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Sample records for leg pain magnetic

  1. Leg pain

    Science.gov (United States)

    ... to a muscle cramp (also called a charley horse ). Common causes of cramps include: Dehydration or low ... muscle ( strain ) Hairline crack in the bone (stress fracture) Inflamed tendon ( tendinitis ) Shin splints (pain in the ...

  2. Back Pain with Leg Pain.

    Science.gov (United States)

    Vulfsons, Simon; Bar, Negev; Eisenberg, Elon

    2017-07-01

    The clinical diagnostic dilemma of low back pain that is associated with lower limb pain is very common. In relation to back pain that radiates to the leg, the International Association for the Study of Pain (IASP) states: "Pain in the lower limb should be described specifically as either referred pain or radicular pain. In cases of doubt no implication should be made and the pain should be described as pain in the lower limb." Bogduks' editorial in the journal PAIN (2009) helps us to differentiate and define the terms somatic referred pain, radicular pain, and radiculopathy. In addition, there are other pathologies distal to the nerve root that could be relevant to patients with back pain and leg pain such as plexus and peripheral nerve involvement. Hence, the diagnosis of back pain with leg pain can still be challenging. In this article, we present a patient with back and leg pain. The patient appears to have a radicular pain syndrome, but has no neurological impairment and shows signs of myofascial involvement. Is there a single diagnosis or indeed two overlapping syndromes? The scope of our article encompasses the common diagnostic possibilities for this type of patient. A discussion of treatment is beyond the scope of this article and depends on the final diagnosis/diagnoses made.

  3. The effectiveness of computed tomography scans versus magnetic resonance imaging for decision making in patients with low back pain and radicular leg pain

    OpenAIRE

    Saeid Abrishamkar; Bahram Aminmansour; Hamidreza Arti

    2006-01-01

    BACKGROUND: Low back pain (LBP) and radicular leg pain (RLP) are among the most common types of pain in human beings. Although magnetic resonance imaging (MRI) is very sensitive for diagnosis of discopathy, some factors, such as overestimation of pathology, expensiveness, unavailability, and using it for patients with cardiac pacemaker or metal foreign bodies, limit the utility. The present study is designed to evaluate the efficacy of computed tomography scan (CTS) in patients with disc hern...

  4. Leg pain and gynecologic malignancy.

    Science.gov (United States)

    Singh, Lilly; Stevens, Erin E

    2013-09-01

    Gynecologic malignancies affect more than 83 000 women in the United States, each year. Because the disease involves the pelvis, many patients have side effects distal to this area in their lower extremities. The differential diagnosis of leg pain can be divided into vascular, neurologic, and musculoskeletal causes. In this review article, we address numerous etiologies of leg pain, reviewing the prevalence of disease, physical examination findings, diagnostic as well as treatment modalities.

  5. The effectiveness of computed tomography scans versus magnetic resonance imaging for decision making in patients with low back pain and radicular leg pain

    Directory of Open Access Journals (Sweden)

    Saeid Abrishamkar

    2006-12-01

    Full Text Available BACKGROUND: Low back pain (LBP and radicular leg pain (RLP are among the most common types of pain in human beings. Although magnetic resonance imaging (MRI is very sensitive for diagnosis of discopathy, some factors, such as overestimation of pathology, expensiveness, unavailability, and using it for patients with cardiac pacemaker or metal foreign bodies, limit the utility. The present study is designed to evaluate the efficacy of computed tomography scan (CTS in patients with disc herniation in each level of lumbar spine versus MRI findings at the same level. METHODS: In a prospective trial, 100 consecutive patients with LBP and RLP and signs and symptoms of discopathy referred to our private clinic from September 2004 to April 2005 were studied. CTS and MRI and their data were compared level by level; i.e. CTS of the patients analyzed according to clinical signs and symptoms and compared with MRI at the same level in axial view. RESULTS: Thirty-two patients had clinically S1 root signs and symptoms, in all of them CTS and MRI showed disc herniation at L5/S1 level in axial view. For L5/S1 level, positive predictive value (PPV of CTS was 100%. In upper lumbar region, CTS findings were less reliable than MRI. CTS showed the pathology at 14.2% of upper lumbar, 27.2% at L3/L4 and 46.3% at L4/L5. In nine cases with more than one level involved, CTS confirmed the diagnosis in 11.1% of the cases. CONCLUSIONS: MRI is the gold standard for diagnosis of lumbar disc herniation, but CTS is sensitive in 100% for L5/S1, 68% for L4/L5, 60% for L3/L4, 0% for upper lumbar discopathies and finally 78% for multilevel involvement. Therefore, the higher the level of disc herniation is, the lower the sensitivity of CTS. KEY WORDS: Computed tomography scan, magnetic resonance imaging, low back pain, radicular leg pain.

  6. Leg pain (Osgood-Schlatter) (image)

    Science.gov (United States)

    Leg pain in older children or young adolescents can occur for many reasons. An Osgood-Schlatter lesion results from continued trauma to the anterior tibial bone and causes a visible lump below the knee.

  7. [Restless legs syndrome and nocturnal leg pain : Differential diagnosis and treatment].

    Science.gov (United States)

    Hornyak, M; Stiasny-Kolster, K; Evers, S; Happe, S

    2011-09-01

    Pain in the legs belongs to the five most frequent regional pain symptoms. Restless legs syndrome (RLS) presents a particular differential diagnosis for pain in the legs, which is characterized by a nocturnal urge to move the legs often associated with painful sensations in the legs. It is one of the most common neurological disorders and probably the leading cause of nocturnal pain in the legs. In this overview, the diagnosis and therapy of RLS as well as aspects of pain therapy of the disorder are presented. In addition, the differential diagnoses for exclusion of other specific causes of nocturnal pain in the legs are discussed.

  8. [Pseudo-radicular referred leg pain].

    Science.gov (United States)

    von Heymann, W

    2015-12-01

    Pseudo-radicular leg pain as initially described by Bruegger more than 55 years ago was at that time a genius explanation for so many non-radicular pain syndromes that needed not any kind of surgical intervention but in first line a manual treatment or a treatment by therapeutic local anesthetics. Today we describe this pain as a "referred pain" originating from other anatomic structures that may occur during the development of chronic pain. Nevertheless this pain is found in many patients and it still seems to be a big problem for many physicians and surgeons. Imaging does not help either. The history and the clinical symptoms, the examinations, the chain reactions in the motor system as well as the treatment options from the point of view of manual medicine are described.

  9. Painful legs and moving toes syndrome

    Directory of Open Access Journals (Sweden)

    Qiu-ying Ma

    2015-10-01

    Full Text Available Painful legs and moving toes syndrome (PLMT is a rare movement disorder with low diagnostic rate, which is characterized by lower limb pain with involuntary movements of feet or toes. Etiology and pathogenesis of this disease is still unclear. Patients have different clinical manifestations, so the diagnosis is difficult. Treatment methods for PLMT are numerous, but so far the treatment of this disease is still a major challenge for clinicians. Further research is still needed to guide clinical work. DOI: 10.3969/j.issn.1672-6731.2015.10.013

  10. Magnets for Pain Relief

    Science.gov (United States)

    ... R S T U V W X Y Z Magnets for Pain Share: © Matthew Lester Magnets are often marketed for different types of pain, ... arthritis and fibromyalgia. Made from metal or alloys, magnets vary considerably in their strength. Magnets marketed for ...

  11. Exercise Related Leg Pain (ERLP): a Review of The Literature

    OpenAIRE

    Reinking, Mark F.

    2007-01-01

    Exercise related leg pain (ERLP) is a regional pain syndrome described as pain between the knee and ankle which occurs with exercise. Indiscriminant use of terminology such as “shin splints” has resulted in ongoing confusion regarding the pathoanatomic entities associated with this pain syndrome. Each of the pathoanatomic entities – medial tibial stress syndrome, chronic exertional compartment syndrome, tibial and fibular stress fractures, tendinopathy, nerve entrapment, and vascular patholog...

  12. Exercise Related Leg Pain (ERLP): a Review of The Literature.

    Science.gov (United States)

    Reinking, Mark F

    2007-08-01

    Exercise related leg pain (ERLP) is a regional pain syndrome described as pain between the knee and ankle which occurs with exercise. Indiscriminant use of terminology such as "shin splints" has resulted in ongoing confusion regarding the pathoanatomic entities associated with this pain syndrome. Each of the pathoanatomic entities - medial tibial stress syndrome, chronic exertional compartment syndrome, tibial and fibular stress fractures, tendinopathy, nerve entrapment, and vascular pathology - which manifest as ERLP are each described in terms of relevant anatomy, epidemiology, clinical presentation, associated pathomechanics, and intervention strategies. Evidence regarding risk factors for ERLP general and specific pathoanatomic entities are presented in the context of models of sports injury prevention.

  13. [A woman with painful ulcera on her lower leg].

    Science.gov (United States)

    Schreuder, Ramon-Michel; Horváth, Barbara; van Dullemen, Hendrik M

    2015-01-01

    A 49-year-old woman presented with painful ulcera on her right lower leg. She was known with Crohn's disease. Wound cultures were negative. Based on clinical findings she was diagnosed with pyoderma gangrenosum. After treatment with topical glucocorticoids and intravenous infliximab and ciclosporin, the ulcera gradually disappeared.

  14. Effects of gabapentin enacarbil on restless legs syndrome and leg pain in dementia with Lewy bodies.

    Science.gov (United States)

    Fujishiro, Hiroshige

    2014-06-01

    Restless legs syndrome (RLS) is a common neurological disorder. Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia after Alzheimer's disease. Both RLS and DLB can be effectively treated by dopaminergic medications, suggesting the role of dopamine dysfunction in the pathogenesis of both diseases. Here, I report on a Japanese woman with probable DLB and RLS who was treated with gabapentin enacarbil, a non-dopaminergic agent. Because a dopamine agonist, a first-line therapy for moderate to severe RLS, caused the occurrence of metamorphopsia, an alternative treatment of gabapentin enacarbil was used; this treatment improved the patient's RLS without worsening her psychiatric symptoms. An alternative treatment is desirable for DLB patients with RLS because they often experience intolerable side-effects with a dopamine agonist, especially visual hallucinations. Administering gabapentin enacarbil also improved the continuous leg pain that occurred in conjunction with the development of RLS. Although the neurobiological mechanism in the development of pain remains unclear, a range of non-dopaminergic structures likely mediated pain processing in DLB in the present case based on neuropharmacological results. This is the first report reporting the effects of gabapentin enacarbil for RLS and leg pain in a DLB patient with psychiatric symptoms. © 2014 The Author. Psychogeriatrics © 2014 Japanese Psychogeriatric Society.

  15. Simvastatin-induced nocturnal leg pain disappears with pravastatin substitution

    Directory of Open Access Journals (Sweden)

    Stojaković Nataša

    2013-01-01

    Full Text Available Introduction. Statins have similar side effects that do not always occur at the same rate among the various statins. We present a case of simvastatin-induced muscle toxicity that disappeared when pravastatin was substituted for the original drug. Case Outline. A 74-year-old male, a nonsmoker, complained of severe nocturnal leg cramps. The patient also complained that similar painful cramping occurred when he walked rapidly or jogged. Because some components of his lipid panel exceeded the ‘desirable’ range, and as he had a history of myocardial infarction, his family physician prescribed simvastatin (40 mg/day. The patient had taken this medication for the past eight years. The painful nocturnal episodes started two years ago and affected either one or the other leg. Four months ago we discontinued his simvastatin and prescribed pravastatin (80 mg/day. At a follow-up visit six weeks later, the patient reported that his leg pains at night and the pain experienced after brisk walking had disappeared. Four months after the substitution of pravastatin for simvastatin, the patient reported that his complete lack of symptoms had continued. Conclusion. These painful muscle cramps were probably caused by an inadequate vascular supply to the calf and foot muscles. Perhaps a combination of advanced age and atherosclerotic changes created a predisposition for the simvastatin-induced leg cramps. Pravastatin differs from simvastatin in several ways. It is not metabolized by cytochrome P450 (CYP 3A4 oxidases, and thus is not influenced by CYP 3A4 inhibitors like simvastatin. Also, simvastatin is associated with single-nucleotide polymorphisms located within the SLCO1B1 gene on the chromosome 12 and established myopathy, while pravastatin lacks this association. These differences may contribute to increased tolerance to pravastatin in this particular case.

  16. Exercise-induced leg pain: sifting through a broad differential.

    Science.gov (United States)

    Korkola, M; Amendola, A

    2001-06-01

    The causes of exertional leg pain are not always easily determined but are often linked to repetitive stress. Medial tibial stress syndrome or periostitis, tibial stress fractures, deep posterior compartment syndrome, exertional compartment syndrome, fascial hernias, peripheral neuropathy, and blood vessel entrapments have characteristic signs and symptoms. A complete history and exam coupled with wise use of adjunctive investigations will lead to the correct diagnosis and treatment.

  17. Chronic low back pain patients with accompanying leg pain : The relationship between pain extent and pain intensity, disability and health status

    NARCIS (Netherlands)

    Prins, Maarten R.; van der Wurff, Peter; Groen, Gerbrand J.

    2013-01-01

    Accompanying leg pain is commonly observed in patients with chronic low back pain (CLBP) and is assumed to be an indicator for the disorder severity. However, it is still unknown whether it is possible to estimate a patient's functional status by the extent of leg pain present. In a post

  18. Association of restless legs syndrome, pain, and mood disorders in Parkinson's disease.

    Science.gov (United States)

    Rana, Abdul Qayyum; Qureshi, Abdul Rehman M; Rahman, Labiba; Jesudasan, Ajantha; Hafez, Kevin K; Rana, Mohammad A

    2016-01-01

    The objectives of the study were to analyze the association between Parkinson's disease and restless legs syndrome, and to explore the relationship between mood disorder comorbidity (anxiety and depression), pain, and restless legs syndrome. This study included 123 Parkinson's disease patients and 123 non-Parkinson's disease patients matched for age and gender, and evaluated for anxiety severity, depression severity, pain severity, pain interference, pain disability, and restless legs syndrome prevalence. This was performed using semi-structured interviews and a neurological examination through the restless legs syndrome diagnostic criteria and the following inventories; Hospital Anxiety and Depression Scale, Brief Pain Inventory, and Pain Disability Index. Parkinson's disease patients had significantly greater anxiety severity, depression severity, pain severity, pain interference, pain disability, and restless legs syndrome prevalence in comparison to controls. In addition, Parkinson's disease patients' comorbid for anxiety and depression had significantly greater pain severity, pain interference, and pain disability, but not RLS prevalence, in comparison to Parkinson's disease only, Parkinson's disease anxiety, and Parkinson's disease depression patients. Pain interference, pain severity, and pain disability is greater among Parkinson's disease patients with anxiety and depression, in comparison to Parkinson's disease patients without anxiety and depression. On the contrary, the prevalence of restless legs syndrome was not found to be relevant.

  19. Patients with low back pain differ from those who also have leg pain or signs of nerve root involvement

    DEFF Research Database (Denmark)

    Kongsted, Alice; Kent, Peter; Albert, Hanne

    2012-01-01

    ABSTRACT: BACKGROUND: Leg pain associated with low back pain (LBP) is recognized as a risk factor for a poor prognosis, and is included as a component in most LBP classification systems. The location of leg pain relative to the knee and the presence of a positive straight leg raise test have been...... only, 2) LBP and pain above the knee, 3) LBP and pain below the knee, and 4) LBP and signs of nerve root involvement. METHODS: Analysis of routine clinical data from an outpatient department. Based on patient reported data and clinical findings, patients were allocated to the QTF subgroups...

  20. ON THE MAGNETISM AND DYNAMICS OF PROMINENCE LEGS HOSTING TORNADOES

    Energy Technology Data Exchange (ETDEWEB)

    Martínez González, M. J.; Ramos, A. Asensio; Arregui, I.; Collados, M. [Instituto de Astrofísica de Canarias, Vía Láctea s/n, E-38205 La Laguna, Tenerife (Spain); Beck, C. [National Solar Observatory, Sacramento Peak P.O. Box 62, Sunspot, NM 88349 (United States); Rodríguez, J. de la Cruz [Institute for Solar Physics, Department of Astronomy, Stockholm University, Albanova University Center, SE-10691 Stockholm (Sweden)

    2016-07-10

    Solar tornadoes are dark vertical filamentary structures observed in the extreme ultraviolet associated with prominence legs and filament barbs. Their true nature and relationship to prominences requires an understanding of their magnetic structure and dynamic properties. Recently, a controversy has arisen: is the magnetic field organized forming vertical, helical structures or is it dominantly horizontal? And concerning their dynamics, are tornadoes really rotating or is it just a visual illusion? Here we analyze four consecutive spectro-polarimetric scans of a prominence hosting tornadoes on its legs, which helps us shed some light on their magnetic and dynamical properties. We show that the magnetic field is very smooth in all the prominence, which is probably an intrinsic property of the coronal field. The prominence legs have vertical helical fields that show slow temporal variation that is probably related to the motion of the fibrils. Concerning the dynamics, we argue that (1) if rotation exists, it is intermittent, lasting no more than one hour, and (2) the observed velocity pattern is also consistent with an oscillatory velocity pattern (waves).

  1. On the Magnetism and Dynamics of Prominence Legs Hosting Tornadoes

    Science.gov (United States)

    Martínez González, M. J.; Asensio Ramos, A.; Arregui, I.; Collados, M.; Beck, C.; de la Cruz Rodríguez, J.

    2016-07-01

    Solar tornadoes are dark vertical filamentary structures observed in the extreme ultraviolet associated with prominence legs and filament barbs. Their true nature and relationship to prominences requires an understanding of their magnetic structure and dynamic properties. Recently, a controversy has arisen: is the magnetic field organized forming vertical, helical structures or is it dominantly horizontal? And concerning their dynamics, are tornadoes really rotating or is it just a visual illusion? Here we analyze four consecutive spectro-polarimetric scans of a prominence hosting tornadoes on its legs, which helps us shed some light on their magnetic and dynamical properties. We show that the magnetic field is very smooth in all the prominence, which is probably an intrinsic property of the coronal field. The prominence legs have vertical helical fields that show slow temporal variation that is probably related to the motion of the fibrils. Concerning the dynamics, we argue that (1) if rotation exists, it is intermittent, lasting no more than one hour, and (2) the observed velocity pattern is also consistent with an oscillatory velocity pattern (waves).

  2. ON THE MAGNETISM AND DYNAMICS OF PROMINENCE LEGS HOSTING TORNADOES

    International Nuclear Information System (INIS)

    Martínez González, M. J.; Ramos, A. Asensio; Arregui, I.; Collados, M.; Beck, C.; Rodríguez, J. de la Cruz

    2016-01-01

    Solar tornadoes are dark vertical filamentary structures observed in the extreme ultraviolet associated with prominence legs and filament barbs. Their true nature and relationship to prominences requires an understanding of their magnetic structure and dynamic properties. Recently, a controversy has arisen: is the magnetic field organized forming vertical, helical structures or is it dominantly horizontal? And concerning their dynamics, are tornadoes really rotating or is it just a visual illusion? Here we analyze four consecutive spectro-polarimetric scans of a prominence hosting tornadoes on its legs, which helps us shed some light on their magnetic and dynamical properties. We show that the magnetic field is very smooth in all the prominence, which is probably an intrinsic property of the coronal field. The prominence legs have vertical helical fields that show slow temporal variation that is probably related to the motion of the fibrils. Concerning the dynamics, we argue that (1) if rotation exists, it is intermittent, lasting no more than one hour, and (2) the observed velocity pattern is also consistent with an oscillatory velocity pattern (waves).

  3. STRUCTURE OF PROMINENCE LEGS: PLASMA AND MAGNETIC FIELD

    Energy Technology Data Exchange (ETDEWEB)

    Levens, P. J.; Labrosse, N. [SUPA School of Physics and Astronomy, University of Glasgow, Glasgow, G12 8QQ (United Kingdom); Schmieder, B. [Observatoire de Paris, Meudon, F-92195 (France); Ariste, A. López, E-mail: p.levens.1@research.gla.ac.uk [Institut de Recherche en Astrophysique et Planétologie, Toulouse (France)

    2016-02-10

    We investigate the properties of a “solar tornado” observed on 2014 July 15, and aim to link the behavior of the plasma to the internal magnetic field structure of the associated prominence. We made multi-wavelength observations with high spatial resolution and high cadence using SDO/AIA, the Interface Region Imaging Spectrograph (IRIS) spectrograph, and the Hinode/Solar Optical Telescope (SOT) instrument. Along with spectropolarimetry provided by the Télescope Héliographique pour l’Etude du Magnétisme et des Instabilités Solaires telescope we have coverage of both optically thick emission lines and magnetic field information. AIA reveals that the two legs of the prominence are strongly absorbing structures which look like they are rotating, or oscillating in the plane of the sky. The two prominence legs, which are both very bright in Ca ii (SOT), are not visible in the IRIS Mg ii slit-jaw images. This is explained by the large optical thickness of the structures in Mg ii, which leads to reversed profiles, and hence to lower integrated intensities at these locations than in the surroundings. Using lines formed at temperatures lower than 1 MK, we measure relatively low Doppler shifts on the order of ±10 km s{sup −1} in the tornado-like structure. Between the two legs we see loops in Mg ii, with material flowing from one leg to the other, as well as counterstreaming. It is difficult to interpret our data as showing two rotating, vertical structures that are unrelated to the loops. This kind of “tornado” scenario does not fit with our observations. The magnetic field in the two legs of the prominence is found to be preferentially horizontal.

  4. Can Wound Exudate from Venous Leg Ulcers Measure Wound Pain Status?: A Pilot Study

    Science.gov (United States)

    Tamai, Nao; Nakagami, Gojiro; Kitamura, Aya; Naito, Ayumi; Hirokawa, Masayuki; Shimokawa, Chisako; Takahashi, Kazuo; Umemoto, Junichi; Sanada, Hiromi

    2016-01-01

    We investigated the associations between the self-evaluated pain status and two pain biomarker candidates, nerve growth factor and S100A8/A9, in exudate from venous leg ulcer to finally develop an objective pain evaluation method. Patients with venous leg ulcer participated in this cross-sectional observational study conducted between April and October 2014 at two medical facilities. During routine wound care, each participant self-evaluated their pain status at each examination using the 10-point numerical rating scale (present pain intensity) and the short-form McGill Pain Questionnaire 2 (continuous pain, intermittent pain, neuropathic pain, affective descriptors, and total score). Venous leg ulcer exudate sample was collected after wound cleansing. The nerve growth factor and S100A8/A9 concentrations in the venous leg ulcer exudate were measured by enzyme-linked immunosorbent assay and standardized according to the wound area. The association between each pain status and the two standardized protein concentrations was evaluated using Spearman’s correlation coefficient. In 30 sample collected from 13 participants, the standardized nerve growth factor concentration was negatively correlated with continuous pain (ρ = -0.47, P = 0.01), intermittent pain (ρ = -0.48, P = 0.01), neuropathic pain (ρ = -0.51, P = 0.01), and total score (ρ = -0.46, P = 0.01). The standardized S100A8/A9 concentration was positively correlated with present pain intensity (ρ = 0.46, P = 0.03) and continuous pain (ρ = 0.48, P = 0.03). Thus, these two proteins may be useful for objective evaluation of wound pain in venous leg ulcer patients. PMID:27936243

  5. Ulcer pain in patients with venous leg ulcers related to antibiotic treatment and compression therapy.

    Science.gov (United States)

    Akesson, Nina; Oien, Rut Frank; Forssell, Henrik; Fagerström, Cecilia

    2014-09-01

    The aim of this study was to compare venous leg ulcer patients with and without ulcer pain to see whether ulcer pain affected the use of antibiotic treatment and compression therapy throughout healing. A total of 431 patients with venous leg ulcers were included during the study period. Every patient was registered in a national quality registry for patients with hard-to-heal leg, foot, and pressure ulcers. A high incidence of ulcer pain (57%) was found when the patients entered the study. Patients with ulcer pain had been treated more extensively with antibiotics both before and during the study period. Throughout healing there was a significant reduction of antibiotic use among patients in the 'no pain' group, from 44% to 23% (P=0.008). There was no significant difference between the two groups concerning compression therapy (85% vs. 88%), but 12% of patients in the 'pain' group did not get their prescribed compression compared with 6% of patients in the 'no pain' group. The groups did not differ significantly in terms of ulcer duration, ulcer size or healing time. This study shows a high incidence of ulcer pain, confirming that pain has a great impact on patients with venous leg ulcers. Results further suggest that the presence of ulcer pain increases the prescription of antibiotics but does not affect the use of compression therapy. Several advantages were found from using a national quality registry. The registry is a valuable clinical tool showing the importance of accurate diagnosis and effective treatment.

  6. Are self-reported pain characteristics, classified using the PainDETECT questionnaire, predictive of outcome in people with low back pain and associated leg pain?

    DEFF Research Database (Denmark)

    Morsø, Lars; Kent, Peter M; Albert, Hanne B

    2011-01-01

    This study was designed to investigate whether the PainDETECT Questionnaire (PDQ) classification was predictive of outcomes at 3 and 12 months follow-up in low back pain (LBP) patients with associated leg pain. Identification of clinically important subgroups and targeted treatment is believed...... to be important in LBP care. The PD-Q is designed to classify whether a person has neuropathic pain, based on their self-reported pain characteristics. However, it is unknown whether this classification is a prognostic factor or predicts treatment response....

  7. The bothersomeness of sciatica: patients’ self-report of paresthesia, weakness and leg pain

    Science.gov (United States)

    Haugen, Anne Julsrud; Keller, Anne; Natvig, Bård; Brox, Jens Ivar; Grotle, Margreth

    2009-01-01

    The objective of the study was to investigate how patients with sciatica due to disc herniation rate the bothersomeness of paresthesia and weakness as compared to leg pain, and how these symptoms are associated with socio-demographic and clinical characteristics. A cross-sectional study was conducted on 411 patients with clinical signs of radiculopathy. Items from the Sciatica Bothersomeness Index (0 = none to 6 = extremely) were used to establish values for paresthesia, weakness and leg pain. Associations with socio-demographic and clinical variables were analyzed by multiple linear regression. Mean scores (SD) were 4.5 (1.5) for leg pain, 3.4 (1.8) for paresthesia and 2.6 (2.0) for weakness. Women reported higher levels of bothersomeness for all three symptoms with mean scores approximately 10% higher than men. In the multivariate models, more severe symptoms were associated with lower physical function and higher emotional distress. Muscular paresis explained 19% of the variability in self-reported weakness, sensory findings explained 10% of the variability in paresthesia, and straight leg raising test explained 9% of the variability in leg pain. In addition to leg pain, paresthesia and weakness should be assessed when measuring symptom severity in sciatica. PMID:19488793

  8. Pain location matters: the impact of leg pain on health care use, work disability and quality of life in patients with low back pain.

    Science.gov (United States)

    Hider, Samantha L; Whitehurst, David G T; Thomas, Elaine; Foster, Nadine E

    2015-03-01

    In low back pain (LBP) patients, those with radiating leg pain or sciatica have poorer pain and disability outcomes. Few studies have assessed the effect of leg pain on health care use and quality of life. Prospective cohort study of 1,581 UK LBP primary care consulters. Back pain, employment, health care utilisation, and quality of life (EQ-5D) data were collected at baseline, 6 and 12 months. At baseline, patients were classified as reporting (1) LBP only, (2) LBP and leg pain above the knee only (LBP + AK) or (3) LBP and leg pain extending below the knee (LBP + BK). Self-reported leg pain was common; at baseline 645 (41 %) reported LBP only, 392 (25 %) reported LBP + AK and 544 (34 %) reported LBP + BK. Patients with LBP + BK, compared to those with LBP only, were significantly more likely to be unemployed, take time off work, consult their family doctor, receive physical therapy, or be referred to other health care practitioners. There were statistically significant decrements in EQ-5D scores for LBP + AK compared to LBP only, and for LBP + BK compared to LBP + AK (p ≤ 0.05 for all comparisons). Patients with self-reported leg pain below the knee utilise more health care are more likely to be unemployed and have poorer quality of life than those with LBP only 12 months following primary care consultation. The presence of leg pain warrants early identification in primary care to explore if targeted interventions can reduce the impact and consequences of leg pain.

  9. Reduction of Leg Pain by Oxiplex Gel After Lumbar Discectomy in Patients With Predominant Leg Pain and Elevated Levels of Lower Back Pain: A Prospective, Randomized, Blinded, Multicenter Clinical Study.

    Science.gov (United States)

    Lei, Wei; Ehmsen, Ronald J; Chiacchierini, Richard P; Krelle, John L; diZerega, Gere S

    2015-10-01

    A prospective, randomized, blinded, multicenter clinical study. To evaluate carboxymethylcellulose/polyethylene oxide gel (Oxiplex) in improving clinical outcomes in subjects having predominant leg pain and elevated low back pain undergoing first-time lumbar discectomy for disk herniation. Clinical studies in the United States and Italy found that Oxiplex reduced leg pain after decompression surgery. A total of 68 subjects with herniated lumbar disk were enrolled and randomized into treatment (surgery plus gel) or surgery-only control groups. A prospective statistical analysis assessed the effect of gel in the severe back pain subgroup (prespecified as greater than or equal to median baseline back pain of the population studied). All subjects except 2 controls lost to follow-up completed the study. Preoperative and postoperative visual analogue scale leg pain scores were analyzed and compared between groups at 60 days after surgery. There were no serious adverse events or neurological safety concerns reported in any patients. Gel-treated patients had statistically significantly lower visual analogue scale leg pain scores at study end compared with controls (P=0.0240), representing a 21% additional reduction in leg pain compared with surgery alone in the severe baseline back pain subgroup (P=0.0240). The proportion of subgroup patients experiencing zero leg pain at study end was significantly higher in the gel treatment group (60%) than in the control group (23%) (P=0.0411). The data from this study confirm and extend results of 2 previous studies in Italy and the United States that reported statistically significantly greater reductions in leg pain in gel-treated patients with severe preoperative low back pain compared with patients who only underwent decompression surgery.

  10. UPFLOWS IN FUNNEL-LIKE LEGS OF CORONAL MAGNETIC LOOPS

    International Nuclear Information System (INIS)

    Tian Hui; Marsch, Eckart; Curdt, Werner; He, Jiansen

    2009-01-01

    The prominent blueshifts of Ne VIII associated with the junctions of the magnetic network in the quiet Sun are still not well understood. By comparing the coronal magnetic-field structures as obtained by a potential-field reconstruction with the conspicuous blueshift patches on the Dopplergram of Ne VIII as observed in an equatorial quiet-Sun region, we find that most of the regions with significant upflow are associated with the funnel-like legs of magnetic loops and cospatial with increments of the line width. These quasi-steady upflows can be regarded as the signatures of mass supply to coronal loops. By using the square root of the line intensity as a proxy for the plasma density, the mass flux of the upflow in each funnel can be estimated. We find that the mass flux is anti-correlated with the funnel's expansion factor as determined from the extrapolated magnetic field. One of the loop systems is associated with a coronal bright point, which was observed by several instruments and exhibited various morphologies in different wavelengths and viewing directions. A remarkable agreement between its magnetic structure and the associated EUV emission pattern was found, suggesting an almost potential-field nature of the coronal magnetic field. We also report the direct detection of a small-scale siphon flow by both STEREO satellites. However, this transient siphon flow occurred in a weak mixed-polarity-field region, which was outside the adjacent magnetic funnel, and thus it is perhaps not related to plasma upflow in the funnel. Based on these observations, we suggest that at upper transition region (TR) temperatures the dominant flows in quiet-Sun coronal loops are long-lasting upflows rather than siphon flows. We also discuss the implications of our results for coronal heating and unresolved magnetic structures.

  11. Motor control patterns during an active straight leg raise in pain-free subjects.

    Science.gov (United States)

    Beales, Darren John; O'Sullivan, Peter Bruce; Briffa, N Kathryn

    2009-01-01

    Repeated measures. To investigate motor control (MC) patterns of normal subjects during the low level physical load of the active straight leg raise (ASLR). Aberrant MC patterns, as observed with the ASLR test, are considered to be a mechanism for ongoing pain and disability in subjects with chronic musculoskeletal pelvic girdle pain. These patterns may not only affect the provision of lumbopelvic stability, but also respiration and the control of continence. Greater understanding of MC patterns in pain-free subjects may improve the management of pelvic girdle pain. METHODS.: Fourteen pain-free nulliparous women were examined during the ASLR. Electromyography of the anterior abdominal wall, right chest wall and the anterior scaleni, intraabdominal pressure (IAP), intrathoracic pressure (ITP), respiratory rate, pelvic floor kinematics, and downward leg pressure of the nonlifted leg were compared between a left and right ASLR. There was greater activation of obliquus internus abdominis and obliquus externus abdominis on the side of the ASLR. The predominant pattern of activation for the chest wall was tonic activation during an ipsilateral ASLR, and phasic respiratory activation lifting the contralateral leg. Respiratory fluctuation of both IAP and ITP did not differ lifting either leg. The baseline shifts of these pressure variables in response to the physical demand of lifting the leg was also the same either side. There was no difference in respiratory rate, pelvic floor kinematics, or downward leg pressure. Pain-free subjects demonstrate a predominant pattern of greater ipsilateral tonic activation of the abdominal wall and chest wall on the side of the ASLR. This was achieved with minimal apparent disruption to IAP and ITP. The findings of this study demonstrate the plastic nature of the abdominal cylinder and the flexibility of the neuromuscular system in controlling load transference during an ASLR.

  12. Insomnia and limb pain in hemodialysis patients: What is the share of restless leg syndrome?

    OpenAIRE

    Majid Malaki; Fakhr Sadat Mortazavi; Sussan Moazemi; Maryam Shoaran

    2012-01-01

    Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS) as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, ...

  13. Leg ulcers in older people: a national study addressing variation in diagnosis, pain and sleep disturbance.

    Science.gov (United States)

    Hellström, Amanda; Nilsson, Camilla; Nilsson, Annina; Fagerström, Cecilia

    2016-01-21

    Leg ulcers commonly emerge as a symptom of other comorbidities, often in older people. As a consequence of the ulcer, pain and sleep disturbances might occur. Due to the complex illness, the responsibility of treatment is unclear between health caregivers. The interaction between ulcer type, sleep and pain has not previously been investigated. This study aimed to explore pain in older men and women (65 years and older) with different diagnoses of leg ulcers and to investigate the associations of sleep disturbances and pain in people with leg ulcer diagnosis. The study used a cross-sectional design and data from the Swedish Registry of Ulcer Treatment, collected between May 2009 and December 2013. One thousand and eight hundred and twenty four people were included, and 62.9% were women. The mean age was 83.4 years (SD 8.8). For the analyses, the chi-square test, Mann-Whitney U-test, t-test, one-way ANOVA and logistic regression was performed. Pain was measured by the Numeric Rating Scale (NRS), and sleep disturbances was assessed dichotomously. We found the prevalence of pain intensity ≥ 5 on the NRS to be 34.8% in those reporting pain. Additionally, the pain intensity was associated with the number of ulcers (p = 0.003). Sleep disturbances were associated with pain (p pain and scored higher on the NRS, no significant gender difference in sleep disturbances was found (p = 0.606). The mean NRS scores did not differ significantly between the ulcer types; however, arterial and venous-arterial ulcers increased the risk of sleep disturbances, as did higher pain scores. The majority of the participants were of advanced age (>80 years) and frequently suffered from pain and sleep disturbances. Further research is needed regarding pain, sleep and wound healing in the oldest old with leg ulcers. Ulcer pain sometimes appears to receive less attention in ulcer management, as do sleep disturbances, implying that individual needs might not be satisfactorily met

  14. Chiropractic management of patients with bilateral congenital hip dislocation with chronic low back and leg pain.

    Science.gov (United States)

    Diez, Francisco

    2004-05-01

    To discuss conservative methods for treating patients with chronic low back and leg pain associated with the biomechanical and postural alterations related to bilateral congenital hip dislocation. This report describes the cases of 2 adult female subjects with bilateral congenital hip dislocation without acetabula formation who suffered from chronic low back and leg pain managed conservatively by chiropractic methods. The first subject is a 45-year-old woman with a 9-month history of right buttock pain and radiating right leg pain and paresthesia down to the first 2 toes, with a diagnosis of a herniated L4 intervertebral disk. The second subject is a 53-year-old woman who complained of chronic intermittent low back pain and constant unremitting pain on her right leg for the last 3 years. Chiropractic manipulation utilizing Logan Basic apex and double notch contacts, as well as sacroiliac manipulation on a drop table with a sacrum contact and with a posterior to anterior and superior to inferior (PA-SI) rocking thrust, together with a spinal stabilization exercise program, were used on these 2 patients. Both patients had significant clinical improvement, with reduction on the Visual Analogue Scale (VAS) of 67% and 84%, Oswestry Disability Index improvement of 73% and 81%, and an improvement on the Harris hip score of 71% and 44%, respectively. A conservative management approach, including specific chiropractic manipulation and a spinal stabilization exercise program, can help manage the treatment of adult patients with chronic low back and leg pain related to bilateral congenital dislocation of the hips.

  15. Insomnia and limb pain in hemodialysis patients: What is the share of restless leg syndrome?

    Directory of Open Access Journals (Sweden)

    Majid Malaki

    2012-01-01

    Full Text Available Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, serum phosphorous, ionized calcium, iron and ferritin levels. These variables between patients with insomnia and those with normal sleep were evaluated by independent "t" test. Without considering the etiology or pathogenesis of insomnia, we evaluated the occurrence of insomnia and limb pain in these patients, and specifically, restless leg syndrome. Insomnia and limb pain were common in dialytic patients. 46% of patients had insomnia. 91% of sleepless group had limb pain as a persistent, annoying complaint. Limb pain was not seen in groups with a normal sleep pattern. Restless leg syndrome was found in 8% of total cases (2 out of 26 and 17% among the insomnia group (2 out of 12. In spite of high incidence of insomnia among patients undergoing regular hemodialysis, role of RLS is trivial. There is a strong relationship between hemoglobin levels and duration of renal replacement therapy to insomnia occurrence.

  16. Insomnia and limb pain in hemodialysis patients: what is the share of restless leg syndrome?

    Science.gov (United States)

    Malaki, Majid; Mortazavi, Fakhr Sadat; Moazemi, Sussan; Shoaran, Maryam

    2012-01-01

    Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS) as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, serum phosphorous, ionized calcium, iron and ferritin levels. These variables between patients with insomnia and those with normal sleep were evaluated by independent "t" test. Without considering the etiology or pathogenesis of insomnia, we evaluated the occurrence of insomnia and limb pain in these patients, and specifically, restless leg syndrome. Insomnia and limb pain were common in dialytic patients. 46% of patients had insomnia. 91% of sleepless group had limb pain as a persistent, annoying complaint. Limb pain was not seen in groups with a normal sleep pattern. Restless leg syndrome was found in 8% of total cases (2 out of 26) and 17% among the insomnia group (2 out of 12). In spite of high incidence of insomnia among patients undergoing regular hemodialysis, role of RLS is trivial. There is a strong relationship between hemoglobin levels and duration of renal replacement therapy to insomnia occurrence.

  17. Mechanisms-based classifications of musculoskeletal pain: part 3 of 3: symptoms and signs of nociceptive pain in patients with low back (± leg) pain.

    LENUS (Irish Health Repository)

    Smart, Keith M

    2012-08-01

    As a mechanisms-based classification of pain \\'nociceptive pain\\' (NP) refers to pain attributable to the activation of the peripheral receptive terminals of primary afferent neurones in response to noxious chemical, mechanical or thermal stimuli. The symptoms and signs associated with clinical classifications of NP have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of NP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol after which their pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist indicating the presence\\/absence of various symptoms and signs. A regression analysis identified a cluster of seven clinical criteria predictive of NP, including: \\'Pain localised to the area of injury\\/dysfunction\\

  18. Mechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (± leg) pain.

    LENUS (Irish Health Repository)

    Smart, Keith M

    2012-08-01

    As a mechanisms-based classification of pain \\'peripheral neuropathic pain\\' (PNP) refers to pain arising from a primary lesion or dysfunction in the peripheral nervous system. Symptoms and signs associated with an assumed dominance of PNP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of PNP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol. Patients\\' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of two symptoms and one sign predictive of PNP, including: \\'Pain referred in a dermatomal or cutaneous distribution\\

  19. Prevalence and severity of cyclic leg pain in women with endometriosis and in controls - effect of laparoscopic surgery.

    Science.gov (United States)

    Walch, Katharina; Kernstock, Tamara; Poschalko-Hammerle, Gunda; Gleiß, Andreas; Staudigl, Christine; Wenzl, René

    2014-08-01

    In addition to dysmenorrhea, dyspareunia, and subfertility, pain in the lower extremities has been described to be a further complaint in women affected by endometriosis, and lysis of nerve entrapment was thought to be associated with amelioration of leg pain. Therefore, we aimed to compare the prevalence of cyclic leg pain and pain intensity between women with endometriosis and without endometriosis, and to evaluate the effect of laparoscopic surgery. Forty-four women with endometriosis and 58 controls were included in a prospective, controlled clinical trial at a University hospital/tertiary referral center. Participants were asked to complete questionnaires the day before and six to nine weeks after laparoscopy. The prevalence and intensity of leg pain and improvement after laparoscopic surgery, quantified according to a visual analog scale (VAS) score, were evaluated. We also recorded involvement of dermatomes, the presence and intensity of dysmenorrhea, and correlations between age, stage of endometriosis (rAFS-score), and preoperative VAS scores. Before surgery, more women were affected by leg pain in the endometriosis group, compared to the control group (45.5% and 25.9%, respectively). Preoperative VAS scores for leg pain, however, were not significantly different between the two groups. A moderate correlation in the preoperative VAS scores between leg pain and dysmenorrhea was observed. After laparoscopy, we found a significant improvement in leg pain intensity in both groups. The mean difference in the VAS score for pain reduction between the study group and the control group was 0.74 (95% CI: -0.61-2.08), which was not statistically significant. The prevalence of leg pain is increased in endometriosis, while leg pain intensity is not, compared to women without endometriosis. Laparoscopic surgery-even without preparation and decompression of nerve tissue-is associated with an improvement in pain intensity in women with endometriosis, as well as in the

  20. Is Leg Length Discrepancy Associated With the Side of Radiating Pain in Patients With a Lumbar Herniated Disc?

    NARCIS (Netherlands)

    ten Brinke, Albert P.T.; van der Aa, Hans E.; van der Palen, Jacobus Adrianus Maria; Oosterveld, Frits P.T.

    1999-01-01

    Study Design. The association between leg length discrepancy and the side of the radiating pain in lumbar disc herniation was investigated in a case series. Objectives. To investigate whether pain tends to radiate into the longer or shorter leg in patients with a lumbar herniated disc. Summary of

  1. Painful swollen leg – think beyond deep vein thrombosis or Baker's cyst

    Directory of Open Access Journals (Sweden)

    Babu Vinayagam

    2008-01-01

    Full Text Available Abstract Background The diagnosis of deep vein thrombosis of leg is very common in clinical practice. Not infrequently a range of pathologies are diagnosed after excluding a thrombosis, often after a period of anticoagulation. Case presentation This is a report of three patients who presented with a painful swollen leg and were initially treated as a deep vein thrombosis or a baker's cyst, but later diagnosed as a pleomorphic sarcoma, a malignant giant cell tumor of the muscle and a myxoid liposarcoma. A brief review of such similar reports and the relevant literature is presented. Conclusion A painful swollen leg is a common clinical scenario and though rare, tumors must be thought of without any delay, in a duplex negative, low risk deep vein thrombosis situation.

  2. The Active Straight Leg Raise test in lumbopelvic pain during pregnancy

    NARCIS (Netherlands)

    Mens, Jan M A; Huis in 't Veld, EMJ; Pool-Goudzwaard, A.L.

    2012-01-01

    Although many properties of the Active Straight Leg Raise (ASLR) test as a diagnostic test in lumbopelvic pain (LPP) are well documented, various elements are lacking. A cross-sectional study was performed to compute sensitivity and specificity, to assess the advantages and disadvantages of various

  3. OSTEOPATHIC APPROACH: LEG LENGTH DISCREPANCY AND LOW BACK PAIN

    Directory of Open Access Journals (Sweden)

    Taner AYDIN

    2015-12-01

    Full Text Available Leg length discrepancy (LLD is a biomechanical impediment, which is a potential factor in affecting musculoskeletal disorders in the rest of life, such as scoliosis, osteoarthritis and muscle tightness, or even tenderness in lumbar and pelvic area. Athletes who have developed LLD have symptoms in gait, running, standing posture. Skeletal regions related to the disorder are the lumbar spine, ilium, hip joint, greater trochanter and knee, or even ankle and plantar region. Muscles involved in these areas are numeous. In osteopathic management, the manual practitioner can use a lot of basic techniques to handle these dysfunctions. To cope with musculoskeletal problems, osteopathic manipulation techniques would be an ideal modality to alleviate the LLD syndrome. An overview of the mentioned topics of concern will be discussed in the review.

  4. Complementary and alternative medicine for older adults with venous leg ulcer pain.

    Science.gov (United States)

    Tobón, Jeniffer

    2010-11-01

    Chronic pain management is an important, and often under-addressed, component in the care of older adults with venous leg ulcers (VLUs). Clinicians caring for older adults with VLUs must consider and address both the physiological and psychosocial aspects of chronic pain. Traditional pharmacological approaches to pain management are only part of the solution. One strategy is to adopt a more holistic approach to chronic pain management that includes complementary and alternative medicine (CAM) therapies. Unfortunately, there is a paucity of CAM research that focuses on the pain management of older adults with VLUs. Despite these limitations, pain management that includes discussion of relevant CAM modalities must be a priority for clinicians caring for older adults living with VLUs.

  5. Neurodynamic treatment for patients with nerve-related leg pain: Protocol for a randomized controlled trial.

    Science.gov (United States)

    Ferreira, Giovanni E; Stieven, Fábio F; Araújo, Francisco X; Wiebusch, Matheus; Rosa, Carolina G; Plentz, Rodrigo Della Méa; Silva, Marcelo F

    2016-10-01

    To investigate if neurodynamic treatment is more effective than advice to remain active in patients with nerve-related leg pain. Parallel-group randomized controlled trial blinded to the outcome assessor conducted in Porto Alegre, Brazil. Sixty patients recruited from the community and private practices. Patients will be randomly assigned to receive four sessions of neurodynamic treatment over two weeks comprising passive lumbar foramen opening and neurodynamic sliders plus home exercises or advice to remain active. Leg pain intensity, disability, low back pain intensity, functional ability, symptoms distribution and global impression of recovery will be assessed at two and four weeks after randomization. A linear mixed model will be employed for each outcome following intention to treat principles. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Prognostic implications of the Quebec Task Force classification of back-related leg pain

    DEFF Research Database (Denmark)

    Kongsted, Alice; Kent, Peter; Jensen, Tue Secher

    2013-01-01

    or below the knee. CONCLUSIONS: Subgrouping LBP patients, based on pain location and neurological signs, was associated with activity limitation and sick leave, but not with GPE. The presence of neurological signs and pain in the leg both have prognostic implications but whether that leg pain without...... if this was explained by measured baseline factors. METHODS: Routine clinical data were collected during the first visit to an outpatient department and follow-ups were performed after 3 and 12 months. Patients were divided into the four subgroups and associations between subgroups and the outcomes of activity...... limitation, global perceived effect (GPE) after 3 months, and sick leave after 3 months were tested by means of generalised estimating equations. Models were univariate (I), adjusted for duration (II), and adjusted for all baseline differences (III). RESULTS: A total of 1,752 patients were included...

  7. Primary Sjögren’s Syndrome with Sensory Ganglionopathy and Painful Legs and Moving Toes Syndrome

    Directory of Open Access Journals (Sweden)

    Mehmet Uğur Çevik

    2014-06-01

    Full Text Available Sjogren’s syndrome is characterized by the sicca syndrome, with dryness of the mouth (xerostomia and the eyes (xerophthalmia. Sjogren's syndrome is the only connective tissue disease that has been associated with sensory neuronopathy. The syndrome of painful legs and moving toes consisting of pain in the lower limbs with spontaneous movements of the toes or feet. The association between Sjogren’s syndrome and painful legs and moving toes syndrome is a rare condition

  8. Neuroleptics as a cause of painful legs and moving toes syndrome.

    Science.gov (United States)

    Azzi, Jacques; Atweh, Samir; Saade, Nayef; Jabbour, Rosette

    2014-12-22

    Painful legs and moving toes syndrome is rare. It is predominantly diagnosed in middle-aged adults following a history of spinal cord surgery or trauma. The syndrome consists of abnormal repetitive movements, most commonly in the lower extremities, accompanied by pain in the affected limb. Pain usually precedes the movements. We report a case in a young patient that we believe was induced by the intake of a low-potency neuroleptic, which was prescribed to him for anxiety. The patient was treated with carbamazepine with mild relief of pain and later on with botulinum injection, which significantly reduced the movements and mildly improved the pain. After stopping the treatment, the beneficial effect lasted for about 3 months after which his condition gradually returned to its initial state. 2014 BMJ Publishing Group Ltd.

  9. Prognostic Factors for Persistent Leg-Pain in Patients Hospitalized With Acute Sciatica.

    Science.gov (United States)

    Fjeld, Olaf; Grotle, Margreth; Siewers, Vibeke; Pedersen, Linda M; Nilsen, Kristian Bernhard; Zwart, John-Anker

    2017-03-01

    Prospective cohort study. To identify potential prognostic factors for persistent leg-pain at 12 months among patients hospitalized with acute severe sciatica. The long-term outcome for patients admitted to hospital with sciatica is generally unfavorable. Results concerning prognostic factors for persistent sciatica are limited and conflicting. A total of 210 patients acutely admitted to hospital for either surgical or nonsurgical treatment of sciatica were consecutively recruited and received a thorough clinical and radiographic examination in addition to responding to a comprehensive questionnaire. Follow-up assessments were done at 6 weeks, 6 months, and 12 months. Potential prognostic factors were measured at baseline and at 6 weeks. The impact of these factors on leg-pain was analyzed by multiple linear regression modeling. A total of 151 patients completed the entire study, 93 receiving nonrandomized surgical treatment. The final multivariate models showed that the following factors were significantly associated with leg-pain at 12 months: high psychosocial risk according to the Örebro Musculosceletal Pain Questionnaire (unstandardized beta coefficient 1.55, 95% confidence interval [CI] 0.72-2.38, P sciatica. 2.

  10. Gluteus Medius Tendon Rupture as a Source for Back, Buttock and Leg Pain

    Science.gov (United States)

    Bewyer, Dennis; Chen, Joseph

    2005-01-01

    A 67-year-old woman with chronic lumbosacral and hip symptoms involving gluteus medius tendon rupture and strain injury is presented here. We report her work-up and management. Although this is an uncommonly reported pathology, many patients with back, buttock and leg pain see physicians who often focus on lumbar spinal stenosis, lumbar radiculopathy or hip/knee osteoarthritis. Careful physical examination guided us to this patient's diagnosis. PMID:16089095

  11. Comparative Effectiveness of Straight Leg Raise and Slump Stretching in Subjects with Low Back Pain with Adverse Neural Tension

    Directory of Open Access Journals (Sweden)

    Neha Malik

    2016-03-01

    Full Text Available Background: Chronic low back pain is a common problem in the present time. It is commonly associated with altered mechanical tension in the peripheral nerves as tested by straight leg raising or slump tests. These maneuvers are used for treatment of such disorders. Both the straight leg raise and slump stretching techniques have been found to be beneficial in the treatment of low back pain with distal symptoms. A comparison of the two techniques will determine if one technique is better than the other. Also, it will add to the evidence for their effectiveness in managing symptoms in patients with low back pain. Objective: To evaluate the comparative effectiveness of straight leg raise and slump stretching on pain and range of passive straight leg raise in subjects with low back pain. Methods and measures: 50 patients with low back pain, satisfying the inclusion and exclusion criteria were randomly assigned to three groups. Group 1 was the straight leg raise group (n=15. Group 2 was the slump group (n=13. Group 3 was the control group (n=12. Baseline measurements of pain intensity as measured by the Numeric Pain Rating Scale (NPRS and range of passive straight leg raise (PSLR were taken. Group 1 received 6 sessions of straight leg raise stretching and lumbar stabilization exercises. Group 2 received 6 sessions of slump stretching and lumbar stabilization exercises. Group 3 received 6 sessions of lumbar stabilization exercises only. Statistical analysis: Paired t-test was used for within group analysis of NPRS and PSLR. ANOVA followed by post hoc analysis was employed for between group comparisons. Results: No significant difference was found in NPRS between straight leg raise and slump groups (p > 0.05 while they differed significantly in PSLR (p < 0.05. Both the groups showed significantly better results in PSLR when compared to the control group (P<0.05. Statistically significant improvements were found in all the 3 groups for both the outcome

  12. SURGICAL MANAGEMENT OF SYMPTOMATIC LOW BACK PAIN AND MONORADICULAR LEG PAIN IN ADOLESCENT AND YOUNG ADULT PATIENTS

    Directory of Open Access Journals (Sweden)

    Kalevski Svetoslav

    2014-07-01

    Full Text Available Objectives: The purpose of the present retrospective study is to draw attention to symptomatic low back pain in adolescent patients, in order to encourage earlier diagnosis and surgical treatment. The study assessed the radiological, clinical features and surgical outcomes of 13 of this kind of patient. Materials and Methods: Out of a series of 983 consecutive cases (1999–2011 of lumbar disc excisions from our neurosurgical institution, 13–1,32% of the patients were between the ages of 15 and 20 mean 17,84. Fifteen operations, including two reoperations,were performed on this patient group, by a conventional microsurgical procedure. The indications for surgery were failure of conservative treatment, in tractable pain and/or progressive neurological impairment. Results: Low back pain and monoradicular sciatica were the main complaints in 77%, but findings of neurological deficits were rare — 1 case. The surgical findings revealed a protruding disc in eleven cases, one lateral recess stenosis and one lumbar synovial cyst. Initially, all patients were treated conservatively by their physicians more than 3 months without success. On the day of discharge, Kirkaldy-Willis criteria results were excellent or good in 92% of patients. The follow-up period ranged from 6 months to 2 years with an average of 1 year and 2 months. The results were excellent in 10 patients and good in 3 patients. Discussion: We demonstrate that the cause of low back pain and monoradicular leg pain in adolescent patients may not only be a cause of herniated lumbar disc or lateral recess narrowing. Very rarely these symptoms may be caused by lumbar synovial cysts. Conclusion: Surgical treatment of adolescent patients is able to relieve the clinical symptoms quickly. Clinical symptoms such as low back pain and leg pain and the neurologic deficit disappear within 3 months after surgery.

  13. Surgical management of symptomatic low back pain and monoradicular leg pain in adolescent and young adult patients

    Directory of Open Access Journals (Sweden)

    Kalevski Svetoslav

    2014-07-01

    Full Text Available Objectives: The purpose of the present retrospective study is to draw attention to symptomatic low back pain in adolescent patients, in order to encourage earlier diagnosis and surgical treatment. The study assessed the radiological, clinical features and surgical outcomes of 13of this kind of patient. Materials and Methods: Out of a series of 983 consecutive cases (1999-2011 of lumbar disc excisions from our neurosurgical institution, 13-1,32% of the patients were between the ages of 15 and 20 mean 17,84. Fifteen operations, including two reoperations, were performed on this patient group, by a conventional microsurgical procedure. The indications for surgery were failure of conservative treatment, intractable pain and/or progressive neurological impairment. Results: Low back pain and monoradicular sciatica were the main complaints in 77%, but findings of neurological deficits were rare - 1 case. The surgical findings revealed a protruding disc in eleven cases, one lateral recess stenosis and one lumbar synovial cyst. Initially, all patients were treated conservatively by their physicians more than 3 months without success. On the day of discharge, Kirkaldy-Willis criteria results were excellent or good in 92% of patients. The follow-up period ranged from 6 months to 2 years with an average of 1 year and 2 months. The results were excellent in 10 patients and good in 3 patients. Discussion: We demonstrate that the cause of low back pain and monoradicular leg pain in adolescent patients may not only be a cause of herniated lumbar disc or lateral recess narrowing. Very rarely these symptoms may be caused by lumbar synovial cysts. Conclusion: Surgical treatment of adolescent patients is able to relieve the clinical symptoms quickly. Clinical symptoms such as low back pain and leg pain and the neurologic deficit disappear within 3 months after surgery.

  14. Comparative Effectiveness of Straight Leg Raise and Slump Stretching in Subjects with Low Back Pain with Adverse Neural Tension

    OpenAIRE

    Neha Malik; Chitra Kataria; Nidhi Bhatia Sachdev

    2016-01-01

    Background: Chronic low back pain is a common problem in the present time. It is commonly associated with altered mechanical tension in the peripheral nerves as tested by straight leg raising or slump tests. These maneuvers are used for treatment of such disorders. Both the straight leg raise and slump stretching techniques have been found to be beneficial in the treatment of low back pain with distal symptoms. A comparison of the two techniques will determine if one technique is better than ...

  15. Night Leg Cramps

    Science.gov (United States)

    Symptoms Night leg cramps By Mayo Clinic Staff Night leg cramps, also called nocturnal leg cramps, are painful, involuntary contractions or spasms of muscles in your legs, usually occurring when you're in bed. Night ...

  16. Placebo effect of an inert gel on experimentally induced leg muscle pain

    Directory of Open Access Journals (Sweden)

    James G Hopker

    2010-11-01

    Full Text Available James G Hopker1, Abigail J Foad2, Christopher J Beedie2, Damian A Coleman2, Geoffrey Leach11Centre for Sports Studies, University of Kent, Chatham, Kent, UK; 2Department of Sports Science, Tourism and Leisure, Canterbury Christ Church University, Canterbury, Kent, UKPurpose: This study examined the therapeutic effects of an inert placebo gel on experimentally induced muscle pain in a sports therapy setting. It aimed to investigate the degree to which conditioned analgesia, coupled with an expectation of intervention, was a factor in subsequent analgesia.Methods: Participants were sixteen male and eight female sports therapy students at a UK University. With institutional ethics board approval and following informed consent procedures, each was exposed to pain stimulus in the lower leg in five conditions, ie, conditioning, prebaseline, experimental (two placebo gel applications, and postbaseline. In conditioning trials, participants identified a level of pain stimulus equivalent to a perceived pain rating of 6/10. An inert placebo gel was then applied to the site with the explicit instruction that it was an analgesic. Participants were re-exposed to the pain stimulus, the level of which, without their knowledge, had been decreased, creating the impression of an analgesic effect resulting from the gel. In experimental conditions, the placebo gel was applied and the level of pain stimulus required to elicit a pain rating of 6/10 recorded.Results: Following application of the placebo gel, the level of pain stimulus required to elicit a pain rating of 6/10 increased by 8.2%. Application of the placebo gel significantly decreased participant’s perceptions of muscle pain (P = 0.001.Conclusion: Subjects’ experience and expectation of pain reduction may be major factors in the therapeutic process. These factors should be considered in the sports therapeutic environment.Keywords: conditioning, expectation, perception, positive belief, sports therapy

  17. Low intensity permanent magnets in the treatment of chronic lumbar radicular pain.

    Science.gov (United States)

    Khoromi, Suzan; Blackman, Marc R; Kingman, Albert; Patsalides, Athos; Matheny, Leigh Ann; Adams, Sandra; Pilla, Arthur A; Max, Mitchell B

    2007-10-01

    We assessed the pain-relieving efficacy of static magnetic fields produced by 200 Gauss (G) magnets compared with 50G magnets in a double-blind, randomized, two-phase crossover study in patients with chronic lumbar radicular pain. The surface field strengths of the magnets were 200 and 50G. Phase I included four random periods of two-week duration: two periods with 200G, one period with 50G, and one period of "no treatment." The magnets were positioned either vertically or horizontally in standard lumbosacral elastic corsets. Phase II consisted of two five-week periods with the most effective magnet from Phase I and its corresponding 50 or 200G device. The primary outcome was average daily leg pain score (0-10 scale) in each period of Phase II. Thirty-eight of 40 randomized patients completed Phase I, and 28 of 31 Phase II participants completed the study. In Phase I, pain scores did not differ significantly between 200 and 50G magnets. Phase II average leg pain scores tended to be lower with 200 vs. 50G magnets (3.2+/-2.1 for 200G vs. 3.9+/-2.2 for 50G magnets [P=0.08]) after excluding one unblinded patient. The relative treatment effect of the 200G magnets appeared to increase throughout the five-week period. Although these data cannot rule out a chance effect, the positive trends suggest that larger, longer-duration, sham-controlled trials with 200G magnets be considered in patients with chronic lumbar radicular pain.

  18. Dopaminergic treatment of restless legs syndrome in spinal cord injury patients with neuropathic pain.

    Science.gov (United States)

    Kumru, Hatice; Albu, Sergiu; Vidal, Joan; Barrio, Manuela; Santamaria, Joan

    2016-01-01

    Recent studies report high incidence of restless legs syndrome (RLS) in patients with spinal cord injury (SCI), who may also present pain and sensory disturbances. In the present manuscript, we examine and discuss diagnostic and treatment challenges of comorbid RLS and neuropathic pain (NP) in SCI. We evaluated seven men with a mean age of 55.6 (s.d.=14.0) years, with chronic complete or incomplete SCI at the thoracic or lumbar level, for complaints of sensory disturbances in the legs, which initially were attributed to drug-resistant NP. Because overlapped RLS was suspected, clinical evaluation of NP and RLS, serum ferritin and iron level assessment, and video polysomnographic (VPSG) studies were conducted. Pramipexole (0.18 mg q.d. -1 ) was added to treat RLS, and a follow-up was performed at 2 months. We found that in six subjects the RLS was comorbid with NP and in one subject the symptoms of RLS were misdiagnosed as NP. VPSG revealed periodic limb movements (PLMs) in all patients, including PLMs of the legs, arms or both. Serum ferritin was patients. RLS improved significantly after 2 months with pramipexole. On the basis of current findings, we recommend physicians to be aware of the comorbidity between RLS and NP secondary to SCI to include suitable diagnostic procedures and effective treatments.

  19. [Edematous and painful leg. Pathophysiology in the spotlight: presentation of a case].

    Science.gov (United States)

    Estalayo-Gutiérrez, B

    2013-01-01

    We report on a 74-year-old woman visually impaired and under treatment with amlodipine, valsartan and thyroid hormone. The patient complained of her unique, edematous and painful leg after a local trauma. The worsening was slow and gradual, affecting walk and state of mind. Several unsuccessful diagnoses were done before suspecting and confirming a Complex Regional Pain Syndrome. Edema disappeared dramatically after amlodipine empirical discontinuation. Pain improved gradually with rehabilitation exercises but, mainly, after gaining skills and self-esteem due to cataract surgery of her unique functional eye. It was necessary to decrease thyroid hormone dosage after a long lasting balance. The sympathetic nervous system role of the case is discussed. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  20. Sciatic nerve excursion during a modified passive straight leg raise test in asymptomatic participants and participants with spinally referred leg pain.

    Science.gov (United States)

    Ridehalgh, Colette; Moore, Ann; Hough, Alan

    2015-08-01

    Minimal data exists on in-vivo sciatic nerve motion during straight leg raise (SLR), particularly in symptomatic participants. Such data could help clinicians to better understand nerve mechanic changes following nerve dysfunction. Cross-sectional, controlled laboratory study. To investigate whether individuals with spinally referred leg pain have different nerve excursion patterns compared to healthy participants. The sciatic nerve was scanned using ultrasound imaging in the posterior thigh in asymptomatic participants, and individuals with spinally referred leg pain sub-grouped into somatic pain, radicular pain or radiculopathy. Nerve excursion was measured in transverse and longitudinal planes during a side-lying modified SLR. The ultrasound data was analysed off-line using cross correlation software. Longitudinal plane data was collected from 16 asymptomatic and 60 symptomatic participants and transverse plane data from 16 asymptomatic and 56 symptomatic participants. There was no significant difference in longitudinal nerve excursion between the 4 groups. The direction of transverse plane motion altered between groups. These varied movements may be related to protective muscle activation between the groups, although this is speculative at present. Longitudinal sciatic nerve excursion at the posterior thigh during a modified SLR is not different between asymptomatic participants and those with spinally referred leg pain. Transverse plane movement appears to be more varied. This may suggest that in individuals with nerve root pain, there is no restriction in nerve excursion. However, as it was not possible to measure excursion at the nerve root, more research is needed to confirm these findings. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Knee Pain Predicts Subsequent Shoulder Pain and the Association Is Mediated by Leg Weakness: Longitudinal Observational Data from the Osteoarthritis Initiative.

    Science.gov (United States)

    Laslett, Laura L; Otahal, Petr; Hensor, Elizabeth M A; Kingsbury, Sarah R; Conaghan, Philip G

    2016-11-01

    To assess whether the "spread" of joint pain is related to pain-associated muscle loss in 1 joint leading to increased loading and subsequent pain in other joints. Associations between persistent knee pain (pain in 1 or 2 knees over 0-3 years vs no persistent pain) and incident shoulder pain at Year 4 were examined in participants from the longitudinal National Institutes of Health Osteoarthritis Initiative. Associations were assessed using log multinomial modeling, adjusted for age, sex, body mass index, depression score, other lower limb pain, and baseline leg weakness (difficulty standing from a sitting position). In older adults with clinically significant knee osteoarthritis (OA) or at risk of knee OA (n = 3486), the number of painful joints increased yearly, from 2.1 joints (95% CI 2.0-2.2) at baseline increasing by 5.2% (95% CI 2.2-8.3) at Year 4. Shoulders were the next most commonly affected joints after knees (28.5%). Persistent pain in 1 or 2 knees increased risk of bilateral shoulder pain at Year 4 [1 knee: relative risk (RR) 1.59, 95% CI 0.97-2.61; 2 knees: RR 2.02, 95% CI 1.17-3.49] after adjustment for confounders. Further adjustment for leg weakness attenuated effect sizes (1 knee: RR 1.13, 95% CI 0.60-2.11; 2 knees: RR 1.44, 95% CI 0.75-2.77), indicating mediation by functional leg weakness. Spread of joint pain is not random. Persistently painful knees predict new bilateral shoulder pain, which is likely mediated by leg weakness, suggesting that biomechanical factors influence the spread of pain.

  2. 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.

  3. Periumbilical Pain with Radiation to Both Legs Following Tarantula Bite; a Case Report

    Directory of Open Access Journals (Sweden)

    Mahboob Pouraghaei

    2015-07-01

    Full Text Available Tarantulas have recently become as pets in most parts of the world that increased the probability of encountering emergency physicians with patients hurt with these spiders. Their attacks usually do not cause general manifestation, however there are some case reports in this regard. Here, a 40-year-old man was reported who was referred to the emergency department with severe periumbilical pain that radiated to both legs and diagnosed as a victim of tarantula bite. Such symptoms usually are belonging to other spiders like Black Widow spider, but it seems that tarantula can mimic them in some cases, too.

