distribution of aggrecan within the TFCC is likely to be reflected by regional differences in water content and mobility on the radial and ulnar side. This needs to be taken into account in the design of improved MRI protocols for visualizing this ulnocarpal complex of the wrist. PMID:17532798

  9. The European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine Joint Committee Practice Advisory on Controversial Topics in Pediatric Regional Anesthesia.

    Science.gov (United States)

    Ivani, Giorgio; Suresh, Santhanam; Ecoffey, Claude; Bosenberg, Adrian; Lonnqvist, Per-Anne; Krane, Elliot; Veyckemans, Francis; Polaner, David M; Van de Velde, Marc; Neal, Joseph M

    2015-01-01

    Some topics in the clinical management of regional anesthesia in children remain controversial. To evaluate and come to a consensus regarding some of these topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a joint committee practice advisory on pediatric regional anesthesia (PRA). Representatives from both ASRA and ESRA comprised the joint committee practice advisory on PRA. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Experts selected controversial topics in PRA. The performance of PRA under general anesthesia or deep sedation is associated with acceptable safety and should be viewed as the standard of care (Evidence B2 and Evidence B3). Because of the difficulty interpreting a negative test dose, the use of test dosing should remain discretionary (Evidence B4). The use of either air-loss of resistance or saline-loss of resistance techniques is supported by expert opinion, but the literature supporting one technique over the other is sparse and controversial; when used appropriately, each technique may be safely used in children. There are no current evidence-based data that the use of RA increases the risk for acute compartment syndrome or delays its diagnosis in children. High-level evidence is not yet available for the topics evaluated, and most recommendations are based on Evidence B studies. The ESRA/ASRA recommendations intend to provide guidance for the safe practice of regional anesthesia in children.

  10. The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia.

    Science.gov (United States)

    Suresh, Santhanam; Ecoffey, Claude; Bosenberg, Adrian; Lonnqvist, Per-Anne; de Oliveira, Gildasio S; de Leon Casasola, Oscar; de Andrés, José; Ivani, Giorgio

    2018-02-01

    Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Representatives from both ASRA and ESRA composed the joint committee practice advisory. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Spinal anesthesia with bupivacaine can be performed with a dose of 1 mg/kg for newborn and/or infant and a dose of 0.5 mg/kg in older children (>1 year of age). Tetracaine 0.5% is recommended for spinal anesthesia (dose, 0.07-0.13 mL/kg). Ultrasound-guided upper-extremity peripheral nerve blocks (eg, axillary, infraclavicular, interscalene, supraclavicular) in children can be performed successfully and safely using a recommended LA dose of bupivacaine or ropivacaine of 0.5 to 1.5 mg/kg. Dexmedetomidine can be used as an adjunct to prolong the duration of peripheral nerve blocks in children. High-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice.

  11. Chronic stress and peripheral pain: Evidence for distinct, region-specific changes in visceral and somatosensory pain regulatory pathways.

    Science.gov (United States)

    Zheng, Gen; Hong, Shuangsong; Hayes, John M; Wiley, John W

    2015-11-01

    Chronic stress alters the hypothalamic-pituitary-adrenal (HPA) axis and enhances visceral and somatosensory pain perception. It is unresolved whether chronic stress has distinct effects on visceral and somatosensory pain regulatory pathways. Previous studies reported that stress-induced visceral hyperalgesia is associated with reciprocal alterations of endovanilloid and endocannabinoid pain pathways in DRG neurons innervating the pelvic viscera. In this study, we compared somatosensory and visceral hyperalgesia with respect to differential responses of peripheral pain regulatory pathways in a rat model of chronic, intermittent stress. We found that chronic stress induced reciprocal changes in the endocannabinoid 2-AG (increased) and endocannabinoid degradation enzymes COX-2 and FAAH (decreased), associated with down-regulation of CB1 and up-regulation of TRPV1 receptors in L6-S2 DRG but not L4-L5 DRG neurons. In contrast, sodium channels Nav1.7 and Nav1.8 were up-regulated in L4-L5 but not L6-S2 DRGs in stressed rats, which was reproduced in control DRGs treated with corticosterone in vitro. The reciprocal changes of CB1, TRPV1 and sodium channels were cell-specific and observed in the sub-population of nociceptive neurons. Behavioral assessment showed that visceral hyperalgesia persisted, whereas somatosensory hyperalgesia and enhanced expression of Nav1.7 and Nav1.8 sodium channels in L4-L5 DRGs normalized 3 days after completion of the stress phase. These data indicate that chronic stress induces visceral and somatosensory hyperalgesia that involves differential changes in endovanilloid and endocannabinoid pathways, and sodium channels in DRGs innervating the pelvic viscera and lower extremities. These results suggest that chronic stress-induced visceral and lower extremity somatosensory hyperalgesia can be treated selectively at different levels of the spinal cord. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Duloxetine Plasma Concentrations and Its Effectiveness in the Treatment of Nonorganic Chronic Pain in the Orofacial Region.

    Science.gov (United States)

    Kobayashi, Yuka; Nagashima, Wataru; Tokura, Tatsuya; Yoshida, Keizo; Umemura, Eri; Miyauchi, Tomoya; Arao, Munetaka; Ito, Mikiko; Kimura, Hiroyuki; Kurita, Kenichi; Ozaki, Norio

    The purpose of this study was to examine the relationship between the pain-relieving effects of duloxetine and its plasma concentrations in patients with burning mouth syndrome and atypical odontalgia characterized by chronic nonorganic pain in the orofacial region. We administered duloxetine to 77 patients diagnosed as having burning mouth syndrome or atypical odontalgia for 12 weeks. The initial dose of duloxetine was established as 20 mg/d and was increased to 40 mg/d after week 2. We evaluated pain using the visual analog scale and depressive symptoms using the Structured Interview Guide for the Hamilton Depression Rating Scale at weeks 0, 2, 4, 6, 8, 10, and 12 and measured plasma concentrations of duloxetine 12 weeks after the start of its administration. Visual analog scale scores were significantly lower 12 weeks after than at the start of the administration of duloxetine (paired t test, t = 6.65, P pain in patients with chronic nonorganic pain in the orofacial region. However, no relationship was observed between its pain-relieving effects and plasma concentrations.

  13. Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: A one-year randomized controlled trial

    DEFF Research Database (Denmark)

    Andersen, Lars L.; Christensen, Karl Bang; Holtermann, Andreas

    2010-01-01

    office workers; specific neck/shoulder resistance training, all-round physical exercise, or a reference intervention. Pain symptoms were determined by questionnaire screening of twelve selected body regions. Case individuals were identified for each body region as those reporting pain intensities...... group (Ptraining and all-round physical...... exercise for office workers caused better effects than a reference intervention in relieving musculoskeletal pain symptoms in exposed regions of the upper body....

  14. The role of the pituitary region in the endogenous pain control mechanism

    NARCIS (Netherlands)

    A. Trouwborst (Adrianus)

    1982-01-01

    textabstractIt is often difficult to come to grips with the phenomenon of pain . It is still impossible with any degree of elegance, to combine together under one single theory all our knowledge of pain prevention , and all the factors that play a role in pain perception. Indeed , the very

  15. Steadiness of Spinal Regions during Single-Leg Standing in Older Adults with and without Chronic Low Back Pain.

    Directory of Open Access Journals (Sweden)

    Yi-Liang Kuo

    Full Text Available The aims of this study were to compare the steadiness index of spinal regions during single-leg standing in older adults with and without chronic low back pain (LBP and to correlate measurements of steadiness index with the performance of clinical balance tests. Thirteen community-dwelling older adults (aged 55 years or above with chronic LBP and 13 age- and gender-matched asymptomatic volunteers participated in this study. Data collection was conducted in a university research laboratory. Measurements were steadiness index of spinal regions (trunk, thoracic spine, lumbar spine, and pelvis during single-leg standing including relative holding time (RHT and relative standstill time (RST, and clinical balance tests (timed up and go test and 5-repetition sit to stand test. The LBP group had a statistically significantly smaller RHT than the control group, regardless of one leg stance on the painful or non-painful sides. The RSTs on the painful side leg in the LBP group were not statistically significantly different from the average RSTs of both legs in the control group; however, the RSTs on the non-painful side leg in the LBP group were statistically significantly smaller than those in the control group for the trunk, thoracic spine, and lumbar spine. No statistically significant intra-group differences were found in the RHTs and RSTs between the painful and non-painful side legs in the LBP group. Measurements of clinical balance tests also showed insignificant weak to moderate correlations with steadiness index. In conclusion, older adults with chronic LBP demonstrated decreased spinal steadiness not only in the symptomatic lumbar spine but also in the other spinal regions within the kinetic chain of the spine. When treating older adults with chronic LBP, clinicians may also need to examine their balance performance and spinal steadiness during balance challenging tests.

  16. Clinical-pathologic correlations in voltage-gated Kv1 potassium channel complex-subtyped autoimmune painful polyneuropathy.

    Science.gov (United States)

    Lahoria, Rajat; Pittock, Sean J; Gadoth, Avi; Engelstad, Janean K; Lennon, Vanda A; Klein, Christopher J

    2017-04-01

    Voltage-gated Kv1 potassium channel complex (VGKC) autoantibodies subtyped for leucine-rich glioma-inactivated 1 (LGI1), contactin-associated-proteinlike 2 (CASPR2), and Kv IgGs have a spectrum of neurological presentations. Painful polyneuropathy is seen in some patients, but nerve pathology descriptions are lacking. Clinicopathologic features were studied in subtyped VGKC-autoantibody-seropositive patients who had undergone nerve biopsies. Five patients were identified, 1 LGI1 IgG positive and 1 CASPR2 IgG positive, but all negative for Kv1.1-, 1.2-, 1.6-subtyped IgG autoantibodies. Median symptom duration was 17 months. Pain was the predominant symptom; 3 had mild sensory loss and/or weakness. Histopathological abnormalities were limited to axonal loss in 3. None had mononuclear cellular infiltrates. Electron micrographs revealed no interstitial abnormalities. Three patients reported marked improvement in pain with immunotherapy. The nerve biopsy histopathology of patients subtyped for LGI1 and CASPR2 IgGs within the VGKC-complex spectrum disorders shows either normal density or axonal fiber loss without inflammatory infiltrates. A reversible neural hyperexcitable mechanism is considered to be the cause of this painful polyneuropathy. Muscle Nerve 55: 520-525, 2017. © 2016 Wiley Periodicals, Inc.

  17. Complex approach to power supply system in the Tomsk region

    International Nuclear Information System (INIS)

    Meshcheryakov, V.N.; Bojko, V.I.; Koshelev, F.P.; Kolpakov, G.N.; Shamanin, I.V.

    2001-01-01

    The problem of power supply of the Tomsk region is under consideration. Power sources are compared with regard to economical and ecological effectiveness. It is shown that nuclear power industry is promising for the Tomsk region due to a unique nuclear park in a town of Seversk with developed scientific, industrial, skilled personnel and construction bases. It is noted that the construction of the NPP based on two WWER-640, WWER-1000 reactors of new generation permits solving the problem of power supply of the Tomsk region [ru

  18. The effect of ergonomics in dentistry on the occurrence of pain in the cervical neck region of the spine

    Directory of Open Access Journals (Sweden)

    Jędrzej Płocki

    2015-03-01

    Full Text Available Introduction: The problem of health risks resulting from the performance of the occupation of a dentist concerns, among other things, the cervical region of the spine. Due to the position assumed at work, this part of the spine is overloaded, and the degree of this overload depends, among other things, on the technique used by a dentist, the ergonomic conditions, patient adaptation skills, and cooperation with an assistant or assistants. Aim of the research : The objective of the study was to obtain an answer to the research questions posed: whether dentists possess knowledge concerning the principles of ergonomics; is there any relationship between the period of employment and cervical spine pain, age, technique of work, duration of performing work during the week, and pain in the neck region; and if dentists attach importance to the prophylaxis of musculoskeletal disorders. Material and methods : The study covered 52 dentists – 33 females (63.5% and 19 males (36.5%, and was conducted using an anonymous questionnaire designed by the authors, the Visual Analogue Scale (VAS, a modified pain assessment questionnaire according to Laitinen, and methods of descriptive statistics (Pearson’s χ 2 test for independence. Results : Physicians possess knowledge concerning the ergonomics of work. In addition, more than 60% of respondents possess modern, electrically adjustable equipment, and the technique of work depends on the age of the dentist. There is a relationship between cervical spine pain and the duration of performance of the occupation (p = 0.01122. According to dentists (48.1%, pain in the neck region of the spine is caused by long-lasting maintenance of a static position of the body, and kinesitherapeutic exercises alleviate these complaints in 23.1% of respondents. Conclusions : Despite the use the principles of ergonomics at work, dentists are exposed to the occurrence of pain in the neck region of the spine.

  19. Conflict and complexity countering terrorism, insurgency, ethnic and regional violence

    CERN Document Server

    Bar-Yam, Yaneer; Minai, Ali

    2015-01-01

    Complexity science affords a number of novel tools for examining terrorism, particularly network analysis and NK-Boolean fitness landscapes as well as other tools drawn from non-linear dynamical systems modeling. This book follows the methodologies of complex adaptive systems research in their application to addressing the problems of terrorism, specifically terrorist networks, their structure and various methods of mapping and interdicting them as well as exploring the complex landscape of network-centric and irregular warfare. A variety of new models and approaches are presented here, including Dynamic Network Analysis, DIME/PMESII models, percolation models and emergent models of insurgency. In addition, the analysis is informed by practical experience, with analytical and policy guidance from authors who have served within the U.S. Department of Defense, the British Ministry of Defence as well as those who have served in a civilian capacity as advisors on terrorism and counter-terrorism.

  20. THE COMPLEX NORTH TRANSITION REGION OF CENTAURUS A: RADIO STRUCTURE

    Energy Technology Data Exchange (ETDEWEB)

    Neff, Susan G. [NASA' s Goddard Space Flight Center, Laboratory for Observational Cosmology, Mail Code 665, Greenbelt, MD 20771 (United States); Eilek, Jean A. [Physics Department, New Mexico Tech, Socorro, NM 87801 (United States); Owen, Frazer N., E-mail: susan.g.neff@nasa.gov [National Radio Astronomy Observatory, P.O. Box O,  Socorro, NM 87801 (United States)

    2015-04-01

    We present deep radio images of the inner ∼50 kpc of Centaurus A, taken with the Karl G. Jansky Very Large Array at 90 cm. We focus on the Transition Regions between the inner galaxy—including the active nucleus, inner radio lobes, and star-forming disk—and the outer radio lobes. We detect previously unknown extended emission around the Inner Lobes, including radio emission from the star-forming disk. We find that the radio-loud part of the North Transition Region (NTR), known as the North Middle Lobe, is significantly overpressured relative to the surrounding interstellar medium. We see no evidence for a collimated flow from the active galactic nucleus through this region. Our images show that the structure identified by Morganti et al. as a possible large-scale jet appears to be part of a narrow ridge of emission within the broader, diffuse, radio-loud region. This knotty radio ridge is coincident with other striking phenomena: compact X-ray knots, ionized gas filaments, and streams of young stars. Several short-lived phenomena in the NTR, as well as the frequent re-energization required by the Outer Lobes, suggest that energy must be flowing through both Transition Regions at the present epoch. We suggest that the energy flow is in the form of a galactic wind.

  1. High Prevalence of Nontraumatic Shoulder Pain in a Regional Sample of Female High School Volleyball Athletes

    Science.gov (United States)

    Frisch, Kayt E.; Clark, Jacob; Hanson, Chad; Fagerness, Chris; Conway, Adam; Hoogendoorn, Lindsay

    2017-01-01

    Background: Shoulder pain is becoming increasingly problematic in young players as volleyball gains popularity. Associations between repetitive motion and pain and overuse injury have been observed in other overhand sports (most notably baseball). Studies of adult athletes suggest that there is a shoulder pain and overuse problem present in volleyball players, but minimal research has been done to establish rates and causes in juvenile participants. Purpose: To establish rates of shoulder pain, regardless of whether it resulted in a loss of playing time, in female high school volleyball players. A secondary goal was to determine whether high repetition volumes correlated with an increased likelihood of experiencing pain. Study Design: Descriptive epidemiology study. Methods: A self-report survey focusing on the prevalence of pain not associated with a traumatic event in female high school youth volleyball players was developed. Survey questions were formulated by certified athletic trainers, experienced volleyball coaches, and biomechanics experts. Surveys were received from 175 healthy, active high school volleyball players in Iowa, South Dakota, and Minnesota. Results: Forty percent (70/175) of active high school volleyball players remembered experiencing shoulder pain not related to traumatic injury, but only 33% (23/70) reported taking time off to recover from the pain. Based on these self-reported data, activities associated with significantly increased risk of nontraumatic shoulder pain included number of years playing competitive volleyball (P = .01) and lifting weights out of season (P = .001). Players who reported multiple risk factors were more likely to experience nontraumatic shoulder pain. Conclusion: When using time off for recovery as the primary injury criterion, we found that the incidence of shoulder pain is more than twice as high as the incidence of injury reported by previous studies. Findings also indicated that the incidence of shoulder pain

  2. High Prevalence of Nontraumatic Shoulder Pain in a Regional Sample of Female High School Volleyball Athletes

    OpenAIRE

    Frisch, Kayt E.; Clark, Jacob; Hanson, Chad; Fagerness, Chris; Conway, Adam; Hoogendoorn, Lindsay

    2017-01-01

    Background: Shoulder pain is becoming increasingly problematic in young players as volleyball gains popularity. Associations between repetitive motion and pain and overuse injury have been observed in other overhand sports (most notably baseball). Studies of adult athletes suggest that there is a shoulder pain and overuse problem present in volleyball players, but minimal research has been done to establish rates and causes in juvenile participants. Purpose: To establish rates of shoulder pai...

  3. High Prevalence of Nontraumatic Shoulder Pain in a Regional Sample of Female High School Volleyball Athletes.

    Science.gov (United States)

    Frisch, Kayt E; Clark, Jacob; Hanson, Chad; Fagerness, Chris; Conway, Adam; Hoogendoorn, Lindsay

    2017-06-01

    Shoulder pain is becoming increasingly problematic in young players as volleyball gains popularity. Associations between repetitive motion and pain and overuse injury have been observed in other overhand sports (most notably baseball). Studies of adult athletes suggest that there is a shoulder pain and overuse problem present in volleyball players, but minimal research has been done to establish rates and causes in juvenile participants. To establish rates of shoulder pain, regardless of whether it resulted in a loss of playing time, in female high school volleyball players. A secondary goal was to determine whether high repetition volumes correlated with an increased likelihood of experiencing pain. Descriptive epidemiology study. A self-report survey focusing on the prevalence of pain not associated with a traumatic event in female high school youth volleyball players was developed. Survey questions were formulated by certified athletic trainers, experienced volleyball coaches, and biomechanics experts. Surveys were received from 175 healthy, active high school volleyball players in Iowa, South Dakota, and Minnesota. Forty percent (70/175) of active high school volleyball players remembered experiencing shoulder pain not related to traumatic injury, but only 33% (23/70) reported taking time off to recover from the pain. Based on these self-reported data, activities associated with significantly increased risk of nontraumatic shoulder pain included number of years playing competitive volleyball ( P = .01) and lifting weights out of season ( P = .001). Players who reported multiple risk factors were more likely to experience nontraumatic shoulder pain. When using time off for recovery as the primary injury criterion, we found that the incidence of shoulder pain is more than twice as high as the incidence of injury reported by previous studies. Findings also indicated that the incidence of shoulder pain may be correlated with volume of previous volleyball experience.

  4. The Emerging Architecture of a Regional Security Complex in the ...

    African Journals Online (AJOL)

    2015-03-03

    Mar 3, 2015 ... Council for the Development of Social Science Research in Africa, 2017 .... of International Security Studies by appropriating Regional Security .... collaborative network is also embedded across Saharan and Sahelian Africa, ... (previously located in the city of Baga in Nigeria's Borno State), fell into the.

  5. Peripheral nerve stimulation (PNS) in the trapezius muscle region alleviate chronic neuropathic pain after lower brachial plexus root avulsion lesion: A case report

    DEFF Research Database (Denmark)

    Sørensen, Jens Christian Hedemann; Meier, Kaare; Perinpam, Larshan

    Peripheral nerve stimulation (PNS) in the trapezius muscle region alleviate chronic neuropathic pain after lower brachial plexus root avulsion lesion: A case report......Peripheral nerve stimulation (PNS) in the trapezius muscle region alleviate chronic neuropathic pain after lower brachial plexus root avulsion lesion: A case report...

  6. REGIONAL FEATURES OF SPATIAL DEVELOPMENT OF THE INDUSTRIAL COMPLEX OF REGION IN CONDITIONS OF INSTABILITY

    Directory of Open Access Journals (Sweden)

    J.G. Lavrikova

    2009-09-01

    Full Text Available In clause the methodical approach to typology of spatial development of economy of the regions, considering position of region in national geoeconomic space, orientation to the global markets and character of interactions (network or integrated managing subjects in region is considered. Regional features of spatial development of regions of the Ural federal district are allocated. Directions of perfection of a level of the organization of spatial development of economy of regions in conditions of instability from positions of theories of unbalanced growth are offered.

  7. Distraction of attention with the use of virtual reality. Influence of the level of game complexity on the level of experienced pain

    Directory of Open Access Journals (Sweden)

    Piskorz Joanna

    2014-12-01

    Full Text Available : Research done in recent years shows that Virtual Reality (VR can be an effective tool for distracting attention from pain. The purpose of this study was to test how the complexity of Virtual Environment (VE influences the experienced intensity of thermal pain stimuli.

  8. Complex muscular adaptation to perturbations after induction of experimental low back pain in healthy participants

    DEFF Research Database (Denmark)

    Larsen, Lars Henrik; Hirata, Rogerio Pessoto; Graven-Nielsen, Thomas

    2014-01-01

    Background and aims Spine stability is affected in low back (LB) pain and potentially by muscle fatigue and soreness. This study assessed motor control responses to unexpected surface perturbations during stance during experimental LB muscle pain combined with fatigue and muscle soreness. Methods...... Nineteen healthy participants were examined day 1-3 before and after bilateral injections of hypertonic saline into m. longissimus. Pain intensity was scored on a visual analogue scale (VAS). Day 2 included injections during post-exercise LB muscle fatigue and day 3 during delayed onset back muscle...... soreness (DOMS). Twenty perturbations were conducted randomly with tilts in sagittal and frontal plane or displacements in the frontal plane. Bilateral electromyography (EMG) was recorded from 12 trunk muscles. The root-mean-square (RMS-EMG) was extracted. Changes (DeltaRMS) and absolute changes (Delta...

  9. The effects of complex exercise on shoulder range of motion and pain for women with breast cancer-related lymphedema: a single-blind, randomized controlled trial.

    Science.gov (United States)

    Park, Jin-Hyuck

    2017-07-01

    This study was to investigate the effects of complex exercise on shoulder range of motion and pain for women with breast cancer-related lymphedema. 69 women participated in this study and then they were randomly allocated to complex exercise group (n = 35) or the conventional decongestive therapy group (n = 34). All subjects received 8 sessions for 4 weeks. To identify the effects on shoulder range of motion and pain, goniometer and visual analog scale were used, respectively. The outcome measurements were performed before and after the 4 week intervention. After 4 weeks, complex exercise group had greater improvements in shoulder range of motion and pain compared with the conventional decongestive therapy group (p women with breast cancer-related lymphedema. Complex exercise would be useful to improve shoulder range of motion and pain of the women with breast cancer-related lymphedema.

