Physical, psychosocial, and individual risk factors for neck/shoulder pain with pressure tenderness in the muscles among workers performing monotonous, repetitive work

DEFF Research Database (Denmark)

Andersen, JH; Kaergaard, A.; Frost, P.

2002-01-01

factors versus individual factors in the etiology of pain in the neck and/or shoulders. METHODS: Study participants were 3123 workers from 19 plants. Physical risk factors were evaluated via video observations, and psychosocial risk factors were assessed with the job content questionnaire. Other...... procedures included symptom survey, clinical examination, and assessment of health-related quality of life (SF-36). The main outcome variable, neck/shoulder pain with pressure tenderness, was defined on the basis of subjective pain score and pressure tenderness in muscles of the neck/shoulder region. RESULTS......STUDY DESIGN: Cross-sectional study. OBJECTIVES: To evaluate the effect of individual characteristics and physical and psychosocial workplace factors on neck/shoulder pain with pressure tenderness in the muscles. SUMMARY OF BACKGROUND DATA: Controversy prevails about the importance of workplace...

Nonarticular tenderness and functional status in patients with diffuse idiopathic skeletal hyperostosis.

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Mader, Reuven; Novofastovski, Irina; Rosner, Ehud; Adawi, Muhammad; Herer, Paula; Buskila, Dan

2010-09-01

To investigate the degree of nonarticular tenderness and functional status in patients with diffuse idiopathic skeletal hyperostosis (DISH). We assessed these variables' correlation with their clinical, radiographic, and constitutional measurements and with metabolic syndrome (MS). Eighty-seven patients with DISH were compared with 65 controls without DISH. Examination of nonarticular tenderness was performed by thumb palpation. Tenderness was scored for the 18 fibromyalgia tender points (TP), and 4 control points. Nonarticular tenderness was expressed by the number of TP and by the total tenderness score (TTS). The Short Health Assessment Questionnaire (HAQ II) was administered to all participants. Clinical and laboratory data were collected from all patients. Patients were classified as having MS by both the National Cholesterol Education Program and World Health Organization definitions. There was a statistically significant difference in TTS between controls and patients with DISH. The mean tenderness of many individual TP was significantly higher in the DISH group compared with the control group. TP counts, TTS, and body mass index (BMI) positively correlated with the HAQ II. There was a linear trend in intensity of T-spine bony bridges (BB) and the total number of TP as well as many individual TP. Patients with DISH were more likely to be affected by MS. No correlation was found between TP count, TTS, and MS. Patients with DISH have a lower pain threshold than patients who do not have DISH. TP count and TTS correlate with the functional status, BMI, waist circumference, and high-grade BB. No correlation was observed between pain threshold and MS.

Inter-Rater Reliability of Neck Reflex Points in Women with Chronic Neck Pain.

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Weinschenk, Stefan; Göllner, Richard; Hollmann, Markus W; Hotz, Lorenz; Picardi, Susanne; Hubbert, Katharina; Strowitzki, Thomas; Meuser, Thomas

2016-01-01

Neck reflex points (NRP) are tender soft tissue areas of the cervical region that display reflectory changes in response to chronic inflammations of correlated regions in the visceral cranium. Six bilateral areas, NRP C0, C1, C2, C3, C4 and C7, are detectable by palpating the lateral neck. We investigated the inter-rater reliability of NRP to assess their potential clinical relevance. 32 consecutive patients with chronic neck pain were examined for NRP tenderness by an experienced physician and an inexperienced medical student in a blinded design. A detailed description of the palpation technique is included in this section. Absence of pain was defined as pain index (PI) = 0, slight tenderness = 1, and marked pain = 2. Findings were evaluated either by pair-wise Cohen's kappa (ĸ) or by percentage of agreement (PA). Examiners identified 40% and 41% of positive NRP, respectively (PI > 0, physician: 155, student: 157) with a slight preference for the left side (1.2:1). The number of patients identified with >6 positive NRP by the examiners was similar (13 vs. 12 patients). ĸ values ranged from 0.52 to 0.95. The overall kappa was ĸ = 0.80 for the left and ĸ = 0.74 for the right side. PA varied from 78.1% to 96.9% with strongest agreement at NRP C0, NRP C2, and NRP C7. Inter-rater agreement was independent of patients' age, gender, body mass index and examiner's experience. The high reproducibility suggests the clinical relevance of NRP in women. © 2016 S. Karger GmbH, Freiburg.

Relationships between the fibromyalgia impact questionnaire, tender point count, and muscle strength in female patients with fibromyalgia

DEFF Research Database (Denmark)

Henriksen, Marius; Lund, Hans; Christensen, Robin

2009-01-01

of the patients completed version 1 of the Fibromyalgia Impact Questionnaire (FIQ) and were assessed for tender points and knee muscle strength. All subjects underwent bilateral isokinetic knee muscle strength testing in flexion and extension. Normative knee muscle strength values were calculated from the healthy......OBJECTIVE: To test the hypothesis that fibromyalgia (FM) patients with reduced lower extremity strength are more symptomatic and tender than FM patients with normal muscle strength. METHODS: A total of 840 FM patients and 122 healthy subjects were evaluated between 1998 and 2005. All....... There were no clinically significant differences between patients with low versus normal muscle strength. There were no clinically significant correlations between total FIQ score, tender point count, and muscle strength. Only 4.6% of the FIQ scores and 5.1% of the tender point counts were explained...

Symptoms of Fibromyalgia According to the 2016 Revised Fibromyalgia Criteria in Chronic Pain Patients Referred to Multidisciplinary Pain Rehabilitation: Influence on Clinical and Experimental Pain Sensitivity

DEFF Research Database (Denmark)

Plesner, Karin Bruun; Vaegter, Henrik Bjarke

2018-01-01

Fibromyalgia is a condition with chronic widespread pain and signs of generalized pain hypersensitivity. FM has previously been classified according to the ACR1990 criteria, where the presence of hypersensitivity is estimated by a tender point examination. Due to the limitations of these classifi......Fibromyalgia is a condition with chronic widespread pain and signs of generalized pain hypersensitivity. FM has previously been classified according to the ACR1990 criteria, where the presence of hypersensitivity is estimated by a tender point examination. Due to the limitations...... of these classification criteria, new diagnostic criteria have been proposed, abandoning this examination. This cross-sectional study investigated the prevalence of FM according to the revised 2016 FM criteria in a large cohort of chronic pain patients. Pain drawings, the Fibromyalgia Symptom Severity Scale...

Correlação entre a contagem dos pontos dolorosos na fibromialgia com a intensidade dos sintomas e seu impacto na qualidade de vida Correlation between the number of tender points in fibromyalgia, the intensity of symptoms and its impact on quality of life

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José Eduardo Martinez

2009-02-01

Full Text Available OBJETIVO: Estabelecer se há correlação entre o número de pontos dolorosos e a intensidade da percepção de aspectos centrais da síndrome (dor, fadiga, ansiedade, depressão e do seu impacto na capacidade funcional. MATERIAL E MÉTODOS: Avaliaram-se quarenta e um prontuários de pacientes que preenchem os Critérios de Classificação para Fibromialgia do Colégio Americano de Reumatologia, considerando as seguintes variáveis: percepção da intensidade de dor, fadiga, qualidade de vida global, depressão, ansiedade e contagem de pontos dolorosos. A avaliação da capacidade funcional foi realizada através do Questionário de Avaliação de Saúde simplificado (Health Assessment Questionnaire-HAQ. RESULTADOS: Observou-se correlação entre a contagem de pontos dolorosos e a intensidade da dor e a capacidade funcional. Não houve correlação com as notas atribuídas à fadiga (p = 0,358, ansiedade (p = 0,58, depressão (p = 0,50 e qualidade de vida (p = 0,538. A correlação entre o número de pontos dolorosos e a intensidade da dor foi mais forte que com o HAQ. CONCLUSÃO: Há correlação entre contagem dos pontos dolorosos e intensidade da dor e capacidade funcional. A correlação entre os pontos dolorosos e a intensidade da dor é mais importante do que com a capacidade funcional medida pelo HAQ. Não há correlação com as demais variáveis estudadas.OBJECTIVE: to study the correlation between the number of tender points and the intensity of the perception of key aspects of the fibromyalgia syndrome (pain, fatigue, anxiety, depression, and its impact in functional capacity. MATERIAL AND METHODS: forty-one records of patients who meet the Criteria for Classification of Fibromyalgia of the American College of Rheumatology were reviewed, focusing on the following variables: perception of the intensity of pain, fatigue, quality of sleep, depression, anxiety and the tender point count. The assessment of functional capacity was done by

Usefulness of tenderness to characterise fibromyalgia severity in women.

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Aparicio, V A; Carbonell-Baeza, A; Ortega, F B; Estevez, F; Ruiz, J R; Delgado-Fernández, M

2011-01-01

To investigate the usefulness of tenderness (tender points count (TPC) and algometer score) to characterise fibromyalgia (FM) severity and symptomatology in women. The study sample comprised 174 women aged 51±7 years. We ossesse tenderness using pressure algometry; quality of life by means of the Short-Form 36 Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). We used the FM impact questionnaire (FIQ) to assess FM severity and symptomatology. Patients were categorised according to three FIQ-derived categories: FIQFIQFIQ≥59 (16.9±2 vs. 15.6±4, p=0.02), whereas no differences between groups were observed according to FIQ≥70 (17.0±2 vs. 16.2±3, p=0.12) or FM type (16.8±3 for type II vs. 15.9±4 for type I, p=0.13). We observed a significant association between TPC and FIQ-job difficulty, pain, morning tiredness and stiffness dimensions (all pFIQ, FIQ-anxiety, fatigue and depression dimensions (all p>0.05). Algometer score was lower in the FIQ≥70 (45.7±12 vs. 51.1±14, p=0.05) and FIQ≥59 (46.7±13 vs. 52.7±14, p=0.05) groups, and there were no difference between FM types (48.7±13 vs. 49.5±14 for type II and I respectively, p=0.81). Algometer score was not associated with total score of FIQ or FIQ dimensions (all p≥0.1). Widespread pain and pain hypersensitivity, as measured by TPC and algometer score, do not seem to be useful to characterise FM severity and symptomatology (measured by FIQ) in women.

OnabotulinumtoxinA (Botox) nerve blocks provide durable pain relief for men with chronic scrotal pain: a pilot open-label trial.

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Khambati, Aziz; Lau, Susan; Gordon, Allan; Jarvi, Keith A

2014-12-01

Chronic scrotal pain (CSP) is a common, often debilitating, condition affecting approximately 4.75% of men. While nerve blocks using local anesthetics usually provide temporary pain relief, there are no publications on the use of longer acting nerve blocks to provide more durable pain relief for men with CSP. The aim of this study was to determine if onabotulinumtoxinA (Botox) cord blocks provide durable pain relief for men with CSP. In this pilot open-label study, men with CSP who had failed medical management but experienced temporary pain relief from a standard cord block underwent a cord block with 100U Botox. The outcomes measured were changes 1, 3, and 6 months post-Botox injection in (i) a 10-point visual analog scale (VAS) pain score; (ii) scrotal tenderness on a three-point scale as rated by physical examination; and (iii) the Chronic Epididymitis Symptom Index (CESI) to measure the severity and impact of scrotal pain on men. Paired t-tests were used to compare groups. Eighteen patients with CSP seen between April and September 2013 had Botox injected as a cord block. At the 1-month follow-up, pain reduction was reported by 72% of patients (mean VAS score: 7.36 vs. 5.61, P pain reduction and reduced tenderness based on the VAS score (mean: 7.36 vs. 6.02, P pain and tenderness. Our pilot study found that Botox cord blocks provide pain reduction for 3 months or more for most men with CSP. © 2014 International Society for Sexual Medicine.

The 6-minute walk test in female fibromyalgia patients: relationship with tenderness, symptomatology, quality of life, and coping strategies.

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Carbonell-Baeza, Ana; Ruiz, Jonatan R; Aparicio, Virginia A; Ortega, Francisco B; Delgado-Fernández, Manuel

2013-12-01

The purpose of this study was to examine the relationship between the 6-minute walk test (6-MWT) and tenderness, symptomatology, quality of life, and coping strategies in women with fibromyalgia. One hundred eighteen women with fibromyalgia aged 51.9 ± 7.3 years participated in the study. The examination included the 6-MWT, tender points, and the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ), Short-Form Health Survey 36 (SF-36), and Vanderbilt Pain Management Inventory. Fair correlations between the 6-MWT and the subscales of physical impairment (FIQ) and physical function (SF-36) were observed (ρ -0.365 and 0.347, respectively, both p fibromyalgia shows significant relationships, ranging from weak to fair, between the 6-MWT and tenderness, symptomatology, quality of life, and coping strategies. These findings indicate that functional capacity, as assessed by the distance walked in 6 minutes, might be important when planning the assessment, treatment, and monitoring of patients with fibromyalgia. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Fibromyalgia as a neuropathic pain syndrome

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Manuel Martinez-Lavin

2003-06-01

Full Text Available This article discusses scientific evidence supporting the notion that all fibromyalgia (FM features can be explained on the basis of autonomic (sympathetic nervous system dysfunction. Also suggests that FM main features (widespread pain and tenderness at palpation on specific anatomic points are manifestations of painful neuropathy. On these bases, a holistic approach for FM treatment is proposed.

A cross-sectional study of the relationship between body mass index and clinical characteristics, tenderness measures, quality of life, and physical functioning in fibromyalgia patients.

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Neumann, Lily; Lerner, Ella; Glazer, Yael; Bolotin, Arkady; Shefer, Alexander; Buskila, Dan

2008-12-01

We examined the relationship between body mass index (BMI) and measures of tenderness, quality of life, and physical functioning in female fibromyalgia (FMS) patients. A random sample of 100 female FMS patients from a database of 550 FMS individuals was interviewed and assessed according to a structured questionnaire that included FMS-related symptoms, measures of tenderness (point count and dolorimetry), quality of life (SF-36), physical functioning, and BMI. Weight was defined as normal, overweight, and obesity according to BMI. Twenty-seven percent of the FMS patients had normal BMI, 28% were overweight, and 45% were obese. BMI was negatively correlated with quality of life (r = -0.205, P = 0.044) and tenderness threshold (r = -0.238, P = 0.021) and positively correlated with physical dysfunctioning (r = 0.202, P = 0.047) and point count (r = 0.261, P = 0.011). Obese FMS patients display higher pain sensitivity and lower levels of quality of life. In designing studies that explore factors affecting tenderness, BMI should be included in addition to sex, age, etc.

Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness.

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FitzGerald, M P; Payne, C K; Lukacz, E S; Yang, C C; Peters, K M; Chai, T C; Nickel, J C; Hanno, P M; Kreder, K J; Burks, D A; Mayer, R; Kotarinos, R; Fortman, C; Allen, T M; Fraser, L; Mason-Cover, M; Furey, C; Odabachian, L; Sanfield, A; Chu, J; Huestis, K; Tata, G E; Dugan, N; Sheth, H; Bewyer, K; Anaeme, A; Newton, K; Featherstone, W; Halle-Podell, R; Cen, L; Landis, J R; Propert, K J; Foster, H E; Kusek, J W; Nyberg, L M

2012-06-01

We determined the efficacy and safety of pelvic floor myofascial physical therapy compared to global therapeutic massage in women with newly symptomatic interstitial cystitis/painful bladder syndrome. A randomized controlled trial of 10 scheduled treatments of myofascial physical therapy vs global therapeutic massage was performed at 11 clinical centers in North America. We recruited women with interstitial cystitis/painful bladder syndrome with demonstrable pelvic floor tenderness on physical examination and a limitation of no more than 3 years' symptom duration. The primary outcome was the proportion of responders defined as moderately improved or markedly improved in overall symptoms compared to baseline on a 7-point global response assessment scale. Secondary outcomes included ratings for pain, urgency and frequency, the O'Leary-Sant IC Symptom and Problem Index, and reports of adverse events. We compared response rates between treatment arms using the exact conditional version of the Mantel-Haenszel test to control for clustering by clinical center. For secondary efficacy outcomes cross-sectional descriptive statistics and changes from baseline were calculated. A total of 81 women randomized to the 2 treatment groups had similar symptoms at baseline. The global response assessment response rate was 26% in the global therapeutic massage group and 59% in the myofascial physical therapy group (p=0.0012). Pain, urgency and frequency ratings, and O'Leary-Sant IC Symptom and Problem Index decreased in both groups during followup, and were not significantly different between the groups. Pain was the most common adverse event, occurring at similar rates in both groups. No serious adverse events were reported. A significantly higher proportion of women with interstitial cystitis/painful bladder syndrome responded to treatment with myofascial physical therapy than to global therapeutic massage. Myofascial physical therapy may be a beneficial therapy in women with this

Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia?