  4. Use of Temporary Implantable Biomaterials to Reduce Leg Pain and Back Pain in Patients with Sciatica and Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    Gere S. diZerega

    2010-05-01

    Full Text Available The principle etiology of leg pain (sciatica from lumbar disc herniation is mechanical compression of the nerve root. Sciatica is reduced by decompression of the herniated disc, i.e., removing mechanical compression of the nerve root. Decompression surgery typically reduces sciatica more than lumbar back pain (LBP. Decompression surgery reduces mechanical compression of the nerve root. However, decompression surgery does not directly reduce sensitization of the sensory nerves in the epidural space and disc. In addition, sensory nerves in the annulus fibrosus and epidural space are not protected from topical interaction with pain mediators induced by decompression surgery. The secondary etiology of sciatica from lumbar disc herniation is sensitization of the nerve root. Sensitization of the nerve root results from a mechanical compression, b exposure to cellular pain mediators, and/or c exposure to biochemical pain mediators. Although decompression surgery reduces nerve root compression, sensory nerve sensitization often persists. These observations are consistent with continued exposure of tissue in the epidural space, including the nerve root, to increased cellular and biochemical pain mediators following surgery. A potential contributor to lumbar back pain (LBP is stimulation of sensory nerves in the annulus fibrosus by a cellular pain mediators and/or b biochemical pain mediators that accompany annular tears or disruption. Sensory fibers located in the outer one-third of the annulus fibrosus increase in number and depth as a result of disc herniation. The nucleus pulposus is comprised of material that can produce an autoimmune stimulation of the sensory nerves located in the annulus and epidural space leading to LBP. The sensory nerves of the annulus fibrosus and epidural space may be sensitized by topical exposure to cellular and biochemical pain mediators induced by lumbar surgery. Annulotomy or annular rupture allows the nucleus pulposus

  5. Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial

    Directory of Open Access Journals (Sweden)

    Giovanni Ferreira

    2016-10-01

    Full Text Available Question: In people with nerve-related leg pain, does adding neurodynamic treatment to advice to remain active improve leg pain, disability, low back pain, function, global perceived effect and location of symptoms? Design: Randomised trial with concealed allocation and intention-to-treat analysis. Participants: Sixty participants with nerve-related leg pain recruited from the community. Interventions: The experimental group received four sessions of neurodynamic treatment. Both groups received advice to remain active. Outcome measures: Leg pain and low back pain (0, none, to 10, worst, Oswestry Disability Index (0, none, to 100, worst, Patient-Specific Functional Scale (0, unable to perform, to 30, able to perform, global perceived effect (–5 to 5 and location of symptoms were measured at 2 and 4 weeks after randomisation. Continuous outcomes were analysed by linear mixed models. Location of symptoms was assessed by relative risk (95% CI. Results: At 2 weeks, the experimental group did not have significantly greater improvement than the control group in leg pain (MD –1.1, 95% CI –2.3 to 0.1 or disability (MD –3.3, 95% CI –9.6 to 2.9. At 4 weeks, the experimental group experienced a significantly greater reduction in leg pain (MD –2.4, 95% CI –3.6 to –1.2 and low back pain (MD –1.5, 95% CI –2.8 to –0.2. The experimental group also improved significantly more in function at 2 weeks (MD 5.2, 95% CI 2.2 to 8.2 and 4 weeks (MD 4.7, 95% CI 1.7 to 7.8, as well as global perceived effect at 2 weeks (MD 2.5, 95% CI 1.6 to 3.5 and 4 weeks (MD 2.9, 95% CI 1.9 to 3.9. No significant between-group differences occurred in disability at 4 weeks and location of symptoms. Conclusion: Adding neurodynamic treatment to advice to remain active did not improve leg pain and disability at 2 weeks. Trial registration: NCT01954199. [Ferreira G, Stieven F, Araujo F, Wiebusch M, Rosa C, Plentz R, et al. (2016 Neurodynamic treatment did not improve

  6. Time course of subjective pain ratings, and wound and leg tenderness after hysterectomy

    DEFF Research Database (Denmark)

    Møiniche, S; Dahl, J B; Erichsen, C J

    1997-01-01

    BACKGROUND: Little information is available on time course of wound tenderness and relationship to subjective pain ratings following surgery. Furthermore, it is not clarified whether surgical procedures may induce hyperalgesia to mechanical stimulation outside the area of the surgical incision. We...... on the abdominal wall 0.05, 5, 10 and 15 cm perpendicular to the wound, and on the anterior surface of the left thigh and tuberositas tibia. Furthermore, pain was assessed on a visual analogue scale (VAS) at rest and during cough. RESULTS: PPT decreased significantly 0.5, 5, 10 and 15 cm from skin incision up...... to 96 h after surgery (P wound. There was no significant changes in PPT on the thigh or the tuberositas tibia (P = 0.49 and P = 0.12) and no correlation between changes in PPT near the wound and in remote (areas the legs) (Rs = -0...

  7. [Magnetic therapy in treatment of patients with leg ulcers].

    Science.gov (United States)

    Alekseenko, A V; Gusak, V V; Tarabanchuk, V V; Iftodiĭ, A G; Sherban, N G; Stoliar, V F

    1998-01-01

    Various magnetic (continuous current, alternating current and "running" impulse) fields were applied in 74 patients with trophic ulcers of lower limbs. 10-12 days after the beginning of the magnetic therapy wound surface has completely cleaned from necrotic tissues, surrounding inflammatory changes eliminated, epithelization of the wounds began. The most pronounced clinical effect was observed after the use of "running" impulse of magnetic field.

  8. Patients with low back pain differ from those who also have leg pain or signs of nerve root involvement – a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Kongsted Alice

    2012-11-01

    Full Text Available Abstract Background Leg pain associated with low back pain (LBP is recognized as a risk factor for a poor prognosis, and is included as a component in most LBP classification systems. The location of leg pain relative to the knee and the presence of a positive straight leg raise test have been suggested to have clinical implications. To understand differences between such leg pain subgroups, and whether differences include potentially modifiable characteristics, the purpose of this paper was to describe characteristics of patients classified into the Quebec Task Force (QTF subgroups of: 1 LBP only, 2 LBP and pain above the knee, 3 LBP and pain below the knee, and 4 LBP and signs of nerve root involvement. Methods Analysis of routine clinical data from an outpatient department. Based on patient reported data and clinical findings, patients were allocated to the QTF subgroups and described according to the domains of pain, activity limitation, work participation, psychology, general health and clinical examination findings. Results A total of 2,673 patients aged 18–95 years (median 47 who were referred for assessment of LBP were included. Increasing severity was consistently observed across the subgroups from LBP only to LBP with signs of nerve root involvement although subgroup differences were small. LBP patients with leg pain differed from those with LBP only on a wide variety of parameters, and patients with signs of nerve root involvement had a more severe profile on almost all measures compared with other patients with back-related leg pain. Conclusion LBP patients with pain referral to the legs were more severely affected than those with local LBP, and patients with signs of nerve root involvement were the ones most severily affected. These findings underpin the concurrent validity of the Quebec Task Force Classification. However, the small size of many between-subgroup differences amid the large variability in this sample of cross

  9. Use of the one‐legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis

    Science.gov (United States)

    Masci, L; Pike, J; Malara, F; Phillips, B; Bennell, K; Brukner, P

    2006-01-01

    Background Active spondylolysis is an acquired lesion in the pars interarticularis and is a common cause of low back pain in the young athlete. Objectives To evaluate whether the one‐legged hyperextension test can assist in the clinical detection of active spondylolysis and to determine whether magnetic resonance imaging (MRI) is equivalent to the clinical gold standard of bone scintigraphy and computed tomography in the radiological diagnosis of this condition. Methods A prospective cohort design was used. Young active subjects with low back pain were recruited. Outcome measures included clinical assessment (one‐legged hyperextension test) and radiological investigations including bone scintigraphy (with single photon emission computed tomography (SPECT)) and MRI. Computed tomography was performed if bone scintigraphy was positive. Results Seventy one subjects were recruited. Fifty pars interarticulares in 39 subjects (55%) had evidence of active spondylolysis as defined by bone scintigraphy (with SPECT). Of these, 19 pars interarticulares in 14 subjects showed a fracture on computed tomography. The one‐legged hyperextension test was neither sensitive nor specific for the detection of active spondylolysis. MRI revealed bone stress in 40 of the 50 pars interarticulares in which it was detected by bone scintigraphy (with SPECT), indicating reduced sensitivity in detecting bone stress compared with bone scintigraphy (p  =  0.001). Conversely, MRI revealed 18 of the 19 pars interarticularis fractures detected by computed tomography, indicating concordance between imaging modalities (p  =  0.345). There was a significant difference between MRI and the combination of bone scintigraphy (with SPECT)/computed tomography in the radiological visualisation of active spondylolysis (p  =  0.002). Conclusions These results suggest that there is a high rate of active spondylolysis in active athletes with low back pain. The one‐legged hyperextension test is not

  10. Inflammatory Myopathy Causing Leg Pain in a Soccer Player: Case Report and Return-to-Play Considerations.

    Science.gov (United States)

    Lueders, Daniel R; Howe, Benjamin M; Sellon, Jacob L

    2016-04-01

    Leg pain is a common condition in athletes as well as in the general population, and has a broad differential diagnosis that includes musculoskeletal, vascular, rheumatologic, and neurologic etiologies. Idiopathic inflammatory myopathy (IM) is a relatively uncommon but recognized etiology of leg pain. In this case, we describe an acute presentation of IM in an athlete resulting in leg pain and activity limitation. The available literature suggests that moderate-intensity exercise is safe and beneficial in idiopathic IM, but studies to date have not assessed the effects of high-intensity exercise in IM or provided recommendations for return to competitive contact sport in this population. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  11. Trigger point-related sympathetic nerve activity in chronic sciatic leg pain: a case study.

    Science.gov (United States)

    Skorupska, Elżbieta; Rychlik, Michał; Pawelec, Wiktoria; Bednarek, Agata; Samborski, Włodzimierz

    2014-10-01

    Sciatica has classically been associated with irritation of the sciatic nerve by the vertebral disc and consequent inflammation. Some authors suggest that active trigger points in the gluteus minimus muscle can refer pain in similar way to sciatica. Trigger point diagnosis is based on Travel and Simons criteria, but referred pain and twitch response are significant confirmatory signs of the diagnostic criteria. Although vasoconstriction in the area of a latent trigger point has been demonstrated, the vasomotor reaction of active trigger points has not been examined. We report the case of a 22-year-old Caucasian European man who presented with a 3-year history of chronic sciatic-type leg pain. In the third year of symptoms, coexistent myofascial pain syndrome was diagnosed. Acupuncture needle stimulation of active trigger points under infrared thermovisual camera showed a sudden short-term vasodilatation (an autonomic phenomenon) in the area of referred pain. The vasodilatation spread from 0.2 to 171.9 cm(2) and then gradually decreased. After needling, increases in average and maximum skin temperature were seen as follows: for the thigh, changes were +2.6°C (average) and +3.6°C (maximum); for the calf, changes were +0.9°C (average) and +1.4°C (maximum). It is not yet known whether the vasodilatation observed was evoked exclusively by dry needling of active trigger points. The complex condition of the patient suggests that other variables might have influenced the infrared thermovision camera results. We suggest that it is important to check if vasodilatation in the area of referred pain occurs in all patients with active trigger points. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Effects of neural mobilization on pain, straight leg raise test and disability in patients with radicular low back pain

    Directory of Open Access Journals (Sweden)

    Haris Čolaković

    2013-09-01

    Full Text Available Introduction: Radicular low back pain is a disorder involving the dysfunction of the lumbosacral nerve roots. Clinical rehabilitation approaches for low back pain include kinesiotherapy, and physical therapyprocedures: ice , rest , heat, ultrasound, TENS, but evidences regarding their effectiveness are lacking. The purpose of this study was to determine if nerve mobilization brings better improvements in pain, SLR testand functional disability in patients with radicular low back pain compared to standard physical therapy.Methods: The study was conducted on a 60 patients with Radicular low back pain, treated in Regional medical center "Dr Safet Mujić", Mostar, during the period from 01.04.2010 untill 31.04.2011. Patientswere divided into two groups. First group (n=30 received a 4-week rehabilitation program including neural mobilization and lumbar stabilization program. Second group (n=30 received a 4-week rehabilitation program including active range of motion (ROM exercises and lumbar stabilization program.Results: At the beginning, the two groups were not signifi cantly different in terms of score or SLR. After therapy there was statistically signifi cant improvement between groups in both VAS scores[Group A: 1.16±1.5; Group B: 2.25±2.2] and SLR [Group A: 80.9±17.4; Group B: 65.9±16.4]. ]. After the treatment, in group A, 46.6% (14 participants had been rated with 4, but in Group B: 33.3% (10 participants had been rated with 3.Conclusions: Patients treated with neural mobilization and lumbar stabilization showed better VAS scores and Straight Leg Test scores compared to patients treated with active range of motion exercises and lumbar stabilization. Further research to investigate their long term effi cacy is warranted, with emphasis on greater number of participants.

  13. Restless Legs Syndrome/Willis-Ekbom Disease and Growing Pains in Children and Adolescents.

    Science.gov (United States)

    Simakajornboon, Narong; Dye, Thomas J; Walters, Arthur S

    2015-09-01

    Recent studies have shown that restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are common in pediatric population. The diagnostic criteria for Pediatric RLS have recently been updated to simplify and integrate with newly revised adult RLS criteria. Management of RLS and PLMD involves pharmacologic and nonpharmacologic interventions. Children with low iron storage are likely to benefit from iron therapy. Although, there is limited information on pharmacologic therapy, there are emerging literatures showing the effectiveness of dopaminergic medications in the management of RLS and PLMD in children. This article covers clinical evaluation of RLS and PLMD in children and the relationship with growing pains. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain

    DEFF Research Database (Denmark)

    Bronfort, Gert; Hondras, Maria; Schulz, Craig A

    2014-01-01

    at 12 weeks. RESULTS: Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. For leg pain, SMT plus HEA had a clinically important advantage over HEA (difference, 10 percentage points [95% CI, 2 to 19]; P = 0.008) at 12 weeks but not at 52 weeks...... (difference, 7 percentage points [CI, -2 to 15]; P = 0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred....... LIMITATION: Patients and providers could not be blinded. CONCLUSION: For patients with BRLP, SMT plus HEA was more effective than HEA alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks. PRIMARY FUNDING SOURCE: U.S. Department of Health and Human Services....

  15. Movement of the sacroiliac joint during the Active Straight Leg Raise test in patients with long-lasting severe sacroiliac joint pain.

    Science.gov (United States)

    Kibsgård, Thomas J; Röhrl, Stephan M; Røise, Olav; Sturesson, Bengt; Stuge, Britt

    2017-08-01

    The Active Straight Leg Raise is a functional test used in the assessment of pelvic girdle pain, and has shown to have good validity, reliability and responsiveness. The Active Straight Leg Raise is considered to examine the patients' ability to transfer load through the pelvis. It has been hypothesized that patients with pelvic girdle pain lack the ability to stabilize the pelvic girdle, probably due to instability or increased movement of the sacroiliac joint. This study examines the movement of the sacroiliac joints during the Active Straight Leg Raise in patients with pelvic girdle pain. Tantalum markers were inserted in the dorsal sacrum and ilium of 12 patients with long-lasting pelvic girdle pain scheduled for sacroiliac joint fusion surgery. Two to three weeks later movement of the sacroiliac joints during the Active Straight Leg Raise was measured with radiostereometric analysis. Small movements were detected. There was larger movement of the sacroiliac joint of the rested leg's sacroiliac joint compared to the lifted leg's side. A mean backward rotation of 0.8° and inward tilt of 0.3° were seen in the rested leg's sacroiliac joint. The movements of the sacroiliac joints during the Active Straight Leg Raise are small. There was a small backward rotation of the innominate bone relative to sacrum on the rested leg's side. Our findings contradict an earlier understanding that a forward rotation of the lifted leg's innominate occur while performing the Active Straight Leg Raise. Copyright © 2017. Published by Elsevier Ltd.

  16. Venous leg ulcer patients: a review of the literature on lifestyle and pain-related interventions.

    NARCIS (Netherlands)

    Heinen, M.M.; Achterberg, T. van; Reimer, W.S. op; Kerkhof, P.C.M. van de; Laat, H.E.W. de

    2004-01-01

    BACKGROUND: Having a leg ulcer has a major impact on daily life. Lifestyle is mentioned in most leg ulcer guidelines but mostly without much emphasis on the subject. AIMS AND OBJECTIVES: Evidence for the effect of nutrition, leg elevation and exercise on the healing of leg ulcers was reconsidered.

  17. Predictors of Pain Relief Following Spinal Cord Stimulation in Chronic Back and Leg Pain and Failed Back Surgery Syndrome: A Systematic Review and Meta-Regression Analysis

    Science.gov (United States)

    Taylor, Rod S; Desai, Mehul J; Rigoard, Philippe; Taylor, Rebecca J

    2014-01-01

    We sought to assess the extent to which pain relief in chronic back and leg pain (CBLP) following spinal cord stimulation (SCS) is influenced by patient-related factors, including pain location, and technology factors. A number of electronic databases were searched with citation searching of included papers and recent systematic reviews. All study designs were included. The primary outcome was pain relief following SCS, we also sought pain score (pre- and post-SCS). Multiple predictive factors were examined: location of pain, history of back surgery, initial level of pain, litigation/worker's compensation, age, gender, duration of pain, duration of follow-up, publication year, continent of data collection, study design, quality score, method of SCS lead implant, and type of SCS lead. Between-study association in predictive factors and pain relief were assessed by meta-regression. Seventy-four studies (N = 3,025 patients with CBLP) met the inclusion criteria; 63 reported data to allow inclusion in a quantitative analysis. Evidence of substantial statistical heterogeneity (P pain relief following SCS was noted. The mean level of pain relief across studies was 58% (95% CI: 53% to 64%, random effects) at an average follow-up of 24 months. Multivariable meta-regression analysis showed no predictive patient or technology factors. SCS was effective in reducing pain irrespective of the location of CBLP. This review supports SCS as an effective pain relieving treatment for CBLP with predominant leg pain with or without a prior history of back surgery. Randomized controlled trials need to confirm the effectiveness and cost-effectiveness of SCS in the CLBP population with predominant low back pain. PMID:23834386

  18. Health technology assessment of magnet therapy for relieving pain.

    Science.gov (United States)

    Arabloo, Jalal; Hamouzadeh, Pejman; Eftekharizadeh, Fereshteh; Mobinizadeh, Mohammadreza; Olyaeemanesh, Alireza; Nejati, Mina; Doaee, Shila

    2017-01-01

    Background: Magnet therapy has been used increasingly as a new method to alleviate pain. Magnetic products are marketed with claims of effectiveness for reducing pain of various origins. However, there are inconsistent results from a limited number of randomized controlled trials (RCTs) testing the analgesic efficacy of magnet therapy. This study aimed to evaluate the safety and effectiveness of magnet therapy on reliving various types of pain. Methods: A systematic search of two main medical databases (Cochrane Library and Ovid Medline) was conducted from 1946 to May 2014. Only English systematic reviews that compared magnet therapy with other conventional treatments in patients with local pain in terms of pain relieving measures were included. The results of the included studies were thematically synthesized. Results: Eight studies were included. Magnet therapy could be used to alleviate pain of various origins including pain in various organs, arthritis, myofascial muscle pain, lower limb muscle cramps, carpal tunnel syndrome and pelvic pain. Results showed that the effectiveness of magnetic therapy was only approved in muscle pains, but its effectiveness in other indications and its application as a complementary treatment have not been established. Conclusion: According to the results, it seems that magnet therapy could not be an effective treatment for relieving different types of pain. Our results highlighted the need for further investigations to be done in order to support any recommendations about this technology.

  19. Magnetic resonance arthrography in chronic wrist pain

    International Nuclear Information System (INIS)

    Valeri, G.; Ferrara, C.; Carloni, S.

    1999-01-01

    The purpose of this paper is to investigate the clinical role of Magnetic Resonance Arthrography (MRA) of the wrist in subjects with chronic pain. Thirty-five patients complaining of wrist pain for more than 6 months were submitted to MRI an MRA. All patients received and intra-articular injection of 2-10 mL of a 10 mmol saline solution of Gd-DPTA. The overall diagnostic accuracy rates of MRI and MRA were 40% and 81% respectively, with sensitivity and specificity of 63% and 39% (MRI) and of 82% and 79% (MRA). The conclusion is that compared with MRI, MRA can be considered a useful tool for the visualization of interosseus carpal ligaments and of the triangular fibrocartilage complex. MRA also helps detect injuries in these structures [it

  20. Conservative management of a 31 year old male with left sided low back and leg pain: a case report.

    Science.gov (United States)

    Howell, Emily R

    2012-09-01

    This case study reported the conservative management of a patient presenting with left sided low back and leg pain diagnosed as a left sided L5-S1 disc prolapse/herniation. A 31-year-old male recreational worker presented with left sided low back and leg pain for the previous 3-4 months that was exacerbated by prolonged sitting. The plan of management included interferential current, soft tissue trigger point and myofascial therapy, lateral recumbent manual low velocity, low amplitude traction mobilizations and pelvic blocking as necessary. Home care included heat, icing, neural mobilizations, repeated extension exercises, stretching, core muscle strengthening, as well as the avoidance of prolonged sitting and using a low back support in his work chair. The patient responded well after the first visit and his leg and back pain were almost completely resolved by the third visit. Conservative chiropractic care appears to reduce pain and improve mobility in this case of a L5-S1 disc herniation. Active rehabilitative treatment strategies are recommended before surgical referral.

  1. Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain.

    LENUS (Irish Health Repository)

    Smart, Keith M

    2012-08-01

    As a mechanisms-based classification of pain \\'central sensitisation pain\\' (CSP) refers to pain arising from a dominance of neurophysiological dysfunction within the central nervous system. Symptoms and signs associated with an assumed dominance of CSP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of CSP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol. Patients\\' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of three symptoms and one sign predictive of CSP, including: \\'Disproportionate, non-mechanical, unpredictable pattern of pain provocation in response to multiple\\/non-specific aggravating\\/easing factors\\

  2. Limb symmetry during double-leg squats and single-leg squats on land and in water in adults with long-standing unilateral anterior knee pain; a cross sectional study.

    Science.gov (United States)

    Severin, Anna C; Burkett, Brendan J; McKean, Mark R; Wiegand, Aaron N; Sayers, Mark G L

    2017-01-01

    The presence of pain during movement typically results in changes in technique. However, the physical properties of water, such as flotation, means that water-based exercise may not only reduce compensatory movement patterns but also allow pain sufferers to complete exercises that they are unable to perform on land. The purpose of this study was to assess bilateral kinematics during double-leg squats and single-leg squats on land and in water in individuals with unilateral anterior knee pain. A secondary aim was to quantify bilateral asymmetry in both environments in affected and unaffected individuals using a symmetry index. Twenty individuals with unilateral knee pain and twenty healthy, matched controls performed body weight double- and single-leg squats in both environments while inertial sensors (100 Hz) recorded trunk and lower body kinematics. Repeated-measures statistics tested for environmental effects on movement depths and peak angles within the anterior knee pain group. Differences in their inter-limb symmetry in each environments was compared to the control group using analysis of variance tests. Water immersion allowed for greater movement depths during both exercises (double-leg squat: +7 cm, p  = 0.032, single-leg squat: +9 cm, p  = 0.002) for the knee pain group. The double-leg squat was symmetrical on land but water immersion revealed asymmetries in the lower body frontal plane movements. The single-leg squat revealed decreased hip flexion and frontal plane shank motions on the affected limb in both environments. Water immersion also affected the degree of lower limb asymmetry in both groups, with differences also showing between groups. Individuals with anterior knee pain achieved increased squat depth during both exercises whilst in water. Kinematic differences between the affected and unaffected limbs were often increased in water. Individuals with unilateral anterior knee pain appear to utilise different kinematics in the affected

  3. Idiopathic Acute Isolated Lateral Compartment Syndrome of a Lower Leg: A Magnetic Resonance Imaging Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Yeom, Dong Heon; Lee, Ji Hae; Cho, Woo Ho; Kim, Jae Hyung; Jeong, Myeong Ja; Kim, Soung Hee; Kim, Ji Young; Kim, Soo Hyun; Kang, Mi Jin; Lee, Han Bee [Dept. of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Bae, Kyung Eun [Dept. of Radiology, Seoul Asan Hospital, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2013-01-15

    Acute compartment syndrome of the lower leg is usually associated with major trauma such as fracture, and most commonly occurs in the anterior or deep posterior compartments. Isolated lateral compartment syndrome is less typical and usually associated with minor trauma or exertion. There are a few reports of the acute compartment syndrome which develops without an obvious cause. However, there are few reports of idiopathic acute isolated lateral compartment syndrome, and there are no reports of the radiologic findings. This study presents a radiologic finding of idiopathic acute isolated lateral compartment of lower leg, which shows localized enlargement of the peroneal muscles with peripheral convex bowing and change of their signal intensity with fluid signal along the adjacent fascial planes on magnetic resonance imaging.

  4. 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. ...

  5. Chiropractic and self-care for back-related leg pain: design of a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Schulz Craig A

    2011-03-01

    Full Text Available Abstract Background Back-related leg pain (BRLP is a common variation of low back pain (LBP, with lifetime prevalence estimates as high as 40%. Often disabling, BRLP accounts for greater work loss, recurrences, and higher costs than uncomplicated LBP and more often leads to surgery with a lifetime incidence of 10% for those with severe BRLP, compared to 1-2% for those with LBP. In the US, half of those with back-related conditions seek CAM treatments, the most common of which is chiropractic care. While there is preliminary evidence suggesting chiropractic spinal manipulative therapy is beneficial for patients with BRLP, there is insufficient evidence currently available to assess the effectiveness of this care. Methods/Design This study is a two-site, prospective, parallel group, observer-blinded randomized clinical trial (RCT. A total of 192 study patients will be recruited from the Twin Cities, MN (n = 122 and Quad Cities area in Iowa and Illinois (n = 70 to the research clinics at WHCCS and PCCR, respectively. It compares two interventions: chiropractic spinal manipulative therapy (SMT plus home exercise program (HEP to HEP alone (minimal intervention comparison for patients with subacute or chronic back-related leg pain. Discussion Back-related leg pain (BRLP is a costly and often disabling variation of the ubiquitous back pain conditions. As health care costs continue to climb, the search for effective treatments with few side-effects is critical. While SMT is the most commonly sought CAM treatment for LBP sufferers, there is only a small, albeit promising, body of research to support its use for patients with BRLP. This study seeks to fill a critical gap in the LBP literature by performing the first full scale RCT assessing chiropractic SMT for patients with sub-acute or chronic BRLP using important patient-oriented and objective biomechanical outcome measures. Trial Registration ClinicalTrials.gov NCT00494065

  6. (31)P cardiac magnetic resonance spectroscopy during leg exercise at 3 Tesla.

    Science.gov (United States)

    Hudsmith, Lucy E; Tyler, Damian J; Emmanuel, Yaso; Petersen, Steffen E; Francis, Jane M; Watkins, Hugh; Clarke, Kieran; Robson, Matthew D; Neubauer, Stefan

    2009-12-01

    Investigation of phosphorus ((31)P) magnetic resonance spectroscopy under stress conditions provides a non-invasive tool to examine alterations in cardiac high-energy phosphate metabolism that may not be evident at rest. Our aim was to establish cardiac (31)P MR spectroscopy during leg exercise at 3T. The increased field strength should provide a higher signal to noise ratio than at lower field strengths. Furthermore, relatively high temporal resolution at a sufficiently fine spatial resolution should be feasible. (31)P MR spectra were obtained with a 3D acquisition weighted chemical shift imaging sequence in 20 healthy volunteers at rest, during dynamic physiological leg exercise and after recovery at 3T. Haemodynamic measurements were made throughout and the rate pressure product calculated. With exercise, the mean heart rate increased by 73%, achieving a mean increase in rate pressure product of 115%. The corrected PCr/ATP ratio for subjects at rest was 2.02 +/- 0.43, exercise 2.14 +/- 0.67 (P = 0.54 vs. rest) and at recovery 2.03 +/- 0.52 (P = 0.91 vs. rest, P = 0.62 vs. exercise). A cardiac (31)P MR spectroscopy physiological exercise-recovery protocol is feasible at 3T. There was no significant change in high-energy cardiac phosphate metabolite concentrations in healthy volunteers at rest, during physiological leg exercise or during recovery. When applied to patients with heart disease, this protocol should provide insights into physiological and pathological cardiac metabolism.

  7. Patients' Attitudes Toward Nonphysician Screening of Low Back and Low Back Related Leg Pain Complaints Referred for Surgical Assessment.

    Science.gov (United States)

    Rempel, Joshua; Busse, Jason W; Drew, Brian; Reddy, Kesava; Cenic, Aleksa; Kachur, Edward; Murty, Naresh; Candelaria, Henry; Moore, Ainsley E; Riva, John J

    2017-03-01

    A questionnaire survey. The aim of this study was to explore patient attitudes toward screening to assess suitability for low back surgery by nonphysician health care providers. Canadian spine surgeons have shown support for nonphysician screening to assess and triage patients with low back pain and low back related leg pain. However, patients' attitudes toward this proposed model are largely unknown. We administered a 19-item cross-sectional survey to adults with low back and/or low back related leg pain who were referred for elective surgical assessment at one of five spine surgeons' clinics in Hamilton, Ontario, Canada. The survey inquired about demographics, expectations regarding wait time for surgical consultation, as well as willingness to pay, travel, and be screened by nonphysician health care providers. Eighty low back patients completed our survey, for a response rate of 86.0% (80 of 93). Most respondents (72.5%; 58 of 80) expected to be seen by a surgeon within 3 months of referral, and 88.8% (71 of 80) indicated willingness to undergo screening with a nonphysician health care provider to establish whether they were potentially a surgical candidate. Half of respondents (40 of 80) were willing to travel >50 km for assessment by a nonphysician health care provider, and 46.2% were willing to pay out-of-pocket (25.6% were unsure). However, most respondents (70.0%; 56 of 80) would still want to see a surgeon if they were ruled out as a surgical candidate, and written comments from respondents revealed concern regarding agreement between surgeons' and nonphysicians' determination of surgical candidates. Patients referred for surgical consultation for low back or low back related leg pain are largely willing to accept screening by nonphysician health care providers. Future research should explore the concordance of screening results between surgeon and nonphysician health care providers. 3.

  8. Design of an Electric Commutated Frog-Leg Winding Permanent-Magnet DC Machine

    Directory of Open Access Journals (Sweden)

    Hang Zhang

    2014-03-01

    Full Text Available An electric commutated frog-leg winding permanent-magnet (PM DC machine is proposed in this paper. It has a semi-closed slotted stator with a classical type of mesh winding introduced from the conventional brushed DC machine and a polyphase electric commutation besides a PM excitation rotor and a circular arrayed Hall position sensor. Under the cooperation between the position sensor and the electric commutation, the proposed machine is basically operated on the same principle of the brushed one. Because of its simplex frog-leg winding, the combination between poles and slots is designed as 4/22, and the number of phases is set as 11. By applying an exact analytical method, which is verified comparable with the finite element analyses (FEA, to the prediction of its instantaneous magnetic field, electromotive force (EMF, cogging torque and output torque, it is well designed with a series of parameters in dimension aiming at the lowest cogging torque. A 230 W, 4-pole, and 22-slot new machine is prototyped and tested to verify the analysis.

  9. Signatures of pairing in the magnetic excitation spectrum of strongly correlated two-leg ladders

    Science.gov (United States)

    Nocera, A.; Patel, N. D.; Dagotto, E.; Alvarez, G.

    2017-11-01

    Magnetic interactions are widely believed to play a crucial role in the microscopic mechanism leading to high critical temperature superconductivity. It is therefore important to study the signatures of pairing in the magnetic excitation spectrum of simple models known to show unconventional superconducting tendencies. Using the density matrix renormalization group technique, we calculate the dynamical spin structure factor S (k ,ω ) of a generalized t -U -J Hubbard model away from half filling in a two-leg ladder geometry. The addition of J enhances pairing tendencies. We analyze quantitatively the signatures of pairing in the magnetic excitation spectra. We found that the superconducting pair-correlation strength, that can be estimated independently from ground state properties, is closely correlated with the integrated low-energy magnetic spectral weight in the vicinity of (π ,π ) . In this wave-vector region, robust spin incommensurate features develop with increasing doping. The branch of the spectrum with rung direction wave vector krung=0 does not change substantially with doping where pairing dominates and thus plays a minor role. We discuss the implications of our results for neutron scattering experiments, where the spin excitation dynamics of hole-doped quasi-one-dimensional magnetic materials can be measured and also address implications for recent resonant inelastic x-ray scattering experiments.

  10. Establishing Intra- and Inter-Rater Agreement of the Face, Legs, Activity, Cry, Consolability Scale for Evaluating Pain in Toddlers During Immunization

    Directory of Open Access Journals (Sweden)

    Rebecca J Gomez

    2013-01-01

    Full Text Available BACKGROUND: The Face, Legs, Activity, Cry, Consolability (FLACC scale is a five-item tool that was developed to assess postoperative pain in young children. The tool is frequently used as an outcome measure in studies investigating acute procedural pain in young children; however, there are limited published psychometric data in this context.

  11. Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with 'nociceptive', 'peripheral neuropathic' and 'central sensitisation' pain. The discriminant validity of mechanisms-based classifications of low back (±leg) pain.

    LENUS (Irish Health Repository)

    Smart, Keith M

    2012-04-01

    Evidence of validity is required to support the use of mechanisms-based classifications of pain clinically. The purpose of this study was to evaluate the discriminant validity of \\'nociceptive\\' (NP), \\'peripheral neuropathic\\' (PNP) and \\'central sensitisation\\' (CSP) as mechanisms-based classifications of pain in patients with low back (±leg) pain by evaluating the extent to which patients classified in this way differ from one another according to health measures associated with various dimensions of pain. This study employed a cross-sectional, between-subjects design. Four hundred and sixty-four patients with low back (±leg) pain were assessed using a standardised assessment protocol. Clinicians classified each patient\\'s pain using a mechanisms-based classification approach. Patients completed a number of self-report measures associated with pain severity, health-related quality of life, functional disability, anxiety and depression. Discriminant validity was evaluated using a multivariate analysis of variance. There was a statistically significant difference between pain classifications on the combined self-report measures, (p = .001; Pillai\\'s Trace = .33; partial eta squared = .16). Patients classified with CSP (n = 106) reported significantly more severe pain, poorer general health-related quality of life, and greater levels of back pain-related disability, depression and anxiety compared to those classified with PNP (n = 102) and NP (n = 256). A similar pattern was found in patients with PNP compared to NP. Mechanisms-based pain classifications may reflect meaningful differences in attributes underlying the multidimensionality of pain. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.

  12. EVALUATING THE INFLUENCE OF MASSAGE ON LEG STRENGTH, SWELLING, AND PAIN FOLLOWING A HALF-MARATHON

    Directory of Open Access Journals (Sweden)

    Peter M. Tiidus

    2004-11-01

    Full Text Available Massage therapy is commonly used following endurance running races with the expectation that it will enhance post-run recovery of muscle function and reduce soreness. A limited number of studies have reported little or no influence of massage therapy on post-exercise muscle recovery. However, no studies have been conducted in a field setting to assess the potential for massage to influence muscle recovery following an actual endurance running race. To evaluate the potential for repeated massage therapy interventions to influence recovery of quadriceps and hamstring muscle soreness, recovery of quadriceps and hamstring muscle strength and reduction of upper leg muscle swelling over a two week recovery period following an actual road running race. Twelve adult recreational runners (8 male, 4 female completed a half marathon (21.1 km road race. On days 1,4, 8, and 11 post-race, subjects received 30 minutes of standardized massage therapy performed by a registered massage therapist on a randomly assigned massage treatment leg, while the other (control leg received no massage treatment. Two days prior to the race (baseline and preceding the treatments on post-race days 1, 4, 8, and 11 the following measures were conducted on each of the massage and control legs: strength of quadriceps and hamstring muscles, leg swelling, and soreness perception. At day 1, post-race quadriceps peak torque was significantly reduced (p 0.05. All measures had returned to baseline at day 11. Massage did not affect the recovery of muscles in terms of physiological measures of strength, swelling, or soreness. However, questionnaires revealed that 7 of the 12 participants perceived that the massaged leg felt better upon recovery.

  13. Comparison of the EuroQOL-5D with the Oswestry Disability Index, back and leg pain scores in patients with degenerative lumbar spine pathology.

    Science.gov (United States)

    Mueller, Benjamin; Carreon, Leah Y; Glassman, Steven D

    2013-04-20

    Cross-sectional study. To evaluate the response behavior of EuroQOL-5D (EQ-5D) compared with the Oswestry Disability Index (ODI), and back and leg pain scores. Recent changes in policies have highlighted the need for demonstration of both quality and cost effectiveness. In an effort to meet these requirements, surgeons are collecting health-related quality of life and utility data. Unfortunately, the burden of extensive data collection on both physician and patient is considerable. The EQ-5D is a commonly used, easily administered, brief utility measure that can provide both clinical and utility data. The EQ-5D has not yet been validated in spine patients in comparison with established outcome measures. EQ-5D, ODI, back and leg pain (0-10) scores were collected as part of standard clinical practice. Spearman rank correlations between the ODI, back and leg pain scores, and the EQ-5D were determined. A subanalysis to determine dimension-specific effects was done. Data were categorized by level of low back disability and level of back and leg pain. Data from 8385 patients (5046 females, 3339 males), mean age 52 (range, 18-96) were analyzed. There was a strong correlation between EQ-5D and ODI (r = -0.776) and between EQ-5D and back pain (r = -0.648); and moderate correlation between EQ-5D and leg pain scores (r = -0.538). Increasing disability, as measured by ODI, lead to lower EQ-5D scores, with similar response behavior for both back and leg pain scores. All correlations were statistically significant at P < 0.0001. The EQ-5D correlated well with established spine outcome measures, including ODI, and back and leg pain scores. EQ-5D correlated best with ODI scores. Correlation with back pain was stronger than leg pain, but all correlations were relatively strong. The EQ-5D can serve spine surgeons as an effective measure of clinical outcome and health utility for economic analysis.

  14. Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study.

    Science.gov (United States)

    Sjödahl, Jenny; Gutke, Annelie; Ghaffari, Ghazaleh; Strömberg, Tomas; Öberg, Birgitta

    2016-06-01

    The relationship between activation of the stabilizing muscles of the lumbopelvic region during the Active Straight Leg Raise test and pelvic girdle pain remains unknown. Therefore, the aim was to examine automatic contractions in relation to pre-activation in the muscles of the pelvic floor and the lower lateral abdominal wall during leg lifts, performed as the Active Straight Leg Raise test, in women with and without persistent postpartum pelvic girdle pain. Sixteen women with pelvic girdle pain and eleven pain-free women performed contralateral and ipsilateral leg lifts, while surface electromyographic activity was recorded from the pelvic floor and unilaterally from the lower lateral abdominal wall. As participants performed leg lifts onset time was calculated as the time from increased muscle activity to leg lift initiation. No significant differences were observed between the groups during the contralateral leg lift. During the subsequent ipsilateral leg lift, pre-activation in the pelvic floor muscles was observed in 36% of women with pelvic girdle pain and in 91% of pain-free women (P=0.01). Compared to pain-free women, women with pelvic girdle pain also showed significantly later onset time in both the pelvic floor muscles (P=0.01) and the muscles of the lower lateral abdominal wall (Pactivation patterns influence women's ability to stabilize the pelvis during leg lifts. This could be linked to provocation of pain during repeated movements. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Cultural adaptation to Brazilian Portuguese of the Face, Legs, Activity, Cry, Consolability revised (FLACCr scale of pain assessment

    Directory of Open Access Journals (Sweden)

    Edna Aparecida Bussotti

    2015-08-01

    Full Text Available AbstractObjective: to perform the translation into Brazilian Portuguese and cultural adaptation of the Face, Legs, Activity, Cry, Consolability revised (FLACCr scale, with children under 18 years old, affected by cerebral palsy, presenting or not cognitive impairment and unable to report their pain.Method: methodological development study of translation into Portuguese and cultural adaptation of the FLACCr. After approval by the ethics committee, the process aimed at translation and back-translation, evaluation of translation and back-translation using the Delphi technique and assessment of cultural equivalence. The process included the five categories of the scale and the four application instructions, considering levels of agreement equal to or greater than 80%.Results: it was necessary three rounds of the Delphi technique to achieve consensus among experts. The agreement achieved for the five categories was: Face 95.5%, Legs 90%, Activity 94.4%, Cry 94.4% and Consolability 99.4%. The four instructions achieved the following consensus levels: 1st 99.1%, 2nd 99.2%, 3rd 99.1% and 4th 98.3%.Conclusion: the method enabled the translation and cultural adaptation of the FLACCr. This is a study able to expand the knowledge of Brazilian professionals on pain assessment in children with CP

  16. The Influence of Dual Pressure Biofeedback Units on Pelvic Rotation and Abdominal Muscle Activity during the Active Straight Leg Raise in Women with Chronic Lower Back Pain

    OpenAIRE

    Noh, Kyung-Hee; Kim, Ji-Won; Kim, Gyoung-Mo; Ha, Sung-Min; Oh, Jae-Seop

    2014-01-01

    [Purpose] This study was performed to assess the influence of applying dual pressure biofeedback units (DPBUs) on the angle of pelvic rotation and abdominal muscle activity during the active straight leg raise (ASLR). [Subjects] Seventeen patients with low-back pain (LBP) participated in this study. [Methods] The subjects were asked to perform an active straight leg raise (ASLR) without a PBU, with a single PBU, and with DPBUs. The angles of pelvic rotation were measured using a three-dimensi...

  17. Restless legs syndrome: a new entity of neuropathic pain? Treatment with prolonged release oxycodone/naloxone combination

    Directory of Open Access Journals (Sweden)

    Gemignani F

    2016-04-01

    Full Text Available Franco Gemignani,1 Andrea Melpignano,1,2 Giulia Milioli,1,2 Silvia Riccardi,1,2 Liborio Parrino1,2 1Neurology Unit, Department of Neurosciences, University of Parma, Parma, Italy; 2Sleep Disorders Center, Department of Neurosciences, University of Parma, Parma, Italy Abstract: Restless legs syndrome (RLS is a disorder of sensorimotor integration characterized by an urge to move the legs when at rest, especially at night or in the evening, which is relieved by movement. Sensory symptoms may be prominent, often exhibiting features consistent with neuropathic pain. Iron deficiency and genetic factors are implicated in RLS causation in most patients. The pathogenetic model of impaired circadian dopaminergic modulation of sensorimotor integration circuitry at the spinal level is fitting with the co-occurrence of movement disorders, sensory symptoms, and sleep disruption in RLS. Accordingly, levodopa and dopamine agonists are effective for RLS symptoms, which compensate for the impaired descending control by diencephalo-spinal dopa(minergic pathway. Dopamine agonists are usually indicated as the first-line therapy, but their use in long-term treatment is often complicated by augmentation and impulse control disorder, thus alpha-2-delta ligands also are now considered the first line of treatment. It has been recognized that endogenous opioid system is also involved in the mechanisms generating RLS, possibly through an impaired modulation of pain pathways. Opioids can be considered as an alternative therapy, particularly in patients with augmentation and/or refractory to other treatments. Recently introduced prolonged-release oxycodone–naloxone was efficacious for short-term treatment of patients with severe RLS inadequately controlled with previous treatment. It will be important to assess whether opioids, as well as other drugs, are especially effective in definite RLS subtypes such as the painful phenotype. Keywords: small fiber neuropathy

  18. Comprehensive study of back and leg pain improvements after adult spinal deformity surgery: analysis of 421 patients with 2-year follow-up and of the impact of the surgery on treatment satisfaction.

    Science.gov (United States)

    Scheer, Justin K; Smith, Justin S; Clark, Aaron J; Lafage, Virginie; Kim, Han Jo; Rolston, John D; Eastlack, Robert; Hart, Robert A; Protopsaltis, Themistocles S; Kelly, Michael P; Kebaish, Khaled; Gupta, Munish; Klineberg, Eric; Hostin, Richard; Shaffrey, Christopher I; Schwab, Frank; Ames, Christopher P

    2015-05-01

    OBJECT Back and leg pain are the primary outcomes of adult spinal deformity (ASD) and predict patients' seeking of surgical management. The authors sought to characterize changes in back and leg pain after operative or nonoperative management of ASD. Outcomes were assessed according to pain severity, type of surgical procedure, Scoliosis Research Society (SRS)-Schwab spine deformity class, and patient satisfaction. METHODS This study retrospectively reviewed data in a prospective multicenter database of ASD patients. Inclusion criteria were the following: age > 18 years and presence of spinal deformity as defined by a scoliosis Cobb angle ≥ 20°, sagittal vertical axis length ≥ 5 cm, pelvic tilt angle ≥ 25°, or thoracic kyphosis angle ≥ 60°. Patients were grouped into nonoperated and operated subcohorts and by the type of surgical procedure, spine SRS-Schwab deformity class, preoperative pain severity, and patient satisfaction. Numerical rating scale (NRS) scores of back and leg pain, Oswestry Disability Index (ODI) scores, physical component summary (PCS) scores of the 36-Item Short Form Health Survey, minimum clinically important differences (MCIDs), and substantial clinical benefits (SCBs) were assessed. RESULTS Patients in whom ASD had been operatively managed were 6 times more likely to have an improvement in back pain and 3 times more likely to have an improvement in leg pain than patients in whom ASD had been nonoperatively managed. Patients whose ASD had been managed nonoperatively were more likely to have their back or leg pain remain the same or worsen. The incidence of postoperative leg pain was 37.0% at 6 weeks postoperatively and 33.3% at the 2-year follow-up (FU). At the 2-year FU, among patients with any preoperative back or leg pain, 24.3% and 37.8% were free of back and leg pain, respectively, and among patients with severe (NRS scores of 7-10) preoperative back or leg pain, 21.0% and 32.8% were free of back and leg pain, respectively

  19. Application of a classification system and description of a combined manual therapy intervention: a case with low back related leg pain.

    Science.gov (United States)

    Petersen, Shannon M; Scott, Daphne R

    2010-06-01

    Low back pain and leg pain commonly occur together. Multiple factors can cause low back related leg pain; therefore, identification of the source of symptoms is required in order to develop an appropriate intervention program. The patient in this case presented with low back and leg pain. A patho-mechanism based classification is described in combination with the patient's subjective and objective examination findings to guide treatment. The patient's symptoms improved marginally with intervention addressing primarily the musculoskeletal impairments and with intervention addressing primarily the neurodynamic impairments. Full functional improvements were attained with a manual therapy intervention directed at both mechanisms simultaneously. The approach described in this case address a mixed pathology utilizing passive accessory and passive physiological lumbar mobilizations in combination with lower extremity neurodynamic mobilization. The patient reported complete resolution of symptoms after a total of seven visits over a period of 6 weeks. While specific guidelines do not yet exist for treatment based on the classification approach utilized, this case report provides an example of manual therapy to address low back related leg pain of mixed pathology.

  20. Doppler ultrasound exam of an arm or leg

    Science.gov (United States)

    Peripheral vascular disease - Doppler; PVD - Doppler; PAD - Doppler; Blockage of leg arteries - Doppler; Intermittent claudication - Doppler; Arterial insufficiency of the legs - Doppler; Leg pain and ...

  1. Novel 10-kHz High-frequency Therapy (HF10 Therapy) Is Superior to Traditional Low-frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: The SENZA-RCT Randomized Controlled Trial.

    Science.gov (United States)

    Kapural, Leonardo; Yu, Cong; Doust, Matthew W; Gliner, Bradford E; Vallejo, Ricardo; Sitzman, B Todd; Amirdelfan, Kasra; Morgan, Donna M; Brown, Lora L; Yearwood, Thomas L; Bundschu, Richard; Burton, Allen W; Yang, Thomas; Benyamin, Ramsin; Burgher, Abram H

    2015-10-01

    Current treatments for chronic pain have limited effectiveness and commonly known side effects. Given the prevalence and burden of intractable pain, additional therapeutic approaches are desired. Spinal cord stimulation (SCS) delivered at 10 kHz (as in HF10 therapy) may provide pain relief without the paresthesias typical of traditional low-frequency SCS. The objective of this randomized, parallel-arm, noninferiority study was to compare long-term safety and efficacy of SCS therapies in patients with back and leg pain. A total of 198 subjects with both back and leg pain were randomized in a 1:1 ratio to a treatment group across 10 comprehensive pain treatment centers. Of these, 171 passed a temporary trial and were implanted with an SCS system. Responders (the primary outcome) were defined as having 50% or greater back pain reduction with no stimulation-related neurological deficit. At 3 months, 84.5% of implanted HF10 therapy subjects were responders for back pain and 83.1% for leg pain, and 43.8% of traditional SCS subjects were responders for back pain and 55.5% for leg pain (P leg pain comparisons). The relative ratio for responders was 1.9 (95% CI, 1.4 to 2.5) for back pain and 1.5 (95% CI, 1.2 to 1.9) for leg pain. The superiority of HF10 therapy over traditional SCS for leg and back pain was sustained through 12 months (P leg pain with broad applicability to patients, physicians, and payers.

  2. Comparison between Infusion Pumps: Fentanyl/Ketamine and Fentanyl/Paracetamol in Pain control Following Tight and Leg Surgeries

    Directory of Open Access Journals (Sweden)

    Behnam Mahmoodiyeh

    2016-08-01

    Full Text Available Background: Adjuvants such as ketamine, promethazine and paracetamol could bring up patients satisfaction and control harmful effects of opioids besides lessening their needed doses, as seen by fentanyl/paracetamol and fentanyl/ketamine combination before. The current study headed to compare paracetamol and ketamine in addition to fentanyl applied by infusion pumps in order to pain relief following major surgery.Methods: Through a double blinded randomized clinical trial, patients between18 and 65 with elective surgery for tight or leg fractures with ASA Class 1 and 2 referring to a university hospital in Arak, a town in central region of Iran, were recruited and used infusion pump for their postoperative pain control. The participants were divided into cases and controls regarding using ketamine/fentanyl (KF or paracetamol/fentanyl (PF infusion pumps.Results: The mean pain score was totally 3.87 with higher value in KF (5.06 and lower in PF (4.5 immediately after finishing surgery and getting conscious when started using infusion pump. There was no statistical difference between the groups in this regard. Concerning the side effects of the applied medications, blood pressure and heart rate had no differences comparing the groups.Conclusion: This study showed that paracetamol used in infusion pump can be brilliant in pain control after major surgeries like what done in lower extremities and joint replacement while lessens opioid use. Although paracetamol was more effective than ketamine in the current trial, more qualified studies at bigger size and in other fields of surgery beside orthopedic ones would be useful to support the effects if applicable.Keywords: Infusion pump, Ketamine, Paracetamol, Fentanyl, Postoperative pain

  3. Magnetic resonance arthrography of the shoulder: a painful procedure?

    Directory of Open Access Journals (Sweden)

    Paulo César Xavier do Nascimento

    2018-03-01

    Full Text Available Abstract Objective: To compare the pain expected to that effectively caused by magnetic resonance arthrography of the shoulder and, secondarily, to describe a simplified approach to the technique for articular access. Materials and Methods: We prospectively evaluated 40 participants who used a visual analog scale and a simplified categorical scale to indicate the level of pain expected and that experienced after the procedure, comparing the two with the Wilcoxon matched-pairs test. We also determined gender-related differences in pain conditions using the Mann-Whitney U test. In addition, we described a modified technique involving radiographic localization and the use of standard puncture needles for articular access. Results: Analysis of the visual analog scales showed that the pain experienced was less than had been expected, with median scores of 1.75 and 3.75, respectively (p < 0.001. The level of pain expected was higher among women than among men, with median scores of 8.0 and 3.0, respectively (p = 0.014, as was the level of pain experienced, with median scores of 3.0 and 1.5, respectively (p = 0.139. The overall categorical evaluation corroborated that difference (p = 0.03. Articular access with the modified technique was successful in all patients. Conclusion: Magnetic resonance arthrography of the shoulder is less painful than patients expect. In addition, digital radiographic guidance combined with the use of standard puncture needles appears to improve the efficiency of the method.

  4. Imaging of Groin Pain: Magnetic Resonance and Ultrasound Imaging Features.

    Science.gov (United States)

    Lee, Susan C; Endo, Yoshimi; Potter, Hollis G

    Evaluation of groin pain in athletes may be challenging as pain is typically poorly localized and the pubic symphyseal region comprises closely approximated tendons and muscles. As such, magnetic resonance imaging (MRI) and ultrasound (US) may help determine the etiology of groin pain. A PubMed search was performed using the following search terms: ultrasound, magnetic resonance imaging, sports hernia, athletic pubalgia, and groin pain. Date restrictions were not placed on the literature search. Clinical review. Level 4. MRI is sensitive in diagnosing pathology in groin pain. Not only can MRI be used to image rectus abdominis/adductor longus aponeurosis and pubic bone pathology, but it can also evaluate other pathology within the hip and pelvis. MRI is especially helpful when groin pain is poorly localized. Real-time capability makes ultrasound useful in evaluating the pubic symphyseal region, as it can be used for evaluation and treatment. MRI and US are valuable in diagnosing pathology in athletes with groin pain, with the added utility of treatment using US-guided intervention. Strength-of Recommendation Taxonomy: C.

  5. Prevention and treatment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch Armed Forces.

    Science.gov (United States)

    Zimmermann, Wes O; Helmhout, P H; Beutler, A

    2017-04-01

    Overuse injuries of the leg are a common problem for young soldiers. This article reviews the literature concerning the prevention and treatment of exercise related leg pain in military settings and presents the latest developments in proposed mechanisms and treatments. Current practice and treatment protocols from the Dutch Armed Forces are reviewed, with an emphasis on the most prevalent conditions of medial tibial stress syndrome and chronic exertional compartment syndrome. The conclusion is that exercise related leg pain in the military is an occupational problem that deserves further study. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  6. Aortic Dissection and Thrombosis Diagnosed by Emergency Ultrasound in a Patient with Leg Pain and Paralysis

    Directory of Open Access Journals (Sweden)

    Ann H. Tsung

    2013-01-01

    Full Text Available The authors present a case of aortic dissection and abdominal aortic aneurysm thrombosis in a 78-year-old male who presented to the emergency department (ED complaining of lower extremity and paralysis for the past 1.5 hours. The initial vital signs in the ED were as follows: blood pressure (BP 132/88 mmHg, heart rate (HR 96, respiratory rate (RR 14, and an oxygen saturation of 94% at room air. Physical exam was notable for pale and cold left leg. The ED physician was unable to palpate or detect a Doppler signal in the left femoral artery. Bedside ultrasound was performed which showed non-pulsatile left femoral artery and limited flow on color Doppler. Abdominal aortic aneurysm screening ultrasound was performed showing a 4.99 cm infrarenal abdominal aortic aneurysm and an intra-aortic thrombus with an intimal flap. Vascular surgery was promptly contacted and the patient underwent emergent aorto-bi-femoral bypass, bilateral four compartment fasciotomy, right common femoral artery endarterectomy with profundoplasty, and subsequent left leg amputation. Emergency physicians should utilize bedside ultrasound in patients who present with risk factors or threatening signs and symptoms that may suggest aortic dissection or aneurysm. Bedside ultrasound decreases time to definitive treatment and the mortality of the patients.

  7. Femoral infarction following intraarterial chemotherapy for osteosarcoma of the leg: A possible pitfall in magnetic resonance imaging

    International Nuclear Information System (INIS)

    Ollivier, L.; Leclerc, J.; Pouillart, P.; Vanel, D.; Forest, M.; Tomeno, B.; Riche, M.C.

    1991-01-01

    Bone infarction of the distal femur is reported in two patients with osteosarcoma of the leg (1 tibia, 1 fibula) treated by preoperative chemotherapy including intraarterial chemotherapy (IAC) by Cis-platinum. Both patients were examined by magnetic resonance imaging before chemotherapy and again prior to limb salvage surgery. The location of these lesions in the distal femur must suggest bone infarction especially if the tumor has decreased in size under treatment. (orig.)

  8. Does magnetic resonance imaging predict future low back pain?

    DEFF Research Database (Denmark)

    Steffens, D; Hancock, M J; Maher, C G

    2014-01-01

    Magnetic resonance imaging (MRI) has the potential to identify pathology responsible for low back pain (LBP). However, the importance of findings on MRI remains controversial. We aimed to systematically review whether MRI findings of the lumbar spine predict future LBP in different samples with a...

  9. Subcutaneous Stimulation as an Additional Therapy to Spinal Cord Stimulation for the Treatment of Low Back Pain and Leg Pain in Failed Back Surgery Syndrome: Four-Year Follow-Up.

    Science.gov (United States)

    Hamm-Faber, Tanja E; Aukes, Hans; van Gorp, Eric-Jan; Gültuna, Ismail

    2015-10-01

    The objective of this study is to investigate the efficacy of long-term follow-up of subcutaneous stimulation (SubQ) as an additional therapy for patients with failed back surgery syndrome (FBSS) with chronic refractory pain, for whom spinal cord stimulation (SCS) alone was unsuccessful in treating low back pain. Prospective case series. FBSS patients with leg and/or low back pain whose conventional therapies had failed, received a combination of SCS (8-contact Octad lead, 3877-45 cm, Medtronic, Minneapolis, MN, USA) and/or SubQ (4-contact Quad Plus lead (s), 2888-28 cm, Medtronic). Initially, an Octad lead was placed in the epidural space for SCS for a trial stimulation to assess the suppression of leg and/or low back pain. Where SCS alone was insufficient in treating low back pain, lead(s) were placed superficially in the subcutaneous tissue of the lower back, exactly in the middle of the pain area. A pulse generator (Prime Advanced, 37702, Medtronic) was implanted if the patient reported more than 50% pain relief during the trial period. We investigated the long-term effect of neuromodulation on pain with the visual analog scale (VAS), and disability using the Quebec Pain Disability Scale. The results after 46 months are presented. Eleven patients, five men and six women (age 51 ± 8 years, mean ± SD) were included in the pilot study. In nine cases, SCS was used in combination with SubQ leads. Two patients received only SubQ leads. In one patient, the SCS + SubQ system was removed after nine months and these results were not taken into account for the analysis. Baseline scores for leg (N = 8) and low back pain (N = 10) were VASbl: 59 ± 15 and VASbl: 63 ± 14, respectively. The long-term follow-up period was 46 ± 4 months. SCS significantly reduced leg pain after 12 months (VAS12: 20 ± 11, p12 = 0.001) and 46 months (VAS46: 37 ± 17, p46 = 0.027). Similarly, SubQ significantly reduced back pain after 12 months(VAS12: 33 ± 16, p12 = 0.001) and 46 months

  10. Predicting SF-6D utility scores from the Oswestry disability index and numeric rating scales for back and leg pain.

    Science.gov (United States)

    Carreon, Leah Y; Glassman, Steven D; McDonough, Christine M; Rampersaud, Raja; Berven, Sigurd; Shainline, Michael

    2009-09-01

    Cross-sectional cohort. The purpose of this study is to provide a model to allow estimation of utility from the Short Form (SF)-6D using data from the Oswestry Disability Index (ODI), Back Pain Numeric Rating Scale (BPNRS), and the Leg Pain Numeric Rating Scale (LPNRS). Cost-utility analysis provides important information about the relative value of interventions and requires a measure of utility not often available from clinical trial data. The ODI and numeric rating scales for back (BPNRS) and leg pain (LPNRS), are widely used disease-specific measures for health-related quality of life in patients with lumbar degenerative disorders. The purpose of this study is to provide a model to allow estimation of utility from the SF-6D using data from the ODI, BPNRS, and the LPNRS. SF-36, ODI, BPNRS, and LPNRS were prospectively collected before surgery, at 12 and 24 months after surgery in 2640 patients undergoing lumbar fusion for degenerative disorders. Spearman correlation coefficients for paired observations from multiple time points between ODI, BPNRS, and LPNRS, and SF-6D utility scores were determined. Regression modeling was done to compute the SF-6D score from the ODI, BPNRS, and LPNRS. Using a separate, independent dataset of 2174 patients in which actual SF-6D and ODI scores were available, the SF-6D was estimated for each subject and compared to their actual SF-6D. In the development sample, the mean age was 52.5 +/- 15 years and 34% were male. In the validation sample, the mean age was 52.9 +/- 14.2 years and 44% were male. Correlations between the SF-6D and the ODI, BPNRS, and LPNRS were statistically significant (P < 0.0001) with correlation coefficients of 0.82, 0.78, and 0.72, respectively. The regression equation using ODI, BPNRS,and LPNRS to predict SF-6D had an R of 0.69 and a root mean square error of 0.076. The model using ODI alone had an R of 0.67 and a root mean square error of 0.078. The correlation coefficient between the observed and estimated

  11. Reliability of MR-Based Volumetric 3-D Analysis of Pelvic Muscles among Subjects with Low Back with Leg Pain and Healthy Volunteers

    Science.gov (United States)

    Skorupska, Elżbieta; Keczmer, Przemysław; Łochowski, Rafał M.; Tomal, Paulina; Rychlik, Michał; Samborski, Włodzimierz

    2016-01-01

    Aim Lately, the diagnostic value of magnetic resonance imaging, Lasègue sign and classic neurological signs have been considered not accurate enough to distinguish the radicular from non-radicular low back with leg pain (LBLP) and a calculation of the symptomatic side muscle volume has been indicated as a probable valuable marker. However, only the multifidus muscle volume has been calculated so far. The main objective of the study was to verify whether LBLP subjects presented symptomatic side pelvic muscle atrophy compared to healthy volunteers. The second aim was to assess the inter-rater reliability of 3-D manual method for segmenting and measuring the volume of the gluteus maximus, gluteus medius, gluteus minimus and piriformis muscles in both LBLP patients and healthy subjects. Method Two independent raters analyzed MR images of LBLP and healthy subjects towards muscle volume of four pelvic muscles, i.e. the piriformis, gluteus minimus, gluteus medius and gluteus maximus. For both sides, the MR images of the muscles without adipose tissue infiltration were manually segmented in 3-D medical images. Results Symptomatic muscle atrophy was confirmed in only over 50% of LBLP subjects (gluteus maximus (pgluteus minimus (pgluteus medius muscle in LBLP patients, which was equal to 0.848. Conclusion More than 50% of LBLP subjects presented symptomatic gluteus maximus, gluteus minimus and piriformis muscle atrophy. 3-D manual segmentation reliably measured muscle volume in all the measured pelvic muscles in both healthy and LBLP subjects. To answer the question of what kind of muscle atrophy is indicative of radicular or non-radicular pain further studies are required. PMID:27459688

  12. Reliability of MR-Based Volumetric 3-D Analysis of Pelvic Muscles among Subjects with Low Back with Leg Pain and Healthy Volunteers.

    Directory of Open Access Journals (Sweden)

    Elżbieta Skorupska

    Full Text Available Lately, the diagnostic value of magnetic resonance imaging, Lasègue sign and classic neurological signs have been considered not accurate enough to distinguish the radicular from non-radicular low back with leg pain (LBLP and a calculation of the symptomatic side muscle volume has been indicated as a probable valuable marker. However, only the multifidus muscle volume has been calculated so far. The main objective of the study was to verify whether LBLP subjects presented symptomatic side pelvic muscle atrophy compared to healthy volunteers. The second aim was to assess the inter-rater reliability of 3-D manual method for segmenting and measuring the volume of the gluteus maximus, gluteus medius, gluteus minimus and piriformis muscles in both LBLP patients and healthy subjects.Two independent raters analyzed MR images of LBLP and healthy subjects towards muscle volume of four pelvic muscles, i.e. the piriformis, gluteus minimus, gluteus medius and gluteus maximus. For both sides, the MR images of the muscles without adipose tissue infiltration were manually segmented in 3-D medical images.Symptomatic muscle atrophy was confirmed in only over 50% of LBLP subjects (gluteus maximus (p<0.001, gluteus minimus (p<0.01 and piriformis (p<0.05. The ICC values indicated that the inter-rater reproducibility was greater than 0.90 for all measurements (LBLP and healthy subjects, except for the measurement of the right gluteus medius muscle in LBLP patients, which was equal to 0.848.More than 50% of LBLP subjects presented symptomatic gluteus maximus, gluteus minimus and piriformis muscle atrophy. 3-D manual segmentation reliably measured muscle volume in all the measured pelvic muscles in both healthy and LBLP subjects. To answer the question of what kind of muscle atrophy is indicative of radicular or non-radicular pain further studies are required.

  13. Venogram - leg

    Science.gov (United States)

    Phlebogram - leg; Venography - leg; Angiogram - leg ... into a vein in the foot of the leg being looked at. An intravenous (IV) line is ... vein. A tourniquet may be placed on your leg so the dye flows into the deeper veins. ...

  14. Effects of functional training on pain, leg strength, and balance in women with fibromyalgia.

    Science.gov (United States)

    Latorre Román, Pedro Ángel; Santos E Campos, María Aparecida; García-Pinillos, Felipe

    2015-01-01

    The aim of this study was to analyze the effect of 18-week functional training (FT) program consisting in two sessions a week of in-water exercise and one of on-land exercise on pain, strength, and balance in women with fibromyalgia. A sample consisting of 36 fibromyalgia patients was included in the study. The patients were allocated randomly into the experimental group (EG, n = 20), and control group (CG, n = 16). Standardized field-based fitness tests were used to assess muscle strength (30-s chair stand and handgrip strength) and agility/dynamic balance and static balance. Fibromyalgia impact and pain were analyzed by Fibromyalgia Impact Questionnaire (FIQ), tender points (TPs), visual analog scale (VAS). We observed a significant reduction in the FIQ (p = 0.042), the algometer scale of TP (p = 0.008), TP (p pain and improves functional capacity in FM patients. These results suggested that FT could play an important role in maintaining an independent lifestyle in patients with FM.

  15. Propulsion phase of the single leg triple hop test in women with patellofemoral pain syndrome: a biomechanical study.

    Directory of Open Access Journals (Sweden)

    Andre Serra Bley

    Full Text Available Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS, caused by an increase in patellofemoral (PF joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT, which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM, gluteus medius (GMed, biceps femoris (BF and vastus lateralis (VL. Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress.

  16. Propulsion Phase of the Single Leg Triple Hop Test in Women with Patellofemoral Pain Syndrome: A Biomechanical Study

    Science.gov (United States)

    Bley, Andre Serra; Correa, João Carlos Ferrari; Reis, Amir Curcio Dos; Rabelo, Nayra Deise Dos Anjos; Marchetti, Paulo Henrique; Lucareli, Paulo Roberto Garcia

    2014-01-01

    Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS), caused by an increase in patellofemoral (PF) joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT), which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM), gluteus medius (GMed), biceps femoris (BF) and vastus lateralis (VL). Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress. PMID:24830289

  17. Clinical course, characteristics and prognostic indicators in patients presenting with back and leg pain in primary care. The ATLAS study protocol

    Directory of Open Access Journals (Sweden)

    Konstantinou Kika

    2012-01-01

    Full Text Available Abstract Background Low-back related leg pain with or without nerve root involvement is associated with a poor prognosis compared to low back pain (LBP alone. Compared to the literature investigating prognostic indicators of outcome for LBP, there is limited evidence on prognostic factors for low back-related leg pain including the group with nerve root pain. This 1 year prospective consultation-based observational cohort study will describe the clinical, imaging, demographic characteristics and health economic outcomes for the whole cohort, will investigate differences and identify prognostic indicators of outcome (i.e. change in disability at 12 months, for the whole cohort and, separately, for those classified with and without nerve root pain. In addition, nested qualitative studies will provide insights on the clinical consultation and the impact of diagnosis and treatment on patients' symptom management and illness trajectory. Methods Adults aged 18 years and over consulting their General Practitioner (GP with LBP and radiating leg pain of any duration at (n = 500 GP practices in North Staffordshire and Stoke-on-Trent, UK will be invited to participate. All participants will receive a standardised assessment at the clinic by a study physiotherapist and will be classified according to the clinically determined presence or absence of nerve root pain/involvement. All will undergo a lumbar spine MRI scan. All participants will be managed according to their clinical need. The study outcomes will be measured at 4 and 12 months using postal self-complete questionnaires. Data will also be collected each month using brief postal questionnaires to enable detailed description of the course of low back and leg pain over time. Clinical observations and patient interviews will be used for the qualitative aspects of the study. Discussion This prospective clinical observational cohort will combine self-reported data, comprehensive clinical and MRI

  18. The effect of a nurse-directed intervention to reduce pain and improve behavioral and physical outcomes in patients with critically colonized/infected chronic leg ulcers.

    Science.gov (United States)

    Kelechi, Teresa J; Mueller, Martina; Spencer, Cam; Rinard, Bobbie; Loftis, Greg

    2014-01-01

    We compared a WOC nurse-directed, patient-centered intervention called MECALF (motivational enhancement and conditioning activity for leg function) compared to conditioning activities for lower leg function (CALF) alone. Outcomes were study feasibility, pain, motivation, self-efficacy, physical activity, leg strength, and range of motion. Comparative study. The sample was drawn from 2 wound centers in the Southeastern United States. Twenty-one patients (n = 12 MECALF site A and n = 9 CALF site B) with painful lower legs and critically colonized/infected wounds participated in the study. All patients received usual wound care per center protocol. The MECALF intervention was delivered by WOC nurses for 6 weeks at site A and a handout of CALF depicting the conditioning activities was provided by site staff (not WOC nurses) to patients at site B. We assessed study feasibility with postsurvey questionnaires given to WOC nurses (training usefulness, ease of use of ME with patients) and subjects (able to perform activities, use logs). Pre- and postintervention outcome data were collected by study staff using pain, motivation, and self-efficacy scales, functional measures of physical activity, and physical measures of strength and range of motion. The study was found to be somewhat feasible by the WOC nurses and patients. WOC nurses had time management problems using MECALF during usual patient care. Patients reported that they were able to perform CALF. Overall pain was statistically significantly reduced (P = .046) in both groups of patients with painful critically colonized/infected leg ulcers measured at week 8, 2 weeks after the study period. The CALF group experienced a slightly greater reduction in pain intensity than did the MECALF group. No statistically significant differences between the groups were observed in behavioral outcomes for motivation (P = .641) and self-efficacy (P = .643), or for physical outcomes including overall ankle strength (P = .609) and

  19. Functional resonance magnetic imaging (fMRI) in adolescents with idiopathic musculoskeletal pain: a paradigm of experimental pain

    OpenAIRE

    Molina, Juliana; Amaro, Edson; da Rocha, Liana Guerra Sanches; Jorge, Liliana; Santos, Flavia Heloisa; Len, Claudio A.

    2017-01-01

    Background Studies on functional magnetic resonance imaging (fMRI) have shown that adults with musculoskeletal pain syndromes tolerate smaller amount of pressure (pain) as well as differences in brain activation patterns in areas related to pain.The objective of this study was to evaluate, through fMRI, the brain activation in adolescents with idiopathic musculoskeletal pain (IMP) while performing an experimental paradigm of pain. Methods The study included 10 consecutive adolescents with idi...