  10. Ketamine differentially restores diverse alterations of neuroligins in brain regions in a rat model of neuropathic pain-induced depression.

    Science.gov (United States)

    Pan, Wei; Zhang, Guang-Fen; Li, Hui-Hui; Ji, Mu-Huo; Zhou, Zhi-Qiang; Li, Kuan-Yu; Yang, Jian-Jun

    2018-07-04

    Depression is present in a large proportion of patients suffering from chronic pain, and yet the underlying mechanisms remain to be elucidated. Neuroligins (NLs), as a family of cell-adhesion proteins, are involved in synaptic formation and have been linked to various neuropsychiatric disorders. Here, we studied the alterations in NL1 and NL2 in the medial prefrontal cortex (mPFC), the anterior cingulate cortex (ACC), and the hippocampus in a rat model of neuropathic pain-induced depression, and whether ketamine, a rapid and robust antidepressant, could restore these abnormalities. In the present study, we found that spared nerve injury induced significant mechanical allodynia and subsequent depressive-like symptoms, along with decreased NL1 and increased NL2 in the mPFC, decreased NL1 in the ACC, and decreased NL2 in the hippocampus. In addition, brain-derived neurotrophic factor (BDNF) was reduced in these brain regions. It is noteworthy that ketamine (10 mg/kg) relieved neuropathic pain-induced depressive behaviors and restored alterations of BDNF and NLs in the mPFC and the hippocampus at 24 h and 72 h after the administration of ketamine, but only restored BDNF in the ACC. In conclusion, NLs showed diverse changes in different brain regions in the rat model of neuropathic pain-induced depression, which could be reversed differentially by the administration of ketamine.

  11. Critical Hydrologic and Atmospheric Measurements in Complex Alpine Regions

    Science.gov (United States)

    Parlange, M. B.; Bou-Zeid, E.; Barrenetxea, G.; Krichane, M.; Ingelrest, F.; Couach, O.; Luyet, V.; Vetterli, M.; Lehning, M.; Duffy, C.; Tobin, C.; Selker, J.; Kumar, M.

    2007-12-01

    The Alps are often referred to as the « Water Towers of Europe » and as such play an essential role in European water resources. The impact of climatic change is expected to be particularly pronounced in the Alps and the lack of detailed hydrologic field observations is problematic for predictions of hydrologic and hazard assessment. Advances in information technology and communications provide important possibilities to improve the situation with relatively few measurements. We will present sensorscope technology (arrays of wireless weather stations including soil moisture, pressure, and temperature) that has now been deployed at the Le Genepi and Grand St. Bernard pass. In addition, a Distributed Temperature Sensor array on the stream beds has been deployed and stream discharge monitored. The high spatial resolution data collected in these previously "ungaged" regions are used in conjunction with new generation hydrologic models. The framework as to what is possible today with sensor arrays and modeling in extreme mountain environments is discussed.

  12. Tapentadol in the management of chronic low back pain: a novel approach to a complex condition?

    Directory of Open Access Journals (Sweden)

    Pergolizzi J

    2011-07-01

    Full Text Available Joseph Pergolizzi1, Eli Alon2, Ralf Baron3, Cesare Bonezzi4, Jan Dobrogowski5, Rafael Gálvez6, Troels Jensen7, Hans-Georg Kress8, Marco AE Marcus9, Bart Morlion10, Serge Perrot11, Rolf-Detlef Treede121Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Universitätsspital Zurich, Switzerland; 3Universitätsklinikum Schleswig-Holstein, Kiel, Germany; 4Fondazione Salvatore Maugeri, Pavia, Italy; 5Zaklad Badania i Leczenia Bólu, Kraków, Poland; 6Hospital Universitario Virgen de las Nieves, Granada, Spain; 7Aarhus University, Denmark; 8Medical University of Vienna, Austria; 9Maastricht University Medical Center and University of Muenster, Maastricht, The Netherlands; 10University Hospitals Leuven, Belgium; 11Hôpital Dieu, Paris, France; 12Ruprecht-Karls-University, Heidelberg, GermanyAbstract: Chronic pain affects approximately 1 in 5 people in Europe, and around half of sufferers receive inadequate pain management. The most common location is the lower back. Pharmacological treatment of this condition is challenging because of the range of causative mechanisms and the difficulty of balancing analgesic efficacy and tolerability. An international panel of clinical pain specialists met in September, 2009, to discuss the treatment of chronic low back pain, and to review preclinical and clinical data relating to the new analgesic, tapentadol. A lack of consensus exists on the best treatment for low back pain. The range of regularly prescribed pharmacological agents extends from nonopioids (paracetamol, NSAIDs, and COX-2 inhibitors to opioids, antidepressants and anticonvulsants. Pain relief may be compromised, however, by an undetected neuropathic component or intolerable side effects. Treatment is potentially life-long and effective analgesics are urgently needed, with demonstrable long-term safety. Combining separate agents with different mechanisms of action could overcome the limitations of present

  13. Some observations on lameness associated with pain in the proximal metacarpal region

    International Nuclear Information System (INIS)

    Dyson, S.

    1988-01-01

    The carpus and metacarpus of 40 horses which were free from lameness and 40 horses with lameness associated with the metacarpophalangeal joint or more distal limb were examined radiographically (Group A). The opacity of the proximal third of the third metacarpal bone was regular, with a uniform trabecular pattern. Osseous cyst-like lesions (OCLLs) were identified in the radial carpal bone (1), the ulnar carpal bone (2), the second carpal bone (15) and the fourth carpal bone (1). Thirty-one of 638 horses (4.8 percent) with forelimb lameness had pain localised to the proximal metacarpal region using local anaesthesia (Group B). All these horses were examined radiographically and an ultrasonographic examination was performed in seven. No definitive diagnosis was reached in 16 horses, seven of which had an OCLL in one of the carpal bones or the second metacarpal bone. One horse had, in addition to a poorly defined lucent area in the second carpal bone, radiographic evidence of degenerative joint disease of the carpometacarpal joint and an hypoechoic lesion in the accessory ligament of the deep digital flexor tendon. One horse had an hypoechoic lesion in the proximal part of the suspensory ligament. Abnormalities of the trabecular structure of the third metacarpal bone were identified in 13 horses. In 11 of these there was a vertically orientated lucent line, usually surrounded by sclerotic bone. These lucent lines may represent fatigue fractures seen end on. In one horse an horizontal lucent line was seen. One of these 13 horses also had a lesion in the proximal part of the suspensory ligament. Ten of the 13 (77 per cent) horses with presumed fractures of the third metacarpal bone recovered completely, whereas only eight of the 16 (50 per cent) horses in which no definitive diagnosis was reached returned to their former function

  14. Testing the validity of preventing chronic regional pain syndrome with vitamin C after distal radius fracture. [Corrected].

    Science.gov (United States)

    Malay, Sunitha; Chung, Kevin C

    2014-11-01

    The American Academy of Orthopaedic Surgeons recommends the use of vitamin C to prevent complex regional pain syndrome (CRPS) for patients with distal radius fractures (DRFs). We hypothesized that the evidence for supporting this recommendation is weak, based on epidemiological principles of association and causality. The specific aim of this project was to test the validity of this recommendation. We conducted a literature review to retrieve articles reporting on the use of vitamin C to prevent CRPS. Data collected included sample size, study design type, dose of vitamin C used, and outcome measures of association expressed as relative risk (RR) and odds ratio. We then applied Hill criteria to evaluate the relationship between vitamin C and CRPS. We obtained 225 articles from the database search. After the exclusion of duplicates, unrelated articles, editorial letters, and commentaries, we found 4 articles and 1 systematic review relevant to our topic. Six of the 9 Hill criteria were met, and an earlier meta-analysis showed a quantified reduction in CRPS risk. However, criteria like biological plausibility, specificity, and coherence were not met. The number of causal/association criteria met was adequate to support the scientific premise of the effect of vitamin C in preventing CRPS after DRF. Furthermore, vitamin C administration is of relatively low cost and has few complications unless administered in large doses. Owing to sufficient epidemiological evidence availability, the American Academy of Orthopaedic Surgeons recommendation of vitamin C to prevent CRPS has practical merit. Therapeutic II. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. Regional Anesthesia and Valproate Sodium for the Prevention of Chronic Post Amputation Pain

    Science.gov (United States)

    2016-10-01

    effective for pain, chronic narcotic medications also carry risks of sedation, confusion, and possible addiction . Identifying preventive mechanisms...consented. Duke University Medical Center 2015 SEPTEMBER Amendment submitted to request approval of a phone script for the purposes of conducting

  16. Experience from the ECORS program in regions of complex geology

    Science.gov (United States)

    Damotte, B.

    1993-04-01

    The French ECORS program was launched in 1983 by a cooperation agreement between universities and petroleum companies. Crustal surveys have tried to find explanations for the formation of geological features, such as rifts, mountains ranges or subsidence in sedimentary basins. Several seismic surveys were carried out, some across areas with complex geological structures. The seismic techniques and equipment used were those developed by petroleum geophysicists, adapted to the depth aimed at (30-50 km) and to various physical constraints encountered in the field. In France, ECORS has recorded 850 km of deep seismic lines onshore across plains and mountains, on various kinds of geological formations. Different variations of the seismic method (reflection, refraction, long-offset seismic) were used, often simultaneously. Multiple coverage profiling constitutes the essential part of this data acquisition. Vibrators and dynamite shots were employed with a spread generally 15 km long, but sometimes 100 km long. Some typical seismic examples show that obtaining crustal reflections essentialy depends on two factors: (1) the type and structure of shallow formations, and (2) the sources used. Thus, when seismic energy is strongly absorbed across the first kilometers in shallow formations, or when these formations are highly structured, standard multiple-coverage profiling is not able to provide results beyond a few seconds. In this case, it is recommended to simultaneously carry out long-offset seismic in low multiple coverage. Other more methodological examples show: how the impact on the crust of a surface fault may be evaluated according to the seismic method implemented ( VIBROSEIS 96-fold coverage or single dynamite shot); that vibrators make it possible to implement wide-angle seismic surveying with an offset 80 km long; how to implement the seismic reflection method on complex formations in high mountains. All data were processed using industrial seismic software

  17. Steadiness of Spinal Regions during Single-Leg Standing in Older Adults with and without Chronic Low Back Pain

    OpenAIRE

    Kuo, Yi-Liang; Huang, Kuo-Yuan; Chiang, Pei-Tzu; Lee, Pei-Yun; Tsai, Yi-Ju

    2015-01-01

    The aims of this study were to compare the steadiness index of spinal regions during single-leg standing in older adults with and without chronic low back pain (LBP) and to correlate measurements of steadiness index with the performance of clinical balance tests. Thirteen community-dwelling older adults (aged 55 years or above) with chronic LBP and 13 age- and gender-matched asymptomatic volunteers participated in this study. Data collection was conducted in a university research laboratory. ...

  18. Acid-sensing ion channels in trigeminal ganglion neurons innervating the orofacial region contribute to orofacial inflammatory pain.

    Science.gov (United States)

    Fu, Hui; Fang, Peng; Zhou, Hai-Yun; Zhou, Jun; Yu, Xiao-Wei; Ni, Ming; Zheng, Jie-Yan; Jin, You; Chen, Jian-Guo; Wang, Fang; Hu, Zhuang-Li

    2016-02-01

    Orofacial pain is a common clinical symptom that is accompanied by tooth pain, migraine and gingivitis. Accumulating evidence suggests that acid-sensing ion channels (ASICs), especially ASIC3, can profoundly affect the physiological properties of nociception in peripheral sensory neurons. The aim of this study is to examine the contribution of ASICs in trigeminal ganglion (TG) neurons to orofacial inflammatory pain. A Western blot (WB), immunofluorescence assay of labelled trigeminal ganglion neurons, orofacial formalin test, cell preparation and electrophysiological experiments are performed. This study demonstrated that ASIC1, ASIC2a and ASIC3 are highly expressed in TG neurons innervating the orofacial region of rats. The amplitude of ASIC currents in these neurons increased 119.72% (for ASIC1-like current) and 230.59% (for ASIC3-like current) in the formalin-induced orofacial inflammatory pain model. In addition, WB and immunofluorescence assay demonstrated a significantly augmented expression of ASICs in orofacial TG neurons during orofacial inflammation compared with the control group. The relative protein density of ASIC1, ASIC2a and ASIC3 also increased 58.82 ± 8.92%, 45.30 ± 11.42% and 55.32 ± 14.71%, respectively, compared with the control group. Furthermore, pharmacological blockade of ASICs and genetic deletion of ASIC1 attenuated the inflammation response. These findings indicate that peripheral inflammation can induce the upregulation of ASICs in TG neurons, causing orofacial inflammatory pain. Additionally, the specific inhibitor of ASICs may have a significant analgesic effect on orofacial inflammatory pain. © 2016 John Wiley & Sons Australia, Ltd.

  19. Effect of acetylcholine receptors on the pain-related electrical activities in the hippocampal CA3 region of morphine-addicted rats

    OpenAIRE

    Li, Guan Zeng; Liu, Zhe Hui; Wei, XinYa; Zhao, Pan; Yang, Chun Xiao; Xu, Man Ying

    2015-01-01

    Objective(s): To determine the effect of acetylcholine (ACh), pilocarpine, and atropine on pain evoked responses of pain excited neurons (PEN) and pain inhibited neurons (PIN) in hippocampal CA3 region of morphine addicted rats. Materials and Methods: Female Wistar rats, weighing between 230-260 g were used in this study. Morphine addicted rats were generated by subcutaneous injection of increasing concentrations of morphine hydrochloride for six days. Trains of electrical impulses applied to...

  20. Hierarchical Model for the Similarity Measurement of a Complex Holed-Region Entity Scene

    Directory of Open Access Journals (Sweden)

    Zhanlong Chen

    2017-11-01

    Full Text Available Complex multi-holed-region entity scenes (i.e., sets of random region with holes are common in spatial database systems, spatial query languages, and the Geographic Information System (GIS. A multi-holed-region (region with an arbitrary number of holes is an abstraction of the real world that primarily represents geographic objects that have more than one interior boundary, such as areas that contain several lakes or lakes that contain islands. When the similarity of the two complex holed-region entity scenes is measured, the number of regions in the scenes and the number of holes in the regions are usually different between the two scenes, which complicates the matching relationships of holed-regions and holes. The aim of this research is to develop several holed-region similarity metrics and propose a hierarchical model to measure comprehensively the similarity between two complex holed-region entity scenes. The procedure first divides a complex entity scene into three layers: a complex scene, a micro-spatial-scene, and a simple entity (hole. The relationships between the adjacent layers are considered to be sets of relationships, and each level of similarity measurements is nested with the adjacent one. Next, entity matching is performed from top to bottom, while the similarity results are calculated from local to global. In addition, we utilize position graphs to describe the distribution of the holed-regions and subsequently describe the directions between the holes using a feature matrix. A case study that uses the Great Lakes in North America in 1986 and 2015 as experimental data illustrates the entire similarity measurement process between two complex holed-region entity scenes. The experimental results show that the hierarchical model accounts for the relationships of the different layers in the entire complex holed-region entity scene. The model can effectively calculate the similarity of complex holed-region entity scenes, even if the

  1. Methods for deconvoluting and interpreting complex gamma- and x-ray spectral regions

    International Nuclear Information System (INIS)

    Gunnink, R.

    1983-06-01

    Germanium and silicon detectors are now widely used for the detection and measurement of x and gamma radiation. However, some analysis situations and spectral regions have heretofore been too complex to deconvolute and interpret by techniques in general use. One example is the L x-ray spectrum of an element taken with a Ge or Si detector. This paper describes some new tools and methods that were developed to analyze complex spectral regions; they are illustrated with examples

  2. Validation of the Malayalam version of Leeds assessment of neuropathic symptoms and signs pain scale in cancer patients in the Regional Cancer Centre, Thiruvananthapuram, Kerala, India

    Directory of Open Access Journals (Sweden)

    Shoukkathali Anzar

    2017-01-01

    Full Text Available Objective: The Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS is a 7-item self-report scale developed to identify pain which is of predominantly neuropathic origin. The aim of this study was to develop a Malayalam version of the LANSS and to test its validity and reliability in chronic pain patients. Methodology: We enrolled 101 Malayalam-speaking chronic pain patients who visited the Division of Palliative Medicine, Regional Cancer Centre, Thiruvananthapuram, Kerala, India. The translated version of S- LANSS was constructed by standard means. Fifty-one neuropathic pain and fifty nociceptive pain patients were identified by an independent pain physician and were subjected to the new pain scale by a palliative care nurse who was blinded to the diagnosis. The “gold standard diagnosis” is what the physician makes after clinical examination. Its validation, sensitivity, specificity, and positive and negative predictive values were determined. Results: Fifty-one neuropathic pain and fifty nociceptive pain patients were subjected to the Malayalam version of S-LANSS pain scale for validity testing. The agreement by Cohen's Kappa 0.743, Chi-square test P < 0.001, sensitivity 89.58, specificity 84.91, positive predictive value 84.31, negative predictive value 90.00, accuracy by 87.13, and likelihood ratio 5.94. Conclusion: The Malayalam version of S-LANSS pain scale is a validated screening tool for identifying neuropathic pain in chronic pain patients in Malayalam-speaking regions.

  3. Chronic orofacial pain.

    Science.gov (United States)

    Renton, T

    2017-07-01

    The issues specific to trigeminal pain include the complexity of the region, the problematic impact on daily function and significant psychological impact (J Dent, 43, 2015, 1203). By nature of the geography of the pain (affecting the face, eyes, scalp, nose, mouth), it may interfere with just about every social function we take for granted and enjoy (J Orofac Pain, 25, 2011, 333). The trigeminal nerve is the largest sensory nerve in the body, protecting the essential organs that underpin our very existence (brain, eyes, nose, mouth). It is no wonder that pain within the trigeminal system in the face is often overwhelming and inescapable for the affected individual. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Complex researches on substantiation of construction and seismic stability of large dams in seismic region

    International Nuclear Information System (INIS)

    Negmatullaev, S.Kh.; Yasunov, P.A.

    2001-01-01

    This article is devoted to complex researches on substantiation of construction and seismic stability of large dams (Nurec hydroelectric power station) in seismic region. Geological, seismological, model, and engineering investigations are discussed in this work. At construction of Nurec hydroelectric power station the rich experience is accumulated. This experience can be used in analogous seismically active regions at construction similar hydroelectric power stations.

  5. Spinal pain

    International Nuclear Information System (INIS)

    Izzo, R.; Popolizio, T.; D’Aprile, P.; Muto, M.

    2015-01-01

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  6. Spinal pain

    Energy Technology Data Exchange (ETDEWEB)

    Izzo, R., E-mail: roberto1766@interfree.it [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: t.popolizio1@gmail.com [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: paoladaprile@yahoo.it [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)

    2015-05-15

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  7. Complex regional pain syndrome (CRPS) type I: historical perspective and critical issues.

    Science.gov (United States)

    Iolascon, Giovanni; de Sire, Alessandro; Moretti, Antimo; Gimigliano, Francesca

    2015-01-01

    The history of algodystrophy is controversial and its denomination has changed significantly over time. Silas Weir Mitchell described several cases of causalgia due to gunshot wounds that occurred during the American Civil War, increasing knowledge about this clinical condition. A later key milestone in the history of CRPS is tied to the name of Paul Sudeck that, using X-ray examinations, described findings of bone atrophy following a traumatic event or infection of the upper limb. The most widely accepted pathogenic hypothesis, proposed by Rene Leriche, supported a key role of the sympathetic nervous system in the onset of the typical clinical picture of the disease, which was thus defined as "reflex sympathetic dystrophy". In the 50s John J. Bonica proposed a staging of CRPS. In a consensus conference held in Budapest in 2003, it was proposed a new classification system that included the presence of at least two clinical signs included in the four categories and at least three symptoms in its four categories. There have been other classification systems proposed for the diagnosis of CRPS, such as Veldman diagnostic criteria based on the presence of at least 4 signs and symptoms of the disease associated with a worsening of the same following the use of the limb and their location in the same area distal to the one that suffered the injury. On the other hand, the Atkins diagnostic criteria are much more objective than those proposed by IASP and are specifically applicable to an orthopaedic context. However, current classification systems and related criteria proposed to make a diagnosis of CRPS, do not include instrumental evaluations and imaging, but rely solely on clinical findings. This approach does not allow an optimal disease staging especially in orthopaedics.

  8. Migraine and Complex Regional Pain Syndrome: A Case-Referent Clinical Study

    Science.gov (United States)

    Cooley, Corinne; Foley-Saldena, Katharine; Cowan, Robert P.

    2017-01-01

    We studied clinical phenotype differences between migraineurs with CRPS (Mig + CRPS) and those without (Mig − CRPS). Mig + CRPS cases and Mig − CRPS referents aged ≥18 years were enrolled. Diagnosis was made in accordance with International Classification of Headache Disorders-3 beta (ICHD-3 beta) for migraine and Budapest Criteria for CRPS. Migraines both with and without aura were included. A total of 70 Mig + CRPS cases (13% males, mean age 48 years) and 80 Mig − CRPS referents (17% males, mean age 51 years) were included. 33% of Mig + CRPS and 38% of Mig − CRPS exhibited episodic migraine (EM) while 66% of Mig + CRPS and 62% of Mig − CRPS had chronic migraine (CM) (OR = 0.98, CI 0.36, 2.67). Median duration of CRPS was 3 years among EM + CRPS and 6 years among CM + CRPS cohort (p CRPS (57%) carried higher psychological and medical comorbidities compared to Mig − CRPS (6%) (OR 16.7, CI 10.2, 23.6). Higher migraine frequency was associated with longer CRPS duration. Migraineurs who developed CRPS had higher prevalence of psychological and medical disorders. Alleviating migraineurs' psychological and medical comorbidities may help lower CRPS occurrence. PMID:29214172

  9. Migraine and Complex Regional Pain Syndrome: A Case-Referent Clinical Study

    OpenAIRE

    Woldeamanuel, Yohannes W.; Cooley, Corinne; Foley-Saldena, Katharine; Cowan, Robert P.

    2017-01-01

    We studied clinical phenotype differences between migraineurs with CRPS (Mig + CRPS) and those without (Mig − CRPS). Mig + CRPS cases and Mig − CRPS referents aged ≥18 years were enrolled. Diagnosis was made in accordance with International Classification of Headache Disorders-3 beta (ICHD-3 beta) for migraine and Budapest Criteria for CRPS. Migraines both with and without aura were included. A total of 70 Mig + CRPS cases (13% males, mean age 48 years) and 80 Mig − CRPS referents (17% males,...

  10. The Cost-Effectiveness of Spinal Cord Stimulation for Complex Regional Pain Syndrome

    NARCIS (Netherlands)

    Kemler, Marius A.; Raphael, Jon H.; Bentley, Anthony; Taylor, Rod S.

    2010-01-01

    Objectives: Health-care policymakers and payers require cost-effectiveness evidence to inform their treatment funding decisions. The aims of this study were to assess the cost-effectiveness of the addition of spinal cord stimulation (SCS) compared with conventional management alone (CMM) in patients

  11. [Neurotropic effect of B vitamins in the complex treatment of pain syndrome].