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Bagis, Selda; Karabiber, Mehmet; As, Ismet; Tamer, Lülüfer; Erdogan, Canan; Atalay, Ayçe

2013-01-01

The aims of this study were to investigate the relationship between magnesium levels and fibromyalgia symptoms and to determine the effect of magnesium citrate treatment on these symptoms. Sixty premenopausal women diagnosed with fibromyalgia according to the ACR criteria and 20 healthy women whose age and weight matched the premenopausal women were evaluated. Pain intensity, pain threshold, the number of tender points, the tender point index, the fibromyalgia impact questionnaire (FIQ), the Beck depression and Beck anxiety scores and patient symptoms were evaluated in all the women. Serum and erythrocyte magnesium levels were also measured. The patients were divided into three groups. The magnesium citrate (300 mg/day) was given to the first group (n = 20), amitriptyline (10 mg/day) was given to the second group (n = 20), and magnesium citrate (300 mg/day) + amitriptyline (10 mg/day) treatment was given to the third group (n = 20). All parameters were reevaluated after the 8 weeks of treatment. The serum and erythrocyte magnesium levels were significantly lower in patients with fibromyalgia than in the controls. Also there was a negative correlation between the magnesium levels and fibromyalgia symptoms. The number of tender points, tender point index, FIQ and Beck depression scores decreased significantly with the magnesium citrate treatment. The combined amitriptyline + magnesium citrate treatment proved effective on all parameters except numbness. Low magnesium levels in the erythrocyte might be an etiologic factor on fibromyalgia symptoms. The magnesium citrate treatment was only effective tender points and the intensity of fibromyalgia. However, it was effective on all parameters when used in combination with amitriptyline.

[Myofascial pain syndrome--frequent occurrence and often misdiagnosed].

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Pongratz, D E; Späth, M

1998-09-30

Myofascial pain syndrome (MPS) is a very common localized--sometimes also polytopic--painful musculoskeletal condition associated with trigger points, for which, however, diagnostic criteria established in well-designed studies are still lacking. These two facts form the basis for differentiating between MPS and the fibromyalgia syndrome. The difference between trigger points (MPS) and tender points (fibromyalgia) is of central importance--not merely in a linguistic sense. A knowledge of the signs and symptoms typically associated with a trigger point often obviates the need for time-consuming and expensive technical diagnostic measures. The assumption that many cases of unspecific complaints affecting the musculoskeletal system may be ascribed to MPS makes clear the scope for the saving of costs.

Pain and functional capacity in female fibromyalgia patients.

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Carbonell-Baeza, Ana; Aparicio, Virginia A; Sjöström, Michael; Ruiz, Jonatan R; Delgado-Fernández, Manuel

2011-11-01

To examine the association between pain and functional capacity levels. [corrected] Cross-sectional study. University of Granada. One hundred twenty-three women with fibromyalgia (51.7 ± 7.2 years). We measured weight and height, and body mass index (BMI) was calculated. We assessed tender points by pressure pain and functional capacity by means of the 30-second chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8-ft up and go and 6-minute walk tests. We observed an association of tender points count with the chair stand and 6-minute walk tests (r = -0.273, P = 0.004 and r = -0.183, P = 0.046, respectively). These associations became nonsignificant once the analyses were adjusted by weight or BMI. We observed an association of algometer score with the back scratch, chair stand, and 6-minute walk tests (r = 0.238, P = 0.009; r = 0.363, P BMI, except the association between algometer score and the 6-minute walk test that became nonsignificant once the analyses were adjusted by weight. Prevalence of overweight and obesity was 39.2 and 33.3%, respectively. There is an inverse association of tender points count with the chair stand and distance walked in the 6-minute walk tests, and a positive association of algometer score with the chair stand, distance walked in the 6-minute walk and back scratch tests, yet, weight status seems to play a role in these associations. Wiley Periodicals, Inc.

Pain point system scale (PPSS: a method for postoperative pain estimation in retrospective studies

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Gkotsi A

2012-11-01

Full Text Available Anastasia Gkotsi,1 Dimosthenis Petsas,2 Vasilios Sakalis,3 Asterios Fotas,3 Argyrios Triantafyllidis,3 Ioannis Vouros,3 Evangelos Saridakis,2 Georgios Salpiggidis,3 Athanasios Papathanasiou31Department of Experimental Physiology, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Department of Anesthesiology, 3Department of Urology, Hippokration General Hospital, Thessaloniki, GreecePurpose: Pain rating scales are widely used for pain assessment. Nevertheless, a new tool is required for pain assessment needs in retrospective studies.Methods: The postoperative pain episodes, during the first postoperative day, of three patient groups were analyzed. Each pain episode was assessed by a visual analog scale, numerical rating scale, verbal rating scale, and a new tool – pain point system scale (PPSS – based on the analgesics administered. The type of analgesic was defined based on the authors’ clinic protocol, patient comorbidities, pain assessment tool scores, and preadministered medications by an artificial neural network system. At each pain episode, each patient was asked to fill the three pain scales. Bartlett’s test and Kaiser–Meyer–Olkin criterion were used to evaluate sample sufficiency. The proper scoring system was defined by varimax rotation. Spearman’s and Pearson’s coefficients assessed PPSS correlation to the known pain scales.Results: A total of 262 pain episodes were evaluated in 124 patients. The PPSS scored one point for each dose of paracetamol, three points for each nonsteroidal antiinflammatory drug or codeine, and seven points for each dose of opioids. The correlation between the visual analog scale and PPSS was found to be strong and linear (rho: 0.715; P <0.001 and Pearson: 0.631; P < 0.001.Conclusion: PPSS correlated well with the known pain scale and could be used safely in the evaluation of postoperative pain in retrospective studies.Keywords: pain scale, retrospective studies, pain point system

Evaluation of the pain and local tenderness in bone metastasis treated with magnetic resonance-guided focused ultrasound surgery (MRgFUS)

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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.

Unexplained lower abdominal pain associated with sacroiliac joint dysfunction: report of 2 cases.

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Morimoto, Daijiro; Isu, Toyohiko; Kim, Kyongsong; Matsumoto, Ryoji; Isobe, Masanori

2011-01-01

A 25-year-old woman and a 31-year-old man presented with chronic lower back pain and unexplained lower abdominal pain. Both patients had groin tenderness at the medial border of the anterior superior iliac spine. The results of radiographical and physical examinations suggested sacroiliac joint dysfunction. Sacroiliac joint injection relieved their symptoms, including groin tenderness. In our experience, groin tenderness is highly specific for sacroiliac joint dysfunction. We speculate that spasm of the iliac muscle can cause groin pain and tenderness. Groin pain and a history of unexplained abdominal pain, with lower back pain, are symptoms that suggest sacroiliac joint dysfunction. Additionally, compression of the iliac muscle is a simple and useful maneuver; therefore, it can be used as a screening test for sacroiliac joint dysfunction, alongside other provocation tests.

Widespread pain: is an improved classification possible?

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MacFarlane, G J; Croft, P R; Schollum, J; Silman, A J

1996-09-01

The classification of widespread pain, proposed by the American College of Rheumatology (ACR) for use in the clinic as a screen for fibromyalgia, as described, does not require truly widespread pain. Studies considering the epidemiology of widespread pain per se may therefore require a definition with greater face validity, which might also show enhanced associations with other physical and psychological measures. We aimed to develop a more coherent definition of widespread pain for use in epidemiological studies and to compare performance in identifying individuals with significant morbidity. A group of 172 subjects who had participated in a community based study on the occurrence of pain were identified and categorized by their pain experience as indicated on line drawings of the body according to ACR definition and to a new, more stringent definition that required the presence of more diffuse limb pain. A number of other clinical and psychological measures were recorded for these individuals and the association between their pain status measures and these other variables was assessed and compared. Persons satisfying the newly proposed definition for chronic widespread pain, in comparison with those who satisfied only the present ACR definition, had a significantly higher score on the General Health Questionnaire [median difference (MD) 7.95% CI 1.13], a higher score on the Health and Fatigue Questionnaire (MD 10.95% CI 0.15), and greater problems with sleep (sleep problem score MD 4.95% CI 0.9). Those satisfying the new definition also had a greater number of tender points on examination (MD 3.95% CI -1.7). The morbidity of those satisfying only the present ACR definition was closer to persons who had regional pain. A redefinition of widespread pain has produced a group of subjects whose pain is (a) likely to be more "widespread" and (b) is associated more strongly with factors such as psychological disturbance, fatigue, sleep problems, and tender points, and

Radiating leg pain and positive straight leg raising in spondylolysis in children.

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Halperin, N; Copeliovitch, L; Schachner, E

1983-09-01

Three children presented with low back pain radiating to the leg and with spasm of the hamstring and paravertebral muscles. Since the pain could not be ascribed to trauma, it was necessary to exclude the presence of infection or tumors. All the signs--localization of the pain, tenderness on one side of the back, X-ray film findings of unilateral or bilateral spondylolysis, and localized positive bone scan--pointed to spondylolysis as the cause of pain. All three children exhibited symptoms resembling those found in the facet syndrome described by Mooney and Robertson.

Tender in power-plants back to starting point

International Nuclear Information System (INIS)

TREND

2003-01-01

Even though there was no progress in privatisation of a 40-percent stake in Slovenske elektrarne (SE), a.s., Bratislava a government decree on re-opening of the tender issued in July will allow more prospects to participate. New prospects that are expected to submit their offers are Czech CEZ and American AES. At the same time the original eight prospects that submitted their offers earlier will have the opportunity to withdraw from the tender or review their offers. The new prospects can show their interest in requesting a information memorandum that will be published shortly and then PricewaterhouseCoopers (PwC) will state a date when the offers have to be submitted. After the original offers are updated and the new ones submitted, the offers will be evaluated. Representative of PwC, Peter Mitka refused to discuss the evaluation deadlines and the consecutive due diligence in SE to be conducted by selected investors. The company to have restarted the whole process was the Czech CEZ that had announces its intention to privatise not only the conventional part of SE but the nuclear part as well. The remaining prospects only show interest in hydraulic power plants or conventional power plants but none of them is interested in nuclear power plants. Even though the process is still open and theoretically other prospects could show their interest in the future, Minister of Economy, Robert Nemcsics does not expect that this step would be repeated. And so the number of prospects is ten. In the past the Minister expressed his view that the most suitable solution would be so sell the SE as a whole and during the first press conference given together with privatisation advisor the Minister explained that there was no time-pressure in regards to the privatisation process as an internal restructuring of the company had to be completed first

Ear acupuncture in the control of migraine pain: selecting the right acupoints by the "needle-contact test".

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Romoli, M; Allais, G; Airola, G; Benedetto, C

2005-05-01

There is increasing evidence that somatic acupuncture can be helpful in migraine treatment, but substantial data on ear acupuncture (EAP) are still lacking. EAP can be useful both in the diagnosis and in the treatment of many medical conditions. As regards the control of migrainous pain, we present a case report in which a procedure called the "needle-contact test" is described in detail. During a migraine attack, the patient undergoes an accurate search for tender points of the outer ear by means of a specific pressure algometer. Once the most sensitive point has been identified, an acupuncture needle is placed in contact with it for about 10 s, without skin penetration. The expected effect is a quick and evident reduction of acute pain. If no appreciable variation in pain intensity occurs within the following 60 s, a second or third attempt is made on other previously identified tender points, until the point at which the patient notices a clear remission of pain is found. In this positive case, the same testing needle can be immediately used for therapy, completely penetrating the skin, and then extracted after about 30 min. Alternatively, a temporary needle can be implanted and left in situ for a variable period of time (1-15 days). This innovative technique allows the identification, with maximum accuracy, of the most effective ear acupoints on migraine pain during acute attacks.

Psychosocial factors partially mediate the relationship between mechanical hyperalgesia and self-reported pain.

Science.gov (United States)

Mason, Kayleigh J; O'Neill, Terence W; Lunt, Mark; Jones, Anthony K P; McBeth, John

2018-01-26

Amplification of sensory signalling within the nervous system along with psychosocial factors contributes to the variation and severity of knee pain. Quantitative sensory testing (QST) is a non-invasive test battery that assesses sensory perception of thermal, pressure, mechanical and vibration stimuli used in the assessment of pain. Psychosocial factors also have an important role in explaining the occurrence of pain. The aim was to determine whether QST measures were associated with self-reported pain, and whether those associations were mediated by psychosocial factors. Participants with knee pain identified from a population-based cohort completed a tender point count and a reduced QST battery of thermal, mechanical and pressure pain thresholds, temporal summation, mechanical pain sensitivity (MPS), dynamic mechanical allodynia (DMA) and vibration detection threshold performed following the protocol by the German Research Network on Neuropathic Pain. QST assessments were performed at the most painful knee and opposite forearm (if pain-free). Participants were asked to score for their global and knee pain intensities within the past month (range 0-10), and complete questionnaire items investigating anxiety, depression, illness perceptions, pain catastrophising, and physical functioning. QST measures (independent variable) significantly correlated (Spearman's rho) with self-reported pain intensity (dependent variable) were included in structural equation models with psychosocial factors (latent mediators). Seventy-two participants were recruited with 61 participants (36 women; median age 64 years) with complete data included in subsequent analyses. Tender point count was significantly correlated with global pain intensity. DMA at the knee and MPS at the most painful knee and opposite pain-free forearm were significantly correlated with both global pain and knee pain intensities. Psychosocial factors including pain catastrophising sub-scales (rumination and

Comparing complementary alternative treatment for chronic shoulder pain of myofascial origin: Collateral meridian therapy versus local tender area-related meridians therapy.

Science.gov (United States)

Pan, Ru-Yu; Hsu, Yung-Chi; Wong, Chih-Shung; Lin, Shinn-Long; Li, Tsung-Ying; Cherng, Chen-Hwan; Ko, Shan-Chi; Yeh, Chun-Chang

2016-08-01

The aim of this study was to compare the short-term outcomes between 2 different treatments for unilateral chronic shoulder pain of myofascial origin, that is, local tender area related meridians (LTARMs) treatment and collateral meridian therapy (CMT), which were performed 6 times over a period of 4 weeks.Seventy patients with unilateral shoulder pain of chronic myofascial origin were enrolled. The patients were randomly assigned to 2 different treatment groups: 1 group received CMT (n = 35) and the other received LTARM (n = 35). Before and after the 2 treatment processes, all patients rated their overall pain intensity on a visual analogue scale (VAS) and a validated 13-question shoulder pain and disability index (SPADI) questionnaire was used to measure shoulder pain and functional impairment after therapy for 4 weeks.After CMT, the pain intensity was reduced after CMT. VAS score is reduced from 5.90 ± 2.07 (a mean of 5.90 and standard deviation of 2.07) to 3.39 ± 1.2. This was verified by the SPADI pain subscale scores (from 0.58 ± 0.193 to 0.33 ± 0.14). The pain-relief effect of CMT was significantly better than that of LTARM (VAS score from 5.78 ± 1.64 to 4.58 ± 1.40; P pain subscale score from 0.58 ± 0.16 to 0.45 ± 0.14, P pain, whereas the VAS scores for moderate pain were even higher in the LTARM group in 75% of patients (P chronic shoulder pain of myofascial origin than the LTARM treatment, where treatment with the former resulted in better functional recovery after 4 weeks than the latter.

Efeito da acupuntura na melhora da dor, sono e qualidade de vida em pacientes fibromiálgicos: estudo preliminar Effect of acupuncture on pain, sleep and quality of life improvement in fibromyalgia patients: preliminary study

Directory of Open Access Journals (Sweden)

Raymond S. Takiguchi

2008-09-01

Full Text Available A fibromialgia é uma síndrome definida por dor crônica generalizada e em pelo menos 11 dos 18 tender points, pontos dolorosos específicos. Este ensaio clínico randômico visou verificar a eficácia da acupuntura na melhora da dor, sono e qualidade de vida de pacientes fibromiálgicas. Dentre 20 mulheres com média de idade 44 anos, com diagnóstico de fibromialgia segundo critérios do Colégio Americano de Reumatologia, finalizaram o estudo 12, distribuídas aleatoriamente em dois grupos: A (GA, n=5, que recebeu acupuntura segundo a medicina tradicional chinesa; e B (GB, n=7, que teve a inserção de agulhas nos tender points base do occipital, trapézio, supraespinhoso e epicôndilo lateral. A dor foi avaliada por escala visual analógica e dolorimetria; o sono, pelo Inventário do Sono; e a qualidade de vida, pelo Questionário de Impacto da Fibromialgia (QIF. Os grupos receberam acupuntura uma vez por semana, durante oito semanas, com inserção de oito agulhas por 25 minutos. Os dados foram tratados estatisticamente, adotando-se o nível de significância ±=0,05. No GA, houve melhora estatisticamente significante do sono; e no GB, na dor, limiar de dor nos tender points, no sono e nos itens do QIF dor, cansaço matinal, ansiedade e depressão (pFibromyalgia is a syndrome defined by chronic widespread pain and sensitivity to pressure at at least 11 of 18 tender points. The aim of this random blind clinical trial was to assess the effectiveness of acupuncture on pain relief, on quality of sleep and life in fibromyalgia patients. From 20 female fibromyalgic patients (diagnosed according to the American College of Rheumatology, mean aged 44 years, 12 completed the study, randomly assigned into two groups: group A (GA, n=5 received acupuncture according to the traditional Chinese medicine; and group B (GB, n=7 received acupuncture at eight tender points: at the occiput, trapezius muscle, supraspinatus muscle, and lateral epicondyle. Pain

Tendering specification and contracting

International Nuclear Information System (INIS)

Koch, E. von

1975-01-01

The lecture tendering, specification and contracting is prepared in two parts: This first part deals with technical aspects while part two features the commercial and legal situation in the partnership of two: the supplier of the fuel bundles and the utility. In this lecture a look is given on the way how a supplier can offer its fuel and some certain points are mentioned which are important to compare the bid of one competitor to the other. The major points are summarized which are or at least should be in an offer so as to find out which offer is the best. (orig./FW) [de

Microcurrent Point Stimulation Applied to Lower Back Acupuncture Points for the Treatment of Nonspecific Neck Pain.