  20. Exertional muscle pain in familial Mediterranean fever patients evaluated by MRI and 31P magnetic resonance spectroscopy

    International Nuclear Information System (INIS)

    Kushnir, T.; Eshed, I.; Heled, Y.; Livneh, A.; Langevitz, P.; Ben Zvi, I.; Konen, E.; Lidar, M.

    2013-01-01

    Aim: To evaluate the effect of physical activity on the structural, morphological, and metabolic characteristics of the gastrocnemius muscle in familial Mediterranean fever (FMF) patients, utilizing quantitative 31 P magnetic resonance spectroscopy (MRS), in order to elucidate the mechanism of their exertional leg pain. Materials and methods: Eleven FMF patients suffering from exertional leg pain (eight male, three female; mean age 33 years) and six healthy individuals (three male, three female; mean age 39 years) constituted the control group. All of the participants underwent magnetic resonance imaging (MRI) and non-selective 31 P MRS (3 T) of the leg muscles before and after graded exercise on a treadmill. Phosphocreatine (PCr):inorganic phosphate (Pi), PCr:adenosine triphosphate (ATP) ratios and the intracellular pH of the leg muscles were measured using 31 P MRS. Results: For both groups, normal muscle mass with no signal alterations was observed on the MRI images after exercise. The normal range of pre- and post- exercise MRS muscle parameters was observed in both groups. However, the intracellular pH post-exercise, was significantly higher (less acidic) in the FMF group compared to the control group [pH (FMF) = 7.03 ± 0.02; pH (control) 7.00 ± 0.02; p < 0.0006]. Conclusions: The finding of a less prominent, post-exercise acidification of the gastrocnemius muscle in this FMF patient group suggests a forme fruste of glycogenosis. This preliminary observation should be further investigated in a future, larger-scale study

  1. Impact of Position on Efficacy of Caudal Epidural Injection for Low Back Pain and Radicular Leg Pain Due to Central Spinal Stenosis and Lumbar Disc Hernia.

    Science.gov (United States)

    Altun, Idiris; Yuksel, Kasım Zafer

    2017-03-01

    This study was performed to evaluate and compare the efficacies of caudal epidural injections performed at prone and lateral decubitus positions. A total of 120 patients suffering from low back pain and radicular leg pain were included and patients were randomly distributed into 2 groups according to the position during injection. In Group 1 (n=60; 32 women, 28 men), caudal epidural injection was performed at prone position, whereas it was implemented at lateral decubitus position in Group 2 (n=60; 33 women, 27 men). Visual analogue scale, Oswestry Disability Index (ODI), walking tolerance (WT) and standing tolerance (ST) were compared in 2 groups before and after injection. In Group 1, ODI values were higher at 30th minute ( p =0.007), 3rd week ( p =0.043) and 6th month ( p =0.013). In Group 1, ODI, VAS and ST values were improved significantly at all follow-up periods compared to initial values. In Group 1, WT scores were better than initial values at 30th minute, 3rd week and 3rd month. In Group 2, ODI scores at 30th minute, 3rd week, 3rd month and 6th month were improved while VAS and ST scores were improved at all periods after injection. WT scores were better at 30th minute, 3rd week and 3rd month compared to initial WT scores. Our results indicated that application of injection procedure at lateral decubitus position allowing a more concentrated local distribution may provide better relief of pain.

  2. October 2001: 40-year-old Xhosa male with back pain and leg weakness.

    Science.gov (United States)

    Rutherfoord, G Stuart; Lamprecht, Deon; Hewlett, Richard H

    2002-04-01

    A 40-year-old Xhosa male presented with progressive upper lumbar back pain and weakness At examination he was emaciated and had enlarged lymph nodes in the groin and axilla. Both lower limbs were severely atrophic and weak. Sensation to touch and pain was decreased below L3 bilaterally. MR of the spine showed a discrete, contrast-enhancing epidural mass. A T10-T12 laminectomy revealed an soft, vascular extradural tumor dorsal to the cord. The mass was loosely applied to the dura and easy to remove. The operative specimen consisted of a sausage-shaped (3.5 x 2.0 x 1.2 cm), thinly-encapsulated mass of reddish-brown tissue. The cut surface had a mottled, vaguely nodular, yellowish-brown appearance. Microscopic examination revealed sheets of hematopoeitic elements, including myeloid, red cell and megakaryocytic lines, the latter showing Factor 8-related positivity. The final diagnosis was extramedullary hematopoiesis (EMH). A bone marrow biopsy performed as a result of the diagnosis showed a myeloproliferative disease and polycythemia vera. EMH in the spinal epidural space is a rare but treatable cause of progressive paraparesis in patients with a variety of hematological disorders. Since 1956 there have been more than 50 reported cases, most of which occurred in association with thalassaemia. In spinal cord compression secondary to EMH, the lesions are commonly localized to the mid-lower thoracic region.

  3. B-Cell lymphoma presenting as mechanical low-back pain with leg pain: the importance of the physical and ultrasound examination of the buttock in patients with low-back and leg pain: a case report

    OpenAIRE

    Guben, Jason N.; Van Der Mark, Robin L.J.; Yeghiayan, Edouard

    2001-01-01

    Malignancies are an important, although rare, cause of back pain which must be a consideration in patients with certain historical factors, or in patients who do not respond to treatment. This case report emphasizes the importance of performing a thorough examination of any unexplained complaint of low back, buttock or hip pain, the need for continual re-evaluation and modification of the initial diagnosis, and the importance of diagnostic ultrasound when clinically indicated. The decision to...

  4. Nonlinear dynamics near resonances of a rotor-active magnetic bearings system with 16-pole legs and time varying stiffness

    Science.gov (United States)

    Wu, R. Q.; Zhang, W.; Yao, M. H.

    2018-02-01

    In this paper, we analyze the complicated nonlinear dynamics of rotor-active magnetic bearings (rotor-AMB) with 16-pole legs and the time varying stiffness. The magnetic force with 16-pole legs is obtained by applying the electromagnetic theory. The governing equation of motion for rotor-active magnetic bearings is derived by using the Newton's second law. The resulting dimensionless equation of motion for the rotor-AMB system is expressed as a two-degree-of-freedom nonlinear system including the parametric excitation, quadratic and cubic nonlinearities. The averaged equation of the rotor-AMB system is obtained by using the method of multiple scales when the primary parametric resonance and 1/2 subharmonic resonance are taken into account. From the frequency-response curves, it is found that there exist the phenomena of the soft-spring type nonlinearity and the hardening-spring type nonlinearity in the rotor-AMB system. The effects of different parameters on the nonlinear dynamic behaviors of the rotor-AMB system are investigated. The numerical results indicate that the periodic, quasi-periodic and chaotic motions occur alternately in the rotor-AMB system.

  5. Social position modifies the association between severe shoulder/arm and knee/leg pain, and quality of life after retirement.

    Science.gov (United States)

    Dionne, Clermont E; Leclerc, Annette; Carton, Matthieu; Mediouni, Zakia; Goldberg, Marcel; Zins, Marie; Descatha, Alexis

    2016-01-01

    Musculoskeletal disorders are extremely frequent and account for an important part of the global burden of disease. Risk factors for musculoskeletal disorders include sustained occupational exposure to physically demanding jobs. The effects of sustained occupational physical exposures on knee and shoulder pain are known to persist after retirement; also, several studies have shown a socio-economic gradient in health and quality-of-life outcomes, including for musculoskeletal pain. It is thus possible that prolonged occupational exposures affect workers differently in the long-term along a socio-economic gradient. This study was conducted to investigate whether the impacts of severe shoulder/arm and knee/leg pain on the quality of life of retired workers follow a socio-economic gradient. Data from the French GAZEL cohort study (n = 14,249) were used to compare the impacts of severe shoulder/arm and knee/leg pain separately on the SF-36, Nottingham Health Profile and limitations in activities of daily living measured in 2006 and 2007, between four groups of social position (measured in 1989). Analyses were made in 2014 with multiple linear and logistic regressions and stratified by sex. For both pain sites, in men and women, there was a strong general tendency for the impacts of severe pain to be smaller among participants in higher social positions. Most important differences were related to pain and physical limitations. These results suggest inequalities in the impacts of severe joint pain by socio-economic status. The source of these inequalities is still speculative and merits the scientific attention.

  6. Estimating EQ-5D values from the Oswestry Disability Index and numeric rating scales for back and leg pain.

    Science.gov (United States)

    Carreon, Leah Y; Bratcher, Kelly R; Das, Nandita; Nienhuis, Jacob B; Glassman, Steven D

    2014-04-15

    Cross-sectional cohort. The purpose of this study is to determine whether the EuroQOL-5D (EQ-5D) can be derived from commonly available low back disease-specific health-related quality of life measures. The Oswestry Disability Index (ODI) and numeric rating scales (0-10) for back pain (BP) and leg pain (LP) are widely used disease-specific measures in patients with lumbar degenerative disorders. Increasingly, the EQ-5D is being used as a measure of utility due to ease of administration and scoring. The EQ-5D, ODI, BP, and LP were prospectively collected in 14,544 patients seen in clinic for lumbar degenerative disorders. Pearson correlation coefficients for paired observations from multiple time points between ODI, BP, LP, and EQ-5D were determined. Regression modeling was done to compute the EQ-5D score from the ODI, BP, and LP. The mean age was 53.3 ± 16.4 years and 41% were male. Correlations between the EQ-5D and the ODI, BP, and LP were statistically significant (P < 0.0001) with correlation coefficients of -0.77, -0.50, and -0.57, respectively. The regression equation: [0.97711 + (-0.00687 × ODI) + (-0.01488 × LP) + (-0.01008 × BP)] to predict EQ-5D, had an R2 of 0.61 and a root mean square error of 0.149. The model using ODI alone had an R2 of 0.57 and a root mean square error of 0.156. The model using the individual ODI items had an R2 of 0.64 and a root mean square error of 0.143. The correlation coefficient between the observed and estimated EQ-5D score was 0.78. There was no statistically significant difference between the actual EQ-5D (0.553 ± 0.238) and the estimated EQ-5D score (0.553 ± 0.186) using the ODI, BP, and LP regression model. However, rounding off the coefficients to less than 5 decimal places produced less accurate results. Unlike previous studies showing a robust relationship between low back-specific measures and the Short Form-6D, a similar relationship was not seen between the ODI, BP, LP, and the EQ-5D. Thus, the EQ-5D cannot be

  7. Effects of chondroitin sulfate on brain response to painful stimulation in knee osteoarthritis patients. A randomized, double-blind, placebo-controlled functional magnetic resonance imaging study.

    Science.gov (United States)

    Monfort, Jordi; Pujol, Jesús; Contreras-Rodríguez, Oren; Llorente-Onaindia, Jone; López-Solà, Marina; Blanco-Hinojo, Laura; Vergés, Josep; Herrero, Marta; Sánchez, Laura; Ortiz, Hector; Montañés, Francisco; Deus, Joan; Benito, Pere

    2017-06-21

    Knee osteoarthritis is causing pain and functional disability. One of the inherent problems with efficacy assessment of pain medication was the lack of objective pain measurements, but functional magnetic resonance imaging (fMRI) has emerged as a useful means to objectify brain response to painful stimulation. We have investigated the effect of chondroitin sulfate (CS) on brain response to knee painful stimulation in patients with knee osteoarthritis using fMRI. Twenty-two patients received CS (800mg/day) and 27 patients placebo, and were assessed at baseline and after 4 months of treatment. Two fMRI tests were conducted in each session by applying painful pressure on the knee interline and on the patella surface. The outcome measurement was attenuation of the response evoked by knee painful stimulation in the brain. fMRI of patella pain showed significantly greater activation reduction under CS compared with placebo in the region of the mesencephalic periaquecductal gray. The CS group, additionally showed pre/post-treatment activation reduction in the cortical representation of the leg. No effects of CS were detected using the interline pressure test. fMRI was sensitive to objectify CS effects on brain response to painful pressure on patellofemoral cartilage, which is consistent with the known CS action on chondrocyte regeneration. The current work yields further support to the utility of fMRI to objectify treatment effects on osteoarthritis pain. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  8. Effectiveness of repetitive trancranial or peripheral magnetic stimulation in neuropathic pain.

    Science.gov (United States)

    Kumru, Hatice; Albu, Sergiu; Vidal, Joan; Tormos, Josep Maria

    2017-05-01

    Maladaptive plasticity in the sensorimotor system, following neurological lesions or diseases, plays a central role in the generation and maintenance of neuropathic pain. Repetitive magnetic stimulation of the central and peripheral nervous system has gained relevance as noninvasive approach for neuromodulation and pain relief. Systematic reviews that evaluate the effectiveness and specificity of different protocols of repetitive magnetic stimulation to control neuropathic pain in clinical populations have the potential to improve the therapeutic applicability of this technique. Studies whose primary goal was to evaluate the effectiveness of repetitive magnetic stimulation for the treatment of various types of neuropathic pain published in PubMed until August 2015 have been included in this systematic review. A total of 39 articles fulfilling the inclusion criteria were analyzed of which 37 studies investigated pain modulation using repetitive magnetic stimulation over the motor or non-motor cortices and two studies evaluated pain modulation using repetitive peripheral magnetic stimulation protocols. Repetitive transcranial magnetic stimulation of the primary motor cortex using high frequency stimulation protocols can effectively reduce neuropathic pain, particularly in individuals with pain related to non-cerebral lesions. The application of multiple sessions can lead to long-lasting pain modulation and cumulative effects. Implications for Rehabilitation Maladaptive plasticity plays a central role in sensitization of nociceptive pathways, generation and maintainance of neuropathic pain; Most neuropathic pain conditions are refractory to pharmacological therapies; Repetitive magnetic stimulation of the central and peripheral nervous system has gained relevance as noninvasive approach for neuromodulation and pain relief.

  9. Validity of the Korean Version of the Face, Legs, Activity, Cry, and Consolability Scale for Assessment of Pain in Dementia Patients.

    Science.gov (United States)

    Moon, Yeonsil; Kim, Yoon Sook; Lee, Jongmin; Han, Seol Heui

    2017-11-01

    Pain is often associated with a more rapid progression of cognitive and functional decline, and behavioral disturbance in dementia. Therefore, it is essential to accurately assesses pain for proper intervention in patients with dementia. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale is an excellent behaviour scale which includes most of the domains that are recommended by the American Geriatrics Society to evaluate when assessing pain in patients with dementia. The purpose of this study was to develop the Korean version of the FLACC (K-FLACC) and to verify its reliability and validity in assessing pain of elderly patients with dementia. We developed the K-FLACC to consist of the five domains (face, legs, activity, cry, and consolability) with scores of 0, 1, and 2 for each domain and a total score ranging from 0 to 10 as in the original FLACC. Eighty-eight patients with dementia who visited Konkuk University Medical Center were evaluated. The K-FLACC revealed good validity as compared to the Numeric Rating Scale (NRS; r = 0.617, P dementia in Korea. © 2017 The Korean Academy of Medical Sciences.

  10. Static magnetic therapy does not decrease pain or opioid requirements: a randomized double-blind trial.

    Science.gov (United States)

    Cepeda, M Soledad; Carr, Daniel B; Sarquis, Tony; Miranda, Nelcy; Garcia, Ricardo J; Zarate, Camilo

    2007-02-01

    A growing multibillion dollar industry markets magnetic necklaces, bracelets, bands, insoles, back braces, mattresses, etc., for pain relief, although there is little evidence for their efficacy. We sought to evaluate the effect of magnetic therapy on pain intensity and opioid requirements in patients with postoperative pain. We designed a randomized, double-blind, controlled trial. One-hundred-sixty-five patients older than 12 yr of age were randomized to magnetic (n = 81) or sham therapy (n = 84) upon reporting moderate-to-severe pain in the postanesthesia care unit. Devices were placed over the surgical incision and left in place for 2 h. Patients rated their pain intensity on a 0-10 scale every 10 min and received incremental doses of morphine until pain intensity was Magnetic therapy lacks efficacy in controlling acute postoperative pain intensity levels or opioid requirements and should not be recommended for pain relief in this setting.

  11. Intra-observer and interobserver reliability ofOne Leg Stand Test as a measure of posturalbalance in low back pain patients

    DEFF Research Database (Denmark)

    Maribo, Thomas; Iversen, Elena; Andersen, Niels Trolle

    2009-01-01

    Objective: To determine the absolute and relative reliability of intra-observer and interobserver To determine the absolute and relative reliability of intra-observer and interobserver measurements of postural balance using the One Leg Stand Test in patients with low back pain. Patients and methods...... to stand for the maximum time, and no further analysis was done. Eyes closed: intra-observer reliability was tested in 21 patients; absolute reliability showed a standard error of the measurement (SEM) of 2.48 s and a minimal detectable change (MDC) of 6.88. The relative reliability was acceptable...... with an intra class correlation coefficient (ICC) of 0.86. Interobserver reliability was tested in 27 patients; absolute reliability showed a SEM of 1.42 s and a MDC of 3.95. The relative reliability was acceptable with an ICC of 0.91. Conclusions: The One Leg Stand Test can be used to test postural balance...

  12. Evaluation of nurse accuracy in rating procedural pain among pediatric burn patients using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale.

    Science.gov (United States)

    Shen, Jiabin; Giles, Sheila A; Kurtovic, Kelli; Fabia, Renata; Besner, Gail E; Wheeler, Krista K; Xiang, Huiyun; Groner, Jonathan I

    2017-02-01

    Accurate pain assessment is essential for proper analgesia during medical procedures in pediatric patients. The Faces, Legs, Activity, Cry, and Consolability (FLACC) scale has previously been shown to be a valid and reliable tool for assessing pediatric procedural pain in research labs. However, no study has investigated how rater factors (gender, number of dressing changes performed/week, burn history, having children, nursing experience, stress at home/work) and patient factors (pain intensity) affect the accuracy of FLACC ratings for procedural pain when implemented by bedside care providers. Twenty-four nurses in an ABA verified Pediatric Burn Center watched four videos of dressing changes for pediatric burn patients in random order three times and rated the children's procedural pain using the FLACC scale. The four videos had standard FLACC scores established by an interdisciplinary panel. Descriptive and mixed modeling analysis was conducted to explore nurse rating accuracy and to evaluate the rater and patient factors that influenced the rating accuracy. The highest accuracy was reached when rating high procedural pain (with a FLACC of 6). Nurses underrated both mild and severe procedural pain. Nurses who had less nursing experience demonstrated significantly higher accuracy than those with more experience. The present study is the first study in the literature to systematically examine the factors influencing the accuracy of FLACC rating for pediatric procedural pain among bedside care providers. The findings suggest that nurse clinical experience and patient pain intensity are two significant contributors to rating accuracy. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  13. Deconstructing Chronic Low Back Pain in the Older Adult-Step-by-Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part XII: Leg Length Discrepancy.

    Science.gov (United States)

    Havran, Mark; Scholten, Joel D; Breuer, Paula; Lundberg, Jennifer; Kochersberger, Gary; Newman, Dave; Weiner, Debra K

    2016-12-01

     To present the last in a 12-part series designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on leg length discrepancy (LLD) and presents an algorithm outlining approaches to diagnosis and management of LLD in older adults, along with a representative clinical case. METHODS : Using a modified Delphi approach, the LLD evaluation and treatment algorithm was developed by a multidisciplinary expert panel representing expertise in physical therapy, geriatric medicine, and physical medicine and rehabilitation. The materials were subsequently refined through an iterative process of input from a primary care provider panel comprised of VA and non-VA providers. The clinical case was taken from one of the authors. RESULTS : We present an algorithm and illustrative clinical case to help guide the care of older adults with LLD, which can be an important contributor to CLBP. Firstline assessment includes referral to physical therapy or orthopedics, depending on the context of the LLD. A variety of nonsurgical interventions may ensue depending on the etiology of the LLD, including shoe inserts, customized shoes, manual therapy, or a combination. CONCLUSIONS : To promote a patient-centered approach, providers should consider evaluating for leg length discrepancy when treating older adults with CLBP to help diminish pain and disability. Published by Oxford University Press on behalf of the American Academy of Pain Medicine 2016. This work is written by US Government employees and is in the public domain in the US.

  14. Foot posture, leg length discrepancy and low back pain--their relationship and clinical management using foot orthoses--an overview.

    Science.gov (United States)

    Kendall, Julie C; Bird, Adam R; Azari, Michael F

    2014-06-01

    Mechanical low back pain (LBP) is a very common, expensive, and significant health issue in the western world. Functional musculoskeletal conditions are widely thought to cause mechanical low back pain. The role of foot posture and leg length discrepancy in contributing to abnormal biomechanics of the lumbopelvic region and low back pain is not sufficiently investigated. This critical review examines the evidence for the association between foot function, particularly pronation, and mechanical LBP. It also explores the evidence for a role for foot orthoses in the treatment of this condition. There is a body of evidence to support the notion that foot posture, particularly hyperpronation, is associated with mechanical low back pain. Mechanisms that have been put forward to account for this finding are based on either mechanical postural changes or alterations in muscular activity in the lumbar and pelvic muscles. More research is needed to explore and quantify the effects of foot orthoses on chronic low back pain, especially their effects on lumbopelvic muscle function and posture. The clinical implications of this work are significant since foot orthoses represent a simple and potentially effective therapeutic measure for a clinical condition of high personal and social burden. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Magnetic Resonance Assessment of Hypertrophic and Pseudo-Hypertrophic Changes in Lower Leg Muscles of Boys with Duchenne Muscular Dystrophy and Their Relationship to Functional Measurements.

    Science.gov (United States)

    Vohra, Ravneet S; Lott, Donovan; Mathur, Sunita; Senesac, Claudia; Deol, Jasjit; Germain, Sean; Bendixen, Roxanna; Forbes, Sean C; Sweeney, H Lee; Walter, Glenn A; Vandenborne, Krista

    2015-01-01

    The primary objectives of this study were to evaluate contractile and non-contractile content of lower leg muscles of boys with Duchenne muscular dystrophy (DMD) and determine the relationships between non-contractile content and functional abilities. Lower leg muscles of thirty-two boys with DMD and sixteen age matched unaffected controls were imaged. Non-contractile content, contractile cross sectional area and non-contractile cross sectional area of lower leg muscles (tibialis anterior, extensor digitorum longus, peroneal, medial gastrocnemius and soleus) were assessed by magnetic resonance imaging (MRI). Muscle strength, timed functional tests and the Brooke lower extremity score were also assessed. Non-contractile content of lower leg muscles (peroneal, medial gastrocnemius, and soleus) was significantly greater than control group (p<0.05). Non-contractile content of lower leg muscles correlated with Brooke score (rs = 0.64-0.84) and 30 feet walk (rs = 0.66-0.80). Dorsiflexor (DF) and plantarflexor (PF) specific torque was significantly different between the groups. Overall, non-contractile content of the lower leg muscles was greater in DMD than controls. Furthermore, there was an age dependent increase in contractile content in the medial gastrocnemius of boys with DMD. The findings of this study suggest that T1 weighted MR images can be used to monitor disease progression and provide a quantitative estimate of contractile and non-contractile content of tissue in children with DMD.

  16. Magnetic Resonance Assessment of Hypertrophic and Pseudo-Hypertrophic Changes in Lower Leg Muscles of Boys with Duchenne Muscular Dystrophy and Their Relationship to Functional Measurements.

    Directory of Open Access Journals (Sweden)

    Ravneet S Vohra

    Full Text Available The primary objectives of this study were to evaluate contractile and non-contractile content of lower leg muscles of boys with Duchenne muscular dystrophy (DMD and determine the relationships between non-contractile content and functional abilities.Lower leg muscles of thirty-two boys with DMD and sixteen age matched unaffected controls were imaged. Non-contractile content, contractile cross sectional area and non-contractile cross sectional area of lower leg muscles (tibialis anterior, extensor digitorum longus, peroneal, medial gastrocnemius and soleus were assessed by magnetic resonance imaging (MRI. Muscle strength, timed functional tests and the Brooke lower extremity score were also assessed.Non-contractile content of lower leg muscles (peroneal, medial gastrocnemius, and soleus was significantly greater than control group (p<0.05. Non-contractile content of lower leg muscles correlated with Brooke score (rs = 0.64-0.84 and 30 feet walk (rs = 0.66-0.80. Dorsiflexor (DF and plantarflexor (PF specific torque was significantly different between the groups.Overall, non-contractile content of the lower leg muscles was greater in DMD than controls. Furthermore, there was an age dependent increase in contractile content in the medial gastrocnemius of boys with DMD. The findings of this study suggest that T1 weighted MR images can be used to monitor disease progression and provide a quantitative estimate of contractile and non-contractile content of tissue in children with DMD.

  17. Cross-cultural Adaptation and Validation of the Exercise-Induced Leg Pain Questionnaire for English- and Greek-Speaking Individuals.

    Science.gov (United States)

    Korakakis, Vasileios; Malliaropoulos, Nikos; Baliotis, Konstantinos; Papadopoulou, Sofia; Padhiar, Nat; Nauck, Tanja; Lohrer, Heinz

    2015-06-01

    Clinical measurement. To translate the German version of the Exercise-Induced Leg Pain Questionnaire (EILP-G) to Greek and English and evaluate the psychometric properties of the Greek version. The EILP-G was developed to evaluate the severity of symptoms and sports ability in individuals with exercise-induced leg pain (EILP). Translation of the questionnaire to other languages will provide a standard outcome measure across populations. The EILP-G questionnaire was cross-culturally adapted to Greek and English, according to established guidelines. The validity and reliability of the Greek version were assessed in 40 patients with EILP, 40 patients with other lower extremity injuries, 40 track-and-field athletes with no history of EILP, and 40 young adults without pathology. Participants completed the questionnaire at baseline and again after 7 to 10 days. The expert committee and the participants considered the questionnaire to have good face and content validity. Concurrent validity as assessed using the Schepsis score was almost perfect (rho = 0.947, PGreek version exhibited excellent test-retest reliability (intraclass correlation coefficient = 0.995 for the EILP group) and internal consistency (Cronbach α = .942 for the EILP group). Finally, no ceiling or floor effects were found, as none of the individuals with EILP scored the maximum or minimum possible values on the questionnaire. The Greek version, adapted from the original EILP-G, is a valid and reliable questionnaire, and its psychometric properties are comparable with the original version.

  18. The Influence of Dual Pressure Biofeedback Units on Pelvic Rotation and Abdominal Muscle Activity during the Active Straight Leg Raise in Women with Chronic Lower Back Pain.

    Science.gov (United States)

    Noh, Kyung-Hee; Kim, Ji-Won; Kim, Gyoung-Mo; Ha, Sung-Min; Oh, Jae-Seop

    2014-05-01

    [Purpose] This study was performed to assess the influence of applying dual pressure biofeedback units (DPBUs) on the angle of pelvic rotation and abdominal muscle activity during the active straight leg raise (ASLR). [Subjects] Seventeen patients with low-back pain (LBP) participated in this study. [Methods] The subjects were asked to perform an active straight leg raise (ASLR) without a PBU, with a single PBU, and with DPBUs. The angles of pelvic rotation were measured using a three-dimensional motion-analysis system, and the muscle activity of the bilateral internal oblique abdominis (IO), external oblique abdominis (EO), and rectus abdominis (RA) was recorded using surface electromyography (EMG). One-way repeated-measures ANOVA was performed to determine the rotation angles and muscle activity under the three conditions. [Results] The EMG activity of the ipsilateral IO, contralateral EO, and bilateral RA was greater and pelvic rotation was lower with the DPBUs than with no PBU or a single PBU. [Conclusion] The results of this study suggest that applying DPBUs during ASLR is effective in decreasing unwanted pelvic rotation and increasing abdominal muscle activity in women with chronic low back pain.

  19. Differentiating nocturnal leg cramps and restless legs syndrome.

    Science.gov (United States)

    Rana, Abdul Qayyum; Khan, Fatima; Mosabbir, Abdullah; Ondo, William

    2014-07-01

    Leg pain and discomfort are common complaints in any primary physician's clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). NLC present as painful and sudden contractions mostly in part of the calf. Diagnosis of NLC is mainly clinical and sometimes involves investigations to rule out other mimics. RLS is a condition characterized by the discomfort or urge to move the lower limbs, which occurs at rest or in the evening/night. The similarity of RLS and leg cramps poses the issue of errors in diagnosing and differentiating the two. In this paper we review the pathopysiology of each entity and their diagnosis as well as treatment. The two conditions are then compared to appreciate the differences and similarities. Finally, suggestions are recommended for complete assessment.

  20. Magnetic resonance imaging of abnormal shoulder pain following influenza vaccination

    Energy Technology Data Exchange (ETDEWEB)

    Okur, Gokcan [Etimesgut Military Hospital, Department of Radiology, Ankara (Turkey); Chaney, Kimberly A. [Presence St. Joseph Hospital, Department of Radiology, Elgin, IL (United States); Lomasney, Laurie M. [Loyola University Medical Center, Department of Radiology, Maywood, IL (United States)

    2014-09-15

    The influenza vaccine is increasingly available to the general public and mandated by many employers in the United States. The prevalence of post-vaccination complications is likely on the rise. Complications are well known to general clinicians, but are under-reported in the imaging literature. We present four cases of post-vaccination shoulder pain with magnetic resonance imaging (MRI) findings. An intrasubstance fluid-like signal in deep muscular and/or tendinous structures was the most common finding on MRI of these four cases. Focal bone marrow signal within the humeral head and inflammatory changes in the subacromial/subdeltoid bursa were also observed. The most likely reason for a humeral intraosseous edema-like signal was presumed injection of vaccine substance directly into osseous structures that might lead to focal osteitis. In the published literature, there is little emphasis on the imaging of local injection site complications accompanying influenza vaccination. We intended to increase familiarity of MRI findings in the setting of prolonged or severe clinical symptoms following influenza vaccination through the imaging findings of these four cases. (orig.)

  1. Relationship between pain and effusion on magnetic resonance imaging in temporomandibular disorder patients

    International Nuclear Information System (INIS)

    Park, Ha Na; Kim, Kyoung A; Koh, Kwang Joon

    2014-01-01

    This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). MRI examinations were performed using a 1.5-T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the chi2 test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p 0.05). Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain.

  2. Relationship between pain and effusion on magnetic resonance imaging in temporomandibular disorder patients

    Science.gov (United States)

    Park, Ha-Na; Kim, Kyoung-A

    2014-01-01

    Purpose This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. Materials and Methods The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). MRI examinations were performed using a 1.5-T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the χ2 test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Results Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p0.05). Conclusion Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain. PMID:25473637

  3. Surgeon attitudes toward nonphysician screening of low back or low back-related leg pain patients referred for surgical assessment: a survey of Canadian spine surgeons.

    Science.gov (United States)

    Busse, Jason W; Riva, John J; Nash, Jennifer V; Hsu, Sandy; Fisher, Charles G; Wai, Eugene K; Brunarski, David; Drew, Brian; Quon, Jeffery A; Walter, Stephen D; Bishop, Paul B; Rampersaud, Raja

    2013-04-01

    Questionnaire survey. To explore spine surgeons' attitudes toward the involvement of nonphysician clinicians (NPCs) to screen patients with low back or low back-related leg pain referred for surgical assessment. Although the utilization of physician assistants is common in several healthcare systems, the attitude of spine surgeons toward the independent assessment of patients by NPCs remains uncertain. We administered a 28-item survey to all 101 surgeon members of the Canadian Spine Society, which inquired about demographic variables, patient screening efficiency, typical wait times for both assessment and surgery, important components of low back-related complaints history and examination, indicators for assessment by a surgeon, and attitudes toward the use of NPCs to screen patients with low back and leg pain referred for elective surgical assessment. Eighty-five spine surgeons completed our survey, for a response rate of 84.1%. Most respondents (77.6%) were interested in working with an NPC to screen patients with low back-related complaints referred for elective surgical assessment. Perception of suboptimal wait time for consultation and poor screening efficiency for surgical candidates were associated with greater surgeon interest in an NPC model of care. We achieved majority consensus regarding the core components for a low back-related complaints history and examination, and findings that would support surgical assessment. A majority of respondents (75.3%) agreed that they would be comfortable not assessing patients with low back-related complaints referred to their practice if indications for surgery were ruled out by an NPC. The majority of Canadian spine surgeons were open to an NPC model of care to assess and triage nonurgent or emergent low back-related complaints. Clinical trials to establish the effectiveness and acceptance of an NPC model of care by all stakeholders are urgently needed.

  4. Determining the activation of gluteus medius and the validity of the single leg stance test in chronic, nonspecific low back pain.

    Science.gov (United States)

    Penney, Tracy; Ploughman, Michelle; Austin, Mark W; Behm, David G; Byrne, Jeannette M

    2014-10-01

    To determine the activation of the gluteus medius in persons with chronic, nonspecific low back pain compared with that in control subjects, and to determine the association of the clinical rating of the single leg stance (SLS) with chronic low back pain (CLBP) and gluteus medius weakness. Cohort-control comparison. Academic research laboratory. Convenience sample of people (n=21) with CLBP (>12wk) recruited by local physiotherapists, and age- and sex-matched controls (n=22). Subjects who received specific pain diagnoses were excluded. Not applicable. Back pain using the visual analog scale (mm); back-related disability using the Oswestry Back Disability Index (%); strength of gluteus medius measured using a hand dynamometer (N/kg); SLS test; gluteus medius onset and activation using electromyography during unipedal stance on a forceplate. Individuals in the CLBP group exhibited significant weakness in the gluteus medius compared with controls (right, P=.04; left, P=.002). They also had more pain (CLBP: mean, 20.50mm; 95% confidence interval [CI], 13.11-27.9mm; control subjects: mean, 1.77mm; 95% CI, -.21 to 3.75mm) and back-related disability (CLBP: mean, 18.52%; 95% CI, 14.46%-22.59%; control subjects: mean, .68%; 95% CI, -.41% to 1.77%), and reported being less physically active. Weakness was accompanied by increased gluteus medius activation during unipedal stance (R=.50, P=.001) but by no difference in muscle onset times. Although greater gluteus medius weakness was associated with greater pain and disability, there was no difference in muscle strength between those scoring positive and negative on the SLS test (right: F=.002, P=.96; left: F=.1.75, P=.19). Individuals with CLBP had weaker gluteus medius muscles than control subjects without back pain. Even though there was no significant difference in onset time of the gluteus medius when moving to unipedal stance between the groups, the CLBP group had greater gluteus medius activation. A key finding was that

  5. Comparison of 10-kHz High-Frequency and Traditional Low-Frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: 24-Month Results From a Multicenter, Randomized, Controlled Pivotal Trial.

    Science.gov (United States)

    Kapural, Leonardo; Yu, Cong; Doust, Matthew W; Gliner, Bradford E; Vallejo, Ricardo; Sitzman, B Todd; Amirdelfan, Kasra; Morgan, Donna M; Yearwood, Thomas L; Bundschu, Richard; Yang, Thomas; Benyamin, Ramsin; Burgher, Abram H

    2016-11-01

    Pain relief with spinal cord stimulation (SCS) has focused historically on paresthesias overlapping chronically painful areas. A higher level evidence supports the use of SCS in treating leg pain than supports back pain, as it is difficult to achieve adequate paresthesia coverage, and then pain relief, in the low back region. In comparison, 10-kHz high-frequency (HF10 therapy) SCS therapy does not rely on intraoperative paresthesia mapping and remains paresthesia-free during therapy. To compare long-term results of HF10 therapy and traditional low-frequency SCS. A pragmatic randomized, controlled, pivotal trial with 24-month follow-up was conducted across 11 comprehensive pain treatment centers. Subjects had Visual Analog Scale scores of ≥5.0/10.0 cm for both back and leg pain, and were assigned randomly (1:1) to receive HF10 therapy or low-frequency SCS. The primary end point was a responder rate, defined as ≥50% back pain reduction from baseline at 3 months with a secondary end point at 12 months (previously reported). In this article, 24-month secondary results are presented. Non-inferiority was first assessed, and if demonstrated the results were tested for superiority. In the study, 198 subjects were randomized (101 HF10 therapy, 97 traditional SCS). One hundred seventy-one subjects (90 HF10 therapy, 81 traditional SCS) successfully completed a short-term trial and were implanted. Subjects averaged 54.9 ± 12.9 years old, 13.6 ± 11.3 years since diagnosis, 86.6% had back surgery, 88.3% were taking opioid analgesics. At 3 months, 84.5% of implanted HF10 therapy subjects were responders for back pain and 83.1% for leg pain, and 43.8% of traditional SCS subjects were responders for back pain and 55.5% for leg pain (P back and leg pain comparisons, non-inferiority and superiority). At 24 months, more subjects were responders to HF10 therapy than traditional SCS (back pain: 76.5% vs 49.3%; 27.2% difference, 95% CI, 10.1%-41.8%; P pain: 72.9% vs 49.3%; 23

  6. Comparison of 10-kHz High-Frequency and Traditional Low-Frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: 24-Month Results From a Multicenter, Randomized, Controlled Pivotal Trial

    Science.gov (United States)

    Yu, Cong; Doust, Matthew W.; Gliner, Bradford E.; Vallejo, Ricardo; Sitzman, B. Todd; Amirdelfan, Kasra; Morgan, Donna M.; Yearwood, Thomas L.; Bundschu, Richard; Yang, Thomas; Benyamin, Ramsin; Burgher, Abram H.

    2016-01-01

    BACKGROUND: Pain relief with spinal cord stimulation (SCS) has focused historically on paresthesias overlapping chronically painful areas. A higher level evidence supports the use of SCS in treating leg pain than supports back pain, as it is difficult to achieve adequate paresthesia coverage, and then pain relief, in the low back region. In comparison, 10-kHz high-frequency (HF10 therapy) SCS therapy does not rely on intraoperative paresthesia mapping and remains paresthesia-free during therapy. OBJECTIVE: To compare long-term results of HF10 therapy and traditional low-frequency SCS. METHODS: A pragmatic randomized, controlled, pivotal trial with 24-month follow-up was conducted across 11 comprehensive pain treatment centers. Subjects had Visual Analog Scale scores of ≥5.0/10.0 cm for both back and leg pain, and were assigned randomly (1:1) to receive HF10 therapy or low-frequency SCS. The primary end point was a responder rate, defined as ≥50% back pain reduction from baseline at 3 months with a secondary end point at 12 months (previously reported). In this article, 24-month secondary results are presented. Non-inferiority was first assessed, and if demonstrated the results were tested for superiority. RESULTS: In the study, 198 subjects were randomized (101 HF10 therapy, 97 traditional SCS). One hundred seventy-one subjects (90 HF10 therapy, 81 traditional SCS) successfully completed a short-term trial and were implanted. Subjects averaged 54.9 ± 12.9 years old, 13.6 ± 11.3 years since diagnosis, 86.6% had back surgery, 88.3% were taking opioid analgesics. At 3 months, 84.5% of implanted HF10 therapy subjects were responders for back pain and 83.1% for leg pain, and 43.8% of traditional SCS subjects were responders for back pain and 55.5% for leg pain (P back and leg pain comparisons, non-inferiority and superiority). At 24 months, more subjects were responders to HF10 therapy than traditional SCS (back pain: 76.5% vs 49.3%; 27.2% difference, 95% CI, 10

  7. Functional resonance magnetic imaging (fMRI) in adolescents with idiopathic musculoskeletal pain: a paradigm of experimental pain.

    Science.gov (United States)

    Molina, Juliana; Amaro, Edson; da Rocha, Liana Guerra Sanches; Jorge, Liliana; Santos, Flavia Heloisa; Len, Claudio A

    2017-11-14

    Studies on functional magnetic resonance imaging (fMRI) have shown that adults with musculoskeletal pain syndromes tolerate smaller amount of pressure (pain) as well as differences in brain activation patterns in areas related to pain.The objective of this study was to evaluate, through fMRI, the brain activation in adolescents with idiopathic musculoskeletal pain (IMP) while performing an experimental paradigm of pain. The study included 10 consecutive adolescents with idiopathic musculoskeletal pain (average age 16.3±1.0) and 10 healthy adolescents age-matched. fMRI exams were performed in a 3 T scanner (Magnetom Trio, Siemens) using an event-related design paradigm. Pressure stimuli were performed in the nondominant hand thumb, divided into two stages, fixed pain and variable pain. The two local Research Ethics Committees (Ethics Committee from Universidade Federal de São Paulo- Brazil, process number 0688/11, on July 1st, 2011 and Ethics Committee from Hospital Israelita Albert Einsten - Brazil, process number 1673, on October 19th, 2011) approved the study. The idiopathic musculoskeletal pain (IMP) group showed a reduced threshold for pain (3.7 kg/cm 2 versus 4.45 kg/cm 2 , p = 0.005). Control group presented increased bain activation when compared to IMP group in the following areas: thalamus (p = 0.00001), precentral gyrus (p = 0.0004) and middle frontal gyrus (p = 0.03). In intragroup analysis, IMP group showed greater brain activation during the unpredictable stimuli of the variable pain stage, especially in the lingual gyrus (p = 0.0001), frontal lobe (p = 0.0001), temporal gyrus (p = 0.0001) and precentral gyrus (p = 0.03), when compared to predictable stimulus of fixed pain. The same intragroup analysis with the control group showed greater activation during the unpredictable stimuli in regions of the precentral gyrus (p = 0.0001), subcallosal area (p = 0.0001), right and left occipital fusiform gyrus (p

  8. Beyond patient reported pain: perfusion magnetic resonance imaging demonstrates reproducible cerebral representation of ongoing post-surgical pain.

    Directory of Open Access Journals (Sweden)

    Matthew A Howard

    Full Text Available Development of treatments for acute and chronic pain conditions remains a challenge, with an unmet need for improved sensitivity and reproducibility in measuring pain in patients. Here we used pulsed-continuous arterial spin-labelling [pCASL], a relatively novel perfusion magnetic-resonance imaging technique, in conjunction with a commonly-used post-surgical model, to measure changes in regional cerebral blood flow [rCBF] associated with the experience of being in ongoing pain. We demonstrate repeatable, reproducible assessment of ongoing pain that is independent of patient self-report. In a cross-over trial design, 16 participants requiring bilateral removal of lower-jaw third molars underwent pain-free pre-surgical pCASL scans. Following extraction of either left or right tooth, repeat scans were acquired during post-operative ongoing pain. When pain-free following surgical recovery, the pre/post-surgical scanning procedure was repeated for the remaining tooth. Voxelwise statistical comparison of pre and post-surgical scans was performed to reveal rCBF changes representing ongoing pain. In addition, rCBF values in predefined pain and control brain regions were obtained. rCBF increases (5-10% representing post-surgical ongoing pain were identified bilaterally in a network including primary and secondary somatosensory, insula and cingulate cortices, thalamus, amygdala, hippocampus, midbrain and brainstem (including trigeminal ganglion and principal-sensory nucleus, but not in a control region in visual cortex. rCBF changes were reproducible, with no rCBF differences identified across scans within-session or between post-surgical pain sessions. This is the first report of the cerebral representation of ongoing post-surgical pain without the need for exogenous tracers. Regions of rCBF increases are plausibly associated with pain and the technique is reproducible, providing an attractive proposition for testing interventions for on-going pain that

  9. More gain less pain: balance control learning shifts the activation patterns of leg and neck muscles and increases muscular parsimony.

    Science.gov (United States)

    Iodice, Pierpaolo; Cesinaro, Stefano; Romani, Gian Luca; Pezzulo, Giovanni

    2015-07-01

    Athletes such as skaters or surfers maintain their balance on very unstable platforms. Remarkably, the most skilled athletes seem to execute these feats almost effortlessly. However, the dynamics that lead to the acquisition of a defined and efficient postural strategy are incompletely known. To understand the posture reorganization process due to learning and expertise, we trained twelve participants in a demanding balance/posture maintenance task for 4 months and measured their muscular activity before and after a (predictable) disturbance cued by an auditory signal. The balance training determined significant delays in the latency of participants' muscular activity: from largely anticipatory muscular activity (prior to training) to a mixed anticipatory-compensatory control strategy (after training). After training, the onset of activation was delayed for all muscles, and the sequence of activation systematically reflected the muscle position in the body from top to bottom: neck/upper body muscles were recruited first and in an anticipatory fashion, whereas leg muscles were recruited after the disturbance onset, producing compensatory adjustments. The resulting control strategy includes a mixture of anticipatory and compensatory postural adjustments, with a systematic sequence of muscular activation reflecting the different demands of neck and leg muscles. Our results suggest that subjects learned the precise timing of the disturbance onset and used this information to deploy postural adjustments just-in-time and to transfer at least part of the control of posture from anticipatory to less-demanding feedback-based strategies. In turn, this strategy shift increases the cost-efficiency of muscular activity, which is a key signature of skilled performance.

  10. Relationship between pain and effusion on magnetic resonance imaging in temporomandibular disorder patients

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ha Na; Kim, Kyoung A; Koh, Kwang Joon [Dept. of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju (Korea, Republic of)

    2014-12-15

    This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). MRI examinations were performed using a 1.5-T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the chi2 test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p<0.05). However, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ (G1) was not related to joint effusion in TMD patients (p>0.05). Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain.

  11. Attenuation of cortical activity triggering descending pain inhibition in chronic low back pain patients: a functional magnetic resonance imaging study.

    Science.gov (United States)

    Matsuo, Yohei; Kurata, Jiro; Sekiguchi, Miho; Yoshida, Katsuhiro; Nikaido, Takuya; Konno, Shin-Ichi

    2017-08-01

    A considerable portion of chronic low back pain (cLBP) patients lack anatomical abnormality, resist conventional therapeutic interventions, and their symptoms are often complicated with psychological and social factors. Such patients have been reported to show cerebral abnormalities both in anatomy and function by neuroimaging studies. Here we examined differences in cerebral reactivity to a simulated low back pain stimulus between cLBP patients and healthy controls by functional magnetic resonance imaging (fMRI), and their behavioral correlates from a psychophysical questionnaire. Eleven cLBP patients and 13 healthy subjects (HS) were enrolled in this study. After psychophysical evaluation on-going pain with McGill Pain Questionnaire Short Form (MPQ), they underwent whole-brain fMRI in a 3-Tesla MRI scanner while receiving three blocks of 30-s mechanical pain stimuli at the left low back with a 30-s rest in between, followed by a three-dimensional anatomical imaging. Functional images were analyzed with a multi-subject general linear model for blood oxygenation level-dependent (BOLD) signal changes associated with pain. Individual BOLD signal amplitudes at activated clusters were examined for correlation with psychophysical variables. Two in the cLBP and five data sets in the HS groups were excluded from analysis because of deficient or artifactual data or mismatch in age. The HS group showed LBP-related activation at the right insular cortex, right dorsolateral prefrontal cortex (DLPFC), left anterior cingulate cortex (ACC), and left precuneus; and deactivation in a large area over the parietal and occipital cortices, including the bilateral superior parietal cortex. On the other hand, the cLBP group did not show any significant activation at those cortical areas, but showed similar deactivation at the bilateral superior parietal cortex and part of the premotor area. An HS > cLBP contrast revealed significantly less activity at the ACC and DLPFC in the c

  12. Osteomalacia as a Cause of Chronic Pain

    Directory of Open Access Journals (Sweden)

    Robert W Teasell

    1996-01-01

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

  13. The effect of lumbar posture on abdominal muscle thickness during an isometric leg task in people with and without non-specific low back pain.

    Science.gov (United States)

    Pinto, Rafael Zambelli; Ferreira, Paulo Henrique; Franco, Marcia Rodrigues; Ferreira, Mariana Calais; Ferreira, Manuela Loureiro; Teixeira-Salmela, Luci Fuscaldi; Oliveira, Vinicius C; Maher, Christopher

    2011-12-01

    This study investigated the effect of lumbar posture on function of transversus abdominis (TrA) and obliquus internus (OI) in people with and without non-specific low back pain (LBP) during a lower limb task. Rehabilitative ultrasound was used to measure thickness change of TrA and OI during a lower limb task that challenged the stability of the spine. Measures were taken in supine in neutral and flexed lumbar postures in 30 patients and 30 healthy subjects. Data were analysed using a two-way (groups, postures) ANOVA. Our results showed that lumbar posture influenced percent thickness change of the TRA muscle but not for OI. An interaction between group and posture was found for TrA thickness change (F(1,56) = 6.818, p = 0.012). For this muscle, only healthy participants showed greater thickness change with neutral posture compared to flexed (mean difference = 6.2%; 95% CI: 3.1-9.3%; p posture can facilitate an increase in thickness of the TrA muscle while performing a leg task, however this effect was not observed for this muscle in patients with LBP. No significant difference in TrA and OI thickness change between people with and without non-specific LBP was found. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Leg Swelling

    Science.gov (United States)

    ... ed. New York, N.Y.: The McGraw Hill Companies; 2016. http://www.accessmedicine.com. Accessed Dec. 31, ... http://www.mayoclinic.org/symptoms/leg-swelling/basics/definition/SYM-20050910 . Mayo Clinic Footer Legal Conditions and ...

  15. [Swollen leg with blisters].

    Science.gov (United States)

    Rafeiner, Ph; Templeton, A J; Vonesch, H J

    2005-10-05

    We report the case of a 84-year-old woman suffering from strong pain in her right leg initially resembling thrombosis of deep veins. Eight hours after admission a superficial blister developed at the calf with following hemorrhagic aspect and spontanous eruption of clear yellowish fluid. Later on a new blister appeared at the thigh. The patient died 33 hours after admission of streptococcal toxic shock syndrome. The latter was based on a necrotizing fasciitis. Streptoccus pyogenes (group A) could be cultivated from the blood and fluid of the blister. We discuss the clinical presentation of necrotizing fasciitis with "pain out of proportion" as characteristic complaint and the appropriate management.

  16. Fifteen Minutes of Left Prefrontal Repetitive Transcranial Magnetic Stimulation Acutely Increases Thermal Pain Thresholds in Healthy Adults

    Directory of Open Access Journals (Sweden)

    Jeffrey J Borckardt

    2007-01-01

    Full Text Available BACKGROUND: Transcranial magnetic stimulation (TMS of the motor cortex appears to alter pain perception in healthy adults and in patients with chronic neuropathic pain. There is, however, emerging brain imaging evidence that the left prefrontal cortex is involved in pain inhibition in humans.

  17. Internal derangement as a predictor of provoked pain on mouth opening: A magnetic resonance imaging study.

    Science.gov (United States)

    Koh, Kwang-Joon; Park, Ha-Na; Kim, Kyoung-A

    2017-12-01

    This study investigated the relationship between pain and internal derangement in temporomandibular disorder (TMD) patients using magnetic resonance imaging (MRI). This study analyzed 356 TMD patients (712 temporomandibular joints [TMJs]). The inclusion criteria were the presence of spontaneous or provoked pain on one or both TMJs and having undergone MRI. The patients with provoked pain were divided into 3 groups: pain on palpation, pain on mouth opening, and pain on mastication. MRI was performed using a 1.5-T scanner. T1- and T2-weighted parasagittal and paracoronal images were obtained. According to the findings on the T1-weighted images, another 3 groups were created based on internal derangement: normal, disc displacement with reduction, and disc displacement without reduction. The MRI findings were independently interpreted by 2 experienced oral and maxillofacial radiologists at 2 different times. Statistical analysis was performed by the chi-square test using SPSS (version 12.0; SPSS Inc., Chicago, IL, USA). Provoked pain on mouth opening was found to be correlated with internal derangement in TMD patients ( P .05). These results suggest that internal derangement was a significant predictor of provoked pain on mouth opening.

  18. Leg Problems

    Science.gov (United States)

    ... TEAR of the ACHILLES TENDON that attaches the calf muscle to the heel. This injury will cause pain and difficulty pointing the foot down. A TORN CALF MUSCLE will be painful and might produce bruises. Self ...

  19. The automatic pelvic floor muscle response to the active straight leg raise in cases with pelvic girdle pain and matched controls.

    Science.gov (United States)

    Stuge, Britt; Sætre, Kaja; Ingeborg Hoff, Brækken

    2013-08-01

    The active straight leg raise (ASLR) test has been proposed as a clinical test for the assessment of pelvic girdle pain (PGP). Little is known about the activation of the pelvic floor muscles (PFM) during ASLR. The main aim of this study was to examine the automatic PFM contraction during ASLR. Specific aims were to compare automatic contraction to rest and to voluntary contraction, to compare PFM contraction during ASLR with and without compression and to examine whether there were any differences in PFM contraction between women with and without clinically diagnosed PGP during ASLR. Forty-nine pairs of women participated in a cross-sectional study with individual, one-to-one matched cases and controls. PFM was assessed by reliable and valid 3D ultrasound at rest, during voluntary and automatic contraction. Test-retest data for the levator hiatus during ASLR showed good repeatability. Significantly automatic PFM contractions occurred when ASLR tests were performed. There was a strong positive correlation between voluntary and automatic PFM contractions. Manual compression reduced the automatic PFM contraction during ASLR by 62-66%. There were no significant differences between cases and controls in reduction of levator hiatus or muscle length from rest to automatic contractions during ASLR. Interestingly, a significantly smaller levator hiatus was found in women with PGP than in controls, at rest, during an automatic contraction with ASLR and during voluntary contraction. In conclusion, a significant automatic PFM contraction occurred during ASLR, both in cases and in controls. Women with PGP had a significantly smaller levator hiatus than controls. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Magnetic resonance imaging findings in the painful adult coccyx.

    Science.gov (United States)

    Maigne, Jean-Yves; Pigeau, Isabelle; Roger, Bernard

    2012-10-01

    Imaging of the painful coccyx currently relies on standard and dynamic radiography. There are no literature data on MRI of the coccyx. This examination could provide information on the cause of pain. 172 patients with severe chronic coccydynia underwent MRI and dynamic radiography of the coccyx. Disc abnormalities (seen in 70 patients) were related to either the presence of intradiscal liquid effusion (17/70), or abnormality of the endplates similar to Modic 1 changes (38/70), or uncertain abnormalities (15/70). Abnormalities of the tip of the coccyx (seen in 41 patients) were located in the surrounding soft tissues: venous dilatations (18/41), soft tissue inflammation (13/41) and ambiguous images (9/41). Vertebral bone oedema was observed in five cases and a benign tumour was observed once. The type of imaging feature depend broadly on the mobility of the coccyx: the 105 cases with a mobile coccyx mainly presented abnormal features mainly in a disc (63 cases vs. 4 cases for the tip), whereas the 67 patients with a rigid coccyx mainly showed abnormal features at the tip (37 cases vs. 7 for the joints, p coccyx when dynamic radiography fails to reveal clearly a pathological lesion (i.e., normal or slightly increased mobility of the coccyx or a rigid coccyx lacking a spicule).

  1. Painful and painless shoulder magnetic resonance imaging comparisons in hemodialysis patients and correlation with clinical findings.

    Science.gov (United States)

    Turk, Ayla Caglıyan; Fıdan, Nurdan; Ozcan, Oguzhan; Ozdemır, Ferda; Tomak, Leman; Ozkurt, Sultan; Sahın, Fusun

    2016-05-20

    Shoulder pain is frequently observed in haemodialysis patients. To compare haemodialysis patients with or without shoulder pain in terms of shoulder motion ranges, β2 microglobulin levels and magnetic resonance imaging findings. Forty-three patients undergoing dialysis were enrolled, of which 23 patients had explicit shoulder pain at night, which appeared during dialysis. Range of joint motion and impingement tests were evaluated. β 2 microglobulin value was recorded. MRI was used to evaluate rotator cuff tendons for thickness, homogeneity, integrity and presence of effusion. Ranges of motion were significantly lower in the painful shoulder group. Supraspinatus tendon thickness and the number of areas with effusion were higher in the painful group. There was a positive correlation between the β 2 microglobulin level and supraspinatus (r:0.352 ppain (r:0.351 ppain and shoulder motion ranges. Shoulder pain in dialysis patients can be related with tendon thickness and effusion. While the β 2 microglobulin level affects tendon thickness, it has no relation to pain and movement constraint.

  2. Broken Leg

    Science.gov (United States)

    ... the leg, which can result in a fracture. Stress fractures outside of sport situations are more common in people who have: ... shoes. Choose the appropriate shoe for your favorite sports or activities. And ... can prevent stress fractures. Rotate running with swimming or biking. If ...

  3. Transcranial magnetic stimulation of the brain: guidelines for pain treatment research.

    Science.gov (United States)

    Klein, Max M; Treister, Roi; Raij, Tommi; Pascual-Leone, Alvaro; Park, Lawrence; Nurmikko, Turo; Lenz, Fred; Lefaucheur, Jean-Pascal; Lang, Magdalena; Hallett, Mark; Fox, Michael; Cudkowicz, Merit; Costello, Ann; Carr, Daniel B; Ayache, Samar S; Oaklander, Anne Louise

    2015-09-01

    Recognizing that electrically stimulating the motor cortex could relieve chronic pain sparked development of noninvasive technologies. In transcranial magnetic stimulation (TMS), electromagnetic coils held against the scalp influence underlying cortical firing. Multiday repetitive transcranial magnetic stimulation (rTMS) can induce long-lasting, potentially therapeutic brain plasticity. Nearby ferromagnetic or electronic implants are contraindications. Adverse effects are minimal, primarily headaches. Single provoked seizures are very rare. Transcranial magnetic stimulation devices are marketed for depression and migraine in the United States and for various indications elsewhere. Although multiple studies report that high-frequency rTMS of the motor cortex reduces neuropathic pain, their quality has been insufficient to support Food and Drug Administration application. Harvard's Radcliffe Institute therefore sponsored a workshop to solicit advice from experts in TMS, pain research, and clinical trials. They recommended that researchers standardize and document all TMS parameters and improve strategies for sham and double blinding. Subjects should have common well-characterized pain conditions amenable to motor cortex rTMS and studies should be adequately powered. They recommended standardized assessment tools (eg, NIH's PROMIS) plus validated condition-specific instruments and consensus-recommended metrics (eg, IMMPACT). Outcomes should include pain intensity and qualities, patient and clinician impression of change, and proportions achieving 30% and 50% pain relief. Secondary outcomes could include function, mood, sleep, and/or quality of life. Minimum required elements include sample sources, sizes, and demographics, recruitment methods, inclusion and exclusion criteria, baseline and posttreatment means and SD, adverse effects, safety concerns, discontinuations, and medication-usage records. Outcomes should be monitored for at least 3 months after initiation

  4. Other Causes of Leg Pain

    Science.gov (United States)

    ... several long plane flights from New York to Kuwait, and had a genetic pre-disposition to blood ... about P.A.D. and to download free education materials, visit: MedlinePlus: medlineplus.gov/ peripheralarterialdisease.html Stay ...

  5. Magnetic resonance imaging for pain after surgical treatment for athletic pubalgia and the "sports hernia".

    Science.gov (United States)

    Zoga, Adam C; Meyers, William C

    2011-09-01

    Magnetic resonance (MR) imaging technique and findings in the setting of athletic pubalgia, including injury at the rectus abdominis/adductor aponeurosis, are becoming widely recognized. A subset of these patients is treated with various pelvic floor repairs, mesh reinforcements, and tendon releases. Most of these patients do well after intervention, but some have persistent or refractory groin pain, and others eventually develop new injuries in the pubic region or elsewhere about the pelvic girdle. This review describes the expected and some unexpected MRI findings in patients with recurrent or persistent groin pain after a "sports hernia" repair. © Thieme Medical Publishers.

  6. Music modulation of pain perception and pain-related activity in the brain, brain stem, and spinal cord: a functional magnetic resonance imaging study.

    Science.gov (United States)

    Dobek, Christine E; Beynon, Michaela E; Bosma, Rachael L; Stroman, Patrick W

    2014-10-01

    The oldest known method for relieving pain is music, and yet, to date, the underlying neural mechanisms have not been studied. Here, we investigate these neural mechanisms by applying a well-defined painful stimulus while participants listened to their favorite music or to no music. Neural responses in the brain, brain stem, and spinal cord were mapped with functional magnetic resonance imaging spanning the cortex, brain stem, and spinal cord. Subjective pain ratings were observed to be significantly lower when pain was administered with music than without music. The pain stimulus without music elicited neural activity in brain regions that are consistent with previous studies. Brain regions associated with pleasurable music listening included limbic, frontal, and auditory regions, when comparing music to non-music pain conditions. In addition, regions demonstrated activity indicative of descending pain modulation when contrasting the 2 conditions. These regions include the dorsolateral prefrontal cortex, periaqueductal gray matter, rostral ventromedial medulla, and dorsal gray matter of the spinal cord. This is the first imaging study to characterize the neural response of pain and how pain is mitigated by music, and it provides new insights into the neural mechanism of music-induced analgesia within the central nervous system. This article presents the first investigation of neural processes underlying music analgesia in human participants. Music modulates pain responses in the brain, brain stem, and spinal cord, and neural activity changes are consistent with engagement of the descending analgesia system. Copyright © 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.

  7. Efficacy of zoledronic acid for chronic low back pain associated with Modic changes in magnetic resonance imaging.

    Science.gov (United States)

    Koivisto, Katri; Kyllönen, Eero; Haapea, Marianne; Niinimäki, Jaakko; Sundqvist, Kaj; Pehkonen, Timo; Seitsalo, Seppo; Tervonen, Osmo; Karppinen, Jaro

    2014-03-04

    Modic changes (MC) are associated with low back pain (LBP), but effective treatments are lacking. The aim of this randomized, placebo-controlled, double-blinded trial was to evaluate the efficacy of zoledronic acid (ZA) for chronic LBP among patients with MC in magnetic resonance imaging (MRI). Inclusion criteria were LBP lasting ≥3 months, with an intensity of ≥6 on a 10-cm VAS or an Oswestry Disability Index (ODI) of ≥30%, and MC in MRI. Patients were randomized into single intravenous infusion of ZA 5 mg (n = 20), or placebo (n = 20) groups. The primary outcome was LBP intensity, secondary outcomes leg pain intensity, ODI, health-related quality of life (RAND-36), lumbar flexibility, sick leaves and use of pain medication. The treatment differences at one month and one year were analysed using ANCOVA with adjustment for the baseline score. The mean difference (MD) between the groups in the primary outcome, intensity of LBP, was 1.4 (95% confidence intervals (CI) 0.01 to 2.9) in favour of ZA at one month. We observed no significant between-group difference in the intensity of LBP at one year (MD 0.7; 95% CI -1.0 to 2.4) or in secondary outcomes at any time point except that 20% of patients in the ZA group used non-steroidal anti-inflammatory drugs at one year compared to 60% in the placebo group (P = 0.022). Acute phase reactions (fever, flu-like symptoms, arthralgia) emerged in 95% of the patients in the ZA group, compared to 35% in the placebo group. ZA was effective in reducing the intensity of LBP in the short term and in reducing the use of NSAIDs within the time span of one year among patients with chronic LBP and MC confirmed in MRI. Although the results seem encouraging, larger studies are required to analyse the effectiveness and safety of ZA for patients with MC. ClinicalTrial.gov identifier NCT01330238.

  8. Transcranial magnetic stimulation over human secondary somatosensory cortex disrupts perception of pain intensity.

    Science.gov (United States)

    Lockwood, Patricia L; Iannetti, Gian Domenico; Haggard, Patrick

    2013-09-01

    Pain is a complex sensory experience resulting from the activity of a network of brain regions. However, the functional contribution of individual regions in this network remains poorly understood. We delivered single-pulse transcranial magnetic stimulation (TMS) to the contralateral primary somatosensory cortex (S1), secondary somatosensory cortex (S2) and vertex (control site) 120 msec after selective stimulation of nociceptive afferents using neodymium:yttrium-aluminium-perovskite (Nd:YAP) laser pulses causing painful sensations. Participants were required to judge either the intensity (medium/high) or the spatial location (proximal/distal) of the stimulus in a two-alternative forced choice paradigm. When TMS pulses were delivered over S2, participants' ability to judge pain intensity was disrupted, as compared to S1 and vertex (control) stimulation. Signal-detection analysis demonstrated a loss of sensitivity to stimulation intensity, rather than a shift in perceived pain level or response bias. We did not find any effect of TMS on the ability to localise nociceptive stimuli on the skin. The novel finding that TMS over S2 can disrupt perception of pain intensity suggests a causal role for S2 in encoding of pain intensity. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Motor Cortex Reorganization and Repetitive Transcranial Magnetic Stimulation for Pain-A Methodological Study.

    Science.gov (United States)

    Nurmikko, Turo; MacIver, Kathryn; Bresnahan, Rebecca; Hird, Emily; Nelson, Andrew; Sacco, Paul

    2016-10-01

    Somatotopic reorganization of primary motor cortex (M1) has been described in several neurological conditions associated with chronic pain. We hypothesized that such reorganization impacts on the mechanisms of M1 stimulation induced analgesia and may either compromise the treatment effect of or provide an alternative target site for repetitive transcranial magnetic stimulation (rTMS). The aim of the study was to compare pain relief following rTMS of the standard motor "hotspot" with that of the reorganized area. We used TMS motor mapping in 30 patients to establish the location of the standard motor "hotspot" (site A) and an alternative site located in the reorganized area (site B), both within M1. Where TMS mapping was not possible (N = 8) we determined the location of the two sites using task-related fMRI. We compared the analgesic effect on neuropathic pain of 5 sessions of navigated rTMS applied over (i) site A, (ii) site B, and (iii) occipital fissure (SHAM stimulation site). Total Pain Relief (TOTPAR) was determined as the difference in average weekly pain scores between baseline and following each rTMS cycle, over three weeks. Data from 27 patients was analyzed. rTMS of sites A and B resulted in greater TOTPAR than that of SHAM. No difference was seen between sites A and B. Responders (≥15% pain relief) were seen in both groups, with partial overlap only. Addition of stimulation over site B improved the responder rate by 58% compared with site A. In an open-label extension study of five sessions of rTMS aimed at the optimized target site, 8/11 responders and 1/12 nonresponders reported pain relief. Cortical reorganization may provide a more effective stimulation target for rTMS in some individuals with neuropathic pain. © 2016 International Neuromodulation Society.

  10. Central pain processing in chronic chemotherapy-induced peripheral neuropathy: a functional magnetic resonance imaging study.

    Directory of Open Access Journals (Sweden)

    Elaine G Boland

    Full Text Available Life expectancy in multiple myeloma has significantly increased. However, a high incidence of chemotherapy induced peripheral neuropathy (CIPN can negatively influence quality of life during this period. This study applied functional magnetic resonance imaging (fMRI to compare areas associated with central pain processing in patients with multiple myeloma who had chemotherapy induced peripheral neuropathy (MM-CIPN with those from healthy volunteers (HV. Twenty-four participants (n = 12 MM-CIPN, n = 12 HV underwent Blood Oxygen Level-Dependent (BOLD fMRI at 3T whilst noxious heat-pain stimuli were applied to the foot and then thigh. Patients with MM-CIPN demonstrated greater activation during painful stimulation in the precuneus compared to HV (p = 0.014, FWE-corrected. Patients with MM-CIPN exhibited hypo-activation of the right superior frontal gyrus compared to HV (p = 0.031, FWE-corrected. Significant positive correlation existed between the total neuropathy score (reduced version and activation in the frontal operculum (close to insular cortex during foot stimulation in patients with MM-CIPN (p = 0.03, FWE-corrected; adjusted R2 = 0.87. Painful stimuli delivered to MM-CIPN patients evoke differential activation of distinct cortical regions, reflecting a unique pattern of central pain processing compared with healthy volunteers. This characteristic activation pattern associated with pain furthers the understanding of the pathophysiology of painful chemotherapy induced peripheral neuropathy. Functional MRI provides a tool for monitoring cerebral changes during anti-cancer and analgesic treatment.

  11. Association between preoperative magnetic resonance imaging, pain intensity and quantitative sensory testing in patients awaiting lumbar diskectomy.

    LENUS (Irish Health Repository)

    Hegarty, Dominic

    2011-02-01

    Magnetic resonance imaging (MRI) offers important information regarding the morphology, location and size of a herniated disc, which influences the decision to offer lumbar diskectomy (LD). This study aims to examine the association between clinical neurophysiologic indices including pain intensity and quantitative sensory testing (QST), and the degree of lumbar nerve root compromise depicted on magnetic resonance (MR) in patients awaiting LD.

  12. Magnetic Resonance-Guided High-Intensity-Focused Ultrasound for Palliation of Painful Skeletal Metastases: A Pilot Study.