    Science.gov (United States)

    Shavlovskaya, O A

    Combined vitamin preparations in therapeutic doses are used, along with simple analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle and epidural blockade, for the relief of acute pain. It is recommended to use the B vitamin preparation neuromultivit. The tablet form of this preparation contains vitamin thiamine hydrochloride (100 mg), pyridoxine hydrochloride (200 mg), cyanocobalamin (0.2 mg), and injectable form includes thiamine hydrochloride (100mg), pyridoxine hydrochloride (100 mg), cyanocobalamin (1 mg). The efficacy of neuromultivit in a two stage scheme (intramuscular injections of 2 ml daily for 5-10 days with further injections 2-3 times a week for 2-3 weeks at the initial stage and 1 tablet 3 times a day for 4 weeks at the second stage) was shown.

  12. Regional Anesthesia and Valproate Sodium for the Prevention of Chronic Post-Amputation Pain

    Science.gov (United States)

    2013-10-01

    Previous surgical interventions (vascular, diabetic , infection-related procedure or amputation for other cause) • Narcotic medication (total daily...change the three-dimensional chromatin structure and subsequent gene expression [59,60]. One of the more common modi - fications involves acetylation...cytokine produc- tion and pain intensity has been noted in multiple disease models such as migraine headache [122], diabetes [114], and osteoarthritis

  13. Region-specific expression of mitochondrial complex I genes during murine brain development.

    Directory of Open Access Journals (Sweden)

    Stefanie Wirtz

    Full Text Available Mutations in the nuclear encoded subunits of mitochondrial complex I (NADH:ubiquinone oxidoreductase may cause circumscribed cerebral lesions ranging from degeneration of the striatal and brainstem gray matter (Leigh syndrome to leukodystrophy. We hypothesized that such pattern of regional pathology might be due to local differences in the dependence on complex I function. Using in situ hybridization we investigated the relative expression of 33 nuclear encoded complex I subunits in different brain regions of the mouse at E11.5, E17.5, P1, P11, P28 and adult (12 weeks. With respect to timing and relative intensity of complex I gene expression we found a highly variant pattern in different regions during development. High average expression levels were detected in periods of intense neurogenesis. In cerebellar Purkinje and in hippocampal CA1/CA3 pyramidal neurons we found a second even higher peak during the period of synaptogenesis and maturation. The extraordinary dependence of these structures on complex I gene expression during synaptogenesis is in accord with our recent findings that gamma oscillations--known to be associated with higher cognitive functions of the mammalian brain--strongly depend on the complex I activity. However, with the exception of the mesencephalon, we detected only average complex I expression levels in the striatum and basal ganglia, which does not explain the exquisite vulnerability of these structures in mitochondrial disorders.

  14. Reduced task-induced variations in the distribution of activity across back muscle regions in individuals with low back pain.

    Science.gov (United States)

    Falla, Deborah; Gizzi, Leonardo; Tschapek, Marika; Erlenwein, Joachim; Petzke, Frank

    2014-05-01

    This study investigated change in the distribution of lumbar erector spinae muscle activity and pressure pain sensitivity across the low back in individuals with low back pain (LBP) and healthy controls. Surface electromyographic (EMG) signals were recorded from multiple locations over the lumbar erector spinae muscle with a 13×5 grid of electrodes from 19 people with chronic nonspecific LBP and 17 control subjects as they performed a repetitive lifting task. The EMG root mean square (RMS) was computed for each location of the grid to form a map of the EMG amplitude distribution. Pressure pain thresholds (PPT) were recorded before and after the lifting task over a similar area of the back. For the control subjects, the EMG RMS progressively increased more in the caudal region of the lumbar erector spinae during the repetitive task, resulting in a shift in the distribution of muscle activity. In contrast, the distribution of muscle activity remained unaltered in the LBP group despite an overall increase in EMG amplitude. PPT was lower in the LBP group after completion of the repetitive task compared to baseline (average across all locations: pre: 268.0±165.9 kPa; post: 242.0±166.7 kPa), whereas no change in PPT over time was observed for the control group (320.1±162.1 kPa; post: 322.0±179.5 kPa). The results demonstrate that LBP alters the normal adaptation of lumbar erector spinae muscle activity to exercise, which occurs in the presence of exercise-induced hyperalgesia. Reduced variability of muscle activity may have important implications for the provocation and recurrence of LBP due to repetitive tasks. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  15. GBA manager: an online tool for querying low-complexity regions in proteins.

    Science.gov (United States)

    Bandyopadhyay, Nirmalya; Kahveci, Tamer

    2010-01-01

    Abstract We developed GBA Manager, an online software that facilitates the Graph-Based Algorithm (GBA) we proposed in our earlier work. GBA identifies the low-complexity regions (LCR) of protein sequences. GBA exploits a similarity matrix, such as BLOSUM62, to compute the complexity of the subsequences of the input protein sequence. It uses a graph-based algorithm to accurately compute the regions that have low complexities. GBA Manager is a user friendly web-service that enables online querying of protein sequences using GBA. In addition to querying capabilities of the existing GBA algorithm, GBA Manager computes the p-values of the LCR identified. The p-value gives an estimate of the possibility that the region appears by chance. GBA Manager presents the output in three different understandable formats. GBA Manager is freely accessible at http://bioinformatics.cise.ufl.edu/GBA/GBA.htm .

  16. The plausible reason why the length of 5' untranslated region is unrelated to organismal complexity

    Directory of Open Access Journals (Sweden)

    Chen Feng-Chi

    2011-08-01

    Full Text Available Abstract Background Organismal complexity is suggested to increase with the complexity of transcriptional and translational regulations. Supporting this notion is a recent study that demonstrated a higher level of tissue-specific gene expression in human than in mouse. However, whether this correlation can be extended beyond mammals remains unclear. In addition, 5' untranslated regions (5'UTRs, which have undergone stochastic elongation during evolution and potentially included an increased number of regulatory elements, may have played an important role in the emergence of organismal complexity. Although the lack of correlation between 5'UTR length and organismal complexity has been proposed, the underlying mechanisms remain unexplored. Results In this study, we select the number of cell types as the measurement of organismal complexity and examine the correlation between (1 organismal complexity and transcriptional regulatory complexity; and (2 organismal complexity and 5'UTR length by comparing the 5'UTRs and multiple-tissue expression profiles of human (Homo sapiens, mouse (Mus musculus, and fruit fly (Drosophila melanogaster. The transcriptional regulatory complexity is measured by using the tissue specificity of gene expression and the ratio of non-constitutively expressed to constitutively expressed genes. We demonstrate that, whereas correlation (1 holds well in the three-way comparison, correlation (2 is not true. Results from a larger dataset that includes more than 15 species, ranging from yeast to human, also reject correlation (2. The reason for the failure of correlation (2 may be ascribed to: Firstly, longer 5'UTRs do not contribute to increased tissue specificity of gene expression. Secondly, the increased numbers of common translational regulatory elements in longer 5'UTRs do not lead to increased organismal complexity. Conclusions Our study has extended the evidence base for the correlation between organismal complexity and

  17. Time-Resolved Fast Mammalian Behavior Reveals the Complexity of Protective Pain Responses

    Directory of Open Access Journals (Sweden)

    Liam E. Browne

    2017-07-01

    Full Text Available Potentially harmful stimuli are detected at the skin by nociceptor sensory neurons that drive rapid protective withdrawal reflexes and pain. We set out to define, at a millisecond timescale, the relationship between the activity of these sensory neurons and the resultant behavioral output. Brief optogenetic activation of cutaneous nociceptors was found to activate only a single action potential in each fiber. This minimal input was used to determine high-speed behavioral responses in freely behaving mice. The localized stimulus generated widespread dynamic repositioning and alerting sub-second behaviors whose nature and timing depended on the context of the animal and its position, activity, and alertness. Our findings show that the primary response to injurious stimuli is not limited, fixed, or localized, but is dynamic, and that it involves recruitment and gating of multiple circuits distributed throughout the central nervous system at a sub-second timescale to effectively both alert to the presence of danger and minimize risk of harm.

  18. Complex active regions as the main source of extreme and large solar proton events

    Science.gov (United States)

    Ishkov, V. N.

    2013-12-01

    A study of solar proton sources indicated that solar flare events responsible for ≥2000 pfu proton fluxes mostly occur in complex active regions (CARs), i.e., in transition structures between active regions and activity complexes. Different classes of similar structures and their relation to solar proton events (SPEs) and evolution, depending on the origination conditions, are considered. Arguments in favor of the fact that sunspot groups with extreme dimensions are CARs are presented. An analysis of the flare activity in a CAR resulted in the detection of "physical" boundaries, which separate magnetic structures of the same polarity and are responsible for the independent development of each structure.

  19. Painful ankle region in rheumatoid arthritis. Analysis of soft-tissue changes with ultrasonography and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lehtinen, A. [Dept. of Radiology, Univ. Central Hospital, Helsinki (Finland); Paimela, L. [Dept of Rheumatology, Helsinki City Hospital (Finland); Kreula, J. [Dept. of Radiology, Univ. Central Hospital, Helsinki (Finland); Leirisalo-Repo, M. [Dept of Medicine, Univ. Central Hospital, Helsinki (Finland); Taavitsainen, M. [Dept. of Radiology, Univ. Central Hospital, Helsinki (Finland)

    1996-07-01

    Purpose: To establish the diagnostic usefulness of ultrasonography (US) and MR imaging in patients with rheumatoid arthritis (RA) suffering from prolonged pain in the ankle region, where plain radiography did not demonstrate any changes. Material and Methods: Seventeen patients were studied with 0.1 T MR imaging and with high-frequency US. Talocrural and subtalar joints (including talonavicular joints), and medial, lateral, and extensor tendons and their synovial sheaths were examined b MR and US. Results: Abnormal findings were found by MR imaging and US in altogether 76% of the patients, by MR alone in 53%, and by US alone in 59%. In 41% of the patients, lesions were demonstrated only by one method. Talocurural and subtalar joints were the most often affected sites (41% each), followed by the peroneus tendon (23%). In the joints, the abnormal findings were interpreted as synovitis; in the tendon areas, mostly as tenosynovitis. MR and US were highly significantly concordant (p<0.0001), but correlation with clinical features was poor. Conclusion: In patients with pain in the ankle region, US and MR imaging can contribute to the diagnosis and localization of the abnormality when the plain radiography is normal Easily available and inexpensive US can be recommended as the first imaging method after plain radiography. Some divergence seems to exist between US and MR, and in complicated cases both methods are recommended. (orig.).

  20. Painful ankle region in rheumatoid arthritis. Analysis of soft-tissue changes with ultrasonography and MR imaging

    International Nuclear Information System (INIS)

    Lehtinen, A.; Paimela, L.; Kreula, J.; Leirisalo-Repo, M.; Taavitsainen, M.

    1996-01-01

    Purpose: To establish the diagnostic usefulness of ultrasonography (US) and MR imaging in patients with rheumatoid arthritis (RA) suffering from prolonged pain in the ankle region, where plain radiography did not demonstrate any changes. Material and Methods: Seventeen patients were studied with 0.1 T MR imaging and with high-frequency US. Talocrural and subtalar joints (including talonavicular joints), and medial, lateral, and extensor tendons and their synovial sheaths were examined b MR and US. Results: Abnormal findings were found by MR imaging and US in altogether 76% of the patients, by MR alone in 53%, and by US alone in 59%. In 41% of the patients, lesions were demonstrated only by one method. Talocurural and subtalar joints were the most often affected sites (41% each), followed by the peroneus tendon (23%). In the joints, the abnormal findings were interpreted as synovitis; in the tendon areas, mostly as tenosynovitis. MR and US were highly significantly concordant (p<0.0001), but correlation with clinical features was poor. Conclusion: In patients with pain in the ankle region, US and MR imaging can contribute to the diagnosis and localization of the abnormality when the plain radiography is normal Easily available and inexpensive US can be recommended as the first imaging method after plain radiography. Some divergence seems to exist between US and MR, and in complicated cases both methods are recommended. (orig.)

  1. Current state and development trends of the agroindustrial complex and rural territories of Perm Region

    Directory of Open Access Journals (Sweden)

    Gennadiy Vladimirovich Klimenkov

    2011-12-01

    Full Text Available Analysis of regional agricultural sector status and rural areas of Perm in 1990-2011 years indicates a systemic crisis of agriculture in Perm region, which is largely determined by the fact that Perm region has no strategy or strategic plan and program for sustainable agricultural sector and rural areas of Perm region development, there is no scheme of territorial development and master plans of territorial development with the development of agro-industrial complex of Perm region. In these circumstances, there is a steady downward trend in production, weakening and bankruptcy of enterprises, social impoverishment of rural areas, appearance of many of irreversible processes (sale and neglect of agricultural land, demographic problems associated with low living standards, population migration, policy optimization in the areas of education and health, union of territories, policy of depopulation of territories etc.. This paper presents main recommendations for improving the situation in agriculture of Perm region.

  2. Heterogeneous convergence of regional house prices and the complexity in China

    Directory of Open Access Journals (Sweden)

    Rui Lin

    2015-12-01

    Full Text Available The purpose of this research is to analyze the convergence of regional house prices and its complexity in China. In this purpose it used nonlinear time varying factor model. The obtained results have provided evidences for the existence of some degree of segmentation in China’s housing market. By further dynamic analysis of the convergence, we have found that important housing policies from Chinese central government can significantly alter the housing market but with a time lag of 4 to 5 months, and that quite different behaviors exist between the new house market and the second-hand house market in China, which provides the evidence for the complexity of housing market in China. Multiple factors together are the driving forces for the regional house price convergence. And the driving forces differ among three clubs. The basic conclusion provided from the realized research is that the conventional definitions of economic regions may not be appropriate to analyze house price segregation in China. Heterogeneous convergence exists in China’s regional house prices, indicating the complexity of regional house prices in China. And housing policies should be implemented with different focus among the regions. The way of the central government is to make housing policies aiming at different sub-markets of the new house market and the second-hand house market.

  3. Prevalence of pain in the orofacial regions in patients visiting general dentists in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry research network.

    Science.gov (United States)

    Horst, Orapin V; Cunha-Cruz, Joana; Zhou, Lingmei; Manning, Walter; Mancl, Lloyd; DeRouen, Timothy A

    2015-10-01

    This study aimed to measure prevalence of pain in the orofacial regions and determine association with demographics, treatment history, and oral health conditions in dental patients visiting clinics in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT) research network. Data were recorded in a survey with systematic random sampling of patients (n = 1,668, 18 to 93 years old, 56% female) visiting 100 general dentists in the Northwest PRECEDENT research network. Prevalence ratios (PR) of orofacial pain by each variable were estimated by generalized estimating equations for Poisson regression. The prevalence of orofacial pain during the past year was 16.1% (95% confidence interval [CI], 13.4-18.9), of which the most prevalent pain locations were dentoalveolar (9.1%; 95% CI, 7.0-11.2) and musculoligamentous tissues (6.6%; 95% CI, 4.5-8.7). Other locations included soft tissues (0.5%; 95% CI, 0.2-0.8) and nonspecific areas (0.6%; 95% CI, 0.2-1.0). The prevalence of dentoalveolar but not musculoligamentous pain decreased with age. When comparing the 18- to 29-year-old patients, dentoalveolar pain decreased significantly in 45- to 64-year-old patients (PR, 0.59; 95% CI, 0.4-0.9) and in those 65 years or older (PR, 0.5; 95% CI, 0.3-0.9). Sex significantly affected the prevalence of musculoligamentous but not dentoalveolar pain. Women (PR, 3.2; 95% CI, 2.0-5.1) were more likely to have musculoligamentous pain. The prevalence of dentoalveolar and musculoligamentous pain did not vary significantly by ethnicity. Dentoalveolar pain was reported more frequently in patients who did not receive dental maintenance (PR, 2.9; 95% CI, 2.1-4.2) and those visiting community-based public health clinics (PR, 2.2; 95% CI, 1.2-3.7). One in 6 patients visiting a general dentist had experienced orofacial pain during the past year. Dentoalveolar and musculoligamentous pains were the most prevalent types of pain. Pain in the muscles and

  4. Pain genes.

    Directory of Open Access Journals (Sweden)

    Tom Foulkes

    2008-07-01

    Full Text Available Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors signal the existence of tissue damage to the central nervous system (CNS, where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception.

  5. Unique Phrenic Nerve-Sparing Regional Anesthetic Technique for Pain Management after Shoulder Surgery

    Directory of Open Access Journals (Sweden)

    Jason K. Panchamia

    2017-01-01

    Full Text Available Background. Ipsilateral phrenic nerve blockade is a common adverse event after an interscalene brachial plexus block, which can result in respiratory deterioration in patients with preexisting pulmonary conditions. Diaphragm-sparing nerve block techniques are continuing to evolve, with the intention of providing satisfactory postoperative analgesia while minimizing hemidiaphragmatic paralysis after shoulder surgery. Case Report. We report the successful application of a combined ultrasound-guided infraclavicular brachial plexus block and suprascapular nerve block in a patient with a complicated pulmonary history undergoing a total shoulder replacement. Conclusion. This case report briefly reviews the important innervations to the shoulder joint and examines the utility of the infraclavicular brachial plexus block for postoperative pain management.

  6. Formation of competitive potential of the machine-building complex of the region

    Directory of Open Access Journals (Sweden)

    Oleg Ivanovich Botkin

    2014-03-01

    Full Text Available The article describes the features of competitive potential of regional machine-building complex in a globalized world economy. The purpose of the research is the development of theoretically reasonable economic basis of the machine-building complex considering  the  features of business in the conditions of the WTO. In the work, the hypothesis of a special role of the external economic factors locates in development of the enterprises of regional industrial complexes. The study of the theoretical provisions defining the development of the region revealed the factors determining influence of the international trade agreements on spatial localization of the industry. The main attention is paid to an analytical assessment of the current state and the trends, which have developed in the period of post-crisis economic recovery. Analysis of the main indicators of attractiveness has revealed the weak position of local industrial enterprises in the WTO. The directions of strengthening of the competitive capacity of the local industrial enterprises are defined. The obtained results allow us to increase the sustainability of the industry by means of effective management mechanism improvements and to create favorable operating conditions of a machine-building complex of the region

  7. ECOLOGICAL SAFETY OF MINING REGIONS THROUGH CREATION OF POWER‐HEATING COMPLEXES (in Russian

    Directory of Open Access Journals (Sweden)

    I. A. YEFREMOV

    2014-04-01

    Full Text Available There was presented a method of use of alterative source of energy, namely coal mine methane, the use of which as a fuel for power and heatiing generation is a main direction in coal mines. By this means some ecological problems of the region are solved. Highly efficient power and heating technologies are implemented and energy complexes are established.

  8. Ecosystem services provided by a complex coastal region: challenges of classification and mapping

    Science.gov (United States)

    Sousa, Lisa P.; Sousa, Ana I.; Alves, Fátima L.; Lillebø, Ana I.

    2016-03-01

    A variety of ecosystem services classification systems and mapping approaches are available in the scientific and technical literature, which needs to be selected and adapted when applied to complex territories (e.g. in the interface between water and land, estuary and sea). This paper provides a framework for addressing ecosystem services in complex coastal regions. The roadmap comprises the definition of the exact geographic boundaries of the study area; the use of CICES (Common International Classification of Ecosystem Services) for ecosystem services identification and classification; and the definition of qualitative indicators that will serve as basis to map the ecosystem services. Due to its complexity, the Ria de Aveiro coastal region was selected as case study, presenting an opportunity to explore the application of such approaches at a regional scale. The main challenges of implementing the proposed roadmap, together with its advantages are discussed in this research. The results highlight the importance of considering both the connectivity of natural systems and the complexity of the governance framework; the flexibility and robustness, but also the challenges when applying CICES at regional scale; and the challenges regarding ecosystem services mapping.

  9. Regional and Historical Minerageny of the Gemstone Complexes in Russia (Quantitative Aspects

    Directory of Open Access Journals (Sweden)

    Polyanin V.S.

    2015-06-01

    Full Text Available The paper presents an approximate quantitative estimation of the mineragenic potentials of gems in the paleogeodynamic systems, complexes, and geological formations of Russia, which are characterized by different age and regional distribution. General trends of the changes in the scale and intensity of formation processes of the same gem deposits over geologic time were identified.

  10. Modelling of the flow of stable air over a complex region

    CSIR Research Space (South Africa)

    Scholtz, MT

    1976-01-01

    Full Text Available The flow of stable air over a general region of complex topography and non-uniform surface temperature has been investigated. In order to gain further understanding of the motion of surface air, it was necessary to study the vertical structure...

  11. Ecosystem services provided by a complex coastal region: challenges of classification and mapping.

    Science.gov (United States)

    Sousa, Lisa P; Sousa, Ana I; Alves, Fátima L; Lillebø, Ana I

    2016-03-11

    A variety of ecosystem services classification systems and mapping approaches are available in the scientific and technical literature, which needs to be selected and adapted when applied to complex territories (e.g. in the interface between water and land, estuary and sea). This paper provides a framework for addressing ecosystem services in complex coastal regions. The roadmap comprises the definition of the exact geographic boundaries of the study area; the use of CICES (Common International Classification of Ecosystem Services) for ecosystem services identification and classification; and the definition of qualitative indicators that will serve as basis to map the ecosystem services. Due to its complexity, the Ria de Aveiro coastal region was selected as case study, presenting an opportunity to explore the application of such approaches at a regional scale. The main challenges of implementing the proposed roadmap, together with its advantages are discussed in this research. The results highlight the importance of considering both the connectivity of natural systems and the complexity of the governance framework; the flexibility and robustness, but also the challenges when applying CICES at regional scale; and the challenges regarding ecosystem services mapping.

  12. Determination of haplotypes at structurally complex regions using emulsion haplotype fusion PCR.

    Science.gov (United States)

    Tyson, Jess; Armour, John A L

    2012-12-11

    Genotyping and massively-parallel sequencing projects result in a vast amount of diploid data that is only rarely resolved into its constituent haplotypes. It is nevertheless this phased information that is transmitted from one generation to the next and is most directly associated with biological function and the genetic causes of biological effects. Despite progress made in genome-wide sequencing and phasing algorithms and methods, problems assembling (and reconstructing linear haplotypes in) regions of repetitive DNA and structural variation remain. These dynamic and structurally complex regions are often poorly understood from a sequence point of view. Regions such as these that are highly similar in their sequence tend to be collapsed onto the genome assembly. This is turn means downstream determination of the true sequence haplotype in these regions poses a particular challenge. For structurally complex regions, a more focussed approach to assembling haplotypes may be required. In order to investigate reconstruction of spatial information at structurally complex regions, we have used an emulsion haplotype fusion PCR approach to reproducibly link sequences of up to 1kb in length to allow phasing of multiple variants from neighbouring loci, using allele-specific PCR and sequencing to detect the phase. By using emulsion systems linking flanking regions to amplicons within the CNV, this led to the reconstruction of a 59kb haplotype across the DEFA1A3 CNV in HapMap individuals. This study has demonstrated a novel use for emulsion haplotype fusion PCR in addressing the issue of reconstructing structural haplotypes at multiallelic copy variable regions, using the DEFA1A3 locus as an example.