Science.gov (United States)

Armstrong, Kelly; Gokal, Raman; Chevalier, Antoine; Todorsky, William; Lim, Mike

2017-04-01

Although acupuncture and microcurrent are widely used for chronic pain, there remains considerable controversy as to their therapeutic value for neck pain. We aimed to determine the effect size of microcurrent applied to lower back acupuncture points to assess the impact on the neck pain. This was a cohort analysis of treatment outcomes pre- and postmicrocurrent stimulation, involving 34 patients with a history of nonspecific chronic neck pain. Consenting patients were enrolled from a group of therapists attending educational seminars and were asked to report pain levels pre-post and 48 hours after a single MPS application. Direct current microcurrent point stimulation (MPS) applied to standardized lower back acupuncture protocol points was used. Evaluations entailed a baseline visual analog scale (VAS) pain scale assessment, using a VAS, which was repeated twice after therapy, once immediately postelectrotherapy and again after a 48-h follow-up period. All 34 patients received a single MPS session. Results were analyzed using paired t tests. Results and Outcomes: Pain intensity showed an initial statistically significant reduction of 68% [3.9050 points; 95% CI (2.9480, 3.9050); p = 0.0001], in mean neck pain levels after standard protocol treatment, when compared to initial pain levels. There was a further statistically significant reduction of 35% in mean neck pain levels at 48 h when compared to pain levels immediately after standard protocol treatment [0.5588 points; 95% CI (0.2001, 0.9176); p = 0.03], for a total average pain relief of 80%. The positive results in this study could have applications for those patients impacted by chronic neck pain.

Relationships between the fibromyalgia impact questionnaire, tender point count, and muscle strength in female patients with fibromyalgia

DEFF Research Database (Denmark)

Henriksen, Marius; Lund, Hans Peter; Christensen, Robin

2009-01-01

To test the hypothesis that fibromyalgia (FM) patients with reduced lower extremity strength are more symptomatic and tender than FM patients with normal muscle strength.......To test the hypothesis that fibromyalgia (FM) patients with reduced lower extremity strength are more symptomatic and tender than FM patients with normal muscle strength....

Concurrent validation of a pressure pain threshold scale for individuals with myofascial pain syndrome and fibromyalgia.

Science.gov (United States)

Cheatham, Scott W; Kolber, Morey J; Mokha, G Monique; Hanney, William J

2018-02-01

Manual pressure palpation is an examination technique used in the classification of myofascial pain syndrome (MPS) and fibromyalgia (FM). Currently, there are no validated systems for classifying results. A valid and reliable pressure pain threshold scale (PPTS) may provide a means for clinicians to grade, document, and report findings. The purpose of this investigation was to validate a PPTS in individuals diagnosed with MPS and FM. Intra-rater reliability, concurrent validity, minimum cut-off value, and patient responses were evaluated. Eighty-four participants who met the inclusion criteria were placed into three groups of 28 ( N = 84): MPS, FM, and asymptomatic controls. All participants underwent a two-part testing session using the American College of Rheumatology criteria for classifying FM. Part-1 consisted of manual palpation with a digital pressure sensor for pressure consistency and part 2 consisted of algometry. For each tender point (18 total), participants graded tenderness using the visual analog scale (VAS) while the examiner concurrently graded response using a five-point PPTS. The PPTS had good intra-rater reliability (ICC ≥ .88). A moderate to excellent relationship was found between the PPTS and VAS for all groups with the digital pressure sensor and algometer ( ρ  ≥ .61). A minimum cut-off value of 2 on the PPTS differentiated participants with MPS and FM from asymptomatic controls. The results provide preliminary evidence validating the PPTS for individuals with MPS and FM. Future research should further study the clinimetric properties of the PPTS with other chronic pain and orthopedic conditions. 2c. ClinicalTrials.gov registration No. NCT02802202.

Grading the intensity of nondental orofacial pain: identification of cutoff points for mild, moderate, and severe pain

Directory of Open Access Journals (Sweden)

Brailo V

2015-02-01

Full Text Available Vlaho Brailo,1 Joanna M Zakrzewska2 1Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 2Facial Pain Unit, Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital, UCLH NHS Foundation Trust/University College London, London, UK Background: When assessing pain in clinical practice, clinicians often label pain as mild, moderate, and severe. However, these categories are not distinctly defined, and are often used arbitrarily. Instruments for pain assessment use more sophisticated scales, such as a 0–10 numerical rating scale, and apart from pain intensity assess pain-related interference and disability. The aim of the study was to identify cutoff points for mild, moderate, and severe nondental orofacial pain using a numerical rating scale, a pain-related interference scale, and a disability measurement. Materials and methods: A total of 245 patients referred to the Facial Pain Unit in London were included in the study. Intensity and pain-related interference were assessed by the Brief Pain Inventory. Pain-related disability was assessed by the Chronic Graded Pain Scale. Average pain intensity (0–10 was classified into nine schemes with varying cutoff points of mild, moderate, and severe pain. The scheme with the most significant intergroup difference, expressed by multivariate analysis of variance, provided the cutoffs between mild, moderate, and severe pain. Results: The combination that showed the greatest intergroup differences for all patients was scheme 47 (mild 1–4, moderate 5–7, severe 8–10. The same combination provided the greatest intergroup differences in subgroups of patients with temporomandibular disorder and chronic idiopathic facial pain, respectively. Among the trigeminal neuralgia patients alone, the combination with the highest intergroup differences was scheme 48 (mild 1–4, moderate 5–8, severe 9–10. Conclusion: The cutoff points established in

Attenuation of Experimental Pain by Vibro-Tactile Stimulation in Patients with Chronic Local or Widespread Musculoskeletal Pain

OpenAIRE

Staud, Roland; Robinson, Michael E.; Goldman, Casey T.; Price, Donald D.

2011-01-01

Patients with chronic pain syndromes, like fibromyalgia (FM) complain of widespread pain and tenderness, as well as non-refreshing sleep, cognitive dysfunction, and negative mood. Several lines of evidence implicate abnormalities of central pain processing as contributors for chronic pain, including dysfunctional descending pain inhibition. One form of endogenous pain inhibition, diffuse noxious inhibitory controls (DNIC), has been found to be abnormal in some chronic pain patients and eviden...

[Differential diagnosis of polyarthritis pain syndrome of the locomotor apparatus].

Science.gov (United States)

Menninger, H

1998-02-28

Widespread pain syndromes of the musculoskeletal system present to general practitioners, internists, neurologists and orthopedic surgeons every day. The syndromes may result both from organic diseases (inflammatory joint diseases, rheumatic manifestations of organ diseases) as well as dysfunctional syndromes, the latter including mainly biomechanically induced syndromes and fibromyalgia. The approach is predominantly clinically oriented and requires laboratory means or technical procedures only in a limited extend. The duration of history, the recognition of synovitis and of myofascial trigger points or of integumental tender points allow in most patients to achieve appropriate diagnostic criteria.

Defining Abnormally Low Tenders

DEFF Research Database (Denmark)

Ølykke, Grith Skovgaard; Nyström, Johan

2017-01-01

The concept of an abnormally low tender is not defined in EU public procurement law. This article takes an interdisciplinary law and economics approach to examine a dataset consisting of Swedish and Danish judgments and verdicts concerning the concept of an abnormally low tender. The purpose...

Review of overlap between thermoregulation and pain modulation in fibromyalgia

Science.gov (United States)

Larson, Alice A.; Pardo, José V.; Pasley, Jeffrey D.

2013-01-01

Fibromyalgia syndrome is characterized by widespread pain that is exacerbated by cold and stress but relieved by warmth. We review the points along thermal and pain pathways where temperature may influence pain. We also present evidence addressing the possibility that brown adipose tissue activity is linked to the pain of fibromyalgia given that cold initiates thermogenesis in brown adipose tissue via adrenergic activity, while warmth suspends thermogenesis. Although females have a higher incidence of fibromyalgia as well as more resting thermogenesis, they are less able to recruit brown adipose tissue in response to chronic stress than males. In addition, conditions that are frequently comorbid with fibromyalgia compromise brown adipose activity making it less responsive to sympathetic stimulation. This results in lower body temperatures, lower metabolic rates, and lower circulating cortisol/corticosterone in response to stress - characteristics of fibromyalgia. In the periphery, sympathetic nerves to brown adipose also project to surrounding tissues, including tender points characterizing fibromyalgia. As a result, the musculoskeletal hyperalgesia associated with conditions like fibromyalgia may result from referred pain in the adjacent muscle and skin. PMID:23887348

Tender Notices | About IASc | Indian Academy of Sciences

Indian Academy of Sciences (India)

Limited tender notification for AMC for computers & peripherals. Open tender for supply of printing and photocopier paper. Tender for Transport, Housekeeping and Catering services. Tender for website redesign - Work awarded to lowest bidder Sriranga Digital Software Technologies after scrutiny of price bids; Tender for ...

49 CFR 230.107 - Tender frame and body.

Science.gov (United States)

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Tender frame and body. 230.107 Section 230.107... Tenders Trucks, Frames and Equalizing System § 230.107 Tender frame and body. (a) Maintenance. Tender... repaired: (1) Portions of the tender frame or body (except wheels) that have less than a 21/2 inches...

No effect of experimental occlusal interferences on pressure pain thresholds of the masseter and temporalis muscles in healthy women

NARCIS (Netherlands)

Michelotti, A; Farella, M; Steenks, MH; Gallo, LM; Palla, S

It has been suggested that occlusal interferences may lead to pain and tenderness of the masticatory muscles. Tender jaw muscles are more sensitive to pressure pain, as assessed by means of pressure algometry. We tested the effects of occlusal interferences on the pressure pain threshold of the jaw

Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness.

Science.gov (United States)

Cohen, Steven P; Peterlin, B Lee; Fulton, Larry; Neely, Edward T; Kurihara, Connie; Gupta, Anita; Mali, Jimmy; Fu, Diana C; Jacobs, Michael B; Plunkett, Anthony R; Verdun, Aubrey J; Stojanovic, Milan P; Hanling, Steven; Constantinescu, Octav; White, Ronald L; McLean, Brian C; Pasquina, Paul F; Zhao, Zirong

2015-12-01

Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline -2.743 ± 2.487 vs -1.377 ± 1.970; P occipital pain through 3 months (mean change from baseline -1.925 ± 3.204 vs -0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline -2.738 ± 2.753 vs -1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.

A Case of Painful Hashimoto Thyroiditis that Mimicked Subacute Thyroiditis

Science.gov (United States)

Seo, Hye Mi; Kim, Miyeon; Bae, Jaeseok; Kim, Jo-Heon; Lee, Jeong Won; Lee, Sang Ah; Koh, Gwanpyo

2012-01-01

Hashimoto thyroiditis (HT) is an autoimmune thyroid disorder that usually presents as a diffuse, nontender goiter, whereas subacute thyroiditis (SAT) is an uncommon disease that is characterized by tender thyroid enlargement, transient thyrotoxicosis, and an elevated erythrocyte sedimentation rate (ESR). Very rarely, patients with HT can present with painful, tender goiter or fever, a mimic of SAT. We report a case of painful HT in a 68-year-old woman who presented with pain and tenderness in a chronic goiter. Her ESR was definitely elevated and her thyroid laboratory tests suggested subclinical hypothyroidism of autoimmune origin. 99mTc pertechnetate uptake was markedly decreased. Fine needle aspiration biopsy revealed reactive and polymorphous lymphoid cells and occasional epithelial cells with Hürthle cell changes. Her clinical symptoms showed a dramatic response to glucocorticoid treatment. She became hypothyroid finally and is now on levothyroxine therapy. PMID:22570820

Effects of moisture enhancement, enzyme treatment, and blade tenderization on the processing characteristics and tenderness of beef semimembranosus steaks.

Science.gov (United States)

Pietrasik, Z; Shand, P J

2011-05-01

The individual and combined effects of moisture enhancement with a salt/phosphate solution (ME), blade tenderization (BT), and enzyme injection with proteinases derived from Aspergillus oryzae or Bacillus subtilis on cooking properties, Warner-Bratzler shear force (WBSF), and sensory characteristics of beef semimembranosus were investigated. ME significantly (P < 0.01) reduced WBSF and increased (P < 0.05) sensory scores for juiciness and tenderness. BT increased (P < 0.05) initial and overall tenderness scores and made connective tissue less perceptible. BT combined with ME resulted in the highest initial and overall tenderness scores, however, combining ME with either proteinase was as effective for reducing WBSF and increasing tenderness, particularly at 20 (vs. 10) ppm enzyme inclusion. Tenderness of enzyme-injected steaks was increased without compromising other palatability attributes. All treatments increased the frequency of steaks rated slightly tender or higher, with the ME+BT combination, or ME with inclusion of 20 ppm of either proteinase, being most effective. Copyright © 2010 The American Meat Science Association. Published by Elsevier Ltd. All rights reserved.

Effect of Ice Massage on Hoku Point for Reduction of Labor Pain

Directory of Open Access Journals (Sweden)

N Naghshin

2008-01-01

Full Text Available Introduction: One the most anxious moments for mothers and families is labor pain and various methods for its relief have an effect on labor management, patient satisfaction and labor outcome. Both pharmacological and non-pharmacological methods are used to relieve labor pain, but in recently years, researchers have focused their attention to non-pharmacological methods for reduction of labor pain. Acupressure is one of the pain relieving methods that can be used for labor pain, but there have been few studies to date. The purpose of this research was to determine the effect of Hoku point ice massage on labor pain. Methods: Participants of this clinical trial study were 60 pregnant women having the inclusive criteria. Participants were randomly divided to two groups of thirty, each. (Control Group=only touch of Hoku point, Case group= ice massage of Huko point. This procedure was done for thirty minutes. Labor pain of subjects was measured by visual analog scale before and after the procedure. Results: There was no statistical difference between the gestational age, parity and age of the two groups. Results showed that reduction of labor pain by ice massage of Huko point was statistically significant (P<0.001. Conclusion: Acupressure is a noninvasive, simple and cheap method of relieving pain and our study confirms its effect on reduction of labor pain. This method is therefore applicable in delivery rooms.

Is temporomandibular pain in chronic whiplash-associated disorders part of a more widespread pain syndrome?

Science.gov (United States)

Visscher, Corine; Hofman, Nico; Mes, Carola; Lousberg, Richel; Naeije, Machiel

2005-01-01

The prevalence of temporomandibular disorders in patients with chronic whiplash-associated disorder is a controversial issue that may be influenced by the widespread pain character and psychologic distress frequently observed in patients with chronic pain. The aim of this study was to determine the prevalence of temporomandibular disorder pain, widespread pain, and psychologic distress in persons with chronic whiplash-associated disorder pain, using a controlled, single blind study design. The prevalence of temporomandibular disorder pain in the chronic whiplash-associated disorder pain group was compared with 2 control groups: a chronic neck pain group and a no neck pain group. From 65 persons, a standardized oral history was taken, a physical examination of the neck and the masticatory system was performed, widespread pain was investigated by tender point palpation, and psychologic distress was measured with a questionnaire (SCL-90). Because the recognition of temporomandibular disorder pain and neck pain remains a matter of debate, 3 well-defined classification systems were used: one based on the oral history, a second on a combination of oral history and pain on active movements and palpation, and a third one based on a combination of oral history and function tests. Irrespective of the classification system used, the chronic whiplash-associated disorder pain group more often suffered from temporomandibular disorder pain (0.001neck pain group. Moreover, patients with whiplash-associated disorder showed more psychologic distress (0.000disorder suggests that the higher prevalence of temporomandibular disorder pain in these patients is part of a more widespread chronic pain disorder.