    Science.gov (United States)

    Chan, Michael; Dennis, Kristopher; Huang, Yuexi; Mougenot, Charles; Chow, Edward; DeAngelis, Carlo; Coccagna, Jennifer; Sahgal, Arjun; Hynynen, Kullervo; Czarnota, Gregory; Chu, William

    2017-10-01

    Bone is one of the most common sites of metastases, with bone metastases-related pain representing a significant source of morbidity among patients with cancer. Magnetic resonance-guided focused ultrasound is a noninvasive, outpatient modality with the potential for treating painful bone metastases. The aim of this study is to report our initial experience with magnetic resonance-guided focused ultrasound in the treatment of bone metastases and our preliminary analysis of urinary cytokine levels after therapy. This was a single-center pilot study of 10 patients with metastatic cancer to investigate the feasibility of magnetic resonance-guided focused ultrasound for primary pain control in device-accessible skeletal metastases. Treatments were performed on a clinical magnetic resonance-guided focused ultrasound system using a volumetric ablation technique. Primary efficacy was assessed using Brief Pain Inventory scores and morphine equivalent daily dose intake at 3 time points: before, day 14, and day 30 after the magnetic resonance-guided focused ultrasound treatment. Urine cytokines were measured 3 days before treatment and 2 days after the treatment. Of the 10 patients, 8 were followed up 14 days and 6 were followed up 30 days after the treatment. At day 14, 3 patients (37.5%) exhibited partial pain response and 4 patients (50%) exhibited an indeterminate response, and at day 30 after the treatment, 5 patients (83%) exhibited partial pain response. No treatment-related adverse events were recorded. Of the urine cytokines measured, only Transforming growth factor alpha (TGFα) demonstrated an overall decrease, with a trend toward statistical significance ( P = .078). Our study corroborates magnetic resonance-guided focused ultrasound as a feasible and safe modality as a primary, palliative treatment for painful bone metastases and contributes to the limited body of literature using magnetic resonance-guided focused ultrasound for this clinical indication.

  13. A tool for classifying individuals with chronic back pain: using multivariate pattern analysis with functional magnetic resonance imaging data.

    Directory of Open Access Journals (Sweden)

    Daniel Callan

    Full Text Available Chronic pain is one of the most prevalent health problems in the world today, yet neurological markers, critical to diagnosis of chronic pain, are still largely unknown. The ability to objectively identify individuals with chronic pain using functional magnetic resonance imaging (fMRI data is important for the advancement of diagnosis, treatment, and theoretical knowledge of brain processes associated with chronic pain. The purpose of our research is to investigate specific neurological markers that could be used to diagnose individuals experiencing chronic pain by using multivariate pattern analysis with fMRI data. We hypothesize that individuals with chronic pain have different patterns of brain activity in response to induced pain. This pattern can be used to classify the presence or absence of chronic pain. The fMRI experiment consisted of alternating 14 seconds of painful electric stimulation (applied to the lower back with 14 seconds of rest. We analyzed contrast fMRI images in stimulation versus rest in pain-related brain regions to distinguish between the groups of participants: 1 chronic pain and 2 normal controls. We employed supervised machine learning techniques, specifically sparse logistic regression, to train a classifier based on these contrast images using a leave-one-out cross-validation procedure. We correctly classified 92.3% of the chronic pain group (N = 13 and 92.3% of the normal control group (N = 13 by recognizing multivariate patterns of activity in the somatosensory and inferior parietal cortex. This technique demonstrates that differences in the pattern of brain activity to induced pain can be used as a neurological marker to distinguish between individuals with and without chronic pain. Medical, legal and business professionals have recognized the importance of this research topic and of developing objective measures of chronic pain. This method of data analysis was very successful in correctly classifying

  14. Leg Injuries and Disorders

    Science.gov (United States)

    Your legs are made up of bones, blood vessels, muscles, and other connective tissue. They are important for motion ... falling, or having an accident can damage your legs. Common leg injuries include sprains and strains, joint ...

  15. Reducing wound pain in venous leg ulcers with Biatain Ibu: A randomized, controlled double-blind clinical investigation on the performance and safety

    DEFF Research Database (Denmark)

    Gottrup, F.; Jorgensen, B.; Karlsmark, T.

    2008-01-01

    Six out of 10 patients with chronic wounds suffer from persistent wound pain. A multinational and multicenter randomized double-blind clinical investigation of 122 patients compared two moist wound healing dressings: a nonadhesive foam dressing with ibuprofen (62 patients randomized to Biatain Ibu...... without compromising safety including appropriate healing rate. Additional endpoints were change in persistent wound pain between dressing changes and pain at dressing change on days 1-5 (double blind) and days 43-47 (single blind). The primary response variable, persistent pain relief, was significantly...... higher in the ibuprofen-foam group, as compared with the comparator on day 1-5, with a quick onset of action (p Wound pain intensity was significantly reduced with the ibuprofen foam during day 1-5 with 40% from baseline, compared with 30% with the comparator (p

  16. Peripheral artery disease - legs

    Science.gov (United States)

    Peripheral vascular disease; PVD; PAD; Arteriosclerosis obliterans; Blockage of leg arteries; Claudication; Intermittent claudication; Vaso-occlusive disease of the legs; Arterial insufficiency of ...

  17. The differences of brain cortical activation between superficial pain and deep pain

    International Nuclear Information System (INIS)

    Ikemoto, Tatsunori; Ushida, Takahiro; Taniguchi, Shinichirou; Tani, Toshikazu; Morio, Kazuo; Sasaki, Toshikazu; Tanaka, Shigeki

    2006-01-01

    Using functional magnetic resonance imaging (FMRI) technology, we investigated the difference of pain related brain cortical activation derived from noxious stimulation to the skin and muscular tissue. Ten healthy volunteers who have no history of brain vascular disease were enrolled in this study. A cutaneous pain was provoked by isotonic (0.9%) saline injection into intra-dermal space on right lower leg through 24G plastic catheter, and a muscle pain was provoked by hypertonic (3%) saline injection into right tibialis anterior muscle. We used event-related FMRI to measure brain activity during each injection. Visual analogue scale (VAS) was used to quantify pain intensity and unpleasantness, and pain quality was assessed with several verbal descriptions. Pain unpleasantness rating was higher in the muscle pain compared to the cutaneous pain, despite the same pain intensity rating. The cutaneous pain had more acute pain onset than the muscle pain. Pain duration after stimulation was short in the cutaneous pain, but long in the muscle pain. The extent of the painful region tended to be larger with the muscle pain, but there was no statistical significance. Evoked FMRI response from the cutaneous pain showed distinct brain activation in the inferior and superior parietal cortex (BA: Brodmann area 5/7/40), primary and secondary somatosensory cortex (S1 and S2), insula, supplementary motor area (SMA, BA6), posterior cingulate cortex and cerebellum. On the other hand, FMRI response from muscle pain showed distinct brain activation mainly in the contralateral insula. These results suggest that the parietal lobe including the S1 is the essential area for cognition of sharp and well-localized pain conditions such as cutaneous pain, and may not be essential for cognition of diffuse pain derived from muscular tissue. (author)

  18. Restless Legs Syndrome and Leg Motor Restlessness in Parkinson's Disease.

    Science.gov (United States)

    Suzuki, Keisuke; Miyamoto, Masayuki; Miyamoto, Tomoyuki; Hirata, Koichi

    2015-01-01

    Sleep disturbances are important nonmotor symptoms in Parkinson's disease (PD) that are associated with a negative impact on quality of life. Restless legs syndrome (RLS), which is characterized by an urge to move the legs accompanied by abnormal leg sensations, can coexist with PD, although the pathophysiology of these disorders appears to be different. RLS and PD both respond favorably to dopaminergic treatment, and several investigators have reported a significant relationship between RLS and PD. Sensory symptoms, pain, motor restlessness, akathisia, and the wearing-off phenomenon observed in PD should be differentiated from RLS. RLS in PD may be confounded by chronic dopaminergic treatment; thus, more studies are needed to investigate RLS in drug-naïve patients with PD. Recently, leg motor restlessness (LMR), which is characterized by an urge to move the legs that does not fulfill the diagnostic criteria for RLS, has been reported to be observed more frequently in de novo patients with PD than in age-matched healthy controls, suggesting that LMR may be a part of sensorimotor symptoms intrinsic to PD. In this paper, we provide an overview of RLS, LMR, and PD and of the relationships among these disorders.

  19. Transcranial magnetic stimulation in the treatment of chronic widespread pain: a randomized controlled study.

    Science.gov (United States)

    Avery, David H; Zarkowski, Paul; Krashin, Daniel; Rho, Wang-Ku; Wajdik, Chandra; Joesch, Jutta M; Haynor, David R; Buchwald, Dedra; Roy-Byrne, Peter

    2015-03-01

    Our objective was to assess transcranial magnetic stimulation (TMS) in the treatment of chronic widespread pain. Nineteen participants were randomized into 2 groups: one group receiving active TMS (n = 7) and another group receiving sham stimulation (n = 11) applied to the left dorsolateral prefrontal cortex. During sham stimulation, subjects heard a sound similar to the sound heard by those receiving the active treatment and received an active electrical stimulus to the scalp. The stimulation protocol consisted of 15 sessions completed within a 4-week period. Blind assessments were done at baseline and after each 5 sessions followed by blind assessments at 1 week, 1 month, and 3 months after the last TMS sessions. The primary outcome variable was a pain measure, the Gracely Box Intensity Scale (BIRS). The percentage of subjects who guessed that they were receiving TMS was similar in the 2 groups. Both the TMS group and the sham group showed a statistically significant reduction in the BIRS scores from baseline during the acute phase of treatment and the follow-up phase. However, the TMS and sham groups did not differ in the change in the BIRS scores. Although some previous clinical studies and basic science studies of TMS in treating pain are promising, this study found no difference in the analgesic effect of TMS and sham stimulation. Future studies should use a sham condition that attempts to simulate the sound and sensation of the TMS stimulation. Stimulus location and other stimulus parameters should be explored in future studies.

  20. Reducing wound pain in venous leg ulcers with Biatain Ibu: A randomized, controlled double-blind clinical investigation on the performance and safety

    DEFF Research Database (Denmark)

    Gottrup, F.; Jorgensen, B.; Karlsmark, T.

    2008-01-01

    Six out of 10 patients with chronic wounds suffer from persistent wound pain. A multinational and multicenter randomized double-blind clinical investigation of 122 patients compared two moist wound healing dressings: a nonadhesive foam dressing with ibuprofen (62 patients randomized to Biatain Ibu...... without compromising safety including appropriate healing rate. Additional endpoints were change in persistent wound pain between dressing changes and pain at dressing change on days 1-5 (double blind) and days 43-47 (single blind). The primary response variable, persistent pain relief, was significantly......-47, the patients in the ibuprofen-foam group had a significant (p Wound healing was similar in the ibuprofen foam and comparator group. No difference in adverse events between...

  1. Shaped magnetic field pulses by multi-coil repetitive transcranial magnetic stimulation (rTMS) differentially modulate anterior cingulate cortex responses and pain in volunteers and fibromyalgia patients

    Science.gov (United States)

    2013-01-01

    Background Repetitive transcranial magnetic stimulation (rTMS) has shown promise in the alleviation of acute and chronic pain by altering the activity of cortical areas involved in pain sensation. However, current single-coil rTMS technology only allows for effects in surface cortical structures. The ability to affect activity in certain deep brain structures may however, allow for a better efficacy, safety, and tolerability. This study used PET imaging to determine whether a novel multi-coil rTMS would allow for preferential targeting of the dorsal anterior cingulate cortex (dACC), an area always activated with pain, and to provide preliminary evidence as to whether this targeted approach would allow for efficacious, safe, and tolerable analgesia both in a volunteer/acute pain model as well as in fibromyalgia chronic pain patients. Methods Part 1: Different coil configurations were tested in a placebo-controlled crossover design in volunteers (N = 16). Tonic pain was induced using a capsaicin/thermal pain model and functional brain imaging was performed by means of H215O positron emission tomography – computed tomography (PET/CT) scans. Differences in NRS pain ratings between TMS and sham treatment (NRSTMS-NRSplacebo) which were recorded each minute during the 10 minute PET scans. Part 2: 16 fibromyalgia patients were subjected to 20 multi-coil rTMS treatments over 4 weeks and effects on standard pain scales (Brief Pain Inventory, item 5, i.e. average pain NRS over the last 24 hours) were recorded. Results A single 30 minute session using one of 3 tested rTMS coil configurations operated at 1 Hz consistently produced robust reduction (mean 70% on NRS scale) in evoked pain in volunteers. In fibromyalgia patients, the 20 rTMS sessions also produced a significant pain inhibition (43% reduction in NRS pain over last 24 hours), but only when operated at 10 Hz. This degree of pain control was maintained for at least 4 weeks after the final session

  2. Magnetic resonance-guided focused ultrasound surgery for treatment of painful osseous metastases

    Science.gov (United States)

    Hurwitz, Mark; Machtinger, Ronit; Fennessy, Fiona

    2011-03-01

    Magnetic resonance guided focused ultrasound surgery (MRgFUS) is an emerging technology that can non-invasively heat and ablate targeted tissue utilizing ultrasound energy. Use of MR imaging for treatment guidance provides several key advantages over more widely used ultrasound guidance for focused ultrasound ablation. MR allows for precise targeting, detailed beam path visualization, real time non-invasive temperature measurement, and treatment feedback to ensure therapeutic goals are achieved. In the realm of oncology, management of painful bone metastases is a common and daunting clinical problem. The Insightec ExAblate System has been shown in phase I/II trials for treatment of bone metastases to have an excellent safety profile and high rates of pain response. An international multi-center phase III trial for patients with painful bone metastases or multiple myeloma who are not candidates for radiation therapy is currently open. Patients are randomized 3:1 to MRgFUS or sham treatment with crossover to study treatment allowed for sham failures. The primary study endpoint is assessment of pain control over 3 months following treatment. In addition safety, quality of life, cost effectiveness analysis, and patient perceived clinical benefit are also being assessed. Details of the MRgFUS system, technical and clinical therapeutic parameters, use of real time non-invasive MR thermometry, and examples of patient treatments with use of MRgFUS to treat bone metastases will be discussed. New directions in use of MRgFUS including an update on development of a new mobile applicator and integration of MRgFUS in multimodality oncologic care will also be presented.

  3. Role of magnetic resonance imaging in the evaluation of articular cartilage in painful knee joint

    Directory of Open Access Journals (Sweden)

    Digish Shah

    2014-01-01

    Full Text Available Aim: The aim of this study was to determine the role of the magnetic resonance imaging (MRI in patients with atraumatic knee pain. Background and Objectives: Knee pain is one of the most common problems faced by people from time immemorial. There is a wide range of disease ranging from traumatic to degenerative causing knee pain in which articular cartilage is involved. Over the past 15 years, MRI has become the premier, first-line imaging study that should be performed in the evaluation of the painful knee in particular in tears of menisci, cruciate and collateral ligaments, osteochondral abnormalities (chondromalacia, osteoarthritis and osteochondral defects, synovial cysts and bone bruises. MRI, by virtue of its superior soft-tissue contrast, lack of ionizing radiation and multiplanar capabilities, is superior to more conventional techniques for the evaluation of articular cartilage. Materials and Methods: A prospective study was carried out on 150 patients in the Department of Radio-diagnosis, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune over a period of 2 years from June 2011 to May 2013. Patients having fracture or dislocations of the knee joint were also excluded from the study. Detailed clinical history, physical and systemic examination findings of all patients were noted in addition to the laboratory investigations. All patients were subjected to radiograph of knee anterior-posterior and lateral view. MRI was performed with Siemens 1.5 Tesla MAGNETOM Avanto machine. Results: In our study of 150 patients with knee pain, articular cartilage defect was found in 90 patients (60%. Out of 90 patients with articular cartilage defect, 30 patients (20% had full thickness cartilage defects. Subchondral marrow edema was seen beneath 30 patients (20% with articular cartilage defects. 32 patients (21.1% had a complex or macerated meniscal tear. Complete anterior cruciate ligament tear was found in seven

  4. The somatosensory link in fibromyalgia: functional connectivity of the primary somatosensory cortex is altered by sustained pain and is associated with clinical/autonomic dysfunction.

    Science.gov (United States)

    Kim, Jieun; Loggia, Marco L; Cahalan, Christine M; Harris, Richard E; Beissner, Florian; Garcia, Ronald G; Kim, Hyungjun; Wasan, Ajay D; Edwards, Robert R; Napadow, Vitaly

    2015-05-01

    Fibromyalgia (FM) is a chronic functional pain syndrome characterized by widespread pain, significant pain catastrophizing, sympathovagal dysfunction, and amplified temporal summation for evoked pain. While several studies have demonstrated altered resting brain connectivity in FM, studies have not specifically probed the somatosensory system and its role in both somatic and nonsomatic FM symptoms. Our objective was to evaluate resting primary somatosensory cortex (S1) connectivity and to explore how sustained, evoked deep tissue pain modulates this connectivity. We acquired functional magnetic resonance imaging and electrocardiography data on FM patients and healthy controls during rest (the rest phase) and during sustained mechanical pressure-induced pain over the lower leg (the pain phase). Functional connectivity associated with different S1 subregions was calculated, while S1(leg) connectivity (representation of the leg in the primary somatosensory cortex) was contrasted between the rest phase and the pain phase and was correlated with clinically relevant measures in FM. During the rest phase, FM patients showed decreased connectivity between multiple ipsilateral and cross-hemispheric S1 subregions, which was correlated with clinical pain severity. Compared to the rest phase, the pain phase produced increased S1(leg) connectivity to the bilateral anterior insula in FM patients, but not in healthy controls. Moreover, in FM patients, sustained pain-altered S1(leg) connectivity to the anterior insula was correlated with clinical/behavioral pain measures and autonomic responses. Our study demonstrates that both somatic and nonsomatic dysfunction in FM, including clinical pain, pain catastrophizing, autonomic dysfunction, and amplified temporal summation, are closely linked with the degree to which evoked deep tissue pain alters S1 connectivity to salience/affective pain-processing regions. Additionally, diminished connectivity between S1 subregions during the rest

  5. Clinical and electrophysiological impact of repetitive low-frequency transcranial magnetic stimulation on the sensory-motor network in patients with restless legs syndrome.

    Science.gov (United States)

    Lanza, Giuseppe; Cantone, Mariagiovanna; Aricò, Debora; Lanuzza, Bartolo; Cosentino, Filomena Irene Ilaria; Paci, Domenico; Papotto, Maurizio; Pennisi, Manuela; Bella, Rita; Pennisi, Giovanni; Paulus, Walter; Ferri, Raffaele

    2018-01-01

    Based on the hyperexcitability and disinhibition observed in patients with restless legs syndrome (RLS) following transcranial magnetic stimulation (TMS), we conducted a study with low-frequency repetitive TMS (rTMS) over the primary motor (M1) and somatosensory cortical areas (S1) in patients with RLS. A total of 13 right-handed patients and 10 age-matched controls were studied using clinical scales and TMS. Measurements included resting motor threshold (rMT), motor-evoked potentials (MEPs), cortical silent period (CSP), and central motor conduction time (CMCT). A single evening session of rTMS (1 Hz, 20 trains, 50 stimuli each) was administered over the left M1, left S1, and sham stimulation over M1 in a random order. Clinical and TMS measures were repeated after each stimulation modality. Baseline CSP was shorter in patients than in controls and remained shorter in patients for both motor and somatosensory stimulation. The patients reported a subjective improvement of both initiating and maintaining sleep the night after the rTMS over S1. Patients exhibited a decrease in rMT after rTMS of S1 only, although the effect was smaller than in controls. MEP latency and CMCT changed only in controls after stimulation. Sham stimulation was without effect on the observed variables. rTMS on S1-M1 connectivity alleviated the sensory-motor complaints of RLS patients. The TMS indexes of excitation and inhibition indicate an intracortical and corticospinal imbalance, mainly involving gamma-aminobutyric acid (GABA)ergic and glutamatergic circuitries, as well as an impairment of the short-term mechanisms of cortical plasticity. The rTMS-induced activation of the dorsal striatum with the consequent increase of dopamine release may have contributed to the clinical and neurophysiological outcome.

  6. Facilitated Pronociceptive Pain Mechanisms in Radiating Back Pain Compared With Localized Back Pain

    DEFF Research Database (Denmark)

    Vaegter, Henrik Bjarke; Palsson, Thorvaldur Skuli; Graven-Nielsen, Thomas

    2017-01-01

    pressure pain threshold (cPPT), tolerance (cPTT), temporal summation of pain (TSP: increase in pain scores to ten repeated stimulations at cPTT intensity), and conditioning pain modulation (CPM: increase in cPPT during cuff pain conditioning on the contralateral leg). Heat detection (HDT) and heat pain...

  7. A diagnostic study in patients with sciatica establishing the importance of localization of worsening of pain during coughing, sneezing and straining to assess nerve root compression on MRI.

    Science.gov (United States)

    Verwoerd, Annemieke J H; Mens, Jan; El Barzouhi, Abdelilah; Peul, Wilco C; Koes, Bart W; Verhagen, Arianne P

    2016-05-01

    To test whether the localization of worsening of pain during coughing, sneezing and straining matters in the assessment of lumbosacral nerve root compression or disc herniation on MRI. Recently the diagnostic accuracy of history items to assess disc herniation or nerve root compression on magnetic resonance imaging (MRI) was investigated. A total of 395 adult patients with severe sciatica of 6-12 weeks duration were included in this study. The question regarding the influence of coughing, sneezing and straining on the intensity of pain could be answered on a 4 point scale: no worsening of pain, worsening of back pain, worsening of leg pain, worsening of back and leg pain. Diagnostic odds ratio's (DORs) were calculated for the various dichotomization options. The DOR changed into significant values when the answer option was more narrowed to worsening of leg pain. The highest DOR was observed for the answer option 'worsening of leg pain' with a DOR of 2.28 (95 % CI 1.28-4.04) for the presence of nerve root compression and a DOR of 2.50 (95 % CI 1.27-4.90) for the presence of a herniated disc on MRI. Worsening of leg pain during coughing, sneezing or straining has a significant diagnostic value for the presence of nerve root compression and disc herniation on MRI in patients with sciatica. This study also highlights the importance of the formulation of answer options in history taking.

  8. Deep Transcranial Magnetic Stimulation: A Promising Drug-Free Treatment Modality in the Treatment of Chronic Low Back Pain.

    Science.gov (United States)

    Yates, Erin; Balu, Ganesh

    2016-03-01

    Deep Transcranial Magnetic Stimulation (dTMS) is the next generation of technology used to treat Major Depressive Disorder (MDD). dTMS has been proven to be a safe and effective treatment modality for MDD and may have secondary benefits in patients with chronic low back pain by reducing pain related morbidity. We are presenting two case studies with MDD and chronic low back pain to demonstrate the effectiveness of both the antidepressant and analgesic effects of dTMS. Transcranial Magnetic Stimulation (rTMS) utilizes MRI-strength magnetic pulses outside the cranium to stimulate the brain to a depth of approximately 1 cm. The technique was approved by the US Food and Drug Administration (FDA) for the treatment of Major Depressive Disorder (MDD) in 2008. In 2013 the Brainsway Deep Transcranial Magnetic Stimulation (dTMS) device, which has the potential for cranial penetration up to 5 cm received FDA clearance for pharmacotherapy and psychotherapy resistant MDD. The mechanism of action of dTMS in MDD is not completely understood. However, its clinical efficacy is proven.' The effect of dTMS on the brain has been studied since 1985 in clinical trials and has been demonstrated as an effective treatment modality for refractory depressive symptoms. The mechanism of action of dTMS is thought to be mediated by increased connectivity between the dorsolateral prefrontal cortex (DLPFC) and the thalamus and reduced subgenual cingulate to caudate connectivity. These brain areas are believed to be responsible for modulating mood. Chronic pain is often accompanied by MDD. Specifically, chronic low back pain is highly prevalent and accompanied by significant disability.2 Low back pain is defined as chronic when the pain is continuous for more than three months. The current chronic pain treatment algorithm includes judicious use of non pharmacological interventions like physical therapy, chiropractic adjustments, therapeutic massage, or acupuncture combined with pharmacological

  9. The transverse abdominal muscle is excessively active during active straight leg raising in pregnancy-related posterior pelvic girdle pain: an observational study

    NARCIS (Netherlands)

    Mens, Jan M A; Pool-Goudzwaard, A.L.

    2017-01-01

    BACKGROUND: Many studies suggest that impairment of motor control is the mechanical component of the pathogenesis of painful disorders in the lumbo-sacral region; however, this theory is still unproven and the results and recommendations for intervention remain questionable. The need for a force to

  10. The transverse abdominal muscle is excessively active during active straight leg raising in pregnancy-related posterior pelvic girdle pain: An observational study

    NARCIS (Netherlands)

    J.M.A. Mens (Jan); A.L. Pool-Goudzwaard (Annelies)

    2017-01-01

    textabstractBackground: Many studies suggest that impairment of motor control is the mechanical component of the pathogenesis of painful disorders in the lumbo-sacral region; however, this theory is still unproven and the results and recommendations for intervention remain questionable. The need for

  11. Changeability of tissue's magnetic remanence after galvanic-magnetostimulation in upper-back pain treatment.

    Science.gov (United States)

    Dyszkiewicz, Andrzej Jan; Kępiński, Paweł; Połeć, Paweł; Chachulski, Damian; Nowak-Kostrzewska, Ewa

    2015-11-01

    Research was conducted on parametric profiles of healthy subjects and patients with cervico-brachial pain syndrome resulting from C4/5 and/or C5/6 discopathy, including magnetic remanence of tissues in marker points 1-12 (L+R) and functional parameters, and their subsequent change after treatment in group A, using method of push-pull galvanic magnetostimulation (GMT 2.0). GMT 2.0 device, comprised of one air solenoid and three galvanic solenoids in electrolytic tubs, was designed for push-pull magnetostimulation of the head, coupled with simultaneous stimulation of the limbs. Clinical trial was conducted in Outpatient Private Clinic "VIS" under the auspices of Silesian Higher Medical School in Katowice, Poland. 55 subjects participated in the study: control group K consisted of 23 healthy individuals, whereas 33 patients in group A were treated using GMT 2.0. Only patients in group A were treated with GMT 2.0 during 40-min sessions over a period of 10 days. Parametric profile of the patients was defined using various measurements: electronic SFTR test (C-Th-shoulders), HR, RR, BDI and VAS tests, magnetic remanence in marker points 1-12 (L+R) and blood parameters: HB, ER, CREA, BIL, K(+), Na(+), Cl(-) Fe(2+), Ca(2+) and Mg(2+). There was a significant reduction in pain (VAS), increase in the range of motion (SFTR), lower depression symptoms (BDI), slower heart rate (HR), lower blood pressure (RR), greater concentration of Mg(2+), K(+), Ca(2+)ions and reduction in the concentration of BIL, CREA Fe(2+) after GMT 2.0 treatment in group A. Evaluation of magnetic remanence in marker points M1-12 (L+R) initially showed higher values in group K, which after treatment were normalized to values similar to those in group K. GMT 2.0 treatment in group A resulted in normalization of magnetic remanence, synergically with increased range of motion (SFTR test), decreased HR and RR parameters, smaller depressive trends (BDI test), as well as increased ion levels (K(+), Mg(2+), Ca(2

  12. Sickle cell disease painful crisis and steady state differentiation by proton magnetic resonance.

    Science.gov (United States)

    Fernández, Adolfo A; Cabal, Carlos A; Lores, Manuel A; Losada, Jorge; Pérez, Enrique R

    2009-01-01

    The delay time of the Hb S polymerization process was investigated in 63 patients with sickle cell disease during steady state and 10 during painful crisis starting from spin-spin proton magnetic resonance (PMR) time behavior measured at 36 degrees C and during spontaneous deoxygenation. We found a significant decrease of delay time as a result of the crisis (36 +/- 10%) and two well-differentiated ranges of values for each state: 273-354 min for steady state and 166-229 min for crisis with an uncertainty region of 15%. It is possible to use PMR as an objective and quantitative method in order to differentiate both clinical conditions of the sickle cell patient, but a more clear differentiation can be established comparing the delay time (td) value of one patient during crisis with his own td value during steady state.

  13. Transcranial Magnetic Stimulation in the Treatment of Chronic Widespread Pain: A Randomized, Controlled Study

    Science.gov (United States)

    Avery, David H.; Zarkowski, Paul; Krashin, Daniel; Rho, Wang-ku; Wajdik, Chandra; Joesch, Jutta M.; Haynor, David R.; Buchwald, Dedra; Roy-Byrne, Peter

    2014-01-01

    Objective Our objective was to assess transcranial magnetic stimulation (TMS) in the treatment of chronic widespread pain (CWP). Methods Nineteen participants were randomized to two groups: one receiving active TMS (N=7) and another receiving sham stimulation (N=11) applied to the left dorsolateral prefrontal cortex. During sham stimulation, subjects heard a sound similar to the sound heard by those receiving the active treatment and received an active electrical stimulus to the scalp. The stimulation protocol consisted of 15 sessions completed within a 4-week period. Blind assessments were done at baseline and after each 5 sessions followed by blind assessments at 1 week, 1 month and 3 months after the last TMS sessions. The primary outcome variable was a pain measure, the Gracely Box Intensity Scale (BIRS). Results The percentage of subjects who guessed that they were receiving TMS was similar in the two groups. Both the TMS group and the sham group showed a statistically significant reduction in the BIRS scores from baseline during the acute phase of treatment and the follow-up phase. However, the TMS and sham groups did not differ in the change in the BIRS scores. Discussion Although some previous clinical studies and basic science studies of TMS in treating pain are promising, this study found no difference in the analgesic effect of TMS and sham stimulation. Future studies should utilize a sham condition that attempts to simulate the sound and sensation of the TMS stimulation. Stimulus location and other stimulus parameters should be explored in future studies. PMID:24755729

  14. Repetitive peripheral magnetic neurostimulation of multifidus muscles combined with motor training influences spine motor control and chronic low back pain.

    Science.gov (United States)

    Massé-Alarie, Hugo; Beaulieu, Louis-David; Preuss, Richard; Schneider, Cyril

    2017-03-01

    The study tested whether combining repetitive peripheral magnetic stimulation (RPMS) and motor training of the superficial multifidus muscle (MF) better improved the corticomotor control of spine than training alone in chronic low back pain (CLBP). Twenty-one participants with CLBP were randomly allocated to [RPMS+training] and [Sham+training] groups for three sessions (S1-S3) over a week where MF was stimulated before training (volitional contraction). Training was also home-practiced twice a day. Changes were tested at S1 and S3 for anticipatory postural adjustments (APAs) of MF and semi-tendinosus (ST), MF EMG activation, cortical motor plasticity (transcranial magnetic stimulation) and pain/disability. The RPMS group showed immediate decrease of pain at S1, then improvement of MF activation, ST APA, M1 facilitation, and pain/disability at S3. Changes were larger when brain excitability was lower at baseline. Disability index remained improved one month later. Combining RPMS with training of MF in CLBP impacted motor planning, MF and lumbopelvic spine motor control and pain/disability one week after the onset of protocol. Brain plasticity might have favoured motor learning and improved daily lumbopelvic spine control without pain generation. Clinically, RPMS impacted the function by improving the gains beyond those reached by training alone in CLBP. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  15. Repetitive transcranial magnetic stimulation for pain after spinal cord injury: a systematic review and meta-analysis.

    Science.gov (United States)

    Gao, Feng; Chu, Hongyu; Li, Jianjun; Yang, Mingliang; DU, Liangjie; Li, Jun; Chen, Liang; Yang, Degang; Zhang, Hong; Chan, Chetwyn

    2017-10-01

    The evidence regarding efficiency of repetitive transcranial magnetic stimulation (rTMS) on relief of neuropathic pain (NP) in patients with prior spinal cord injury (SCI) is controversial. The current meta-analysis aimed to assess the efficacy of rTMS in pain relieve in patients suffering from SCI associated NP. Medline, PubMed, Cochrane Database, EMBASE, Google Scholar databases were searched for clinical studies on effects of rTMS treatment on NP caused by prior SCI published before March 14th, 2016 with various combinations of following key words: "transcranial magnetic stimulation," "spinal injury," "pain." Standardized difference in means with 95% confidence interval was calculated for the change of pain scores after rTMS or sham rTMS treatments. A total of two randomized controlled studies (RCTs) and 4 crossover RCTs were included in the present meta-analysis. The RCTs recruited a total of 27 patients. The crossover RCTs recruited a total of 100 patients. The combined standardized difference in means indicated that patients who received rTMS intervention had better pain relief than those who received sham rTMS intervention, however, the results did not reach statistical significance (standardized mean difference -0.607, 95% CI: -1.29 to 0.075, P=0.081). rTMS might reduce SCI associated neuropathic pain; however, further studies are required to support our conclusions.

  16. 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.

  17. 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.

  18. Restless legs syndrome mimicking S1 radiculopathy.

    Science.gov (United States)

    Zambelis, Th; Wolgamuth, B R; Papoutsi, S N; Economou, N T

    2016-01-01

    Α case of a chronic idiopathic form of a severe type of Restless Legs Syndrome (RLS), which developed during pregnancy and persisted after this, misdiagnosed for 34 years as radiculopathy S1, is reported. In spite of the thorough clinical and laboratory investigation, in addition to constant changes of the therapeutic approach, the diagnosis of S1 radiculopathy could not be confirmed, resulting in a chronic clinical course; the latter was characterized by relapses and remissions not attributed or linked in any way to the treatment (various types of). In fact, it was due to a routine workup in a sleep clinic, where the patient was referred because of a coincident chronic insomnia (Restless Legs Syndrome is a known and important cause of insomnia/chronic insomnia), which resulted in a proper diagnosis and treatment of this case. With the use of Restless Legs Syndrome appropriate treatment (Pramipexole 0.18 mg taken at bedtime, a dopaminergic agent and Level A recommended drug for Restless Legs Syndrome) an excellent response and immediate elimination of symptoms was achieved. Restless Legs Syndrome may present with a variety of symptoms (with the most prominent shortly being reported with the acronym URGE: Urge to move the legs usually associated with unpleasant leg sensations, Rest induces symptoms, Getting active brings relief, Evening and night deteriorate symptoms); given the fact that Restless Legs Syndrome presents with a great variety and heterogeneity of symptoms (mostly pain, dysesthesia and paresthesia), which may occur in several other diseases (the so called "RLS mimics"), proper diagnosis of Restless Legs Syndrome usually fails. Restless Legs Syndrome misinterpreted as S1 radiculopathy, to the best of our knowledge, has not been reported yet in the literature. Here, case history, clinical course and common RLS mimics are presented. Different forms of Restless Legs Syndrome manifestations, which are commonly -as in this case- misinterpreted due to their

  19. Leg lengthening - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100127.htm Leg lengthening - series—Indications To use the sharing features ... with lengthening procedures are the bones of the leg, the tibia and the femur. Surgical treatment may ...

  20. Arterial bypass leg - slideshow

    Science.gov (United States)

    ... medlineplus.gov/ency/presentations/100155.htm Arterial bypass leg - series—Normal anatomy To use the sharing features ... Overview The arteries which supply blood to the leg originate from the aorta and iliac vessels. Review ...

  1. Leg lengthening and shortening

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002965.htm Leg lengthening and shortening To use the sharing features on this page, please enable JavaScript. Leg lengthening and shortening are types of surgery to ...

  2. Human brain activity associated with painful mechanical stimulation to muscle and bone

    OpenAIRE

    Maeda, Lynn; Ono, Mayu; Koyama, Tetsuo; Oshiro, Yoshitetsu; Sumitani, Masahiko; Mashimo, Takashi; Shibata, Masahiko

    2011-01-01

    Purpose The purpose of this study was to elucidate the central processing of painful mechanical stimulation to muscle and bone by measuring blood oxygen level-dependent signal changes using functional magnetic resonance imaging (fMRI). Methods Twelve healthy volunteers were enrolled. Mechanical pressure on muscle and bone were applied at the right lower leg by an algometer. Intensities were adjusted to cause weak and strong pain sensation at either target site in preliminary testing. Brain ac...

  3. Evaluation of the patient with hip pain.

    Science.gov (United States)

    Wilson, John J; Furukawa, Masaru

    2014-01-01

    Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. Posterior hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication. Lateral hip pain occurs with greater trochanteric pain syndrome. Clinical examination tests, although helpful, are not highly sensitive or specific for most diagnoses; however, a rational approach to the hip examination can be used. Radiography should be performed if acute fracture, dislocations, or stress fractures are suspected. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and frog-leg lateral view of the symptomatic hip. Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. Magnetic resonance imaging is valuable for the detection of occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head. Magnetic resonance arthrography is the diagnostic test of choice for labral tears.

  4. Repetitive transcranial magnetic stimulation once a week induces sustainable long-term relief of central poststroke pain.

    Science.gov (United States)

    Kobayashi, Masahito; Fujimaki, Takamitsu; Mihara, Ban; Ohira, Takayuki

    2015-06-01

    Central poststroke pain is a serious problem for some patients after stroke. Repetitive transcranial magnetic stimulation (rTMS) has been reported to relieve poststroke pain but its efficacy is still controversial. We tested the possibility that rTMS, when applied once a week, would induce sustainable relief of poststroke pain. Eighteen patients with central poststroke pain were included in this study. rTMS (10 trains of 10-sec 5 Hz-rTMS) was delivered over the primary motor cortex on the affected side. The rTMS session was repeated once a week for 12 weeks, and for six patients the intervention was continued for one year. The degree of the pain was assessed before each weekly rTMS session to evaluate sustainable effects. The effects of the rTMS reached a plateau at the eighth week. At the 12th week, the rTMS was effective in 61.1% of the patients; 5 of the 18 patients showed more than 70% reduction based on a visual analog scale, 6 patients showed 40-69% reduction, and 7 remained at a pain reduction level of less than 40%. When patients were divided into two groups with or without severe dysesthesia, it was found that eight patients with severe dysesthesia showed less pain relief than those without. In the six patients who continued rTMS for one year, the pain relief effects also were sustained. Although this was an open-label study without a control group, our findings suggest that rTMS of the primary motor cortex, when maintained once a week, could help to relieve poststroke pain. © 2015 International Neuromodulation Society.

  5. Foot, leg, and ankle swelling

    Science.gov (United States)

    Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Foot, leg, and ankle swelling is common when the person also: Is overweight Has a blood clot in the leg Is older Has ...

  6. Bone marrow lesions on magnetic resonance imaging in hand osteoarthritis are associated with pain and interact with synovitis.

    Science.gov (United States)

    Liu, R; Damman, W; Reijnierse, M; Bloem, J L; Rosendaal, F R; Kloppenburg, M

    2017-07-01

    To determine the association between bone marrow lesions (BMLs) and (teno)synovitis as assessed on magnetic resonance (MR) imaging in patients with pain in hand osteoarthritis (OA). In 105 consecutive primary hand OA patients (83% women, mean age 59 years), who were diagnosed by rheumatologists and included in the HOSTAS (Hand OSTeoArthritis in Secondary care) cohort, contrast enhanced MR imaging of right distal and proximal interphalangeal joints were obtained. In 92 patients joint site specific pain upon palpation was assessed within 3 weeks of magnetic resonance imaging (MRI) examination. MR features were scored (0-3) following the Oslo hand OA score: BMLs, synovitis, cysts, flexor tenosynovitis (FTS). Additionally, extensor tendon inflammation (ETI) (0-3) was scored. Odds ratios (OR, 95% confidence interval (CI)) were calculated using generalized estimating equations for MR features with joint pain, adjusted for putative confounders. Stratified analyses were performed to investigate interaction. BMLs, synovitis, cysts, FTS and ETI were demonstrated in 56%, 90%, 22%, 16% and 30% of patients, respectively. BMLs (grade 2/3 vs 0: 3.5 (1.6-7.7)) and synovitis (3 vs 0: OR 3.6 (95% CI 1.9-6.6)) were severity-dependent associated with joint pain, but FTS and ETI were not. Stratified analyses showed that BMLs did not associate with pain in the absence of synovitis, whereas synovitis was associated with pain in the absence of BMLs. Interaction was seen between BMLs and synovitis grade 2 or 3. In hand OA patients severe synovitis is associated with joint pain, which is worsened when BMLs co-occur, suggesting synovitis as primary target of treatment. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  7. Clinical Evaluation and Magnetic Resonance Imaging Assessment of Intradiscal Methylene Blue Injection for the Treatment of Discogenic Low Back Pain.

    Science.gov (United States)

    Zhang, XiaoJun; Hao, Jie; Hu, Zhenming; Yang, HaiTao

    2016-01-01

    Low back pain is a common worldwide health problem and has a significant socioeconomic impact on public health. Internal disc disruption has been considered as the most common cause of low back pain. Various therapies, including interbody fusion, disc replacement, injection therapies, and thermal annular procedures have been utilized for the treatment of discogenic low back pain. Recently, a new method of intradiscal methylene blue injection has been introduced to treat discogenic low back pain, but the clinical outcomes are controversial. To investigate the clinical outcomes and magnetic resonance imaging changes of intradiscal methylene blue injection for the treatment of discogenic low back pain. Observational study. An interventional low back pain management practice in a university hospital. A total of 33 patients were selected to be treated with intradiscal methylene blue injection. The clinical outcomes were evaluated by numeric rating scale and Oswestry Disability Index at pretreatment, one month, 3, 6, and 12 months after treatment. The magnetic resonance imaging changes of involved intervertebral discs were assessed by apparent diffusion coefficient and T2 values at pretreatment, 3, 6, and 12 months after treatment. All of the patients got a follow-up period up to 12 months. The mean numeric rating scale scores at pretreatment, one month, 3, 6, and 12 months after treatment were 6.54, 2.98, 3.23, 3.66, and 4.72, respectively. There was a minimum of 2 points reduction at one month, 3, and 6 months after treatment, but less than 2 points reduction at 12 months. There was at least 50% improvement on the Oswestry Disability Index at one month, 3, and 6 months after treatment, but not at 12 months. The mean apparent diffusion coefficient and T2 value were significantly higher at 6 and12 months after treatment compared to pretreatment, but there was no significant difference between pretreatment and 3 months after treatment. This is an observational study with

  8. How Can I Relieve My Pregnancy Leg Cramps?

    Science.gov (United States)

    ... Español How Can I Relieve My Pregnancy Leg Cramps? KidsHealth / For Parents / How Can I Relieve My Pregnancy Leg Cramps? Print Now that I'm in my third trimester, I keep getting these painful cramps in my calves. Sometimes they even wake me ...

  9. Magnet therapy for the relief of pain and inflammation in rheumatoid arthritis (CAMBRA: A randomised placebo-controlled crossover trial

    Directory of Open Access Journals (Sweden)

    Richmond Stewart J

    2008-09-01

    Full Text Available Abstract Background Rheumatoid arthritis is a common inflammatory autoimmune disease. Although disease activity may be managed effectively with prescription drugs, unproven treatments such as magnet therapy are sometimes used as an adjunct for pain control. Therapeutic devices incorporating permanent magnets are widely available and easy to use. Magnets may also be perceived as a more natural and less harmful alternative to analgesic compounds. Of interest to health service researchers is the possibility that magnet therapy might help to reduce the economic burden of managing chronic musculoskeletal disorders. Magnets are extremely cheap to manufacture and prolonged treatment involves a single cost. Despite this, good quality scientific evidence concerning the safety, effectiveness and cost-effectiveness of magnet therapy is scarce. The primary aim of the CAMBRA trial is to investigate the effectiveness of magnet therapy for relieving pain and inflammation in rheumatoid arthritis. Methods/Design The CAMBRA trial employs a randomised double-blind placebo-controlled crossover design. Participant will each wear four devices: a commercially available magnetic wrist strap; an attenuated wrist strap; a demagnetised wrist strap; and a copper bracelet. Device will be allocated in a randomised sequence and each worn for five weeks. The four treatment phases will be separated by wash out periods lasting one week. Both participants and researchers will be blind, as far as feasible, to the allocation of experimental and control devices. In total 69 participants will be recruited from general practices within the UK. Eligible patients will have a verified diagnosis of rheumatoid arthritis that is being managed using drugs, and will be experiencing chronic pain. Outcomes measured will include pain, inflammation, disease activity, physical function, medication use, affect, and health related costs. Data will be collected using questionnaires, diaries, manual

  10. Magnet therapy for the relief of pain and inflammation in rheumatoid arthritis (CAMBRA): a randomised placebo-controlled crossover trial.

    Science.gov (United States)

    Richmond, Stewart J

    2008-09-12

    Rheumatoid arthritis is a common inflammatory autoimmune disease. Although disease activity may be managed effectively with prescription drugs, unproven treatments such as magnet therapy are sometimes used as an adjunct for pain control. Therapeutic devices incorporating permanent magnets are widely available and easy to use. Magnets may also be perceived as a more natural and less harmful alternative to analgesic compounds. Of interest to health service researchers is the possibility that magnet therapy might help to reduce the economic burden of managing chronic musculoskeletal disorders. Magnets are extremely cheap to manufacture and prolonged treatment involves a single cost. Despite this, good quality scientific evidence concerning the safety, effectiveness and cost-effectiveness of magnet therapy is scarce. The primary aim of the CAMBRA trial is to investigate the effectiveness of magnet therapy for relieving pain and inflammation in rheumatoid arthritis. The CAMBRA trial employs a randomised double-blind placebo-controlled crossover design. Participant will each wear four devices: a commercially available magnetic wrist strap; an attenuated wrist strap; a demagnetised wrist strap; and a copper bracelet. Device will be allocated in a randomised sequence and each worn for five weeks. The four treatment phases will be separated by wash out periods lasting one week. Both participants and researchers will be blind, as far as feasible, to the allocation of experimental and control devices. In total 69 participants will be recruited from general practices within the UK. Eligible patients will have a verified diagnosis of rheumatoid arthritis that is being managed using drugs, and will be experiencing chronic pain. Outcomes measured will include pain, inflammation, disease activity, physical function, medication use, affect, and health related costs. Data will be collected using questionnaires, diaries, manual pill counts and blood tests. Magnetism is an inherent

  11. Aches and pains during pregnancy

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000580.htm Aches and pains during pregnancy To use the sharing ... back stress and maintain a healthy posture. Leg Aches and Pains The extra weight you carry when ...

  12. Magnetic Resonance Signal, Rather Than Tendon Volume, Correlates to Pain and Functional Impairment in Chronic Achilles Tendinopathy

    Energy Technology Data Exchange (ETDEWEB)

    Gaerdin, A.; Bruno, J.; Movin, T.; Kristoffersen-Wiberg, M.; Shalabi, A. [Karolinska Univ. Hospital, Stockholm (Sweden). Depts. of Radiology and Orthopedics

    2006-09-15

    Purpose: To depict abnormal tendon matrix composition using magnetic resonance imaging (MRI) in chronic Achilles tendinopathy, and correlate intratendinous signal alterations to pain and functional impairment. Material and Methods: MRI of the Achilles tendon was performed on 25 patients with chronic Achilles tendinopathy (median age 50, range 37-71 years). All patients suffered from pain in the mid-portion of the Achilles tendon. Intratendinous signal was calculated from five different sagittal sequences, using a computerized 3D seed-growing technique. Pain and functional impairment were evaluated using a questionnaire completed by patients. Results: Severity of pain and functional impairment correlated to increased mean intratendinous signal in the painful tendon in all MR sequences (P 0.05). Difference in mean intratendinous signal between symptomatic and contralateral asymptomatic tendons was highly significant in all sequences (P <0.05) except on T2-weighted images (P = 0.6). Conclusion: Severity of pain and disability correlated to increased MR signal rather than to tendon volume in patients with unilateral mid-portion chronic Achilles tendinopathy.

  13. Evaluation of the effectiveness of pregabalin in alleviating pain associated with fibromyalgia: using functional magnetic resonance imaging study.

    Directory of Open Access Journals (Sweden)

    Seong-Ho Kim

    Full Text Available To assess the efficacy of pregabalin by showing differences in the neuronal activities of fibromyalgia (FM patients before and after longitudinal treatment using functional magnetic resonance imaging (fMRI.In total, 21 female patients with FM and 11 age- and gender-matched healthy controls participated. FM patients underwent fMRI at baseline and following pharmacological therapy with pregabalin to diminish their pain. Pressure-pain stimuli were delivered on the subject's thumbnail bed during fMRI scans. Brain activation regions in fMRI were evaluated for longitudinal changes using a paired t-test. Changes in clinical features were also assessed with the Fibromyalgia Impact Questionnaire (FIQ, Brief Fatigue Inventory (BFI, Beck Depression Inventory (BDI, Widespread Pain Index (WPI, Symptom Severity Scale Score (SSS, and State-Trait Anxiety Inventory (STAI.Clinical scores were reduced significantly following therapy with five of the six clinical tests (FIQ, BFI, BDI, WPI, SSS; p < 0.05. Brain activation post-treatment was significantly lower than that pre-treatment in 13 regions of the brain (p < 0.001.Our findings confirm that pregabalin influences aspects of the whole pain matrix, using fMRI, inducing longitudinal changes in neuronal activity during the pain state, and that it reduces pain and other core symptoms of FM. This method could be applied to other longitudinal clinical trials of pharmacological treatments for FM.

  14. Magnetic resonance imaging in low back pain and sciatica with special emphasis on the postdiskectomy period

    International Nuclear Information System (INIS)

    Annertz, M.

    1994-01-01

    The diagnostic capability of magnetic resonance (MR) imaging at 0.3 T was evaluated and compared with other modalities in patients with previous disk surgery and remaining or recurrent sciatica, and in patients with spondylolisthesis and sciatica. In the early postoperative period after successful lumbar diskectomy, MR showed a large amount of abnormal soft tissue in the anterior epidural space, without correlation with clinical symptoms. In the late postoperative period, contrast-enhanced MR provided the best correlation with surgical findings, compared with CT and myelography, in discriminating recurrent/remaining disk herniation from epidural fibrosis in patients with the lumbar postdiskectomy syndrome. Contrast-enhanced MR could not demonstrate any differences regarding presence and extent of epidural fibrosis between symptomatic and asymptomatic patients. In spondylolisthesis, MR gave excellent information about the root canals and the degree of nerve root stretching and compression, which was not possible to evaluate with myelography. MR at 0.3 T provided information comparable to that reported from examinations performed with superconducting MR scanners, and is well suited as the imaging modality in the evaluation of lumbar spine disorders. After introducing MR at 0.2 and 0.3 T with vertical magnetic fields as the first neuroradiological modality, instead of myelography or CT, in the evaluation of the soft tissues of the lumbar spine in patients with low back pain and sciatica, a significant increase in the number of patients examined, a moderate increase in the total cost of investigations, and a significant decrease in the cost per investigated and per operated patient was noted

  15. Thick legs - not always lipedema.

    Science.gov (United States)

    Reich-Schupke, Stefanie; Altmeyer, Peter; Stücker, Markus

    2013-03-01

    Due to its increased presence in the press and on television, the diagnosis of lipedema is on the way to becoming a trendy diagnosis for those with thick legs. Despite this, one must recognize that lipedema is a very rare disease. It is characterized by disproportional obesity of the extremities, especially in the region of the hip and the legs, hematoma development after minimal trauma, and increased pressure-induced or spontaneous pain. Aids for making the correct diagnosis are (duplex) sonography, the waist-hip index or the waist-height index and lymphoscintigraphy. Important differential diagnoses are constitutional variability of the legs, lipohypertrophy in obesity, edema in immobility, edema in chronic venous insufficiency and rheumatic diseases. The symptom-based therapy of lipedema consists of conservative (compression, manual lymphatic drainage, exercise) and surgical treatments (liposuction). Until now there is no curative therapy. Obesity is an important risk factor for the severity and prognosis of lipedema. Further studies for a better understanding of the pathogenesis of lipedema and in the end possible curative treatments are urgently needed. © The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.

  16. The association between Modic changes and pain during 1-year follow-up in patients with lumbar radicular pain

    Energy Technology Data Exchange (ETDEWEB)

    Schistad, Elina Iordanova; Roee, Cecilie [Oslo University Hospital, Department of Physical Medicine and Rehabilitation, Ullevaal, Nydalen, Postbox 4956, Oslo (Norway); University of Oslo, Faculty of Medicine, Oslo (Norway); Espeland, Ansgar [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Section for Radiology, Department of Clinical Medicine, Bergen (Norway); Rygh, Lars Joergen [Haukeland University Hospital, Department of Anesthesiology, Bergen (Norway); Gjerstad, Johannes [National Institute of Occupational Health, Oslo (Norway); University of Oslo, Department of Molecular Biosciences, Oslo (Norway)

    2014-09-15

    To examine whether Modic changes influence pain during a 1-year follow-up in patients with lumbar radicular pain. A total of 243 patients with lumbar radicular pain due to disc herniation were recruited from two hospitals in Norway and followed up at 6 weeks, 6 months, and 12 months. On baseline lumbar magnetic resonance images, two observers independently evaluated Modic changes (types I-III; craniocaudal size 0-3). Outcomes were sensory pain (McGill Pain Questionnaire), back and leg pain (visual analogue scale, VAS). Association between Modic type and outcomes was explored with a mixed model and then by two-way analysis of variance (ANOVA) at each time point with Modic and treatment groups (surgical, n = 126; nonsurgical, n = 117) as fixed factors, adjusted for disc degeneration, age, sex, smoking, and duration of radicular pain. Modic size was also analyzed using ANOVA. Pain scores had decreased significantly at 1-year follow-up. Modic type was significantly related to McGill sensory scores (mixed model: p = 0.014-0.026; ANOVA: p = 0.007 at 6 weeks), but not to VAS back pain or VAS leg pain scores. At 6 weeks, the mean McGill sensory score was higher in Modic I than in Modic II-III patients (p = 0.003) and in patients without Modic changes (p = 0.018). Modic size L1-S1 was not associated with pain outcomes. Patients with lumbar radicular pain have a substantial pain reduction during 1-year follow-up, but Modic type I changes may imply a slower initial decrease in sensory pain. (orig.)

  17. Insula-specific responses induced by dental pain. A proton magnetic resonance spectroscopy study

    International Nuclear Information System (INIS)

    Gutzeit, A.; Weymarn, C. von; Froehlich, J.M.; Binkert, C.A.; Meier, D.; Meier, M.L.; Bruegger, M.; Ettlin, D.A.; Graf, N.

    2011-01-01

    To evaluate whether induced dental pain leads to quantitative changes in brain metabolites within the left insular cortex after stimulation of the right maxillary canine and to examine whether these metabolic changes and the subjective pain intensity perception correlate. Ten male volunteers were included in the pain group and compared with a control group of 10 other healthy volunteers. The pain group received a total of 87-92 electrically induced pain stimuli over 15 min to the right maxillary canine tooth. Contemporaneously, they evaluated the subjective pain intensity of every stimulus using an analogue scale. Neurotransmitter changes within the left insular cortex were evaluated by MR spectroscopy. Significant metabolic changes in glutamine (+55.1%), glutamine/glutamate (+16.4%) and myo-inositol (-9.7%) were documented during pain stimulation. Furthermore, there was a significant negative correlation between the subjective pain intensity perception and the metabolic levels of Glx, Gln, glutamate and N-acetyl aspartate. The insular cortex is a metabolically active region in the processing of acute dental pain. Induced dental pain leads to quantitative changes in brain metabolites within the left insular cortex resulting in significant alterations in metabolites. Negative correlation between subjective pain intensity rating and specific metabolites could be observed. (orig.)

  18. Insula-specific responses induced by dental pain. A proton magnetic resonance spectroscopy study

    Energy Technology Data Exchange (ETDEWEB)

    Gutzeit, A.; Weymarn, C. von; Froehlich, J.M.; Binkert, C.A. [Cantonal Hospital Winterthur, Department of Radiology, Winterthur (Switzerland); Meier, D. [University and ETH Zurich, Institute for Biomedical Engineering, Zurich (Switzerland); Meier, M.L.; Bruegger, M. [University of Zurich, Institute of Psychology, Division Neuropsychology, Zurich (Switzerland); Ettlin, D.A. [University of Zuerich, Center for Dental and Oral Medicine and Cranio-Maxillofacial Surgery, Clinic for Removable Prosthodontics, Masticatory Disorders and Special Care Dentistry, Zuerich (Switzerland); Graf, N. [University Hospital of Zurich, Clinical Trials Center, Center for Clinical Research, Zurich (Switzerland)

    2011-04-15

    To evaluate whether induced dental pain leads to quantitative changes in brain metabolites within the left insular cortex after stimulation of the right maxillary canine and to examine whether these metabolic changes and the subjective pain intensity perception correlate. Ten male volunteers were included in the pain group and compared with a control group of 10 other healthy volunteers. The pain group received a total of 87-92 electrically induced pain stimuli over 15 min to the right maxillary canine tooth. Contemporaneously, they evaluated the subjective pain intensity of every stimulus using an analogue scale. Neurotransmitter changes within the left insular cortex were evaluated by MR spectroscopy. Significant metabolic changes in glutamine (+55.1%), glutamine/glutamate (+16.4%) and myo-inositol (-9.7%) were documented during pain stimulation. Furthermore, there was a significant negative correlation between the subjective pain intensity perception and the metabolic levels of Glx, Gln, glutamate and N-acetyl aspartate. The insular cortex is a metabolically active region in the processing of acute dental pain. Induced dental pain leads to quantitative changes in brain metabolites within the left insular cortex resulting in significant alterations in metabolites. Negative correlation between subjective pain intensity rating and specific metabolites could be observed. (orig.)

  19. Venous leg ulcers.

    Science.gov (United States)

    Nelson, E Andrea; Adderley, Una

    2016-01-15

    Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0 in 1000 people have active leg ulcers. Prevalence increases with age to about 20 in 1000 people aged over 80 years. We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of treatments for venous leg ulcers? What are the effects of organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). At this update, searching of electronic databases retrieved 116 studies. After deduplication and removal of conference abstracts, 63 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 43 studies and the further review of 20 full publications. Of the 20 full articles evaluated, four systematic reviews were updated and four RCTs were added at this update. We performed a GRADE evaluation for 23 PICO combinations. In this systematic overview, we categorised the efficacy for 13 interventions based on information about the effectiveness and safety of advice to elevate leg, advice to keep leg active, compression stockings for prevention of recurrence, compression bandages and stockings to treat venous leg ulcers, laser treatment (low level), leg ulcer clinics, pentoxifylline, skin grafting, superficial vein surgery for prevention of recurrence, superficial vein surgery to treat venous leg ulcers, therapeutic ultrasound, and topical negative pressure.

  20. Straight leg elevation to rule out pelvic injury.

    Science.gov (United States)

    Bolt, Caroline; O'Keeffe, Francis; Finnegan, Pete; Dickson, Kristofer; Smit, De Villiers; Fitzgerald, Mark C; Mitra, Biswadev

    2018-02-01

    Pelvic x-ray is frequently used as a screening tool during initial assessment of injured patients. However routine use in the awake and alert blunt trauma patient may be questioned due to low yield. We propose a clinical tool that may avoid unnecessary imaging by examining whether the ability to straight leg raise, without pain, can rule out pelvic injury. We conducted a prospective cohort study with the exposure variables of ability to straight leg raise and presence of pain on doing so, and presence of pelvic fracture on x-ray as the primary outcome variable. Of the 328 participants, 35 had pelvic fractures, and of these 32 were either unable to straight leg raise, or had pain on doing so, with a sensitivity of 91.43% (95% CI: 76.94-98.2%) and a negative predictive value of 98.57% (95% CI: 95.88-99.70%). The 3 participants with a pelvic fracture who could straight leg raise with no pain, all had a GCS of less than 15, and therefore, among the sub-group of patients with GCS15, a 100% sensitivity and 100% negative predictive value for straight leg raise with no pain to rule out pelvic fracture was demonstrated. Among awake, alert patients, painless straight leg raise can exclude pelvic fractures and be incorporated into initial examination during reception and resuscitation of injured patients. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  1. Computed tomography and magnetic resonance imaging of unusual causes of ankle pain

    International Nuclear Information System (INIS)

    Kaushik, S.

    2006-01-01

    Computed tomography and MRI are frequently utilized to evaluate ankle pain that remains unexplained by radiography. The most common causes of ankle pain are related to trauma and the imaging appearances of these entities are well established in the radiologic and orthopedic literature. A smaller percentage is comprised of non-traumatic disorders. Our goal is to emphasize the value of CT and MRI in recognition of these less common and unusual causes of ankle pain. Copyright (2006) Blackwell Science Pty Ltd

  2. Dynamically Stable Legged Locomotion.

    Science.gov (United States)

    1983-01-27

    balanced itself in 31) using a tabular ctontrol sclwnme. With only thUiee actuated degrees it used a shuffling gait to balance that reminds one of Charlie ... Chaplin . * The present study explores the control of a physical one-legged hopping machine. The objective of using a machine with only one leg was to

  3. Lyden-af-Leg

    DEFF Research Database (Denmark)

    Toft, Herdis

    Præsentation af seniorforsker-projekt Lyden-af-Leg i et traderingsperspektiv og med indledende fokus på YouTube som traderings-platform.......Præsentation af seniorforsker-projekt Lyden-af-Leg i et traderingsperspektiv og med indledende fokus på YouTube som traderings-platform....

  4. Pressure pain thresholds increase after preconditioning 1 Hz repetitive transcranial magnetic stimulation with transcranial direct current stimulation.

    Directory of Open Access Journals (Sweden)

    Tonya M Moloney

    Full Text Available BACKGROUND: The primary motor cortex (M1 is an effective target of non-invasive cortical stimulation (NICS for pain threshold modulation. It has been suggested that the initial level of cortical excitability of M1 plays a key role in the plastic effects of NICS. OBJECTIVE: Here we investigate whether transcranial direct current stimulation (tDCS primed 1 Hz repetitive transcranial magnetic stimulation (rTMS modulates experimental pressure pain thresholds and if this is related to observed alterations in cortical excitability. METHOD: 15 healthy, male participants received 10 min 1 mA anodal, cathodal and sham tDCS to the left M1 before 15 min 1 Hz rTMS in separate sessions over a period of 3 weeks. Motor cortical excitability was recorded at baseline, post-tDCS priming and post-rTMS through recording motor evoked potentials (MEPs from right FDI muscle. Pressure pain thresholds were determined by quantitative sensory testing (QST through a computerized algometer, on the palmar thenar of the right hand pre- and post-stimulation. RESULTS: Cathodal tDCS-primed 1 Hz-rTMS was found to reverse the expected suppressive effect of 1 Hz rTMS on cortical excitability; leading to an overall increase in activity (p<0.001 with a parallel increase in pressure pain thresholds (p<0.01. In contrast, anodal tDCS-primed 1 Hz-rTMS resulted in a corresponding decrease in cortical excitability (p<0.05, with no significant effect on pressure pain. CONCLUSION: This study demonstrates that priming the M1 before stimulation of 1 Hz-rTMS modulates experimental pressure pain thresholds in a safe and controlled manner, producing a form of analgesia.

  5. Association between magnetic resonance imaging, temporo-mandibular joint scanographic findings and clinical manifestations of joint pain and sounds in temporo-mandibular disorders

    International Nuclear Information System (INIS)

    Goodarzi Pour, D.; Rajaee, E.; Golestan, B.

    2010-01-01

    Exploring the association between magnetic resonance imaging, temporomandibular joint scanography and clinical manifestations of joint pain and sounds in patients with temporomandibular disorder. Patients and Methods: This study included 62 temporomandibular joints with internal derangement. Sagittal scanography and magnetic resonance imaging of these temporomandibular joints were obtained and reported blindly by the consensus of two radiologists. Results: No significant association was observed between clinical and scanographic findings with magnetic resonance imaging. The abnormal range of motion had significant relationship with pain (P=0.017) and sound (P=0.046). There was a strong association between sound and condylar flattening (P=0.007). Conclusion: It was demonstrated that joint pain and sounds were predictors of the abnormal range of motion in temporomandibular joint scanography. Sound could be heard more often in patients with condylar flattening, and temporomandibular joint scanographic findings as well as joint pain and sounds had limited value in the diagnosis of disk position or effusion.

  6. Knee pain and inflammation in the infrapatellar fat pad estimated by conventional and dynamic contrast-enhanced magnetic resonance imaging in obese patients with osteoarthritis

    DEFF Research Database (Denmark)

    Ballegaard, C; Riis, R G C; Bliddal, H

    2014-01-01

    OBJECTIVE: To investigate the association between knee pain and signs of inflammation in the infrapatellar fat pad (IPFP) in obese patients with knee osteoarthritis (KOA). DESIGN: In a cross-sectional setting, 3-T conventional contrast-enhanced (CE) magnetic resonance imaging (MRI) and dynamic...... contrast-enhanced (DCE)-MRI of KOA were analysed to quantify the extent of inflammation in the IPFP, and correlated (Spearman's rank correlation) to pain and other symptoms assessed via the Knee injury and Osteoarthritis Outcome Score (KOOS) (100 = no pain, 0 = extreme pain). The extent of inflammation...

  7. Observing back pain provoking lifting actions modulates corticomotor excitability of the observer's primary motor cortex.

    Science.gov (United States)

    Lehner, Rea; Meesen, Raf; Wenderoth, Nicole

    2017-07-01

    Observing another person experiencing exogenously inflicted pain (e.g. by a sharp object penetrating a finger) modulates the excitability of the observer' primary motor cortex (M1). By contrast, far less is known about the response to endogenously evoked pain such as sudden back pain provoked by lifting a heavy object. Here, participants (n=26) observed the lifting of a heavy object. During this action the actor (1) flexed and extended the legs (LEG), (2) flexed and extended the back (BACK) or (3) flexed and extended the back which caused visible pain (BACKPAIN). Corticomotor excitability was measured by applying a single transcranial magnetic stimulation pulse to the M1 representation of the muscle erector spinae and participants scored their perception of the actor's pain on the numeric pain rating scale (NPRS). The participants scored vicarious pain as highest during the BACKPAIN condition and lowest during the LEG condition. MEP size was significantly lower for the LEG than the BACK and BACKPAIN condition. Although we found no statistical difference in the motor-evoked potential (MEP) size between the conditions BACK and BACKPAIN, there was a significant correlation between the difference in NPRS scores between the conditions BACKPAIN and BACK and the difference in MEP size between these conditions. Participants who believed the vicarious pain to be much stronger in the BACKPAIN than in the BACK condition also exhibited higher MEPs for the BACKPAIN than the BACK condition. Our results indicate that observing how others lift heavy objects facilitates motor representations of back muscles in the observer. Modulation occurs in a movement-specific manner and is additionally modulated by the extent to which the participants perceived the actor's pain. Our findings suggest that movement observation might be a promising paradigm to study the brain's response to back pain. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Significant reduction in phantom limb pain after low-frequency repetitive transcranial magnetic stimulation to the primary sensory cortex.

    Science.gov (United States)

    Grammer, Geoffrey G; Williams-Joseph, Sonya; Cesar, Ashley; Adkinson, David K; Spevak, Christopher

    2015-01-01

    Phantom limb pain (PLP) is believed to be linked to the reorganization of the deafferented sensory cortex. We present a case of a patient with upper extremity PLP who was successfully treated with repetitive transcranial magnetic stimulation (rTMS). We treated an active duty service member who suffered an amputation of his right upper extremity after sustaining a blast injury in Afghanistan. He had 28 sessions of alternating sequences of rTMS to the left dorsolateral prefrontal cortex and primary sensory cortex of the left cerebral hemisphere. Pain intensity was assessed with the Visual Analogue Scale. We delivered 1 Hz stimulation to the sensory cortex corresponding to the area of amputation five times a week. After 4 sessions, the patient's pain decreased from a Visual Analogue Scale of 5 to 2. Left 10 Hz stimulation was added and after 28 sessions, the pain decreased from 2 to 1. Our findings support that rTMS was an effective modality for this patient in treating his PLP. The significance of 10 Hz stimulation is unknown because of the lack of an effect size and is possibly associated with a floor effect. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  9. Pressure pain thresholds increase after preconditioning 1 Hz repetitive transcranial magnetic stimulation with transcranial direct current stimulation.

    Science.gov (United States)

    Moloney, Tonya M; Witney, Alice G

    2014-01-01

    The primary motor cortex (M1) is an effective target of non-invasive cortical stimulation (NICS) for pain threshold modulation. It has been suggested that the initial level of cortical excitability of M1 plays a key role in the plastic effects of NICS. Here we investigate whether transcranial direct current stimulation (tDCS) primed 1 Hz repetitive transcranial magnetic stimulation (rTMS) modulates experimental pressure pain thresholds and if this is related to observed alterations in cortical excitability. 15 healthy, male participants received 10 min 1 mA anodal, cathodal and sham tDCS to the left M1 before 15 min 1 Hz rTMS in separate sessions over a period of 3 weeks. Motor cortical excitability was recorded at baseline, post-tDCS priming and post-rTMS through recording motor evoked potentials (MEPs) from right FDI muscle. Pressure pain thresholds were determined by quantitative sensory testing (QST) through a computerized algometer, on the palmar thenar of the right hand pre- and post-stimulation. Cathodal tDCS-primed 1 Hz-rTMS was found to reverse the expected suppressive effect of 1 Hz rTMS on cortical excitability; leading to an overall increase in activity (ppain thresholds (ppain. This study demonstrates that priming the M1 before stimulation of 1 Hz-rTMS modulates experimental pressure pain thresholds in a safe and controlled manner, producing a form of analgesia.

  10. Magnetic resonance imaging, percentage of dense cells and serum prostanoids as tools for objective assessment of pain crisis

    International Nuclear Information System (INIS)

    Mankad, V.N.; Williams, J.P.; Harpen, M.; Longenecker, G.; Brogdon, B.; Moore, B.