  13. Determination of haplotypes at structurally complex regions using emulsion haplotype fusion PCR

    Directory of Open Access Journals (Sweden)

    Tyson Jess

    2012-12-01

    Full Text Available Abstract Background Genotyping and massively-parallel sequencing projects result in a vast amount of diploid data that is only rarely resolved into its constituent haplotypes. It is nevertheless this phased information that is transmitted from one generation to the next and is most directly associated with biological function and the genetic causes of biological effects. Despite progress made in genome-wide sequencing and phasing algorithms and methods, problems assembling (and reconstructing linear haplotypes in regions of repetitive DNA and structural variation remain. These dynamic and structurally complex regions are often poorly understood from a sequence point of view. Regions such as these that are highly similar in their sequence tend to be collapsed onto the genome assembly. This is turn means downstream determination of the true sequence haplotype in these regions poses a particular challenge. For structurally complex regions, a more focussed approach to assembling haplotypes may be required. Results In order to investigate reconstruction of spatial information at structurally complex regions, we have used an emulsion haplotype fusion PCR approach to reproducibly link sequences of up to 1kb in length to allow phasing of multiple variants from neighbouring loci, using allele-specific PCR and sequencing to detect the phase. By using emulsion systems linking flanking regions to amplicons within the CNV, this led to the reconstruction of a 59kb haplotype across the DEFA1A3 CNV in HapMap individuals. Conclusion This study has demonstrated a novel use for emulsion haplotype fusion PCR in addressing the issue of reconstructing structural haplotypes at multiallelic copy variable regions, using the DEFA1A3 locus as an example.

  14. Causes, coping, and culture: a comparative survey study on representation of back pain in three Swiss language regions.

    Directory of Open Access Journals (Sweden)

    Peter J Schulz

    Full Text Available INTRODUCTION: This study intends to contribute to a research tradition that asks how causal attributions of illnesses affect coping behavior. Causal attributions are understood as the most important element of illness representations and coping as a means to preserve quality of life. The issue is applied to a condition so far often neglected in research on illness representations-back pain-and a third concept is added to the picture: culture. AIM: The aim of this study is (a to explore the causal factors to which persons with back pain attribute the further course of their illness, (b to find out whether the attributed causes are predictors of coping maxims, and (c to find out whether cultural factors affect attributions and coping and moderate the relationship between the two. METHODS: A total of 1259 gainfully employed or self-employed persons with recent episodes of back pain were recruited in the three language regions of Switzerland. They were asked to complete a structured online interview, measuring among many other variables attributed causes, coping maxims, and affiliation to one of the Swiss micro-cultures (German-, French- or Italian-speaking. RESULTS: Attributed causes of the illness that can be influenced by a patient go along with more active coping styles. Cultural affiliation impacts on coping maxims independently, but culture moderates the relationship of attributed causes and coping maxims only in two of twenty possible cases. IMPLICATIONS: The results show that cultural differences can be analytically incorporated in the models of illness representations. Results may help to improve healthcare providers' communication with patients and plan public health campaigns. The approach to micro-cultural differences and the substantive relationships between alterability of causes and activity in coping may help the further development of models of illness representations.

  15. Causes, coping, and culture: a comparative survey study on representation of back pain in three Swiss language regions.

    Science.gov (United States)

    Schulz, Peter J; Hartung, Uwe; Riva, Silvia

    2013-01-01

    This study intends to contribute to a research tradition that asks how causal attributions of illnesses affect coping behavior. Causal attributions are understood as the most important element of illness representations and coping as a means to preserve quality of life. The issue is applied to a condition so far often neglected in research on illness representations-back pain-and a third concept is added to the picture: culture. The aim of this study is (a) to explore the causal factors to which persons with back pain attribute the further course of their illness, (b) to find out whether the attributed causes are predictors of coping maxims, and (c) to find out whether cultural factors affect attributions and coping and moderate the relationship between the two. A total of 1259 gainfully employed or self-employed persons with recent episodes of back pain were recruited in the three language regions of Switzerland. They were asked to complete a structured online interview, measuring among many other variables attributed causes, coping maxims, and affiliation to one of the Swiss micro-cultures (German-, French- or Italian-speaking). Attributed causes of the illness that can be influenced by a patient go along with more active coping styles. Cultural affiliation impacts on coping maxims independently, but culture moderates the relationship of attributed causes and coping maxims only in two of twenty possible cases. The results show that cultural differences can be analytically incorporated in the models of illness representations. Results may help to improve healthcare providers' communication with patients and plan public health campaigns. The approach to micro-cultural differences and the substantive relationships between alterability of causes and activity in coping may help the further development of models of illness representations.

  16. Independent variable complexity for regional regression of the flow duration curve in ungauged basins

    Science.gov (United States)

    Fouad, Geoffrey; Skupin, André; Hope, Allen

    2016-04-01

    The flow duration curve (FDC) is one of the most widely used tools to quantify streamflow. Its percentile flows are often required for water resource applications, but these values must be predicted for ungauged basins with insufficient or no streamflow data. Regional regression is a commonly used approach for predicting percentile flows that involves identifying hydrologic regions and calibrating regression models to each region. The independent variables used to describe the physiographic and climatic setting of the basins are a critical component of regional regression, yet few studies have investigated their effect on resulting predictions. In this study, the complexity of the independent variables needed for regional regression is investigated. Different levels of variable complexity are applied for a regional regression consisting of 918 basins in the US. Both the hydrologic regions and regression models are determined according to the different sets of variables, and the accuracy of resulting predictions is assessed. The different sets of variables include (1) a simple set of three variables strongly tied to the FDC (mean annual precipitation, potential evapotranspiration, and baseflow index), (2) a traditional set of variables describing the average physiographic and climatic conditions of the basins, and (3) a more complex set of variables extending the traditional variables to include statistics describing the distribution of physiographic data and temporal components of climatic data. The latter set of variables is not typically used in regional regression, and is evaluated for its potential to predict percentile flows. The simplest set of only three variables performed similarly to the other more complex sets of variables. Traditional variables used to describe climate, topography, and soil offered little more to the predictions, and the experimental set of variables describing the distribution of basin data in more detail did not improve predictions

  17. Young stellar population and star formation history ofW4 HII region/Cluster Complex

    Science.gov (United States)

    Panwar, Neelam

    2018-04-01

    The HII region/cluster complex has been a subject of numerous investigations to study the feedback effect of massive stars on their surroundings. Massive stars not only alter the morphology of the parental molecular clouds, but also influence star formation, circumstellar disks and the mass function of low-mass stars in their vicinity. However, most of the studies of low-mass stellar content of the HII regions are limited only to the nearby regions. We study the star formation in the W4 HII region using deep optical observations obtained with the archival data from Canada - France - Hawaii Telescope, Two-Micron All Sky Survey, Spitzer, Herschel and Chandra. We investigate the spatial distribution of young stellar objects in the region, their association with the remnant molecular clouds, and search for the clustering to establish the sites of recent star formation. Our analysis suggests that the influence of massive stars on circumstellar disks is significant only to thei! r immediate neighborhood. The spatial correlation of the young stars with the distribution of gas and dust of the complex indicate that the clusters would have formed in a large filamentary cloud. The observing facilities at the 3.6-m Devasthal Optical Telescope (DOT), providing high-resolution spectral and imaging capabilities, will fulfill the major objectives in the study of HII regions.

  18. A cross-sectional retrospective analysis of the regionalization of complex surgery.

    Science.gov (United States)

    Studnicki, James; Craver, Christopher; Blanchette, Christopher M; Fisher, John W; Shahbazi, Sara

    2014-08-16

    longest lengths of stay were found in higher volume hospitals. Complex surgery in Florida is effectively regionalized so that small volume hospitals operating within the range of complex procedures appropriate to their capabilities provide no increased risk of post surgical mortality.

  19. Simulating Complex, Cold-region Process Interactions Using a Multi-scale, Variable-complexity Hydrological Model

    Science.gov (United States)

    Marsh, C.; Pomeroy, J. W.; Wheater, H. S.

    2017-12-01

    Accurate management of water resources is necessary for social, economic, and environmental sustainability worldwide. In locations with seasonal snowcovers, the accurate prediction of these water resources is further complicated due to frozen soils, solid-phase precipitation, blowing snow transport, and snowcover-vegetation-atmosphere interactions. Complex process interactions and feedbacks are a key feature of hydrological systems and may result in emergent phenomena, i.e., the arising of novel and unexpected properties within a complex system. One example is the feedback associated with blowing snow redistribution, which can lead to drifts that cause locally-increased soil moisture, thus increasing plant growth that in turn subsequently impacts snow redistribution, creating larger drifts. Attempting to simulate these emergent behaviours is a significant challenge, however, and there is concern that process conceptualizations within current models are too incomplete to represent the needed interactions. An improved understanding of the role of emergence in hydrological systems often requires high resolution distributed numerical hydrological models that incorporate the relevant process dynamics. The Canadian Hydrological Model (CHM) provides a novel tool for examining cold region hydrological systems. Key features include efficient terrain representation, allowing simulations at various spatial scales, reduced computational overhead, and a modular process representation allowing for an alternative-hypothesis framework. Using both physics-based and conceptual process representations sourced from long term process studies and the current cold regions literature allows for comparison of process representations and importantly, their ability to produce emergent behaviours. Examining the system in a holistic, process-based manner can hopefully derive important insights and aid in development of improved process representations.

  20. Painful Intercourse Is Significantly Associated with Evoked Pain Perception and Cognitive Aspects of Pain in Women with Pelvic Pain

    Directory of Open Access Journals (Sweden)

    Meryl J. Alappattu, DPT, PhD

    2015-03-01

    Conclusions: Differences in local pain ratings suggest that women with pelvic pain perceive stimuli in this region as more painful than pain-free women although the magnitude of stimuli does not differ. Alappattu MJ, George SZ, Robinson ME, Fillingim RB, Moawad N, LeBrun EW, and Bishop MD. Painful intercourse is significantly associated with evoked pain perception and cognitive aspects of pain in women with pelvic pain. Sex Med 2015;3:14–23.

  1. ON MAGNETIC ACTIVITY BAND OVERLAP, INTERACTION, AND THE FORMATION OF COMPLEX SOLAR ACTIVE REGIONS

    Energy Technology Data Exchange (ETDEWEB)

    McIntosh, Scott W. [High Altitude Observatory, National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO 80307 (United States); Leamon, Robert J., E-mail: mscott@hao.ucar.edu [Department of Physics, Montana State University, Bozeman, MT 59717 (United States)

    2014-11-20

    Recent work has revealed a phenomenological picture of the how the ∼11 yr sunspot cycle of the Sun arises. The production and destruction of sunspots is a consequence of the latitudinal-temporal overlap and interaction of the toroidal magnetic flux systems that belong to the 22 yr magnetic activity cycle and are rooted deep in the Sun's convective interior. We present a conceptually simple extension of this work, presenting a hypothesis on how complex active regions can form as a direct consequence of the intra- and extra-hemispheric interaction taking place in the solar interior. Furthermore, during specific portions of the sunspot cycle, we anticipate that those complex active regions may be particularly susceptible to profoundly catastrophic breakdown, producing flares and coronal mass ejections of the most severe magnitude.

  2. The comparative osteology of the petrotympanic complex (ear region of extant baleen whales (Cetacea: Mysticeti.

    Directory of Open Access Journals (Sweden)

    Eric G Ekdale

    Full Text Available Anatomical comparisons of the ear region of baleen whales (Mysticeti are provided through detailed osteological descriptions and high-resolution photographs of the petrotympanic complex (tympanic bulla and petrosal bone of all extant species of mysticete cetaceans. Salient morphological features are illustrated and identified, including overall shape of the bulla, size of the conical process of the bulla, morphology of the promontorium, and the size and shape of the anterior process of the petrosal. We place our comparative osteological observations into a phylogenetic context in order to initiate an exploration into petrotympanic evolution within Mysticeti.The morphology of the petrotympanic complex is diagnostic for individual species of baleen whale (e.g., sigmoid and conical processes positioned at midline of bulla in Balaenoptera musculus; confluence of fenestra cochleae and perilymphatic foramen in Eschrichtius robustus, and several mysticete clades are united by derived characteristics. Balaenids and neobalaenids share derived features of the bulla, such as a rhomboid shape and a reduced anterior lobe (swelling in ventral aspect, and eschrichtiids share derived morphologies of the petrosal with balaenopterids, including loss of a medial promontory groove and dorsomedial elongation of the promontorium. Monophyly of Balaenoidea (Balaenidae and Neobalaenidae and Balaenopteroidea (Balaenopteridae and Eschrichtiidae was recovered in phylogenetic analyses utilizing data exclusively from the petrotympanic complex.This study fills a major gap in our knowledge of the complex structures of the mysticete petrotympanic complex, which is an important anatomical region for the interpretation of the evolutionary history of mammals. In addition, we introduce a novel body of phylogenetically informative characters from the ear region of mysticetes. Our detailed anatomical descriptions, illustrations, and comparisons provide valuable data for current and

  3. Regional labour market analysis and policy evaluation: Job insecurity, flexibility and complexity. Evidence from Switzerland

    OpenAIRE

    Baruffini, Moreno; Maggi, Rico

    2014-01-01

    The thesis focuses on labour market flexibility, security and complexity. The research is divided into three chapters: two of the chapters specifically relate to perceived security, flexibility and job satisfaction, using data from the longitudinal Swiss Household Panel (SHP), while the last investigates labour market programs and their impact on a regional labour market. The first essay analyses perceptions of economic insecurity in Switzerland, during the business cycle between 2008 an...

  4. Geographic/conceptual delimitation of the «Southern Mediterranean». A Regional Security Complex?

    Directory of Open Access Journals (Sweden)

    Alberto Priego Moreno

    2016-07-01

    Full Text Available This article seeks to analyse how the Mediterranean Area has evolved after the changes occurred with the so-called Arab Springs. The main idea is to focus on the Southern Mediterranean as a dynamic space that expands itself as a result of its internal transformations and subsequent external changes caused by the Arab Spring. We will use the IR theory of the Regional Security Complex as it is considered as the most adaptable to this changing reality.

  5. PROPERTIES OF THE COMPACT H II REGION COMPLEX G-0.02-0.07

    International Nuclear Information System (INIS)

    Mills, E.; Morris, M. R.; Lang, C. C.; Dong, H.; Wang, Q. D.; Cotera, A.; Stolovy, S. R.

    2011-01-01

    We present new extinction maps and high-resolution Paschen-alpha images of G-0.02-0.07, a complex of compact H II regions located adjacent to the M-0.02-0.07 giant molecular cloud, 6 pc in projection from the center of the Galaxy. These H II regions, which lie in projection just outside the boundary of the Sgr A East supernova remnant, represent one of the most recent episodes of star formation in the central parsecs of the Galaxy. The 1.87 μm extinctions of regions A, B, and C are almost identical, approximately 3.7 mag. Region D, in contrast, has a peak extinction of A 1.87 = 5.9 mag. Adopting an extinction law specific to the Galactic center, we find that these extinctions correspond to visual extinctions of A V = 45 and A V = 71. The similar and uniform extinctions of regions A, B, and C are consistent with that expected for foreground extinction in the direction of the Galactic center, suggesting that they lie at the front side of the M-0.02-0.07 molecular cloud. Region D is more compact, has a higher extinction, and is thus suspected to be younger and embedded in a dense core in a compressed ridge on the western edge of this cloud.

  6. Brain morphological signatures for chronic pain.

    Directory of Open Access Journals (Sweden)

    Marwan N Baliki

    Full Text Available Chronic pain can be understood not only as an altered functional state, but also as a consequence of neuronal plasticity. Here we use in vivo structural MRI to compare global, local, and architectural changes in gray matter properties in patients suffering from chronic back pain (CBP, complex regional pain syndrome (CRPS and knee osteoarthritis (OA, relative to healthy controls. We find that different chronic pain types exhibit unique anatomical 'brain signatures'. Only the CBP group showed altered whole-brain gray matter volume, while regional gray matter density was distinct for each group. Voxel-wise comparison of gray matter density showed that the impact on the extent of chronicity of pain was localized to a common set of regions across all conditions. When gray matter density was examined for large regions approximating Brodmann areas, it exhibited unique large-scale distributed networks for each group. We derived a barcode, summarized by a single index of within-subject co-variation of gray matter density, which enabled classification of individual brains to their conditions with high accuracy. This index also enabled calculating time constants and asymptotic amplitudes for an exponential increase in brain re-organization with pain chronicity, and showed that brain reorganization with pain chronicity was 6 times slower and twice as large in CBP in comparison to CRPS. The results show an exuberance of brain anatomical reorganization peculiar to each condition and as such reflecting the unique maladaptive physiology of different types of chronic pain.

  7. Towards a regional ontology of management education in Africa: A complexity leadership theory perspective

    Directory of Open Access Journals (Sweden)

    Nixon M. Ochara

    2017-02-01

    Full Text Available Orientation: The title of this critique, ‘Towards a regional ontology of management education in Africa: A complexity leadership theory perspective’, sought to capture a paradox in the prescriptive nature and universalistic leaning of current leadership theories; yet local realities may call for being cognisant of (possible extant regional ontologies. Motivation for the study: The argumentation and analysis developed in this article were based on a synthesis of ideas from literature to evolve a preliminary regional ontology for reorienting business and management education relevant for Africa. Research design, approach and method: The critique was structured on insights from complexity leadership theory. The outcome was a proposition for an Afrocentric regional ontology for strengthening business and management education anchored on four themes: ethical and moral engagement, entrepreneurial leadership, Ubuntu and local National Systems of Innovation (NSI. These emerging ideas were considered to be tentative and should be considered as a foundation to inform further inquiry into how business and management education in Africa can be better interpreted and legitimised in the behavioural sciences. Practical/managerial implications: From an Afrocentric perspective, conceptualising and maintaining the logic of leadership was considered to be desirable and imperative in evolving a regional ontology of leadership that takes into account local realities. Of course, we recognised that these defining rationalities are not unique to Africa, but that said; a regional perspective that is unique cannot continue to be ignored but should find their place in discourses about leadership in the 21st century. Contribution/value-add: The synthesis and narrative presented in this paper concisely summarises and provides traction on how to advance business and management education in Africa.

  8. Feasibility randomized-controlled trial of online Acceptance and Commitment Therapy for patients with complex chronic pain in the United Kingdom.

    Science.gov (United States)

    Scott, W; Chilcot, J; Guildford, B; Daly-Eichenhardt, A; McCracken, L M

    2018-04-28

    Acceptance and Commitment Therapy (ACT) has growing support for chronic pain. However, more accessible treatment delivery is needed. This study evaluated the feasibility of online ACT for patients with complex chronic pain in the United Kingdom to determine whether a larger trial is justified. Participants with chronic pain and clinically meaningful disability and distress were randomly assigned to ACT online plus specialty medical pain management, or specialty medical management alone. Participants completed questionnaires at baseline, and 3- and 9-month post-randomization. Primary feasibility outcomes included recruitment, retention and treatment completion rates. Secondary outcomes were between-groups effects on treatment outcomes and psychological flexibility. Of 139 potential participants, 63 were eligible and randomized (45% recruitment rate). Retention rates were 76-78% for follow-up assessments. Sixty-one per cent of ACT online participants completed treatment. ACT online was less often completed by employed (44%) compared to unemployed (80%) participants. Fifty-six per cent of ACT online participants rated themselves as 'much improved' or better on a global impression of change rating, compared to only 20 per cent of control participants. Three-month effects favouring ACT online were small for functioning, medication and healthcare use, committed action and decentring, medium for mood, and large for acceptance. Small-to-medium effects were maintained for functioning, healthcare use and committed action at 9 months. Online ACT for patients with chronic pain in the United Kingdom appears feasible to study in a larger efficacy trial. Some adjustments to treatment and trial procedures are warranted, particularly to enhance engagement among employed participants. This study supports the feasibility of online Acceptance and Commitment Therapy for chronic pain in the United Kingdom and a larger efficacy trial. Refinements to treatment delivery, particularly to

  9. Implementation of a Prehospital Triage System for Patients With Chest Pain and Logistics for Primary Percutaneous Coronary Intervention in the Region of Amsterdam, The Netherlands

    NARCIS (Netherlands)

    Adams, Rob; Appelman, Yolande; Bronzwaer, Jean G.; Slagboom, Ton; Amoroso, Giovanni; van Exter, Pieternel; Tijssen, G. P. Jan; de Winter, Robbert J.

    2010-01-01

    We aimed to describe the logistics of a prehospital triage system for patients with acute chest pain in the region of Amsterdam, The Netherlands. Ambulance electrocardiograms (ECGs) were evaluated immediately in 1 of the percutaneous coronary intervention (PCI)-capable centers. Patients accepted for

  10. Complex emergencies in the Eastern Mediterranean Region: Impact on tuberculosis control.

    Science.gov (United States)

    Seita, Akihiro

    2016-12-01

    The Eastern Mediterranean Region (EMR) has witnessed the largest refugee crisis in history. Overall, 70% of the global refugee populations are from Palestine, Syria, Afghanistan, or Somalia. We reviewed the possible impact of such crisis on the tuberculosis situation in EMR. We used the available data and information from the World Health Organization and other international and national institutions. Overall, 15 out of 22 countries in the EMR are either engulfed in complex emergencies (10 countries) or suffering from their neighbors' complex emergencies (7 countries), whereas two countries suffer from both. Eighty-five percent of the total population (636 million) in the region lives in these 15 countries. For tuberculosis, these 15 countries account for a significant burden in EMR: 94% of the estimated total incidence of 740,000 cases a year and 95% of the estimated total mortality of 91,000 a year. These countries have yet to show the significant negative impact on tuberculosis epidemiology as such changes take considerable time to manifest. Still, there are reports on health systems impact: access to health facilities, destruction of health facilities, health staff casualties, and shortage of medicines. Complex emergencies pose a significant negative impact on tuberculosis in the EMR. This issue should be raised in the global health and political arena. This is a time bomb for tuberculosis. Copyright © 2016.

  11. Brazilian Policy and the Creation of a Regional Security Complex in the South Atlantic: Pax Brasiliana?

    Directory of Open Access Journals (Sweden)

    Beatriz Rodrigues Bessa Mattos

    Full Text Available Abstract Over the past five years, the South Atlantic region has become a central element of Brazilian security policy, with Brazil actively supporting the notion of a trans-oceanic security consciousness involving African littoral states. It has invested in diplomatic initiatives such as the Zone of Peace and Cooperation of the South Atlantic (ZPCSA, or ZOPACAS, and extensive military co-operation with West African states such as São Tomé e Príncipe, Namibia and Cape Verde. Its internal security and defence policy documents have repeatedly been updated to reflect this dimension, and now provide the foundation for advancing these initiatives. This policy thrust is directed at securing Brazil’s offshore oil assets, and limiting the influence of what it has termed ‘extra-regional powers’ such as the P-5. This article highlights these initiatives and reviews the prospects for this policy by examining the plausibility of the South Atlantic region as a regional security complex in the sense coined by Buzan and Wæver. The analysis is based on the role of geographical and linguistic proximity in international relations, and the impact of multilateral bodies on building support for a regional approach to security governance.