Gender Differences in Symptoms, Health-Related Quality of Life, Sleep Quality, Mental Health, Cognitive Performance, Pain-Cognition, and Positive Health in Spanish Fibromyalgia Individuals: The Al-Ándalus Project

Directory of Open Access Journals (Sweden)

Víctor Segura-Jiménez

2016-01-01

Full Text Available Objective. To test the gender differences in tenderness, impact of fibromyalgia, health-related quality of life, fatigue, sleep quality, mental health, cognitive performance, pain-cognition, and positive health in Spanish fibromyalgia patients and in age-matched nonfibromyalgia individuals from the same region. To test the optimal cut-off score of the different tender points for women and men. Methods. A total of 405 (384 women fibromyalgia versus 247 (195 women nonfibromyalgia control participants from southern Spain (Andalusia took part in this cross-sectional study. The outcomes studied were assessed by means of several tests. Results. In the fibromyalgia group, men showed better working memory than women (all, P<0.01, whereas sleep latency was lower in women compared to men (P=0.013. In the nonfibromyalgia group, men showed higher pain threshold in all the tender points (all, P<0.01, except in right and left lateral epicondyle. Furthermore, men showed better working memory than women (all, P<0.01, whereas memory performance was better in women compared to men (all, P≤0.01. Conclusion. The results of the present study do not support consistent evidence of gender differences in fibromyalgia-related symptoms. However, it seems that detriment of some symptoms (especially pain in fibromyalgia men compared with their nonfibromyalgia counterparts is greater than those of fibromyalgia women compared with their nonfibromyalgia peers.

Scapulothoracic bursitis as a significant cause of breast and chest wall pain: underrecognized and undertreated.

Science.gov (United States)

Boneti, Cristiano; Arentz, Candy; Klimberg, V Suzanne

2010-10-01

Pain is one of the most commonly reported breast complaints. Referred pain from inflammation of the shoulder bursa is often overlooked as a cause of breast pain. The objective of this study is to evaluate the role of shoulder bursitis as a cause of breast/chest pain. An IRB-approved retrospective review from July 2005 to September 2009 identified 461 patients presenting with breast/chest pain. Cases identified with a trigger point in the medial aspect of the ipsilateral scapula were treated with a bursitis injection at the point of maximum tenderness. The bursitis injection contains a mixture of local anesthetic and corticosteroid. Presenting complaint, clinical response and associated factors were recorded and treated with descriptive statistics. Average age of the study group was 53.4 ± 12.7 years, and average BMI was 30.4 ± 7.4. One hundred and three patients were diagnosed with shoulder bursitis as the cause of breast pain and received the bursitis injection. Most cases (81/103 or 78.6%) presented with the breast/chest as the site of most significant discomfort, where 8.7% (9/103) had the most severe pain at the shoulder, 3.9% (4/103) at the axilla and 3.9% (4/103) at the medial scapular border. Of the treated patients, 83.5% (86/103) had complete relief of the pain, 12.6% (13/103) had improvement of symptoms with some degree of residual pain, and only 3.9%(4/103) did not respond at all to the treatment. The most commonly associated factor to the diagnosis of bursitis was the history of a previous mastectomy, present in 27.2% (28/103) of the cases. Shoulder bursitis represents a significant cause of breast/chest pain (22.3% or 103/461) and can be successfully treated with a local injection at site of maximum tenderness in the medial scapular border.

Prevalence of neck pain in migraine and tension-type headache: a population study.

Science.gov (United States)

Ashina, Sait; Bendtsen, Lars; Lyngberg, Ann C; Lipton, Richard B; Hajiyeva, Nazrin; Jensen, Rigmor

2015-03-01

We assessed the prevalence of neck pain in the population in relation to headache. In a cross-sectional study, a total of 797 individuals completed a headache interview and provided self-reported data on neck pain. We identified migraine, TTH or both migraine and TTH (M+TTH) groups. Pericranial tenderness was recorded in 496 individuals. A total tenderness score (TTS) was calculated as the sum of local scores with a maximum score of 48. The one-year prevalence of neck pain was 68.4% and higher in those with vs. without primary headache (85.7% vs. 56.7%; adjusted OR 3.0, 95% CI 2.0-4.4, pneck pain (56.7%) was significantly higher in those with M+TTH (89.3%), pure TTH (88.4%) and pure migraine (76.2%) (pneck pain had higher TTS than individuals without neck pain (15.1±10.5 vs. 8.4±8.0, pNeck pain is highly prevalent in the general population and even more prevalent in individuals with primary headaches. Prevalence is highest in coexistent M+TTH, followed by pure TTH and migraine. Myofascial tenderness is significantly increased in individuals with neck pain. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Chronic pelvic pain

African Journals Online (AJOL)

misdiagnoses, inappropriate or inadequate treatment strategies, and poor patient compliance .... excitation tenderness implies an active pelvic inflammatory process. Pain localising to ... neoplastic process, particularly cervical cancer, must be excluded. .... The dosage should be started at 10 mg at night, and increased by 5 ...

Anaesthetic injection versus ischemic compression for the pain relief of abdominal wall trigger points in women with chronic pelvic pain.

Science.gov (United States)

Montenegro, Mary L L S; Braz, Carolina A; Rosa-e-Silva, Julio C; Candido-dos-Reis, Francisco J; Nogueira, Antonio A; Poli-Neto, Omero B

2015-12-01

Chronic pelvic pain is a common condition among women, and 10 to 30 % of causes originate from the abdominal wall, and are associated with trigger points. Although little is known about their pathophysiology, variable methods have been practiced clinically. The purpose of this study was to evaluate the efficacy of local anaesthetic injections versus ischemic compression via physical therapy for pain relief of abdominal wall trigger points in women with chronic pelvic pain. We conducted a parallel group randomized trial including 30 women with chronic pelvic pain with abdominal wall trigger points. Subjects were randomly assigned to one of two intervention groups. One group received an injection of 2 mL 0.5 % lidocaine without a vasoconstrictor into a trigger point. In the other group, ischemic compression via physical therapy was administered at the trigger points three times, with each session lasting for 60 s, and a rest period of 30 s between applications. Both treatments were administered during one weekly session for four weeks. Our primary outcomes were satisfactory clinical response rates and percentages of pain relief. Our secondary outcomes are pain threshold and tolerance at the trigger points. All subjects were evaluated at baseline and 1, 4, and 12 weeks after the interventions. The study was conducted at a tertiary hospital that was associated with a university providing assistance predominantly to working class women who were treated by the public health system. Clinical response rates and pain relief were significantly better at 1, 4, and 12 weeks for those receiving local anaesthetic injections than ischemic compression via physical therapy. The pain relief of women treated with local anaesthetic injections progressively improved at 1, 4, and 12 weeks after intervention. In contrast, women treated with ischemic compression did not show considerable changes in pain relief after intervention. In the local anaesthetic injection group, pain threshold

49 CFR 230.103 - Tender roller bearing journal boxes.

Science.gov (United States)

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Tender roller bearing journal boxes. 230.103... Locomotives and Tenders Running Gear § 230.103 Tender roller bearing journal boxes. Tender roller bearing journal boxes shall be maintained in a safe and suitable condition. ...

Digital tender point examination may be helpful in the evaluation of low back pain: clinical signs vs. magnetic resonance imaging

DEFF Research Database (Denmark)

Jensen, Ole Kudsk; Nielsen, Claus Vinther; Stengaard-Pedersen, Kristian

on MRI. After adjustment for age, sex and widespread pain, the number of TPs was still significantly reduced in patients with clinical radiculopathy. More than 8 and 11 TPs in men and women, respectively, made the diagnosis of radiculopathy less probable. The intensity of back pain, but not leg pain...... of the lumbar spine was performed. Associations were analyzed by linear regression analyses. Results: TPs were negatively associated with radiculopathy and with most degenerative manifestations on MRI, but the negative associations were primarily due to the presence of radiculopathy and/or nerve root compromise...... with and without degenerative changes and patients with and without radiculopathy, a TP count may help understanding LBP patients better, especially patients with normal or near normal MRI. Accordingly, digital TP examination may be a valuable supplemental tool in the clinical assessment of LBP patients....

Limited tender for disposal of old printed journals

Indian Academy of Sciences (India)

2016-09-20

Sep 20, 2016 ... TENDER NO IASC 03 /DISPOSAL OF OLD PRINTED JOURNALS I 2016-17. F. No. : Tender No. ... The competent authority also reserves the right to reject any or all the tenders without assigning any reason thereof. 19.

Prevalence of neck pain in migraine and tension-type headache

DEFF Research Database (Denmark)

Ashina, Sait; Bendtsen, Lars; Lyngberg, Ann C

2015-01-01

BACKGROUND: We assessed the prevalence of neck pain in the population in relation to headache. METHODS: In a cross-sectional study, a total of 797 individuals completed a headache interview and provided self-reported data on neck pain. We identified migraine, TTH or both migraine and TTH (M......+TTH) groups. Pericranial tenderness was recorded in 496 individuals. A total tenderness score (TTS) was calculated as the sum of local scores with a maximum score of 48. RESULTS: The one-year prevalence of neck pain was 68.4% and higher in those with vs. without primary headache (85.7% vs. 56.7%; adjusted...... OR 3.0, 95% CI 2.0-4.4, pneck pain (56.7%) was significantly higher in those with M+TTH (89.3%), pure TTH (88.4%) and pure migraine (76.2%) (p

12 CFR 335.501 - Tender offers.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Tender offers. 335.501 Section 335.501 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND STATEMENTS OF GENERAL POLICY SECURITIES OF NONMEMBER INSURED BANKS § 335.501 Tender offers. The provisions of the applicable and currently...

Chronic low back pain in older adults: prevalence, reliability, and validity of physical examination findings.

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Weiner, Debra K; Sakamoto, Sara; Perera, Subashan; Breuer, Paula

2006-01-01

To develop a structured physical examination protocol that identifies common biomechanical and soft-tissue abnormalities for older adults with chronic low back pain (CLBP) that can be used as a triage tool for healthcare providers and to test the interobserver reliability and discriminant validity of this protocol. Cross-sectional survey and examination. Older adult pain clinic. One hundred eleven community-dwelling adults aged 60 and older with CLBP and 20 who were pain-free. Clinical history for demographics, pain duration, previous lumbar surgery or advanced imaging, neurogenic claudication, and imaging clinically serious symptoms. Physical examination for scoliosis, functional leg length discrepancy, pain with lumbar movement, myofascial pain (paralumbar, piriformis, tensor fasciae latae (TFL)), regional bone pain (sacroiliac joint (SIJ), hip, vertebral body), and fibromyalgia. Scoliosis was prevalent in those with (77.5%) and without pain (60.0%), but prevalence of SIJ pain (84% vs 5%), fibromyalgia tender points (19% vs 0%), myofascial pain (96% vs 10%), and hip pain (48% vs 0%) was significantly different between groups (P physical examination. Their recognition may save unnecessary healthcare expenditure and patient suffering.

Successful Treatment of Gluteal Pain from Obturator Internus Tendinitis and Bursitis with Ultrasound-Guided Injection.

Science.gov (United States)

Chen, Boqing; Rispoli, Leia; Stitik, Todd; Leong, Michelle

2017-10-01

This case report describes what the authors believe is the first case of a patient with obturator internus tendinitis and bursitis successfully treated with a corticosteroid injection using a trans-tendinous lateral to medial approach. The patient presented with right gluteal pain not relieved by physical therapy or right hip and ischial bursa corticosteroid injections. Pelvic and lumbar spine MRIs and EMG/NCS findings were unremarkable. Physical examination demonstrated tenderness to palpation at the right middle lower gluteal region. Ultrasound imaging with sonopalpation identified the maximal local tender point as the right obturator internus muscle and/or its underlying bursa. A 22-gauge 3.5-inch needle was inserted in-plane to the transducer and longitudinal to the obturator internus from a lateral to medial direction, an approach previously described in cadavers. The obturator internus tendon sheath and bursa were injected with 2.5 ml of 0.5% lidocaine combined with 10 mg of triamcinolone. The patient reported immediate complete relief of pain with continued relief at 2 and 6 months post-injection. This case report demonstrates an injection of the obturator internus tendon sheath and bursa using a trans-tendinous approach, which may be successful for treatment of patients presenting with persistent gluteal pain from obturator internus tendinitis and bursitis.

[Clinical observation on auricular point magnetotherapy for treatment of senile low back pain].

Science.gov (United States)

Sun, Gui-Ping

2007-02-01

To compare the therapeutic effects of auricular point magnetotherapy and auricular point sticking of Vaccaria seed on senile low back pain. Sixty cases, aged 60 or over 60 years with back pain, were randomly divided into 2 groups, a control group and a test group. The control group were treated with auricular sticking of Vaccaria seed with no pressing, and the test group with sticking magnetic bead of 66 gauss each piece with no pressing. Auricular points, Shenmen, Kidney, Bladder, Yaodizhui, Gluteus, Liver and Spleen were selected. Three weeks constituted one course. The effects before, during and after the course were assessed by questionnaire about back pain. Compared with the control group, in the test group the back pain was more effectively improved, including reducing pain and numbness in the back and the legs, decreasing the disorder of physical strength induced by this disease, and improving daily life quality of the patient. Follow-up survey for 2-4 weeks showed the effects still were kept. Auricular magnetotherapy can effectively improve senile back pain.

Shoulder Pain After Thoracic Surgery

DEFF Research Database (Denmark)

Blichfeldt-Eckhardt, Morten R; Andersen, Claus; Ørding, Helle

2017-01-01

OBJECTIVES: To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach. DESIGN: Prospective, observational cohort study. SETTING: Odense University Hospital, Denmark...... for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant...... shoulder pain. On postoperative day 4, 19 patients (32%) still suffered shoulder pain, but only 4 patients (7%) had clinically relevant pain. Four patients (8%) still suffered shoulder pain 12 months after surgery. In 26 patients (55%), the shoulder pain was classified as referred versus 21 patients (45...

Persistent orofacial muscle pain: Its synonymous terminology and presentation.

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Spierings, Egilius L H; Mulder, Maxim J H L

2017-09-01

The purpose of the present paper is to describe the presentation of persistent orofacial muscle pain, also commonly referred to as myofascial temporomandibular disorder. In this practice survey, the authors reviewed the demographic and clinical features of 34 patients who were evaluated and diagnosed personally. The majority of the 34 patients were women (82.4%), and their age at consultation averaged 44.6 ± 12.6 (SD) years. The median pain duration was 4.0 years (range: 0.2-34 years). In 97.1% of patients, the pain occurred daily and continuously, and in 51.9% it was unilateral. Chewing or eating made the pain worse in 50% of the patients, and talking in 29.4%. On examination, tightness of the masseter muscle(s) was present in 58.8%, and tenderness in 58.8%. Persistent orofacial muscle pain mostly affects women, generally occurs daily and continuously, and is equally often unilateral and bilateral. Chewing, eating, and talking are the most common aggravating factors, and tightness or tenderness of the masseter muscle(s) is often found on examination.

Groin pain associated with sacroiliac joint dysfunction and lumbar disorders.

Science.gov (United States)

Kurosawa, Daisuke; Murakami, Eiichi; Aizawa, Toshimi

2017-10-01

We investigated the prevalence of groin pain in patients with sacroiliac joint (SIJ) dysfunction, lumbar spinal canal stenosis (LSS), and lumbar disc herniation (LDH) who did not have hip disorders, and evaluated the clinical features that distinguished SIJ dysfunction from LSS and LDH. We evaluated 127 patients (57 men, 70 women, average age 55 years) with SIJ dysfunction, 146 (98 men, 48 women, average age 71 years) with LSS, and 124 (83 men, 41 women, average age 50 years) with LDH. The following data were retrospectively collected from the patients' medical charts: (1) the prevalence of groin pain for each pathology; (2) corresponding spinal level of LSS and LDH in the patients with groin pain; (3) the pain areas in the buttocks and back; pain increase while in positions such as sitting, lying supine, and side-lying; an SIJ shear test; and four tender points composed of the posterior superior iliac spine (PSIS), long posterior sacroiliac ligament (LPSL), sacrotuberous ligament (STL), and iliac muscle. Fifty-nine (46.5%) patients with SIJ dysfunction, 10 (6.8%) with LSS, and 10 (8.1%) with LDH reported groin pain. Of the 10 patients with LSS, five presented with cauda equina symptoms, two had stenosis of L2-L3, and three had stenosis below L3-L4. The other five presented with radiculopathy: the corresponding nerve root was L2, L3, and L4 in one patient each, and L5 in two. Of the 10 patients with LDH, eight presented with radiculopathy: the corresponding nerve root was L2 and L4 in three patients each, and L5 in two. Two patients presented with L4-L5 discogenic pain without radiculopathy. In patients with groin pain, pain provoked by the SIJ shear test and the tenderness of the PSIS and LPSL were significant physical signs that differentiated SIJ dysfunction from LSS and LDH. (Fisher's exact test, P<0.05) CONCLUSION: The prevalence of groin pain in patients with SIJ dysfunction was higher than in those with LSS or LDH. When patients who do not have hip disorders

17 CFR 240.14e-1 - Unlawful tender offer practices.

Science.gov (United States)

2010-04-01

... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Unlawful tender offer... Securities Exchange Act of 1934 Regulation 14e § 240.14e-1 Unlawful tender offer practices. As a means... section 14(e) of the Act, no person who makes a tender offer shall: (a) Hold such tender offer open for...