    1987-01-01

    Magnetic resonance imaging (MRI) has added a new dimension to the identification of soft tissue abnormalities. Chemical and histological characteristics of the tissues can be separated by computerized reconstruction algorithms which produce images and quantitative data. This technique, which is now becoming available in many centers, determines the density of protons of hydrogen in various tissues. If the infarction of the tissues leads to changes in chemical composition of the cells, it may produce changes in the image or in the quantitative data about the resonance of protons. Studies correlating hematologic parameters, radiologic changes in the bones or bone marrow and pain crises are scarce. It is likely that presence of abnormal hemoglobin in the red cell, which produces changes in red cells and rheology of blood, would produce changes in hematological parameters and MRI during pain crisis. The authors, therefore, undertook an evaluation of MRI of bones in sickle cell patients during pain-free and painful periods and obtained measurements of dense sickle cells and prostanoids derived from platelets and endothelium

  11. The diagnostic value of three sacroiliac joint pain provocation tests for sacroiliitis identified by magnetic resonance imaging

    DEFF Research Database (Denmark)

    Arnbak, Bodil Al-Mashhadi; Jurik, Anne Grethe; Jensen, Rikke Krüger

    2017-01-01

    OBJECTIVES: The aim of the current study was to investigate the diagnostic value of three sacroiliac (SI) joint pain provocation tests for sacroiliitis identified by magnetic resonance imaging (MRI) and stratified by gender. METHOD: Patients without clinical signs of nerve root compression were...... selected from a cohort of patients with persistent low back pain referred to an outpatient spine clinic. Data from Gaenslen's test, the thigh thrust test, and the long dorsal sacroilia ligament test and sacroiliitis identified by MRI were analysed. RESULTS: The median age of the 454 included patients......-79), and specificity 81% (95% CI 77-85)]. In women, no significant associations were observed between the SI joint tests and sacroiliitis. CONCLUSIONS: Only in men were the SI joint tests found to be associated with sacroiliitis identified by MRI. Although, the diagnostic value was relatively low, the results indicate...

  12. Proton magnetic resonance spectroscopy assessment of metabolite status of the anterior cingulate cortex in chronic pain patients and healthy controls

    Directory of Open Access Journals (Sweden)

    Ito T

    2017-01-01

    Full Text Available Takahiro Ito,1 Sachiko Tanaka-Mizuno,2,3 Narihito Iwashita,4 Ikuo Tooyama,5 Akihiko Shiino,6 Katsuyuki Miura,1,7 Sei Fukui4 1Department of Public Health, Shiga University of Medical Science, 2Department of Medical Statistics, Shiga University of Medical Science, Otsu, Japan; 3The Center for Data Science Education and Research, Shiga University, Hikone, Japan; 4Department of Anesthesiology, Interdisciplinary Pain Management Center, Shiga University of Medical Science Hospital, 5Molecular Neuroscience Research Center, Shiga University of Medical Science, 6Biomedical MR Science Center, Shiga University of Medical Science, 7Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan Background: Chronic pain is a common cause of reduced quality of life. Recent studies suggest that chronic pain patients have a different brain neurometabolic status to healthy people. Proton magnetic resonance spectroscopy (1H-MRS can determine the concentrations of metabolites in a specific region of the brain without being invasive. Patients and methods: We recruited 56 chronic pain patients and 60 healthy controls to compare brain metabolic characteristics. The concentrations of glutamic acid (Glu, myo-inositol (Ins, N-acetylaspartate (NAA, Glu + glutamine (Glx, and creatine + phosphocreatine (total creatine [tCr] in the anterior cingulate cortex of participants were measured using 1H-MRS. We used age- and gender-adjusted general linear models and receiver-operating characteristic analyses for this investigation. Patients were also assessed using the Hospital Anxiety and Depression Scale (HADS to reveal the existence of any mental health issues. Results: Our analysis indicates that pain patients have statistically significantly higher levels of Glu/tCr (p=0.039 and Glx/tCr (p<0.001 and lower levels of NAA/tCr than controls, although this did not reach statistical significance (p=0.052. Receiver-operating characteristic analysis

  13. Functional scoliosis caused by leg length discrepancy

    Science.gov (United States)

    Daniszewska, Barbara; Zolynski, Krystian

    2010-01-01

    Introduction Leg length discrepancy (LLD) causes pelvic obliquity in the frontal plane and lumbar scoliosis with convexity towards the shorter extremity. Leg length discrepancy is observed in 3-15% of the population. Unequalized lower limb length discrepancy leads to posture deformation, gait asymmetry, low back pain and discopathy. Material and methods In the years 1998-2006, 369 children, aged 5 to 17 years (209 girls, 160 boys) with LLD-related functional scoliosis were treated. An external or internal shoe lift was applied. Results Among 369 children the discrepancy of 0.5 cm was observed in 27, 1 cm in 329, 1.5 cm in 9 and 2 cm in 4 children. During the first follow-up examination, within 2 weeks, the adjustment of the spine to new static conditions was noted and correction of the curve in 316 examined children (83.7%). In 53 children (14.7%) the correction was observed later and was accompanied by slight low back pain. The time needed for real equalization of limbs was 3 to 24 months. The time needed for real equalization of the discrepancy was 11.3 months. Conclusions Leg length discrepancy equalization results in elimination of scoliosis. Leg length discrepancy < 2 cm is a static disorder; that is why measurements should be performed in a standing position using blocks of adequate thickness and the position of the posterior superior iliac spine should be estimated. PMID:22371777

  14. Diagnostic role of magnetic resonance imaging in assessing orofacial pain and paresthesia.

    Science.gov (United States)

    Ohba, Seigo; Yoshimura, Hitoshi; Matsuda, Shinpei; Kobayashi, Junichi; Kimura, Takashi; Aiki, Minako; Sano, Kazuo

    2014-09-01

    The aim of this study was to compare the efficacy of CT and MRI in evaluating orofacial pain and paresthesia. A total of 96 patients with orofacial pain and/or paresthesia were included in this study. The patients who underwent CT and/or MRI examinations were assessed, and the efficacy of CT and/or MRI examinations in detecting the causative disease of the orofacial pain and paresthesia was evaluated. Seventy (72.9%) of 96 patients underwent CT and/or MRI examinations. Whereas CT examinations detected 2 diseases (4.5%) in 44 tests, 13 diseases (37.1%) were detected in 35 MRI examinations. Seven (53.8%) of 13 diseases, which were detected by MRI, were found in elderly patients. A high percentage of patients, who claimed orofacial pain and paresthesia, have other diseases in their brain, especially in elderly patients, and MRI is more useful than CT for evaluating these patients.

  15. Acute effects of Kinesio taping on pain, disability and back extensor muscle endurance in patients with low back pain caused by magnetic resonance imaging-confirmed lumbar disc degeneration.

    Science.gov (United States)

    Chang, Nai-Jen; Chou, Willy; Hsiao, Pei-Chi; Chang, Wen-Dien; Lo, Yi-Ming

    2018-02-06

    Individuals with disc degeneration experience associated pain and disability. Considering its safety and affordability, Kinesio tape (KT) may be a viable treatment. However, most KT studies have demonstrated its effects in healthy adults and patients with nonspecific low back pain. The efficacy of KT in patients with disc degeneration is yet to be investigated. To examine the acute effects of KT on patients with lumbar disc degeneration confirmed through magnetic resonance imaging. A total of 31 eligible patients (aged 25-64 years) with low back pain caused by lumbar disc degeneration were divided into mild and moderate-to-severe pain groups. KT was applied to the painful lumbar region in a lumbar brace-like pattern for 1 day. A visual analogue scale for pain and the Oswestry disability index were analysed before and after 1 day of taping. The Biering-Sorensen test for trunk muscle endurance was performed before, immediately after, and 1 day after taping as well as immediately after tape removal. After taping, both groups showed significant pain reduction (ptape removal. KT may be adopted as an assistive aid for immediate pain reduction, particularly in lumbar disc degeneration patients with moderate-to-severe pain; however, its effects on disability and trunk muscle endurance are not clinically worthwhile. The long-term effects of KT, with or without active exercise, warrant further assessment.

  16. RESTLESS LEGS SYNDROME

    Directory of Open Access Journals (Sweden)

    Dmitriy Valer'evich Artem'ev

    2009-01-01

    Full Text Available The paper describes the epidemiology, etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, and treatment of restless legs syndrome. Recommendations are given how to choose therapeutic modalities and drugs in relation to different factors.

  17. Restless legs syndrome.

    Science.gov (United States)

    Venkateshiah, Saiprakash B; Ioachimescu, Octavian C

    2015-07-01

    Restless legs syndrome is a common sensorimotor disorder characterized by an urge to move, and associated with uncomfortable sensations in the legs (limbs). Restless legs syndrome can lead to sleep-onset or sleep-maintenance insomnia, and occasionally excessive daytime sleepiness, all leading to significant morbidity. Brain iron deficiency and dopaminergic neurotransmission abnormalities play a central role in the pathogenesis of this disorder, along with other nondopaminergic systems, although the exact mechanisms are still. Intensive care unit patients are especially vulnerable to have unmasking or exacerbation of restless legs syndrome because of sleep deprivation, circadian rhythm disturbance, immobilization, iron deficiency, and use of multiple medications that can antagonize dopamine. Published by Elsevier Inc.

  18. Neurotransmitters behind pain relief with transcranial magnetic stimulation - positron emission tomography evidence for release of endogenous opioids.

    Science.gov (United States)

    Lamusuo, S; Hirvonen, J; Lindholm, P; Martikainen, I K; Hagelberg, N; Parkkola, R; Taiminen, T; Hietala, J; Helin, S; Virtanen, A; Pertovaara, A; Jääskeläinen, S K

    2017-10-01

    Repetitive transcranial magnetic stimulation (rTMS) at M1/S1 cortex has been shown to alleviate neuropathic pain. To investigate the possible neurobiological correlates of cortical neurostimulation for the pain relief. We studied the effects of M1/S1 rTMS on nociception, brain dopamine D2 and μ-opioid receptors using a randomized, sham-controlled, double-blinded crossover study design and 3D-positron emission tomography (PET). Ten healthy subjects underwent active and sham rTMS treatments to the right M1/S1 cortex with E-field navigated device. Dopamine D2 and μ-receptor availabilities were assessed with PET radiotracers [ 11 C]raclopride and [ 11 C]carfentanil after each rTMS treatment. Thermal quantitative sensory testing (QST), contact heat evoked potential (CHEP) and blink reflex (BR) recordings were performed between the PET scans. μ-Opioid receptor availability was lower after active than sham rTMS (P ≤ 0.0001) suggested release of endogenous opioids in the right ventral striatum, medial orbitofrontal, prefrontal and anterior cingulate cortices, and left insula, superior temporal gyrus, dorsolateral prefrontal cortex and precentral gyrus. There were no differences in striatal dopamine D2 receptor availability between active and sham rTMS, consistent with lack of long-lasting measurable dopamine release. Active rTMS potentiated the dopamine-regulated habituation of the BR compared to sham (P = 0.02). Thermal QST and CHEP remained unchanged after active rTMS. rTMS given to M1/S1 activates the endogenous opioid system in a wide brain network associated with processing of pain and other salient stimuli. Direct enhancement of top-down opioid-mediated inhibition may partly explain the clinical analgesic effects of rTMS. Neurobiological correlates of rTMS for the pain relief are unclear. rTMS on M1/S1 with 11 C-carfentanyl-PET activates endogenous opioids. Thermal and heat pain thresholds remain unchanged. rTMS induces top-down opioid-mediated inhibition

  19. Role and Correlation of High Resolution Ultrasound and Magnetic Resonance Imaging in Evaluation of Patients with Shoulder Pain.

    Science.gov (United States)

    Singh, Amandeep; Thukral, Chuni Lal; Gupta, Kamlesh; Singh, Mahesh Inder; Lata, Sneh; Arora, Ram Krishan

    2017-01-01

    The study aimed to evaluate of the role of high-resolution ultrasound and magnetic resonance imaging in patients with shoulder pain. This prospective study included 50 patients referred for ultrasound and MRI because of shoulder pain. All patients were examined clinically, followed by radiography of the affected shoulder. High-resolution ultrasound examination of the involved shoulder was performed together with an examination of the contralateral normal shoulder, followed by MRI of the symptomatic shoulder in all 50 patients. In the present study, the majority of patients were in age group 56-65 years, 56% were males and 44% were females (of a total of 50 patients). A total of 40 patients were diagnosed as having rotator cuff tears on ultrasound (USG) and MRI. USG showed complete-thickness tears in 25 patients and partial-thickness tears in 15 patients. MRI detected 28 complete- and 12 partial-thickness tears of the rotator cuff. In the diagnosis of rotator cuff tears, the strength of agreement between ultrasound and magnetic resonance imaging was good (kappa coefficient=0.79). Ultrasonography of the shoulder shows promising results in the diagnosis of rotator cuff tears and in differentiating partial from complete tears. A wide availability, cost effectiveness and better tolerability of ultrasonography make it a modality of first choice for evaluating rotator cuff tears.

  20. Effect of high-frequency repetitive transcranial magnetic stimulation on chronic central pain after mild traumatic brain injury: A pilot study

    Directory of Open Access Journals (Sweden)

    Gyu-sik Choi

    2018-01-01

    Full Text Available Objective: Central pain can occur following traumatic brain injury, leading to poor functional recovery, limitation of activities of daily living, and decreased quality of life. The aim of this study was to determine whether high-frequency (10 Hz repetitive transcranial magnetic stimulation, applied over the primary motor cortex of the affected hemisphere, can be used to manage chronic central pain after mild traumatic brain injury. Design: Prospective randomized feasibility study. Methods: Twelve patients with mild traumatic brain injury and chronic central pain were randomly assigned to transcranial magnetic stimulation (high-frequency stimulation, 10 sessions or sham groups. Diffuse tensor tractography revealed partially injured spinothalamocortical tracts in all recruited patients. A numerical rating scale (NRS was used to evaluate pain intensity during pre-treatment and immediately after the 5th transcranial magnetic stimulation session (post1, 10th transcranial magnetic stimulation session (post2, and 1 (post3, 2 (post4, and 4 weeks (post 5 after finishing treatment. Physical and mental health status were evaluated using the Short Form 36 Health Survey (SF-36, including physical and mental component scores (PCS, MCS. Results: The NRS score of the repetitive transcranial magnetic stimulation group was significantly lower than the sham group score at all clinical evaluation time-points during and after transcranial magnetic stimulation sessions. The transcranial magnetic stimulation group’s SF-36 PCS score was significantly higher at post2, post3, post4, and post5 compared with the sham group. Conclusion: High-frequency transcranial magnetic stimulation may be used to manage chronic central pain and improve quality of life in patients with mild traumatic brain injury. However, this is a pilot study and further research is needed.

  1. Referral Patterns for Chronic Groin Pain and Athletic Pubalgia/Sports Hernia: Magnetic Resonance Imaging Findings, Treatment, and Outcomes.

    Science.gov (United States)

    Zoland, Mark P; Maeder, Matthew E; Iraci, Joseph C; Klein, Devon A

    Chronic groin pain is a common problem and has been well-described in high-performance athletes. Its presentation in the recreational athlete has been less frequently described. We present the experience of a tertiary group of physicians specializing in groin pain and athletic pubalgia. Dynamic magnetic resonance imaging (MRI) protocol was employed. Surgery was performed in patients failing non-surgical management. A retrospective review was performed. Of 117 mostly non-professional athletes, there were 79 MRI-positive cases of athletic pubalgia (68%). Other common findings were acetabular labral tear (57%) and inguinal hernia (35%). Employment of a dynamic MRI protocol increased sensitivity for certain pathologies. Of positive athletic pubalgia cases, 49% went on to have surgical repair. The satisfaction rate in the surgical group was 90% at follow up. Advances in MRI have increased our ability to characterize and diagnose specific injuries causing groin pain. We present our diagnostic algorithm, including an MRI protocol that not only evaluates the groin, but has increased sensitivity for additional findings such as inguinal hernia and abdominal wall deficiencies. A targeted work-up and subsequent surgical treatment in the appropriate patient, even in the recreational athletic population, has yielded a 90% satisfaction rate.

  2. Leg ulcers in sickle cell patients: management challenges

    Directory of Open Access Journals (Sweden)

    El Khatib AM

    2016-11-01

    Full Text Available Arij M El Khatib,1 Shady N Hayek2 1Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center (AUBMC, 2Private Practice, Cosmetic Surgery Center, Beirut, Lebanon Abstract: Sickle cell disease is an autosomal recessive hemoglobinopathy caused by an amino acid substitution from glutamic acid to valine in the beta hemoglobin chain. One of the common symptoms occurring in sickle cell patients are leg ulcers, which are notoriously painful, difficult to treat, and frequently recurrent. These ulcers pose a therapeutic challenge with multiple modalities proposed for treatment, but with scarce evidence of efficacy of any single modality. Ulcer prevention, rigorous wound care, pain control, and surgery are the current mainstays of sickle cell leg ulcer treatment. Keywords: sickle cell leg ulcer, leg wound, sickle cell disease 

  3. Emphysematous Pyelonephritis Presenting as Necrotizing Fasciitis of the Leg

    Directory of Open Access Journals (Sweden)

    Yu-Xiong Ye

    2009-03-01

    Full Text Available We report a 50-year-old man with poorly controlled diabetes mellitus who presented with a painful, swollen right leg. He had also experienced right flank pain for 1 week prior to admission. Physical examination was notable for tenderness over the right flank. The right leg was diffusely swollen and exquisitely tender to touch, with palpable crepitance. Laboratory tests revealed leukocytosis and pyuria. Computed tomography showed a right ureteral stone with hydronephrosis and characteristic findings of emphysematous pyelonephritis. Furthermore, a right perirenal gas-forming abscess with extension to the right leg was noted. The patient was successfully treated with antibiotic therapy, aggressive control of blood sugar, percutaneous drainage of the hydronephrosis and perirenal abscess, and aggressive debridement of the leg.

  4. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes)

    DEFF Research Database (Denmark)

    Albert, H. B.; Sørensen, Joan S.; Berit Schiott, Christensen

    2013-01-01

    PURPOSE: Modic type 1 changes/bone edema in the vertebrae are present in 6 % of the general population and 35-40 % of the low back pain population. It is strongly associated with low back pain. The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain (>6...... in the vertebrae adjacent to the previous herniation. Patients were randomized to either 100 days of antibiotic treatment (Bioclavid) or placebo and were blindly evaluated at baseline, end of treatment and at 1-year follow-up. OUTCOME MEASURES: Primary outcome, disease-specific disability, lumbar pain. Secondary...... outcome leg pain, number of hours with pain last 4 weeks, global perceived health, EQ-5D thermometer, days with sick leave, bothersomeness, constant pain, magnetic resonance image (MRI). RESULTS: 144 of the 162 original patients were evaluated at 1-year follow-up. The two groups were similar at baseline...

  5. Effect of elastic bandage wraps on leg edema in patients before and after liver transplant.

    Science.gov (United States)

    Mathews, Susan; James, Shantell; Anderson, Janet D; Merchant, Mehwish; Benenati, Sonia; Henry, Samantha; Comrie, Gem; Pirani, Shamsa; Zellinger, Mary

    2015-12-01

    Few studies have evaluated the benefits of short-term use of compression therapy to prevent or minimize edema and/or pain in the legs of acutely ill, hospitalized patients without venous leg ulcers. To determine if the use of elastic bandage wraps of the leg in patients before and after liver transplant decreases edema formation and pain in the leg. Study Population-A convenience sample of inpatients before and after liver transplant. Pretest, posttest, randomized controlled trial with each participant serving as his or her own control. Intervention-Elastic bandage wrap applied to leg for 8 hours. Edema and pain in leg. In 13 patients before and 11 patients after liver transplant, the mean (SD) change in leg circumference after a single 8-hour application of an elastic bandage wrap was -2.6 (2.2) cm at the ankle and -3.1 (2.9) cm at midcalf for wrapped legs, as opposed to -0.4 (1.6) cm at the ankle and 1.0 (2.8) cm at midcalf for unwrapped legs (PLeg pain, measured on a visual analog scale, was significantly lower for the wrapped (mean [SD], 10.3 [26.5] mm) versus the unwrapped (20.3 [33.5] mm) leg (P=.04). In inpatients before and after liver transplant, the application of elastic bandage wraps to 1 leg for an 8-hour period led to significantly less edema formation and pain compared with the unwrapped leg. These results support the use of elastic bandage wraps in liver transplant patients to reduce leg edema and improve comfort.

  6. Single leg stance control in individuals with symptomatic gluteal tendinopathy.

    Science.gov (United States)

    Allison, Kim; Bennell, Kim L; Grimaldi, Alison; Vicenzino, Bill; Wrigley, Tim V; Hodges, Paul W

    2016-09-01

    Lateral hip pain during single leg loading, and hip abductor muscle weakness, are associated with gluteal tendinopathy, but it has not been shown how or whether kinematics in single leg stance differ in those with gluteal tendinopathy. To compare kinematics in preparation for, and during, single leg stance between individuals with and without gluteal tendinopathy, and the effect of hip abductor muscle strength on kinematics. Twenty individuals with gluteal tendinopathy and 20 age-matched pain-free controls underwent three-dimensional kinematic analysis of single leg stance and maximum isometric hip abductor strength testing. Maximum values of hip adduction, pelvic obliquity (contralateral pelvis rise/drop), lateral pelvic translation (ipsilateral/contralateral shift) and ipsilateral trunk lean during preparation for leg lift and average values in steady single leg stance, were compared between groups using an analysis of covariance, with and without anthropometric characteristics and strength as covariates. Individuals with gluteal tendinopathy demonstrated greater hip adduction (standardized mean difference (SMD)=0.70, P=0.04) and ipsilateral pelvic shift (SMD=1.1, P=0.002) in preparation for leg lift, and greater hip adduction (SMD=1.2, P=0.002) and less contralateral pelvic rise (SMD=0.86, P=0.02) in steady single leg stance than controls. When including strength as a covariate, only between-group differences in lateral pelvic shift persisted (SMD=1.7, P=0.01). Individuals with gluteal tendinopathy use different frontal plane kinematics of the hip and pelvis during single leg stance than pain-free controls. This finding is not influenced by pelvic dimension or the potentially modifiable factor of body mass index, but is by hip abductor muscle weakness. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. Predictors of long-term pain and disability in patients with low back pain investigated by magnetic resonance imaging: A longitudinal study

    Directory of Open Access Journals (Sweden)

    Sampson Madeleine

    2011-10-01

    Full Text Available Abstract Background It is possible that clinical outcome of low back pain (LBP differs according to the presence or absence of spinal abnormalities on magnetic resonance imaging (MRI, in which case there could be value in using MRI findings to refine case definition of LBP in epidemiological research. We therefore conducted a longitudinal study to explore whether spinal abnormalities on MRI for LBP predict prognosis after 18 months. Methods A consecutive series of patients aged 20-64 years, who were investigated by MRI because of mechanical LBP (median duration of current episode 16.2 months, were identified from three radiology departments, and those who agreed completed self-administered questionnaires at baseline and after a mean follow-up period of 18.5 months (a mean of 22.2 months from MRI investigation. MRI scans were assessed blind to other clinical information, according to a standardised protocol. Associations of baseline MRI findings with pain and disability at follow-up, adjusted for treatment and for other potentially confounding variables, were assessed by Poisson regression and summarised by prevalence ratios (PRs with their 95% confidence intervals (CIs. Results Questionnaires were completed by 240 (74% of the patients who had agreed to be followed up. Among these 111 men and 129 women, 175 (73% reported LBP in the past four weeks, 89 (37% frequent LBP, and 72 (30% disabling LBP. In patients with initial disc degeneration there was an increased risk of frequent (PR 1.3, 95%CI 1.0-1.9 and disabling LBP (PR 1.7, 95%CI 1.1-2.5 at follow-up. No other associations were found between MRI abnormalities and subsequent outcome. Conclusions Our findings suggest that the MRI abnormalities examined are not major predictors of outcome in patients with LBP. They give no support to the use of MRI findings as a way of refining case definition for LBP in epidemiological research.

  8. A novel magnetic stimulator increases experimental pain tolerance in healthy volunteers - a double-blind sham-controlled crossover study.

    Directory of Open Access Journals (Sweden)

    Rudie Kortekaas

    Full Text Available UNLABELLED: The 'complex neural pulse'(TM (CNP is a neuromodulation protocol employing weak pulsed electromagnetic fields (PEMF. A pioneering paper reported an analgesic effect in healthy humans after 30 minutes of CNP-stimulation using three nested whole head coils. We aimed to devise and validate a stimulator with a novel design entailing a multitude of small coils at known anatomical positions on a head cap, to improve applicability. The main hypothesis was that CNP delivery with this novel device would also increase heat pain thresholds. Twenty healthy volunteers were enrolled in this double-blind, sham-controlled, crossover study. Thirty minutes of PEMF (CNP or sham was applied to the head. After one week the other treatment was given. Before and after each treatment, primary and secondary outcomes were measured. Primary outcome was heat pain threshold (HPT measured with thermal quantitative sensory testing. Other outcomes were warmth detection threshold, and aspects of cognition, emotion and motor performance. As hypothesized heat pain threshold was significantly increased after the PEMF stimulation. All other outcomes were unaltered by the PEMF but there was a trend level reduction of cognitive performance after PEMF stimulation as measured by the digit-symbol substitution task. Results from this pilot study suggest that our device is able to stimulate the brain and to modulate its function. This is in agreement with previous studies that used similar magnetic field strengths to stimulate the brain. Specifically, pain control may be achieved with PEMF and for this analgesic effect, coil design does not appear to play a dominant role. In addition, the flexible configuration with small coils on a head cap improves clinical applicability. TRIAL REGISTRATION: Dutch Cochrane Centre NTR1093.

  9. A Novel Magnetic Stimulator Increases Experimental Pain Tolerance in Healthy Volunteers - A Double-Blind Sham-Controlled Crossover Study

    Science.gov (United States)

    Kortekaas, Rudie; Konopka, Karl-Heinz; Harbers, Marten; van der Hoeven, Johannes H.; van Wijhe, Marten; Aleman, André; Maurits, Natasha M.

    2013-01-01

    The ‘complex neural pulse’TM (CNP) is a neuromodulation protocol employing weak pulsed electromagnetic fields (PEMF). A pioneering paper reported an analgesic effect in healthy humans after 30 minutes of CNP-stimulation using three nested whole head coils. We aimed to devise and validate a stimulator with a novel design entailing a multitude of small coils at known anatomical positions on a head cap, to improve applicability. The main hypothesis was that CNP delivery with this novel device would also increase heat pain thresholds. Twenty healthy volunteers were enrolled in this double-blind, sham-controlled, crossover study. Thirty minutes of PEMF (CNP) or sham was applied to the head. After one week the other treatment was given. Before and after each treatment, primary and secondary outcomes were measured. Primary outcome was heat pain threshold (HPT) measured with thermal quantitative sensory testing. Other outcomes were warmth detection threshold, and aspects of cognition, emotion and motor performance. As hypothesized heat pain threshold was significantly increased after the PEMF stimulation. All other outcomes were unaltered by the PEMF but there was a trend level reduction of cognitive performance after PEMF stimulation as measured by the digit-symbol substitution task. Results from this pilot study suggest that our device is able to stimulate the brain and to modulate its function. This is in agreement with previous studies that used similar magnetic field strengths to stimulate the brain. Specifically, pain control may be achieved with PEMF and for this analgesic effect, coil design does not appear to play a dominant role. In addition, the flexible configuration with small coils on a head cap improves clinical applicability. Trial Registration Dutch Cochrane Centre NTR1093 PMID:23620795

  10. A Rare Case of Progressive Palsy of the Lower Leg during Percutaneous Endoscopic Lumbar Discectomy via a Transforaminal Approach

    Directory of Open Access Journals (Sweden)

    Hiroaki Manabe

    2018-01-01

    Full Text Available Percutaneous endoscopic discectomy (PED for lumbar disc herniation is gaining popularity with the transforaminal (TF approach preferred because it allows surgery under local anesthesia and preserves the spinal muscles. Although this procedure has some characteristic complications, it is rare for PED to be converted to conventional open surgery due to worsening of symptoms intraoperatively. Here, we report PED via the TF approach that required conversion to open surgery. A 20-year-old man with a large disc herniation at L3/4 developed severe progressive leg pain and muscle weakness of the left leg intraoperatively. Magnetic resonance imaging revealed that the size of the herniation was unchanged and the endoscope did not reach the herniated mass. We converted to open surgery, and the patient’s postoperative course was favorable. We discuss the reasons for failure of the approach and suggest planning for an appropriate foraminoplasty to avoid the potential need for conversion to open surgery.

  11. Making Better Lives: Patient-Focused Care for Low Back Pain (LBP)

    Science.gov (United States)

    2017-11-15

    Chronic Low Back Pain; Hip Ostearthritis; Myofascial Pain Syndrome; Fibromyalgia; Depression; Maladaptive Coping; Lumbar Spinal Stenosis; Insomnia; Sacroiliac Joint Pain; Lateral Hip and Thigh Pain; Anxiety; Dementia; Recent Leg Length Discrepancy

  12. Hypertrophic Synovitis of the Facet Joint Causing Root Pain

    Directory of Open Access Journals (Sweden)

    Koichi Iwatsuki M.D.

    2008-01-01

    Full Text Available Osteoarthritic changes in the facet joints are common in the presence of degenerative disc disease. Changes in the joint capsule accompany changes in the articular surfaces. Intraspinal synovial cysts that cause radicular pain, cauda equina syndrome, and myelopathy have been reported; however, there have been few reports in orthopedic or neurosurgical literature regarding hypertrophic synovitis of the facet joint presenting as an incidental para-articular mass. Here, we report a case of hypertrophic synovitis causing root pain. We describe the case of a 65-year-old man suffering from right sciatica and right leg pain in the L5 nerve-root dermatome for 1 year; magnetic resonance imaging (MRI revealed an enhanced mass around the L4–5 facet joint. We investigated this mass pathologically. After right medial facetectomy, the symptoms resolved. Pathological investigation revealed this mass was hypertrophic synovitis. Hypertrophic synovitis of the facet joint might cause root pain.

  13. The Relationship of Lumbar Multifidus Muscle Morphology to Previous, Current, and Future Low Back Pain

    DEFF Research Database (Denmark)

    Hebert, Jeffrey J; Kjær, Per; Fritz, Julie M

    2014-01-01

    Study Design. Population based prospective cohort study.Objective. We explored the cross-sectional relationships between lumbar multifidus (LM) intramuscular adipose tissue (IMAT) infiltration and LBP at three successive time points and investigated the role of IMAT in predicting the occurrence....... At each time point, participants underwent magnetic resonance imaging and reported ever having had LBP, LBP in the previous year, non-trivial LBP in the previous year, or a history of pain radiating into the legs. Pixel intensity and frequencies from T1-weighted magnetic resonance images identified...... at age 45 or age 49 and LM IMAT did not predict future LBP.Conclusion. The relationship between LM IMAT and lbp/leg pain is inconsistent and may be modified by age....

  14. Venous leg ulcers.

    Science.gov (United States)

    Nelson, E Andrea

    2011-12-21

    Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide

  15. Modeling sickle cell vasoocculsion in the rat leg: Quantification of trapped sickle cells and correlation with 31P metabolic and 1H magnetic resonance imaging changes

    International Nuclear Information System (INIS)

    Fabry, M.E.; Rajanayagam, V.; Fine, E.; Holland, S.; Gore, J.C.; Nagel, R.L.; Kaul, D.K.

    1989-01-01

    The authors have developed an animal model to elucidate the acute effects of perfusion abnormalities on muscle metabolism induced by different density-defined classes of erythrocytes isolated from sickle cell anemia patients. Technetium-99m ( 99m Tc)-labeled, saline-washed normal (AA), homozygous sickle (SS), or high-density SS (SS4) erythrocytes were injected into the femoral artery of the rat and quantitative 99m Tc imaging, 31 P magnetic resonance spectroscopy by surface coil at 2 teslas, and 1 H magnetic resonance imaging at 0.15 tesla were performed. Between 5 and 25 μl of SS4 cells was trapped in the microcirculation of the thigh. In contrast, fewer SS discocytes (SS2) or AA cells were trapped. After injection of SS4 cells an initial increase in inorganic phosphate was observed in the region of the thigh served by the femoral artery, intracellular pH decreased, and subsequently the proton relaxation time T 1 reached a broad maximum at 18-28 hr. When T 1 obtained at this time was plotted against the volume of cells trapped, an increase of T 1 over the control value of 411 ± 48 msec was found that was proportional to the number of cells trapped. They conclude that the densest SS cells are most effective at producing vasoocclusion. The extent of the change detected by 1 H magnetic resonance imaging is dependent on the amount of cells trapped in the microcirculation and the magnitude of the initial increase of inorganic phosphate

  16. [The new magnetic therapy TAMMEF in the treatment of simple shoulder pain].

    Science.gov (United States)

    Battisti, E; Bianciardi, L; Albanese, A; Piazza, E; Rigato, M; Galassi, G; Giordano, N

    2007-01-01

    Numerous studies have demonstrated the utility of extremely low frequencies (ELF) electromagnetic fields in the treatment of pain. Moreover, the effects of these fields seems to depend on their respective codes (frequency, intensity, waveform). In our study we want to assess the effects of the TAMMEF (Therapeutic Application of a Musically Modulated Electromagnetic Field) system, whose field is piloted by a musical signal and its parameters (frequency, intensity, waveform) are modified in time, randomly varying within the respective ranges, so that all possible codes can occur during a single application. Sixty subjects, affected by shoulder periarthritis were enrolled in the study and randomly divided into three groups of 20 patients each: A exposed to TAMMEF, B exposed to ELF, C exposed to a simulated field. All subjects underwent a cycle of 15 daily sessions of 30 minutes each and a clinical examination upon enrollment, after 7 days of therapy, at the end of the cycle and at a follow-up 30 days later. All the patients of groups A and B completed the therapy without the appearance of side effects: they presented a significant improvement of the subjective pain and the functional limitation, which remained stable at the follow-up examination. In group C, there was no improvement of the pain symptoms or articular functionality. This study suggests that the TAMMEF system is efficacious in the control of pain symptoms and in the reduction of functional limitation in patients with shoulder periarthritis. Moreover, the effects of the TAMMEF system cover those produced by the ELF field.

  17. Effects of intranasal oxytocin on thermal pain in healthy men: a randomized functional magnetic resonance imaging study.

    Science.gov (United States)

    Zunhammer, Matthias; Geis, Sandra; Busch, Volker; Greenlee, Mark W; Eichhammer, Peter

    2015-01-01

    Intranasal oxytocin has been shown to affect human social and emotional processing, but its potential to affect pain remains elusive. This randomized, placebo-controlled, double-blind, crossover trial investigated the effect of intranasal oxytocin on the perception and processing of noxious experimental heat in 36 healthy male volunteers. Thermal thresholds were determined according to the Quantitative Sensory Testing protocol. A functional magnetic resonance imaging experiment including intensity and unpleasantness ratings of tonic heat was used to investigate the effects of oxytocin within the brain. Thirty men (aged 18-50 years) were included in the study. Intranasal oxytocin had no significant effect on thermal thresholds, but significantly (t = -2.06, p = .046) reduced heat intensity ratings during functional magnetic resonance imaging. The effect on intensity ratings was small (-3.46 points on a 100-point visual analog scale [95% confidence interval {CI} = -6.86 to -0.07] and independent of temperature. No effects of oxytocin on stimulus- or temperature-related processing were found at the whole-brain level at a robust statistical threshold. A region of interest analysis indicated that oxytocin caused small but significant decreases in left (-0.045%, 95% CI = -0.087 to -0.003, t = -2.19, p = .037) and right (-0.051%, 95% CI = -0.088 to -0.014], t = -2.82, p = .008) amygdala activity across all temperatures. The present study provides evidence for a significant but subtle inhibitory effect of oxytocin on thermal stimulus ratings and concurrent amygdala activity. Neither of the two effects significantly depended of temperature; therefore, the hypothesis of a pain-specific effect of oxytocin could not be confirmed. EUDRA-CT 2009-015115-40.

  18. Temporomandibular joint (TMJ) pain revisited with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)

    International Nuclear Information System (INIS)

    Tasali, N.; Cubuk, R.; Aricak, M.; Ozarar, M.; Saydam, B.; Nur, H.; Tuncbilek, N.

    2012-01-01

    Purpose: We aimed to assess the contrast enhancement patterns of the retrodiscal tissue with dynamic contrast-enhanced MR imaging (DCE-MRI) with respect to different temporomandibular joint disc pathologies. Additionally, we questioned the relationship between the temporomandibular joint (TMJ) pain and the contrast enhancement pattern of the retrodiscal tissue regardless of the TMJ disc position. Materials and methods: 52 joints of 26 patients (4 males and 22 females) who have pain in at least at one of their TMJ were included in this study. For the qualitative analysis, the joints were divided into four groups in terms of their disc positions: normal (1), partially displaced with or without reduction (2), totally dislocated with reduction (3) and totally dislocated without reduction (4). Besides, two different joint groups were constituted, namely the painful group and painless group according to the clinical findings without taking the TMJ disc positions into account. Quantitative analyses were made by means of measuring signal intensity ratios (SI) ratio at the retrodiscal tissue (from internal side and external side of the each joint) using DCE-MRI and these measurements were analyzed with paired samples t test to define the difference between the measurements. At the second stage, the time-dependent arithmetical mean values of the SI ratios were calculated for each joint group and significant differences between the groups were questioned using analysis of variance (ANOVA) test. Besides, painful and painless groups which were classified on the basis of the clinical data were compared according to the mean SI ratios found for each joint and the significant differences between these two groups were assessed by means of Student's T test. The results were assessed in 95% confidence interval where the significance level was p < 0.05. Results: A significant difference was observed between the internal and external contrast enhancement of the joints with partial

  19. Evaluation of low back pain with low field open magnetic resonance imaging scanner in rural hospital of Southern India

    Directory of Open Access Journals (Sweden)

    Sadhanandham Shrinuvasan

    2016-01-01

    Full Text Available Background: Low back pain (LBP is the most common symptom which is associated with limitation of normal activities and work-related disability. Imaging techniques are often essential in making the correct diagnosis for prompt management. Plain Radiography though remain a first imaging modality, magnetic resonance imaging (MRI due to its inherent softtissue contrast resolution and lack of ionizing radiation remains invaluable modality in the evaluation of LBP. Aim: To find the common causes of LBP in different age groups and the role of MRI in detecting the spectrum of various pathological findings. Materials and Methods: This is a prospective study done in the Department of Radiodiagnosis during a period of 2 years from July 2013 to July 2015. The study population includes all the cases referred to our department with complaints of LBP. Patients with ferromagnetic metallic implants and uncooperative cases were excluded. HITACHI 0.4 Tesla open MRI machine was used for imaging. Results and Conclusion: This study involved a total of 235 cases. There were 121 males and 114 females. The age of the patient ranged from 21 to 68 years with an average of 41.3 years. Back pain was commonly observed in the third to fifth decade. The common causes for back pain are disc herniations (disc bulge - 35.3%, disc protrusion - 39.6%, disc extrusion - 7.2% accounting to 82.1%, followed by normal study (10.2%, vertebral collapse (traumatic - 2.1%, osteoporotic - 1.7%, infections (2.1%, and neoplasm (1.7%. MRI provides valuable information regarding the underlying causes of LBP, especially in disc and marrow pathology.

  20. Combining information obtained from magnetic resonance imaging and conventional radiographs to detect sacroiliitis in patients with recent onset inflammatory back pain

    NARCIS (Netherlands)

    Heuft-Dorenbosch, L.; Landewé, R.; Weijers, R.; Wanders, A.; Houben, H.; van der Linden, S.; van der Heijde, D.

    2006-01-01

    To compare the contribution of changes on magnetic resonance imaging (MRI) and conventional radiography (CR) in the sacroiliac joints of patients with recent onset inflammatory back pain (IBP) in making an early diagnosis of spondyloarthritides. The study involved 68 patients with IBP (38% male;

  1. Magnetic resonance imaging changes of sacroiliac joints in patients with recent-onset inflammatory back pain: inter-reader reliability and prevalence of abnormalities

    NARCIS (Netherlands)

    Heuft-Dorenbosch, Liesbeth; Weijers, René; Landewé, Robert; van der Linden, Sjef; van der Heijde, Désirée

    2006-01-01

    To study the inter-reader reliability of detecting abnormalities of sacroiliac (SI) joints in patients with recent-onset inflammatory back pain by magnetic resonance imaging (MRI), and to study the prevalence of inflammation and structural changes at various sites of the SI joints. Sixty-eight

  2. Restless Legs Syndrome and Leg Motor Restlessness in Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Keisuke Suzuki

    2015-01-01

    Full Text Available Sleep disturbances are important nonmotor symptoms in Parkinson’s disease (PD that are associated with a negative impact on quality of life. Restless legs syndrome (RLS, which is characterized by an urge to move the legs accompanied by abnormal leg sensations, can coexist with PD, although the pathophysiology of these disorders appears to be different. RLS and PD both respond favorably to dopaminergic treatment, and several investigators have reported a significant relationship between RLS and PD. Sensory symptoms, pain, motor restlessness, akathisia, and the wearing-off phenomenon observed in PD should be differentiated from RLS. RLS in PD may be confounded by chronic dopaminergic treatment; thus, more studies are needed to investigate RLS in drug-naïve patients with PD. Recently, leg motor restlessness (LMR, which is characterized by an urge to move the legs that does not fulfill the diagnostic criteria for RLS, has been reported to be observed more frequently in de novo patients with PD than in age-matched healthy controls, suggesting that LMR may be a part of sensorimotor symptoms intrinsic to PD. In this paper, we provide an overview of RLS, LMR, and PD and of the relationships among these disorders.

  3. Clinical quality indicators of venous leg ulcers

    DEFF Research Database (Denmark)

    Kjaer, Monica L; Mainz, Jan; Soernsen, Lars T

    2005-01-01

    and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel......; an independent medical doctor tested the feasibility and reliability of these clinical indicators, assessing the quality of medical technical care on 100 consecutive venous leg ulcer patients. Main outcome measures were healing, recurrence, pain, venous disease diagnosis, differential diagnosis and treatment......%) were assessed for venous surgery. Distal arterial pressure was measured following initial examination in 33 of the patients (34%). All patients (100%) were prescribed compression therapy. Of the 98 patients, 11 (11%) had ulcers recur in 3 months and 72 (73%) healed in 12 months, which is in line...

  4. Criteria in diagnosing nocturnal leg cramps: a systematic review.

    Science.gov (United States)

    Hallegraeff, Joannes; de Greef, Mathieu; Krijnen, Wim; van der Schans, Cees

    2017-02-28

    Up to 33% of the general population over 50 years of age are affected by nocturnal leg cramps. Currently there are no generally accepted clinical characteristics, which identify nocturnal leg cramps. This study aims to identify these clinical characteristics and to differentiate between them and the characteristics of restless leg syndrome and periodic limb disorder. A systematic literature study was executed from December 2015 to May 2016. This study comprised of a systematic literature review of randomized clinical trials, observational studies on nocturnal and rest cramps of legs and other muscles, and other systematic and narrative reviews. Two researchers independently extracted literature data and analyzed this using a standardized reviewing protocol. Modified versions of the Cochrane Collaboration tools assessed the risk of bias. A Delphi study was conducted to assess agreement on the characteristics of nocturnal leg cramps. After systematic and manual searches, eight randomized trials and ten observational studies were included. On the basis of these we identified seven diagnostic characteristics of nocturnal leg cramps: intense pain, period of duration from seconds to maximum 10 minutes, location in calf or foot, location seldom in thigh or hamstrings, persistent subsequent pain, sleep disruption and distress. The seven above characteristics will enhance recognition of the condition, and help clinicians make a clear distinction between NLC and other sleep-related musculoskeletal disorder among older adults.

  5. Fantom pain: Case report

    Directory of Open Access Journals (Sweden)

    Marić Sanja S.

    2017-01-01

    Full Text Available Background Phantom limb pain is a common problem after limb amputation (41-85%. It is described as an extremely painful sensation in the missing part of the body that can last for hours, days or even years. It is considered to arise from cortical reorganization, although many factors can increase the risk of phantom limb pain: pain before surgery, age and sex of the patients, the time elapsed since surgery, stump pain, inadequate prosthesis. Phantom limb pain therapy is very complicated. Case report We reported a case of 80-year-old patient suffering from phantom limb pain and phantom sensation 25 years after the amputation of his left leg due to the injury. The patient has pain at the site of amputation, sensation that he has the leg and that it occupies an unusual position and almost daily exhausting phantom limb pain (6-9 visual analogue scale - VAS with disturbed sleep and mood. We managed to reduce the pain under 4 VAS and decrease the patient suffering by combining drugs from the group of coanalgetics (antidepressants, antiepileptics, non-pharmacological methods (transcutaneous electroneurostimulation - TENS, mirror therapy and femoral nerve block in the place of disarticulation of the left thigh. Conclusion Phantom limb pain therapy is multimodal, exhausting for both the patient and the physician and it is often unsuccessful. The combination of different pharmacological and non-pharmacological modalities can give satisfactory therapeutic response.

  6. Genetic association between leg conformation in young pigs and sow reproduction

    DEFF Research Database (Denmark)

    Le, Thu Hong; Nilsson, Katja; Norberg, Elise

    2015-01-01

    Lameness is an issue of concern in pig production due both to animal welfare and to economical aspects. Lame sows are believed to suffer from pain and stress which is reported to have a negative influence on reproduction. Leg conformation and locomotion traits in young animals are associated...... of simultaneous improvement of both leg quality and reproduction performance by selecting on sound leg conformation and locomotion of young pigs....

  7. Ultrasound and magnetic resonance findings and correlation in hemiplegic patients with shoulder pain.

    Science.gov (United States)

    Doğun, Asuman; Karabay, İlkay; Hatipoğlu, Cem; Özgirgin, Neşe

    2014-01-01

    The aim of this study was to evaluate the ultrasonography (US) and MRI findings in hemiplegic patients with shoulder pain and investigate the correlation between them. It is not possible for these patients to fully perform active range of motion (ROM) and stress tests, so imaging methods take center stage in diagnosis and treatment planning. A total of 68 hemiplegic patients with shoulder pain attending the inpatient rehabilitation program were included in the study. MRI and US results from the patient files were recorded. The frequency of each pathology identified by US and MRI was determined. The distribution of MRI and US findings was investigated to see whether there was a statistical difference between the correlation of MRI and US results. The mean (SD) age of the patients was 63.7 (8.3) years and the mean (SD) duration of hemiplegia was 49 (8.9) days. According to the MRI results, glenohumeral and acromioclavicular joint degeneration was found in 77.9% and 79.7% of the patients, respectively; subacromial-subdeltoid bursitis in 80.9%; fluid increase in the joint space in 41.2%; supraspinatus tendinitis in 36.8%; and supraspinatus partial rupture in 33.8%. Shoulder US findings were supraspinatus tendinitis in 54.4%, acromioclavicular joint degeneration in 26.5%, bicipital tendinitis in 20.6%, and subacromial-subdeltoid bursitis in 19.1%. There was a statistically significant difference between MRI and US findings. The results were not compatible with each other (P ≯ .05), and these findings were not consistent with each other since the kappa coefficient was under 0.40 for all these results. Although US is recommended as the first method in determining shoulder pathologies in hemiplegic patients, we suggest that MRI should be used as the first choice in hemiplegic patients with shoulder pain. MRI and US findings were not consistent, and US is dependent on the experience of the operator. MRI should be the first choice in cases where the diagnosis will affect

  8. Increased pain sensitivity in accident-related chronic pain patients with comorbid posttraumatic stress

    DEFF Research Database (Denmark)

    Vaegter, Henrik Bjarke; Andersen, Tonny Elmose; Harvold, Mathea

    2018-01-01

    OBJECTIVES: Posttraumatic stress disorder (PTSD) is prevalent in chronic pain, and associated with increased pain, hyperalgesia and psychological distress. This study aimed to investigate anti-nociceptive and pro-nociceptive pain mechanisms, pain intensity, and psychological distress (depression......, anxiety, pain catastrophizing, and fear of movement) in patients with accident-related chronic spinal pain with (N=44) and without (N=64) comorbid PTSD characteristics. METHODS: Cuff algometry was performed on lower legs to assess pressure pain threshold (cPPT), tolerance (cPTT), temporal summation...... of pain (TSP: increase in pain scores to ten repeated stimulations), and conditioning pain modulation (CPM: increase in cPPT during cuff pain conditioning on the contralateral leg). Warmth detection threshold (WDT) and heat pain threshold (HPT) at the hand were also assessed. Clinical pain intensity...

  9. ORTHOPEDIC LEG BRACE

    Science.gov (United States)

    Myers, William Neil (Inventor)

    2005-01-01

    Knee braces generally have been rigid in both the knee bending direction and in the knee straightening direction unless a manually operated release is incorporated in them to allow the knee to bend. Desirably a braced knee joint should effectively duplicate the compound, complex, actions of a normal knee. The key to knee braces is the knee joint housing. The housing herein carries a number of cam action pawls. with teeth adapted to engage the internal teeth of a ratchet ring mounted in the housing. Cam action return springs and the shape of the cam action pawl teeth allow rotation of the ratchet ring in a leg straightening direction while still supporting a load. The leg can then be extended during walking while at the same time being prevented by the cam action pawls from buckling in the knee bending direction.

  10. Quality of Life in People with Leg Ulcer, Integrative Review

    Directory of Open Access Journals (Sweden)

    Daniela Alves

    2016-04-01

    Full Text Available Objective: To identify the main changes in the daily life of people with leg ulcer and how that affects the person’s quality of life. Methodology: We used the methodology PI [C] OD and selected four research articles, taken from EBSCO, PubMed, and EWMA. Results: The main changes identified in the people’s daily live with leg ulcers are physical (pain, decreased mobility, presence of exudate, bad smell from the wound and change in the style of clothing, psychological (sleep disorders, depression, anxiety, feelings of rejection and low self-steem, social (isolation, restriction in leisure activities, inability to perform household chores. Conclusions: The literature about the person’s quality of life with leg ulcer reported a significant impact in the daily life. The care provided by nurses should be centered on the person, integrating all the kind of needs and the leg ulcer must not be the sole focus of care

  11. INSTRUMENTAL STRAIGHT-LEG RAISING - A NEW APPROACH TO LASEGUES TEST

    NARCIS (Netherlands)

    GOEKEN, LN; HOF, AL

    1991-01-01

    In clinical practice the outcome of Lasegue's test is interpreted with respect to two variables: (1) the maximum angle between the leg and the horizontal plane to which the leg can be lifted, and (2) the pain that is provoked by the movement. For a number of reasons it is difficult in many patients

  12. Pain-inhibiting inhomogeneous static magnetic field fails to influence locomotor activity and anxiety behavior in mice: no interference between magnetic field- and morphine-treatment.

    Science.gov (United States)

    László, János; Tímár, Júlia; Gyarmati, Zsuzsanna; Fürst, Zsuzsanna; Gyires, Klára

    2009-06-30

    We wanted to demonstrate (i) in the writhing test in mice, whether there was a prolonged analgesic effect induced by an inhomogeneous static magnetic field (SMF) exposure; (ii) whether SMF had an effect on the analgesic effect induced by 0.5mg/kgs.c. administered morphine, on the behavioral patterns, and on the hyperlocomotion-inducing effect of morphine. A magnetic exposure system developed by the present authors was used with peak-to-peak flux densities in the 2-754mT range. The writhing test was used for the assessment of pain. An elevated plus maze and a Conducta System was used for studying the anxiogenic or anxyolitic effect in mice, and the locomotor activity, respectively. We looked for the difference in the number of writhings and in the behavioral patterns between treated (s.c. morphine and/or SMF exposure) and control animals, respectively. (i) The antinociceptive effect could be identified 10-30min following SMF exposition in the writhing test in mice. (ii) SMF failed to affect the morphine-induced antinociception, the behavioral patterns in either type of tests, and the hyperlocomotion-inducing effect of morphine. (i) The long-lasting antinociceptive effect of SMF allows experiments under conditions, when in situ application of the SMF-producing device would be technically difficult or impossible; or where it would disturb the experiments. (ii) The results of behavioral tests with freely moving mice in or in the vicinity of inhomogeneous SMFs are not affected by the SMF in the applied flux density range. (iii) Morphine in treated subjects is not interacting with the inhomogeneous SMFs in the applied flux density range.

  13. Legāti

    OpenAIRE

    Segliņa, Aiga

    2010-01-01

    Autore teorētiski analizē legāta jēdzienu testamentārās mantošanas ietvaros un atspoguļo praktiska pētījuma rezultātus. Teorētiskā daļa apskata legāta nodibināšanas formu un spēkā esamību, tā iegūšanu un atraidīšanu, izpildi un zaudēšanu, novēlējuma robežas un aprobežojumus. Pētījums veikts aptaujas veidā ar mērķi noskaidrot, cik liela Latvijas iedzīvotāju daļa apzinās legāta nodrošinātās priekšrocības testamentārajā mantošanā. Apskatīts notāra neitralitātes jautājums attiecībā pret mantošana...

  14. Stable walking with asymmetric legs

    International Nuclear Information System (INIS)

    Merker, Andreas; Rummel, Juergen; Seyfarth, Andre

    2011-01-01

    Asymmetric leg function is often an undesired side-effect in artificial legged systems and may reflect functional deficits or variations in the mechanical construction. It can also be found in legged locomotion in humans and animals such as after an accident or in specific gait patterns. So far, it is not clear to what extent differences in the leg function of contralateral limbs can be tolerated during walking or running. Here, we address this issue using a bipedal spring-mass model for simulating walking with compliant legs. With the help of the model, we show that considerable differences between contralateral legs can be tolerated and may even provide advantages to the robustness of the system dynamics. A better understanding of the mechanisms and potential benefits of asymmetric leg operation may help to guide the development of artificial limbs or the design novel therapeutic concepts and rehabilitation strategies.

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

    Science.gov (United States)

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

    2016-09-01

    Anterior knee pain (AKP) is a frequent clinical presentation in jumping athletes and may be aggravated by sustained sitting, stair use, and loading of the quadriceps. Corticospinal activation of the quadriceps in athletes with AKP has not yet been investigated, but is important in guiding efficacious treatment. This cross-sectional study assessed corticospinal excitability (CSE) of the quadriceps in jumping athletes using transcranial magnetic stimulation (TMS). Groups consisted of Control (no knee pain); patellar tendinopathy (PT) [localized inferior pole pain on single-leg decline squat (SLDS)]; and other AKP (nonlocalized pain around the patella). SLDS (numerical score of pain 0-10), Victorian Institute of Sport Assessment Patellar tendon (VISA-P), maximal voluntary isometric contraction (MVIC), active motor threshold (AMT), CSE, and Mmax were tested. Twenty nine athletes participated; control n = 8, PT n = 11, AKP n = 10. There were no group differences in age (P = 0.23), body mass index (P = 0.16), MVIC (P = 0.38) or weekly activity (P = 0.22). PT had elevated CSE compared with controls and other AKP (P knee pain may direct better treatment approaches. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Immediate Changes Following Manual Therapy in Resting State Functional Connectivity As Measured By Magnetic Resonance Imaging (fMRI) In Subjects With Induced Low Back Pain

    Science.gov (United States)

    Gay, Charles W.; Robinson, Michael E.; George, Steven Z.; Perlstein, William M.; Bishop, Mark D.

    2014-01-01

    Objective The purpose of this study was to use functional magnetic resonance imaging (fMRI) to investigate the immediate changes in functional connectivity (FC) between brain regions that process and modulate the pain experience following 3 different types of manual therapies (MT) and to identify reductions in experimentally induced myalgia and changes in local and remote pressure pain sensitivity. Methods Twenty-four participants (17 females, mean age ± SD = 21.6 ± 4.2 years), who completed an exercise-injury protocol to induce low back pain, were randomized into 3 groups: chiropractic spinal manipulation (n=6), spinal mobilization (n=8) or therapeutic touch (n=10). The primary outcome was the immediate change in FC as measured on fMRI between the following brain regions: somatosensory cortex, secondary somatosensory cortex, thalamus, anterior and posterior cingulate cortices, anterior and poster insula, and periaqueductal grey. Secondary outcomes were immediate changes in pain intensity measured with a 101-point numeric rating scale, and pain sensitivity, measured with a hand-held dynamometer. Repeated measures ANOVA models and correlation analyses were conducted to examine treatment effects and the relationship between within-person changes across outcome measures. Results Changes in FC were found between several brain regions that were common to all 3 manual therapy interventions. Treatment-dependent changes in FC were also observed between several brain regions. Improvement was seen in pain intensity following all interventions (p0.05). There were no observed changes in pain sensitivity, or an association between primary and secondary outcome measures. Conclusion These results suggest that manual therapies (chiropractic spinal manipulation, spinal mobilization, and therapeutic touch) have an immediate effect on the FC between brain regions involved in processing and modulating the pain experience. This suggests that neurophysiological changes following MT

  17. The study of vascular dynamics for the effect of a compress pack on pain relief using magnetic resonance angiography

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Ji Won; Lim, Young Khi [Gachon University, Sungnam (Korea, Republic of)

    2015-12-15

    This study was to investigate the effects of the hot compress pack on alleviating local muscular discomfort, stiffness in limbs as well as the chronic pains such as migraine in terms of hemodynamics. In this study, the hot compress band was put on the neck and the local physiological change on the stimulation site and the cranial blood circulation change were examined. We recruited healthy volunteers (n=8, mean age: 32.13 (4.61)), who participated in the magnetic resonance imaging (MRI) study. Local skin color and temperature were measured for the local effect of the hot compress band and the changes of intra-cranial and extra-cranial blood vessels were examined with MR angiography (MRA) images. The skin temperature increased from 36.4 degrees Celsius at the rest condition to 36.7 degrees Celsius and 37.1 degrees Celsius after 15 min and 30 min stimulation, respectively. The change of the extra-cranial blood vessels between pre-stimulation and post-stimulation of 30 min was significantly increased (+38.8%), while the change of the intra-cranial blood vessels was negligible. In this study, we demonstrated that the hot compress band on the neck yielded the increase of local skin temperature on the stimulation site and it made an effect on the extracranial circulation. In conclusion, the stimulation with a hot compress could facilitate the blood circulation, causing to relieve the muscular discomfort, stiffness in limbs as well as the chronic pains such as migraine.

  18. Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging.

    Science.gov (United States)

    Pathik, Bhupesh; Raman, Betty; Mohd Amin, Nor Hanim; Mahadavan, Devan; Rajendran, Sharmalar; McGavigan, Andrew D; Grover, Suchi; Smith, Emma; Mazhar, Jawad; Bridgman, Cameron; Ganesan, Anand N; Selvanayagam, Joseph B

    2016-10-01

    Troponin-positive chest pain patients with unobstructed coronaries represent a clinical dilemma. Cardiovascular magnetic resonance (CMR) imaging has an increasingly prominent role in the assessment of these patients; however, its utility in addition to expert clinical judgement is unclear. We sought to determine the incremental diagnostic value of CMR and the heterogeneity in diagnoses by experienced cardiologists when presented with blinded clinical and investigative data in this population. A total of 125 consecutive patients presenting to a tertiary centre between 2010 and 2014 with cardiac chest pain, elevated troponin (>29 ng/L), and unobstructed coronaries were enrolled and underwent CMR. A panel of three experienced cardiologists unaware of the CMR diagnosis and blinded to each other's assessment provided a diagnosis based on clinical and investigative findings. A consensus panel diagnosis was defined as two or more cardiologists sharing the same clinical diagnosis. Findings were classified into acute myocarditis, Takotsubo cardiomyopathy, acute myocardial infarction (AMI), or indeterminate. CMR provided a diagnosis in 87% of patients. Consensus panel diagnosis and CMR were concordant in 65/125 (52%) patients. There was an only moderate level of agreement between the three cardiologists (k = 0.47, P < 0.05) and a poor level of agreement between the consensus panel and CMR (k = 0.38, P < 0.05) with the most disagreement seen in patients with AMI diagnosed on CMR. The clinical diagnosis of patients with non-obstructive coronaries and positive troponin remains a challenge. The concordance between CMR and clinical diagnosis is poor. CMR provides a diagnosis in majority of these patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  19. Limited magnetic resonance imaging in low back pain instead of plain radiographs: Experience with first 1000 cases

    Energy Technology Data Exchange (ETDEWEB)

    McNally, Eugene G.; Wilson, David J.; Ostlere, Simon J

    2001-11-01

    AIM: We report our experience with the first 1000 patients with non-traumatic low back pain (LBP) without radiculopathy undergoing limited sequence magnetic resonance imaging (MRI) instead of plain radiography. METHODS: Between January 1996 and December 1998, 1042 patients with low back pain unresponsive to conservative treatment were examined using a limited MR protocol comprising sagittal T1-weighted and STIR imaging. Plain radiographs were not performed. RESULTS: Malignancy, infection, vertebral fracture, spondylitis, pars defects and cord tumours were detected in 20%. Of the 82 osteoporotic vertebral fractures detected, 51 (62%) were recent and 31 had normal marrow signal indicating that they were old. Eighty pars defects were identified, 45(56%) had spondylolisthesis, 29(37%) were undisplaced and 6 (7%) had pars oedema only. Neoplastic disease was found in 17(8%) of which none was suspected before imaging. Benign neoplastic diseases such as vertebral AVM/haemangiomata were excluded. Twenty-one patients had a variety of disorders including ankylosing spondylitis (7), large vessel aneurysm (3), discitis (2), ovarian cyst (2), sequestered disc (2), sacral insufficiency fracture (2) and one patient each with burst fracture, retroperitoneal haematoma and a previously unsuspected horseshoe kidney. CONCLUSION: The majority of patients with LBP are best assessed clinically and imaging is usually not required. In patients with worrying symptoms, MRI with a limited protocol detects a greater number of abnormalities than previously reported studies using plain radiographs and has replaced plain radiography in our hospital. We report our experience with the first 1000 patients and highlight issues such as protocols, detection rates and communication issues. McNally E.G. et al. (2001)

  20. The study of vascular dynamics for the effect of a compress pack on pain relief using magnetic resonance angiography

    International Nuclear Information System (INIS)

    Baek, Ji Won; Lim, Young Khi

    2015-01-01

    This study was to investigate the effects of the hot compress pack on alleviating local muscular discomfort, stiffness in limbs as well as the chronic pains such as migraine in terms of hemodynamics. In this study, the hot compress band was put on the neck and the local physiological change on the stimulation site and the cranial blood circulation change were examined. We recruited healthy volunteers (n=8, mean age: 32.13 (4.61)), who participated in the magnetic resonance imaging (MRI) study. Local skin color and temperature were measured for the local effect of the hot compress band and the changes of intra-cranial and extra-cranial blood vessels were examined with MR angiography (MRA) images. The skin temperature increased from 36.4 degrees Celsius at the rest condition to 36.7 degrees Celsius and 37.1 degrees Celsius after 15 min and 30 min stimulation, respectively. The change of the extra-cranial blood vessels between pre-stimulation and post-stimulation of 30 min was significantly increased (+38.8%), while the change of the intra-cranial blood vessels was negligible. In this study, we demonstrated that the hot compress band on the neck yielded the increase of local skin temperature on the stimulation site and it made an effect on the extracranial circulation. In conclusion, the stimulation with a hot compress could facilitate the blood circulation, causing to relieve the muscular discomfort, stiffness in limbs as well as the chronic pains such as migraine

  1. Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity

    DEFF Research Database (Denmark)

    Vaegter, Henrik Bjarke; Graven-Nielsen, Thomas

    2016-01-01

    between subgroups. Cuff algometry was performed on lower legs in 400 chronic pain patients to assess pressure pain threshold (cPPT), pressure pain tolerance (cPTT), temporal summation of pain (TSP: increase in pain scores to ten repeated stimulations), and conditioned pain modulation (CPM: increase in c......PPT during cuff pain conditioning on the contralateral leg). Heat detection (HDT) and heat pain thresholds (HPT) at clinical painful and non-painful body areas were assessed. Based on TSP and CPM four distinct groups were formed: Group 1 (n=85) had impaired CPM and facilitated TSP. Group 2 (n=148) had...... impaired CPM and normal TSP. Group 3 (n=45) had normal CPM and facilitated TSP. Group 4 (n=122) had normal CPM and normal TSP. Group 1 showed more pain regions compared with the other three groups (PCPM and facilitated TSP plays an important role in widespread pain. Group 1...

  2. The effect of age on result of straight leg raising test in patients suffering lumbar disc herniation and sciatica

    Directory of Open Access Journals (Sweden)

    Homayoun Tabesh

    2015-01-01

    Full Text Available Background: Ninety percent of all people sometimes during their lives experience low back pain, and 30-40% develops radicular leg pain with the sciatica characteristics. Although for clinical diagnosis of lumbar disc herniation (LDH straight leg raising (SLR test in 85-90% of cases indicates LDH, but in our practice with LDH patients this test is frequently negative despite radicular leg pain due to LDH. Hence, we decided to evaluate this test in LDH in different age groups. Materials and Methods: All patients with leg pain referring to neurosurgery clinic were enrolled. Those with a history of pain other than sciatica excluded and SLR test and magnetic resonance imaging (MRI of the lumbosacral spine performed. The patients with negative MRI findings excluded and finally 269 patients with true sciatica and positive MRI were included. SLR tests were performed for different age groups. Results: Of 269 patients, 167 were male. The age range was 16-80 years. The most involved levels were L5-S1 (47% and L4-L5 (42%, respectively. The rate of positive SLR result, which was 100%, 87% and 82% for 10-19, 20-29 and 30-39 years age group respectively. With an increment of age, the rate of positive test regularly declined . The chance of positive SLR in men is 1.3 times the women (odds ratio [OR] 2.4; 95% confidence interval [CI] = 1.265-4.557; P = 0.007. Increasing the age has suppression effect in positivity of SLR so that for each 1-year the chance of SLR become 0.27 times less to become positive and this is also statically meaningful (OR = 0.271;95% CI = 0.188-0.391; P,0.001. The chance of positive SLR for patients under 60 is 5.4 folds more than patients above 60 years old (OR = 5.4; 95% CI = 4-8.3; P, 0.001. Conclusion: Age, sex (male, and disk level had statistically the effect on SLR positive test.

  3. The effects of total knee replacement and non-surgical treatment on pain sensitization and clinical pain

    DEFF Research Database (Denmark)

    Skou, S. T.; Roos, E. M.; Simonsen, O.

    2016-01-01

    (PPTs) at the knee (localized sensitization) and the lower leg (spreading sensitization), (2) peak pain intensity during the previous 24 h, (3) pain intensity after 30 min of walking, (4) pain location and pattern, (5) spreading of pain on a region-divided body chart and (6) the usage of pain medication...

  4. Leg cramps and restless legs syndrome during pregnancy.

    Science.gov (United States)

    Hensley, Jennifer G

    2009-01-01

    Sleep disturbance during pregnancy can result in excessive daytime sleepiness, diminished daytime performance, inability to concentrate, irritability, and the potential for an increased length of labor and increased risk of operative birth. Sleep disturbance may be the result of a sleep disorder, such as leg cramps, a common yet benign disorder, or restless legs syndrome, a sensorimotor disorder. Both disrupt sleep, are distressing to the pregnant woman, and mimic one another and other serious disorders. During pregnancy, up to 30% of women can be affected by leg cramps, and up to 26% can be affected by restless legs syndrome.

  5. [Comparison of the effect of laser and magnetic therapy for pain level and the range of motion of the spine of people with osteoarthritis lower back].

    Science.gov (United States)

    Zdrodowska, Beata; Leszczyńska-Filus, Magdalena; Leszczyński, Ryszard; Błaszczyk, Jan

    2015-01-01

    Increased expression of degenerative disease of the lumbar spine is an onerous task, which reduces the efficiency of the activity and life of many populations. It is the most common cause of medical visits. In 95% of cases the cause of complaints is a destructive process in the course of degenerative intervertebral disc called a lumbar disc herniation. Protrusion of the nucleus pulposus causes severe pain and impaired muscle tone, often more chronic and difficult to master. Successful treatment of lumbar disc herniation constitutes a serious interdisciplinary problem. It is important to properly planned and carried out physiotherapy. Based on the number of non-invasive methods, to reduce muscle tension, mute pain and alleviation of inflammation. It is the treatment safe, effective, and at the same time, which is their big advantage, readily available and cheap. It is worth noting that not every method has the same efficiency. The question that the methods are effective in relieving pain and helping to effectively increase the range of motion led to a comparison of two methods - Low Level Laser Therapy (LLLT) and pulsating magnetic field therapy. The aim of the study was to compare the efficacy of LLLT and pulsating magnetic field therapy in combating pain and increase range of motion of the spine of people with degenerative spine disease of the lower back. 120 patients with diagnose lumbar disc herniation whit no nerve roots symptoms. Patients were divided into two Groups: A and B. Group A of 60 patients were subjected to laser therapy (λ=820nm, P=400mW, Ed=6-12 J/cm²) and the second Group B of 60 patients too, to pulsating magnetic fields procedures (5mT, 30 Hz, 15 minutes). Every patient before rehabilitation started and right after it has finished has undergone examination. Subjective pain assessment was carried out using a modified Laitinen questionnaire and Visual Analogue Scale of Pain intensity. Spine mobility was evaluated whit the Schober test and the

  6. Textiloma in the leg

    Directory of Open Access Journals (Sweden)

    Patel Amol

    2007-01-01

    Full Text Available Textiloma is defined as a tumor formed due to retained gauze. It is rarely reported in the musculoskeletal system. We are presenting a case with a soft tissue swelling over the lateral aspect of the lower third of the leg, come for implant removal of the distal tibia and fibular fracture. We removed the soft tissue mass enbloc thinking it to be a benign tumor. On cutting the mass on the operation table, a gauze piece encased by fibrous tissue was found. Textiloma can present as tumoral forms and can mimic as a pseudo-tumor.