  12. Pinning-controlled synchronization of complex networks with bounded or unbounded synchronized regions

    International Nuclear Information System (INIS)

    Yan-Li, Zou; Guan-Rong, Chen

    2009-01-01

    This paper studies pinning-controlled synchronization of complex networks with bounded or unbounded synchronized regions. To study a state-feedback pinning-controlled network with N nodes, it first converts the controlled network to an extended network of N+1 nodes without controls. It is shown that the controlled synchronizability of the given network is determined by the real part of the smallest nonzero eigenvalue of the coupling matrix of its extended network when the synchronized region is unbounded; but it is determined by the ratio of the real parts of the largest and the smallest nonzero eigenvalues of the coupling matrix when the synchronized region is bounded. Both theoretical analysis and numerical simulation show that the portion of controlled nodes has no critical values when the synchronized region is unbounded, but it has a critical value when the synchronized region is bounded. In the former case, therefore, it is possible to control the network to achieve synchronization by pinning only one node. In the latter case, the network can achieve controlled synchronization only when the portion of controlled nodes is larger than the critical value. (general)

  13. Regional Versus General Anesthesia and the Incidence of Unplanned Health Care Resource Utilization for Postoperative Pain After Wrist Fracture Surgery: Results From a Retrospective Quality Improvement Project.

    Science.gov (United States)

    Sunderland, Sarah; Yarnold, Cynthia H; Head, Stephen J; Osborn, Jill A; Purssell, Andrew; Peel, John K; Schwarz, Stephan K W

    2016-01-01

    The establishment at our center of a dedicated regional anesthesia service in 2008-2009 has resulted in a marked increase in single-shot brachial plexus blocks (sBPBs) for ambulatory wrist fracture surgery. Despite the documented benefits of regional over general anesthesia (GA), there has been a perceived increase among sBPB patients in postoperative return rates for pain at our institution. We conducted a retrospective quality improvement project to examine this. After exemption from human ethics board review, we sought to identify and contact all wrist fracture surgery patients treated at our center between 2003 and 2012. Our primary outcome was the incidence of unplanned physician visits (office/clinic or emergency department) for pain in the first 48 hours after surgery. Other main outcomes included the incidence of seeking any form of medical attention for pain and self-reporting of severe pain in the first 48 hours. Of 1008 identified patients, 419 could be contacted; 195 qualified for analysis. The incidence of unplanned physician visits in the first 48 hours was 12% (13 of 118) among sBPB patients versus 4% (3 of 77) in GA patients (odds ratio [OR], 3.1; 95% confidence interval [95% CI], 0.8-11.1; P = 0.11). More sBPB versus GA patients sought any form of medical attention for pain (20% vs 5%; OR, 4.7; 95% CI, 1.4-10.9; P = 0.003). Similarly, more sBPB patients reported severe postoperative pain (41% vs 10%; OR, 5.9; 95% CI, 2.6-13.4; P resource utilization caused by pain after hospital discharge than those undergoing GA. These findings warrant confirmation in a prospective trial and emphasize the need for a defined postdischarge analgesic pathway as well as the potential merits of perineural home catheters.

  14. Ultrasound guided transversus abdominis plane vs surgeon administered intraoperative regional field infiltration with bupivacaine for early postoperative pain control in children undergoing open pyeloplasty.

    Science.gov (United States)

    Lorenzo, Armando J; Lynch, Johanne; Matava, Clyde; El-Beheiry, Hossam; Hayes, Jason

    2014-07-01

    Regional analgesic techniques are commonly used in pediatric urology. Ultrasound guided transversus abdominis plane block has recently gained popularity. However, there is a paucity of information supporting a benefit over regional field infiltration. We present a parallel group, randomized, controlled trial evaluating ultrasound guided transversus abdominis plane block superiority over surgeon delivered regional field infiltration for children undergoing open pyeloplasty at a tertiary referral center. Following ethics board approval and registration, children 0 to 6 years old were recruited and randomized to undergo perioperative transversus abdominis plane block or regional field infiltration for early post-pyeloplasty pain control. General anesthetic delivery, surgical technique and postoperative analgesics were standardized. A blinded assessor regularly captured pain scores in the recovery room using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. The primary outcome was the need for rescue morphine administration based on a FLACC score of 3 or higher. Two pediatric urologists performed 57 pyeloplasties during a 2.5-year period, enrolling 32 children (16 in each group, balanced for age and weight). There were statistically significant differences in the number of children requiring rescue morphine administration (13 of 16 receiving transversus abdominis plane block and 6 of 16 receiving regional field infiltration, p = 0.011), mean ± SD total morphine consumption (0.066 ± 0.051 vs 0.028 ± 0.040 mg/kg, p = 0.021) and mean ± SD pain scores (5 ± 5 vs 2 ± 3, p = 0.043) in the recovery room, in favor of surgeon administered regional field infiltration. No local anesthetic specific adverse events were noted. Ultrasound guided transversus abdominis plane block is not superior to regional field infiltration with bupivacaine as a strategy to minimize early opioid requirements following open pyeloplasty in children. Instead, our data suggest that

  15. 13. Sacroiliac joint pain

    NARCIS (Netherlands)

    Vanelderen, P.; Szadek, K.M.; Cohen, S.P.; Witte, J.; Lataster, A.; Patijn, J.; Mekhail, N.; van Kleef, M.; van Zundert, J.

    2010-01-01

    The sacroiliac joint accounts for approximately 16% to 30% of cases of chronic mechanical low back pain. Pain originating in the sacroiliac joint is predominantly perceived in the gluteal region, although pain is often referred into the lower and upper lumbar region, groin, abdomen, and/ or lower

  16. Sympathetically maintained pain presenting first as temporomandibular disorder, then as parotid dysfunction.

    Science.gov (United States)

    Giri, Subha; Nixdorf, Donald

    2007-03-01

    Complex regional pain syndrome (CRPS) is a chronic condition characterized by intense pain, swelling, redness, hypersensitivity and additional sudomotor effects. In all 13 cases of CRPS in the head and neck region reported in the literature, nerve injury was identified as the etiology for pain initiation. In this article, we present the case of a 30-year-old female patient with sympathetically maintained pain without apparent nerve injury. Her main symptoms--left-side preauricular pain and inability to open her mouth wide--mimicked temporomandibular joint arthralgia and myofascial pain of the masticatory muscles. Later, symptoms of intermittent preauricular pain and swelling developed, along with hyposalivation, which mimicked parotitis. After an extensive diagnostic process, no definitive underlying pathology could be identified and a diagnosis of neuropathic pain with a prominent sympathetic component was made. Two years after the onset of symptoms and initiation of care, treatment with repeated stellate ganglion blocks and enteral clonidine pharmacotherapy provided adequate pain relief.

  17. Segmental Duplication, Microinversion, and Gene Loss Associated with a Complex Inversion Breakpoint Region in Drosophila

    Science.gov (United States)

    Calvete, Oriol; González, Josefa; Betrán, Esther; Ruiz, Alfredo

    2012-01-01

    Chromosomal inversions are usually portrayed as simple two-breakpoint rearrangements changing gene order but not gene number or structure. However, increasing evidence suggests that inversion breakpoints may often have a complex structure and entail gene duplications with potential functional consequences. Here, we used a combination of different techniques to investigate the breakpoint structure and the functional consequences of a complex rearrangement fixed in Drosophila buzzatii and comprising two tandemly arranged inversions sharing the middle breakpoint: 2m and 2n. By comparing the sequence in the breakpoint regions between D. buzzatii (inverted chromosome) and D. mojavensis (noninverted chromosome), we corroborate the breakpoint reuse at the molecular level and infer that inversion 2m was associated with a duplication of a ∼13 kb segment and likely generated by staggered breaks plus repair by nonhomologous end joining. The duplicated segment contained the gene CG4673, involved in nuclear transport, and its two nested genes CG5071 and CG5079. Interestingly, we found that other than the inversion and the associated duplication, both breakpoints suffered additional rearrangements, that is, the proximal breakpoint experienced a microinversion event associated at both ends with a 121-bp long duplication that contains a promoter. As a consequence of all these different rearrangements, CG5079 has been lost from the genome, CG5071 is now a single copy nonnested gene, and CG4673 has a transcript ∼9 kb shorter and seems to have acquired a more complex gene regulation. Our results illustrate the complex effects of chromosomal rearrangements and highlight the need of complementing genomic approaches with detailed sequence-level and functional analyses of breakpoint regions if we are to fully understand genome structure, function, and evolutionary dynamics. PMID:22328714

  18. Persistent pain is common 1 year after ankle and wrist fracture surgery: a register-based questionnaire study

    DEFF Research Database (Denmark)

    Friesgaard, Kristian Dahl; Gromov, Kirill; Knudsen, Lone

    2016-01-01

    BACKGROUND: Substantial literature documents that persistent postsurgical pain is a possible outcome of many common surgical procedures. As fracture-related surgery implies a risk of developing neuropathic pain and complex regional pain syndrome (CRPS), further studies investigating the prevalence...... and pain characteristics are required. METHODS: All patients undergoing primary surgery because of ankle or wrist fracture at Hvidovre and Odense University Hospitals, Denmark, between April 15, 2013 and April 15, 2014, were identified from the Danish Fracture Database. A questionnaire regarding pain...... be informed about the substantial risk of developing persistent postsurgical pain. Future studies investigating risk factors for persistent postsurgical pain that include both surgically and conservatively treated fractures are required....

  19. Synaptonemal complex aberrations in the pseudoautosomal region of X, Y chromosomes in irradiated hamsters

    Energy Technology Data Exchange (ETDEWEB)

    Allen, J.W.; Collins, B.W. [Environmental Protection Agency, Research Triangle Park, NC (United States); Poorman-Allen, P. [Wellcome Research Lab., Research Triangle Park, N.C. (United States); Sontag, M.R. [Duke Univ., Durham, NC (United States). Medical Center

    1994-05-01

    The effects of X-radiation, bleomycin and amsacrine (m-AMSA) on the meiotic chromosomes of male Armenian hamsters were determined by electron microscopic analysis of synaptonemal complex (SC) damage. Pachytene stage cells were analyzed 5 or 6 days following their treatment at putative preleptotene-leptotene stages of meiosis. Of the multiple types of SC aberrations observed to be significantly increased over control levels, lateral element breakage and synaptic anomalies were most prevalent. The focus of these studies was on the sex chromosomes which, in the Armenian hamster, reveal an unusally well-defined pseudoautosomal region. In the XY pair, radiation and chemical treatments caused certain forms of structural and synaptic anomalies which appeared to be preferentially localized to telomeric and/or crossover regions. The nature of these specific aberrations, involving breakage, bridge formation and asynapsis, is not well understood; however, their distributions are suggestive of possible relationships with sites and processes of crossing over. (author).

  20. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017.

    Science.gov (United States)

    Neal, Joseph M; Barrington, Michael J; Fettiplace, Michael R; Gitman, Marina; Memtsoudis, Stavros G; Mörwald, Eva E; Rubin, Daniel S; Weinberg, Guy

    2018-02-01

    The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity. WHAT'S NEW IN THIS UPDATE?: This interim update summarizes recent scientific findings that have enhanced our understanding of the mechanisms that lead to lipid emulsion reversal of LAST, including rapid partitioning, direct inotropy, and post-conditioning. Since the previous practice advisory, epidemiological data have emerged that suggest a lower frequency of LAST as reported by single institutions and some registries, nevertheless a considerable number of events still occur within the general community. Contemporary case reports suggest a trend toward delayed presentation, which may mirror the increased use of ultrasound guidance (fewer intravascular injections), local infiltration techniques (slower systemic uptake), and continuous local anesthetic infusions. Small patient size and sarcopenia are additional factors that increase potential risk for LAST. An increasing number of reported events occur outside of the traditional hospital setting and involve non-anesthesiologists.

  1. Complexity of the Relationships of Pain, Posttraumatic Stress, and Depression in Combat-Injured Populations: An Integrative Review to Inform Evidence-Based Practice.

    Science.gov (United States)

    Giordano, Nicholas A; Bader, Christine; Richmond, Therese S; Polomano, Rosemary C

    2018-04-01

    Understanding the complex interrelationships between combat injuries, physical health, and mental health symptoms is critical to addressing the healthcare needs of wounded military personnel and veterans. The relationship between injury characteristics, pain, posttraumatic stress disorder (PTSD), and depression among combat-injured military personnel is unique to modern conflicts and understudied in the nursing literature. This integrative review synthesizes clinical presentations and relationships of combat injury, PTSD, depression, and pain in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) United States military service members and veterans. A literature search was conducted using relative key terms across databases to identify peer-reviewed publications between 2001 and 2016 that examined health outcomes of combat-injured persons in OEF and OIF. The quality of evidence was evaluated and results synthesized to examine the association of combat injury as a risk factor for PTSD, the relationship of PTSD and depression pre- and postinjury, and pain management throughout care. Twenty-two articles were included in this review. Greater injury and pain severity poses risks for developing PTSD following combat injury, while early symptom management lessens risks for PTSD. Depression appears to be both a contributing risk factor to postinjury PTSD, as well as a comorbidity. Findings demonstrate a compelling need for improvements in standardized assessment of pain and mental health symptoms across transitions in care. This integrative review informs nurse researchers and providers of the clinical characteristics of pain, PTSD, and depression following combat injury and offers implications for future research promoting optimal surveillance of symptoms. © 2018 Sigma Theta Tau International.

  2. Block-induced Complex Structures Building the Flare-productive Solar Active Region 12673

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Shuhong; Zhang, Jun [CAS Key Laboratory of Solar Activity, National Astronomical Observatories, Chinese Academy of Sciences, Beijing 100012 (China); Zhu, Xiaoshuai [Max-Planck Institute for Solar System Research, D-37077 Göttingen (Germany); Song, Qiao, E-mail: shuhongyang@nao.cas.cn [Key Laboratory of Space Weather, National Center for Space Weather, China Meteorological Administration, Beijing 100081 (China)

    2017-11-10

    Solar active region (AR) 12673 produced 4 X-class, 27 M-class, and numerous lower-class flares during its passage across the visible solar disk in 2017 September. Our study is to answer the questions why this AR was so flare-productive and how the X9.3 flare, the largest one of the past decade, took place. We find that there was a sunspot in the initial several days, and then two bipolar regions emerged nearby it successively. Due to the standing of the pre-existing sunspot, the movement of the bipoles was blocked, while the pre-existing sunspot maintained its quasi-circular shaped umbra only with the disappearance of a part of penumbra. Thus, the bipolar patches were significantly distorted, and the opposite polarities formed two semi-circular shaped structures. After that, two sequences of new bipolar regions emerged within the narrow semi-circular zone, and the bipolar patches separated along the curved channel. The new bipoles sheared and interacted with the previous ones, forming a complex topological system, during which numerous flares occurred. At the highly sheared region, a great deal of free energy was accumulated. On September 6, one negative patch near the polarity inversion line began to rapidly rotate and shear with the surrounding positive fields, and consequently the X9.3 flare erupted. Our results reveal that the block-induced complex structures built the flare-productive AR and the X9.3 flare was triggered by an erupting filament due to the kink instability. To better illustrate this process, a block-induced eruption model is proposed for the first time.

  3. Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20-71 years of age

    DEFF Research Database (Denmark)

    Leboeuf-Yde, Charlotte; Nielsen, Jan; Kyvik, Kirsten O

    2009-01-01

    , aged 20 to 71 years, representative of the general Danish population. Identical questions on pain were asked for the lumbar, thoracic and cervical regions. RESULTS: Low back pain was most common, followed by neck pain with thoracic pain being least common. Pain for at least 30 days in the past year......BACKGROUND: It is unclear to what extent spinal pain varies between genders and in relation to age. It was the purpose of this study to describe the self-reported prevalence of 1) pain ever and pain in the past year in each of the three spinal regions, 2) the duration of such pain over the past...... year, 3) pain radiating from these areas, and 4) pain in one, two or three areas. In addition, 5) to investigate if spinal pain reporting is affected by gender and 6) to see if it increases gradually with increasing age. METHOD: A cross-sectional survey was conducted in 2002 on 34,902 twin individuals...

  4. Genes involved in complex adaptive processes tend to have highly conserved upstream regions in mammalian genomes

    Directory of Open Access Journals (Sweden)

    Kohane Isaac

    2005-11-01

    Full Text Available Abstract Background Recent advances in genome sequencing suggest a remarkable conservation in gene content of mammalian organisms. The similarity in gene repertoire present in different organisms has increased interest in studying regulatory mechanisms of gene expression aimed at elucidating the differences in phenotypes. In particular, a proximal promoter region contains a large number of regulatory elements that control the expression of its downstream gene. Although many studies have focused on identification of these elements, a broader picture on the complexity of transcriptional regulation of different biological processes has not been addressed in mammals. The regulatory complexity may strongly correlate with gene function, as different evolutionary forces must act on the regulatory systems under different biological conditions. We investigate this hypothesis by comparing the conservation of promoters upstream of genes classified in different functional categories. Results By conducting a rank correlation analysis between functional annotation and upstream sequence alignment scores obtained by human-mouse and human-dog comparison, we found a significantly greater conservation of the upstream sequence of genes involved in development, cell communication, neural functions and signaling processes than those involved in more basic processes shared with unicellular organisms such as metabolism and ribosomal function. This observation persists after controlling for G+C content. Considering conservation as a functional signature, we hypothesize a higher density of cis-regulatory elements upstream of genes participating in complex and adaptive processes. Conclusion We identified a class of functions that are associated with either high or low promoter conservation in mammals. We detected a significant tendency that points to complex and adaptive processes were associated with higher promoter conservation, despite the fact that they have emerged

  5. Evaluation of Optimized WRF Precipitation Forecast over a Complex Topography Region during Flood Season

    Directory of Open Access Journals (Sweden)

    Yuan Li

    2016-11-01

    Full Text Available In recent years, the Weather Research and Forecast (WRF model has been utilized to generate quantitative precipitation forecasts with higher spatial and temporal resolutions. However, factors including horizontal resolution, domain size, and the physical parameterization scheme have a strong impact on the dynamic downscaling ability of the WRF model. In this study, the influence of these factors has been analyzed in precipitation forecasting for the Xijiang Basin, southern China—a region with complex topography. The results indicate that higher horizontal resolutions always result in higher Critical Success Indexes (CSI, but higher biases as well. Meanwhile, the precipitation forecast skills are also influenced by the combination of microphysics parameterization scheme and cumulus convective parameterization scheme. On the basis of these results, an optimized configuration of the WRF model is built in which the horizontal resolution is 10 km, the microphysics parameterization is the Lin scheme, and the cumulus convective parameterization is the Betts–Miller–Janjic scheme. This configuration is then evaluated by simulating the daily weather during the 2013–2014 flood season. The high Critical Success Index scores and low biases at various thresholds and lead times confirm the high accuracy of the optimized WRF model configuration for Xijiang Basin. However, the performance of the WRF model varies from different sub-basins due to the complexity of the mesoscale convective system (MCS over this region.

  6. Region- or state-related differences in expression and activation of extracellular signal-regulated kinases (ERKs in naïve and pain-experiencing rats

    Directory of Open Access Journals (Sweden)

    Cui Xiu-Yu

    2007-07-01

    Full Text Available Abstract Background Extracellular signal-regulated kinase (ERK, one member of the mitogen-activated protein kinase (MAPK family, has been suggested to regulate a diverse array of cellular functions, including cell growth, differentiation, survival, as well as neuronal plasticity. Recent evidence indicates a role for ERKs in nociceptive processing in both dorsal root ganglion and spinal cord. However, little literature has been reported to examine the differential distribution and activation of ERK isoforms, ERK1 and ERK2, at different levels of pain-related pathways under both normal and pain states. In the present study, quantitative blot immunolabeling technique was used to determine the spatial and temporal expression of ERK1 and ERK2, as well as their activated forms, in the spinal cord, primary somatosensory cortex (SI area of cortex, and hippocampus under normal, transient pain and persistent pain states. Results In naïve rats, we detected regional differences in total expression of ERK1 and ERK2 across different areas. In the spinal cord, ERK1 was expressed more abundantly than ERK2, while in the SI area of cortex and hippocampus, there was a larger amount of ERK2 than ERK1. Moreover, phosphorylated ERK2 (pERK2, not phosphorylated ERK1 (pERK1, was normally expressed with a high level in the SI area and hippocampus, but both pERK1 and pERK2 were barely detectable in normal spinal cord. Intraplantar saline or bee venom injection, mimicking transient or persistent pain respectively, can equally initiate an intense and long-lasting activation of ERKs in all three areas examined. However, isoform-dependent differences existed among these areas, that is, pERK2 exhibited stronger response than pERK1 in the spinal cord, whereas ERK1 was more remarkably activated than ERK2 in the S1 area and hippocampus. Conclusion Taken these results together, we conclude that: (1 under normal state, while ERK immunoreactivity is broadly distributed in the rat

  7. Effect of acetylcholine receptors on the pain-related electrical activities in the hippocampal CA3 region of morphine-addicted rats

    Directory of Open Access Journals (Sweden)

    Guan Zeng Li

    2015-07-01

    Full Text Available Objective(s:To determine the effect of acetylcholine (ACh, pilocarpine, and atropine on pain evoked responses of pain excited neurons (PEN and pain inhibited neurons (PIN in hippocampal CA3 region of morphine addicted rats. Materials and Methods:Female Wistar rats, weighing between 230-260 g were used in this study. Morphine addicted rats were generated by subcutaneous injection of increasing concentrations of morphine hydrochloride for six days. Trains of electrical impulses applied to the sciatic nerve were used as noxious stimulation and the evoked electrical activities of PEN or PIN in hippocampal CA3 area were recorded using extracellular electrophysiological recording techniques in hippocampal slices. The effect of acetylcholine receptor stimulation byACh, the muscarinic agonist pilocarpine, and the muscarinic antagonist atropine on the pain evoked responses of pain related electrical activities was analyzed in hippocampal CA3 area of morphine addicted rats. Results:Intra-CA3 microinjection of ACh (2 μg/1 μl or pilocarpine (2 μg/1 μl decreased the discharge frequency and prolonged the firing latency of PEN, but increased the discharge frequency and shortened the firing inhibitory duration (ID of PIN. The intra-CA3 administration of atropine (0.5 μg/1 μl produced opposite effect. The peak activity of cholinergic modulators was 2 to 4 min later in morphine addicted rats compared to peak activity previously observed in normal rats. Conclusion: ACh dependent modulation of noxious stimulation exists in hippocampal CA3 area of morphine addicted rats. Morphine treatment may shift the sensitivity of pain related neurons towards a delayed response to muscarinergic neurotransmission in hippocampal CA3 region.

  8. Effect of acetylcholine receptors on the pain-related electrical activities in the hippocampal CA3 region of morphine-addicted rats.

    Science.gov (United States)

    Li, Guan Zeng; Liu, Zhe Hui; Wei, XinYa; Zhao, Pan; Yang, Chun Xiao; Xu, Man Ying

    2015-07-01

    To determine the effect of acetylcholine (ACh), pilocarpine, and atropine on pain evoked responses of pain excited neurons (PEN) and pain inhibited neurons (PIN) in hippocampal CA3 region of morphine addicted rats. Female Wistar rats, weighing between 230-260 g were used in this study. Morphine addicted rats were generated by subcutaneous injection of increasing concentrations of morphine hydrochloride for six days. Trains of electrical impulses applied to the sciatic nerve were used as noxious stimulation and the evoked electrical activities of PEN or PIN in hippocampal CA3 area were recorded using extracellular electrophysiological recording techniques in hippocampal slices. The effect of acetylcholine receptor stimulation by ACh, the muscarinic agonist pilocarpine, and the muscarinic antagonist atropine on the pain evoked responses of pain related electrical activities was analyzed in hippocampal CA3 area of morphine addicted rats. Intra-CA3 microinjection of ACh (2 μg/1 μl) or pilocarpine (2 μg/1 μl) decreased the discharge frequency and prolonged the firing latency of PEN, but increased the discharge frequency and shortened the firing inhibitory duration (ID) of PIN. The intra-CA3 administration of atropine (0.5 μg/1 μl) produced opposite effect. The peak activity of cholinergic modulators was 2 to 4 min later in morphine addicted rats compared to peak activity previously observed in normal rats. ACh dependent modulation of noxious stimulation exists in hippocampal CA3 area of morphine addicted rats. Morphine treatment may shift the sensitivity of pain related neurons towards a delayed response to muscarinergic neurotransmission in hippocampal CA3 region.