Fibromyalgia

Science.gov (United States)

Fibromyalgia is a disorder that causes muscle pain and fatigue. People with fibromyalgia have "tender points" on the body. Tender points ... when pressure is put on them. People with fibromyalgia may also have other symptoms, such as Trouble ...

Prevalence, classification, and etiology of pain in Parkinson's disease: association between Parkinson's disease and fibromyalgia or chronic widespread pain.

Science.gov (United States)

Toda, Katsuhiro; Harada, Toshihide

2010-09-01

Parkinson's disease (PD) is characterized by resting tremor, slow and decreased movement (hypokinesia and akinesia), rigidity, postural instability, problems with gait, and coordination. The prevalence of PD is between 0.1% and 0.3% in the general population and between 1% and 2% in persons 65 years of age or older. Patients with PD are more likely to suffer from pain. Indeed, the chief complaint of patients with severe motor disturbance and severe pain is pain rather than motor disturbance. Fibromyalgia (FM) is defined by widespread pain (pain in the left and right sides of the body, pain above the waist, pain below the waist, and axial skeletal pain) for more than 3 months and the presence of at least 11 of the 18 specified tender points. FM and chronic widespread pain (CWP), which is usually an incomplete form of FM, cause pain in the musculoskeletal region, but their etiologies are unknown. Therefore, it is almost impossible to determine whether or not pain in the musculoskeletal region is in the musculoskeletal origin. We suspect that dysfunction or degeneration of the nerves that control pain, mind, and movement in the brain causes FM, depression, and PD, respectively. When pain in PD is discussed, FM and CWP should be considered because their prevalence is high. Patients with PD may be likely to suffer from FM and CWP; however, the prevalence of FM and CWP in patients with PD has not been reported. Here, we discuss the relationship between PD and FM or CWP.

49 CFR 230.102 - Tender plain bearing journal boxes.

Science.gov (United States)

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Tender plain bearing journal boxes. 230.102... Locomotives and Tenders Running Gear § 230.102 Tender plain bearing journal boxes. Plain bearing journal boxes... expected to damage the bearing; or have a detrimental effect on the lubrication of the journal and bearing...

Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain: Variability and Influence of Sex and Catastrophizing.

Science.gov (United States)

Boonstra, Anne M; Stewart, Roy E; Köke, Albère J A; Oosterwijk, René F A; Swaan, Jeannette L; Schreurs, Karlein M G; Schiphorst Preuper, Henrica R

2016-01-01

Objectives: The 0-10 Numeric Rating Scale (NRS) is often used in pain management. The aims of our study were to determine the cut-off points for mild, moderate, and severe pain in terms of pain-related interference with functioning in patients with chronic musculoskeletal pain, to measure the variability of the optimal cut-off points, and to determine the influence of patients' catastrophizing and their sex on these cut-off points. Methods: 2854 patients were included. Pain was assessed by the NRS, functioning by the Pain Disability Index (PDI) and catastrophizing by the Pain Catastrophizing Scale (PCS). Cut-off point schemes were tested using ANOVAs with and without using the PSC scores or sex as co-variates and with the interaction between CP scheme and PCS score and sex, respectively. The variability of the optimal cut-off point schemes was quantified using bootstrapping procedure. Results and conclusion: The study showed that NRS scores ≤ 5 correspond to mild, scores of 6-7 to moderate and scores ≥8 to severe pain in terms of pain-related interference with functioning. Bootstrapping analysis identified this optimal NRS cut-off point scheme in 90% of the bootstrapping samples. The interpretation of the NRS is independent of sex, but seems to depend on catastrophizing. In patients with high catastrophizing tendency, the optimal cut-off point scheme equals that for the total study sample, but in patients with a low catastrophizing tendency, NRS scores ≤ 3 correspond to mild, scores of 4-6 to moderate and scores ≥7 to severe pain in terms of interference with functioning. In these optimal cut-off schemes, NRS scores of 4 and 5 correspond to moderate interference with functioning for patients with low catastrophizing tendency and to mild interference for patients with high catastrophizing tendency. Theoretically one would therefore expect that among the patients with NRS scores 4 and 5 there would be a higher average PDI score for those with low

Pain in the hip joint

Directory of Open Access Journals (Sweden)

Yuri Aleksandrovich Olyunin

2013-01-01

Full Text Available Pathological changes that develop in the hip joints (HJ have different origins and mechanisms of development, but their main manifestation is pain. The nature of this pain cannot be well established on frequent occasions. The English-language medical literature currently classifies such disorders as greater trochanter pain syndrome (GTPS. Its major signs are chronic pain and local palpatory tenderness in the outer part of HJ. The development of GTPS may be associated with inflammation of the synovial bursae situated in the greater tronchanter, as well as with tendinitis, myorrhexis, iliotibial band syndrome, and other local changes in the adjacent tissues or with systemic diseases. So GTPS may be characterized as regional pain syndrome that frequently mimics pain induced by different diseases, including myofascial pain syndrome, osteoarthrosis, spinal diseases, etc.

49 CFR 230.90 - Draw gear between steam locomotive and tender.

Science.gov (United States)

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Draw gear between steam locomotive and tender. 230... Steam Locomotives and Tenders Draw Gear and Draft Systems § 230.90 Draw gear between steam locomotive and tender. (a) Maintenance and testing. The draw gear between the steam locomotive and tender...

Orofacial pain of cervical origin: A case report.

Science.gov (United States)

Ganesh, G Shankar; Sahu, Mamata Manjari; Tigga, Pramod

2018-04-01

The etiopathogenesis of orofacial pain remains complex and a number of pain referral patterns for this region have been reported in the literature. The purpose of this report is to describe the assessment and successful clinical management of orofacial pain possibly attributable to cervical origin. A 55-year-old male teacher with a 3-year history of pain in the right lower jaw, radiating to the ear, consulted our institute for assessment and management. The patient was unsuccessfully treated for dental pain and trigeminal neuralgia. The patient's functioning was grossly limited and the patient was unable to sleep because of severe pain. Current and previous medical and physical examinations revealed no infection, malignancies, or sinusitis. Palpation revealed no temporomandibular disorder, tenderness or myofascial trigger points. Examination of the cervical range of motion showed a reduction in rotation to the right side. The patient was treated for upper cervical joint dysfunction involving mobilization of the first three cervical vertebrae and motor control exercises. The patient had an almost complete resolution of symptoms and reported significant improvement in the Patient Specific Functional Scale (PSFS) and the Global Rating of Change (GRC) scale. This case study demonstrates the importance of considering, assessing and treating the cervical spine as a possible source of orofacial pain, and the positive role of cervical mobilization on these disorders. Copyright © 2017 Elsevier Ltd. All rights reserved.

49 CFR 230.100 - Defects in tender truck axles and journals.

Science.gov (United States)

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Defects in tender truck axles and journals. 230... Steam Locomotives and Tenders Running Gear § 230.100 Defects in tender truck axles and journals. (a... wheel seats that is more than 1/8 of an inch in depth. (b) Tender truck journal condemning defects...

Managing meat tenderness.

Science.gov (United States)

Thompson, John

2002-11-01

This paper discusses the management of meat tenderness using a carcass grading scheme which utilizes the concept of total quality management of those factors which impact on beef palatability. The scheme called Meat Standards Australia (MSA) has identified the Critical Control Points (CCPs) from the production, pre-slaughter, processing and value adding sectors of the beef supply chain and quantified their relative importance using large-scale consumer testing. These CCPs have been used to manage beef palatability in two ways. Firstly, CCPs from the pre-slaughter and processing sectors have been used as mandatory criteria for carcasses to be graded. Secondly, other CCPs from the production and processing sectors have been incorporated into a model to predict palatability for individual muscles. The evidence for the importance of CCPs from the production (breed, growth path and HGP implants), pre-slaughter and processing (pH/temperature window, alternative carcass suspension, marbling and ageing) sectors are reviewed and the accuracy of the model to predict palatability for specific muscle×cooking techniques is presented.

Combined effect of electrical stimulation and blade tenderization on some bovine muscles

Energy Technology Data Exchange (ETDEWEB)

Raccach, M.; Henrickson, R.L.

1979-01-01

The electrical stimulation (ES) period was a very important factor determining the tenderness of three bovine muscles: Biceps femoris (BF), Longissimus dorsi (LD), and Semimembranosus (SM). Tenderness (shear force values) increased in most cases with increasing the ES period. An ES period of 15 min was optimal for obtaining a tenderness equal to that obtained by conventional processing of beef. The shortest ES period used (1 min) was adequate in most cases to set the muscles in rigor mortis and in preventing cold shortening. The tenderness of blade tenderized muscles was in most cases independent from the ES period. Blade tenderization was very effective to tenderize the BF muscle followed in decreasing order of efficacy by the LD and SM muscles. The cooking times and cooking losses of the three muscles were not affected by either the ES period or by blade tenderization.

Jaw dysfunction is associated with neck disability and muscle tenderness in subjects with and without chronic temporomandibular disorders.

Science.gov (United States)

Silveira, A; Gadotti, I C; Armijo-Olivo, S; Biasotto-Gonzalez, D A; Magee, D

2015-01-01

Tender points in the neck are common in patients with temporomandibular disorders (TMD). However, the correlation among neck disability, jaw dysfunction, and muscle tenderness in subjects with TMD still needs further investigation. This study investigated the correlation among neck disability, jaw dysfunction, and muscle tenderness in subjects with and without chronic TMD. Participants. Forty females between 19 and 49 years old were included in this study. There were 20 healthy controls and 20 subjects who had chronic TMD and neck disability. Subjects completed the neck disability index and the limitations of daily functions in TMD questionnaires. Tenderness of the masticatory and cervical muscles was measured using an algometer. The correlation between jaw disability and neck disability was significantly high (r = 0.915, P cervical muscles with jaw dysfunction and neck disability showed fair to moderate correlations (r = 0.32-0.65). High levels of muscle tenderness in upper trapezius and temporalis muscles correlated with high levels of jaw and neck dysfunction. Moreover, high levels of neck disability correlated with high levels of jaw disability. These findings emphasize the importance of considering the neck and its structures when evaluating and treating patients with TMD.

Kinesio taping and manual pressure release: Short-term effects in subjects with myofasical trigger point.

Science.gov (United States)

Chao, Yu Wen; Lin, Jiu Jenq; Yang, Jing Lan; Wang, Wendy Tzyy-Jiuan

2016-01-01

Randomized controlled trial. Myofascial pain syndrome is characterized by myofascial trigger points (MTrPs) and fascia tenderness. We investigated the effects of manual pressure release (MPR) alone or in combination with taping (MPR/MKT) in subjects with MTrPs. Fifteen and 16 subjects received MPR and MPR/MKT respectively. Outcomes including Pressure pain threshold, muscle stiffness, mechanomyography were assessed at baseline, post-intervention and 7-days later. Pressure pain threshold improved significantly (d = 1.79, p < 0.005) in both groups. Significant improvement in muscle stiffness in the MPR/MKT group (0.27-0.49 mm) as compared to the MPR group (-0.02-0.23 mm). Mechanomyography amplitude in the MPR/MKT group was significantly higher than that of the MPR group (p < 0.05). MPR and MPR/MKT are effective in reducing pain in these subjects. MPR/MKT has a greater effect on muscle stiffness and contraction amplitude. IV. Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain : Variability and Influence of Sex and Catastrophizing

NARCIS (Netherlands)

Boonstra, Anne M; Stewart, Roy E; Köke, Albère J A; Oosterwijk, René F A; Swaan, Jeannette L; Schreurs, Karlein M G; Schiphorst Preuper, Henrica R

2016-01-01

Objectives: The 0-10 Numeric Rating Scale (NRS) is often used in pain management. The aims of our study were to determine the cut-off points for mild, moderate, and severe pain in terms of pain-related interference with functioning in patients with chronic musculoskeletal pain, to measure the

31 CFR 309.10 - Tenders; reservation of right to reject.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Tenders; reservation of right to... BILLS § 309.10 Tenders; reservation of right to reject. In considering the acceptance of tenders, the highest prices offered will be accepted in full down to the amount required, and if the same price appears...

Auricular Point Acupressure for Chronic Low Back Pain: A Feasibility Study for 1-Week Treatment

Directory of Open Access Journals (Sweden)

Chao-Hsing Yeh

2012-01-01

Full Text Available Objectives. The objective of this one-group, repeated-measures design was to explore the acceptance of auricular point acupressure (APA to reduce chronic low back pain (CLBP and estimate minimum clinically important differences (MCIDs for pain intensity change. Methods. Subjects received 7-day APA treatment. After appropriate acupoints were identified, vaccaria seeds were carefully taped onto each selected auricular point for 7-day. The Brief Pain Inventory Short Form (BPI was used to collect outcome data. Results. A total of 74 subjects participated in the study. Ten subjects dropped out and the retention rate was 87%. Subjects reported a 46% reduction in BPI worst pain, and over 50% reduction in BPI average pain, overall pain severity and pain interference by the end of study, and 62.5% subjects also reported less pain medication use. The MCIDs for the subscale of BPI ranged from .70 to 1.86 points. The percentage improvement of MCIDs from baseline was between 14.5–24.9%. Discussion. APA appears to be highly acceptable to patients with CLBP. A sham group is needed in order to differentiate the true effects of APA from the possible psychological effects of more frequent visits by the auricular therapist and patients’ expectation of the APA treatment.

Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain: Variability and Influence of Sex and Catastrophizing

NARCIS (Netherlands)

Boonstra, A.M.; Stewart, R.; Koke, A.J.A.; Oosterwijk, R.F.A.; Swaan, J.L.; Schreurs, Karlein Maria Gertrudis; Schiphorst Preuper, H.R.

2016-01-01

Objectives: The 0–10 Numeric Rating Scale (NRS) is often used in pain management. The aims of our study were to determine the cut-off points for mild, moderate, and severe pain in terms of pain-related interference with functioning in patients with chronic musculoskeletal pain, to measure the

Risk factors in the onset of neck/shoulder pain in a prospective study of workers in industrial and service companies

DEFF Research Database (Denmark)

Andersen, JH; Kaergaard, A.; Mikkelsen, S.

2003-01-01

AIMS: To quantify the relative contribution of work related physical factors, psychosocial workplace factors, and individual factors and aspects of somatisation to the onset of neck/shoulder pain. METHODS: Four year prospective cohort study of workers from industrial and service companies...... in Denmark. Participants were 3123 workers, previously enrolled in a cross sectional study, where objective measurement of physical workplace factors was used. Eligible participants were followed on three subsequent occasions with approximately one year intervals. Outcomes of interest were: new onset of neck...... subsequent neck/shoulder pain, and neck/shoulder pain with pressure tenderness. CONCLUSIONS: High levels of distress, and physical and psychosocial workplace factors are predictors of onset of pain in the neck and/or shoulders, particularly pain with pressure tenderness in the muscles...

Occlusal stabilization splint therapy in orofacial pain and tension-type headache.

Science.gov (United States)

Kostrzewa-Janicka, J; Mierzwinska-Nastalska, E; Rolski, D; Szczyrek, P

2013-01-01

Studies suggest an association between orofacial pain, accompanying temporomandibular disorders of myogenous origin, and headache, especially its tension-type. The occlusal appliance therapy is one of the options for the treatment of orofacial pain due to masticatory muscles tenderness. The aim of the present study was to assess the effectiveness of occlusal stabilization splint therapy in myofascial pain and tension-type headache in patients with sleep-disordered breathing. Forty three such patients were enrolled into the study group. The patients were treated with stabilization occlusal splint of vertical thickness at vertical jaw separation, established individually for each patient using a cephalometric analysis. The intensity of orofacial pain (numeric rating scale) and headache (analog rating scale), frequency of headache (%), and jaw qualitative function were assessed at baseline and after 2 and 6 months. Medians of headache and orofacial pain intensity were reduced after 6 months of treatment compared with baseline: 6.0 vs. 2.0 (p Pain decreased below 3 score points in 61.8 % of the patients with headache (p = 0.23) and in 85.3 % of patients with orofacial pain (p orofacial pain was observed 81.4 % of patients after using occlusal stabilization splint for 6 months. We conclude that occlusal stabilization splint was effective in reducing painful symptoms of temporomandibular disorders of myogenous origin, a frequent feature of sleep disordered breathing.

The beef tenderness model

African Journals Online (AJOL)

Kedibone KY. Modika

2015-07-29

Jul 29, 2015 ... The concept of meat tenderness is very complex and is biologically .... of feed additives (β-agonists) so that the animals can be harvested at a younger ...... in the rearing and processing of experimental animals and carcasses.