  7. Magnetic resonance imaging assessment of regional abdominal muscle function in elite AFL players with and without low back pain.

    Science.gov (United States)

    Hides, Julie; Hughes, Brita; Stanton, Warren

    2011-06-01

    Changes in the motor control of trunk muscles have been identified in people with low back pain (LBP) including elite football players. Previous research has found functional differences in the anatomical regions of abdominal muscles; however, this has not been examined in football players with LBP. The aim of this study was to investigate if the ability to draw-in the abdominal wall is altered among football players with LBP, and to determine if there are functional differences between the middle and lower abdominal regions in participants with and without LBP. Forty-three elite Australian Football League players were imaged using magnetic resonance imaging (MRI) as they drew in their abdominal walls, and the trunk cross-sectional area (CSA) was measured in relaxed and contracted states. At the lower region, participants with LBP (1.1%) reduced their trunk CSA to a lesser extent than those without LBP (3.2%) (P = 0.018). The results also showed that the draw-in of the abdominal wall was smaller in Region 1 (8.8%) compared to Region 2 (16.0%) and Region 3 (19.7%) (P < 0.001). This study provides evidence of regional differences in motor control and altered control of the lower region in participants with LBP. This may direct physiotherapists, especially those treating athletes, to focus on the lower abdominal region in those with LBP. Copyright © 2010 Elsevier Ltd. All rights reserved.

  8. Cardiac magnetic resonance imaging in patients with chest pain, high troponin levels and absence of coronary artery obstruction

    International Nuclear Information System (INIS)

    Avegliano, G.P.; Costabel, J.P.; Kuschnir, P.; Thierer, J.; Alves de Lima, A.; Sanchez, G.; Ronderos, J.; Huguet, M.; Petit, M.; Frangi, A.A.

    2011-01-01

    The prevalence of myocardial infarction with angiographically normal coronary arteries is approximately 7-10%. The etiological diagnosis is sometimes difficult and is important in terms of clinical practice and prognosis. The goal of our study was to show a series of consecutive patients with an initial diagnosis of acute coronary syndrome with high troponin levels and absence of coronary artery obstruction in which cardiac magnetic resonance imaging (CMRI) gave a description of the myocardial lesion, orientating towards the etiological diagnosis. From January 2005 to December 2009, 720 consecutive patients with an initial diagnosis of acute coronary syndrome and elevated troponins were included; 64 of these patients did not present angiographically significant coronary artery stenosis. Within 72 ± 24 h after coronary angiography, these patients underwent CMRI using b-SSFP sequences for cine imaging in short-axis, 2-, 3- and 4- chamber views for the evaluation of segmental wall motion, with T2-weighted and delayed enhancement (DE) images of the myocardium with an 'inversion-recovery' sequence. The following diagnoses were made: myocarditis (39 patients); myocardial infarction (12 patients); Tako-Tsubo syndrome (8 patients); apical hypertrophic cardiomyopathy (2 patients); 3 patients remained without diagnosis. These findings demonstrate the usefulness of CMRI in the clinical scenario of patients with chest pain, inconclusive ECG findings and high troponin levels with angiographically normal coronary arteries. The presence and distribution pattern of DE make it possible to define the etiological diagnosis and interpret the physiopathological process. (authors) [es

  9. Neuro magnetic resonance spectroscopy using wavelet decomposition and statistical testing identifies biochemical changes in people with spinal cord injury and pain.

    Science.gov (United States)

    Stanwell, Peter; Siddall, Philip; Keshava, Nirmal; Cocuzzo, Daniel; Ramadan, Saadallah; Lin, Alexander; Herbert, David; Craig, Ashley; Tran, Yvonne; Middleton, James; Gautam, Shiva; Cousins, Michael; Mountford, Carolyn

    2010-11-01

    Spinal cord injury (SCI) can be accompanied by chronic pain, the mechanisms for which are poorly understood. Here we report that magnetic resonance spectroscopy measurements from the brain, collected at 3T, and processed using wavelet-based feature extraction and classification algorithms, can identify biochemical changes that distinguish control subjects from subjects with SCI as well as subdividing the SCI group into those with and without chronic pain. The results from control subjects (n=10) were compared to those with SCI (n=10). The SCI cohort was made up of subjects with chronic neuropathic pain (n=5) and those without chronic pain (n=5). The wavelet-based decomposition of frequency domain MRS signals employs statistical significance testing to identify features best suited to discriminate different classes. Moreover, the features benefit from careful attention to the post-processing of the spectroscopy data prior to the comparison of the three cohorts. The spectroscopy data, from the thalamus, best distinguished control subjects without SCI from those with SCI with a sensitivity and specificity of 0.9 (Percentage of Correct Classification). The spectroscopy data obtained from the prefrontal cortex and anterior cingulate cortex both distinguished between SCI subjects with chronic neuropathic pain and those without pain with a sensitivity and specificity of 1.0. In this study, where two underlying mechanisms co-exist (i.e. SCI and pain), the thalamic changes appear to be linked more strongly to SCI, while the anterior cingulate cortex and prefrontal cortex changes appear to be specifically linked to the presence of pain. Copyright 2010 Elsevier Inc. All rights reserved.

  10. No evidence for generalized increased postoperative responsiveness to pain: a combined behavioral and serial functional magnetic resonance imaging study

    DEFF Research Database (Denmark)

    Kupers, Ron; Schneider, Fabien C G; Christensen, Rune

    2009-01-01

    BACKGROUND: Although it is generally accepted that increased pain responsiveness and central sensitization develop after major tissue injury, this claim has not been tested using brain imaging methods in a clinical pain setting. We tested this hypothesis using a postoperative pain model, in conju...

  11. Interventions for leg cramps in pregnancy.

    Science.gov (United States)

    Zhou, Kunyan; West, Helen M; Zhang, Jing; Xu, Liangzhi; Li, Wenjuan

    2015-08-11

    differences were: frequency of leg cramps after treatment: never, and twice a week (risk ratio (RR) 5.66, 95% confidence interval (CI) 1.35 to 23.68, one trial, 69 women, evidence graded low; RR 0.29, 95% CI 0.11 to 0.80, one trial, 69 women), and frequency of leg cramps: 50% reduction in number of leg cramps after treatment (RR 1.42, 95% CI 1.09 to 1.86, one trial, 86 women, evidence graded low). The outcomes that showed no difference were: frequency of leg cramps during two weeks of treatment (mean difference (MD) 1.80, 95% CI -1.32 to 4.92, one trial, 38 women, evidence graded low); frequency of leg cramps after treatment: daily, every other day, and once a week (RR 1.20, 95% CI 0.45 to 3.21, one trial, 69 women; RR 0.44, 95% CI 0.12 to 1.57, one trial, 69 women; RR 1.54, 95% CI 0.62 to 3.87, one trial, 69 women).Evidence about whether magnesium supplements reduced the intensity of pain was inconclusive, with two studies showing that it may slightly reduce pain, while one showed no difference. There were no differences in the experience of side effects (including nausea, flatulence, diarrhoea and intestinal air) between pregnant women receiving magnesium compared with placebo/no treatment. Oral calcium versus no treatmentA greater proportion of women receiving calcium supplements experienced no leg cramps after treatment than those receiving no treatment (frequency of leg cramps after treatment: never RR 8.59, 95% CI 1.19 to 62.07, one study, 43 women, evidence graded very low). There was no difference between groups for a composite outcome (intensity and frequency) for partial improvement (RR 0.64, 95% CI 0.36 to 1.15, one trial, 42 women); however, the same trial showed a greater proportion of women experiencing no leg cramps after treatment with calcium compared with no treatment (RR 5.50, 95% CI 1.38 to 21.86).Other secondary outcomes, including side effects, were not reported. Oral vitamin B versus no treatment Frequency of leg cramps was not reported in the one

  12. Magnets

    International Nuclear Information System (INIS)

    Young, I.R.

    1984-01-01

    A magnet pole piece for an NMR imaging magnet is made of a plurality of magnetic wires with one end of each wire held in a non-magnetic spacer, the other ends of the wires being brought to a pinch, and connected to a magnetic core. The wires may be embedded in a synthetic resin and the magnetisation and uniformity thereof can be varied by adjusting the density of the wires at the spacer which forms the pole piece. (author)

  13. Effect of static magnetic field on pain level and expression of P2X3 receptors in the trigeminal ganglion in mice following experimental tooth movement.

    Science.gov (United States)

    Zhu, Yafen; Wang, Shengguo; Long, Hu; Zhu, Jingyi; Jian, Fan; Ye, Niansong; Lai, Wenli

    2017-01-01

    Recent research has demonstrated that static magnetic fields (SMF) can generate an analgesic effect in different conditions. The present study explored effects of SMF on pain levels and expressions of P2X3 receptors in trigeminal ganglion (TG) in mice after experimental tooth movement (tooth movement induced by springs between teeth). Experiments were performed in male mice (body mass: 25-30 g) and divided into SMF + force group, force group, and no force group. Exposure time was over 22 h per day. Mouse Grimace Scale was used for evaluating orofacial pain levels during experimental tooth movement at 4 h and 1, 3, 7, and 14 days. Meanwhile, expression levels of P2X3 receptors in the TG were evaluated by immunohistochemistry and western blotting at same time points. We finally found that during experimental tooth movement, pain levels of mice peaked at 3 days, and then decreased. While pain levels of mice were reduced in the SMF environment at 4 h, 1 and 3 days, there was a significant difference at 1 and 3 days. Meanwhile, under the action of SMF, expression levels of P2X3 receptors in TG were significantly lower at 4 h, 3 and 7 days. These results suggest that SMF can reduce pain levels in mice, and down-regulate P2X3 receptors in TG. Bioelectromagnetics. 38:22-30, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  14. Using the Quebec Task Force Classification to subgroup low back pain patients in primary care

    DEFF Research Database (Denmark)

    Hartvigsen, Lisbeth; Kongsted, Alice; Hestbæk, Lise

    BackgroundLow back pain (LBP) patients with related leg pain and signs of nerve root involvement (NRI) are considered to have a worse prognosis than patients with LBP alone. However, knowledge is limited about the importance of distinguishing between leg pain above or below the knee and leg pain...... with and without NRI. The objectives of this study were 1) to investigate whether patients in the four QTF categories (LPB alone, LBP + leg pain above knee, LBP + leg pain below knee, and LBP + NRI) differ on baseline characteristics; 2) to investigate the relationship between QTF categories and global perceived......) patients. Compared with patients with LBP alone, patients with leg pain and patients with NRI were more severely affected across baseline characteristics and outcome measures in both CP and GP. QTF categories were associated with activity limitation at all follow-up time-points in both CP and GP (p

  15. Low back pain (non-specific).

    NARCIS (Netherlands)

    Krismer, M.; van Tulder, M.W.

    2007-01-01

    Low back pain (LBP) is defined as pain localised between the 12th rib and the inferior gluteal folds, with or without leg pain. Most cases are non-specific, but in about 10% of cases a specific cause is identified. Red flags are typical signs or symptoms that are frequently associated with specific

  16. Klinefelter Syndrome With Leg Ulcers

    Directory of Open Access Journals (Sweden)

    Narendra G

    1999-01-01

    Full Text Available Leg ulcers are frequently caused by venous insufficiency, arterial insufficiency, neuropathy, or a combination of these factors. Klinefelter syndrome in association with chronic leg ulcers have been reported earlier. We report a case of Klinefelter syndrome with non- healing ulcer. The diagnosis of the Klinefelter syndrome was confirmed by karyotyping.

  17. The Extent of Inappropriate Use of Magnetic Resonance Imaging in Low Back Pain and its Contributory Factors

    Directory of Open Access Journals (Sweden)

    Sanaz Zargar Balaye Jame

    2014-01-01

    Full Text Available Background: Magnetic resonance imaging (MRI is an expensive and commonly used technology with a variety of indications in patient diagnosis and treatments. The aim of this study is to identify a comprehensive list of indications and contraindications for MRI in patients with low back pain (LBP and to determine the appropriateness of using this technology in these patients on the basis of this list. Methods: A cross-sectional study was conducted in four radiographic centers in Tehran, Iran. A list of MRI indications and contraindications for LBP was developed by review of documents and expert panel. A pre structured checklist was designed and incorporated into a structured form. All 100 consecutive patients referring to four radiographic centers for performing MRI regarding LBP completed the questionnaire. Chi-square, Fisher′s Exact Test and logistic Regression were used to assess statistical significance. Results: In this study, 187 patients (46.7% had an indication for MRI, but 186 patients (46.5% had no indication, 18 patients (4.5% had indication and contraindication at the same time and nine patients (2.3% had contraindication. Moreover, 71 patients (17.8% underwent MRI for LBP during the past 2 years, of which 14 (19.7% had normal results. Patients with complementary private insurance had a history of previous MRI about 20% more than other patients (P = 0.018. There was a statistically significant relationship between complementary private insurance coverage and number of MRI performed (P = 0.006. Conclusions: About half of the patients referring to radiographic centers with LBP for MRI had no indication for this test.

  18. Labor-related sacral stress fracture presenting as lower limb radicular pain.

    Science.gov (United States)

    Thein, Ran; Burstein, Gideon; Shabshin, Nogah

    2009-06-01

    In contrast to radicular pain during pregnancy, the incidence of postpartum radicular pain is rare. Sacral stress fractures are unusual but important causes for low-back and buttock pain and even postpartum radicular pain. To date, only 10 postpartum sacral stress fractures have been reported in the literature, with two descriptions of radicular pain as the presenting symptom. A 36-year-old woman, 7 days after her second delivery, presented with symptoms of spontaneous acute claudicating in conjunction with a left-leg radicular pain for 5 days. Imaging studies revealed a left sacral stress fracture. Bone mineral density was normal. The patient reported no pelvic, back, or radicular pain during the pregnancy, and had no history of menstrual irregularities, previous fracture, eating disorder, trauma or endocrine or metabolic diseases. No smoking or use of anticoagulation drugs was reported. Her obstetric and labor history showed no other risk factors. Epidural analgesia was used. Treatment consisted of toe-touch walking with crutches for 2 months, followed by full weight bearing, which resolved nearly all her symptoms. Clinicians should consider sacral fracture as a diagnostic possibility in postpartum and pregnant patients with lower back and/or buttock pain with or without radicular pain. Bone scintigraphy and computed tomography are considered harmful for the fetus. Magnetic resonance imaging, which is more suitable for pregnancy, is more sensitive than bone scintigraphy in revealing stress injuries of the bone. Physical examination and proper radiologic evaluation are the main keys for revealing the pathology.

  19. Complex Regional Pain Syndrome Caused by Lumbar Herniated Intervertebral Disc Disease.

    Science.gov (United States)

    Kim, Se Hee; Choi, Sang Sik; Lee, Mi Kyung; Kin, Jung Eun

    2016-07-01

    Most cases of complex regional pain syndrome (CRPS) occur after some inciting injury. There are a few cases of CRPS after an operation for disc disease. CRPS from a mild herniated intervertebral disc (HIVD) without surgical intervention is even rarer than CRPS after an operation for disc disease.A 22-year-old man was transferred to a pain clinic. He had continuously complained about back and right leg pain. He presented with a skin color change in the right lower leg, intermittent resting tremor, stiffness, and swelling in the right leg. He complained of a pulling sensation and numbness in his right buttock, posterior thigh, lateral calf, and ankle. This symptom was in accordance with L4/5 radiculopathy. Magnetic resonance imaging (MRI) also showed L4/5 HIVD that was central to the bilateral subarticular protrusion.He was diagnosed as having CRPS, which fits the revised International Association for the Study of Pain (IASP) criteria. He fulfilled 4 symptom categories (allodynia, temperature asymmetry and skin color change, sweating changes, decreased range of motion and motor dysfunction) and 3 of 4 sign categories (allodynia, temperature asymmetry and skin color changes, decreased range of motion and motor dysfunction). The bone scan and thermography also revealed CRPS.For the past 2 months, we have performed intensive treatments. But, he never became pain-free and walking for 5 minutes led to persistent leg pain. We decided to perform percutaneous nucleoplasty, which can directly decompress a HIVD. On the next day, he achieved dramatic symptom relief. The visual analog scale (VAS) score improved to 3, compared to the VAS score of 9 at the first visit. The skin color change, allodynia, and tremor in the right leg disappeared, and the temperature asymmetry normalized. Motor weakness of the right leg also recovered.We report an unusual case of CRPS that was caused by L4/5 HIVD without a history of trauma or surgery. It has a clear causal relationship between HIVD

  20. Injury of the right leg long term after thorotrast injection

    International Nuclear Information System (INIS)

    Ito, Yuzo; Taguma, Kiyohiko; Yatsuzuka, Mitsuo

    1978-01-01

    A patient (57-year-old man) had open fracture of the leg due to a bullet wound penetrating the right leg in 1941, and had arteriography from the right popliteal fossa at an army hospital in 1942. He complained of painful swelling ranging from the inward site of the right femur to the popliteal fossa in 1977. As a result of the examination using a scintillation counter, it was diagnosed as an injury of the right leg long term after thorotrast injection. There was no deposition of thorotrast in the liver, the spleen, or the epigastric lymph nodes. Histopathologically, there was no finding of malignancy but granuloma. The findings on the postoperative examination were restored to the normal, but long-time-course observation seemed to be necessary in future considering a possibility of its exacerbation. (Ichikawa, K.)

  1. Corticomotor control of lumbar multifidus muscles is impaired in chronic low back pain: concurrent evidence from ultrasound imaging and double-pulse transcranial magnetic stimulation.

    Science.gov (United States)

    Massé-Alarie, Hugo; Beaulieu, Louis-David; Preuss, Richard; Schneider, Cyril

    2016-04-01

    Chronic low back pain (CLBP) is often associated with impaired control of deep trunk muscles and reorganization of the primary motor areas (M1). Precisely, functional changes of the lumbar multifidus muscles (MF) involved in spine stability may be of special interest in rehabilitation. Therefore, we tested MF corticomotor control using double transcranial magnetic stimulation (TMS) paradigms for the first time in this muscle and examined its link with MF volitional activation. Eleven individuals with lateralized CLBP and 13 pain-free participants were recruited. Ultrasound imaging enabled measurement of MF volitional isometric contraction in prone lying. TMS of MF M1 area was used to test hemispheric excitability and mechanisms in relation to motor programming, i.e., active motor threshold (AMT), amplitude of motor-evoked potentials and short-interval intracortical inhibition (SICI) and facilitation (SICF). In CLBP, SICI level was lower in the left hemisphere and MF volitional contraction was not related to AMT (M1 excitability), conversely to what was observed in the pain-free group. No other between-group difference was detected. These original findings support a plasticity of cortical maps controlling paravertebral muscles and likely including a different motor strategy for the control of MF. Changes of M1 function may thus underlie impaired motor control of lumbopelvic spine and pain persistence in CLBP.

  2. Restless legs syndrome

    Directory of Open Access Journals (Sweden)

    Ovallath S

    2012-10-01

    Full Text Available Sujith Ovallath, P DeepaJames Parkinson's Movement Disorder Research Centre, Kannur Medical College, Kerala, IndiaBackground: Restless legs syndrome (RLS is a common sleep-related disorder characterized by abnormal sensation and an urge to move the lower limbs. Symptoms occur at rest in the evening or at night, and they are alleviated by moving the affected extremity or by walking. Although the exact etiopathogenesis of RLS remains elusive, the rapid improvement of symptoms with dopaminergic agents suggests that dopaminergic system dysfunction may be a basic mechanism. Dopaminergic agents are the best-studied agents, and are considered first-line treatment of RLS.Objective: To review the diagnostic criteria, clinical features, etiopathogenesis, and the treatment options of RLS.Methods: The suggestions are based on evidence from studies published in peer-reviewed journals, or upon a comprehensive review of the medical literature.Results/conclusion: Extensive data are available for proving the link between the dopaminergic system and RLS. A possible genetic link also has been studied extensively. Dopamine agonists, especially pramipexole and ropinirole, are particularly useful in the treatment of RLS. Pharmacological treatment should however be limited to those patients who suffer from clinically relevant RLS with impaired sleep quality or quality of life.Keywords: dopamine, levodopa, pramipexole

  3. Restless legs syndrome: literature review

    Directory of Open Access Journals (Sweden)

    Emmanouil Symvoulakis

    Full Text Available Restless legs syndrome is a distressing condition, with negative effects on sleep and daytime activities that affect personal, family and occupational life. The overall impact of restless legs syndrome on quality of life is comparable to that of chronic and frustrating conditions such as depression and diabetes. Misdiagnosis and inappropriate treatment may increase patients' suffering in terms of uncertainty, overuse or misuse of care services and lack of trust. Presenting a synthesis of the main topics in the literature on restless legs syndrome facilitates for a better understanding and its management in primary care settings.

  4. Magnetic resonance guided focused ultrasound surgery (MRgFUS) of bone metastases: From primary pain palliation to local tumor control

    Science.gov (United States)

    Napoli, A.; Leonardi, A.; Andrani, F.; Boni, F.; Anzidei, M.; Catalano, C.

    2017-03-01

    Purpose: To evaluate the clinical performance of MRgFUS in primary pain palliation of painful bone metastases and in local tumor control. Materials and Methods: We enrolled 26 consecutive patients (female/male 12/14; age: 64.7±7.5yrs) with painful bone metastases. Before and 3 months after MRgFUS treatment pain severity and pain interference scores were assessed according to Brief Pain Inventory-Quality of Life (BPI-QoL) criteria and patients underwent both CT and MRI. Local tumor control was evaluated according to lesion size, density and perfusion at CT, dynamic contrast enhancement at MRI (Discovery 750HD, GE; Gd-Bopta, Bracco) and metabolic activity at PET or scintigraphy. Patients were classified as responders or non-responders. Results: No treatment-related adverse events were recorded during the study. As statistically significant difference between baseline and follow-up values for both pain severity and pain interference scores was observed (pbone density was observed in 9/26 (34.6%) patients. Non-Perfused Volume values ranged between 20% and 92%. There was no difference in NPV values between responders and non-responders (46.7±24.2% [25 - 90 %] vs. 45±24.9% [20 - 93 %]; p=0.7). In 6 patients (5 prostate and 1 breast primary cancer) there was nearly absence of metabolic activity after treatment (mean SUV=1.2). Conclusion: MRgFUS can be safely and effectively used as the primary treatment for pain palliation in patients with painful bone metastases; moreover our experience demonstrated also a potential role for the MRgFUS in local tumor control.

  5. Measurement of body fat using leg to leg bioimpedance

    OpenAIRE

    Sung, R; Lau, P; Yu, C; Lam, P; Nelson, E

    2001-01-01

    AIMS—(1) To validate a leg to leg bioimpedance analysis (BIA) device in the measurement of body composition in children by assessment of its agreement with dual energy x ray absorptiometry (DXA) and its repeatability. (2) To establish a reference range of percentage body fat in Hong Kong Chinese children.
METHODS—Sequential BIA and DXA methods were used to determine body composition in 49 children aged 7-18 years; agreement between the two methods was calculated. Repea...

  6. Compartment syndrome without pain!

    LENUS (Irish Health Repository)

    O'Sullivan, M J

    2012-02-03

    We report the case of a young male patient who underwent intra-medullary nailing for a closed, displaced mid-shaft fracture of tibia and fibula. He was commenced on patient controlled analgesia post-operatively. A diagnosis of compartment syndrome in the patient\\'s leg was delayed because he did not exhibit a pain response. This ultimately resulted in a below-knee amputation of the patient\\'s leg. We caution against the use of patient controlled analgesia in any traumatised limb distal to the hip or the shoulder.

  7. Leg 201Tl-SPECT in chronic exertional compartment syndrome

    International Nuclear Information System (INIS)

    Elkadri, N.; Slim, I.; Blondet, C.; Choquet, Ph.; Constantinesco, A.; Lecocq, J.

    2004-01-01

    Leg 201 Tl-SPECT in chronic exertional compartment syndrome Background: The chronic exertional compartment syndrome is one of the most frequent origins regarding leg pain due to sport training. The diagnosis can be established by invasive compartment pressure measurement. The aim of this study is to evaluate the role that could have 201 Tl-SPECT for patients with suspicion of compartment syndrome. Patients and methods: 51 leg 201 Tl-SPECT exams were performed (exercise - and rest without reinjection) in 49 patients; 28 had compartment syndrome confirmed by pressure measurement. About 100 MBq of 201 Tl were injected during exercise, when pain appeared or at least after 25 minutes exercise. We studied mean percentages of level uptake for each compartment, referred to the maximal uptake of both legs. Results: 47 compartments were concerned by compartment syndrome and 361 compartments were not. Scintigraphic patterns in compartments are reversible ischaemia (45%), uptake stability (36%) or reverse redistribution (19%); these patterns are not linked to compartment syndrome. However, there is a significant difference of rest 201 Tl level uptake between compartments with and without compartment syndrome and a significant correlation between muscular pressure measurement and rest level uptake. Conclusion: 201 Tl-SPECT shows that only ischaemia does not explain compartment syndrome. Moreover, it allows to predict pressure variation during exercise but it does not offer any interest in order to select patients for muscular invasive pressure measurement. (author)

  8. Lumbar Gout Tophus Mimicking Epidural Abscess with Magnetic Resonance Imaging, Bone, and Gallium Scans.

    Science.gov (United States)

    Vicente, Justo Serrano; Gómez, Alejandro Lorente; Moreno, Rafael Lorente; Torre, Jose Rafael Infante; Bernardo, Lucía García; Madrid, Juan Ignacio Rayo

    2018-01-01

    Gout is a common metabolic disorder, typically diagnosed in peripheral joints. Tophaceous deposits in lumbar spine are a very rare condition with very few cases reported in literature. The following is a case report of a 52-year-old patient with low back pain, left leg pain, and numbness. Serum uric acid level was in normal range. magnetic resonance imaging, bone scan, and gallium-67 images suggested an inflammatory-infectious process focus at L4. After a decompressive laminectomy at L4-L5 level, histological examination showed a chalky material with extensive deposition of amorphous gouty material surrounded by macrophages and foreign-body giant cells (tophaceous deposits).

  9. Dynamic oscillatory signatures of central neuropathic pain in spinal cord injury.

    Science.gov (United States)

    Vuckovic, Aleksandra; Hasan, Muhammad A; Fraser, Matthew; Conway, Bernard A; Nasseroleslami, Bahman; Allan, David B

    2014-06-01

    Central neuropathic pain (CNP) is believed to be accompanied by increased activation of the sensorimotor cortex. Our knowledge of this interaction is based mainly on functional magnetic resonance imaging studies, but there is little direct evidence on how these changes manifest in terms of dynamic neuronal activity. This study reports on the presence of transient electroencephalography (EEG)-based measures of brain activity during motor imagery in spinal cord-injured patients with CNP. We analyzed dynamic EEG responses during imaginary movements of arms and legs in 3 groups of 10 volunteers each, comprising able-bodied people, paraplegic patients with CNP (lower abdomen and legs), and paraplegic patients without CNP. Paraplegic patients with CNP had increased event-related desynchronization in the theta, alpha, and beta bands (16-24 Hz) during imagination of movement of both nonpainful (arms) and painful limbs (legs). Compared to patients with CNP, paraplegics with no pain showed a much reduced power in relaxed state and reduced event-related desynchronization during imagination of movement. Understanding these complex dynamic, frequency-specific activations in CNP in the absence of nociceptive stimuli could inform the design of interventional therapies for patients with CNP and possibly further understanding of the mechanisms involved. This study compares the EEG activity of spinal cord-injured patients with CNP to that of spinal cord-injured patients with no pain and also to that of able-bodied people. The study shows that the presence of CNP itself leads to frequency-specific EEG signatures that could be used to monitor CNP and inform neuromodulatory treatments of this type of pain. Copyright © 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.

  10. Association Between Inflammatory Back Pain Characteristics and Magnetic Resonance Imaging Findings in the Spine and Sacroiliac Joints

    DEFF Research Database (Denmark)

    Arnbak, Bodil; Jurik, Anne G; Jensen, Tue S

    2018-01-01

    and the median age was 33 years. Positive associations were found between the SIJ MRI findings and pain characteristics, odds ratios ranging from 1.4-2.7; 'SIJ bone marrow edema (BME)' was associated with 'morning stiffness >60 minutes', 'SIJ erosions' with the Calin, Berlin, and Bailly IBP definitions......, 'alternating buttock pain' and 'good response to NSAID'; 'SIJ fatty marrow deposition (FMD)' with 'insidious onset'; and 'SIJ sclerosis' with 'pain at night'. Also, the spinal MRI changes were associated with IBP, odds ratios ranging from 1.4-2.0; 'vertebral endplate BME' with, 'morning stiffness...

  11. Leg ulcers in sickle cell patients: management challenges

    OpenAIRE

    El Khatib,Arij; Hayek,Shady

    2016-01-01

    Arij M El Khatib,1 Shady N Hayek2 1Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center (AUBMC), 2Private Practice, Cosmetic Surgery Center, Beirut, Lebanon Abstract: Sickle cell disease is an autosomal recessive hemoglobinopathy caused by an amino acid substitution from glutamic acid to valine in the beta hemoglobin chain. One of the common symptoms occurring in sickle cell patients are leg ulcers, which are notoriously painful, ...

  12. Case-control study of low-back pain referred for magnetic resonance imaging, with special focus on whole-body vibration.

    Science.gov (United States)

    Palmer, Keith T; Harris, Clare E; Harris, E Claire; Griffin, Michael J; Bennett, James; Reading, Isabel; Sampson, Madelaine; Coggon, David

    2008-10-01

    This study investigated risk factors for low-back pain among patients referred for magnetic resonance imaging (MRI), with special focus on whole-body vibration. A case-control approach was used. The study population comprised working-aged persons from a catchment area for radiology services. The cases were those in a consecutive series referred for a lumbar MRI because of low-back pain. The controls were age- and gender-matched persons X-rayed for other reasons. Altogether, 252 cases and 820 controls were studied, including 185 professional drivers. The participants were questioned about physical factors loading the spine, psychosocial factors, driving, personal characteristics, mental health, and certain beliefs about low-back pain. Exposure to whole-body vibration was assessed by six measures, including weekly duration of professional driving, hours driven in one period, and current root mean square A(8). Associations with whole-body vibration were examined with adjustment for age, gender, and other potential confounders. Strong associations were found with poor mental health and belief in work as a causal factor for low-back pain, and with occupational sitting for > or =3 hours while not driving. Associations were also found for taller stature, consulting propensity, body mass index, smoking history, fear-avoidance beliefs, frequent twisting, low decision latitude, and low support at work. However, the associations with the six metrics of whole-body vibration were weak and not statistically significant, and no exposure-response relationships were found. Little evidence of a risk from professional driving or whole-body vibration was found. Drivers were substantially less heavily exposed to whole-body vibration than in some earlier surveys. Nonetheless, it seems that, at the population level, whole-body vibration is not an important cause of low-back pain among those referred for MRI.

  13. Magnetic resonance imaging zygapophyseal joint space changes (gapping) in low back pain patients following spinal manipulation and side-posture positioning: a randomized controlled mechanisms trial with blinding.

    Science.gov (United States)

    Cramer, Gregory D; Cambron, Jerrilyn; Cantu, Joe A; Dexheimer, Jennifer M; Pocius, Judith D; Gregerson, Douglas; Fergus, Michael; McKinnis, Ray; Grieve, Thomas J

    2013-05-01

    The purpose of this study was to quantify lumbar zygapophyseal (Z) joint space separation (gapping) in low back pain (LBP) subjects after spinal manipulative therapy (SMT) or side-posture positioning (SPP). This was a controlled mechanisms trial with randomization and blinding. Acute LBP subjects (N = 112; four n = 28 magnetic resonance imaging [MRI] protocol groups) had 2 MRI appointments (initial enrollment and after 2 weeks of chiropractic treatment, receiving 2 MRI scans of the L4/L5 and L5/S1 Z joints at each MRI appointment. After the first MRI scan of each appointment, subjects were randomized (initial enrollment appointment) or assigned (after 2 weeks of chiropractic treatment appointment) into SPP (nonmanipulation), SMT (manipulation), or control MRI protocol groups. After SPP or SMT, a second MRI was taken. The central anterior-posterior joint space was measured. Difference between most painful side anterior-posterior measurements taken postintervention and preintervention was the Z joint "gapping difference." Gapping differences were compared (analysis of variance) among protocol groups. Secondary measures of pain (visual analog scale, verbal numeric pain rating scale) and function (Bournemouth questionnaire) were assessed. Gapping differences were significant at the first (adjusted, P = .009; SPP, 0.66 ± 0.48 mm; SMT, 0.23 ± 0.86; control, 0.18 ± 0.71) and second (adjusted, P = .0005; SPP, 0.65 ± 0.92 mm; SMT, 0.89 ± 0.71; control, 0.35 ± 0.32) MRI appointments. Verbal numeric pain rating scale differences were significant at first MRI appointment (P = .04) with SMT showing the greatest improvement. Visual analog scale and Bournemouth questionnaire improved after 2 weeks of care in all groups (both P posture positioning showed greatest gapping at baseline. After 2 weeks, SMT resulted in greatest gapping. Side-posture positioning appeared to have additive therapeutic benefit to SMT. Copyright © 2013 National University of Health Sciences

  14. MAGNET

    CERN Multimedia

    by B. Curé

    2011-01-01

    The magnet operation was very satisfactory till the technical stop at the end of the year 2010. The field was ramped down on 5th December 2010, following the successful regeneration test of the turbine filters at full field on 3rd December 2010. This will limit in the future the quantity of magnet cycles, as it is no longer necessary to ramp down the magnet for this type of intervention. This is made possible by the use of the spare liquid Helium volume to cool the magnet while turbines 1 and 2 are stopped, leaving only the third turbine in operation. This obviously requires full availability of the operators to supervise the operation, as it is not automated. The cryogenics was stopped on 6th December 2010 and the magnet was left without cooling until 18th January 2011, when the cryoplant operation resumed. The magnet temperature reached 93 K. The maintenance of the vacuum pumping was done immediately after the magnet stop, when the magnet was still at very low temperature. Only the vacuum pumping of the ma...

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

    DEFF Research Database (Denmark)

    Riis, Robert Gabriel Coumine; Gudbergsen, Henrik; Henriksen, Marius

    2016-01-01

    OBJECTIVES: To investigate the association between pain and peripatellar-synovitis on static and dynamic contrast-enhanced MRI in knee osteoarthritis. METHODS: In a cross-sectional setting, knee synovitis was assessed using 3-Tesla MRI and correlated with pain using the knee injury and osteoarthr...... in KOA. Overall, DCE-MRI showed stronger correlations with KOOS-Pain compared to static MRI. DCE-MRI analyses were highly reproducible and have the potential to be used to further investigate the role of inflammation and perfusion in KOA.......OBJECTIVES: To investigate the association between pain and peripatellar-synovitis on static and dynamic contrast-enhanced MRI in knee osteoarthritis. METHODS: In a cross-sectional setting, knee synovitis was assessed using 3-Tesla MRI and correlated with pain using the knee injury...... in the analyses. RESULTS: Valid data were available in 94 persons with a mean age of 65 years, a BMI of 32.3kg/m(2) and a mean Kellgren-Lawrence grade of 2.5. IRExNvoxel showed a statically significant correlation with KOOS-Pain (r=-0.34; p=0.001), as was the case with all DCE-variables but one. Correlations...

  16. Self-reported pain and disability outcomes from an endogenous model of muscular back pain

    Directory of Open Access Journals (Sweden)

    George Steven Z

    2011-02-01

    Full Text Available Abstract Background Our purpose was to develop an induced musculoskeletal pain model of acute low back pain and examine the relationship among pain, disability and fear in this model. Methods Delayed onset muscle soreness was induced in 52 healthy volunteers (23 women, 17 men; average age 22.4 years; average BMI 24.3 using fatiguing trunk extension exercise. Measures of pain intensity, unpleasantness, and location, and disability, were tracked for one week after exercise. Results Pain intensity ranged from 0 to 68 with 57.5% of participants reporting peak pain at 24 hours and 32.5% reporting this at 48 hours. The majority of participants reported pain in the low back with 33% also reporting pain in the legs. The ratio of unpleasantness to intensity indicated that the sensation was considered more unpleasant than intense. Statistical differences were noted in levels of reported disability between participants with and without leg pain. Pain intensity at 24 hours was correlated with pain unpleasantness, pain area and disability. Also, fear of pain was associated with pain intensity and unpleasantness. Disability was predicted by sex, presence of leg pain, and pain intensity; however, the largest amount of variance was explained by pain intensity (27% of a total 40%. The second model, predicting pain intensity only included fear of pain and explained less than 10% of the variance in pain intensity. Conclusions Our results demonstrate a significant association between pain and disability in this model in young adults. However, the model is most applicable to patients with lower levels of pain and disability. Future work should include older adults to improve the external validity of this model.

  17. 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

  18. Restless legs syndrome and periodic leg movements of sleep.

    Science.gov (United States)

    Rye, David B; Trotti, Lynn Marie

    2012-11-01

    Women are more commonly affected than men by restless legs syndrome, and prevalence is highest amongst those of northern European heritage. The motor manifestations include nonvolitional myoclonus (periodic leg movements). Disinhibition of spinal sensorimotor circuits may underlie these primary features and can be affected by peripheral as well as supraspinal networks. Insufficient mobilizable iron stores increase expressivity in some individuals. The sensorimotor features are relieved by dopamine, especially dopamine agonists, gabapentin and its derivatives, and opioids. A diagnosis relies on recognition of key primary and supportive features, and treatments are generally well tolerated, efficacious, and life-changing. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Association between restless leg syndrom and slow coronary flow.

    Science.gov (United States)

    Erden, İsmail; Çakcak Erden, Emine; Durmuş, Hacer; Tıbıllı, Hakan; Tabakçı, Mustafa; Kalkan, Mehmet Emin; Türker, Yasin; Akçakoyun, Mustafa

    2014-11-01

    Restless legs syndrome (RLS) is a common sleep disorder in which patients feel unpleasent leg sensations and urge to move the legs during rest, especially at night, and symptoms are improved by leg movement. Prior studies analyzing the associations between cardiovascular disease and restless legs syndrome has shown controversial results. The goal of the study was to estimate the relationship between restless legs syndrome and slow coronary flow (SCF). The present study was cross-sectional and observational and consists of 176 individuals who underwent coronary angiography and had angiographically normal coronary arteries of varying coronary flow rates. The study included 86 patients with isolated SCF and 90 control participants with normal coronary flow (NCF). RLS was assessed the day after the coronry flow was evaluated, using a self-administered questionnaire based on the International Restless Legs Study Group criteria. The following question was asked: "Do you have unpleasant leg sensations (like crawling, paraesthesia, or pain) combined with motor restlessness and an urge to move?" The possible responses were as follows: no, less than once/month, 2-4 times/month, 5-14 times/month, and 15 or more times per month. Those who answered that they had these feelings were asked the following two more questions: 1) "Do these symptoms occur only at rest and does moving improve them?" and 2) "Are these symptoms worsen in the evening/at night compared with the morning?" RLS is considered to be probable if the participant has answered "yes" for all three of the above questions, and has a frequency of ≥5 times/month. Student's t-test, Mann-Whitney U test, multiple logistic regression analysis were used for statistical analysis. The prevalence of restless legs syndrome was 48 (27%) and increased significantly with age. Patients with SCF have more likely had RLS than the control group (p<0.001). The age-adjusted prevalence odds of SCF were 3.11 times higher (95% CI: 1

  20. Combined use of an ibuprofen-releasing foam dressing and silver dressing on infected leg ulcers

    DEFF Research Database (Denmark)

    Jorgensen, B.; Gottrup, F.; Karlsmark, T.

    2008-01-01

    OBJECTIVE: To investigate the effect and safety of an ibuprofen-releasing foam (Biatain-Ibu, Coloplast A/S) combined with an ionised silver-releasing wound contact layer (Physiotulle Ag, Coloplast A/S) on painful, infected venous leg ulcers. METHOD: This open non-comparative study involved 24...... decreased from 37% to 4%. No serious adverse events were reported. CONCLUSION: The combined use of the ibuprofen-releasing foam dressing and silver-releasing contact layer reduced wound pain and promoted healing without compromising safety Udgivelsesdato: 2008/5...... patients with painful, exuding, locally infected, and stalled venous leg ulcers. Persistent pain and pain at dressing change were monitored using a 11-point numerical box scale (NBS). The composition of the wound bed, the dressing combination's ability to absorb exudate and minimise leakage, ibuprofen...

  1. MAGNET

    CERN Multimedia

    B. Curé

    2012-01-01

      Following the unexpected magnet stops last August due to sequences of unfortunate events on the services and cryogenics [see CMS internal report], a few more events and initiatives again disrupted the magnet operation. All the magnet parameters stayed at their nominal values during this period without any fault or alarm on the magnet control and safety systems. The magnet was stopped for the September technical stop to allow interventions in the experimental cavern on the detector services. On 1 October, to prepare the transfer of the liquid nitrogen tank on its new location, several control cables had to be removed. One cable was cut mistakenly, causing a digital input card to switch off, resulting in a cold-box (CB) stop. This tank is used for the pre-cooling of the magnet from room temperature down to 80 K, and for this reason it is controlled through the cryogenics control system. Since the connection of the CB was only allowed for a field below 2 T to avoid the risk of triggering a fast d...

  2. MAGNET

    CERN Multimedia

    B. Curé

    2012-01-01

      The magnet was energised at the beginning of March 2012 at a low current to check all the MSS safety chains. Then the magnet was ramped up to 3.8 T on 6 March 2012. Unfortunately two days later an unintentional switch OFF of the power converter caused a slow dump. This was due to a misunderstanding of the CCC (CERN Control Centre) concerning the procedure to apply for the CMS converter control according to the beam-mode status at that time. Following this event, the third one since 2009, a discussion was initiated to define possible improvement, not only on software and procedures in the CCC, but also to evaluate the possibility to upgrade the CMS hardware to prevent such discharge from occurring because of incorrect procedure implementations. The magnet operation itself was smooth, and no power cuts took place. As a result, the number of magnetic cycles was reduced to the minimum, with only two full magnetic cycles from 0 T to 3.8 T. Nevertheless the magnet suffered four stops of the cryogeni...

  3. MAGNET

    CERN Multimedia

    Benoit Curé

    2010-01-01

    Operation of the magnet has gone quite smoothly during the first half of this year. The magnet has been at 4.5K for the full period since January. There was an unplanned short stop due to the CERN-wide power outage on May 28th, which caused a slow dump of the magnet. Since this occurred just before a planned technical stop of the LHC, during which access in the experimental cavern was authorized, it was decided to leave the magnet OFF until 2nd June, when magnet was ramped up again to 3.8T. The magnet system experienced a fault also resulting in a slow dump on April 14th. This was triggered by a thermostat on a filter choke in the 20kA DC power converter. The threshold of this thermostat is 65°C. However, no variation in the water-cooling flow rate or temperature was observed. Vibration may have been the root cause of the fault. All the thermostats have been checked, together with the cables, connectors and the read out card. The tightening of the inductance fixations has also been checked. More tem...

  4. Use of magnetic resonance imaging to identify outcome predictors of caudal epidural steroid injections for lower lumbar radicular pain caused by a herniated disc.

    Science.gov (United States)

    Cha, Sung Oh; Jang, Chul Hoon; Hong, Jin Oh; Park, Joon Sang; Park, Jung Hyun

    2014-12-01

    We used lumbar magnetic resonance image (MRI) findings to determine possible outcome predictors of a caudal epidural steroid injection (CESI) for radicular pain caused by a herniated lumbar disc (HLD). Ninety-one patients with radicular pain whose MRI indicated a HLD were enrolled between September 2010 and July 2013. The CESIs were performed using ultrasound (US). A responder was defined as having complete relief or at least a 50% reduction of pain as assessed by the visual analog scale (VAS) and functional status on the Roland Morris Disability Questionnaire (RMDQ); responder (VAS n=61, RMDQ n=51), and non-responder (VAS n=30, RMDQ n=40). MRI findings were analyzed and compared between the two groups with regard to HLD level, HLD type (protrusion or exclusion), HLD zone (central, subarticular, foraminal, and extraforaminal), HLD volume (mild, moderate, or severe), relationship between HLD and nerve root (no contact, contact, displaced, or compressed), disc height loss (none, less than half, or more than half ), and disc degeneration grade (homogeneous disc structure or inhomogeneous disc structure-clear nucleus and height of intervertebral disc). A centrally located herniated disc was more common in the responder group than that in the non-responder group. Treatment of centrally located herniated discs showed satisfactory results. (VAS p=0.025, RMDQ p=0.040). Other factors, such as HLD level, HLD type, HLD volume, relationship to nerve root, disc height loss, and disc degeneration grade, were not critical. The HLD zone was significant for pain reduction after CESI. A centrally located herniated disc was a predictor of a good clinical outcome.

  5. Magnetic Resonance Imaging Zygapophyseal Joint Space Changes (Gapping) in Low Back Pain Patients following Spinal Manipulation and Side Posture Positioning: A Randomized Controlled Mechanisms Trial with Blinding

    Science.gov (United States)

    Cramer, Gregory D.; Cambron, Jerrilyn; Cantu, Joe A; Dexheimer, Jennifer M.; Pocius, Judith D; Gregerson, Douglas; Fergus, Michael; McKinnis, Ray; Grieve, Thomas J

    2013-01-01

    Objective The purpose of this study was to quantify lumbar zygapophyseal (Z) joint space separation (gapping) in low back pain (LBP) subjects after spinal manipulative therapy (SMT) or side-posture positioning (SPP). Methods This was a controlled mechanisms trial with randomization and blinding. Acute LBP subjects (N=112, four n=28 MRI protocol groups) had 2 magnetic resonance imaging (MRI) appointments (initial enrollment [M1] and following 2 weeks of chiropractic treatment [M2]; receiving 2 MRI scans of the L4/L5 and L5/S1 Z joints at each MRI appointment. After the first MRI scan of each appointment, subjects were randomized (M1 appointment) or assigned (M2 appointment) into SPP (non-manipulation), SMT (manipulation), or control MRI protocol groups. After SPP or SMT, a second MRI was taken. The central anterior-posterior (A-P) joint space was measured. Difference between most painful side A-P measurements taken post- and pre-intervention was the Z joint “gapping difference.” Gapping differences were compared (ANOVA) among protocol groups. Secondary measures of pain visual analog scale (VAS), verbal numeric pain rating scale (VNPRS), and function Bournemouth questionnaire (BQ) were assessed. Results Gapping differences were significant at the first (adjusted, p=0.01; SPP=0.66 +0.48mm; SMT=0.23 +0.86; control=0.18 +0.71) and second (adjusted, p=0.0005; SPP=0.65 +0.92mm, SMT=0.89 +0.71; control=0.35 +0.32) MRI appointments. VNPRS differences were significant at first MRI appointment (p=0.04) with SMT showing the greatest improvement. VAS and BQ improved after two weeks of care in all groups (both p<0.0001). Conclusions SPP showed greatest gapping at baseline. After two weeks, SMT resulted in greatest gapping. SPP appeared to have additive therapeutic benefit to SMT. PMID:23648055

  6. Lower Leg Anterior and Lateral Intracompartmental Pressure Changes Before and After Classic Versus Skate Nordic Rollerskiing.

    Science.gov (United States)

    Woods, Katherine M; Petron, David J; Shultz, Barry B; Hicks-Little, Charlie A

    2015-08-01

    Chronic exertional compartment syndrome (CECS) is a debilitating condition resulting in loss of function and a decrease in athletic performance. Cases of CECS are increasing among Nordic skiers; therefore, analysis of intracompartmental pressures (ICPs) before and after Nordic skiing is warranted. To determine if lower leg anterior and lateral ICPs and subjective lower leg pain levels increased after a 20-minute Nordic rollerskiing time trial and to examine if differences existed between postexercise ICPs for the 2 Nordic rollerskiing techniques, classic and skate. Crossover study. Outdoor paved loop. Seven healthy Division I Nordic skiers (3 men, 4 women; age = 22.71 ± 1.38 y, height = 175.36 ± 6.33 cm, mass = 70.71 ± 6.58 kg). Participants completed two 20-minute rollerskiing time trials using the classic and skate technique in random order. The time trials were completed 7 days apart. Anterior and lateral ICPs and lower leg pain scores were obtained at baseline and at minutes 1 and 5 after rollerskiing. Anterior and lateral ICPs (mm Hg) were measured using a Stryker Quic STIC handheld monitor. Subjective measures of lower leg pain were recorded using the 11-point Numeric Rating Scale. Increases in both anterior (P = .000) and lateral compartment (P = .002) ICPs were observed, regardless of rollerskiing technique used. Subjective lower leg pain increased after the classic technique for the men from baseline to 1 minute postexercise and after the skate technique for the women. Significant 3-way interactions (technique × time × sex) were observed for the anterior (P = .002) and lateral (P = .009) compartment ICPs and lower leg pain (P = .005). Postexercise anterior and lateral ICPs increased compared with preexercise ICPs after both classic and skate rollerskiing techniques. Lower leg pain is a primary symptom of CECS. The subjective lower leg pain 11-point Numeric Rating Scale results indicate that increases in lower leg ICPs sustained during Nordic

  7. Determination of the painful level in osteoporotic vertebral fractures--Retrospective comparison between plain film, bone scan, and magnetic resonance imaging.

    Science.gov (United States)

    Lin, Hsi-Hsien; Chou, Po-Hsin; Wang, Shih-Tien; Yu, Jung-Kuang; Chang, Ming-Chau; Liu, Chien-Lin

    2015-12-01

    Determining the actual painful vertebral level is difficult when evaluating osteoporotic vertebral fracture, especially when there are acute and chronic fractures simultaneously. In this study, we retrospectively evaluated and compared the findings between plain film, bone scan, and magnetic resonance imaging (MRI) in the diagnosis of new fracture in osteoporotic vertebral fractures. This is a retrospective clinical study of patients who were diagnosed with osteoporotic vertebral fractures using plain film, bone scan, and MRI within a 1-month interval between February 2008 and December 2012. The findings in plain film, the extent of increased uptake in bone scan, and signal change in MRI were compared to evaluate the actual level of pain. All patients received percutaneous vertebroplasty according to MR finding. Pain scores (visual analog scale) of the study patients were compared prior to and after the procedure. A total of 52 patients with a mean age of 79.1 years (range 59-92 years) were enrolled in this study, and were treated by vertebroplasty confirmed by MRI. It was observed that patient pain score (visual analog scale) improved from 7.6 to 2.8. Plain film examination revealed 79 vertebrae that were suspected to be compression fractures. Among the suspected vertebrae, 62 showed increased uptake in bone scan, and MRI showed bony edema change in 58 vertebrae. The consistency between bone scan and MRI was 96.9% in patients with single-level suspected fracture on plain film. There was moderate agreement (kappa was 0.56) in patients where multiple levels were noted. Fifteen vertebrae with vacuum cleft sign on plain film showed total concordance in both bone scan and MRI. For patients with single-level compression fracture, the painful level in osteoporotic vertebral fractures can be determined by plain film and bone scan testing. Vacuum cleft sign noted on plain film may be enough to localize the level of pain. However, MRI testing is further needed in multiple

  8. Nuclear magnetic resonance therapy in lumbar disc herniation with lumbar radicular syndrome: effects of the intervention on pain intensity, health-related quality of life, disease-related disability, consumption of pain medication, duration of sick leave and MRI analysis.

    Science.gov (United States)

    Salfinger, H; Salomonowitz, G; Friedrich, K M; Hahne, J; Holzapfel, J; Friedrich, M

    2015-06-01

    The objective was to assess the effects of therapeutic nuclear magnetic resonance (tNMR) as a conservative treatment for lumbar radicular syndrome (LRS) in patients with lumbar disc herniation. The prospective, randomised, double-blind, placebo-controlled trial included 94 patients, aged 20-60 years (44.79 ± 8.83), with LRS caused by lumbar disc herniation confirmed by MRI scans and with clinical signs of a radicular lesion without indication for surgical intervention. Treatment group (TG) and control group (CG) received standard non-surgical therapy. Additionally, the TG had seven sessions with the tNMR device with a magnetic flux density of 2.3 mT and a frequency of 85 kHz; the CG received 7 sham treatments. Outcome parameters were the treatment effect on pain intensity (Visual Analogue Scale-VAS), health-related quality of life (36-item Short Form Health Survey-SF-36), disease-related disability (Roland Morris Disability Questionnaire-RMDQ), pain medication intake, duration of sick leave and morphological changes assessed by MRI scan analysis. VAS scores improved significantly in both groups (p Patients in the TG recorded significantly fewer days of sick leave in month 3 after treatment (p = 0.026). MRI scan summary scores improved significantly in both groups (L4/5 p treatment of lumbar disc herniation with LRS. The application of tNMR did not meet MCID criteria. It rendered few statistically significant differences between patient groups. The overall results of this trial make a clinical implementation of tNMR in the treatment of lumbar disc herniation with LRS appear premature. Further research is needed to better understand the mode of action of tNMR on compressed neural tissue and to elucidate the issue of the cost/benefit ratio.

  9. Promethus Hot Leg Piping Concept

    International Nuclear Information System (INIS)

    AM Girbik; PA Dilorenzo

    2006-01-01

    The Naval Reactors Prime Contractor Team (NRPCT) recommended the development of a gas cooled reactor directly coupled to a Brayton energy conversion system as the Space Nuclear Power Plant (SNPP) for NASA's Project Prometheus. The section of piping between the reactor outlet and turbine inlet, designated as the hot leg piping, required unique design features to allow the use of a nickel superalloy rather than a refractory metal as the pressure boundary. The NRPCT evaluated a variety of hot leg piping concepts for performance relative to SNPP system parameters, manufacturability, material considerations, and comparison to past high temperature gas reactor (HTGR) practice. Manufacturability challenges and the impact of pressure drop and turbine entrance temperature reduction on cycle efficiency were discriminators between the piping concepts. This paper summarizes the NRPCT hot leg piping evaluation, presents the concept recommended, and summarizes developmental issues for the recommended concept

  10. Leg ulcers due to hyperhomocysteinemia

    Directory of Open Access Journals (Sweden)

    Krupa Shankar D

    2006-01-01

    Full Text Available Chronic leg ulcers are rare in young adults and generally indicate a vascular cause. We report a case of a 26-year-old man with leg ulcers of eight months duration. Doppler study indicated venous incompetence and a postphlebitic limb. However, as the distribution and number of ulcers was not consistent with stasis alone and no features of collagen vascular disease were noted, a hyperviscosity state was considered and confirmed with significantly elevated homocysteine level in the serum. Administration of vitamins B1, B2, B6 and B12, trimethyl-glycine, mecobalamine, folic acid and povidone iodine dressings with culture-directed antibiotic therapy led to a satisfactory healing of ulcers over a period of one month. Hyperhomocysteinemia must be considered in the differential diagnosis of leg ulcers in young individuals.

  11. MAGNET

    CERN Multimedia

    B. Curé

    2013-01-01

      The magnet was operated without any problem until the end of the LHC run in February 2013, apart from a CERN-wide power glitch on 10 January 2013 that affected the CMS refrigerator, causing a ramp down to 2 T in order to reconnect the coldbox. Another CERN-wide power glitch on 15 January 2013 didn’t affect the magnet subsystems, the cryoplant or the power converter. At the end of the magnet run, the reconnection of the coldbox at 2.5 T was tested. The process will be updated, in particular the parameters of some PID valve controllers. The helium flow of the current leads was reduced but only for a few seconds. The exercise will be repeated with the revised parameters to validate the automatic reconnection process of the coldbox. During LS1, the water-cooling services will be reduced and many interventions are planned on the electrical services. Therefore, the magnet cryogenics and subsystems will be stopped for several months, and the magnet cannot be kept cold. In order to avoid unc...

  12. MAGNET

    CERN Multimedia

    Benoit Curé

    2010-01-01

    The magnet was successfully operated at the end of the year 2009 despite some technical problems on the cryogenics. The magnet was ramped up to 3.8 T at the end of November until December 16th when the shutdown started. The magnet operation met a few unexpected stops. The field was reduced to 3.5 T for about 5 hours on December 3rd due to a faulty pressure sensor on the helium compressor. The following day the CERN CCC stopped unintentionally the power converters of the LHC and the experiments, triggering a ramp down that was stopped at 2.7 T. The magnet was back at 3.8 T about 6 hours after CCC sent the CERN-wide command. Three days later, a slow dump was triggered due to a stop of the pump feeding the power converter water-cooling circuit, during an intervention on the water-cooling plant done after several disturbances on the electrical distribution network. The magnet was back at 3.8 T in the evening the same day. On December 10th a break occurred in one turbine of the cold box producing the liquid ...

  13. MAGNET

    CERN Multimedia

    B. Curé

    2011-01-01

    The CMS magnet has been running steadily and smoothly since the summer, with no detected flaw. The magnet instrumentation is entirely operational and all the parameters are at their nominal values. Three power cuts on the electrical network affected the magnet run in the past five months, with no impact on the data-taking as the accelerator was also affected at the same time. On 22nd June, a thunderstorm caused a power glitch on the service electrical network. The primary water cooling at Point 5 was stopped. Despite a quick restart of the water cooling, the inlet temperature of the demineralised water on the busbar cooling circuit increased by 5 °C, up to 23.3 °C. It was kept below the threshold of 27 °C by switching off other cooling circuits to avoid the trigger of a slow dump of the magnet. The cold box of the cryogenics also stopped. Part of the spare liquid helium volume was used to maintain the cooling of the magnet at 4.5 K. The operators of the cryogenics quickly restarted ...

  14. MAGNET

    CERN Multimedia

    B. Curé

    2012-01-01

      The magnet and its sub-systems were stopped at the beginning of the winter shutdown on 8th December 2011. The magnet was left without cooling during the cryogenics maintenance until 17th January 2012, when the cryoplant operation resumed. The magnet temperature reached 93 K. The vacuum pumping was maintained during this period. During this shutdown, the yearly maintenance was performed on the cryogenics, the vacuum pumps, the magnet control and safety systems, and the power converter and discharge lines. Several preventive actions led to the replacement of the electrovalve command coils, and the 20A DC power supplies of the magnet control system. The filters were cleaned on the demineralised water circuits. The oil of the diffusion pumps was changed. On the cryogenics, warm nitrogen at 343 K was circulated in the cold box to regenerate the filters and the heat exchangers. The coalescing filters have been replaced at the inlet of both the turbines and the lubricant trapping unit. The active cha...

  15. Cross-legged Gods and One-legged Foresters

    NARCIS (Netherlands)

    Petrovskaia, N.I.

    The present article is a re-evaluation of a marvellous element in a medieval Welsh romance, Chwedl Iarlles y Ffynnawn ‘Tale of the Lady of the Fountain’, also known as Owein. One of the characters encountered by the hero is a one-eyed one-legged dark giant forester who appears to have a particular

  16. The one-leg standing radiograph

    OpenAIRE

    Pinsornsak, P.; Naratrikun, K.; Kanitnate, S.; Sangkomkamhang, T.

    2016-01-01

    Objectives The purpose of this study was to compare the joint space width between one-leg and both-legs standing radiographs in order to diagnose a primary osteoarthritis of the knee. Methods Digital radiographs of 100 medial osteoarthritic knees in 50 patients were performed. The patients had undergone one-leg standing anteroposterior (AP) views by standing on the affected leg while a both-legs standing AP view was undertaken while standing on both legs. The severity of the osteoarthritis wa...

  17. Low Back Pain

    Science.gov (United States)

    ... an X-ray, computerized tomography (CT) scan, or magnetic resonance imaging (MRI). Tests help to diagnose the ... posture when you are sitting, standing, sleeping, or lifting. Severe cases of low back pain may require ...

  18. MAGNET

    CERN Multimedia

    B. Curé

    2011-01-01

    The magnet ran smoothly in the last few months until a fast dump occurred on 9th May 2011. Fortunately, this occurred in the afternoon of the first day of the technical stop. The fast dump was due to a valve position controller that caused the sudden closure of a valve. This valve is used to regulate the helium flow on one of the two current leads, which electrically connects the coil at 4.5 K to the busbars at room temperature. With no helium flow on the lead, the voltage drop and the temperatures across the leads increase up to the defined thresholds, triggering a fast dump through the Magnet Safety System (MSS). The automatic reaction triggered by the MSS worked properly. The helium release was limited as the pressure rise was just at the limit of the safety valve opening pressure. The average temperature of the magnet reached 72 K. It took four days to recover the temperature and refill the helium volumes. The faulty valve controller was replaced by a spare one before the magnet ramp-up resumed....

  19. Kan leg skabe fremtidens vindere?

    DEFF Research Database (Denmark)

    Holm, Claus

    2006-01-01

    Dansk Boldspil Union skruer ned for den præstationsorienterede tilgang til børnefodbold. I stedet skal børnenes leg med bolden i fokus. Målet er at forhindre massivt frafald i børne- og ungdomsfodbolden og højne niveauet hos topspillerne....

  20. Sex differences in peripheral arterial disease: leg symptoms and physical functioning.

    Science.gov (United States)

    McDermott, Mary McGrae; Greenland, Philip; Liu, Kiang; Criqui, Michael H; Guralnik, Jack M; Celic, Lillian; Chan, Cheeling

    2003-02-01

    To compare lower extremity functioning and leg symptoms between women and men with peripheral arterial disease (PAD). Cross-sectional. Three Chicago-area medical centers. One hundred eighty-seven women and 273 men with PAD identified consecutively in patients in the noninvasive vascular laboratories and a general medicine practice at the three medical centers. Walking speed, 6-minute walk, accelerometer-measured 7-day physical activity, and a summary performance score. The summary performance score combines data on walking velocity, time for five repeated chair rises, and standing balance to achieve a score on a 0 to 12 scale (12 = best). Women with PAD were older and had a lower prevalence of prior leg revascularization, a higher prevalence of spinal stenosis, and a lower prevalence of other cardiovascular disease than men with PAD. Mean ankle brachial index (ABI) values +/- standard deviation were similar in women and men with PAD (0.64 +/- 0.15 vs 0.66 +/- 0.14, P =.15). Women with PAD were significantly more likely than men with PAD to have exertional leg pain that sometimes begins at rest (27.8% vs 13.2%, P speed (0.81 vs 0.92 m/s, P vs 1,182 feet, P vs 9.8, P leg symptoms. After adjusting for leg strength, sex differences in 6-minute walk performance and summary performance score were attenuated modestly (1,089 vs 1,177 feet for 6-minute walk, P =.022 and 9.2 vs 9.8 for summary performance score, P =.027). Women with PAD had a higher prevalence of leg pain on exertion and rest, poorer functioning, and greater walking impairment from leg symptoms than men with PAD. A higher prevalence of spinal stenosis in women may explain the observed sex differences in leg symptoms. Poorer leg strength in women may contribute to poorer lower extremity functioning in women with PAD than in men with PAD.

  1. Restless legs syndrome and central nervous system gamma-aminobutyric acid: preliminary associations with periodic limb movements in sleep and restless leg syndrome symptom severity.

    Science.gov (United States)

    Winkelman, John W; Schoerning, Laura; Platt, Sam; Jensen, J Eric

    2014-10-01

    Previous research has demonstrated abnormalities in glutamate and N-acetyl aspartate (NAA) in the thalamus in individuals with restless legs syndrome (RLS) compared with healthy matched controls. However, levels of these transmitters in other RLS-related brain areas and levels of the most common inhibitory neurotransmitter, gamma-aminobutyric acid (GABA), have not been assessed. This study examined GABA, glutamate, and NAA levels in the dorsal anterior cingulate cortex (ACC), thalamus and cerebellum with the use of proton magnetic resonance spectroscopy ((1)H-MRS) at 4 tesla (4 T) and Megapress difference-editing in 18 subjects with RLS and a matched control group without RLS. Actigraphy was performed on the nights before scans to assess periodic limb movements of sleep (PLMS). Levels of GABA, glutamate, and NAA were no different between RLS and control subjects in any of the three voxels of interest. However, GABA levels were positively correlated with both PLM indices and RLS severity in the thalamus and negatively with both of these measures in the cerebellum in RLS subjects. In addition, NAA levels were higher in the ACC in RLS than in controls. Our preliminary data suggest that known cerebellar-thalamic interactions may modulate the intensity of RLS sensory and motor symptoms. In addition, anterior cingulate cortex may be associated with the affective components of the painful symptoms in this disorder. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Frustrated spin-1/2 ladder with ferro- and antiferromagnetic legs

    Science.gov (United States)

    Maiti, Debasmita; Dey, Dayasindhu; Kumar, Manoranjan

    2018-01-01

    Two-leg spin-1/2 ladder systems consisting of a ferromagnetic leg and an antiferromagnetic leg are considered where the spins on the legs interact through antiferromagnetic rung couplings J1 . These ladders can have two geometrical arrangements either zigzag or normal ladder and these systems are frustrated irrespective of their geometry. This frustration gives rise to incommensurate spin density wave, dimer and spin fluid phases in the ground state. The magnetization in the systems decreases linearly with J12, and the systems show an incommensurate phase for 0.0 magnetic field. In large J1 limit, the normal ladder behaves like a collection of singlet dimers, whereas the zigzag ladder behaves as a one dimensional spin-1/2 antiferromagnetic chain.

  3. The effect of lumbosacral manipulation on growing pains

    Directory of Open Access Journals (Sweden)

    Dawid de Beer

    2015-06-01

    Conclusion: The results from this study, specifically the feedback from parent(s/guardians(s and the pain diaries, indicated that spinal manipulation is beneficial in the treatment of growing pains. The results also showed that other methods of treating growing pains, such as simple leg rubs, may also bring relief.

  4. Cervical disc herniation presenting with neck pain and contralateral symptoms: a case report

    Directory of Open Access Journals (Sweden)

    Yeung Jacky T

    2012-06-01

    Full Text Available Abstract Introduction Cervical disc herniation often results in neck and arm pain in patients as a result of direct impingement of nerve roots and associated inflammatory processes. The clinical presentation usually corresponds with the side of herniation and ipsilateral symptoms predominate the clinical picture. Case presentation A 35-year-old Caucasian man presented to our facility with neck pain and left-sided upper and lower extremity pain. A magnetic resonance imaging scan revealed a right paramedian herniated disc at the C5 to C6 level. All other cervical levels were normal without central canal stenosis or neural foraminal stenosis. Results from magnetic reasonance imaging scans of the brain and lumbar spine were negative. An anterior cervical discectomy was performed at the C5 to C6 level, and an inter-body graft and plate were placed. Our patient had complete resolution of his neck and left arm pain. Conclusions Anterior discectomy and fusion of the cervical spine resulted in complete resolution of our patient’s neck and left arm symptoms and improvement of his contralateral left leg pain. Cervical disc herniation may present with contralateral symptoms that are different from the current perception of this disease.

  5. Pulsed electromagnetic field therapy for management of osteoarthritis-related pain, stiffness and physical function: clinical experience in the elderly

    Directory of Open Access Journals (Sweden)

    Iannitti T

    2013-09-01

    .5 ± 2.08, respectively vs control leg (2.6 ± 0.2; 1.6 ± 0.1; 4.5 ± 0.5 respectively, also showed a significant difference in favor of PEMF therapy (P < 0.001. No adverse reactions to therapy were observed. Conclusion: The present study shows that PEMF therapy improves pain, stiffness and physical function in elderly patients affected by knee osteoarthritis. Keywords: osteoarthritis, elderly, pulsed electromagnetic field, magnet therapy, knee

  6. Quality of life of elderly patients with leg ulcers

    Directory of Open Access Journals (Sweden)

    Ana Paula Cardoso Tavares

    2017-10-01

    Full Text Available Abstract Objectives: To identify compromised domains of the 36-Item Short Form Survey (SF-36 for elderly individuals with leg ulcers and correlate their clinical and sociodemographic variables with the SF-36's components. Method: Exploratory and cross-sectional study conducted with 50 elderly individuals with leg ulcers. The instruments were the sociodemographic and clinical form and the SF-36. The Statistical Package for the Social Sciences was used to analyze data. Results: Most were married, retired, and received one times the minimum wage, were Caucasians or of mixed race, and had hypertension. In regard to the SF-36, the most compromised domain was physical limitations, while social aspects and general health status were the less compromised domains. The SF-36 domains were not correlated with age, income, duration or size of the lesion or pain. Conclusion: The ulcer-related biopsychosocial aspects need to be considered in order to devise more effective nursing interventions.

  7. When physiology becomes pathology: the role of magnetic resonance imaging in evaluating bone marrow oedema in the humerus in elite tennis players with an upper limb pain syndrome.