  9. Path Complexity in Virtual Water Maze Navigation: Differential Associations with Age, Sex, and Regional Brain Volume.

    Science.gov (United States)

    Daugherty, Ana M; Yuan, Peng; Dahle, Cheryl L; Bender, Andrew R; Yang, Yiqin; Raz, Naftali

    2015-09-01

    Studies of human navigation in virtual maze environments have consistently linked advanced age with greater distance traveled between the start and the goal and longer duration of the search. Observations of search path geometry suggest that routes taken by older adults may be unnecessarily complex and that excessive path complexity may be an indicator of cognitive difficulties experienced by older navigators. In a sample of healthy adults, we quantify search path complexity in a virtual Morris water maze with a novel method based on fractal dimensionality. In a two-level hierarchical linear model, we estimated improvement in navigation performance across trials by a decline in route length, shortening of search time, and reduction in fractal dimensionality of the path. While replicating commonly reported age and sex differences in time and distance indices, a reduction in fractal dimension of the path accounted for improvement across trials, independent of age or sex. The volumes of brain regions associated with the establishment of cognitive maps (parahippocampal gyrus and hippocampus) were related to path dimensionality, but not to the total distance and time. Thus, fractal dimensionality of a navigational path may present a useful complementary method of quantifying performance in navigation. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  10. Complex pegmatite - apelitic of Cabecinha - strategies appreciation of geological heritage and economic development of the region

    Science.gov (United States)

    Nobre, José; Cabral, Tiago; Cabral, João; Gomes, Ana

    2014-05-01

    The Complex pegmatite - apelitic of Cabecinha corresponds to an isolated ridge that reaches 933 meters, located in the middle zone of transition between the Hesperian massif and the Cova da Beira being located in the NE central part of Portugal, more specifically in the Mountainous region of the province of Beira Alta, council of Sabugal. This complex lies embedded in porphyritic granites with terms of switching to a medium-grained granite rich in sodium feldspars in which they are muscovite granite intrusions. The lodes have pegmatites with NE-SW orientation, presenting phases of predominantly quartz crystallization with multiple parageneses. The inclusions observed are veins filonianian secondary. Some veins have structural discontinuity due to further their training tectonics. The apelitico material is basic in nature engaging in descontinuiddes of pegmatite material, showing no preferred orientation. The petrological characteristics of the area in question provide the appearance of motivating exotic landforms of scientific interest. These landforms, over time, have motivated the popular level the emergence of various myths, thus contributing to the enrichment of the local cultural heritage. This study proceeded to the geological and geomorphological mapping an area of about 6945,350 m2 with a maximum length of 182 m. The huge patent mineralogical, petrological and geomorphological level geodiversity, allied to the structural complexity and associated cultural heritage, allow geoconservation strategies and recovery, using new multimedia technologies including use of QR codes and 3D. All this geological framework and environment becomes an asset for the scientific, educational and economic development of the region. On the other hand, it has the vital Importance in the context of the strategy of forming a geological park, in the point of view of tourism, research and interpretation.

  11. Dynamical downscaling of ERA-40 in complex terrain using the WRF regional climate model

    Energy Technology Data Exchange (ETDEWEB)

    Heikkilae, U. [Bjerknes Centre for Climate Research, Uni Bjerknes Centre, Bergen (Norway); Sandvik, A. [Bjerknes Centre for Climate Research, Institute for Marine Research (IMR), Bergen (Norway); Sorteberg, A. [University of Bergen, Geophysical Institute, Bergen (Norway)

    2011-10-15

    Results from a first-time employment of the WRF regional climate model to climatological simulations in Europe are presented. The ERA-40 reanalysis (resolution 1 ) has been downscaled to a horizontal resolution of 30 and 10 km for the period of 1961-1990. This model setup includes the whole North Atlantic in the 30 km domain and spectral nudging is used to keep the large scales consistent with the driving ERA-40 reanalysis. The model results are compared against an extensive observational network of surface variables in complex terrain in Norway. The comparison shows that the WRF model is able to add significant detail to the representation of precipitation and 2-m temperature of the ERA-40 reanalysis. Especially the geographical distribution, wet day frequency and extreme values of precipitation are highly improved due to the better representation of the orography. Refining the resolution from 30 to 10 km further increases the skill of the model, especially in case of precipitation. Our results indicate that the use of 10-km resolution is advantageous for producing regional future climate projections. Use of a large domain and spectral nudging seems to be useful in reproducing the extreme precipitation events due to the better resolved synoptic scale features over the North Atlantic, and also helps to reduce the large regional temperature biases over Norway. This study presents a high-resolution, high-quality climatological data set useful for reference climate impact studies. (orig.)

  12. Central Asia as a Regional Security Complex from the Perspectives of Realism, Liberalism and Constructivism

    Directory of Open Access Journals (Sweden)

    Caroline Putri Pratama

    2013-05-01

    Full Text Available Tulisan ini bertujuan menganalisis kawasan Asia Tengah, dilihat dari perspektif Realisme, Liberalisme dan Konstruktivisme, melalui teori Regional Security Complex oleh Barry Buzan dan Ole Waever. Teori ini hendak menunjukkan keamanan regional berdasarkan interdependensi antar unit dalam kawasan dilihat dari struktur power dan proses sekuritisasi di dalamnya, demikian pola hubungan keamanan dalam kawasan Asia Tengah berusaha dijelaskan dengan elemen-elemen dari ketiga paradigma yang terdapat dalam teori tersebut. Hasil analisis tulisan ini menunjukkan bahwa Asia Tengah dipandang sebagai bentuk insecurity interdependence by external forces dari perspektif Realis, security interdependence by interest dari perspektif Liberalis dan securitization interdependence by understanding of threat/security dari perspektif Konstruktivis. Kompleks keamanan Asia Tengah termasuk dalam tipe kompleks keamanan Great Power, terlihat dari peran besar kekuatan-kekuatan eksternal terutama Rusia dan Cina dalam kawasan tersebut; baik dalam pembentukan pola pertemanan dengan kerjasama, pola permusuhan dengan persaingan dan ketakutan, juga proses sekuritisasi isu separatisme, ekstremisme dan terorisme sebagai ancaman terhadap keamanan regional.Tulisan ini diambil dari tugas karya akhir penulis yang diajukan untuk medapatkan gelar Sarjana Sosial dari Departemen Ilmu Hubungan Internasional, Universitas Indonesia.

  13. EFFECT OF KINESIO TAPING AND SOFT ORTHOSIS APPLICATION ON THE PAIN AND FUNCTIONAL DISABILITY IN LUMBAR REGION PATHOLOGIES WITHOUT NEUROLOGICAL DEFICITS: A RANDOMIZED CONTROLLED EXPERIMENTAL STUDY

    Directory of Open Access Journals (Sweden)

    Burcu TALU

    2016-12-01

    Full Text Available Background: Back pain caused by lumbar region pathologies is a condition that leads to loss of productivity and physical disability, with high costs of diagnosis and treatment. This study was planned to investigate the effect of taping and soft orthosis application on the pain and functional disability in the pathology of lumbar region without neurological deficit. Methods: This study is randomized controlled trial. Sixty-three volunteer patients were randomly divided into three groups of 21 people. Group I, soft orthotics and stabilization exercise program; Group II, Kinesio taping and stabilization exercise program; Group III, stabilization exercise program was applied. After obtaining demographic data of the participants; patients were evaluated in terms of range of motion and muscle strength. We used visual analog scale for pain level assessment, sit and reach test for flexibility assessment, timed up and go test (TUG for functional ambulation and balance, modified Schober test for lumbar spine flexibility, Oswestry Disability Index in the assessment of functional disability. They were assessed at the pretreatment, third (post treatment and six week (home programs and follow-up. Results: The results showed that significant differences (p<0.05 occurred over time in the study parameters such as functional ambulation, flexibility, lumbar flexibility, functional disability, pain, strength, range of motion in all groups. In comparisons between groups, there was a difference mainly in favor of Group II (p<0.05. Conclusions: We have concluded that in lumbar region pathologies without neurological deficits, stabilization exercises combined with orthotics and Kinesio taping applications reduces pain and functional disability.

  14. Cambrian nepheline syenite complex at Jabal Sawda, Midyan region, Kingdom of Saudi Arabia

    Science.gov (United States)

    Liddicoat, W.K.; Ramsay, C.R.; Hedge, C.E.

    1986-01-01

    The only nepheline syenite complex presently known in the Arabian Shield is at Jabal Sawda, about 30 km S of Haql in the extreme NW of Saudi Arabia. It is a post-tectonic, composite intrusion with a crudely concentric structure. A core of leuco-nepheline syenite, a partial ring of mela-nepheline syenite, and an almost complete outer ring of alkali-feldspar syenite are the main rock units. Several mega-inclusions of porphyritic nepheline syenite, nepheline monzosyenite, malignite and ijolite are present in the leuco-nepheline syenite. The chemical composition is notable for very high values of Al2O3, Na2O, Ba, La, Nb, Sr and Zr. U{single bond}Pb isotope dating indicates an emplacement age of 553 ?? 4 Ma, one of an increasing number of reliable Cambrian isotope dates in the northern Red Sea region. ?? 1986.

  15. Complex organic molecules toward low-mass and high-mass star forming regions

    Science.gov (United States)

    Favre, C.; Ceccarelli, C.; Lefloch, B.; Bergin, E.; Carvajal, M.; Brouillet, N.; Despois, D.; Jørgensen, J.; Kleiner, I.

    2016-12-01

    One of the most important questions in molecular astrophysics is how, when, and where complex organic molecules, COMs (≥ 6 atoms) are formed. In the Interstellar-Earth connection context, could this have a bearing on the origin of life on Earth? Formation mechanisms of COMs, which include potentially prebiotic molecules, are still debated and may include grain-mantle and/or gas-phase chemistry. Understanding the mechanisms that lead to the interstellar molecular complexification, along with the involved physicochemical processes, is mandatory to answer the above questions. In that context, active researches are ongoing in theory, laboratory experiment, chemical modeling and observations. Thanks to recent progress in radioastronomy instrumentation for both single-dish and millimeter array (e.g. Herschel, NOEMA, ALMA), new results have been obtained. I will review some notable results on the detection of COMs, including prebiotic molecules, towards star forming regions.

  16. Cambrian nepheline syenite complex at Jabal Sawda, Midyan region, Kingdom of Saudi Arabia

    Science.gov (United States)

    Liddicoat, W. K.; Ramsay, C. R.; Hedge, C. E.

    The only nepheline syenite complex presently known in the Arabian Shield is at Jabal Sawda, about 30 km S of Haql in the extreme NW of Saudi Arabia. It is a post-tectonic, composite intrusion with a crudely concentric structure. A core of leuco-nepheline syenite, a partial ring of mela-nepheline syenite, and an almost complete outer ring of alkali-feldspar syenite are the main rock units. Several mega-inclusions of porphyritic nepheline syenite, nepheline monzosyenite, malignite and ijolite are present in the leuco-nepheline syenite. The chemical composition is notable for very high values of Al 2O 3, Na 2O, Ba, La, Nb, Sr and Zr. U sbnd Pb isotope dating indicates an emplacement age of 553 ± 4 Ma, one of an increasing number of reliable Cambrian isotope dates in the northern Red Sea region.

  17. A comparison of patient pain and visual outcome using topical anesthesia versus regional anesthesia during cataract surgery.

    Science.gov (United States)

    Hosoda, Yoshikatsu; Kuriyama, Shoji; Jingami, Yoko; Hattori, Hidetsugu; Hayashi, Hisako; Matsumoto, Miho

    2016-01-01

    The purpose of this study was to compare the level of patient pain during the phacoemulsification and implantation of foldable intraocular lenses while under topical, intracameral, or sub-Tenon lidocaine. This was a retrospective study. Three hundred and one eyes subjected to cataract surgery were included in this study. All eyes underwent phacoemulsification surgery and intraocular lens implantation using topical, sub-Tenon, or intracameral anesthesia. The topical group received 4% lidocaine drops, and the intracameral group received a 0.1-0.2 cc infusion of 1% preservative-free lidocaine into the anterior chamber through the side port combined with topical drops of lidocaine. The sub-Tenon group received 2% lidocaine. Best-corrected visual acuity, corneal endothelial cell loss, and intraoperative pain level were evaluated. Pain level was assessed on a visual analog scale (range 0-2). There were no significant differences in visual outcome and corneal endothelial cell loss between the three groups. The mean pain score in the sub-Tenon group was significantly lower than that in the topical and intracameral groups (P=0.0009 and P=0.0055, respectively). In 250 eyes without high myopia (< -6D), there were no significant differences in mean pain score between the sub-Tenon and intracameral groups (P=0.1417). No additional anesthesia was required in all groups. Intracameral lidocaine provides sufficient pain suppressive effects in eyes without high myopia, while sub-Tenon anesthesia is better for cataract surgery in eyes with high myopia.

  18. Neonatal pain

    Science.gov (United States)

    Walker, Suellen M

    2014-01-01

    Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. PMID:24330444

  19. Granulitic orthogneisses geochemistry of Caraiba complex, in Riachao do Jacuipe region - Bahia state, Brazil

    International Nuclear Information System (INIS)

    Teixeira, L.R.; Mello, R.C.

    1990-01-01

    This paper describes the granulitic orthogneisses of the Riachao do Jacuipe unit (Caraiba Complex) petrographicaly classified as tonalitic (predominating), trondhjemitic, granodioritic and quartz dioritic hyperstene gneisses. The chemical composition of the orthogneisses is dominantly tonalitic/granodioritic, that is typical of a calc-alkaline parentage depleted in K and enriched in Al sub(2) O sub(3). Their geochemical characteristics are very similar to those of the grey gneisses of other regions of the world, usually named TTG (tonalite-trondhhemite-granodiorite). In the sequence of orthogneiss coexist rocks both normal and depleted in LILE. The patterns of distribution of highly fractioned REE (La/YbN ratio up to 102) with Eu anomaly small or absent points against a direct mantle origin. On the other hand the only Rb-Sr age determination in the se rocks gives an age of 2,35 Ga with an initial ratio (Ro) of 0,702. This initial ratio suggests that the rocks did not originated from reworking of a much older continental crust. The available data suggest that the granulitized orthogneisses of the Caraiba Complex were formed by partial melt of basaltic material (amphibalitized oceanic crust). (author)

  20. Stratigraphic units overlying the Zambales Ophiolite Complex (ZOC) in Luzon, (Philippines): Tectonostratigraphic significance and regional implications

    Science.gov (United States)

    Queaño, Karlo L.; Dimalanta, Carla B.; Yumul, Graciano P.; Marquez, Edanjarlo J.; Faustino-Eslava, Decibel V.; Suzuki, Shigeyuki; Ishida, Keisuke

    2017-07-01

    The Zambales Ophiolite Complex (ZOC) on the island of Luzon, Philippines is one of the most well-studied crust-mantle sequences in the region. Several massifs comprise the ZOC, one of which is the Coto Block overlain by clastic sedimentary units previously dated as Eocene. Geochronologic studies from diabase, granodiorites and other late-stage magmatic products similarly yielded the same age. Succeeding tectonic models have therefore all been grounded on the assumption that the entire ZOC is Eocene. Recent investigations, however, revealed the presence of chert blocks within the Early to Middle Miocene clastic formation overlying the Acoje Block in the northern part of the ophiolite complex. Radiolarians extracted from the cherts yielded a stratigraphic range that suggests a Late Jurassic to Early Cretaceous age. The recognition of a much older age than previously reported of the ZOC warrants a re-examination of its actual distribution and genesis. Correlating with other similarly-aged ophiolites, we suggest defining a western Mesozoic ophiolite belt, largely extending from the west-central portion of the archipelago to the northeastern tip of Luzon island. Tentatively, we attribute the Mesozoic ophiolitic and associated rocks in western Luzon to an arc-continent collision involving the Philippine Mobile Belt and the Palawan Microcontinental Block. In addition, differences in the clastic compositions of the Cenozoic sedimentary formations provide material not only for deciphering the ZOC's unroofing history but also for constraining the timing of province linkage. The intermittent appearance of lithic fragments and detrital minerals from the ophiolite in the units of the Middle Miocene Candelaria Limestone and the Late Miocene to Early Pliocene Sta. Cruz Formation indicates significant but geographically variable contributions from the ophiolite complex. In the northern Zambales Range, the Sta. Cruz Formation caps the Coto Block and the Acoje Block of the ZOC

  1. A comparison of spatial interpolation methods for soil temperature over a complex topographical region

    Science.gov (United States)

    Wu, Wei; Tang, Xiao-Ping; Ma, Xue-Qing; Liu, Hong-Bin

    2016-08-01

    Soil temperature variability data provide valuable information on understanding land-surface ecosystem processes and climate change. This study developed and analyzed a spatial dataset of monthly mean soil temperature at a depth of 10 cm over a complex topographical region in southwestern China. The records were measured at 83 stations during the period of 1961-2000. Nine approaches were compared for interpolating soil temperature. The accuracy indicators were root mean square error (RMSE), modelling efficiency (ME), and coefficient of residual mass (CRM). The results indicated that thin plate spline with latitude, longitude, and elevation gave the best performance with RMSE varying between 0.425 and 0.592 °C, ME between 0.895 and 0.947, and CRM between -0.007 and 0.001. A spatial database was developed based on the best model. The dataset showed that larger seasonal changes of soil temperature were from autumn to winter over the region. The northern and eastern areas with hilly and low-middle mountains experienced larger seasonal changes.

  2. A neutral lipophilic technetium-99m complex for regional cerebral blood flow imaging

    International Nuclear Information System (INIS)

    Narra, R.K.; Nunn, A.D.; Kuczynski, B.L.; DiRocco, R.J.; Feld, T.; Silva, D.A.; Eckelman, W.C.

    1990-01-01

    Technetium-99m-DMG-2MP (Chloro[bis[2,3-butanedionedioxime(1-)-0][2,3- butanedionedioximato (2-)-N,N',N double-prime,N'double-prime,N double-prime double-prime,N'double-prime double-prime] (2-methylpropyl borato (2-))technetium]), also known as SQ 32097 is a member of a family of neutral lipophilic compounds generally known as boronic acid adducts of technetium dioxime complexes (BATOs). After i.v. administration, the concentration of [ 99m Tc]DMG-2MP in various regions of the brain appears to be proportional to blood flow. In rats, 1.1% ID was in the brain at 5 min postinjection when the blood contained less than 3% ID. Over 24 hr excretion was 59% in the feces and 23% in the urine. The activity in monkey brain at 5 min was 2.8% ID and it cleared with a t1/2 of 86 min. Autoradiographs of monkey brain sections showed excellent regional detail with a gray/white ratio of 3.6 at 10 min. The distribution of [ 99m Tc]DMG-2MP in the monkey brain corresponds to the known cytoarchitectural pattern of cerebral glucose metabolism. The properties of [ 99m Tc]DMG-2MP make it a potentially useful agent for cerebral perfusion imaging in man

  3. Institutional Analysis of Knowledge Generation Resource Potential at the Enterprises of Regional Military-Industrial Complex

    Directory of Open Access Journals (Sweden)

    Evgeny Vasilyevich Popov

    2016-09-01

    Full Text Available The article is devoted to the processes of knowledge generation at the enterprises of military-industrial complex, which are the leaders of the regional innovative activity. The target of the research is to develop the methodology based on the use of resource application potential for increasing the efficiency of knowledge generation at the instrument-making enterprises of military-industrial complex. The system analysis of the knowledge generation processes is conducted at one of them. It allows to draw a conclusion that such enterprises have a lack of the institutes of knowledge generation processes. The authors are offered a technique of the development of the knowledge generation system at the military-industrial enterprises based on the accounting of assets and opportunities of the enterprise in the realization of intellectual activity. The developed technique is based on the determination of the horizontal resource potential of knowledge generation and allows to determine the potential of resource application at each stage of product life cycle. The comparison of the actual and theoretical values of horizontal resource potential allows to correct the distribution of a share of each of resources within a stage, and therefore, to optimize the realization of tasks at a specific stage. The offered tools were implemented in 2015 at one of the regional military-Industrial enterprises. The methodological tools of the research include the methods of expert assessment, mathematical statistics and the institutional analysis. On the basis of the offered technique and received empirical results, the institutional spiral of knowledge generation during the filling of state order at the military-industrial enterprise is developed. Its implementation will promote the decrease in the level of uncertainty during the whole life cycle of innovative activity product. The developed institutional spiral of knowledge generation at instrument-making military

  4. Complex and region-specific changes in astroglial markers in the aging brain.

    Science.gov (United States)

    Rodríguez, José J; Yeh, Chia-Yu; Terzieva, Slavica; Olabarria, Markel; Kulijewicz-Nawrot, Magdalena; Verkhratsky, Alexei

    2014-01-01

    Morphological aging of astrocytes was investigated in entorhinal cortex (EC), dentate gyrus (DG), and cornu ammonis 1 (CA1) regions of hippocampus of male SV129/C57BL6 mice of different age groups (3, 9, 18, and 24 months). Astroglial profiles were visualized by immunohistochemistry by using glial fibrillary acidic protein (GFAP), glutamine synthetase (GS), and s100β staining; these profiles were imaged using confocal or light microscopy for subsequent morphometric analysis. GFAP-positive profiles in the DG and the CA1 of the hippocampus showed progressive age-dependent hypertrophy, as indicated by an increase in surface, volume, and somata volume at 24 months of age compared with 3-month-old mice. In contrast with the hippocampal regions, aging induced a decrease in GFAP-positive astroglial profiles in the EC: the surface, volume, and cell body volume of astroglial cells at 24 months of age were decreased significantly compared with the 3-month group. The GS-positive astrocytes displayed smaller cellular surface areas at 24 months compared with 3-month-old animals in both areas of hippocampus, whereas GS-positive profiles remained unchanged in the EC of old mice. The morphometry of s100β-immunoreactive profiles revealed substantial increase in the EC, more moderate increase in the DG, and no changes in the CA1 area. Based on the morphological analysis of 3 astroglial markers, we conclude that astrocytes undergo a complex age-dependent remodeling in a brain region-specific manner. Copyright © 2014. Published by Elsevier Inc.