Joint involvement in patients affected by systemic lupus erythematosus: application of the swollen to tender joint count ratio

Directory of Open Access Journals (Sweden)

E. Cipriano

2015-09-01

Full Text Available Joint involvement is a common manifestation in systemic lupus erythematosus (SLE. According to the SLE disease activity index 2000 (SLEDAI-2K, joint involvement is present in case of ≥2 joints with pain and signs of inflammation. However this definition could fail to catch all the various features of joint involvement. Alternatively the Swollen to Tender joint Ratio (STR could be used. This new index, which was originally proposed for rheumatoid arthritis (RA patients, is based on the count of 28 swollen and tender joints. Our study is, therefore, aimed to assess joint involvement in a SLE cohort using the STR. SLE patients with joint symptoms (≥1 tender joint were enrolled over a period of one month. Disease activity was assessed by SLEDAI-2K. We performed the swollen and tender joint count (0-28 and calculated the STR. Depending on the STR, SLE patients were grouped into three categories of disease activity: low (STR1.0. We also calculated the disease activity score based on a 28-joint count and the erythrocyte sedimentation rate (DAS28-ESR. We enrolled 100 SLE patients [F/M 95/5, mean±standard deviation (SD age 46.3±10.6 years, mean±SD disease duration 147.1±103.8 months]. The median of tender and swollen joints was 4 (IQR 7 and 1 (IQR 2.5, respectively. The median STR value was 0.03 (IQR 0.6. According to the STR, disease activity was low in 70 patients, moderate in 23 and high in 7. A significant correlation was identified between STR values and DAS28 (r=0.33, p=0.001. The present study suggests a correlation between STR and DAS28, allowing an easier and faster assessment of joint involvement with the former index.

Ketamine Use for Successful Resolution of Post-ERCP Acute Pancreatitis Abdominal Pain

OpenAIRE

Agerwala, Suneel M.; Sundarapandiyan, Divya; Weber, Garret

2017-01-01

We report a case in which a patient with intractable pain secondary to post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis is successfully treated with a subanesthetic ketamine infusion. Shortly after ERCP, the patient reported severe stabbing epigastric pain. She exhibited voluntary guarding and tenderness without distension. Amylase and lipase levels were elevated. Pain persisted for hours despite hydromorphone PCA, hydromorphone boluses, fentanyl boluses, and post...

Relationships between sensory evaluations of beef tenderness, shear force measurements and consumer characteristics.

Science.gov (United States)

Van Wezemael, Lynn; De Smet, Stefaan; Ueland, Øydis; Verbeke, Wim

2014-07-01

The supply of tender beef is an important challenge for the beef industry. Knowledge about the profile of consumers who are more optimistic or more accurate in their tenderness evaluations is important for product development and beef marketing purposes. Central location tests of beef steaks were performed in Norway and Belgium (n=218). Instrumental and sensorial tenderness of three muscles from Belgian Blue and Norwegian Red cattle was reported. Consumers who are optimistically evaluating tenderness were found to be more often male, less food neophobic, more positive towards beef healthiness, and showed fewer concerns about beef safety. No clear profile emerged for consumers who assessed tenderness similar to shear force measurements, which suggests that tenderness is mainly evaluated subjectively. The results imply a window of opportunities in tenderness improvements, and allow targeting a market segment which is less critical towards beef tenderness. © 2013 Elsevier Ltd. All rights reserved.

Efficacy and Effectiveness of Exercise on Tender Points in Adults with Fibromyalgia: A Meta-Analysis of Randomized Controlled Trials

Directory of Open Access Journals (Sweden)

George A. Kelley

2011-01-01

Full Text Available Fibromyalgia is a major public health problem affecting an estimated 200 to 400 million people worldwide. The purpose of this study was to use the meta-analytic approach to determine the efficacy and effectiveness of randomized controlled exercise intervention trials (aerobic, strength training, or both on tender points (TPs in adults with fibromyalgia. Using random effects models and 95% confidence intervals (CI, a statistically significant reduction in TPs was observed based on per-protocol analyses (8 studies representing 322 participants but not intention-to-treat analyses (5 studies representing 338 participants (per-protocol, , −0.68, 95% CI, −1.16, −0.20; intention-to-treat, , −0.24, 95% CI, −0.62, 0.15. Changes were equivalent to relative reductions of 10.9% and 6.9%, respectively, for per-protocol and intention-to-treat analyses. It was concluded that exercise is efficacious for reducing TPs in women with FM. However, a need exists for additional well-designed and reported studies on this topic.

Risk Pricing in Construction Tenders - How, Who, What

Directory of Open Access Journals (Sweden)

Marcus Tower

2012-11-01

Full Text Available Construction projects are most commonlyprocured in Australia by means of a traditionaldesign–tender–build model, whereby design islargely completed then contractors submittenders in a competitive environment.Construction contractors must consider riskswithin their tenders. This paper reports theresearch findings into pricing for risk incompetitive tenders by constructioncontractors. The research is based onstructured interviews with 10 contractingpersonnel; supplemented by 23 responses ofconstruction personnel from an online survey.Two common methods to price for risk are atrade-by-trade basis or an overall percentageor lump sum addition to the base estimate.Experience and intuition plays a significant rolein pricing for risk in tenders and the numberand type of people involved varies with projectsize, with greater involvement as project sizeincreases. The most significant risks priced intenders were: availability of resources; designor documentation errors; incomplete design;buildability issues; and inclement weather. Themost significant project factors considered bycontractors when pricing for risk in tenders are:value of liquidated damages; type ofcontract/procurement; completeness ofdocumentation; project complexity; and currentworkload. These risks and project factors areprimarily those over which the contractor haslimited or no control.

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

Directory of Open Access Journals (Sweden)

Kailash Kothari

2017-01-01

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

The beef tenderness model | Frylinck | South African Journal of ...

African Journals Online (AJOL)

age feedlot animals produced the most tender LL followed by the B-age pasture and A-age feedlot which was similar to the AB-age pasture. A-age pasture animals produced the least tender LL steaks. The calpain proteolytic system played a ...

Tender moments in the North Sea

Energy Technology Data Exchange (ETDEWEB)

Fox, C

1991-04-01

Described is tender-assisted drilling (TAD) on the UK North Sea Gannet field. The Gannet field is developed by Shell UK Exploration and Production (Shell Expro). In March 1990, Shell Expro awarded Sedco Forex the design and engineering contract to convert the semisubmersible drilling rig Sedco 704 into the Gannet TSV (Tender Support Vessel). The only semisubmersible TSV operation so far to have completed drilling in the North Sea has been in the Norwegian sector. The Odin field, operated by Esso Norge a/s, was developed using the converted drilling rig Treasure Hunter. 1 fig., 1 ill., 3 refs.

Neuro Emotional Technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: A controlled clinical trial

OpenAIRE

Bablis, Peter; Pollard, Henry; Bonello, Rod

2008-01-01

Abstract Background Trigger points have been shown to be active in many myofascial pain syndromes. Treatment of trigger point pain and dysfunction may be explained through the mechanisms of central and peripheral paradigms. This study aimed to investigate whether the mind/body treatment of Neuro Emotional Technique (NET) could significantly relieve pain sensitivity of trigger points presenting in a cohort of chronic neck pain sufferers. Methods Sixty participants presenting to a private chiro...

Has aerobic exercise effect on pain perception in persons with migraine and coexisting tension-type headache and neck pain? A randomized, controlled, clinical trial.

Science.gov (United States)

Krøll, L S; Sjödahl Hammarlund, C; Gard, G; Jensen, R H; Bendtsen, L

2018-04-10

A large subset of persons with migraine suffers from coexisting tension-type headache and neck pain which may adversely affect the prognosis of migraine. Aerobic exercise has been shown to decrease migraine burden in these persons. Therefore, the aim of this study was to investigate whether the effect of aerobic exercise in persons with migraine and coexisting tension-type headache and neck pain can be explained by changes in pain perception. Seventy consecutively recruited persons with migraine and coexisting tension-type headache and neck pain were randomized into exercise group or control group. Aerobic exercise consisted of bike/cross-trainer/brisk walking for 45 min, three times/week for 3 months. Controls continued their usual daily activities. Pericranial tenderness, pain thresholds, supra-thresholds and temporal summation were assessed at baseline, after treatment and at follow-up (6 months from baseline). Fifty-two persons with migraine and coexisting tension-type headache and neck pain completed the study. Aerobic exercise did not induce consistent changes in nociceptive pathways measured by pericranial tenderness, pressure pain thresholds and sensitivity to electrical stimulation. The effect of aerobic exercise cannot be explained by measurable effects on the pain modulation system. Thus, the positive effect on migraine burden may rather be explained by positive alteration of avoidance behaviour. Aerobic exercise can be recommended as a safe and inexpensive migraine treatment strategy. This study adds further knowledge about the positive effect of aerobic exercise for persons with migraine and coexisting tension-type headache and neck pain. This effect cannot be measured by changes in pain modulation, but may rather be explained by positive alteration of avoidance behaviour. © 2018 European Pain Federation - EFIC®.

Italian water service's competitive tendering: does any tender design exist?

International Nuclear Information System (INIS)

Antonioli, B.

2006-01-01

During the last two decades, the procurement of public services has been engaged a process of intensive change, both at the local and national level, particularly in Europe. In Italy, recent developments of legislative framework are aimed to adopt competitive tenders both for service's concession or private partner selection. Economists and operators generally agree about the effectiveness of auctions for the concession's contracting out. Otherwise, the agreement is weaker if the question is how to prepare the auction: bidding market a la Demsetz, beauty contests or hybrid forms? In other words, more attention should be devoted to the analysis of reference market and to auction's design. The aim of this paper is to verify, starting from the analysis of auction realized between 1998 and 2005, the real designing of the auctions other than the presence of an idea of industrial policy for water services. Results highlights that tenders are few, poorly designed and scarcely effective. To be more precise, results remark the lack of foresight of industrial policy and, more generally, the necessity to reflect on the real possibility of the competition for thc market in the water sector, characterized by an high degree of economical and social complexity [it

Pain perception studies in tension-type headache

DEFF Research Database (Denmark)

Bezov, David; Ashina, Sait; Jensen, Rigmor

2011-01-01

Tension-type headache (TTH) is a disorder with high prevalence and significant impact on society. Understanding of pathophysiology of TTH is paramount for development of effective treatments and prevention of chronification of TTH. Our aim was to review the findings from pain perception studies...... of pathophysiology of TTH as well as to review the research of pathophysiology of TTH. Pain perception studies such as measurement of muscle tenderness, pain detection thresholds, pain tolerance thresholds, pain response to suprathreshold stimulation, temporal summation and diffuse noxious inhibitory control (DNIC...... to integrate pain perception and imaging to confirm this finding. Pharmacological studies have shown that drugs like tricyclic anti-depressant amitriptyline and nitric oxide synthase inhibitors can reverse central sensitization and the chronicity of headache. Finally, low frequency electrical stimulation has...

Danish Public Construction Counselling Selection and Assignment Criteria in European Tendering

DEFF Research Database (Denmark)

Larsen, Jesper Kranker; Ussing, Lene Faber; Brunø, Thomas Ditlev

2014-01-01

One of the largest customers in the Danish construction industry is public agencies that own and develop projects. For some of the counselling services, they recur to be put out in European tendering. The aim is to find which selection and assignment criteria are used most in public tendering. How...... projects use selection and assignment criteria for counselling services and finally if there is significant use of selection and assignment methods in public counselling. The method is based on 74 public counselling tenders from the European Tenders Electronic Daily database from January 2010 to March 2013...

Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation

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Freeman Michael D

2009-04-01

Full Text Available Abstract Objective it has been established that chronic neck pain following whiplash is associated with the phenomenon of central sensitization, in which injured and uninjured parts of the body exhibit lowered pain thresholds due to an alteration in central pain processing. it has furthermore been hypothesized that peripheral sources of nociception in the muscles may perpetuate central sensitization in chronic whiplash. the hypothesis explored in the present study was whether myofascial trigger points serve as a modulator of central sensitization in subjects with chronic neck pain. Design controlled case series. Setting outpatient chronic pain clinic. Subjects seventeen patients with chronic and intractable neck pain and 10 healthy controls without complaints of neck pain. Intervention symptomatic subjects received anesthetic infiltration of myofascial trigger points in the upper trapezius muscles and controls received the anesthetic in the thigh. Outcome measures: pre and post injection cervical range of motion, pressure pain thresholds (ppt over the infraspinatus, wrist extensor, and tibialis anterior muscles. sensitivity to light (photophobia and subjects' perception of pain using a visual analog scale (vas were also evaluated before and after injections. only the ppt was evaluated in the asymptomatic controls. Results immediate (within 1 minute alterations in cervical range of motion and pressure pain thresholds were observed following an average of 3.8 injections with 1–2 cc of 1% lidocaine into carefully identified trigger points. cervical range of motion increased by an average of 49% (p = 0.000 in flexion and 44% (p = 0.001 in extension, 47% (p = 0.000 and 28% (p Conclusion the present data suggest that myofascial trigger points serve to perpetuate lowered pain thresholds in uninjured tissues. additionally, it appears that lowered pain thresholds associated with central sensitization can be immediately reversed, even when associated

Chest pain in focal musculoskeletal disorders

DEFF Research Database (Denmark)

Stochkendahl, Mette Jensen; Christensen, Henrik Wulff

2010-01-01

overlapping conditions and syndromes of focal disorders, including Tietze syndrome, costochondritis, chest wall syndrome, muscle tenderness, slipping rib, cervical angina, and segmental dysfunction of the cervical and thoracic spine, have been reported to cause pain. For most of these syndromes, evidence......The musculoskeletal system is a recognized source of chest pain. However, despite the apparently benign origin, patients with musculoskeletal chest pain remain under-diagnosed, untreated, and potentially continuously disabled in terms of anxiety, depression, and activities of daily living. Several...... arises mainly from case stories and empiric knowledge. For segmental dysfunction, clinical features of musculoskeletal chest pain have been characterized in a few clinical trials. This article summarizes the most commonly encountered syndromes of focal musculoskeletal disorders in clinical practice....

Comparative proteomics reveals the physiological differences between winter tender shoots and spring tender shoots of a novel tea (Camellia sinensis L.) cultivar evergrowing in winter.

Science.gov (United States)

Liu, Shengjie; Gao, Jiadong; Chen, Zhongjian; Qiao, Xiaoyan; Huang, Hualin; Cui, Baiyuan; Zhu, Qingfeng; Dai, Zhangyan; Wu, Hualing; Pan, Yayan; Yang, Chengwei; Liu, Jun

2017-11-20

A recently discovered tea [Camellia sinensis (L.) O. Kuntze] cultivar can generate tender shoots in winter. We performed comparative proteomics to analyze the differentially accumulated proteins between winter and spring tender shoots of this clonal cultivar to reveal the physiological basis of its evergrowing character during winter. We extracted proteins from the winter and spring tender shoots (newly formed two leaves and a bud) of the evergrowing tea cultivar "Dongcha11" respectively. Thirty-three differentially accumulated high-confidence proteins were identified by matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF / TOF MS). Among these, 24 proteins had increased abundance while nine showed were decreased abundance in winter tender shoots as compared with the spring tender shoots. We categorized the differentially accumulated proteins into eight critical biological processes based on protein function annotation including photosynthesis, cell structure, protein synthesis & destination, transporters, metabolism of sugars and polysaccharides, secondary metabolism, disease/defense and proteins with unknown functions. Proteins with increased abundance in winter tender shoots were mainly related to the processes of photosynthesis, cytoskeleton and protein synthesis, whereas those with decreased abundance were correlated to metabolism and the secondary metabolism of polyphenolic flavonoids. Biochemical analysis showed that the total contents of soluble sugar and amino acid were higher in winter tender shoots while tea polyphenols were lower as compared with spring tender shoots. Our study suggested that the simultaneous increase in the abundance of photosynthesis-related proteins rubisco, plastocyanin, and ATP synthase delta chain, metabolism-related proteins eIF4 and protease subunits, and the cytoskeleton-structure associated proteins phosphatidylinositol transfer protein and profilin may be because of the adaptation of the

Chronic pain in a patient with Ehlers-Danlos syndrome (hypermobility type): The role of myofascial trigger point injections.

Science.gov (United States)

Tewari, Saipriya; Madabushi, Rajashree; Agarwal, Anil; Gautam, Sujeet K; Khuba, Sandeep

2017-01-01

Chronic widespread musculoskeletal pain is a cardinal symptom in hypermobility type of Ehler Danlos Syndrome (EDS type III). The management of pain in EDS, however, has not been studied in depth. A 30 year old female, known case of EDS, presented to the pain clinic with complaints of severe upper back pain for 6 months. Physical examination of the back revealed two myofascial trigger points over the left rhomboids and the left erector spinae. Local anaesthetic trigger point injections were given at these points, followed by stretching exercises under analgesic cover for the first week. After 1 week the patient reported 60-80% pain relief. This case highlights that we must keep a high index of suspicion for the more treatable causes of pain like myofascial pain syndrome in patients suffering from EDS, and should address it promptly and appropriately in order to maximise patient comfort. Copyright © 2016 Elsevier Ltd. All rights reserved.