    Science.gov (United States)

    Hoy, G; Wood, T; Phillips, N; Connell, D; Hughes, D C

    2006-08-01

    Upper limb stresses are well recognised in tennis, and the normal physiological responses of the humerus to externally applied forces are well defined. Changes to both the microscopic and macroscopic bony architecture are often not apparent on plain radiographs in the early stages of a stress reaction. Bone scintigraphy is more sensitive, but not very specific to subtle changes, as is computer aided tomography. Magnetic resonance imaging (MRI) scans are now used to assess many musculoskeletal injuries, and may allow earlier recognition of changes. This study reports on eight high level tennis players (seven professionals, one highly ranked amateur), who all presented during the course of the 2002 Australian Open and its lead up events. All had an upper limb pain syndrome centred around the elbow. Each underwent an MRI scan. A group of asymptomatic players also had scans of the same area to serve as controls. All symptomatic patients had various levels of bone marrow oedema in their distal humerus, some with periosteal reactions, although most without. No scans revealed a cortical breach. The management of these reactions is problematic in players on an international circuit, as review is sporadic and not always coordinated. The timetabling of international tournaments means it is difficult for top players to obtain adequate rest to avoid injury. Awareness of this early overuse reaction needs to be raised to allow preventive and therapeutic options to be considered to reduce the incidence of this humeral stress response producing an upper limb pain syndrome.

  8. A Case of Painless Legs and Moving Toes Syndrome in Parkinson’s Disease Responsive to Dopaminergic Therapy

    Directory of Open Access Journals (Sweden)

    Sumihiro Kawajiri

    2016-01-01

    Full Text Available Painless Legs and Moving Toes Syndrome (PoLMT is a rare movement disorder characterized by flexion, extension, abduction, adduction, and torsion of toes without pain. It is considered a variant of Painful Legs and Moving Toes Syndrome (PLMT, which is characterized by similar movements but with pain. Although neuropathy and several central nervous system (CNS involvements have been reported to be associated with PoLMT, the actual cause and mechanism remain unclear. Here we describe the first case of PoLMT in Parkinson’s Disease (PD, parallel to parkinsonism in severity, who demonstrated a good response to dopaminergic therapy.

  9. MAGNET

    CERN Multimedia

    Benoit Curé

    2010-01-01

    The magnet worked very well at 3.8 T as expected, despite a technical issue that manifested twice in the cryogenics since June. All the other magnet sub-systems worked without flaw. The issue in the cryogenics was with the cold box: it could be observed that the cold box was getting progressively blocked, due to some residual humidity and air accumulating in the first thermal exchanger and in the adsorber at 65 K. This was later confirmed by the analysis during the regeneration phases. An increase in the temperature difference between the helium inlet and outlet across the heat exchanger and a pressure drop increase on the filter of the adsorber were observed. The consequence was a reduction of the helium flow, first compensated by the automatic opening of the regulation valves. But once they were fully opened, the flow and refrigeration power reduced as a consequence. In such a situation, the liquid helium level in the helium Dewar decreased, eventually causing a ramp down of the magnet current and a field...

  10. MAGNET

    CERN Multimedia

    B. Curé

    MAGNET During the winter shutdown, the magnet subsystems went through a full maintenance. The magnet was successfully warmed up to room temperature beginning of December 2008. The vacuum was broken later on by injecting nitrogen at a pressure just above one atmosphere inside the vacuum tank. This was necessary both to prevent any accidental humidity ingress, and to allow for a modification of the vacuum gauges on the vacuum tank and maintenance of the diffusion pumps. The vacuum gauges had to be changed, because of erratic variations on the measurements, causing spurious alarms. The new type of vacuum gauges has been used in similar conditions on the other LHC experiments and without problems. They are shielded against the stray field. The lubricants of the primary and diffusion pumps have been changed. Several minor modifications were also carried out on the equipment in the service cavern, with the aim to ease the maintenance and to allow possible intervention during operation. Spare sensors have been bough...

  11. MAGNET

    CERN Multimedia

    B. Curé

    2013-01-01

    The magnet is fully stopped and at room temperature. The maintenance works and consolidation activities on the magnet sub-systems are progressing. To consolidate the cryogenic installation, two redundant helium compressors will be installed as ‘hot spares’, to avoid the risk of a magnet downtime in case of a major failure of a compressor unit during operation. The screw compressors, their motors, the mechanical couplings and the concrete blocks are already available and stored at P5. The metallic structure used to access the existing compressors in SH5 will be modified to allow the installation of the two redundant ones. The plan is to finish the installation and commissioning of the hot spare compressors before the summer 2014. In the meantime, a bypass on the high-pressure helium piping will be installed for the connection of a helium drier unit later during the Long Shutdown 1, keeping this installation out of the schedule critical path. A proposal is now being prepared for the con...

  12. MAGNET

    CERN Multimedia

    Benoit Curé.

    The magnet operation restarted end of June this year. Quick routine checks of the magnet sub-systems were performed at low current before starting the ramps up to higher field. It appeared clearly that the end of the field ramp down to zero was too long to be compatible with the detector commissioning and operations plans. It was decided to perform an upgrade to keep the ramp down from 3.8T to zero within 4 hours. On July 10th, when a field of 1.5T was reached, small movements were observed in the forward region support table and it was decided to fix this problem before going to higher field. At the end of July the ramps could be resumed. On July 28th, the field was at 3.8T and the summer CRAFT exercise could start. This run in August went smoothly until a general CERN wide power cut took place on August 3rd, due to an insulation fault on the high voltage network outside point 5. It affected the magnet powering electrical circuit, as it caused the opening of the main circuit breakers, resulting in a fast du...

  13. Combined use of an ibuprofen-releasing foam dressing and silver dressing on infected leg ulcers

    DEFF Research Database (Denmark)

    Jorgensen, B.; Gottrup, F.; Karlsmark, T.

    2008-01-01

    OBJECTIVE: To investigate the effect and safety of an ibuprofen-releasing foam (Biatain-Ibu, Coloplast A/S) combined with an ionised silver-releasing wound contact layer (Physiotulle Ag, Coloplast A/S) on painful, infected venous leg ulcers. METHOD: This open non-comparative study involved 24...... patients with painful, exuding, locally infected, and stalled venous leg ulcers. Persistent pain and pain at dressing change were monitored using a 11-point numerical box scale (NBS). The composition of the wound bed, the dressing combination's ability to absorb exudate and minimise leakage, ibuprofen...... dressing application, the mean concentration of ibuprofen in the wound exudate reached a constant level of 35 +/- 21 microg/ml.After 31 days, the relative wound area had reduced by 42%, with an associated decrease in fibrin and an increase in granulation tissue.The number of patients with wound malodour...

  14. A comparison of one-legged and two-legged countermovement jumps

    NARCIS (Netherlands)

    van Soest, A J; Roebroeck, M.E.; Bobbert, M F; Huijing, P A; van Ingen Schenau, G J

    1985-01-01

    Ten well-trained male volleyball players performed one-legged and two-legged vertical countermovement jumps. Ground reaction forces, cinematographic data, and electromyographic data were recorded. Jumping height in one-legged jumps was 58.5% of that reached in two-legged jumps. Mean net torques in

  15. Exercise increases pressure pain tolerance but not pressure and heat pain thresholds in healthy young men

    DEFF Research Database (Denmark)

    Vaegter, H B; Hoeger Bement, M; Madsen, A B

    2017-01-01

    : On three different days, 20 healthy young men performed two submaximal isometric knee extensions (30% maximal voluntary contraction in 3 min) and a control condition (quiet rest). Before and immediately after exercise and rest, the sensitivity to heat pain and pressure pain was assessed in randomized...... and counterbalanced order. Cuff pressure pain threshold (cPPT) and pain tolerance (cPTT) were assessed on the ipsilateral lower leg by computer-controlled cuff algometry. Heat pain threshold (HPT) was recorded on the ipsilateral foot by a computer-controlled thermal stimulator. RESULTS: Cuff pressure pain tolerance...

  16. The active straight leg raising test and mobility of the pelvic joints

    OpenAIRE

    Mens, J. M. A.; Vleeming, Andry; Snijders, Chris J.; Stam, Henk J.; Ginai, Abida Z.

    1999-01-01

    Objective signs to assess impairment in patients who are disabled by peripartum pelvic girdle pain hardly exist. The purpose of this study was to develop a clinical test to quantify and qualify disability in these patients. The study examined the relationship between impaired active straight leg raising (ASLR) and mobility of pelvic joints in patients with peripartum pelvic girdle pain, focusing on (1) the reduction of impairment of ASLR when the patient was wearing a pelvic belt, and (2) mot...

  17. Psychological aspects of pain.

    Science.gov (United States)

    Gorczyca, Rafał; Filip, Rafał; Walczak, Ewa

    2013-01-01

    functional magnetic resonance imaging (fMRI) was used showed that pain catastrophizing, independent of the influence of depression, was significantly associated with increased activity in brain areas related to anticipation of pain, attention to pain, emotional aspects of pain and motor control. Pain behaviour is a conditioned pain. Care and concern on the part of others, secondarily enhance a patient's pain behaviours, which lead to an increase in the intensity of the pain experienced. A history of early life adversity (ELA) - rejection, neglect, physical or sexual abuse is related to the development of irritable bowel syndrome (IBS) in adulthood. Ovarian hormones have been shown to modulate pain sensitivity. IMAGING OF THE HUMAN BRAIN IN CHRONIC PAIN: Acute pain and chronic pain are encoded in different regions of the brain. Chronic pain can be considered a driving force that carves cortical anatomy and physiology, creating the chronic pain brain/ mind state. Cognitive-behavioural methods of pain treatment in domains of pain experience, cognitive coping and appraisal (positive coping measures), and reduced pain experience are effective in reducing pain in patients.

  18. Metabolic profiles of exudates from chronic leg ulcerations.

    Science.gov (United States)

    Junka, Adam; Wojtowicz, Wojciech; Ząbek, Adam; Krasowski, Grzegorz; Smutnicka, Danuta; Bakalorz, Barbara; Boruta, Agnieszka; Dziadas, Mariusz; Młynarz, Piotr; Sedghizadeh, Parish Paymon; Bartoszewicz, Marzenna

    2017-04-15

    Chronic leg ulceration is a disease usually associated with other comorbidities, and significantly reduces patient quality of life. Infected leg ulcers can lead to limb-threatening sequelae or mortality. Leg ulcerations are colonized by a number of microbes that are able to cause life-threating infections in susceptible patients. Wound exudate is a body fluid that collects metabolites from patient eukaryotic cells and from prokaryotic bacterial communities inhabiting the wound. This study aimed at identification of metabolites in exudates collected from chronic leg ulcers, and correlation of this metabolome with patient comorbidities and microbiological status of the wound. By means of NMR spectroscopy we detected 42 metabolites of microbial or patient origin. The metabolites that were in abundance in exudates analyzed were lactate, lysine, and leucine. Metabolites were associated with the presence of neutrophils in wounds and destruction of high quantities of microbes, but also with hypoxia typical for venous insufficiency. The combination of nuclear magnetic resonance spectroscopy technique and partial least squares discriminant analysis allowed us to further discriminate groups of metabolites with regards to potential clinical meaning. For example, to discriminate between S.aureus versus all other isolated microbial species, or between patients suffering from type I or II diabetes versus patients without diabetes. Therefore, wound exudate seems to be highly applicable material for discriminant analysis performed with the use of NMR technique to provide for rapid metabolomics of chronic wound status. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. [Etiological diagnosis of leg ulcers].

    Science.gov (United States)

    Debure, Clélia

    2010-09-20

    Etiological diagnosis of leg ulcers must be the first step of treatment, even if we know that veinous disease is often present. We can build a clinical decisional diagram, which helps us to understand and not forget the other causes of chronic wounds and choose some basic examination, like ultrasound and histological findings. This diagnosis helps to choose the right treatment in order to cure even the oldest venous ulcers. Educational programs should be improved to prevent recurrence.

  20. Pain Sensitisation in Women with Active Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Vladimirova, Nora; Jespersen, Anders; Bartels, Else Marie

    2015-01-01

    Objectives. In some rheumatoid arthritis (RA) patients, joint pain persists without signs of inflammation. This indicates that central pain sensitisation may play a role in the generation of chronic pain in a subgroup of RA. Our aim was to assess the degree of peripheral and central pain...... on the dominant lower leg. Pain threshold, pain tolerance, and pain sensitivity during tonic painful stimulation were recorded. Results. Women with active RA had significantly lower pain threshold (p pain tolerance (p ....98 (SEM: 0.09) and 0.71 (SEM: 0.04) in HC (p pain threshold compared to HC. In addition, temporal summation of pressure-pain was increased, indicating central pain sensitization, at least in some patients. Defining this subgroup...

  1. Combined use of an ibuprofen-releasing foam dressing and silver dressing on infected leg ulcers

    DEFF Research Database (Denmark)

    Jorgensen, B.; Gottrup, F.; Karlsmark, T.

    2008-01-01

    OBJECTIVE: To investigate the effect and safety of an ibuprofen-releasing foam (Biatain-Ibu, Coloplast A/S) combined with an ionised silver-releasing wound contact layer (Physiotulle Ag, Coloplast A/S) on painful, infected venous leg ulcers. METHOD: This open non-comparative study involved 24 pat...... decreased from 37% to 4%. No serious adverse events were reported. CONCLUSION: The combined use of the ibuprofen-releasing foam dressing and silver-releasing contact layer reduced wound pain and promoted healing without compromising safety Udgivelsesdato: 2008/5......OBJECTIVE: To investigate the effect and safety of an ibuprofen-releasing foam (Biatain-Ibu, Coloplast A/S) combined with an ionised silver-releasing wound contact layer (Physiotulle Ag, Coloplast A/S) on painful, infected venous leg ulcers. METHOD: This open non-comparative study involved 24...... patients with painful, exuding, locally infected, and stalled venous leg ulcers. Persistent pain and pain at dressing change were monitored using a 11-point numerical box scale (NBS). The composition of the wound bed, the dressing combination's ability to absorb exudate and minimise leakage, ibuprofen...

  2. MAGNET

    CERN Multimedia

    Benoit Curé

    The magnet subsystems resumed operation early this spring. The vacuum pumping was restarted mid March, and the cryogenic power plant was restarted on March 30th. Three and a half weeks later, the magnet was at 4.5 K. The vacuum pumping system is performing well. One of the newly installed vacuum gauges had to be replaced at the end of the cool-down phase, as the values indicated were not coherent with the other pressure measurements. The correction had to be implemented quickly to be sure no helium leak could be at the origin of this anomaly. The pressure measurements have been stable and coherent since the change. The cryogenics worked well, and the cool-down went quite smoothly, without any particular difficulty. The automated start of the turbines had to be fine-tuned to get a smooth transition, as it was observed that the cooling power delivered by the turbines was slightly higher than needed, causing the cold box to stop automatically. This had no consequence as the cold box safety system acts to keep ...

  3. MAGNET

    CERN Multimedia

    B. Curé

    During the winter shutdown, the magnet subsystems went through a full maintenance. The magnet was successfully warmed up to room temperature beginning of December 2008. The vacuum was broken later on by injecting nitrogen at a pressure just above one atmosphere inside the vacuum tank. This was necessary both to prevent any accidental humidity ingress, and to allow for a modification of the vacuum gauges on the vacuum tank and maintenance of the diffusion pumps. The vacuum gauges had to be changed, because of erratic variations on the measurements, causing spurious alarms. The new type of vacuum gauges has been used in similar conditions on the other LHC experiments and without problems. They are shielded against the stray field. The lubricants of the primary and diffusion pumps have been changed. Several minor modifications were also carried out on the equipment in the service cavern, with the aim to ease the maintenance and to allow possible intervention during operation. Spare sensors have been bought. Th...

  4. Living with clipped wings-patients' experience of losing a leg

    DEFF Research Database (Denmark)

    Norlyk, Annelise; Martinsen, Bente; Kjaer-Petersen, Klaus

    2013-01-01

    . The essential meaning of losing a leg is a radical and existential upheaval, which restricts patients' lifestyle and irretrievably alters their lifeworld. Life after the operation is associated with despair, and a painful sense of loss, but also with the hope of regaining personal independence. The consequences...

  5. Understanding the Active Straight Leg Raise (ASLR): An electromyographic study in healthy subjects

    NARCIS (Netherlands)

    Hu, H.; Meijer, O.G.; Bruijn, S.M.; Strijers, R.L.M.; Nanayakkara, P.W.B.; van Royen, B.J.; Wu, W; Xia, C.; van Dieen, J.H.

    2012-01-01

    The Active Straight Leg Raise (ASLR) is an important test in diagnosing pelvic girdle pain (PGP). It is difficult to understand what happens normally during the ASLR, let alone why it would be impaired in PGP. In the present study, healthy subjects performed the ASLR under normal conditions, with

  6. Bone scintigraphy in patients with pain

    OpenAIRE

    Shin, Seung Hyeon; Kim, Seong Jang

    2017-01-01

    Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disor...

  7. The Verbal Rating Scale Is Reliable for Assessment of Postoperative Pain in Hip Fracture Patients

    DEFF Research Database (Denmark)

    Bech, R. D.; Lauritsen, J.; Ovesen, O.

    2015-01-01

    Background. Hip fracture patients represent a challenge to pain rating due to the high prevalence of cognitive impairment. Methods. Patients prospectively rated pain on the VRS. Furthermore, patients described the changes in pain after raising their leg, with one of five descriptors. Agreement...... between paired measures on the VRS at rest and by passive straight leg raise with a one-minute interval between ratings at rest and three-minute interval for straight leg raise was expressed by kappa coefficients. Reliability of this assessment of pain using the VRS was compared to the validity...

  8. Pain experience in children with advanced cancer.

    Science.gov (United States)

    Van Cleve, Lois; Muñoz, Cynthia E; Riggs, Matt L; Bava, Laura; Savedra, Marilyn

    2012-01-01

    It is important for health care professionals to understand the pain experience in children with advanced cancer. There has been increased attention to this topic, but systematic studies are limited. To examine pain symptoms and management in children with advanced cancer using child self-report and nurse documentation. A prospective, longitudinal method was used to collect data from 62 children over a 5-month period. Children were English and Spanish speaking, ages 6 to 17 years, with advanced cancer. Nurses also provided data. Across all interviews, pain was reported 56% of the time by all children. Nurses documented pain only 23% of the time. Children most frequently reported head pain (31%), followed by abdomen, lower back, leg, and feet pain (20% to 30%). Children consistently reported more intense pain compared with nurses. Nonopioids were used more frequently (45%) than opioids (32%), and nurses' perception of pain intensity was more highly correlated with administration of opioids (r = .72, P Pain intensity was relatively stable over time. Nurses noted ethnicity related differences with higher pain levels for Caucasian children, who received analgesics more frequently. The children consistently reported pain. Child self-report and nurse documentation of pain differed, as did pain management among children who died compared with those who did not. Ethnicity differences in the identification and management of pain by nurses begs further study. Overall, nurses were aware of and responsive to pain and pain management.

  9. 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. ...

  10. Heel pain

    Science.gov (United States)

    Pain - heel ... Heel pain is most often the result of overuse. However, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: Swelling and pain in the Achilles tendon ...

  11. Flank pain

    Science.gov (United States)

    Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. But, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

  12. Epilepsy and restless legs syndrome.

    Science.gov (United States)

    Geyer, James D; Geyer, Emery E; Fetterman, Zachary; Carney, Paul R

    2017-03-01

    Restless legs syndrome (RLS) is a common neurological movement disorder occurring in approximately 10% of the general population. The prevalence of moderately severe RLS is 2.7% overall (3.7% for women and 1.7% for men). Epilepsy is also a common neurological disorder with significant associated morbidity and impact on quality of life. We evaluated the severity and frequency of primary RLS in patients with localization-related temporal lobe epilepsy (TLE) and investigated the role of prodromal RLS symptoms as a warning sign and lateralizing indicator. All epilepsy patients seen in the outpatient clinic were screened for movement disorders from 2005 to 2015. Ninety-eight consecutive patients with localization-related TLE (50 right TLE and 48 left TLE) who met inclusion criteria were seen in the outpatient clinic. The control group consisted of 50 individuals with no history or immediate family history of epilepsy. Each patient was evaluated with the International Restless Legs Study Group (IRLSSG) questionnaire, NIH RLS diagnostic criteria, ferritin level, and comprehensive sleep screening including polysomnography. Furthermore, patients with obstructive sleep apnea or a definite cause of secondary restless legs syndrome such as low serum ferritin or serum iron levels were also excluded from the study. There was a significant association between the type of epilepsy and whether or not patients had RLS χ 2 (1)=10.17, prestlessness was typically described as moderately severe. The RLS symptoms were more common and somewhat more severe in the right TLE group than the left TLE group. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Uterine Diverticulum With Fetal Leg Entrapment: A Case Report.

    Science.gov (United States)

    Chandrasekaran, Nirmala; Yudin, Mark H; Berger, Howard

    2017-10-01

    Uterine anomalies causing fetal complications are very rarely encountered in obstetric practice and thus pose a diagnostic dilemma. A multigravid patient attended the clinic for an ultrasound examination in the third trimester following a recent hospital admission for abdominal pain. Ultrasound imaging revealed a large uterine diverticulum in the right cornu of the uterus with evidence of fetal leg entrapment. Because of concerns of increased soft tissue edema in the entrapped leg, the patient was delivered at 35 weeks' gestation by elective CS. The CS was complicated by uterine rupture at the diverticular portion. The neonatal course was complicated by compartment syndrome of the leg, and the infant underwent surgery on post-delivery day one with good outcome. Uterine diverticula are rare anomalies, and once they are diagnosed, the possibility of entrapment of fetal parts or placenta in pregnancy should be considered. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  14. MAGNET

    CERN Multimedia

    B. Curé

    The first phase of the commissioning ended in August by a triggered fast dump at 3T. All parameters were nominal, and the temperature recovery down to 4.5K was carried out in two days by the cryogenics. In September, series of ramps were achieved up to 3 and finally 3.8T, while checking thoroughly the detectors in the forward region, measuring any movement of and around the HF. After the incident of the LHC accelerator on September 19th, corrective actions could be undertaken in the forward region. When all these displacements were fully characterized and repetitive, with no sign of increments in displacement at each field ramp, it was possible to start the CRAFT, Cosmic Run at Four Tesla (which was in fact at 3.8T). The magnet was ramped up to 18.16kA and the 3 week run went smoothly, with only 4 interruptions: due to the VIP visits on 21st October during the LHC inauguration day; a water leak on the cooling demineralized water circuit, about 1 l/min, that triggered a stop of the cooling pumps, and resulte...

  15. MAGNET

    CERN Multimedia

    Benoit Curé

    The cooling down to the nominal temperature of 4.5 K was achieved at the beginning of August, in conjunction with the completion of the installation work of the connection between the power lines and the coil current leads. The temperature gradient on the first exchanger of the cold box is now kept within the nominal range. A leak of lubricant on a gasket of the helium compressor station installed at the surface was observed and several corrective actions were necessary to bring the situation back to normal. The compressor had to be refilled with lubricant and a regeneration of the filters and adsorbers was necessary. The coil cool down was resumed successfully, and the cryogenics is running since then with all parameters being nominal. Preliminary tests of the 20kA coil power supply were done earlier at full current through the discharge lines into the dump resistors, and with the powering busbars from USC5 to UXC5 without the magnet connected. On Monday evening August 25th, at 8pm, the final commissionin...

  16. MAGNET

    CERN Multimedia

    Benoit Curé

    2013-01-01

    Maintenance work and consolidation activities on the magnet cryogenics and its power distribution are progressing according to the schedules. The manufacturing of the two new helium compressor frame units has started. The frame units support the valves, all the sensors and the compressors with their motors. This activity is subcontracted. The final installation and the commissioning at CERN are scheduled for March–April 2014. The overhauls of existing cryogenics equipment (compressors, motors) are in progress. The reassembly of the components shall start in early 2014. The helium drier, to be installed on the high-pressure helium piping, has been ordered and will be delivered in the first trimester of 2014. The power distribution for the helium compressors in SH5 on the 3.3kV network is progressing. The 3.3kV switches, between each compressor and its hot spare compressor, are being installed, together with the power cables for the new compressors. The 3.3kV electrical switchboards in SE5 will ...

  17. Quinine for Nocturnal Leg Cramps

    Science.gov (United States)

    Man-Son-Hing, Malcolm; Wells, George; Lau, Anita

    1998-01-01

    OBJECTIVE With respect to the use of quinine for the treatment of nocturnal leg cramps, to determine whether the findings of a previously performed meta-analysis of published data are altered with the addition of unpublished data, and whether publication bias is present in this area. DESIGN A meta-analysis of eight (four published and four unpublished) randomized, double-blind, placebo-controlled trials, seven of which had a crossover design. SETTING Randomized trials that were available as of July 1997. SUBJECTS Ambulatory patients (659) who suffered from regular nocturnal leg cramps. MAIN RESULTS When individual patient data from all crossover studies were pooled, persons had 3.60 (95% confidence interval [CI] 2.15, 5.05) fewer cramps in a 4-week period when taking quinine compared with placebo. This compared with an estimate of 8.83 fewer cramps (95% CI 4.16, 13.49) from pooling published studies alone. The corresponding relative risk reductions were 21% (95% CI 12%, 30%) and 43% (95% CI 21%, 65%), respectively. Compared with placebo, the use of quinine was associated with an increased incidence of side effects, particularly tinnitus. Publication bias is present in the reporting of the efficacy of quinine for this indication, as almost all published studies reported larger estimates of its efficacy than did unpublished studies. CONCLUSIONS This study confirms that quinine is efficacious in the prevention of nocturnal leg cramps. However, its benefit may not be as large as reported from the pooling of published studies alone. Given the side effect profile of quinine, nonpharmacologic therapy (e.g., regular passive stretching of the affected muscle) is the best first-line treatment. For persons who find this ineffective and whose quality of life is significantly affected, a trial of quinine is warranted. Prescribing physicians must closely monitor the risks and benefits in individual patients. Publication bias is present in this area even though there is

  18. [Nocioceptive pain, neuropathic pain and pain memory].

    Science.gov (United States)

    Montero-Homs, Jordi

    2009-01-01

    Pain is a cognitive evaluation. Its appearance in the new functional image systems is promising. Nocioceptive pain, usually acute or persistent, is useful to prevent animals from getting injured. Chronic pain is disease per se: It is due to a sensitisation phenomena and pain memory with an important relationship with emotions. Neuropathic pain is a neurological symptom due to a somatosensorial system dysfunction. In this case, axonal ectopic generation of impulses and synaptic hyperexcitability occurs. In persistent cases, sensitisation phenomenon and memory of pain appear together with neuropathic pain. Pain treatment should be physiopathologicaly orientated. Pain units, specialized in analgesic treatment and some invasive techniques, are usually competent in the treatment of nocioceptive pain. Neuropathic pain should have a neurologic diagnosis and treatment. But neurologist need to be more and more interested in the chronic pain related with memory and sensitisation: better knowledge of the cerebral mechanisms in this phenomenon can add to this pathology in our field.

  19. Invasive Candida krusei infection and Candida vasculitis of a leg ulcer in an immunocompetent patient: A case report

    Directory of Open Access Journals (Sweden)

    Philipp Jud

    2017-02-01

    Full Text Available A 71 year old female Caucasian farmer without any known immunosuppression presented with a painful ulcer of her right lower leg after a trauma caused by a wood billet. There was no response to empirical antibacterial treatment. An ulcer biopsy showed an invasive Candida infection of the soft tissue and leucocytoclastic vasculitis. Voriconazole treatment was followed by wound healing. Invasive Candida infection and localized Candida vasculitis represent a rare cause of persisting leg ulcers. The similar clinical picture of chronic venous leg ulcers might blur the true cause and refractory cases should therefore promptly be processed by histopathological diagnostics.

  20. Invasive Candida krusei infection and Candida vasculitis of a leg ulcer in an immunocompetent patient: A case report.

    Science.gov (United States)

    Jud, Philipp; Valentin, Thomas; Regauer, Sigrid; Gary, Thomas; Hackl, Gerald; Rief, Peter; Brodmann, Marianne; Hafner, Franz

    2017-02-01

    A 71year old female Caucasian farmer without any known immunosuppression presented with a painful ulcer of her right lower leg after a trauma caused by a wood billet. There was no response to empirical antibacterial treatment. An ulcer biopsy showed an invasive Candida infection of the soft tissue and leucocytoclastic vasculitis. Voriconazole treatment was followed by wound healing. Invasive Candida infection and localized Candida vasculitis represent a rare cause of persisting leg ulcers. The similar clinical picture of chronic venous leg ulcers might blur the true cause and refractory cases should therefore promptly be processed by histopathological diagnostics. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  1. Clinical classification in low back pain

    DEFF Research Database (Denmark)

    Petersen, Tom; Laslett, Mark; Juhl, Carsten Bogh

    2017-01-01

    BACKGROUND: Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho...... searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting...

  2. Leg fluid accumulation during prolonged sitting.

    Science.gov (United States)

    Vena, Daniel; Rubianto, Jonathan; Popovic, Milos; Yadollahi, Azadeh

    2016-08-01

    The accumulation of fluid in the legs due to sedentariness can be a health risk in extreme cases. Negative health impacts associated with leg fluid accumulation include leg edema and risk of blood clots. Furthermore, fluid accumulating in the legs is accompanied by fluid shift into the upper body which is also associated with health risks such as: increased blood pressure when lying down, respiratory problems in people with heart failure, and increased sleep apnea. Understanding the pattern by which fluid accumulates in the legs can aid in the development of devices for reducing leg fluid accumulation. The purpose of this study was to characterize the time course of fluid accumulation over a two-and-half-hour seated period. Non-obese participants with sleep apnea and no other co-morbidities were included in the sample as part of a larger study. Leg fluid was measured continuously using a method of bioelectrical impedance. Participants were first asked to lie supine for 30 minutes as a washout, and then sat with their legs still for two and a half hours. The main finding of this study is that the pattern of leg fluid accumulation differed in the first 45 minutes compared to the latter 105 minutes. In the first 45 minutes, fluid accumulated according to first order exponential function. In the latter period, fluid accumulated according to a linear function. The initial exponential accumulation is likely due to the large increase in capillary pressure caused by rapid blood flow into the legs due to gravity, leading to substantial filtration of blood plasma into the tissue spaces. The latter linear portion likely represents continued slow filtration of fluid out of the vasculature and into the tissue spaces. This is the first study to show that fluid accumulation in the legs is a combination of an exponential and linear functions. The linear increase identifies that there is no foreseeable point in which leg fluid stops accumulating while sitting for prolonged periods.

  3. Running with a load increases leg stiffness.

    Science.gov (United States)

    Silder, Amy; Besier, Thor; Delp, Scott L

    2015-04-13

    Spring-mass models have been used to characterize running mechanics and leg stiffness in a variety of conditions, yet it remains unknown how running while carrying a load affects running mechanics and leg stiffness. The purpose of this study was to test the hypothesis that running with a load increases leg stiffness. Twenty-seven subjects ran at a constant speed on a force-measuring treadmill while carrying no load, and while wearing weight vests loaded with 10%, 20%, and 30% of body weight. We measured lower extremity motion and created a scaled musculoskeletal model of each subject, which we used to estimate lower extremity joint angles and leg length. We estimated dimensionless leg stiffness as the ratio of the peak vertical ground reaction force (normalized to body weight) and the change in stance phase leg length (normalized to leg length at initial foot contact). Leg length was calculated as the distance from the center of the pelvis to the center-of-pressure under the foot. We found that dimensionless leg stiffness increased when running with load (p=0.001); this resulted from an increase in the peak vertical ground reaction force (pleg length (p=0.025). When running with load, subjects had longer ground contact times (pleg stiffness to accommodate an added load. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Restless legs syndrome and periodic leg movements in patients with movement disorders: Specific considerations.

    Science.gov (United States)

    Högl, Birgit; Stefani, Ambra

    2017-05-01

    Restless legs syndrome is a frequent neurological disorder with potentially serious and highly distressing treatment complications. The role and potential implications of periodic leg movements during sleep range from being a genetic risk marker for restless legs syndrome to being a cardiovascular risk factor. The diagnosis of restless legs syndrome in patients with daytime movement disorders is challenging and restless legs syndrome needs to be differentiated from other sleep-related movement disorders. This article provides an update on the diagnosis of restless legs syndrome as an independent disorder and the role of periodic leg movements and reviews the association of restless legs syndrome with Parkinson's disease and other movement disorders. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

  5. Prevalence of degenerative and spondyloarthritis-related magnetic resonance imaging findings in the spine and sacroiliac joints in patients with persistent low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Arnbak, Bodil; Jensen, Tue S.; Manniche, Claus [Hospital Lillebaelt, Research Department, Spine Centre of Southern Denmark, Middelfart (Denmark); University of Southern Denmark, Institute of Regional Health Research, Odense C (Denmark); Egund, Niels; Zejden, Anna [Aarhus University Hospital, Department of Radiology, Aarhus C (Denmark); Hoerslev-Petersen, Kim [University of Southern Denmark, Institute of Regional Health Research, Odense C (Denmark); King Christian 10th Hospital for Rheumatic Diseases, Graasten, Graasten (Denmark); Jurik, Anne G. [Hospital Lillebaelt, Research Department, Spine Centre of Southern Denmark, Middelfart (Denmark); University of Southern Denmark, Institute of Regional Health Research, Odense C (Denmark); Aarhus University Hospital, Department of Radiology, Aarhus C (Denmark)

    2016-04-15

    To estimate the prevalence of degenerative and spondyloarthritis (SpA)-related magnetic resonance imaging (MRI) findings in the spine and sacroiliac joints (SIJs) and analyse their association with gender and age in persistent low back pain (LBP) patients. Degenerative and SpA-related MRI findings in the whole spine and SIJs were evaluated in Spine Centre patients aged 18-40 years with LBP. Among the 1,037 patients, the prevalence of disc degeneration, disc contour changes and vertebral endplate signal (Modic) changes were 87 % (±SEM 1.1), 82 % (±1.2) and 48 % (±1.6). All degenerative spinal findings were most frequent in men and patients aged 30-40 years. Spinal SpA-related MRI findings were rare. In the SIJs, 28 % (±1.4) had at least one MRI finding, with bone marrow oedema being the most common (21 % (±1.3)). SIJ erosions were most prevalent in patients aged 18-29 years and bone marrow oedema in patients aged 30-40 years. SIJ sclerosis and fatty marrow deposition were most common in women. SIJ bone marrow oedema, sclerosis and erosions were most frequent in women indicating pregnancy-related LBP. The high prevalence of SIJ MRI findings associated with age, gender, and pregnancy-related LBP need further investigation of their clinical importance in LBP patients. (orig.)

  6. Prevalence of degenerative and spondyloarthritis-related magnetic resonance imaging findings in the spine and sacroiliac joints in patients with persistent low back pain

    International Nuclear Information System (INIS)

    Arnbak, Bodil; Jensen, Tue S.; Manniche, Claus; Egund, Niels; Zejden, Anna; Hoerslev-Petersen, Kim; Jurik, Anne G.

    2016-01-01

    To estimate the prevalence of degenerative and spondyloarthritis (SpA)-related magnetic resonance imaging (MRI) findings in the spine and sacroiliac joints (SIJs) and analyse their association with gender and age in persistent low back pain (LBP) patients. Degenerative and SpA-related MRI findings in the whole spine and SIJs were evaluated in Spine Centre patients aged 18-40 years with LBP. Among the 1,037 patients, the prevalence of disc degeneration, disc contour changes and vertebral endplate signal (Modic) changes were 87 % (±SEM 1.1), 82 % (±1.2) and 48 % (±1.6). All degenerative spinal findings were most frequent in men and patients aged 30-40 years. Spinal SpA-related MRI findings were rare. In the SIJs, 28 % (±1.4) had at least one MRI finding, with bone marrow oedema being the most common (21 % (±1.3)). SIJ erosions were most prevalent in patients aged 18-29 years and bone marrow oedema in patients aged 30-40 years. SIJ sclerosis and fatty marrow deposition were most common in women. SIJ bone marrow oedema, sclerosis and erosions were most frequent in women indicating pregnancy-related LBP. The high prevalence of SIJ MRI findings associated with age, gender, and pregnancy-related LBP need further investigation of their clinical importance in LBP patients. (orig.)

  7. The Effect of Shiatsu Massage on Pain Reduction in Burn Patients

    OpenAIRE

    Ardabili, Fatemeh Mohaddes; Purhajari, Soybeh; Najafi Ghezeljeh, Tahereh; Haghani, Hamid

    2014-01-01

    BACKGROUND Burn is a tragedy that follows multiple problems in a patient including pain, anxiety and lack of confidence into medical team. This study evaluated the effect of shiatsu massage on pain intensity of burn patients. METHODS A total of 120 burn patients from Motahhari Burn Hospital and of both genders were randomly divided into 4 groups of undergoing hand massage, leg massage, both hand and leg massages, and the control group. The effect of shiatsu massage in pain relief of burned pa...

  8. 3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot.

    Directory of Open Access Journals (Sweden)

    Suzanne L Duce

    Full Text Available BACKGROUND: Idiopathic congenital talipes equinovarus (CTEV is the commonest form of clubfoot. Its exact cause is unknown, although it is related to limb development. The aim of this study was to quantify the anatomy of the muscle, subcutaneous fat, tibia, fibula and arteries in the lower legs of teenagers and young adults with CTEV using 3D magnetic resonance imaging (MRI, and thus to investigate the anatomical differences between CTEV participants and controls. METHODOLOGY/PRINCIPAL FINDINGS: The lower legs of six CTEV (2 bilateral, 4 unilateral and five control young adults (age 12-28 were imaged using a 3T MRI Philips scanner. 5 of the CTEV participants had undergone soft-tissue and capsular release surgery. 3D T1-weighted and 3D magnetic resonance angiography (MRA images were acquired. Segmentation software was used for volumetric, anatomical and image analysis. Kolmogorov-Smirnov tests were performed. The volumes of the lower affected leg, muscle, tibia and fibula in unilateral CTEV participants were consistently smaller compared to their contralateral unaffected leg, this was most pronounced in muscle. The proportion of muscle in affected CTEV legs was significantly reduced compared with control and unaffected CTEV legs, whilst proportion of muscular fat increased. No spatial abnormalities in the location or branching of arteries were detected, but hypoplastic anomalies were observed. CONCLUSIONS/SIGNIFICANCE: Combining 3D MRI and MRA is effective for quantitatively characterizing CTEV anatomy. Reduction in leg muscle volume appears to be a sensitive marker. Since 5/6 CTEV cases had soft-tissue surgery, further work is required to confirm that the treatment did not affect the MRI features observed. We propose that the proportion of muscle and intra-muscular fat within the lower leg could provide a valuable addition to current clinical CTEV classification. These measures could be useful for clinical care and guiding treatment pathways, as

  9. Tactile allodynia in patients with lumbar radicular pain (sciatica).

    Science.gov (United States)

    Defrin, Ruth; Devor, Marshall; Brill, Silviu

    2014-12-01

    We report a novel symptom in many patients with low back pain (LBP) that sheds new light on the underlying pain mechanism. By means of quantitative sensory testing, we compared patients with radicular LBP (sciatica), axial LBP (LBP without radiation into the leg), and healthy controls, searching for cutaneous allodynia in response to weak tactile and cooling stimuli on the leg and low back. Most patients with radicular pain (~60%) reported static and dynamic tactile allodynia, as well as cooling allodynia, on the leg, often extending into the foot. Some also reported allodynia on the low back. In axial LBP, allodynia was almost exclusively on the back. The degree of dynamic tactile allodynia correlated with the degree of background pain. The presence of allodynia suggests that the peripheral nerve generators of background leg and back pain have also induced central sensitization. The distal (foot) location of the allodynia in patients who have it indicates that the nociceptive drive that maintains the central sensitization arises paraspinally (ectopically) in injured ventral ramus afferents; this is not an instance of somatic referred pain. The presence of central sensitization also provides the first cogent account of shooting pain in sciatica as a wave of activity sweeping vectorially across the width of the sensitized dorsal horn. Finally, the results endorse leg allodynia as a pain biomarker in animal research on LBP, which is commonly used but has not been previously validated. In addition to informing the underlying mechanism of LBP, bedside mapping of allodynia might have practical implications for prognosis and treatment. How can you tell whether pain radiating into the leg in a patient with sciatica is neuropathic, ie, due to nerve injury? Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Magnetic resonance imaging in low back pain and sciatica with special emphasis on the postdiskectomy period. A study using 0.2 and 0.3 T vertical magnetic fields

    Energy Technology Data Exchange (ETDEWEB)

    Annertz, M.

    1994-09-01

    The diagnostic capability of magnetic resonance (MR) imaging at 0.3 T was evaluated and compared with other modalities in patients with previous disk surgery and remaining or recurrent sciatica, and in patients with spondylolisthesis and sciatica. In the early postoperative period after successful lumbar diskectomy, MR showed a large amount of abnormal soft tissue in the anterior epidural space, without correlation with clinical symptoms. In the late postoperative period, contrast-enhanced MR provided the best correlation with surgical findings, compared with CT and myelography, in discriminating recurrent/remaining disk herniation from epidural fibrosis in patients with the lumbar postdiskectomy syndrome. Contrast-enhanced MR could not demonstrate any differences regarding presence and extent of epidural fibrosis between symptomatic and asymptomatic patients. In spondylolisthesis, MR gave excellent information about the root canals and the degree of nerve root stretching and compression, which was not possible to evaluate with myelography. MR at 0.3 T provided information comparable to that reported from examinations performed with superconducting MR scanners, and is well suited as the imaging modality in the evaluation of lumbar spine disorders. After introducing MR at 0.2 and 0.3 T with vertical magnetic fields as the first neuroradiological modality, instead of myelography or CT, in the evaluation of the soft tissues of the lumbar spine in patients with low back pain and sciatica, a significant increase in the number of patients examined, a moderate increase in the total cost of investigations, and a significant decrease in the cost per investigated and per operated patient was noted.

  12. Human brain activity associated with painful mechanical stimulation to muscle and bone.

    Science.gov (United States)

    Maeda, Lynn; Ono, Mayu; Koyama, Tetsuo; Oshiro, Yoshitetsu; Sumitani, Masahiko; Mashimo, Takashi; Shibata, Masahiko

    2011-08-01

    The purpose of this study was to elucidate the central processing of painful mechanical stimulation to muscle and bone by measuring blood oxygen level-dependent signal changes using functional magnetic resonance imaging (fMRI). Twelve healthy volunteers were enrolled. Mechanical pressure on muscle and bone were applied at the right lower leg by an algometer. Intensities were adjusted to cause weak and strong pain sensation at either target site in preliminary testing. Brain activation in response to mechanical nociceptive stimulation targeting muscle and bone were measured by fMRI and analyzed. Painful mechanical stimulation targeting muscle and bone activated the common areas including bilateral insula, anterior cingulate cortex, posterior cingulate cortex, secondary somatosensory cortex (S2), inferior parietal lobe, and basal ganglia. The contralateral S2 was more activated by strong stimulation than by weak stimulation. Some areas in the basal ganglia (bilateral putamen and caudate nucleus) were more activated by muscle stimulation than by bone stimulation. The putamen and caudate nucleus may have a more significant role in brain processing of muscle pain compared with bone pain.

  13. Avaliação eletromiográfica e ressonância magnética do joelho de indivíduos com síndrome da dor femoropatelar Electromyographic and magnetic resonance imaging evaluations of individuals with patellofemoral pain syndrome

    Directory of Open Access Journals (Sweden)

    Alessandra C. S. Ribeiro

    2010-06-01

    Full Text Available OBJETIVOS: Analisar a atividade elétrica (EMG dos músculos vasto medial oblíquo (VMO, vasto lateral longo (VLL e vasto lateral oblíquo (VLO de indivíduos com síndrome da dor femoropatelar (SDFP durante contração isométrica voluntária máxima (CIVM de extensão da perna com o joelho a 30(0, a dor por meio da Escala Visual Analógica (EVA e o posicionamento da patela por meio da ressonância magnética nuclear por imagem (RMNI. MÉTODOS: Avaliaram-se 12 mulheres com SDFP e 12 clinicamente normais, que realizaram cinco CIVM de extensão da perna no ângulo de 30(0 para análise da EMG. Avaliou-se o ângulo do sulco (AS, ângulo de congruência (AC, ângulo de inclinação patelar (AIP e deslocamento patelar (DP pela RMNI. Utilizaram-se testes estatísticos: ANOVA, análise de variância de medidas repetidas para EMG; o teste Mann-Whitney U para análise da RMNI; o teste de correlação de Pearson (r entre EMG e RMNI e análise de variância one-way para avaliação da dor (pOBJECTIVES: To analyze the electrical activity of the vastus medialis obliquus (VMO, vastus lateralis longus (VLL and vastus lateralis obliquus (VLO muscles of individuals with patellofemoral pain syndrome (PFPS during maximum voluntary isometric contraction (MVIC of lower leg extension with the knee at 30°; to assess pain using a visual analogue scale (VAS; and to assess patellar positioning using magnetic resonance imaging (MRI. METHODS: Twelve women with PFPS and 12 clinically normal women were evaluated. They performed five MVICs of lower leg extension at 30° for electromyographic (EMG analysis. Using MRI, the sulcus angle (SA, congruence angle (CA, patellar tilt angle (PTA and patellar displacement (PD were obtained. The following statistical tests were used: analysis of variance (ANOVA for repeated measurements to assess EMGs; Mann-Whitney U test to analyze MRIs; Pearson's (r correlation test between EMGs and MRIs; and one-way ANOVA to evaluate pain (p<0

  14. Patellofemoral pain in athletes

    Directory of Open Access Journals (Sweden)

    Petersen W

    2017-06-01

    Full Text Available Wolf Petersen,1 Ingo Rembitzki,2 Christian Liebau3 1Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Grunewald, Berlin; 2German Sport University Cologne, 3Asklepios Clinic, Bad Harzburg, Germany Abstract: Patellofemoral pain (PFP is a frequent cause of anterior knee pain in athletes, which affects patients with and without structural patellofemoral joint (PFJ damage. Most younger patients do not have any structural changes to the PFJ, such as an increased Q angle and a cartilage damage. This clinical entity is known as patellofemoral pain syndrome (PFPS. Older patients usually present with signs of patellofemoral osteoarthritis (PFOA. A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking. Causes of dynamic valgus include weak hip muscles and rearfoot eversion with pes pronatus valgus. These factors can also be observed in patients with PFOA. The available evidence suggests that patients with PFP are best managed with a tailored, multimodal, nonoperative treatment program that includes short-term pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs, passive correction of patellar maltracking with medially directed tape or braces, correction of the dynamic valgus with exercise programs that target the muscles of the lower extremity, hip, and trunk, and the use of foot orthoses in patients with additional foot abnormalities. Keywords: anterior knee pain, dynamic valgus, hip strength, rearfoot eversion, single leg squat, hip strength 

  15. A Functional Magnetic Resonance Imaging Study to Investigate the Utility of a Picture Imagination Task in Investigating Neural Responses in Patients with Chronic Musculoskeletal Pain to Daily Physical Activity Photographs.

    Directory of Open Access Journals (Sweden)

    Ann M Taylor

    Full Text Available Pain-related anxiety and fear are associated with increased difficulties in attention, increased awareness of pain, impaired disengagement from pain, and can moderate the effects of attentional coping attempts. Accurately assessing the direct impact of pain-related anxiety and fear on pain behavior has proved difficult. Studies have demonstrated no or limited influence of pain-related fear and anxiety on behavior but this may be due to inherent problems with the scales used. Neuroimaging has improved the understanding of neural processes underlying the factors that influence pain perception. This study aimed to establish if a Picture and Imagination Task (PIT, largely developed from the Photographs of Daily Activity (PHODA assessment tool, could help explore how people living with chronic pain process information about daily activities. Blood oxygenation level dependent (BOLD functional magnetic resonance imaging (fMRI was used to compare brain responses in patients with chronic musculoskeletal pain (CMSKP (n = 15 and healthy controls (n = 15. Subjects were asked to imagine how they would feel mentally and physically if asked to perform daily activities illustrated in PIT. The results found that a number of regions involved in pain processing saw increased BOLD activation in patients compared with controls when undertaking the task and included the insula, anterior cingulate cortex, thalamus and inferior and superior parietal cortices. Similarly, increased BOLD responses in patients compared to controls in the frontal pole, paracingulate and the supplementary motor cortex may be suggestive of a memory component to the responses The amygdala, orbitofrontal cortex, substantia nigra/ventral tegmentum, putamen, thalamus, pallidum, inferior parietal (supramarginal and angular gyrus and cingulate cortex were also seen to have greater differences in BOLD signal changes in patients compared with controls and many of these regions are also associated

  16. Intensive treatment of leg lymphedema

    Directory of Open Access Journals (Sweden)

    Pereira de Godoy Jose

    2010-01-01

    Full Text Available Background: Despite of all the problems caused by lymphedema, this disease continues to affect millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is necessary. Aim: The aim of this study was to evaluate a novel intensive outpatient treatment for leg lymphedema. Methods: Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The inclusion criteria were patients with Grade II and III lymphedema, where the difference, measured by volumetry, between the affected limb below the knee and the healthy limb was greater than 1.5 kg. Intensive treatment was carried out for 6- to 8-h sessions in the outpatient clinic. Analysis of variance was utilized for statistical analysis with an alpha error of 5% (P-value < 0.05 being considered significant. Results: All limbs had significant reductions in size with the final mean loss being 81.1% of the volume of edema. The greatest losses occurred in the first week (P-value < 0.001. Losses of more than 90% of the lymphedema occurred in 9 (39.13% patients; losses of more than 80% in 13 (56.52%, losses of more than 70% in 17 (73.91% and losses of more than 50% were recorded for 95.65% of the patients; only 1 patient lost less than 50% (37.9% of the edema. Conclusion: The intensive treatment of lymphedema in the outpatient clinic can produce significant reductions in the volume of edema over a short period of time and can be recommended for any grade of lymphedema, in particular the more advanced degrees.

  17. Leg Muscle Mass and Foot Symptoms, Structure, and Function: The Johnston County Osteoarthritis Project.

    Science.gov (United States)

    Golightly, Yvonne M; Dufour, Alyssa B; Hannan, Marian T; Hillstrom, Howard J; Katz, Patricia P; Jordan, Joanne M

    2016-03-01

    Loss of muscle mass occurs with aging and in lower limbs it may be accelerated by foot problems. In this cross-sectional analysis, we evaluated the relationship of leg muscle mass to foot symptoms (presence or absence of pain, aching, or stiffness), structure while standing (high arch or low arch), and function while walking (pronated or supinated) in a community-based study of Caucasian and African American men and women who were 50-95 years old. In the Johnston County Osteoarthritis Project, leg muscle mass was measured with whole body dual-energy x-ray absorptiometry, and plantar foot pressure data, using predetermined values, were used to classify foot structure and function. Sex-specific crude and adjusted (age, body mass index, and race) linear regression models examined associations of leg muscle mass index (Leg muscle mass [kg]/Height [m](2)) with foot symptoms, structure, and function. Complete data were available for 1,037 participants (mean age 68 years, mean body mass index 31 kg/m(2), 68% women, 29% African American). In women, pronated foot function was associated with lower leg muscle mass in crude (p = .02), but not adjusted (p = .22), models. A low arch was associated with a higher leg muscle mass in adjusted models for both men and women (p Leg muscle mass was associated with foot structure in our biracial sample, whereas relations between leg muscle mass and foot function were attenuated by age, body mass index, and race. Future longitudinal analyses are needed to explain the temporal relationship between these conditions and how they relate to other aspects of impairment and physical function. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Leg blood flow during static exercise.

    Science.gov (United States)

    Kilbom, A; Persson, J

    1982-01-01

    Leg blood flow was studied with the constant infusion dye technique during static exercise of the thigh muscles (quadriceps) and during hand-grips at 15 and 25-30% of MVC. Blood flow and oxygen uptake in the leg increased in quadriceps exercise and reached their highest values (around 1.21/min and 165 ml/min respectively) at 25-30% of MVC, whereas leg vascular resistance decreased. Regional circulatory adaptations and the oxygen uptake - leg blood flow relationship were in close agreement with the responses found in dynamic leg exercise. In view of the marked rise in intramuscular pressure previously observed during quadriceps contractions, a restriction of blood flow and an increased vascular resistance had been expected. Involuntary activation of leg muscles other than the quadriceps may explain the finding. Contractions of the contralateral quadriceps induced a slight increase in leg blood flow, whereas hand-grips had no influence on blood flow or vascular resistance in the leg. The distribution of the cardiac output during static contractions is discussed, and it is concluded that during hand-grips the increase in blood flow is predominantly distributed to the upper part of the body.

  19. Børns leg og eksperimenterende virksomhed

    DEFF Research Database (Denmark)

    Damgaard Warrer, Sarah; Broström, Stig

    Børns leg og eksperimenterende virksomhed er et rigt felt med mange perspektiver, indgangsvinkler og nuancer. I denne bog kædes leg og det eksperimenterende og skabende sammen som to gensidigt forbundne fænomener og belyses i pædagogisk og didaktisk perspektiv. Desuden beskrives potentialet i båd...

  20. Muscle functional magnetic resonance imaging and acute low back pain: a pilot study to characterize lumbar muscle activity asymmetries and examine the effects of osteopathic manipulative treatment.

    Science.gov (United States)

    Clark, Brian C; Walkowski, Stevan; Conatser, Robert R; Eland, David C; Howell, John N

    2009-08-27

    Muscle functional magnetic resonance imaging (mfMRI) measures transverse relaxation time (T2), and allows for determination of the spatial pattern of muscle activation. The purposes of this pilot study were to examine whether MRI-derived T2 or side-to-side differences in T2 (asymmetries) differ in low back muscles between subjects with acute low back pain (LBP) compared to asymptomatic controls, and to determine if a single osteopathic manipulative treatment (OMT) session alters these T2 properties immediately and 48-hours after treatment. Subjects with non-specific acute LBP (mean score on 110 visual analog score = 3.02 +/- 2.81) and asymptomatic controls (n = 9/group) underwent an MRI, and subsequently the LBP subjects received OMT and then underwent another MRI. The LBP subjects reported back for an additional MRI 48-hours following their initial visit. T2 and T2 asymmetry were calculated from regions of interest for the psoas, quadratus lumborum (QL), multifidus, and iliocostalis lumborum/longissimus thoracis (IL/LT) muscles. No differences were observed between the groups when T2 was averaged for the left and right side muscles. However, the QL displayed a significantly greater T2 asymmetry in LBP subjects when compared to controls (29.1 +/- 4.3 vs. 15.9 +/- 4.1%; p = 0.05). The psoas muscle also displayed a relatively large, albeit non-significant, mean difference (22.7 +/- 6.9 vs. 9.5 +/- 2.8%; p = 0.11). In the subjects with LBP, psoas T2 asymmetry was significantly reduced immediately following OMT (25.3 +/- 6.9 to 6.1 +/- 1.8%, p = 0.05), and the change in LBP immediately following OMT was correlated with the change in psoas T2 asymmetry (r = 0.75, p = 0.02). Collectively, this pilot work demonstrates the feasibility of mfMRI for quantification and localization of muscle abnormalities in patients with acute low back pain. Additionally, this pilot work provides insight into the mechanistic actions of OMT during acute LBP, as it suggests that it may

  1. Active and Inactive Leg Hemodynamics during Sequential Single-Leg Interval Cycling.

    Science.gov (United States)

    Gordon, Nicole; Abbiss, Chris R; Ihsan, Mohammed; Maiorana, Andrew J; Peiffer, Jeremiah J

    2018-01-11

    Leg order during sequential single-leg cycling (i.e. exercising both legs independently within a single session) may affect local muscular responses potentially influencing adaptations. This study examined the cardiovascular and skeletal muscle hemodynamic responses during double-leg and sequential single-leg cycling. Ten young healthy adults (28 ± 6 y) completed six 1-min double-leg intervals interspersed with one minute of passive recovery and, on a separate occasion, 12 (six with one leg followed by six with the other leg) 1-min single-leg intervals interspersed with one minute of passive recovery. Oxygen consumption, heart rate, blood pressure, muscle oxygenation, muscle blood volume and power output were measured throughout each session. Oxygen consumption, heart rate and power output were not different between sets of single-leg intervals but the average of both sets was lower than the double-leg intervals. Mean arterial pressure was higher during double-leg compared with sequential single-leg intervals (115 ± 9 mmHg vs. 104 ± 9 mmHg; p<0.05) and higher during the initial compared with second set of single-leg intervals (108 ± 10 mmHg vs. 101 ± 10 mmHg; p<0.05). The increase in muscle blood volume from baseline was similar between the active single-leg and double-leg (267 ± 150 μM[BULLET OPERATOR]cm vs. 214 ± 169 μM[BULLET OPERATOR]cm; p=0.26). The pattern of change in muscle blood volume from the initial to second set of intervals was significantly different (p<0.05) when the leg was active in the initial (-52.3 ± 111.6%) compared with second set (65.1 ± 152.9%). These data indicate that the order in which each leg performs sequential single-leg cycling influences the local hemodynamic responses, with the inactive muscle influencing the stimulus experienced by the contralateral leg.

  2. Pain and neuroplasticity

    Directory of Open Access Journals (Sweden)

    Sabine Sator-Katzenschlager, MD.

    2014-07-01

    However, the cerebral processing of hyperalgesia and allodynia is still controversially discussed. In recent years, neuroimaging methods (functional magnetic resonance imaging, fMRI; magnetoencephalography, MEG; positron emission tomography, PET have provided new insightsinto the aberrant cerebral processing of neuropathic pain. Thepresent paper reviews different cerebral mechanisms contributing to chronicity processes in neuropathic pain syndromes. These mechanisms include reorganisation of cortical somatotopic maps in sensory or motor areas (highly relevant for phantom limb pain and CRPS, increased activity in primary nociceptive areas, recruitment of new cortical areas usually not activated by nociceptive stimuli and aberrant activity in brain areas normally involved in descending inhibitory pain networks. Moreover, there is evidence from PET studies for changes of excitatory and inhibitory transmitter systems. Finally, advanced methods of structural brain imaging (voxel-based morphometry, VBM show significant structural changes suggesting that chronic pain syndromes may be associated with neurodegeneration.

  3. Neuropathic pain in spinal cord injury.

    Science.gov (United States)

    Nakipoglu-Yuzer, Guidal F; Atçı, Nermin; Ozgirgin, Nese

    2013-01-01

    Several studies have described pain prevalence, risk factors, pain and medical variables in spinal cord injury (SCI) populations. In this study on traumatic SCI in Turkey, we surveyed the neuropathic pain experiences during in-patient rehabilitation and defined the relationships between neuropathic pain and demographic and SCI characteristics of patients. To survey the neuropathic pain experiences during in-patient rehabilitation in traumatic SCI and to define the relationships between neuropathic pain and demographic and SCI-related characteristics of patients. Descriptive study. Physicial Medicine and Rehabilitation inpatient clinic, Ankara, Turkey Sixty-nine SCI patients as inpatients were included in this descriptive study. All patients demographic and SCI-related characteristics were enrolled. The diagnosis of neuropathic pain was made with the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale. Location of pain and pain description, relation to time and severity according to McGill Pain Questionnaire (MPQ) were enrolled. The neuropathic pain localization was below the lesion level in 67 (97.1%) and at the lesion level in 2 (2.9%) patients. The pain was at the hip and leg regions in 36 (52.2%) patients. The neuropathic pain was defined as burning in 27 (39.1%), aching in 26 (37.7%), sharp in 4 (5.8%), stinging in 3 (4.3%), and cramping in 3 (4.3%). We did not find a significant difference between demographic and SCI-related characteristics and the localization of neuropathic pain for the patients (P > 0.05). There was no significant difference according to pain description by MPQ and pain localization (P > 0.05). We found a significant relationship between the patient's lesion level and the region of pain (P neuropathic pain due to SCI to be mostly below the lesion level with a burning or aching character and we did not find a significant relationship between the demographic and SCI-related characteristics of the patient and the pain

  4. Cancer pain

    International Nuclear Information System (INIS)

    Swerdlow, M.; Ventafridda, V.

    1987-01-01

    This book contains 13 chapters. Some of the chapter titles are: Importance of the Problem; Neurophysiology and Biochemistry of Pain; Assessment of Pain in Patients with Cancer; Drug Therapy; Chemotherapy and Radiotherapy for Cancer Pain; Sympton Control as it Relates to Pain Control; and Palliative Surgery in Cancer Pain Treatment

  5. Cognitive processes in comorbid poor sleep and chronic pain.

    Science.gov (United States)

    Byers, Haley D; Lichstein, Kenneth L; Thorn, Beverly E

    2016-04-01

    We examined the unique and shared contributions of pain catastrophizing, cognitive pre-sleep arousal, and somatic pre-sleep arousal, to the prediction of insomnia severity in chronic pain. Forty-eight adults with chronic pain completed self-report measures of these study variables, health, and mood. Hierarchical regression showed that pain catastrophizing accounted for unique variance in insomnia severity, independent of pain intensity, depression, restless legs symptoms, and demographics. However, when cognitive and somatic pre-sleep arousal were also taken into account, the significance of cognitive pre-sleep arousal rendered pain catastrophizing non-significant. We identify research and clinical implications of this study.

  6. Diagnostic value of lasik test for detection of lumbar discopathy in patients attending emergency department with acute low back pain

    Science.gov (United States)

    Aala, Alireza; Alizadeh Shahri, Saeid; Meshkini, Ali; Shams Vahdati, Samad

    2012-01-01

    Abstract: Background: Low back pain is one of the most important health problems. Disk herniation is one of the common causes of low back pain. Accurate examination is the best and simplest diagnostic methods. Physical examination, Straight leg raise (SLR) and neurologic tests as well as other tests are usually used to locate the exact place of herniation. Paraclinical studies such as magnetic resonance imaging (MRI) should be used because of the low diagnostic efficiency of physical examination. Methods: 100 patients attended the emergency unit because of back pain or radicular pain, were enrolled in the study. SLR, Reverse- SLR (R-SLR) and Crossed-SLR (C-SLR) tests were performed for all patients. Then, the patients were referred to the neurosurgery unit for treatment. Lumbar MRI was taken for all patients. Then, all patients were followed up and these data were collected. Results: Sensitivity and specificity of SLR test, C-SLR, and R-SLR tests was 77.52% and 36.36%, 29.21% and 90.9%, and 88.89% and 10.94%, respectively. There was no significant relationship between MRI and positive discopathy in the physical examination and SLR (P=0.11). Conclusions: SLR test has high sensitivity and low specificity. If the SLR test was accompanied by with physical examination the resulting sensitivity and specificity will increase. Findings of this study showed that SLR test has more sensitivity, while C-SLR has more specificity in low back pain diagnosis. Keywords: SLR test, Low Back Pain, Discopathy, Straight leg raise

  7. Effect of leg length on ROM, VJ and leg dexterity in dance.

    Science.gov (United States)

    Wyon, M A; Nevill, A M; Dekker, K; Brown, D D; Clarke, F; Pelly, J; Koutedakis, Y

    2010-09-01

    We investigated the associations between leg length and specific ballet movements in different skill groups. Volunteers were from an undergraduate dance programme (n=18), a pre-professional school (n=43) and from an elite classical ballet company (n=45). Individual data were collected for anthropometry, vertical jump, leg dexterity, and leg active and passive ROM. ANCOVA identified both main effects as significant with regard to vertical jump (gender Peffects with gender, skill or leg length. Active and passive range of motion noted gender (P=0.001) and skill (Peffects of leg length on fundamental ballet skills. The longer legs that benefit vertical jump have a negative influence on range of motion and leg dexterity except for highly skilled dancers, who through skill, seem to have overcome the effects of some of these dichotomies. Georg Thieme Verlag KG Stuttgart . New York.

  8. A modified straight leg raise test to differentiate between sural nerve pathology and Achilles tendinopathy. A cross-sectional cadaver study

    NARCIS (Netherlands)

    Coppieters, M.W.J.; Crooke, J.L.; Lawrenson, P.R.; Khoo, S.J.; Skulstad, T.; Bet-Or, Y.

    2015-01-01

    Background: A modified straight leg raise test for the sural nerve (SLRSURAL) has been proposed to assist in the differential diagnosis of sural nerve pathology in people with posterior calf or ankle pain, or lateral foot pain. The biomechanical rationale is that strain in the

  9. Muscle activity during the active straight leg raise (ASLR), and the effects of a pelvic belt on the ASLR and on treadmill walking

    NARCIS (Netherlands)

    Hu, H.; Meijer, O.G.; van Dieen, J.H.; Hodges, P.W.; Bruijn, S.M.; Strijers, R.L.M.; Nanayakkara, P.W.B.; van Royen, B.J.; Wu, W.H.; Xia, C.

    2010-01-01

    Women with pregnancy-related pelvic girdle pain (PPP), or athletes with groin pain, may have trouble with the active straight leg raise (ASLR), for which a pelvic belt can be beneficial. How the problems emerge, or how the belt works, remains insufficiently understood. We assessed muscle activity

  10. Evaluation of the pain and local tenderness in bone metastasis treated with magnetic resonance-guided focused ultrasound surgery (MRgFUS)

    Science.gov (United States)

    Namba, Hirofumi; Kawasaki, Motohiro; Kato, Tomonari; Tani, Toshikazu; Ushida, Takahiro; Koizumi, Norihiro

    2017-03-01

    It has been reported that MRgFUS has pain palliative effects on the local pain in patients with bone metastasis. In general, a severity of pain has been evaluated using only subjective method with numerical rating scale (NRS) or visual analogue scale (VAS). It is important to evaluate local pain-palliative effects of MRgFUS treatment with objective and quantitative method. The aim of this study is to investigate changes in the severity of local pain of bone metastasis before and after MRgFUS treatments, measuring pressure pain threshold (PPT) using pressure algometer, and pain intensity using electrical stimulation device (the Pain Vision system) at most painful site of bone metastasis. We have conducted MRgFUS for pain palliation of bone metastasis for 8 patients, and evaluated the local tenderness quantitatively for 8 patients, and evaluated local pain intensity for 7 patients. Before the treatments, PPTs were 106.3kPa [40.0-431.5] at metastatic site and 344.8 kPa [206.0-667.0] at normal control site, which showed a significant difference. The PPTs at metastatic site shows a significant increase from 106.3 kPa [40.0-431.5] at the baseline to 270.5 kPa [93.5-533.5] at 3 months after the treatment. The NRS score shows a significant decrease from 6.0 [4-8] at baseline to 1 [0-3] at 3 months after the treatment. Similarly, the pain intensity shows a significant decrease 245 [96.3-888.7] at baseline to 55.9 [2.8-292] at 3 months after the treatment. The results of our study illustrate the pain-relieving effects of MRgFUS for the treatment of painful bone metastasis. PPT might be a useful parameter not only for assessing a treatment's effect, but also for the decision of the painful area to treat with MRgFUS. Pain Vision seems to be useful for quantitative and objective evaluation of local pain of painful bone metastasis.

  11. Pain education combined with neck- and aerobic training is more effective at relieving chronic neck pain than pain education alone--A preliminary randomized controlled trial.

    Science.gov (United States)

    Brage, K; Ris, I; Falla, D; Søgaard, K; Juul-Kristensen, B

    2015-10-01

    To evaluate the effect of training and pain education vs pain education alone, on neck pain, neck muscle activity and postural sway in patients with chronic neck pain. Twenty women with chronic neck pain were randomized to receive pain education and specific training (neck-shoulder exercises, balance and aerobic training) (INV), or pain education alone (CTRL). Effect on neck pain, function and Global Perceived Effect (GPE) were measured. Surface electromyography (EMG) was recorded from neck flexor and extensor muscles during performance of the Cranio-Cervical Flexion Test (CCFT) and three postural control tests (two-legged: eyes open and closed, one-legged: eyes open). Sway parameters were calculated. Fifteen participants (CTRL: eight; INV: seven) completed the study. Per protocol analyses showed a larger pain reduction (p = 0.002) for the INV group with tendencies for increased GPE (p = 0.06), reduced sternocleidomastoid activity during the CCFT (p = 0.09), reduced sway length (p = 0.09), and increased neck extensor activity (p = 0.02) during sway compared to the CTRL group. Pain education and specific training reduce neck pain more than pain education alone in patients with chronic neck pain. These results provide encouragement for a larger clinical trial to corroborate these observations. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Steerable Hopping Six-Legged Robot

    Science.gov (United States)

    Younse, Paulo; Aghazarian, Hrand

    2010-01-01

    The figure depicts selected aspects of a six-legged robot that moves by hopping and that can be steered in the sense that it can be launched into a hop in a controllable direction. This is a prototype of hopping robots being developed for use in scientific exploration of rough terrain on remote planets that have surface gravitation less than that of Earth. Hopping robots could also be used on Earth, albeit at diminished hopping distances associated with the greater Earth gravitation. The upper end of each leg is connected through two universal joints to an upper and a lower hexagonal frame, such that the tilt of the leg depends on the relative position of the two frames. Two non-back-driveable worm-gear motor drives are used to control the relative position of the two frames along two axes 120 apart, thereby controlling the common tilt of all six legs and thereby, further, controlling the direction of hopping. Each leg includes an upper and a lower aluminum frame segment with a joint between them. A fiberglass spring, connected via hinges to both segments, is used to store hopping energy prior to launch into a hop and to cushion the landing at the end of the hop. A cable for loading the spring is run into each leg through the center of the universal joints and then down along the center lines of the segments to the lower end of the leg. A central spool actuated by a motor with a harmonic drive and an electromagnetic clutch winds in all six cables to compress all six springs (thereby also flexing all six legs) simultaneously. To ensure that all the legs push off and land in the same direction, timing- belt pulley drives are attached to the leg segments, restricting the flexing and extension of all six legs to a common linear motion. In preparation for a hop, the spool can be driven to load the spring legs by an amount corresponding to a desired hop distance within range. The amount of compression can be computed from the reading of a shaft-angle encoder that

  13. Back Pain

    Science.gov (United States)

    ... Accessed May 29, 2015. Adult acute and subacute low back pain. Bloomington, Minn.: Institute for Clinical Systems Improvement. http://www.icsi.org/low_back_pain/adult_low_back_pain__8.html. Accessed June ...