  5. Comparison of different wind data interpolation methods for a region with complex terrain in Central Asia

    Science.gov (United States)

    Reinhardt, Katja; Samimi, Cyrus

    2018-01-01

    While climatological data of high spatial resolution are largely available in most developed countries, the network of climatological stations in many other regions of the world still constitutes large gaps. Especially for those regions, interpolation methods are important tools to fill these gaps and to improve the data base indispensible for climatological research. Over the last years, new hybrid methods of machine learning and geostatistics have been developed which provide innovative prospects in spatial predictive modelling. This study will focus on evaluating the performance of 12 different interpolation methods for the wind components \\overrightarrow{u} and \\overrightarrow{v} in a mountainous region of Central Asia. Thereby, a special focus will be on applying new hybrid methods on spatial interpolation of wind data. This study is the first evaluating and comparing the performance of several of these hybrid methods. The overall aim of this study is to determine whether an optimal interpolation method exists, which can equally be applied for all pressure levels, or whether different interpolation methods have to be used for the different pressure levels. Deterministic (inverse distance weighting) and geostatistical interpolation methods (ordinary kriging) were explored, which take into account only the initial values of \\overrightarrow{u} and \\overrightarrow{v} . In addition, more complex methods (generalized additive model, support vector machine and neural networks as single methods and as hybrid methods as well as regression-kriging) that consider additional variables were applied. The analysis of the error indices revealed that regression-kriging provided the most accurate interpolation results for both wind components and all pressure heights. At 200 and 500 hPa, regression-kriging is followed by the different kinds of neural networks and support vector machines and for 850 hPa it is followed by the different types of support vector machine and

  6. [Pain in edentulous patients

    NARCIS (Netherlands)

    Baat, C. de

    2006-01-01

    In daily social life, orofacial pain is strongly associated with teeth. However, edentulousness is no lifetime guarantee of being pain-free in the orofacial region. Common oral pains in edentulous people are caused by denture misfits or occlusal errors, by alveolar ridge atrophy, by (sharp)

  7. Metamorphic and tectonic evolution of the Greater Himalayan Crystalline Complex in Nyalam region, south Tibet

    Science.gov (United States)

    Wang, Jia-Min; Zhang, Jin-Jiang; Rubatto, Daniela

    2016-04-01

    Recent studies evoke dispute whether the Himalayan metamorphic core - Greater Himalayan Crystalline Complex (GHC) - was exhumed as a lateral crustal flow or a critical taper wedge during the India-Asia collision. This contribution investigated the evolution of the GHC in the Nyalam region, south Tibet, with comprehensive studies on structural kinematics, metamorphic petrology and geochronology. The GHC in the Nyalam region can be divided into the lower and upper GHC. Phase equilibria modelling and conventional thermobarometric results show that peak temperature conditions are lower in the lower GHC (~660-700°C) and higher in the upper GHC (~740-780°C), whereas corresponding pressure conditions at peak-T decrease from ~9-13 kbar to ~4 kbar northward. Monazite, zircon and rutile U-Pb dating results reveal two distinct blocks within the GHC of the Nyalam region. The upper GHC underwent higher degree of partial melting (15-25%, via muscovite dehydration melting) that initiated at ~32 Ma, peaked at ~29 Ma to 25 Ma, possibly ended at ~20 Ma. The lower GHC underwent lower degree of melting (0-10%) that lasted from 19 to 16 Ma, which was produced mainly via H2O-saturated melting. At different times, both the upper and lower blocks underwent initial slow cooling (35 ± 8 and 10 ± 5°C/Myr, respectively) and subsequent rapid cooling (120 ± 40°C/Myr). The established timescale of metamorphism suggests that high-temperature metamorphism within the GHC lasted a long duration (~15 Myr), whereas duration of partial melting lasted for ~3 Myr in the lower GHC and lasted for 7-12 Myr in the upper GHC. The documented diachronous metamorphism and discontinuity of peak P-T conditions implies the presence of the Nyalam Thrust in the study area. This thrust is probably connected to the other thrusts in Nepal and Sikkim Himalaya, which extends over ~800 km and is named the "High Himalayan Thrust". Timing of activity along this thrust is at ~25-16 Ma, which is coeval with active

  8. Functional reorganization of the default mode network across chronic pain conditions.

    Directory of Open Access Journals (Sweden)

    Marwan N Baliki

    Full Text Available Chronic pain is associated with neuronal plasticity. Here we use resting-state functional magnetic resonance imaging to investigate functional changes in patients suffering from chronic back pain (CBP, complex regional pain syndrome (CRPS and knee osteoarthritis (OA. We isolated five meaningful resting-state networks across the groups, of which only the default mode network (DMN exhibited deviations from healthy controls. All patient groups showed decreased connectivity of medial prefrontal cortex (MPFC to the posterior constituents of the DMN, and increased connectivity to the insular cortex in proportion to the intensity of pain. Multiple DMN regions, especially the MPFC, exhibited increased high frequency oscillations, conjoined with decreased phase locking with parietal regions involved in processing attention. Both phase and frequency changes correlated to pain duration in OA and CBP patients. Thus chronic pain seems to reorganize the dynamics of the DMN and as such reflect the maladaptive physiology of different types of chronic pain.

  9. Neuron–Glia Crosstalk and Neuropathic Pain: Involvement in the Modulation of Motor Activity in the Orofacial Region

    Science.gov (United States)

    Unno, Shumpei; Ando, Hiroshi; Masuda, Yuji; Kitagawa, Junichi

    2017-01-01

    Neuropathic orofacial pain (NOP) is a debilitating condition. Although the pathophysiology remains unclear, accumulating evidence suggests the involvement of multiple mechanisms in the development of neuropathic pain. Recently, glial cells have been shown to play a key pathogenetic role. Nerve injury leads to an immune response near the site of injury. Satellite glial cells are activated in the peripheral ganglia. Various neural and immune mediators, released at the central terminals of primary afferents, lead to the sensitization of postsynaptic neurons and the activation of glia. The activated glia, in turn, release pro-inflammatory factors, further sensitizing the neurons, and resulting in central sensitization. Recently, we observed the involvement of glia in the alteration of orofacial motor activity in NOP. Microglia and astroglia were activated in the trigeminal sensory and motor nuclei, in parallel with altered motor functions and a decreased pain threshold. A microglial blocker attenuated the reduction in pain threshold, reduced the number of activated microglia, and restored motor activity. We also found an involvement of the astroglial glutamate–glutamine shuttle in the trigeminal motor nucleus in the alteration of the jaw reflex. Neuron–glia crosstalk thus plays an important role in the development of pain and altered motor activity in NOP. PMID:28954391

  10. Neuron-Glia Crosstalk and Neuropathic Pain: Involvement in the Modulation of Motor Activity in the Orofacial Region.

    Science.gov (United States)

    Hossain, Mohammad Zakir; Unno, Shumpei; Ando, Hiroshi; Masuda, Yuji; Kitagawa, Junichi

    2017-09-26

    Neuropathic orofacial pain (NOP) is a debilitating condition. Although the pathophysiology remains unclear, accumulating evidence suggests the involvement of multiple mechanisms in the development of neuropathic pain. Recently, glial cells have been shown to play a key pathogenetic role. Nerve injury leads to an immune response near the site of injury. Satellite glial cells are activated in the peripheral ganglia. Various neural and immune mediators, released at the central terminals of primary afferents, lead to the sensitization of postsynaptic neurons and the activation of glia. The activated glia, in turn, release pro-inflammatory factors, further sensitizing the neurons, and resulting in central sensitization. Recently, we observed the involvement of glia in the alteration of orofacial motor activity in NOP. Microglia and astroglia were activated in the trigeminal sensory and motor nuclei, in parallel with altered motor functions and a decreased pain threshold. A microglial blocker attenuated the reduction in pain threshold, reduced the number of activated microglia, and restored motor activity. We also found an involvement of the astroglial glutamate-glutamine shuttle in the trigeminal motor nucleus in the alteration of the jaw reflex. Neuron-glia crosstalk thus plays an important role in the development of pain and altered motor activity in NOP.

  11. Spinal pain in adolescents

    DEFF Research Database (Denmark)

    Aartun, Ellen; Hartvigsen, Jan; Wedderkopp, Niels

    2014-01-01

    BACKGROUND: The severity and course of spinal pain is poorly understood in adolescents. The study aimed to determine the prevalence and two-year incidence, as well as the course, frequency, and intensity of pain in the neck, mid back, and low back (spinal pain). METHODS: This study was a school......-based prospective cohort study. All 5th and 6th grade students (11-13 years) at 14 schools in the Region of Southern Denmark were invited to participate (N = 1,348). Data were collected in 2010 and again two years later, using an e-survey completed during school time. RESULTS: The lifetime prevalence of spinal pain...... reported their pain as relatively infrequent and of low intensity, whereas the participants with frequent pain also experienced pain of higher intensity. The two-year incidence of spinal pain varied between 40% and 60% across the physical locations. Progression of pain from one to more locations and from...

  12. A comparison of patient pain and visual outcome using topical anesthesia versus regional anesthesia during cataract surgery

    Directory of Open Access Journals (Sweden)

    Hosoda Y

    2016-06-01

    Full Text Available Yoshikatsu Hosoda, Shoji Kuriyama, Yoko Jingami, Hidetsugu Hattori, Hisako Hayashi, Miho Matsumoto Department of Ophthalmology, Otsu Red-Cross Hospital, Otsu, Japan Purpose: The purpose of this study was to compare the level of patient pain during the phacoemulsification and implantation of foldable intraocular lenses while under topical, intracameral, or sub-Tenon lidocaine.Patients and methods: This was a retrospective study. Three hundred and one eyes subjected to cataract surgery were included in this study. All eyes underwent phacoemulsification surgery and intraocular lens implantation using topical, sub-Tenon, or intracameral anesthesia. The topical group received 4% lidocaine drops, and the intracameral group received a 0.1–0.2 cc infusion of 1% preservative-free lidocaine into the anterior chamber through the side port combined with topical drops of lidocaine. The sub-Tenon group received 2% lidocaine. Best-corrected visual acuity, corneal endothelial cell loss, and intraoperative pain level were evaluated. Pain level was assessed on a visual analog scale (range 0–2.Results: There were no significant differences in visual outcome and corneal endothelial cell loss between the three groups. The mean pain score in the sub-Tenon group was significantly lower than that in the topical and intracameral groups (P=0.0009 and P=0.0055, respectively. In 250 eyes without high myopia (<-6D, there were no significant differences in mean pain score between the sub-Tenon and intracameral groups (P=0.1417. No additional anesthesia was required in all groups.Conclusion: Intracameral lidocaine provides sufficient pain suppressive effects in eyes without high myopia, while sub-Tenon anesthesia is better for cataract surgery in eyes with high myopia. Keywords: cataract, anesthesia, topical, intracameral, sub-Tenon

  13. Clinical Trial Assessing the Efficacy of Gabapentin Plus B Complex (B1/B12 versus Pregabalin for Treating Painful Diabetic Neuropathy

    Directory of Open Access Journals (Sweden)

    Alberto Mimenza Alvarado

    2016-01-01

    Full Text Available Introduction. Painful diabetic neuropathy (PDN is a prevalent and impairing disorder. The objective of this study was to show the efficacy and safety of gabapentin (GBP plus complex B vitamins: thiamine (B1 and cyanocobalamine (B12 compared to pregabalin in patients with moderate to severe intensity PDN. Method. Multicenter, randomized, blind study. Two hundred and seventy patients were evaluated, 147 with GBP/B1/B12 and 123 with PGB, with a 7/10 pain intensity on the Visual Analog Scale (VAS. Five visits (12 weeks were scheduled. The GBP/B1 (100 mg/B12 (20 mg group started with 300 mg at visit 1 to 3600 mg at visit 5. The PGB group started with 75 mg/d at visit 1 to 600 mg/d at visit 5. Different safety and efficacy scales were applied, as well as adverse event assessment. Results. Both drugs showed reduction of pain intensity, without significant statistical difference (P=0.900. In the GBP/B1/B12 group, an improvement of at least 30% on VAS correlated to a 900 mg/d dose, compared with PGB 300 mg/d. Likewise, occurrence of vertigo was lower in the GBP/B1-B12 group, with a significant statistical difference, P=0.014. Conclusions. Our study shows that GPB/B1-B12 combination is as effective as PGB. Nonetheless, pain intensity reduction is achieved with 50% of the minimum required gabapentin dose alone (800 to 1600 mg/d in classic NDD trials. Less vertigo and dizziness occurrence was also observed in the GBP/B1/B12 group. This trial is registered with ClinicalTrials.gov NCT01364298.

  14. USING THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT AND REGIONAL INTERDEPENDENCE THEORY TO GUIDE TREATMENT OF AN ATHLETE WITH BACK PAIN: A CASE REPORT.

    Science.gov (United States)

    Goshtigian, Gabriella R; Swanson, Brian T

    2016-08-01

    Despite the multidirectional quality of human movement, common measurement procedures used in physical therapy examination are often uni-planar and lack the ability to assess functional complexities involved in daily activities. Currently, there is no widely accepted, validated standard to assess movement quality. The Selective Functional Movement Assessment (SFMA) is one possible system to objectively assess complex functional movements. The purpose of this case report is to illustrate the application of the SFMA as a guide to the examination, evaluation, and management of a patient with non-specific low back pain (LBP). An adolescent male athlete with LBP was evaluated using the SFMA. It was determined that the patient had mobility limitations remote to the site of pain (thoracic spine and hips) which therapists hypothesized were leading to compensatory hypermobility at the lumbar spine. Guided by the SFMA, initial interventions focused on local (lumbar) symptom management, progressing to remote mobility deficits, and then addressing the local stability deficit. All movement patterns became functional/non-painful except the right upper extremity medial rotation-extension pattern. At discharge, the patient demonstrated increased soft tissue extensibility of hip musculature and joint mobility of the thoracic spine along with normalization of lumbopelvic motor control. Improvements in pain exceeded minimal clinically important differences, from 2-7/10 on a verbal analog scale at initial exam to 0-2/10 at discharge. Developing and progressing a plan of care for an otherwise healthy and active adolescent with non-specific LBP can be challenging. Human movement is a collaborative effort of muscle groups that are interdependent; the use of a movement-based assessment model can help identify weak links affecting overall function. The SFMA helped guide therapists to dysfunctional movements not seen with more conventional examination procedures. Level 4.

  15. Reduction of pain-related fear and increased function and participation in work-related upper extremity pain (WRUEP): effects of exposure in vivo.

    Science.gov (United States)

    de Jong, Jeroen R; Vlaeyen, Johan W S; van Eijsden, Marjon; Loo, Christoph; Onghena, Patrick

    2012-10-01

    There is increasing evidence that pain-related fear influences the development and maintenance of pain disability, presumably mediated through the fear-related avoidance of valued activities. Individually tailored graded exposure in vivo (GEXP) has been demonstrated to reduce pain-related fear and increase functional abilities in patients with chronic low back pain, neck pain, and complex regional pain syndrome. The current study aimed to test whether these effects generalize towards patients with work-related upper extremity pain. A sequential replicated and randomized single-case experimental phase design with multiple measurements was used. Within each participant, GEXP was compared to a no-treatment baseline period and a no-treatment 6-month follow-up period. Eight patients who reported a high level of pain-related fear were included in the study. Daily changes in pain catastrophizing, pain-related fear, and pain intensity were assessed using a diary, and subjected to randomization tests. Before the start of the baseline period, just after GEXP, and at 6-month follow-up, clinically relevant changes of pain catastrophizing, pain-related fear, perceived harmfulness of physical activity, pain disability, and participation/autonomy were verified. When GEXP was introduced, levels of pain catastrophizing and pain-related fear decreased significantly. Clinically relevant improvements were observed for pain disability, perceived participation, and autonomy. These favourable changes were maintained until 6-month follow-up. The findings of the current study underscore the external validity of a cognitive-behavioural GEXP treatment for patients with chronic pain reporting increased pain-related fear. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  16. Dissection of a Complex Disease Susceptibility Region Using a Bayesian Stochastic Search Approach to Fine Mapping.

    Directory of Open Access Journals (Sweden)

    Chris Wallace

    2015-06-01

    Full Text Available Identification of candidate causal variants in regions associated with risk of common diseases is complicated by linkage disequilibrium (LD and multiple association signals. Nonetheless, accurate maps of these variants are needed, both to fully exploit detailed cell specific chromatin annotation data to highlight disease causal mechanisms and cells, and for design of the functional studies that will ultimately be required to confirm causal mechanisms. We adapted a Bayesian evolutionary stochastic search algorithm to the fine mapping problem, and demonstrated its improved performance over conventional stepwise and regularised regression through simulation studies. We then applied it to fine map the established multiple sclerosis (MS and type 1 diabetes (T1D associations in the IL-2RA (CD25 gene region. For T1D, both stepwise and stochastic search approaches identified four T1D association signals, with the major effect tagged by the single nucleotide polymorphism, rs12722496. In contrast, for MS, the stochastic search found two distinct competing models: a single candidate causal variant, tagged by rs2104286 and reported previously using stepwise analysis; and a more complex model with two association signals, one of which was tagged by the major T1D associated rs12722496 and the other by rs56382813. There is low to moderate LD between rs2104286 and both rs12722496 and rs56382813 (r2 ≃ 0:3 and our two SNP model could not be recovered through a forward stepwise search after conditioning on rs2104286. Both signals in the two variant model for MS affect CD25 expression on distinct subpopulations of CD4+ T cells, which are key cells in the autoimmune process. The results support a shared causal variant for T1D and MS. Our study illustrates the benefit of using a purposely designed model search strategy for fine mapping and the advantage of combining disease and protein expression data.

  17. Solar resource assessment in complex orography: a comparison of available datasets for the Trentino region

    Science.gov (United States)

    Laiti, Lavinia; Giovannini, Lorenzo; Zardi, Dino

    2015-04-01

    The accurate assessment of the solar radiation available at the Earth's surface is essential for a wide range of energy-related applications, such as the design of solar power plants, water heating systems and energy-efficient buildings, as well as in the fields of climatology, hydrology, ecology and agriculture. The characterization of solar radiation is particularly challenging in complex-orography areas, where topographic shadowing and altitude effects, together with local weather phenomena, greatly increase the spatial and temporal variability of such variable. At present, approaches ranging from surface measurements interpolation to orographic down-scaling of satellite data, to numerical model simulations are adopted for mapping solar radiation. In this contribution a high-resolution (200 m) solar atlas for the Trentino region (Italy) is presented, which was recently developed on the basis of hourly observations of global radiation collected from the local radiometric stations during the period 2004-2012. Monthly and annual climatological irradiation maps were obtained by the combined use of a GIS-based clear-sky model (r.sun module of GRASS GIS) and geostatistical interpolation techniques (kriging). Moreover, satellite radiation data derived by the MeteoSwiss HelioMont algorithm (2 km resolution) were used for missing-data reconstruction and for the final mapping, thus integrating ground-based and remote-sensing information. The results are compared with existing solar resource datasets, such as the PVGIS dataset, produced by the Joint Research Center Institute for Energy and Transport, and the HelioMont dataset, in order to evaluate the accuracy of the different datasets available for the region of interest.

  18. Using intervention mapping to develop a theory-driven, group-based complex intervention to support self-management of osteoarthritis and low back pain (SOLAS).

    Science.gov (United States)

    Hurley, Deirdre A; Murphy, Laura Currie; Hayes, David; Hall, Amanda M; Toomey, Elaine; McDonough, Suzanne M; Lonsdale, Chris; Walsh, Nicola E; Guerin, Suzanne; Matthews, James

    2016-04-26

    The Medical Research Council framework provides a useful general approach to designing and evaluating complex interventions, but does not provide detailed guidance on how to do this and there is little evidence of how this framework is applied in practice. This study describes the use of intervention mapping (IM) in the design of a theory-driven, group-based complex intervention to support self-management (SM) of patients with osteoarthritis (OA) and chronic low back pain (CLBP) in Ireland's primary care health system. The six steps of the IM protocol were systematically applied to develop the self-management of osteoarthritis and low back pain through activity and skills (SOLAS) intervention through adaptation of the Facilitating Activity and Self-management in Arthritis (FASA) intervention. A needs assessment including literature reviews, interviews with patients and physiotherapists and resource evaluation was completed to identify the programme goals, determinants of SM behaviour, consolidated definition of SM and required adaptations to FASA to meet health service and patient needs and the evidence. The resultant SOLAS intervention behavioural outcomes, performance and change objectives were specified and practical application methods selected, followed by organised programme, adoption, implementation and evaluation plans underpinned by behaviour change theory. The SOLAS intervention consists of six weekly sessions of 90-min education and exercise designed to increase participants' physical activity level and use of evidence-based SM strategies (i.e. pain self-management, pain coping, healthy eating for weight management and specific exercise) through targeting of individual determinants of SM behaviour (knowledge, skills, self-efficacy, fear, catastrophizing, motivation, behavioural regulation), delivered by a trained physiotherapist to groups of up to eight individuals using a needs supportive interpersonal style based on self-determination theory

  19. Brain alpha-ketoglutarate dehydrogenase complex: kinetic properties, regional distribution, and effects of inhibitors.

    Science.gov (United States)

    Lai, J C; Cooper, A J

    1986-11-01

    The substrate and cofactor requirements and some kinetic properties of the alpha-ketoglutarate dehydrogenase complex (KGDHC; EC 1.2.4.2, EC 2.3.1.61, and EC 1.6.4.3) in purified rat brain mitochondria were studied. Brain mitochondrial KGDHC showed absolute requirement for alpha-ketoglutarate, CoA and NAD, and only partial requirement for added thiamine pyrophosphate, but no requirement for Mg2+ under the assay conditions employed in this study. The pH optimum was between 7.2 and 7.4, but, at pH values below 7.0 or above 7.8, KGDHC activity decreased markedly. KGDHC activity in various brain regions followed the rank order: cerebral cortex greater than cerebellum greater than or equal to midbrain greater than striatum = hippocampus greater than hypothalamus greater than pons and medulla greater than olfactory bulb. Significant inhibition of brain mitochondrial KGDHC was noted at pathological concentrations of ammonia (0.2-2 mM). However, the purified bovine heart KGDHC and KGDHC activity in isolated rat heart mitochondria were much less sensitive to inhibition. At 5 mM both beta-methylene-D,L-aspartate and D,L-vinylglycine (inhibitors of cerebral glucose oxidation) inhibited the purified heart but not the brain mitochondrial enzyme complex. At approximately 10 microM, calcium slightly stimulated (by 10-15%) the brain mitochondrial KGDHC. At concentrations above 100 microM, calcium (IC50 = 1 mM) inhibited both brain mitochondrial and purified heart KGDHC. The present results suggest that some of the kinetic properties of the rat brain mitochondrial KGDHC differ from those of the purified bovine heart and rat heart mitochondrial enzyme complexes. They also suggest that the inhibition of KGDHC by ammonia and the consequent effect on the citric acid cycle fluxes may be of pathophysiological and/or pathogenetic importance in hyperammonemia and in diseases (e.g., hepatic encephalopathy, inborn errors of urea metabolism, Reye's syndrome) where hyperammonemia is a

  20. Assessment of synchronous neural activities revealed by regional homogeneity in individuals with acute eye pain: a resting-state functional magnetic resonance imaging study

    Directory of Open Access Journals (Sweden)

    Tang L

    2018-04-01

    Full Text Available Li-Yuan Tang,1,* Hai-Jun Li,2,* Xin Huang,1 Jing Bao,1 Zubin Sethi,3 Lei Ye,1 Qing Yuan,1 Pei-Wen Zhu,1 Nan Jiang,1 Gui-Ping Gao,1 Yi Shao1 1Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China; 2Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China; 3The Department of Medicine, University of Miami, Coral Gables, FL, USA *These authors contributed equally to this work Objective: Previous neuroimaging studies have demonstrated that pain-related diseases are associated with brain function and anatomical abnormalities, whereas altered synchronous neural activity in acute eye pain (EP patients has not been investigated. The purpose of this study was to explore whether or not synchronous neural activity changes were measured with the regional homogeneity (ReHo method in acute EP patients.Methods: A total of 20 patients (15 males and 5 females with EP and 20 healthy controls (HCs consisting of 15 and 5 age-, sex-, and education-matched males and females, respectively, underwent resting-state functional magnetic resonance imaging. The ReHo method was applied to assess synchronous neural activity changes.Results: Compared with HCs, acute EP patients had significantly lower ReHo values in the left precentral/postcentral gyrus (Brodmann area [BA]3/4, right precentral/postcentral gyrus (BA3/4, and left middle frontal gyrus (BA6. In contrast, higher ReHo values in acute EP patients were observed in the left superior frontal gyrus (BA11, right inferior parietal lobule (BA39/40, and left precuneus (BA7. However, no relationship was found between the mean ReHo signal values of the different areas and clinical manifestations, which included both the duration and degree of pain in EP patients.Conclusion: Our study highlighted that acute EP patients showed altered synchronous neural activities in many brain regions, including somatosensory regions. These

  1. Regional molecular and cellular differences in the female rabbit Achilles tendon complex: potential implications for understanding responses to loading.