Tenderness and taste qualification of red brangus beef in Mexico / Suavidad y aceptabilidad de la carne de bovinos brangus rojo en México

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Gaspar Manuel Parra-Bracamonte

2014-01-01

Full Text Available Beef tenderness is an important trait in consumer satisfaction and has been considered as the main trait for palatability, for which reason it is important to evaluate its variability in different cattle breeds. An experiment was designed to evaluate the Warner Bratzler Shear Force (WBSF of Red Brangus cattle rib eye steaks and consumer acceptance. The tenderness of beef rib eye steaks was evaluated by the WBSF. A consumer preference evaluation test was carried out to quantitatively estimate tenderness, juiciness, flavor, doneness and general acceptance of the evaluated steaks. Mean WBSF was 5.03 kg ± 0.93 kg, theoretically indicating a tough beef. The distribution of the samples showed 21 % and 11 % of moderately tender and tender beef cuts, respectively. Cattle condition (bulls and steers was not significant for the WBSF (p > 0.5. All the traits evaluated in the hedonic evaluation had approximately 6 points of a total of 8 (8 was best. Tenderness, juiciness and flavor presented a high and significant correlation (p < 0.5. None of the subjective traits was correlated with total acceptance. Under theoretical criteria, tender Red Brangus beef cuts are infrequent; however the beef has a good acceptance. Characterization studies may be necessary and useful to create marketing niches specific for this and other cattle breeds.

Semisubmersible rigs attractive for tender-assisted drilling

Energy Technology Data Exchange (ETDEWEB)

Tranter, P. (Sedco Forex, Aberdeen (United Kingdom))

1994-09-19

Tender-assisted drilling (TAD) involves the use of tender support vessel (TSV) during the drilling phase of platform development to provide drilling utilities to the platform-mounted drilling package. The TSV provides facilities such as mud mixing, storage, pumping, bulk storage, hotel accommodations, and power. Thus, the platform topsides and jacket weight and size can be smaller and less expensive. The paper discusses the advantages and disadvantages of TAD, then describes the TAD vessel, semisubmersible, platform cost savings, accommodations, drilling and workovers, and field experience.

Assessment of Computer Software Usage for Estimating and Tender ...

African Journals Online (AJOL)

It has been discovered that there are limitations to the use of computer software packages in construction operations especially estimating and tender analysis. The objectives of this research is to evaluate the level of computer software usage for estimating and tender analysis while also assessing the challenges faced by ...

No effect of experimental occlusal interferences on pressure pain thresholds of the masseter and temporalis muscles in healthy women.

Science.gov (United States)

Michelotti, A; Farella, M; Steenks, M H; Gallo, L M; Palla, S

2006-04-01

It has been suggested that occlusal interferences may lead to pain and tenderness of the masticatory muscles. Tender jaw muscles are more sensitive to pressure pain, as assessed by means of pressure algometry. We tested the effects of occlusal interferences on the pressure pain threshold of the jaw muscles by means of a double-blind randomized crossover experiment carried out on 11 young healthy females. Golden strips were glued either to an occlusal contact area (active interference) or to the vestibular surface of the same tooth (dummy interference) and left for 8 d each. Pressure pain thresholds of the masseter and anterior temporalis muscles were assessed under interference-free, dummy-interference and active-interference conditions. The results indicated that the application of an active occlusal interference, as used in this study, did not influence significantly the pressure pain thresholds of these muscles in healthy individuals.

Reliability of four experimental mechanical pain tests in children

DEFF Research Database (Denmark)

Søe, Ann-Britt Langager; Thomsen, Lise L; Tornoe, Birte

2013-01-01

In order to study pain in children, it is necessary to determine whether pain measurement tools used in adults are reliable measurements in children. The aim of this study was to explore the intrasession reliability of pressure pain thresholds (PPT) in healthy children. Furthermore, the aim was a...... was also to study the intersession reliability of the following four tests: (1) Total Tenderness Score; (2) PPT; (3) Visual Analog Scale score at suprapressure pain threshold; and (4) area under the curve (stimulus-response functions for pressure versus pain).......In order to study pain in children, it is necessary to determine whether pain measurement tools used in adults are reliable measurements in children. The aim of this study was to explore the intrasession reliability of pressure pain thresholds (PPT) in healthy children. Furthermore, the aim...

Visual evaluation of beef tenderness by using surface structural ...

African Journals Online (AJOL)

Very low negative correlations were observed between colour and shear force (r = −0.242). Therefore, although it may be possible to judge meat colour by visual analysis, it does not appear possible to predict tenderness by colour judgment. There is potential for an experienced eye to predict tenderness by observing visual ...

Laparoscopic Cholecystectomy for Gallbladder Calculosis in Fibromyalgia Patients: Impact on Musculoskeletal Pain, Somatic Hyperalgesia and Central Sensitization

Science.gov (United States)

Costantini, Raffaele; Affaitati, Giannapia; Massimini, Francesca; Tana, Claudio; Innocenti, Paolo; Giamberardino, Maria Adele

2016-01-01

Fibromyalgia, a chronic syndrome of diffuse musculoskeletal pain and somatic hyperalgesia from central sensitization, is very often comorbid with visceral pain conditions. In fibromyalgia patients with gallbladder calculosis, this study assessed the short and long-term impact of laparoscopic cholecystectomy on fibromyalgia pain symptoms. Fibromyalgia pain (VAS scale) and pain thresholds in tender points and control areas (skin, subcutis and muscle) were evaluated 1week before (basis) and 1week, 1,3,6 and 12months after laparoscopic cholecystectomy in fibromyalgia patients with symptomatic calculosis (n = 31) vs calculosis patients without fibromyalgia (n. 26) and at comparable time points in fibromyalgia patients not undergoing cholecystectomy, with symptomatic (n = 27) and asymptomatic (n = 28) calculosis, and no calculosis (n = 30). At basis, fibromyalgia+symptomatic calculosis patients presented a significant linear correlation between the number of previously experienced biliary colics and fibromyalgia pain (direct) and muscle thresholds (inverse)(pfibromyalgia pain significantly increased and all thresholds significantly decreased at 1week and 1month (1-way ANOVA, pFibromyalgia pain and thresholds returned to preoperative values at 3months, then pain significantly decreased and thresholds significantly increased at 6 and 12months (pfibromyalgia patients undergoing cholecystectomy thresholds did not change; in all other fibromyalgia groups not undergoing cholecystectomy fibromyalgia pain and thresholds remained stable, except in fibromyalgia+symptomatic calculosis at 12months when pain significantly increased and muscle thresholds significantly decreased (pfibromyalgia symptoms and that laparoscopic cholecystectomy produces only a transitory worsening of these symptoms, largely compensated by the long-term improvement/desensitization due to gallbladder removal. This study provides new insights into the role of visceral pain comorbidities and the effects of

31 CFR 309.9 - Tenders; acceptance by the Secretary of the Treasury.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Tenders; acceptance by the Secretary... TREASURY BILLS § 309.9 Tenders; acceptance by the Secretary of the Treasury. At the time fixed for closing... acceptable prices offered and will make public announcement thereof those submitting tenders will be advised...

Neuro Emotional Technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: a controlled clinical trial.

Science.gov (United States)

Bablis, Peter; Pollard, Henry; Bonello, Rod

2008-05-21

Trigger points have been shown to be active in many myofascial pain syndromes. Treatment of trigger point pain and dysfunction may be explained through the mechanisms of central and peripheral paradigms. This study aimed to investigate whether the mind/body treatment of Neuro Emotional Technique (NET) could significantly relieve pain sensitivity of trigger points presenting in a cohort of chronic neck pain sufferers. Sixty participants presenting to a private chiropractic clinic with chronic cervical pain as their primary complaint were sequentially allocated into treatment and control groups. Participants in the treatment group received a short course of Neuro Emotional Technique that consists of muscle testing, general semantics and Traditional Chinese Medicine. The control group received a sham NET protocol. Outcome measurements included pain assessment utilizing a visual analog scale and a pressure gauge algometer. Pain sensitivity was measured at four trigger point locations: suboccipital region (S); levator scapulae region (LS); sternocleidomastoid region (SCM) and temporomandibular region (TMJ). For each outcome measurement and each trigger point, we calculated the change in measurement between pre- and post- treatment. We then examined the relationships between these measurement changes and six independent variables (i.e. treatment group and the above five additional participant variables) using forward stepwise General Linear Model. The visual analog scale (0 to 10) had an improvement of 7.6 at S, 7.2 at LS, 7.5 at SCM and 7.1 at the TMJ in the treatment group compared with no improvement of at S, and an improvement of 0.04 at LS, 0.1 at SCM and 0.1 at the TMJ point in the control group, (P algometer recordings of four trigger point locations in a cohort of chronic neck pain sufferers were significantly improved when compared to a control group which received a sham protocol of NET. Chronic neck pain sufferers may benefit from NET treatment in the relief

Progression of fibromyalgia: results from a 2-year observational fibromyalgia and chronic pain study in the US

Science.gov (United States)

Adams, Edgar H; McElroy, Heather J; Udall, Margarita; Masters, Elizabeth T; Mann, Rachael M; Schaefer, Caroline P; Cappelleri, Joseph C; Clair, Andrew G; Hopps, Markay; Daniel, Shoshana R; Mease, Philip; Silverman, Stuart L; Staud, Roland

2016-01-01

Background A previous fibromyalgia (FM) research reports that 20%–47% of diagnosed patients may not meet the study definition of FM 1–2 years after diagnosis. The aim of this study was to gain a better understanding of the progression of FM in a geographically diverse cohort over a 2-year time period. Methods This cohort study followed 226 subjects recruited online to assess FM and chronic widespread pain (CWP) diagnosis stability over time. At enrollment (baseline), subjects provided informed consent, completed an online questionnaire consisting of the London Fibromyalgia Epidemiology Study Screening Questionnaire to screen for CWP (bilateral pain above/below waist lasting ≥1 week in the past 3 months), visited a site for physician evaluation for FM, and completed a questionnaire with validated patient-reported outcome instruments. Subjects were classified into mutually exclusive groups: FM+CWP+ (screened positive for CWP and received physician diagnosis of FM), FM−CWP+ (screened positive for CWP but did not receive physician diagnosis of FM), and FM−CWP− (screened negative for CWP). Approximately 2 years later (follow-up), subjects were reassessed at the same study site and completed a questionnaire with the same patient-reported outcomes. Results Seventy-six FM+CWP+ subjects completed assessments at both time points; 56 (73.7%) met the FM study definition at follow-up. Twenty subjects no longer met the FM study definition (eleven became FM−CWP− and nine became FM−CWP+). Ten subjects (two from FM−CWP− and eight from FM−CWP+) transitioned into the FM+CWP+ group at follow-up; they reported more tender points and pain interference with sleep and worse physical function at baseline compared with subjects who did not transition to FM+CWP+. Most (76.7%) of the subjects who transitioned into/out of FM+CWP+ experienced changes in CWP, number of positive tender points, or both. Conclusion The results suggest that some FM+CWP+ patients experience

Health resource utilisation costs in acute patients with persistent midline cervical tenderness following road trauma.

Science.gov (United States)

Ackland, Helen M; Wolfe, Rory; Cameron, Peter A; Cooper, D James; Malham, Gregory M; Varma, Dinesh K; Fitt, Gregory J; Rosenfeld, Jeffrey V; Liew, Susan M

2012-11-01

The costs associated with patients discharged with isolated clinician-elicited persistent midline tenderness and negative computed tomography (CT) findings have not been reported. Our aim was to determine the association of acute and post-acute patient and injury characteristics with health resource costs in such patients following road trauma. In a prospective cohort study, road trauma patients presenting with isolated persistent midline cervical tenderness and negative CT, who underwent additional acute imaging with MRI, were recruited. Patients were reviewed in the outpatient spine clinic following discharge, and were followed up at 6 and 12 months post-trauma. Multivariate linear regression was used to assess the association of injury mechanism, clinical assessment, socioeconomic factors and outcome findings with health resource costs generated in the acute hospital and post-acute periods. There were 64 patients recruited, of whom 24 (38%) had cervical spine injury detected on MRI. Of these, 2 patients were managed operatively, 6 were treated in cervical collars and 16 had the cervical spine cleared and were discharged. At 12 months, there were 25 patients (44%) with residual neck pain, and 22 (39%) with neck-related disability. The mean total cost was AUD $10,153 (SD=10,791) and the median was $4015 (IQR: 3044-6709). Transient neurologic deficit, which fully resolved early in the emergency department, was independently associated with higher marginal mean acute costs (represented in the analysis by the β coefficient) by $3521 (95% CI: 50-6880). Low education standard (β coefficient: $5988, 95% CI: 822-13,317), neck pain at 6 months (β coefficient: $4017, 95% CI: 426-9254) and history of transient neurologic deficit (β coefficient: $8471, 95% CI: 1766-18,334) were associated with increased post-acute costs. In a homogeneous group of road trauma patients with non fracture-related persistent midline cervical tenderness, health resource costs varied

Comparison of burrowing and stimuli-evoked pain behaviors as end-points in rat models of inflammatory pain and peripheral neuropathic pain

Directory of Open Access Journals (Sweden)

Arjun eMuralidharan

2016-05-01

Full Text Available Establishment and validation of ethologically-relevant, non-evoked behavioral end-points as surrogate measures of spontaneous pain in rodent pain models has been proposed as a means to improve preclinical to clinical research translation in the pain field. Here, we compared the utility of burrowing behavior with hypersensitivity to applied mechanical stimuli for pain assessment in rat models of chronic inflammatory and peripheral neuropathic pain. Briefly, groups of male Sprague-Dawley rats were habituated to the burrowing environment and trained over a 5-day period. Rats that burrowed ≤450g of gravel on any two days of the individual training phase were excluded from the study. The remaining rats received either a unilateral intraplantar injection of Freund’s complete adjuvant (FCA or saline, or underwent unilateral chronic constriction injury (CCI of the sciatic nerve- or sham-surgery. Baseline burrowing behavior and evoked pain behaviors were assessed prior to model induction, and twice-weekly until study completion on day 14. For FCA- and CCI-rats, but not the corresponding groups of sham-rats, evoked mechanical hypersensitivity developed in a temporal manner in the ipsilateral hindpaws. Although burrowing behavior also decreased in a temporal manner for both FCA- and CCI-rats, there was considerable inter-animal variability. By contrast, mechanical hyperalgesia and mechanical allodynia in the ipsilateral hindpaws of FCA- and CCI-rats respectively, exhibited minimal inter-animal variability. Our data collectively show that burrowing behavior is altered in rodent models of chronic inflammatory pain and peripheral neuropathic pain. However, large group sizes are needed to ensure studies are adequately powered due to considerable inter-animal variability.

Grounds for dispensing with public tender procedures in Government Contracting

Directory of Open Access Journals (Sweden)

P Bolton

2006-01-01

Full Text Available The Constitution of the Republic of South Africa1 provides that organs of state must comply with five principles when procuring goods or services: procurement procedures must be fair, equitable, transparent, competitive and cost-effective. In short, this means that organs of state should make use of competition when procuring goods or services. They should shop around and attract the maximum number of contractors who will participate in such competition. The aim should be the attainment of value for money, meaning, public money should be spent in an effective and efficient manner. Those who participate in competitions should also be treated fairly and without bias. In principle, no preferences should be afforded to different contractors; all contracting parties should have equal access to competition; some contractors should not be afforded more time for the preparation and submission of quotes or tenders than others; and the same information should be made available to all contracting parties. Government procurement procedures should further be transparent, meaning public or open. Thus, organs of state should not contract behind closed doors – government contracts should, as a rule, be advertised. Depending on the nature and value of a particular contract, the use of a public call for tenders is generally the best way to ensure compliance with the principles in the Constitution. By nature, a pubic call for tenders is open, it assists in the prevention of fraud and favouritism, and it ensures that the maximum number of contractors is approached to compete for a contract.Organs of state can also compare prices and quality and can contract with whoever offers the best deal. Most legislation therefore proceeds on the basis that procurement takes place by way of tendering. Generally, contracts above R200 000 are subject to public tender procedures. In certain instances, however, a public call for tenders may be inappropriate regardless of the high

Comparative Effects of Acupressure at Local and Distal Acupuncture Points on Pain Conditions and Autonomic Function in Females with Chronic Neck Pain

Directory of Open Access Journals (Sweden)

Takako Matsubara

2011-01-01

Full Text Available Acupressure on local and distal acupuncture points might result in sedation and relaxation, thereby reducing chronic neck pain. The aim was to investigate the effect of acupressure at local (LP and distal acupuncture points (DP in females with chronic neck pain. Thirty-three females were assigned to three groups: the control group did not receive any stimuli, the LP group received acupressure at local acupuncture points, GB 21, SI 14 and SI 15, and the DP group received acupressure at distal acupuncture points, LI 4, LI 10 and LI 11. Verbal rating scale (VRS, Neck Disability Index (NDI, State-Trait Anxiety Inventory (STAI, muscle hardness (MH, salivary alpha-amylase (sAA activity, heart rate (HR, heart rate variability (HRV values and satisfaction due to acupressure were assessed. VRS, NDI, STAI and MH values decreased after acupressure in the LP and the DP group. HR decreased and the power of high frequency (HF component of HRV increased after acupressure in only the LP group. Although acupressure on not only the LP but also the DP significantly improved pain conditions, acupressure on only the LP affected the autonomic nervous system while acupuncture points per se have different physical effects according to location.