  14. Abdominal Pain

    Science.gov (United States)

    ... to ease your pain. For instance, eat smaller meals if your pain is accompanied by indigestion. Avoid ... http://www.mayoclinic.org/symptoms/abdominal-pain/basics/definition/SYM-20050728 . Mayo Clinic Footer Legal Conditions and ...

  15. Knee pain

    Science.gov (United States)

    Pain - knee ... Knee pain can have different causes. Being overweight puts you at greater risk for knee problems. Overusing your knee can trigger knee problems that cause pain. If you have a history of arthritis, it ...

  16. Breast pain

    Science.gov (United States)

    Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, changes in the level of of hormones during menstruation or pregnancy often cause breast pain. Some swelling and tenderness just before ...

  17. Foot pain

    Science.gov (United States)

    Pain - foot ... Foot pain may be due to: Aging Being on your feet for long periods of time Being overweight A ... sports activity Trauma The following can cause foot pain: Arthritis and gout . Common in the big toe, ...

  18. Eye pain

    Science.gov (United States)

    Ophthalmalgia; Pain - eye ... Pain in the eye can be an important symptom of a health problem. Make sure you tell your health care provider if you have eye pain that does not go away. Tired eyes or ...

  19. Wrist pain

    Science.gov (United States)

    Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ...

  20. Ankle pain

    Science.gov (United States)

    Pain - ankle ... Ankle pain is often due to an ankle sprain. An ankle sprain is an injury to the ligaments, which ... the joint. In addition to ankle sprains, ankle pain can be caused by: Damage or swelling of ...

  1. The effect of shiatsu massage on pain reduction in burn patients.

    Science.gov (United States)

    Ardabili, Fatemeh Mohaddes; Purhajari, Soybeh; Najafi Ghezeljeh, Tahereh; Haghani, Hamid

    2014-07-01

    Burn is a tragedy that follows multiple problems in a patient including pain, anxiety and lack of confidence into medical team. This study evaluated the effect of shiatsu massage on pain intensity of burn patients. A total of 120 burn patients from Motahhari Burn Hospital and of both genders were randomly divided into 4 groups of undergoing hand massage, leg massage, both hand and leg massages, and the control group. The effect of shiatsu massage in pain relief of burned patients was evaluated. The visual analog scale (VAS) was used to assess pain in burn patients. Pain intensity in the control group before and after the intervention was not statistically significant (p=1). In all massage groups, the difference for pain intensity before and after the intervention was statistically significant. According to our data, shiatsu method over both hands and legs were effective in pain reduction and can be recommended together with analgesics to decrease the dose.

  2. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1993-01-01

    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...... 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...

  3. The Impact of Pain on Different Aspects of Life Among Older People With Chronic Pain

    Directory of Open Access Journals (Sweden)

    Seyed Mahmoud Mirzamani

    2008-04-01

    Full Text Available Objectives: This study aimed to investe the impact of pain on older people with chronic pain. Methods & Materials: Participants were 585 individuals (n=77 aged 60 years andover, n=508 aged Lessthan 60 years old with chronic pain in their leg, back, hands, neck and shoulders. The main assessment measure was the West Haven-Yale Multidimensional Pain Inventory (WHYMPI. Results: The two groups showed significant differences in three scales of important dimentions of pain experience. The old patients experienced more sever pain which effected their life, family supports and dependency. There were significant differents in three scales of evaluation and report of routin activities in the two groups. Conclusion: The old patients with chronic pain experienced more sever pain. The more sever pain, the more negative impact of pain in their life, requirement family support and dependency. Also, in the old patients with chronic pain group, the effect of chronic pain was more on outdoor activities, social and general activities than the group of usual patients with chronic pain. So, we should have more attention to general and social activities for providing care among older people with chrcnic pain than the other goups with chronic pain.

  4. Ossification of the Interosseous Membrane of the Leg in a Football Player: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Roberto Postacchini

    2016-01-01

    Full Text Available Introduction. We report a case of ossification of the interosseous membrane (OIM of the leg in a football player who had no history of severe local traumas. A review of the literature of the OIM of the leg in athletes was also carried out. Case Report. A 38-year-old Caucasian male patient complained of pain on lateral aspect of the leg when playing football. Pain progressively worsened until he had to stop the sporting activity. Radiographs, and then CT and MRI, showed OIM in the middle third of the left leg. MRI showed inflammation of tibia periosteum and bone adjacent to the ossification, which was then excised. Two months after surgery the patient returned to play football. Conclusion. A thorough analysis of the literature revealed three types of OIM of the leg in athletes. Type I usually occurs after a syndesmosis ankle sprain, Type II appears to result from a tibia fracture, and Type III, of which only one fully recorded case has been published, is probably caused, as in our patient, by repetitive minor traumas to the leg. Awareness of the existence of Type III OIM can avoid erroneous diagnoses leading to useless investigations and treatments.

  5. The Role of Complex Treatment in Mixed Leg Ulcers – A Case Report of Vascular, Surgical and Physical Therapy

    Science.gov (United States)

    Wollina, Uwe; Heinig, Birgit; Stelzner, Christian; Hansel, Gesina; Schönlebe, Jacqueline; Tchernev, Georgi; Lotti, Torello

    2018-01-01

    BACKGROUND: Leg ulcers are a burden to patients, their families and society. The second most common cause of chronic leg ulcers is the mixed arterio-venous type. An 80-year-old female patient presented to our department due to painful enlarging chronic leg ulcer of mixed arteriovenous origin on her left lower leg. She suffered from peripheral arterial occlusive disease stage I and chronic venous insufficiency Widmer grade IIIa, and a number of comorbidities. AIM: The aim of our ulcer treatment was a complete and stable wound closure that was hampered by arterial occlusion, exposed tendon, and renal insiffuciency. CASE REPORT: To improve the prognosis for ulcer surgery, we performed percutaneous transluminal angioplasty, transcutaneous CO2 and deep ulcer shaving. The wound was closed by sandwich transplantation using elastin-collagen dermal template and meshed split skin graft. She had a 100% graft take with rapid reduction of severe wound pain. CONCLUSION: Complex approaches are necessary, to gain optimum results in leg ulcer therapy in mixed leg ulcers. Therapeutic nihilism should be abandonend. PMID:29483986

  6. A common neural element receiving rhythmic arm and leg activity as assessed by reflex modulation in arm muscles.

    Science.gov (United States)

    Sasada, Syusaku; Tazoe, Toshiki; Nakajima, Tsuyoshi; Futatsubashi, Genki; Ohtsuka, Hiroyuki; Suzuki, Shinya; Zehr, E Paul; Komiyama, Tomoyoshi

    2016-04-01

    Neural interactions between regulatory systems for rhythmic arm and leg movements are an intriguing issue in locomotor neuroscience. Amplitudes of early latency cutaneous reflexes (ELCRs) in stationary arm muscles are modulated during rhythmic leg or arm cycling but not during limb positioning or voluntary contraction. This suggests that interneurons mediating ELCRs to arm muscles integrate outputs from neural systems controlling rhythmic limb movements. Alternatively, outputs could be integrated at the motoneuron and/or supraspinal levels. We examined whether a separate effect on the ELCR pathways and cortico-motoneuronal excitability during arm and leg cycling is integrated by neural elements common to the lumbo-sacral and cervical spinal cord. The subjects performed bilateral leg cycling (LEG), contralateral arm cycling (ARM), and simultaneous contralateral arm and bilateral leg cycling (A&L), while ELCRs in the wrist flexor and shoulder flexor muscles were evoked by superficial radial (SR) nerve stimulation. ELCR amplitudes were facilitated by cycling tasks and were larger during A&L than during ARM and LEG. A low stimulus intensity during ARM or LEG generated a larger ELCR during A&L than the sum of ELCRs during ARM and LEG. We confirmed this nonlinear increase in single motor unit firing probability following SR nerve stimulation during A&L. Furthermore, motor-evoked potentials following transcranial magnetic and electrical stimulation did not show nonlinear potentiation during A&L. These findings suggest the existence of a common neural element of the ELCR reflex pathway that is active only during rhythmic arm and leg movement and receives convergent input from contralateral arms and legs. Copyright © 2016 the American Physiological Society.

  7. Period Pain

    Science.gov (United States)

    ... pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include ibuprofen and naproxen. Besides relieving pain, NSAIDs reduce the amount of prostaglandins that your uterus ...

  8. A Randomized, Double-Blind, Placebo-Controlled Clinical Trial Using a Low-Frequency Magnetic Field in the Treatment of Musculoskeletal Chronic Pain

    OpenAIRE

    Alex W Thomas; Karissa Graham; Frank S Prato; Julia McKay; Patricia Morley Forster; Dwight E Moulin; Sesh Chari

    2007-01-01

    Exposure to a specific pulsed electromagnetic field (PEMF) has been shown to produce analgesic (antinociceptive) effects in many organisms. In a randomized, double-blind, sham-controlled clinical trial, patients with either chronic generalized pain from fibromyalgia (FM) or chronic localized musculoskeletal or inflammatory pain were exposed to a PEMF (400 μT) through a portable device fitted to their head during twice-daily 40 min treatments over seven days. The effect of this PEMF on pain re...

  9. The effect of Vitamin D and calcium plus Vitamin D on leg cramps in pregnant women: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Ameneh Mansouri

    2017-01-01

    Full Text Available Background: This study intended to determine the effects of Vitamin D and calcium-Vitamin D in treating leg cramps in pregnant women. Materials and Methods: This study was conducted as a double-blind randomized controlled clinical trial on 126 participants, 18–35-year-old pregnant women with a minimum of two leg cramps per week who were referred to health-care centers in Tabriz-Iran in 2013. The participants were allocated to three 42 member groups using a randomized block design. For 42 days, the intervention groups took a 1000 unit Vitamin D pill or 300 mg calcium carbonate plus a 1000 unit Vitamin D pill, and the control group received a placebo pill every day. The participants were evaluated with regard to the frequency, length, and pain intensity of leg cramps during the week before and during the 3rd and 6th week of the intervention. The ANCOVA and repeated measurement test were used to analyze the data. Results: Results showed that controlling for the effects before the intervention, calcium-Vitamin D, and Vitamin D supplements had no effect on the frequency, length, and pain intensity of leg cramps. Conclusion: The results of this study showed that the calcium-Vitamin D and the Vitamin D supplements have no effect on the frequency, length, and pain intensity of leg cramps during the 6 weeks of the study.

  10. Reduction in corticospinal inhibition in the trained and untrained limb following unilateral leg strength training.

    Science.gov (United States)

    Latella, Christopher; Kidgell, Dawson J; Pearce, Alan J

    2012-08-01

    This study used transcranial magnetic stimulation to measure the corticospinal responses following 8 weeks of unilateral leg strength training. Eighteen healthy, non-strength trained participants (14 male, 4 female; 18-35 years of age) were matched for age, gender, and pre-training strength; and assigned to a training or control group. The trained group participated in unilateral horizontal leg press strength training, progressively overloaded and wave periodised, thrice per week for 8 weeks. Testing occurred prior to the intervention, at the end of 4 weeks and at the completion of training at 8 weeks. Participants were tested in both legs for one repetition maximum strength, muscle thickness, maximal electromyography (EMG) activity, and corticospinal excitability and inhibition. No changes were observed in muscle thickness in either leg. The trained leg showed an increase in strength of 21.2% (P = 0.001) and 29.0% (P = 0.007, compared to pre-testing) whilst the untrained contralateral leg showed 17.4% (P = 0.01) and 20.4% (P = 0.004, compared to pre-testing) increases in strength at 4 and 8 weeks, respectively. EMG and corticospinal excitability did not change; however, corticospinal inhibition was significantly reduced by 17.7 ms (P = 0.003) and 17.3 ms (P = 0.001) at 4 and 8 weeks, respectively, in the trained leg, and 25.1 ms (P = 0.001) and 20.8 ms (P = 0.001) at 4 and 8 weeks, respectively, in the contralateral untrained leg. This data support the theory of corticospinal adaptations underpinning cross-education gains in the lower limbs following unilateral strength training.

  11. Hot Leg Piping Materials Issues

    International Nuclear Information System (INIS)

    V. Munne

    2006-01-01

    With Naval Reactors (NR) approval of the Naval Reactors Prime Contractor Team (NRPCT) recommendation to develop a gas cooled reactor directly coupled to a Brayton power conversion system as the space nuclear power plant (SNPP) for Project Prometheus (References a and b) the reactor outlet piping was recognized to require a design that utilizes internal insulation (Reference c). The initial pipe design suggested ceramic fiber blanket as the insulation material based on requirements associated with service temperature capability within the expected range, very low thermal conductivity, and low density. Nevertheless, it was not considered to be well suited for internal insulation use because its very high surface area and proclivity for holding adsorbed gases, especially water, would make outgassing a source of contaminant gases in the He-Xe working fluid. Additionally, ceramic fiber blanket insulating materials become very friable after relatively short service periods at working temperatures and small pieces of fiber could be dislodged and contaminate the system. Consequently, alternative insulation materials were sought that would have comparable thermal properties and density but superior structural integrity and greatly reduced outgassing. This letter provides technical information regarding insulation and materials issues for the Hot Leg Piping preconceptual design developed for the Project Prometheus space nuclear power plant (SNPP)

  12. Assessment of musculoskeletal pain sensitivity and temporal summation by cuff pressure algometry

    DEFF Research Database (Denmark)

    Graven-Nielsen, Thomas; Vaegter, Henrik Bjarke; Finocchietti, Sara

    2015-01-01

    Chronic musculoskeletal pain is linked with sensitization and standardized methodologies for assessment are needed. This study investigated 1) the test-retest reliability of computer-controlled cuff-pressure algometry (pain thresholds and temporal pain summation) on the arm and leg, and 2) condit...

  13. Grid-climbing Behaviour as a Pain Measure for Cancer-induced Bone Pain and Neuropathic Pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Gallego-Pedersen, Simone; Petersen, Nicolas Caesar

    2017-01-01

    Despite affecting millions of people, chronic pain is generally treated insufficiently. A major point of focus has been the lack of translation from preclinical data to clinical results, with the predictive value of chronic pain models being a major concern. In contrast to current focus on stimulus......-based nociceptive responses in preclinical research, development of behavioural tests designed to quantify suspension of normal behaviour is likely a more equivalent readout for human pain-assessment tests. In this study, we quantified grid-climbing behaviour as a non-stimulus-evoked behavioural test for potential...... use as a measure of neuropathic and cancer-induced bone pain in mice. In both models, the grid-climbing test demonstrated pain-related sparing of the affected leg during climbing. In both models, the behaviour was reversed by administration of morphine, suggesting that the observed behaviour was pain-specific....

  14. Low back pain in young athletes. A practical approach.

    Science.gov (United States)

    Harvey, J; Tanner, S

    1991-12-01

    Lumbar spine pain accounts for 5 to 8% of athletic injuries. Although back pain is not the most common injury, it is one of the most challenging for the sports physician to diagnose and treat. Factors predisposing the young athlete to back injury include the growth spurt, abrupt increases in training intensity or frequency, improper technique, unsuitable sports equipment, and leg-length inequality. Poor strength of the back extensor and abdominal musculature, and inflexibility of the lumbar spine, hamstrings and hip flexor muscles may contribute to chronic low back pain. Excessive lifting and twisting may produce sprains and strains, the most common cause of low back pain in adolescents. Blows to the spine may create contusions or fractures. Fractures in adolescents from severe trauma include compression fracture, comminuted fracture, fracture of the growth plate at the vertebral end plate, lumbar transverse process fracture, and a fracture of the spinous process. Athletes who participate in sports involving repeated and forceful hyperextension of the spine may suffer from lumbar facet syndrome, spondylolysis, or spondylolisthesis. The large sacroiliac joint is also prone to irritation. The signs and symptoms of disc herniation in adolescents may be more subtle than in adults. Disorders simulating athletic injury include tumours and inflammatory connective tissue disease. Often, however, a specific diagnosis cannot be made in the young athlete with a low back injury due to the lack of pain localisation and the anatomic complexity of the lumbar spine. A thorough history and physical examination are usually more productive in determining a diagnosis and guiding treatment than imaging techniques. Diagnostic tests may be considered, though, for the adolescent athlete whose back pain is severe, was caused by acute trauma, or fails to improve with conservative therapy after several weeks. Radiographs, bone scanning, computed tomography, and magnetic resonance imaging may

  15. [Leg ulcers in sickle cell disease: A retrospective study of 40 cases].

    Science.gov (United States)

    Ndiaye, M; Niang, S O; Diop, A; Diallo, M; Diaz, K; Ly, F; Dioussé, P; Diatta, B A; Seck, N B; Diallo, S; Ndiaye, M T; Diadie, S; Dieng, M T; Kane, A

    2016-02-01

    In Africa, studies primarily devoted to chronic leg ulcer due to sickle cell disease are rare. The objectives of the study were to determine the epidemiology, diagnosis and progression of chronic leg ulcers in sickle cell disease. A 5-year multicentre, retrospective study was conducted in three university hospitals in Dakar. We included all patients with chronic leg ulcers occurring in a setting of sickle cell disease. We identified 40 cases of chronic leg ulcers associated with sickle cell disease, representing 3.4% of the current population of sickle cell patients in our institutions. The average patient age was 25.9 years and the sex ratio was 2.33. Chronic leg ulcer was the presenting feature enabling diagnosis of sickle cell disease in one third of the cases. The average time to consultation from onset was 5.4 years. Pain was reported in 22 cases (48%). Ulcers were isolated in 76% and multiple in 24% of cases. The most common site was the medial malleolus (39%). A CBC allowed identification of anaemia in 35 cases. Haemoglobin electrophoresis was performed and homozygous sickle cell SS disease was identified in 39 cases and heterozygous SC disease in 1 case. Local treatments included physiologic serum, topical antibiotics and skin grafting. Systemic treatment included supplementation with folic acid in all patients, blood transfusion in 16 cases, vasodilators in 11 cases and antibiotics in 25 cases. The outcome was favourable in 61.8% of cases. In Dakar, sickle cell disease is a common cause of chronic leg ulcer and is frequently revealed by chronic leg ulcer. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. Aspirin in venous leg ulcer study (ASPiVLU): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Weller, Carolina D; Barker, Anna; Darby, Ian; Haines, Terrence; Underwood, Martin; Ward, Stephanie; Aldons, Pat; Dapiran, Elizabeth; Madan, Jason J; Loveland, Paula; Sinha, Sankar; Vicaretti, Mauro; Wolfe, Rory; Woodward, Michael; McNeil, John

    2016-04-11

    Venous leg ulceration is a common and costly problem that is expected to worsen as the population ages. Current treatment is compression therapy; however, up to 50 % of ulcers remain unhealed after 2 years, and ulcer recurrence is common. New treatments are needed to address those wounds that are more challenging to heal. Targeting the inflammatory processes present in venous ulcers is a possible strategy. Limited evidence suggests that a daily dose of aspirin may be an effective adjunct to aid ulcer healing and reduce recurrence. The Aspirin in Venous Leg Ulcer study (ASPiVLU) will investigate whether 300-mg oral doses of aspirin improve time to healing. This randomised, double-blinded, multicentre, placebo-controlled, clinical trial will recruit participants with venous leg ulcers from community settings and hospital outpatient wound clinics across Australia. Two hundred sixty-eight participants with venous leg ulcers will be randomised to receive either aspirin or placebo, in addition to compression therapy, for 24 weeks. The primary outcome is time to healing within 12 weeks. Secondary outcomes are ulcer recurrence, wound pain, quality of life and wellbeing, adherence to study medication, adherence to compression therapy, serum inflammatory markers, hospitalisations, and adverse events at 24 weeks. The ASPiVLU trial will investigate the efficacy and safety of aspirin as an adjunct to compression therapy to treat venous leg ulcers. Study completion is anticipated to occur in December 2018. Australian New Zealand Clinical Trials Registry, ACTRN12614000293662.

  17. Living with clipped wings—Patients’ experience of losing a leg

    Directory of Open Access Journals (Sweden)

    Annelise Norlyk

    2013-10-01

    Full Text Available This study explores the lived experience of losing a leg as described by the patients themselves post-discharge. Studies have documented that regardless of aetiology patients are faced with severe physical as well as psychosocial challenges post-amputation. However, only few studies explore in-depth the patients’ perspective on the various challenges following the loss of a leg. The study uses the phenomenological approach of Reflective Lifeworld Research (RLR. Data were collected from 24 in-depth interviews with 12 Danish patients. Data analysis was performed according to the guidelines given in RLR. The essential meaning of losing a leg is a radical and existential upheaval, which restricts patients’ lifestyle and irretrievably alters their lifeworld. Life after the operation is associated with despair, and a painful sense of loss, but also with the hope of regaining personal independence. The consequences of losing a leg gradually materialize as the patients realize how the loss of mobility limits their freedom. Patients experience the professional help as primarily directed towards physical care and rehabilitation. The findings show that the loss of a leg and, subsequently, the restricted mobility carry with them an existential dimension which refers to limitation of action space and loss of freedom experienced as an exclusion from life. Our findings demonstrate a need for complementary care and stress the importance of an increased awareness of the psychosocial and existential consequences of losing a limb.

  18. Support Leg Loading in Punt Kicking

    Science.gov (United States)

    Kermond, John; Konz, Stephen

    1978-01-01

    Maximum distance in football punt kicking is associated with a maximum force transfer to the ball rather than a maximum force transfer through the ground via the support leg. For maximum distance, tred lightly. (Author)

  19. Sturge-Weber syndrome - legs (image)

    Science.gov (United States)

    ... nervous system (neurocutaneous) and is associated with Port Wine Stain, red vascular markings on the face and other parts of the body (shown here on the legs). This is an unusual case, due to the large size of the lesion ( ...

  20. Leg or foot amputation - dressing change

    Science.gov (United States)

    ... patientinstructions/000018.htm Leg or foot amputation - dressing change To use the sharing features on this page, please enable JavaScript. You will need to change the dressing on your limb. This will help ...

  1. Muscle pain

    African Journals Online (AJOL)

    Key Summary Points. • Muscle pain, known as myalgia, can be in one targeted area or across many muscles, occurring with overexertion or overuse of these muscles. • Pain can be classified as acute or chronic pain and further categorized as nociceptive or neuropathic. • Causes of muscle pain include stress, physical ...

  2. The Relationship of Anticipatory Gluteus Medius Activity to Pelvic and Knee Stability in the Transition to Single-Leg Stance.

    Science.gov (United States)

    Kim, Daehan; Unger, Janelle; Lanovaz, Joel L; Oates, Alison R

    2016-02-01

    The knee abduction moment in a weight-bearing limb is an important risk factor of conditions such as patellofemoral pain and knee osteoarthritis. Excessive pelvic drop in single-leg stance can increase the knee abduction moment. The gluteus medius muscle is crucial to prevent pelvic drop and must be activated in anticipation of the transition from double-leg to single-leg stance. To examine the relationship of anticipatory activity of the gluteus medius to pelvic drop and knee abduction moment. Observational, cross-sectional correlational study. Research laboratory. Twenty female adults (mean age 22.6 years, standard deviation 2.5) were recruited and fully participated. Participant selection was limited to healthy women who did not have a history of knee and ankle ligament injuries, any indication of knee, hip, and/or low back pain, and/or knowledge of the proper squat technique. Participants performed 16 single-leg mini squats on their nondominant leg. The onset and magnitude of anticipatory gluteus medius activity were measured in relation to toe-off of the dominant leg during the transition from double-leg to single-leg stance. Preplanned correlations between anticipatory gluteus medius onset and its activation magnitude, pelvic obliquity, and knee abduction moment were examined. The magnitude of anticipatory gluteus medius activity was significantly correlated with the knee abduction moment (rs (18) = -0.303, P pelvic obliquity (rs (18) = 0.361, P pelvic obliquity. The amount of gluteus medius activity is more important for controlling knee and pelvic stability in the frontal plane than the onset of activation. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  3. Assessment of nursing problems for patients after leg vein varicose surgery

    OpenAIRE

    Ardavičiūtė, Aneta

    2016-01-01

    Patients, who suffer from chronic venous blood flow deficiency, feel pain, discomfort, fatigue and other symptoms that disturb the quality of life, emotional wellbeing, and it is a common reason for incapacity and disability. Surgical treatment of venous deficiency includes not only the patient, but also nursing staff. It requires considering post-operative symptoms and needs of the patient. Keywords: leg veins, surgery, nursing, patient, nurse. The aim of research work: to determine and asse...

  4. Motor responses to experimental Achilles tendon pain

    DEFF Research Database (Denmark)

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

    2011-01-01

    of the exercise are affected by Achilles tendon pain. Objective The authors aimed to determine the effects of experimental Achilles tendon pain on motor function during one-legged weight bearing ankle plantar and dorsal flexion exercises. Methods In a crossover study, with 16 healthy subjects tested on two...... before, during and after either experimental Achilles tendon pain or a non-painful control condition. Pain was induced by intratendinous injections of hypertonic saline with isotonic saline injections as control. Joint kinematics, ground reaction force frequency contents and average EMG amplitudes were...... calculated. Results Compared with the control condition experimental Achilles tendon pain reduced the EMG activity in agonistic, synergistic and antagonistic muscles, and increased the ground reaction force frequency content around 10 Hz, during both eccentric and concentric movement phases. Conclusions...

  5. The development of a 'wet leg' pathway for chronic oedema.

    Science.gov (United States)

    Morgan, Karen; Thomas, Melanie

    2018-01-02

    Chronic oedema and leaking lymphorrhoea can be distressing and challenging for patients to live with. This article introduces the Chronic Oedema 'Wet Leg' Pathway, which became an output from the Lymphoedema Network Wales 'On the Ground Education Project' ( Thomas et al, 2017 ). The evidence-based pathway provides nurses and therapists with clear guidelines to support prompt, efficient and effective management of all patients with chronic oedema and wet legs. This article presents the evidence and demonstrates the benefits of timely active treatment for all patients with leaking lymphorrhoea, which includes decreasing pain and improving mobility and daily activities. Other benefits include reducing the risk of cellulitis and the development of chronic wounds. The pathway also demonstrates opportunities for the NHS by decreasing both the number of community nursing visits and the number of wound dressings used. By actively treating symptoms-rather than simply mopping up the leaking lymphorrhoea-this pathway demonstrates value-based health care by reducing waste, harm and variation within the NHS.

  6. Leg ulcer plastic surgery descent by laser therapy

    Science.gov (United States)

    Telfer, Jacqui; Filonenko, Natalia; Salansky, Norman M.

    1994-02-01

    Low energy laser therapy (LELT) was used to treat chronic leg ulcers. Seven patients, aged 59 to 96 years, with 11 leg ulcers were referred for laser therapy by plastic surgeons. They had a history of ulceration of 3 - 50 years and five of the patients had breakdown of previous skin grafts. Laser treatments were administered with a microprocessor-controlled device. A 22 red ((lambda) equals 660 nm) laser head was utilized to provide a dose of (4 - 6) J/cm2 and 7 infrared ((lambda) equals 880 nm) head to provide a dose of (4 - 8) J/cm2. The patients were treated three to five times per week, 25 - 30 treatments per course. Three patients underwent two courses of laser therapy with three weeks interval between them. All patients, after 5 - 10 laser treatments, have gotten relief of pain and decreased the amount of analgesics used. All ulcers in six patients were completely healed and two ulcers in the seventh patient decreased in size by 75%. One may conclude the developed laser methodology might be used as a preventative measure to avoid plastic surgery or improve its success.

  7. Conjoined legs: Sirenomelia or caudal regression syndrome?

    OpenAIRE

    Das, Sakti Prasad; Ojha, Niranjan; Ganesh, G Shankar; Mohanty, Ram Narayan

    2013-01-01

    Presence of single umbilical persistent vitelline artery distinguishes sirenomelia from caudal regression syndrome. We report a case of a12-year-old boy who had bilateral umbilical arteries presented with fusion of both legs in the lower one third of leg. Both feet were rudimentary. The right foot had a valgus rocker-bottom deformity. All toes were present but rudimentary. The left foot showed absence of all toes. Physical examination showed left tibia vara. The chest evaluation in sitting re...

  8. Efficiency and Speed in Legged Robots

    Science.gov (United States)

    2011-03-22

    which we substitute into (4.42) : ( -mv s J O=-km+ mvc -k __ c __ V v 2 c c 46 (4.43) (4.44) (4.45) (4.46) to fInd the switching curve m 3 s...Legged Mechanisms. IVSS. Traverse City, MI Muench, P., Alexander, J., Quinn, R., & Aschenbeck, K. (2005) Pneumatic Spring for Legged Walker. SPIE

  9. Flexural characteristics of a stack leg

    International Nuclear Information System (INIS)

    Cook, J.

    1979-06-01

    A 30 MV tandem Van de Graaff accelerator is at present under construction at Daresbury Laboratory. The insulating stack of the machine is of modular construction, each module being 860 mm in length. Each live section stack module contains 8 insulating legs mounted between bulkhead rings. The design, fabrication (from glass discs bonded to stainless steel discs using an epoxy film adhesive) and testing of the stack legs is described. (U.K.)

  10. Three cross leg flaps for lower leg reconstruction of Gustilo type III C open fracture

    Directory of Open Access Journals (Sweden)

    Kazufumi Sano

    2016-01-01

    Full Text Available A 60 year old male had Gustilo type III C open fracture of the right lower leg. After radical debridement, the large open defect including certain loss of the bone tissue was successfully augmented and covered, by consecutive three cross-leg flaps, which consisted of the free rectus abdominis musculocutaneous flap, the fibula osteocutaneous flap and the conventional sural flap. Although indication for amputation or preservation is decided with multiple factors in each case, a strategic combination of cross-leg flap, free flap, external fixation and vascular delay could increase the potential of preservation of the lower leg with even disastrous Gustilo type III C.

  11. Postural correlates of viewing painful situations

    Directory of Open Access Journals (Sweden)

    Thierry eLelard

    2013-02-01

    Full Text Available Background: Emotional context may play a crucial role in movement production. According to simulation theories, emotional states affect motor systems. The aim of this study was to compare postural responses assessed by posturography and electromyography when subjects were instructed to imagine themselves in a painful or a non-painful situation.Methods: Twenty-nine subjects (22.3 ± 3.7 years participated in this study. While standing quietly on a posturographic platform, they were instructed to imagine themselves in a painful or non-painful situation. Displacement of the centre of pressure (COP, leg muscle electromyographic activity, heart rate, and electrodermal activity were assessed in response to painful and non-painful situations.Results:The anteroposterior path was shorter (p<0.05 when subjects imagined themselves in a painful situation (M = 148.0 ± 33.4 mm compared to a non-painful situation (158.2 ± 38.7 mm. Higher Tibialis Anterior (TA activity (RMS-TA = 3.38 ± 1.95 % vs 3.24 ± 1.85 %; p < 0.001 and higher variability of Soleus (SO activity (variation coefficient of RMS-SO = 13.5 ± 16.2 % vs M = 9.0% ± 7.2 %; p<0.05 were also observed in painful compared to non-painful situations. No significant changes were observed for other physiological data Conclusion: This study demonstrates that simulation of painful situations induces changes in postural control and leg muscle activation compared to non-painful situations, as increased stiffness was demonstrated in response to aversive pictures in accordance with previous results.

  12. Causal connection of non-specific low back pain and disc degeneration in children with transitional vertebra and/or Spina bifida occulta: role of magnetic resonance--prospective study.

    Science.gov (United States)

    Milicić, Gordana; Krolo, Ivan; Anticević, Darko; Roić, Goran; Zadravec, Dijana; Bojić, Davor; Fattorini, Matija Zutelija; Bumci, Igor

    2012-06-01

    The problem of low back pain (LBP) in children is very common and many specialists are dealing with it in everyday practice. The cause for low back pain often is not found and classified under the diagnosis of non specific low back pain. The objective of this prospective study is to determine wether children with non specific low back pain and existence of anomalies in LS spine (transitional vertebra- TV and/or Spina bifida occulta SBO) also have the degeneration of the intervertebral disc (DD) L4-L5 and/or L5-S1. This prospective study included 69 patients from 8 to 16 years of age (X 12.81) of whom 40 were male (57.97%), and 29 female (42.03%). They all were examinated in University of Zagreb, "Sestre milosrdnice" University Hospital Center, Zagreb Children's Hospital, Department of Orthopaedic, Zagreb, Croatia. The reason of their visit was non specific low back pain. Pain was measured by visual analog scale (VAS) and mean score was three, duration of pain was between two and four weeks. Also, pain was sporadic, during daytime and not connected with level of physical activity. They all have undergone an algorithm of radiological examinations. Standard AP and LL radiographs (RTG) were made, as well as magnetic resonance (MR) of LS spine and sacrum in sagittal and transversal plane in T1 and T2 weighted sequence. The anomalies of L5 and S1 were found in 65 patients: transitional vertebra classified according to Castellvi et al. and SBO. In MRI in T2 weighted sequence DD was found in 61 patients which was classified modified from Pearce. Data analysis and comparison showed that 56patients with TV and/or SBO have changes on vertebral dynamic segment L5-S1 (VDS) and that means DD. In 13 patients only DD or spinal anomaly (TV and/or SBO) were found. Correlation between anomalies and DD in those patients was established by McNemar analysis and has shown significant difference (p=0.581) in favour of the patients with anomaly and DD. This has established that all of 56

  13. Angioleiomyoma of the Lower Leg.

    Science.gov (United States)

    Sprinkle, Robert L B; Sangueza, Omar P; Wells, Ashleigh E

    2017-05-01

    Angioleiomyomas are benign tumefactions that originate from smooth muscle in vascular structures and are difficult to definitively diagnose preoperatively. Although these lesions are rarely encountered in the foot, the lower extremity is the most common site of occurrence. An angioleiomyoma typically manifests as a small, painful, solitary, mobile lesion. This case report describes a lateral retromalleolar para-Achilles tendon insertional location for a moderately sized immobile solid tumefaction in the subcutaneous tissues. The lesion was nonpainful and progressively enlarged over 5 years. An excisional biopsy was performed, and the nodular lesion was subsequently diagnosed histopathologically as an angioleiomyoma. Owing to the ambiguous nature of the clinical findings, angioleiomyoma should be included in the differential diagnosis of lower-extremity soft-tissue manifestations.

  14. Ultrasound guided, painful electrical stimulation of lumbar facet joint structures

    DEFF Research Database (Denmark)

    O'Neill, Søren; Graven-Nielsen, Thomas; Manniche, Claus

    2009-01-01

    placed either side of a lumbar facet joint (right L3-4) and used to induce experimental low back pain for 10 min with continuous stimulation. Thresholds, stimulus-response relationships, distribution and quality of the electrically induced pain were recorded. Electrical facet joint stimulation induced...... low back pain and pain referral into the anterior leg, ipsilaterally, proximal to the knee, similar to what is observed clinically. Pressure pain thresholds did not change significantly before, during and after facet joint stimulation. In conclusion, we describe a novel model of acute experimental low...

  15. The pathophysiology of restless legs syndrome

    International Nuclear Information System (INIS)

    Miyamoto, Masayuki; Miyamoto, Tomoyuki; Iwanami, Masaoki; Suzuki, Keisuke; Hirata, Koichi

    2009-01-01

    Restless legs syndrome (RLS) is a sensorimotor disorder that is frequently associated with periodic leg movements (PLMS). RLS is generally considered to be a central nervous system (CNS)-related disorder although no specific lesion has been found to be associated with the syndrome. Reduced intracortical inhibition has been demonstrated in RLS by transcranial magnetic stimulation. Some MRI studies have revealed the presence of morphologic changes in the somatosensory cortex, motor cortex and thalamic gray matter. The results of single photon emission computed tomography (SPECT) and positron emission tomography (PET) studies showed that the limbic and opioid systems also play important roles in the pathophysiology of RLS. A functional MRI study revealed abnormal bilateral cerebellar and thalamic activation during the manifestation of sensory symptoms, with additional red nucleus and reticular formation activity during PLMS. PLMS is likely to occur in patients with spinal cord lesions, and some patients with sensory polyneuropathy may exhibit RLS symptoms. RLS symptoms seem to depend on abnormal spinal sensorimotor integration at the spinal cord level and abnormal central somatosensory processing. PLMS appears to depend on increased excitability of the spinal cord and a decreased supraspinal inhibitory mechanism from the A11 diencephalic dopaminergic system. RLS symptoms respond very dramatically to dopaminergic therapy. The results of analysis by PET and SPECT studies of striatal D2 receptor binding in humans are inconclusive. However, studies in animal models suggest that the participation of the A11 dopaminergic system and the D3 receptor in RLS symptoms. The symptoms of RLS are aggravated in those with iron deficiency, and iron treatment ameliorates the symptoms in some patients. Neuroimaging studies, analysis of the cerebrospinal fluid, and studies on postmortem tissue and use of animal models have indicated that low brain iron concentrations and dysfunction of

  16. Experimental muscle pain challenges the postural stability during quiet stance and unexpected posture perturbation.

    Science.gov (United States)

    Hirata, Rogério Pessoto; Ervilha, Ulysses Fernandes; Arendt-Nielsen, Lars; Graven-Nielsen, Thomas

    2011-08-01

    Musculoskeletal pain impairs postural control and stability. Nine subjects stood as quietly as possible on a moveable force platform before, during, and after experimental pain in the right leg muscles. A moveable force platform was used to measure the center of pressure and provided unexpected perturbations. Lower limb muscle activity, joint angles, and foot pressure distributions were measured. Hypertonic saline was used to induce pain in the vastus lateralis, vastus medialis, or biceps femoris muscle of the right leg. Compared to baseline and control sessions, pain in the knee extensor muscles during quiet standing evoked: 1) larger sway area, greater medial-lateral center of pressure displacement and higher speed (P Pain provoked longer time to return to an equilibrium posture after forward EMG activity for, and pain in vastus medialis muscle decreased the time for the maximum hip flexion during this perturbation (P pain impairs postural stability during quiet standing and after unexpected perturbation, which suggest that people suffering from leg muscle pain are more vulnerable to falls. This article presents the acute responses to leg muscle pain on the postural control. This measure could potentially help clinicians who seek to assess how pain responses may contribute to patient's postural control and stability during quiet standing and after recovering from unexpected perturbations. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

  17. BUILDING A BETTER GLUTEAL BRIDGE: ELECTROMYOGRAPHIC ANALYSIS OF HIP MUSCLE ACTIVITY DURING MODIFIED SINGLE-LEG BRIDGES

    Science.gov (United States)

    Edwards, Michael; Haverkamp, Ryan; Martin, Lani; Porter, Kambry; Thach, Kailey; Sack, Richard J.; Hakansson, Nils A.

    2017-01-01

    Background Gluteal strength plays a role in injury prevention, normal gait patterns, eliminating pain, and enhancing athletic performance. Research shows high gluteal muscle activity during a single-leg bridge compared to other gluteal strengthening exercises; however, prior studies have primarily measured muscle activity with the active lower extremity starting in 90 ° of knee flexion with an extended contralateral knee. This standard position has caused reports of hamstring cramping, which may impede optimal gluteal strengthening. Hypothesis/Purpose The purpose of this study was to determine which modified position for the single-leg bridge is best for preferentially activating the gluteus maximus and medius. Study Design Cross-Sectional Methods Twenty-eight healthy males and females aged 18-30 years were tested in five different, randomized single-leg bridge positions. Electromyography (EMG) electrodes were placed on subjects’ gluteus maximus, gluteus medius, rectus femoris, and biceps femoris of their bridge leg (i.e., dominant or kicking leg), as well as the rectus femoris of their contralateral leg. Subjects performed a maximal voluntary isometric contraction (MVIC) for each tested muscle prior to performing five different bridge positions in randomized order. All bridge EMG data were normalized to the corresponding muscle MVIC data. Results A modified bridge position with the knee of the bridge leg flexed to 135 ° versus the traditional 90 ° of knee flexion demonstrated preferential activation of the gluteus maximus and gluteus medius compared to the traditional single-leg bridge. Hamstring activation significantly decreased (p gluteus maximus and medius, respectively). Conclusion Modifying the traditional single-leg bridge by flexing the active knee to 135 ° instead of 90 ° minimizes hamstring activity while maintaining high levels of gluteal activation, effectively building a bridge better suited for preferential gluteal activation

  18. Lymphedema treatment decreases pain intensity in lipedema.

    Science.gov (United States)

    Szolnoky, G; Varga, E; Varga, M; Tuczai, M; Dósa-Rácz, E; Kemény, L

    2011-12-01

    Lipedema is a disproportional obesity featuring light pressure-induced or spontaneous pain. On the basis of our clinical observations, lymphedema therapy, as practiced in our clinic, reduces the perception of pain beyond leg volume reduction. We therefore aimed to measure pain intensity prior and subsequent to treatment. 38 women with lipedema were enrolled in the study with 19 patients undergoing treatment and 19 serving as the control group using exclusively moisturizers. Treatment consisted of once daily manual lymph drainage (MLD), intermittent pneumatic compression (IPC), and multilayered short-stretch bandaging performed throughout a 5-day-course. Pain was evaluated with a 10-item questionnaire, a pain rating scale (PRS), and the Wong-Baker Faces scale. Treatment resulted in a significant reduction of pain with a decrease in mean scores of all three measures. In the control group, only PRS showed significant decrease. Our study results indicate that this treatment regimen not only reduces leg volume and capillary fragility, but also improves pain intensity in patients with lipedema.

  19. Estimation of peak heat flux onto the targets for CFETR with extended divertor leg

    International Nuclear Information System (INIS)

    Zhang, Chuanjia; Chen, Bin; Xing, Zhe; Wu, Haosheng; Mao, Shifeng; Luo, Zhengping; Peng, Xuebing; Ye, Minyou

    2016-01-01

    Highlights: • A hypothetical geometry is assumed to extend the outer divertor leg in CFETR. • Density scan SOLPS simulation is done to study the peak heat flux onto target. • Attached–detached regime transition in out divertor occurs at lower puffing rate. • Unexpected delay of attached–detached regime transition occurs in inner divertor. - Abstract: China Fusion Engineering Test Reactor (CFETR) is now in conceptual design phase. CFETR is proposed as a good complement to ITER for demonstrating of fusion energy. Divertor is a crucial component which faces the plasmas and handles huge heat power for CFETR and future fusion reactor. To explore an effective way for heat exhaust, various methods to reduce the heat flux to divertor target should be considered for CFETR. In this work, the effect of extended out divertor leg on the peak heat flux is studied. The magnetic configuration of the long leg divertor is obtained by EFIT and Tokamak Simulation Code (TSC), while a hypothetical geometry is assumed to extend the out divertor leg as long as possible inside vacuum vessel. A SOLPS simulation is performed to study peak heat flux of the long leg divertor for CFETR. D 2 gas puffing is used and increasing of the puffing rate means increase of plasma density. Both peak heat flux onto inner and outer targets are below 10 MW/m 2 is achieved. A comparison between the peak heat flux between long leg and conventional divertor shows that an attached–detached regime transition of out divertor occurs at lower gas puffing gas puffing rate for long leg divertor. While for the inner divertor, even the configuration is almost the same, the situation is opposite.

  20. Genetic parameters for claw and leg health, foot and leg conformation, and locomotion in Danish Holsteins

    DEFF Research Database (Denmark)

    Laursen, M. V.; Boelling, D.; Mark, Thomas

    2009-01-01

    The purpose of this study was to estimate the genetic correlations among claw and leg health and potential indicator traits. Claw health was defined as absence of heel horn erosion, interdigital dermatitis, interdigital phlegmon, interdigital hyperplasia, laminitis, and sole ulcer. Leg health...

  1. Discriminant musculo-skeletal leg characteristics between sprint and endurance elite Caucasian runners.

    Science.gov (United States)

    Bex, T; Iannaccone, F; Stautemas, J; Baguet, A; De Beule, M; Verhegghe, B; Aerts, P; De Clercq, D; Derave, W

    2017-03-01

    Excellence in either sprinting or endurance running requires specific musculo-skeletal characteristics of the legs. This study aims to investigate the morphology of the leg of sprinters and endurance runners of Caucasian ethnicity. Eight male sprinters and 11 male endurance runners volunteered to participate in this cross-sectional study. They underwent magnetic resonance imaging and after data collection, digital reconstruction was done to calculate muscle volumes and bone lengths. Sprinters have a higher total upper leg volume compared to endurance runners (7340 vs 6265 cm 3 ). Specifically, the rectus femoris, vastus lateralis, and hamstrings showed significantly higher muscle volumes in the sprint group. For the lower leg, only a higher muscle volume was found in the gastrocnemius lateralis for the sprinters. No differences were found in muscle volume distribution, center of mass in the different muscles, or relative bone lengths. There was a significant positive correlation between ratio hamstrings/quadriceps volume and best running performance in the sprint group. Sprinters and endurance runners of Caucasian ethnicity showed the greatest distinctions in muscle volumes, rather than in muscle distributions or skeletal measures. Sprinters show higher volumes in mainly the proximal and lateral leg muscles than endurance runners. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Association between Thigh Muscle Volume and Leg Muscle Power in Older Women.

    Directory of Open Access Journals (Sweden)

    Ulrich Lindemann

    Full Text Available The construct of sarcopenia is still discussed with regard to best appropriate measures of muscle volume and muscle function. The aim of this post-hoc analysis of a cross-sectional experimental study was to investigate and describe the hierarchy of the association between thigh muscle volume and measurements of functional performance in older women. Thigh muscle volume of 68 independently living older women (mean age 77.6 years was measured via magnetic resonance imaging. Isometric strength was assessed for leg extension in a movement laboratory in sitting position with the knee flexed at 90° and for hand grip. Maximum and habitual gait speed was measured on an electronic walk way. Leg muscle power was measured during single leg push and during sit-to-stand performance. Thigh muscle volume was associated with sit-to-stand performance power (r = 0.628, leg push power (r = 0.550, isometric quadriceps strength (r = 0.442, hand grip strength (r = 0.367, fast gait speed (r = 0.291, habitual gait speed (r = 0.256, body mass index (r = 0.411 and age (r = -0.392. Muscle power showed the highest association with thigh muscle volume in healthy older women. Sit-to-stand performance power showed an even higher association with thigh muscle volume compared to single leg push power.

  3. Inner experience of pain: imagination of pain while viewing images showing painful events forms subjective pain representation in human brain.

    Science.gov (United States)

    Ogino, Yuichi; Nemoto, Hidenori; Inui, Koji; Saito, Shigeru; Kakigi, Ryusuke; Goto, Fumio

    2007-05-01

    Pain is an unpleasant sensation, and at the same time, it is always subjective and affective. Ten healthy subjects viewed 3 counterbalanced blocks of images from the International Affective Picture System: images showing painful events and those evoking emotions of fear and rest. They were instructed to imagine pain in their own body while viewing each image showing a painful event (the imagination of pain). Using functional magnetic resonance imaging, we compared cerebral hemodynamic responses during the imagination of pain with those to emotions of fear and rest. The results show that the imagination of pain is associated with increased activity in several brain regions involved in the pain-related neural network, notably the anterior cingulate cortex (ACC), right anterior insula, cerebellum, posterior parietal cortex, and secondary somatosensory cortex region, whereas increased activity in the ACC and amygdala is associated with the viewing of images evoking fear. Our results indicate that the imagination of pain even without physical injury engages the cortical representations of the pain-related neural network more specifically than emotions of fear and rest; it also engages the common representation (i.e., in ACC) between the imagination of pain and the emotion of fear.

  4. One-legged endurance training: leg blood flow and oxygen extraction during cycling exercise

    DEFF Research Database (Denmark)

    Rud, B; Foss, O; Krustrup, Peter

    2012-01-01

    Aim: As a consequence of enhanced local vascular conductance, perfusion of muscles increases with exercise intensity to suffice the oxygen demand. However, when maximal oxygen uptake (VO(2) max) and cardiac output are approached, the increase in conductance is blunted. Endurance training increases...... muscle metabolic capacity, but to what extent that affects the regulation of muscle vascular conductance during exercise is unknown. Methods: Seven weeks of one-legged endurance training was carried out by twelve subjects. Pulmonary VO(2) during cycling and one-legged cycling was tested before and after...... training, while VO(2) of the trained leg (TL) and control leg (CL) during cycling was determined after training. Results: VO(2) max for cycling was unaffected by training, although one-legged VO(2) max became 6.7 (2.3)% (mean ± SE) larger with TL than with CL. Also TL citrate synthase activity was higher...

  5. Analysis of the body mass index and leg profiles of Asian women after total leg sculpture.

    Science.gov (United States)

    Tsai, Feng-Chou; Chen, Chien-Hao; Lin, Chan-Yi; Ho, Li-Yung

    2009-08-01

    In addition to the conventional methods used to improve leg contours, total leg sculpture, including liposuction, selective neurectomy, and transilluminated powered phlebectomy, provides a one-time solution of leg contour problems, which is a major aesthetic concern among Asian women. The authors present the postoperative results of total leg sculpture and determine any significance and correlation between the leg variables and body mass index by statistical analysis. Thirty female patients who underwent total leg sculpture between 2005 and 2008 were included in the study, and prospective analysis of the patients' data was performed during a follow-up period of 1 year. Local measurement variables and body mass index were recorded, and the correlation between them was determined by Pearson's correlation and regression analysis. A paired t test was used to compare the postoperative outcomes. Subjectively, all patient results were satisfactory. There were significant differences between preoperative and postoperative measurements for all variables for total leg sculpture. Body mass index was strongly correlated with all leg indexes, and there was a significant positive correlation between the index and variables related to the buttocks and upper thigh. The satisfactory postoperative leg variables were buttocks circumference (87.85 cm), thigh circumference (T60, 44.20 cm), maximal calf circumference (32.24 cm), and calf ratio (0.78). Each preoperative body mass index increment represents a 0.3 percent circumference improvement around the buttocks after surgery. No obvious morbidities or long-term hospital stays were noted. Total leg sculpture provides a combined aesthetic solution for improving limb contours with minimal morbidity. Patients with larger body mass index values exhibit better aesthetic improvement than those with smaller values.

  6. Chronic Pain

    Science.gov (United States)

    ... people who have chronic pain may also have low self-esteem, depression, and anger. Symptoms of chronic pain Chronic ... itself often leads to other symptoms. These include low self-esteem, anger, depression, anxiety, or frustration. What causes chronic ...

  7. Ankle Pain

    Science.gov (United States)

    ... it follows an injury. Even a relatively benign ankle injury can be quite painful, at least at first. ... improve after several weeks Self-care For many ankle injuries, self-care measures ease the pain. Examples include: ...

  8. Elbow Pain

    Science.gov (United States)

    ... pain is often caused by overuse. Many sports, hobbies and jobs require repetitive hand, wrist or arm ... Accessed Jan. 16, 2016. Jan. 11, 2018 Original article: http://www.mayoclinic.org/symptoms/elbow-pain/basics/ ...

  9. Finger pain

    Science.gov (United States)

    Pain - finger ... Nearly everyone has had finger pain at some time. You may have: Tenderness Burning Stiffness Numbness Tingling Coldness Swelling Change in skin color Redness Many conditions, such ...

  10. Habituating pain

    DEFF Research Database (Denmark)

    Ajslev, Jeppe Zielinski Nguyen; Lund, Henrik Lambrecht; Møller, Jeppe Lykke

    2013-01-01

    the industry reproduce physical strain and the habituation of pain as unquestioned conditions in construction work. The understanding of this mutual reinforcement of the necessity of physically straining, painful, high-paced construction work provides fruitful perspectives on the overrepresentation...

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

    Directory of Open Access Journals (Sweden)

    Alexander Ritter

    2016-08-01

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

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

    Science.gov (United States)

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

    2016-08-10

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

  13. A systematic review on the impact of leg ulceration on patients' quality of life

    Directory of Open Access Journals (Sweden)

    Rieger Monika A

    2007-07-01

    Full Text Available Abstract Background A systematic review was conducted to analyse journal articles that describe or measure the impact of leg ulceration on patients' quality of life (QoL in order to improve the content of an educational programme that aims to enhance self-care agency in leg ulcer patients. Method Original articles published in English and German between 1990 and 2006 were included if the findings were analysed at the level of patients. Articles were excluded if (1 they investigated the impact of specific treatments or settings on QoL or (2 focused mainly on arterial ulcers or diabetic foot ulcers. Results Twenty-four original research articles met the inclusion criteria; 11 studies used a quantitative, 11 studies a qualitative, and 2 used a mixed method approach. The findings were collapsed into 5 core domains. Quantitative studies commonly investigated the parameters of pain, sleep, social isolation, and physical mobility. Patients had significantly more pain, more restrictions regarding social functioning, less vitality, and limitations with respect to emotional roles compared to the respective controls. Other problem areas identified were restrictions in work capacity, recreation, social interaction, psychological well-being, as well as problems caused by treatment regimes. Inconclusive results were obtained regarding pain intensity, physical restrictions, and gender effects. Limitations Numerous original studies neither undertook a differentiation of participants by ulcer aetiology nor did they analyse the results according to gender differences. Conclusion As leg ulceration has an impact on QoL, national guidelines on the treatment of leg ulceration need to more specifically address these far-ranging effects identified in this review.

  14. Ulcer recurrence after in-hospital treatment for recalcitrant venous leg ulceration.

    Science.gov (United States)

    Reeder, S; de Roos, K-P; de Maeseneer, M; Sommer, A; Neumann, H A M

    2013-05-01

    Leg ulceration caused by chronic venous disease occurs in 1% of the adult Western population. A majority of these patients is successfully treated in the outpatient setting. A minority of patients is hospitalized, most frequently because of the lack of healing tendency. The literature provides recurrence rates for ulcer disease, but lacks specific data on recurrence rates after in-hospital treatment of recalcitrant venous leg ulcers. To investigate time to ulcer recurrence after in-hospital treatment of venous leg ulceration. A multicentre, retrospective cohort study of patients admitted for leg ulceration between 1996 and 2007 was conducted. Data could be collected for 107 of the patients. Of these, 27 had conservative treatment (bed rest, local wound care, pain management) and 48 patients underwent surgical ulcer treatment with (n = 19) or without (n = 29) initial vacuum-assisted closure (VAC) treatment. The treatment method was 'miscellaneous' in the remaining 32 patients. Median admission time was 30 days, median percentage of closure at discharge was 95%, and median time to ulcer recurrence 60 days. The Mann-Whitney U-test showed significant differences between the conservative group and the surgery group, the latter having a longer length of hospital stay (P ulcer closure (P ulcer recurrence (P = 0.273). Comparable differences were demonstrated between the conservative group and the VAC plus surgery group. No significant differences could be demonstrated between the surgically treated patients and those treated by VAC and surgery. Hospital stay is significantly shorter in cases of surgical treatment of recalcitrant venous leg ulcers. Most ulcers recur within 2 months after hospital discharge. Recurrence of venous leg ulcers after hospital admission is independent of the method of treatment and cause of ulceration. © 2012 The Authors. BJD © 2012 British Association of Dermatologists.

  15. Adult-onset Chronic Recurrent Multifocal Osteomyelitis with High Intensity of Muscles Detected by Magnetic Resonance Imaging, Successfully Controlled with Tocilizumab

    Science.gov (United States)

    Sato, Hiroe; Wada, Yoko; Hasegawa, Eriko; Nozawa, Yukiko; Nakatsue, Takeshi; Ito, Tomoyuki; Kuroda, Takeshi; Saeki, Takako; Umezu, Hajime; Suzuki, Yoshiki; Nakano, Masaaki; Narita, Ichiei

    2017-01-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disorder that generally occurs in children and predominantly affects the long bones with marginal sclerosis. We herein report two cases of adult-onset CRMO involving the tibial diaphysis bilaterally, accompanied by polyarthritis. Magnetic resonance imaging (MRI) showed both tibial osteomyelitis and high intensity of the extensive lower leg muscles. Anti-interleukin-6 therapy with tocilizumab (TCZ) effectively controlled symptoms and inflammatory markers in both patients. High intensity of the lower leg muscles detected by MRI also improved. These cases demonstrate that CRMO should be included in the differential diagnosis of adult patients with bone pain, inflammation, and high intensity of the muscles detected by MRI. TCZ may therefore be an effective therapy for muscle inflammation of CRMO. PMID:28794369

  16. Therapeutic advances in restless legs syndrome (RLS).

    Science.gov (United States)

    Högl, Birgit; Comella, Cynthia

    2015-09-15

    Levodopa and dopamine agonists have been the main treatment for restless legs syndrome during the past decades. Although their efficacy has been well documented over the short term, long-term dopaminergic treatment is often complicated by augmentation, loss of efficacy, and other side effects. Recent large randomized controlled trials provide new evidence for the efficacy of high-potency opioids and α2δ ligands, and several post hoc analyses, meta-analyses, algorithms, and guidelines have been published, often with a specific focus, for example, on augmentation, or on management of restless legs syndrome during pregnancy. Several new contributions to understanding the pathophysiology of restless legs syndrome have been published, but at this time, whether they will have an impact on treatment possibilities in the future cannot be estimated. © 2015 International Parkinson and Movement Disorder Society.

  17. Conjoined legs: Sirenomelia or caudal regression syndrome?

    Directory of Open Access Journals (Sweden)

    Sakti Prasad Das

    2013-01-01

    Full Text Available Presence of single umbilical persistent vitelline artery distinguishes sirenomelia from caudal regression syndrome. We report a case of a12-year-old boy who had bilateral umbilical arteries presented with fusion of both legs in the lower one third of leg. Both feet were rudimentary. The right foot had a valgus rocker-bottom deformity. All toes were present but rudimentary. The left foot showed absence of all toes. Physical examination showed left tibia vara. The chest evaluation in sitting revealed pigeon chest and elevated right shoulder. Posterior examination of the trunk showed thoracic scoliosis with convexity to right. The patient was operated and at 1 year followup the boy had two separate legs with a good aesthetic and functional results.

  18. Phantom Pain

    Science.gov (United States)

    ... Because this is yet another version of tangled sensory wires, the result can be pain. A number of other factors are believed to contribute to phantom pain, including damaged nerve endings, scar tissue at the site of the amputation and the physical memory of pre-amputation pain in the affected area. ...

  19. Chest Pain

    Science.gov (United States)

    ... or tightness in your chest Crushing or searing pain that radiates to your back, neck, jaw, shoulders, and one or both arms Pain that lasts ... com. Accessed Sept. 6, 2017. Yelland MJ. Outpatient evaluation of the adult with chest pain. https://www.uptodate.com/contents/search. Accessed Sept. ...

  20. Neck Pain

    Science.gov (United States)

    ... arms or hands or if you have shooting pain into your shoulder or down your arm. Symptoms Signs and symptoms ... org/search/Pages/results.aspx?k=Chronic neck pain. Accessed June 11, 2015. Isaac Z. Evaluation of the patient with neck pain and cervical ...

  1. 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

  2. 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

  3. Leg Spasticity and Ambulation in Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Swathi Balantrapu

    2014-01-01

    Full Text Available Background. Spasticity of the legs is common in multiple sclerosis (MS, but there has been limited research examining its association with ambulatory outcomes. Objective. This study examined spasticity of the legs and its association with multiple measures of ambulation in persons with MS. Methods. The sample included 84 patients with MS. Spasticity of the legs was measured using a 5-point rating scale ranging between 0 (normal and 4 (contracted. Patients completed the 6-minute walk (6 MW, timed 25 foot walk (T25FW, and timed up-and-go (TUG, and O2 cost of walking was measured during the 6 MW. The patients undertook two walking trials on a GAITRite (CIR systems, Inc. for measuring spatial and temporal parameters of gait. The patients completed the Multiple Sclerosis Walking Scale-12 (MSWS-12 and wore an accelerometer over a seven-day period. Results. 52% (n=44 of the sample presented with spasticity of the legs. Those with leg spasticity had significantly worse ambulation as measured by 6 MW (P=0.0001, d=-0.86, T25FW (P=0.003,d=0.72, TUG (P=0.001, d=0.84, MSWS-12 (P=0.0001,d=1.09, O2 cost of walking (P=0.001, d=0.75, average steps/day (P<0.05, d=-0.45, and walking velocity (P<0.05, d=-0.53 and cadence (P<0.05, d=-0.46. Conclusion. Leg spasticity was associated with impairments in ambulation, including alterations in spatiotemporal parameters and free-living walking.

  4. The Molecular Genetics of Restless Legs Syndrome.

    Science.gov (United States)

    Rye, David B

    2015-09-01

    Restless legs syndrome (RLS) is a common sensorimotor trait defined by symptoms that interfere with sleep onset and maintenance in a clinically meaningful way. Nonvolitional myoclonus while awake and asleep is a sign of the disorder and an informative endophenotype. The genetic contributions to RLS/periodic leg movements are substantial, are among the most robust defined to date for a common disease, and account for much of the variance in disease expressivity. The disorder is polygenic, as revealed by recent genome-wide association studies. Experimental studies are revealing mechanistic details of how these common variants might influence RLS expressivity. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Nocturnal leg cramps in older people

    Science.gov (United States)

    Butler, J; Mulkerrin, E; O'Keeffe, S

    2002-01-01

    Nocturnal leg cramps are common in older people. Such cramps are associated with many common diseases and medications. Physiological methods may be useful for preventing cramps in some people, but there have been no controlled trials of these approaches. Quinine is moderately effective in preventing nocturnal leg cramps. However, there are concerns about the risk/benefit ratio with this drug. In patients with severe symptoms, a trial of 4–6 weeks' treatment with quinine is probably still justified, but the efficacy of treatment should be monitored, for example using a sleep and cramp diary. PMID:12415081

  6. Changes of brain microstructure in patients with painful chronic pancreatitis assessed by diffusion tensor imaging

    DEFF Research Database (Denmark)

    Frøkjær, Jens Brøndum; Olesen, Søren Schou; Gram, Mikkel

    Objective In patients with painful chronic pancreatitis (CP) there is increasing evidence of abnormal pain processing in the central nervous system. Using magnetic resonance (MR) diffusion tensor imaging, brain microstructure in areas involved in processing of visceral pain was characterised...

  7. Symptom Severity of Restless Legs Syndrome Predicts Its Clinical Course.

    Science.gov (United States)

    Lee, Chung Suk; Kim, Tae; Lee, Sumin; Jeon, Hong Jun; Bang, Young Rong; Yoon, In-Young

    2016-04-01

    This study examines the clinical course of restless legs syndrome according to its severity and factors associated with the remission of restless legs syndrome symptoms. The remission or persistence of restless legs syndrome symptoms was investigated by considering patients with restless legs syndrome at the sleep clinic of Seoul National University Bundang Hospital. All subjects were observed for at least 18 months, and an incidence of remission was defined as having no restless legs syndrome symptoms for at least 1 year. Restless legs syndrome severity was evaluated by the International Restless Legs Syndrome Study Group Rating Scale. A total of 306 patients participated in this study. Over the observation periods of 4.1 ± 1.6 years, the cumulative incidence of remission is 32.5% (95% confidence interval [CI], 27.0-38.0) and decreased with baseline restless legs syndrome severity (P restless legs syndrome cases, respectively. Most cases of remission (82/96) were observed within 1 year, and the remission occurred sooner for mild restless legs syndrome. The hazard ratios of remission by Cox proportional hazards model were lower for moderate (0.556; 95% CI, 0.340-0.909) and severe to very severe (0.193; 95% CI, 0.108-0.343) restless legs syndrome than for mild restless legs syndrome. The remission incidence was lower for those patients who had a family history of restless legs syndrome and were older at restless legs syndrome diagnosis. Mild restless legs syndrome severity, no family history, and young age at restless legs syndrome diagnosis were significant predictors of restless legs syndrome remission. More than 80% of patients with severe restless legs syndrome showed a chronic clinical course. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Opioid-Induced Hyperalgesia - Worsening Pain in Opioid-Dependent Patients

    Science.gov (United States)

    2013-02-01

    presented to the emergency department (ED) with severe pain in his left leg and perineum. The patient had a history of bilateral above- the-knee amputations...μg to 75 μg/h and started buprenorphine 2 mg sublingual 4 times daily. He reported nausea and chills but denied fever, abdominal pain, dysuria, or...other symptoms. His medical history was significant for posttraumatic stress disorder, anxiety, chronic pain, phantom limb pain, insomnia, and depression

  9. THE EFFECTS OF SINGLE LEG HOP PROGRESSION AND DOUBLE LEGS HOP PROGRESSION EXERCISE TO INCREASE SPEED AND EXPLOSIVE POWER OF LEG MUSCLE

    Directory of Open Access Journals (Sweden)

    Nining W. Kusnanik

    2015-05-01

    Full Text Available The main purpose of this study was to determine the effect of single leg hop progression and double legs hop progression exercise to increase speed and explosive power of leg muscles. Plyometric is one of the training methods that can increase explosive power. There are many models of plyometric training including single leg hop progression and double leg hop progression. This research was experimental using match subject design techniques. The subjects of this study were 39 students who joined basketball school club. There were 3 groups in this study: Group 1 were 13 students who given sin¬gle leg hop progression exercise, Group 2 were 13 students who given double legs hop progression exercise, Group 3 were 13 students who given conventional exercise. The data was collected during pre test and post test by testing 30m speed running and vertical jump. The data was analyzed using Analysis of Varians (Anova. It was found that there were significantly increased on speed and explosive power of leg muscles of Group 1 and Group 2. It can be stated that single leg hop progression exercise was more effective than double leg hop progression exercise. The recent findings supported the hypothesis that single leg hop progression and double legs hop progression exercise can increase speed and explosive power of leg muscles. These finding were supported by some previous studies (Singh, et al, 2011; Shallaby, H.K., 2010. The single leg hop progression is more effective than double legs hop progression. This finding was consistent with some previous evidences (McCurdy, et al, 2005; Makaruk et al, 2011.

  10. Clinical characteristics of leg restlessness in Parkinson's disease compared with idiopathic Restless Legs Syndrome.

    Science.gov (United States)

    Zhu, Xiao-Ying; Liu, Ye; Zhang, Xiao-Jin; Yang, Wen-Hao; Feng, Ya; Ondo, William G; Tan, Eng-King; Wu, Yun-Cheng

    2015-10-15

    There is limited data on motor restlessness in Parkinson's disease (PD). Here we evaluate for clinical differences between cohorts of idiopathic Restless Legs Syndrome (iRLS), PD patients with leg restlessness, and PD with RLS. We examined 276 consecutive PD patients for leg restlessness symptoms, we compared clinical features of PD patients with RLS, PD patients with leg restlessness but not meeting RLS criteria, PD patient without RLS and iRLS. A total of 262 PD patients who satisfied the inclusion criteria were analyzed. After excluding 23 possible secondary RLS or mimics, 28 were diagnosed with RLS and 18 with leg motor restlessness (LMR). Compared with iRLS patients, PD patients with RLS or LMR had older age of RLS/LMR onset, shorter duration of leg restlessness, less positive family history, different seasonal trends and more unilaterality of leg restlessness symptom (Pleg restlessness. PD with LMR had less severe Parkinsonism (Pleg restlessness (P<0.01) symptoms than PD with RLS. Clinical characteristics of PD patients with RLS and LMR were different from iRLS, differentiating these various subtypes can facilitate optimal treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Task driven optimal leg trajectories in insect-scale legged microrobots

    Science.gov (United States)

    Doshi, Neel; Goldberg, Benjamin; Jayaram, Kaushik; Wood, Robert

    Origami inspired layered manufacturing techniques and 3D-printing have enabled the development of highly articulated legged robots at the insect-scale, including the 1.43g Harvard Ambulatory MicroRobot (HAMR). Research on these platforms has expanded its focus from manufacturing aspects to include design optimization and control for application-driven tasks. Consequently, the choice of gait selection, body morphology, leg trajectory, foot design, etc. have become areas of active research. HAMR has two controlled degrees-of-freedom per leg, making it an ideal candidate for exploring leg trajectory. We will discuss our work towards optimizing HAMR's leg trajectories for two different tasks: climbing using electroadhesives and level ground running (5-10 BL/s). T