    Science.gov (United States)

    Huisman, Elise S; Andersson, Gustav; Scott, Alexander; Reno, Carol R; Hart, David A; Thornton, Gail M

    2014-05-01

    The aim of this study was: (i) to analyze the morphology and expression of extracellular matrix genes in six different regions of the Achilles tendon complex of intact normal rabbits; and (ii) to assess the effect of ovariohysterectomy (OVH) on the regional expression of these genes. Female New Zealand White rabbits were separated into two groups: (i) intact normal rabbits (n = 4); and (ii) OVH rabbits (n = 8). For each rabbit, the Achilles tendon complex was dissected into six regions: distal gastrocnemius (DG); distal flexor digitorum superficialis; proximal lateral gastrocnemius (PLG); proximal medial gastrocnemius; proximal flexor digitorum superficialis; and paratenon. For each of the regions, hematoxylin and eosin staining was performed for histological evaluation of intact normal rabbit tissues and mRNA levels for proteoglycans, collagens and genes associated with collagen regulation were assessed by real-time reverse transcription-quantitative polymerase chain reaction for both the intact normal and OVH rabbit tissues. The distal regions displayed a more fibrocartilaginous phenotype. For intact normal rabbits, aggrecan mRNA expression was higher in the distal regions of the Achilles tendon complex compared with the proximal regions. Collagen Type I and matrix metalloproteinase-2 expression levels were increased in the PLG compared to the DG in the intact normal rabbit tissues. The tendons from OVH rabbits had lower gene expressions for the proteoglycans aggrecan, biglycan, decorin and versican compared with the intact normal rabbits, although the regional differences of increased aggrecan expression in distal regions compared with proximal regions persisted. The tensile and compressive forces experienced in the examined regions may be related to the regional differences found in gene expression. The lower mRNA expression of the genes examined in the OVH group confirms a potential effect of systemic estrogen on tendon. © 2014 Anatomical Society.

  2. Upgrading a Social Media Strategy to Increase Twitter Engagement During the Spring Annual Meeting of the American Society of Regional Anesthesia and Pain Medicine.

    Science.gov (United States)

    Schwenk, Eric S; Jaremko, Kellie M; Gupta, Rajnish K; Udani, Ankeet D; McCartney, Colin J L; Snively, Anne; Mariano, Edward R

    Microblogs known as "tweets" are a rapid, effective method of information dissemination in health care. Although several medical specialties have described their Twitter conference experiences, Twitter-related data in the fields of anesthesiology and pain medicine are sparse. We therefore analyzed the Twitter content of 2 consecutive spring meetings of the American Society of Regional Anesthesia and Pain Medicine using publicly available online transcripts. We also examined the potential contribution of a targeted social media campaign on Twitter engagement during the conferences. The original Twitter meeting content was largely scientific in nature and created by meeting attendees, the majority of whom were nontrainee physicians. Physician trainees, however, represent an important and increasing minority of Twitter contributors. Physicians not in attendance predominantly contributed via retweeting original content, particularly picture-containing tweets, and thus increased reach to nonattendees. A social media campaign prior to meetings may help increase the reach of conference-related Twitter discussion.

  3. [Peroral and transdermal application of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of regional musculoskeletal pain syndromes].

    Science.gov (United States)

    Hodinka, László; Bálint, Géza; Budai, Erika; Géher, Pál; Papp, Renáta; Somogyi, Péter; Szántó, Sándor; Vereckei, Edit

    2017-12-01

    In this review the available evidences regarding the most frequently applied medication (peroral and transdermal non-steroidal anti-inflammatory agents) for the most frequent musculoskeletal complaints (regional pain syndromes) have been collected for the appropriate medical professionals who are most frequently faced with these conditions (general practitioners, rheumatologists, orthopedics, occupational and sports medicine experts). The special population at risk (with repeated and high energy overuse because of occupational or sport activities) and the pathology of their syndromes are identified. Mode of action, pharmacological properties of the non-steroidal anti-inflammatory drugs and the unwanted effects of their application especially in infants and elderly are highlighted. Recommendations of the general and specific pain management guidelines have been selected and listed in the review. Orv Hetil. 2017; 158(Suppl. 3): 3-30.

  4. INVESTMENT ACTIVITY OF AGRIBUSINESS IN THE AGROINDUSTRIAL COMPLEX REGION, AS ONE OF THE ELEMENTS OF THE FINANCIAL SECURITY OF THE AGRO-INDUSTRIAL COMPLEX OF THE STATE

    Directory of Open Access Journals (Sweden)

    Olga Nikolaevna Uglitskikh

    2015-09-01

    Full Text Available The developed economic-political situation around of Russia, specifies an indispensability of support of agricultural commodity producers as from their financial well-being, investment activity the financial security of agrarian and industrial complex of the state depends. Limitation of own financial resources at agrarians does not allow them to realize independently conceived projects. Studying of questions of formation and functioning of investment activity in agriculture of Stavropol Territory and an assessment of investment projects offered to reali-zation, have allowed to analyse investment activity of agrarian and industrial complex of region up to the introduction of Russia into WTO and in conditions of its membership. By results of the lead assessment the administrative areas of region showing the greatest investment activity, threats of a financial security of agrarian and industrial complex of region not putting by the activity have been revealed. It is drawn a conclusion on influence West-American sanctions on financial without-danger agra-rian and industrial complex of the state and the responsibility сельхозтоваропроизводителей about delivery of agricultural production in necessary volume and import substitution.

  5. Methodical Approaches To Analysis And Forecasting Of Development Fuel And Energy Complex And Gas Industry In The Region

    Directory of Open Access Journals (Sweden)

    Vladimir Andreyevich Tsybatov

    2014-12-01

    Full Text Available Fuel and energy complex (FEC is one of the main elements of the economy of any territory over which intertwine the interests of all economic entities. To ensure economic growth of the region should ensure that internal balance of energy resources, which should be developed with account of regional specifics of economic growth and energy security. The study examined the status of this equilibrium, indicating fuel and energy balance of the region (TEB. The aim of the research is the development of the fuel and energy balance, which will allow to determine exactly how many and what resources are not enough to ensure the regional development strategy and what resources need to be brought in. In the energy balances as the focus of displays all issues of regional development, so thermopile is necessary as a mechanism of analysis of current issues, economic development, and in the forward-looking version — as a tool future vision for the fuel and energy complex, energy threats and ways of overcoming them. The variety of relationships in the energy sector with other sectors and aspects of society lead to the fact that the development of the fuel and energy balance of the region have to go beyond the actual energy sector, involving the analysis of other sectors of economy, as well as systems such as banking, budgetary, legislative, tax. Due to the complexity of the discussed problems, the obvious is the need to develop appropriate forecast-analytical system, allowing regional authorities to implement evidence-based predictions of the consequences of management decisions. Multivariant scenario study on development of fuel and energy complex and separately industry, to use the methods of project-based management, harmonized application of state regulation of strategic and market mechanisms on the operational directions of development of fuel and energy complex and separately industry in the economy of the region.

  6. [Tips for taking history of pain].

    Science.gov (United States)

    Noda, Kazutaka; Ikusaka, Masatomi

    2012-11-01

    Pain is physiologically classified as nociceptive pain, neuropathic pain, and psychogenic pain. Nociceptive pain is further divided into visceral pain, somatic pain, and referred pain. Visceral pain is dull, and it is difficult to locate the origin of such pain. Somatic pain is sharp, severe, and well localized. On receiving visceral input for pain, it affects somatic nerve inputting to the same spinal segments, then referred pain is felt in the skin and muscles supplied by it. Referred pain is felt in an area that is located at a distance from its cause. History taking is the most important factor for determining the cause of pain. Generally, all the necessary information regarding pain can be acquired if pain-related history is obtained using the "OPQRST" mnemonic, that is, onset, provocation/palliative factor, quality, region/radiation/related symptoms, severity, and time characteristics.

  7. Mitochondrial Complex 1 Activity Measured by Spectrophotometry Is Reduced across All Brain Regions in Ageing and More Specifically in Neurodegeneration.

    Science.gov (United States)

    Pollard, Amelia Kate; Craig, Emma Louise; Chakrabarti, Lisa

    2016-01-01

    Mitochondrial function, in particular complex 1 of the electron transport chain (ETC), has been shown to decrease during normal ageing and in neurodegenerative disease. However, there is some debate concerning which area of the brain has the greatest complex 1 activity. It is important to identify the pattern of activity in order to be able to gauge the effect of age or disease related changes. We determined complex 1 activity spectrophotometrically in the cortex, brainstem and cerebellum of middle aged mice (70-71 weeks), a cerebellar ataxic neurodegeneration model (pcd5J) and young wild type controls. We share our updated protocol on the measurements of complex1 activity and find that mitochondrial fractions isolated from frozen tissues can be measured for robust activity. We show that complex 1 activity is clearly highest in the cortex when compared with brainstem and cerebellum (p<0.003). Cerebellum and brainstem mitochondria exhibit similar levels of complex 1 activity in wild type brains. In the aged brain we see similar levels of complex 1 activity in all three-brain regions. The specific activity of complex 1 measured in the aged cortex is significantly decreased when compared with controls (p<0.0001). Both the cerebellum and brainstem mitochondria also show significantly reduced activity with ageing (p<0.05). The mouse model of ataxia predictably has a lower complex 1 activity in the cerebellum, and although reductions are measured in the cortex and brain stem, the remaining activity is higher than in the aged brains. We present clear evidence that complex 1 activity decreases across the brain with age and much more specifically in the cerebellum of the pcd5j mouse. Mitochondrial impairment can be a region specific phenomenon in disease, but in ageing appears to affect the entire brain, abolishing the pattern of higher activity in cortical regions.

  8. 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.

  9. Therapeutic potential of stellate ganglion block in orofacial pain: a mini review.

    Science.gov (United States)

    Jeon, Younghoon

    2016-09-01

    Orofacial pain is a common complaint of patients that causes distress and compromises the quality of life. It has many etiologies including trauma, interventional procedures, nerve injury, varicella-zoster (shingles), tumor, and vascular and idiopathic factors. It has been demonstrated that the sympathetic nervous system is usually involved in various orofacial pain disorders such as postherpetic neuralgia, complex regional pain syndromes, and atypical facial pain. The stellate sympathetic ganglion innervates the head, neck, and upper extremity. In this review article, the effect of stellate ganglion block and its mechanism of action in orofacial pain disorders are discussed.

  10. Local and regional minimum 1D models for earthquake location and data quality assessment in complex tectonic regions: application to Switzerland

    International Nuclear Information System (INIS)

    Husen, S.; Clinton, J. F.; Kissling, E.

    2011-01-01

    One-dimensional (1D) velocity models are still widely used for computing earthquake locations at seismological centers or in regions where three-dimensional (3D) velocity models are not available due to the lack of data of sufficiently high quality. The concept of the minimum 1D model with appropriate station corrections provides a framework to compute initial hypocenter locations and seismic velocities for local earthquake tomography. Since a minimum 1D model represents a solution to the coupled hypocenter-velocity problem it also represents a suitable velocity model for earthquake location and data quality assessment, such as evaluating the consistency in assigning pre-defined weighting classes and average picking error. Nevertheless, the use of a simple 1D velocity structure in combination with station delays raises the question of how appropriate the minimum 1D model concept is when applied to complex tectonic regions with significant three-dimensional (3D) variations in seismic velocities. In this study we compute one regional minimum 1D model and three local minimum 1D models for selected subregions of the Swiss Alpine region, which exhibits a strongly varying Moho topography. We compare the regional and local minimum 1D models in terms of earthquake locations and data quality assessment to measure their performance. Our results show that the local minimum 1D models provide more realistic hypocenter locations and better data fits than a single model for the Alpine region. We attribute this to the fact that in a local minimum 1D model local and regional effects of the velocity structure can be better separated. Consequently, in tectonically complex regions, minimum 1D models should be computed in sub-regions defined by similar structure, if they are used for earthquake location and data quality assessment. (authors)

  11. Local and regional minimum 1D models for earthquake location and data quality assessment in complex tectonic regions: application to Switzerland

    Energy Technology Data Exchange (ETDEWEB)

    Husen, S.; Clinton, J. F. [Swiss Seismological Service, ETH Zuerich, Zuerich (Switzerland); Kissling, E. [Institute of Geophysics, ETH Zuerich, Zuerich (Switzerland)

    2011-10-15

    One-dimensional (1D) velocity models are still widely used for computing earthquake locations at seismological centers or in regions where three-dimensional (3D) velocity models are not available due to the lack of data of sufficiently high quality. The concept of the minimum 1D model with appropriate station corrections provides a framework to compute initial hypocenter locations and seismic velocities for local earthquake tomography. Since a minimum 1D model represents a solution to the coupled hypocenter-velocity problem it also represents a suitable velocity model for earthquake location and data quality assessment, such as evaluating the consistency in assigning pre-defined weighting classes and average picking error. Nevertheless, the use of a simple 1D velocity structure in combination with station delays raises the question of how appropriate the minimum 1D model concept is when applied to complex tectonic regions with significant three-dimensional (3D) variations in seismic velocities. In this study we compute one regional minimum 1D model and three local minimum 1D models for selected subregions of the Swiss Alpine region, which exhibits a strongly varying Moho topography. We compare the regional and local minimum 1D models in terms of earthquake locations and data quality assessment to measure their performance. Our results show that the local minimum 1D models provide more realistic hypocenter locations and better data fits than a single model for the Alpine region. We attribute this to the fact that in a local minimum 1D model local and regional effects of the velocity structure can be better separated. Consequently, in tectonically complex regions, minimum 1D models should be computed in sub-regions defined by similar structure, if they are used for earthquake location and data quality assessment. (authors)

  12. Spinal cord stimulation: Current applications for treatment of chronic pain.

    Science.gov (United States)

    Vannemreddy, Prasad; Slavin, Konstantin V

    2011-01-01

    Spinal cord stimulation (SCS) is thought to relieve chronic intractable pain by stimulating nerve fibers in the spinal cord. The resulting impulses in the fibers may inhibit the conduction of pain signals to the brain, according to the pain gate theory proposed by Melzack and Wall in 1965 and the sensation of pain is thus blocked. Although SCS may reduce pain, it will not eliminate it. After a period of concern about safety and efficacy, SCS is now regaining popularity among pain specialists for the treatment of chronic pain. The sympatholytic effect of SCS is one of its most interesting therapeutic properties. This effect is considered responsible for the effectiveness of SCS in peripheral ischemia, and at least some cases of complex regional pain syndrome. The sympatholytic effect has also been considered part of the management of other chronic pain states such as failed back surgery syndrome, phantom pain, diabetic neuropathy, and postherpetic neuralgia. In general, SCS is part of an overall treatment strategy and is used only after the more conservative treatments have failed. The concept of SCS has evolved rapidly following the technological advances that have produced leads with multiple contact electrodes and battery systems. The current prevalence of patients with chronic pain requiring treatment other than conventional medical management has significantly increased and so has been the need for SCS. With the cost benefit analysis showing significant support for SCS, it may be appropriate to offer this as an effective alternative treatment for these patients.

  13. Are more complex physiological models of forest ecosystems better choices for plot and regional predictions?

    Science.gov (United States)

    Wenchi Jin; Hong S. He; Frank R. Thompson

    2016-01-01

    Process-based forest ecosystem models vary from simple physiological, complex physiological, to hybrid empirical-physiological models. Previous studies indicate that complex models provide the best prediction at plot scale with a temporal extent of less than 10 years, however, it is largely untested as to whether complex models outperform the other two types of models...

  14. An approach for a complex assessment of the geo-ecological risk from natural disasters in a geographic region

    International Nuclear Information System (INIS)

    Zlateva, Plamena; Stoyanov, Krasimir

    2009-01-01

    The paper proposes an approach for a complex assessment of the geo-ecological risk of a certain geographic region on the basis of quantitative and qualitative datum about the potential natural disasters. A fuzzy logic model is designed. The type of the threats, consequences and interdependencies between infrastructure objects are taken into account. The geographic region is considered as a complex system of interconnected and mutually influencing elements. The expected damages are directly and/or indirectly connected with life quality deterioration. Keywords: Risk, Geo-ecological risk, Damages, Threats, Vulnerabilities, Natural disasters

  15. Application of digital tomosynthesis in diagnosing the fractures or dislocations in irregular bones and regions with complex structures.

    Science.gov (United States)

    Tuerdi, Batuer; Wang, Hui; Zhang, Ying; Zhou, Hao; Zhang, Hao

    2015-01-01

    The application potential of digital tomosynthesis in diagnosing fractures or dislocations in irregular bones and regions with complex structures was evaluated. Digital radiography and tomosynthesis were performed in 121 patients, and the image quality, accuracy, sensitivity, and specificity were compared. The number of participants with a definite diagnosis of fracture and/or dislocation was 98. The ratio of excellent images, accuracy, sensitivity, and specificity of digital tomosynthesis were higher than that of direct radiography. Digital tomosynthesis could be applied in the diagnosis of fractures or dislocations in irregular bones and regions with complex structures. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. [Patient first - The impact of characteristics of target populations on decisions about therapy effectiveness of complex interventions: Psychological variables to assess effectiveness in interdisciplinary multimodal pain therapy].

    Science.gov (United States)

    Kaiser, Ulrike; Sabatowski, Rainer; Balck, Friedrich

    2017-08-01

    The assessment of treatment effectiveness in public health settings is ensured by indicators that reflect the changes caused by specific interventions. These indicators are also applied in benchmarking systems. The selection of constructs should be guided by their relevance for affected patients (patient reported outcomes). The interdisciplinary multimodal pain therapy (IMPT) is a complex intervention based on a biopsychosocial understanding of chronic pain. For quality assurance purposes, psychological parameters (depression, general anxiety, health-related quality of life) are included in standardized therapy assessment in pain medicine (KEDOQ), which can also be used for comparative analyses in a benchmarking system. The aim of the present study was to investigate the relevance of depressive symptoms, general anxiety and mental quality of life in patients undergoing IMPT under real life conditions. In this retrospective, one-armed and exploratory observational study we used secondary data of a routine documentation of IMST in routine care, applying several variables of the German Pain Questionnaire and the facility's comprehensive basic documentation. 352 participants with IMPT (from 2006 to 2010) were included, and the follow-up was performed over two years with six assessments. Because of statistically heterogeneous characteristics a complex analysis consisting of factor and cluster analyses was applied to build subgroups. These subgroups were explored to identify differences in depressive symptoms (HADS-D), general anxiety (HADS-A), and mental quality of life (SF 36 PSK) at the time of therapy admission and their development estimated by means of effect sizes. Analyses were performed using SPSS 21.0®. Six subgroups were derived and mainly proved to be clinically and psychologically normal, with the exception of one subgroup that consistently showed psychological impairment for all three parameters. The follow-up of the total study population revealed medium

  17. A New Sacroiliac Joint Injection Technique and Its Short-Term Effect on Chronic Sacroiliac Region Pain.

    Science.gov (United States)

    Do, Kyung Hee; Ahn, Sang Ho; Jones, Rodney; Jang, Sung Ho; Son, Su Min; Lee, Dong Gyu; Cho, Hee Kyung; Choi, Gyu Sik; Cho, Yun-Woo

    2016-10-01

    Sacroiliac joint (SIJ) injections have been used to provide short-term relief of SIJ pain. In this study, the authors investigated a new technique using a superior approach. Twenty four patients with chronic SI joint paint were recruited. Each patient was treated with a single SIJ intra-articular injection plus a periarticular injection of local anesthetic and corticosteroid in one procedure. Technical accuracy of the intra-articular procedure was determined by having 2 independent observers review and rate the quality of arthrograms obtained. Treatment effects were evaluated using a numerical rating scale, the Oswestry disability index (ODI) and global perceived effect (GPE). Both independent observers agreed that satisfactory arthrograms were obtained in all patients. Pain scores and disability were significantly reduced at 2 weeks and 4 weeks after treatment. Nineteen patients (79%) reported satisfaction with treatment. No serious adverse effects were encountered. The superior approach consistently achieves good access to the SI joint, and achieves outcomes that are compatible with those of other techniques. The superior approach constitutes an alternative to other techniques for injections into the SI joint. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Research on the development efficiency of regional high-end talent in China: A complex network approach.

    Science.gov (United States)

    Zhang, Zhen; Wang, Minggang; Tian, Lixin; Zhang, Wenbin

    2017-01-01

    In this paper, based on the panel data of 31 provinces and cities in China from 1991 to 2016, the regional development efficiency matrix of high-end talent is obtained by DEA method, and the matrix is converted into a continuous change of complex networks through the construction of sliding window. Using a series of continuous changes in the complex network topology statistics, the characteristics of regional high-end talent development efficiency system are analyzed. And the results show that the average development efficiency of high-end talent in the western region is at a low level. After 2005, the national regional high-end talent development efficiency network has both short-range relevance and long-range relevance in the evolution process. The central region plays an important intermediary role in the national regional high-end talent development system. And the western region has high clustering characteristics. With the implementation of the high-end talent policies with regional characteristics by different provinces and cities, the relevance of high-end talent development efficiency in various provinces and cities presents a weakening trend, and the geographical characteristics of high-end talent are more and more obvious.

  19. Investigating Reports of Complex Regional Pain Syndrome: An Analysis of HPV-16/18-Adjuvanted Vaccine Post-Licensure Data

    Directory of Open Access Journals (Sweden)

    Frank Huygen

    2015-09-01

    There is not sufficient evidence to suggest an increased risk of developing CRPS following vaccination with HPV-16/18-adjuvanted vaccine. Post-licensure safety surveillance confirms the acceptable benefit-risk of HPV-16/18 vaccination.

  20. Chronic Pain

    Science.gov (United States)

    ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. × ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. ...

  1. How Discourses on Leisure Affect Regional Development in the Province of Fryslân : a Complex Adaptive Systems Perspective

    NARCIS (Netherlands)

    Meekes, Jasper; Parra Novoa, Constanza; de Roo, Gert

    2014-01-01

    Leisure is seen as an important factor for regional development in the province of Fryslân and many other predominantly rural and peripheral areas. However, planning for leisure, requiring high spatial quality, is a complex challenge. This is due to the fragmentation of leisure policy, but also to

  2. U-Pb age in zircon of intrusive granite at Acopiara complex, Crystal region, domain Central Ceara, Br