Effect of laser acupuncture versus traditional acupuncture in neck pain of cervical spondylosis

Science.gov (United States)

El-Kharbotly, Ahmed M.; El-Gendy, Alyaa A.; Mohammed, Mouchira A.; El-Masry, Manal R.; Daoud, Eitedal M.; Hassan, Nagwa; Abdel-Wahab, Khaled G.; Helmy, Ghada; Mostafa, Taymour

2014-02-01

This prospective cohort study aimed to compare the efficiency of laser versus traditional acupuncture in treating cervical spondylosis (CS) pain. Forty female patients were randomized into two equal groups that received 3 sessions / week for 4 weeks. Group A received needle acupuncture therapy with electrical stimulation for 20 min at standard acupoints, ear points and Ashi point on the average 3 points. Group B received low level laser therapy (LLLT) acupuncture at the same acupoints. The results demonstrated that tenderness disappeared in 65% of patients in group A and 75% of patients in group B with improved percentage of 85.5% and 89.2%. Pain on VAS related to direction of motion at 6 directions was improved in all cases where with improvement percentage 76.45% and 85.88%. Pain on VAS at rest was improved in all patients with improvement percentage of 80.41% and 84.28%. NDIQ score improved in all patients with improvement percentage of 69.78% and 73.77%. Follow up of VAS after 6 months from the last session revealed persistent improvement in 55% of patients of group A vs 80% of patients of group B. Mean serum TNF-α was decreased in 85% of patients of group A vs 95% of patients of group B where serum beta endorphins was increased in all patients. It is concluded that both modes of treatment for CS gave improvement regarding pain intensity, disability and quality of life being more evident in LLLT followed for 6 months supported with improved serum TNFα and beta endorphin.

Experience of adjunctive cannabis use for chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study.

Science.gov (United States)

Degenhardt, Louisa; Lintzeris, Nicholas; Campbell, Gabrielle; Bruno, Raimondo; Cohen, Milton; Farrell, Michael; Hall, Wayne D

2015-02-01

There is increasing debate about cannabis use for medical purposes, including for symptomatic treatment of chronic pain. We investigated patterns and correlates of cannabis use in a large community sample of people who had been prescribed opioids for chronic non-cancer pain. The POINT study included 1514 people in Australia who had been prescribed pharmaceutical opioids for chronic non-cancer pain. Data on cannabis use, ICD-10 cannabis use disorder and cannabis use for pain were collected. We explored associations between demographic, pain and other patient characteristics and cannabis use for pain. One in six (16%) had used cannabis for pain relief, 6% in the previous month. A quarter reported that they would use it for pain relief if they had access. Those using cannabis for pain on average were younger, reported greater pain severity, greater interference from and poorer coping with pain, and more days out of role in the past year. They had been prescribed opioids for longer, were on higher opioid doses, and were more likely to be non-adherent with their opioid use. Those using cannabis for pain had higher pain interference after controlling for reported pain severity. Almost half (43%) of the sample had ever used cannabis for recreational purposes, and 12% of the entire cohort met criteria for an ICD-10 cannabis use disorder. Cannabis use for pain relief purposes appears common among people living with chronic non-cancer pain, and users report greater pain relief in combination with opioids than when opioids are used alone. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Reproduction of overall spontaneous pain pattern by manual stimulation of active myofascial trigger points in fibromyalgia patients

DEFF Research Database (Denmark)

Ge, Hong-You; Wang, Ying; Fernández-de-las-Peñas, César

2011-01-01

It has previously been reported that local and referred pain from active myofascial trigger points (MTPs) in the neck and shoulder region contribute to fibromyalgia (FM) pain and that the pain pattern induced from active MTPs can reproduce parts of the spontaneous clinical FM pain pattern. The cu...

A Contribution to the Understanding of Pain in Fibromyalgia Based on Cerebrospinal Fluid Investigations

Directory of Open Access Journals (Sweden)

Henning Værøy

1996-01-01

Full Text Available Fibromyalgia is established in current practice as a condition with widespread pain and a number of specific tender points, as well as symptoms of limb stiffness, lack of refreshing sleep and depression. Musculoskeletal correlations with the syndrome have generally been disappointing. Chemical changes in the cerebrospinal fluid are of interest and seem to show significant relationships with fibromyalgia, both with respect to opioid peptides and substance P. The nature of these relationships and their possible linkage with neuronal plasticity at the spinal cord level are discussed. The influence of both peripheral sensitization and reduced presynaptic inhibitory feedback is considered in this connection.

Treatment of pain in fibromyalgia patients with testosterone gel: Pharmacokinetics and clinical response.

Science.gov (United States)

White, Hillary D; Brown, Lin A J; Gyurik, Robert J; Manganiello, Paul D; Robinson, Thomas D; Hallock, Linda S; Lewis, Lionel D; Yeo, Kiang-Teck J

2015-08-01

To test our hypothesis that testosterone deficiency plays an important role in chronic pain, a Phase I/II pilot study was initiated with 12 fibromyalgia patients to verify that a daily dose for 28days with transdermal testosterone gel would 1) significantly and safely increase mean serum testosterone concentrations from low baseline levels to mid/high-normal levels, and 2) effectively treat the pain and fatigue symptoms of fibromyalgia. Pharmacokinetic data confirmed that serum free testosterone concentrations were raised significantly above baseline levels, by assessment of maximum hormone concentration (Cmax) and area under the curve (AUC) parameters: free testosterone Cmax was significantly raised from a mean of 2.64pg/mL to 3.91pg/mL (pfibromyalgia by patient questionnaire and tender point exam demonstrated significant change in: decreased muscle pain, stiffness, and fatigue, and increased libido during study treatment. These results are consistent with the hypothesized ability of testosterone to relieve the symptoms of fibromyalgia. Symptoms not tightly related to fibromyalgia were not improved. Copyright © 2015. Published by Elsevier B.V.

Physical Examination for Men and Women With Urologic Chronic Pelvic Pain Syndrome: A MAPP (Multidisciplinary Approach to the Study of Chronic Pelvic Pain) Network Study.

Science.gov (United States)

Yang, Claire C; Miller, Jane L; Omidpanah, Adam; Krieger, John N

2018-06-01

To examine the feasibility of implementing a standardized, clinically relevant genitourinary examination for both men and women, and to identify physical examination findings characteristic of urologic chronic pelvic pain syndrome (UCPPS). This study analyzed 2 samples: men and women with UCPPS who participated in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network Epidemiology and Phenotyping (EP) Study, and age-matched controls who were either positive for chronic fatigue syndrome or healthy (pain-free). We compared physical examination findings in both positive and healthy controls with UCPPS cases: findings from both the EP examinations and from an extended genitourinary examination. EP and extended examinations were performed on 143 participants: 62 UCPPS cases (30 women, 32 men), 42 positive controls (15 women, 27 men), and 39 healthy controls (22 women, 17 men). EP examinations showed that pelvic floor tenderness was more prevalent in cases (55.0%) than in positive (14.6%) or healthy controls (10.5%). Extended examinations revealed specific areas of tenderness in the pelvic floor musculature. Cases were also more likely than healthy controls to report tenderness in multiple areas, including suprapubic, symphysis pubis, and posterior superior iliac spine, and on bimanual examination. No comparative findings were specific to biological sex, and no evidence of pudendal neuropathy was observed on extended examination of cases or controls. The extended genitourinary examination is an easily administered addition to the assessment of men and women during evaluation for UCPPS. Physical findings may help to better categorize patients with UCPPS into clinically relevant subgroups for optimal treatment. Published by Elsevier Inc.

Gender Differences in Symptoms, Health-Related Quality of Life, Sleep Quality, Mental Health, Cognitive Performance, Pain-Cognition, and Positive Health in Spanish Fibromyalgia Individuals: The Al-Ándalus Project.

Science.gov (United States)

Segura-Jiménez, Víctor; Estévez-López, Fernando; Soriano-Maldonado, Alberto; Álvarez-Gallardo, Inmaculada C; Delgado-Fernández, Manuel; Ruiz, Jonatan R; Aparicio, Virginia A

2016-01-01

Objective . To test the gender differences in tenderness, impact of fibromyalgia, health-related quality of life, fatigue, sleep quality, mental health, cognitive performance, pain-cognition, and positive health in Spanish fibromyalgia patients and in age-matched nonfibromyalgia individuals from the same region. To test the optimal cut-off score of the different tender points for women and men. Methods . A total of 405 (384 women) fibromyalgia versus 247 (195 women) nonfibromyalgia control participants from southern Spain (Andalusia) took part in this cross-sectional study. The outcomes studied were assessed by means of several tests. Results . In the fibromyalgia group, men showed better working memory than women (all, P working memory than women (all, P performance was better in women compared to men (all, P ≤ 0.01). Conclusion . The results of the present study do not support consistent evidence of gender differences in fibromyalgia-related symptoms. However, it seems that detriment of some symptoms (especially pain) in fibromyalgia men compared with their nonfibromyalgia counterparts is greater than those of fibromyalgia women compared with their nonfibromyalgia peers.

A rare case of painful goiter secondary to pediatric Hashimoto’s thyroiditis requiring thyroidectomy for pain control

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Liladhar Kashyap

2015-09-01

Full Text Available Hashimoto’s thyroiditis (HT usually presents as painless thyroid swelling. Painful pediatric HT is a rare condition with limited literature on pain management. We report a 15- year-old female who presented with 4 weeks history of fatigue, malaise and progressive, painful midline thyroid swelling. There was no difficulty in swallowing, no fever or recent upper respiratory infection symptoms. Exam was remarkable for diffusely enlarged, very tender, and non-nodular thyroid. Thyroid function tests, C-reactive protein, and complete blood count were normal. Ultrasound revealed diffusely enlarged non-nodular, non-cystic gland with mild increased vascularity. Diagnosis of HT was confirmed by biopsy and thyroid antibodies. Over a 6 week period, pain management with ibuprofen, levothyroxine, corticosteroid, gabapentin and amitriptyline was unsuccessful. Ultimately, total thyroidectomy resulted in complete resolution of thyroid pain. We can conclude that thyroidectomy may be considered for the rare case of painful HT in children.

Calls for Tender and Market Surveys Roles and Procedures

CERN Document Server

Annila, L

2000-01-01

ST division has implemented certain procedures to handle the calls for tender and market surveys. In January 1998, the division leader set up the 'call-for-tender co-ordination office' to check and approve each technical document leaving the division. The mandate of the call-for-tender co-ordination office is to check the quality of the documents, in order for these documents to be as clear as possible in terms of both content and structure. The role of this office is to contribute positively and give service to the people writing the documents, and not to give negative criticism. The aim of this paper is to present the mandate of the office, how papers are processed, and to draw up a first result summary.

48 CFR 47.104-5 - Citation of Government rate tenders.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Citation of Government rate tenders. 47.104-5 Section 47.104-5 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TRANSPORTATION General 47.104-5 Citation of Government rate tenders. When 49 U...

Ketamine Use for Successful Resolution of Post-ERCP Acute Pancreatitis Abdominal Pain

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Suneel M. Agerwala

2017-01-01

Full Text Available We report a case in which a patient with intractable pain secondary to post-endoscopic retrograde cholangiopancreatography (ERCP acute pancreatitis is successfully treated with a subanesthetic ketamine infusion. Shortly after ERCP, the patient reported severe stabbing epigastric pain. She exhibited voluntary guarding and tenderness without distension. Amylase and lipase levels were elevated. Pain persisted for hours despite hydromorphone PCA, hydromorphone boluses, fentanyl boluses, and postprocedure anxiolytics. Pain management was consulted and a ketamine infusion was trialed, leading to a dramatic reduction in pain. This case suggests that ketamine may be a promising option in treating intractable pain associated with ERCP acute pancreatitis.

Acupuncture Treatment of Chronic Low Back Pain by Using the Jingjin (Meridian Sinews) Model.

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Legge, David

2015-10-01

This case report details the unexpected and sustained relief from chronic low back pain in a patient after a single acupuncture treatment. The treatment administered on that occasion was based on the jingjin (i.e., "meridian sinew") model of traditional acupuncture. Treatments based on the jingjin model involve needling the ah shi (i.e., locally tender) points in myofascial tissue along the jingjin pathway. Tight chains can be needled to treat symptoms that are either close to or at some distance from the site of the needling treatment. In this patient, the points were in the gastrocnemius muscle and the hamstring muscles, which are part of the Bladder jingjin pathway. The patient, a 69-year-old woman, had had back pain for more than 40 years. The relief from the pain occurred within a day after the treatment and, at the time of this report, the relief has persisted for 5 months. This report examines two possible mechanisms for such a result: (1) a local increase in the extensibility of the hamstrings could be responsible or (2) the complex interactions within the central nervous system that are involved in acupuncture treatment could be more important factors. Copyright © 2015. Published by Elsevier B.V.

Neuro Emotional Technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: A controlled clinical trial

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Pollard Henry

2008-05-01

Full Text Available Abstract Background Trigger points have been shown to be active in many myofascial pain syndromes. Treatment of trigger point pain and dysfunction may be explained through the mechanisms of central and peripheral paradigms. This study aimed to investigate whether the mind/body treatment of Neuro Emotional Technique (NET could significantly relieve pain sensitivity of trigger points presenting in a cohort of chronic neck pain sufferers. Methods Sixty participants presenting to a private chiropractic clinic with chronic cervical pain as their primary complaint were sequentially allocated into treatment and control groups. Participants in the treatment group received a short course of Neuro Emotional Technique that consists of muscle testing, general semantics and Traditional Chinese Medicine. The control group received a sham NET protocol. Outcome measurements included pain assessment utilizing a visual analog scale and a pressure gauge algometer. Pain sensitivity was measured at four trigger point locations: suboccipital region (S; levator scapulae region (LS; sternocleidomastoid region (SCM and temporomandibular region (TMJ. For each outcome measurement and each trigger point, we calculated the change in measurement between pre- and post- treatment. We then examined the relationships between these measurement changes and six independent variables (i.e. treatment group and the above five additional participant variables using forward stepwise General Linear Model. Results The visual analog scale (0 to 10 had an improvement of 7.6 at S, 7.2 at LS, 7.5 at SCM and 7.1 at the TMJ in the treatment group compared with no improvement of at S, and an improvement of 0.04 at LS, 0.1 at SCM and 0.1 at the TMJ point in the control group, (P Conclusion After a short course of NET treatment, measurements of visual analog scale and pressure algometer recordings of four trigger point locations in a cohort of chronic neck pain sufferers were significantly

Reproduction of overall spontaneous pain pattern by manual stimulation of active myofascial trigger points in fibromyalgia patients

DEFF Research Database (Denmark)

Ge, Hong-You; Wang, Ying; Fernandez-de-las-Penas, Cesar

2011-01-01

It has previously been reported that local and referred pain from active myofascial trigger points (MTPs) in the neck and shoulder region contribute to fibromyalgia (FM) pain and that the pain pattern induced from active MTPs can reproduce parts of the spontaneous clinical FM pain pattern....... The current study investigated whether the overall spontaneous FM pain pattern can be reproduced by local and referred pain from active MTPs located in different muscles....

Soft occlusal splint therapy in the management of myofascial pain dysfunction syndrome: A follow-up study

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Naikmasur Venkatesh

2008-01-01

Full Text Available Background and Objectives: Myofascial Pain Dysfunction Syndrome (MPDS has been recognized as the most common, nontooth-related chronic orofacial pain condition that confronts dentists. A variety of therapies has been described in literature for its management. The present study is a prospective study carried out to evaluate the efficacy of occlusal splint therapy and compare it with pharmacotherapy (using analgesics and muscle relaxants in the management of Myofascial Pain Dysfunction Syndrome. Materials and Methods: Forty patients in the age range of 17-55 years were included in the study and randomly assigned to one of two equally sized groups, A and B. Group A patients received a combination of muscle relaxants and analgesics while Group B patients received soft occlusal splint therapy. All the patients were evaluated for GPI, VAS, maximum comfortable mouth opening, TMJ clicking and tenderness during rest and movement as well as for the number of tender muscles at the time of diagnosis, after the 1 st week of initiation of therapy and every month for three months of follow-up. Results: There was a progressive decrease in GPI scores, number of tender muscles, TMJ clicking and tenderness with various jaw movements and significant improvement in mouth opening in patients on occlusal splint therapy during the follow-up period as compared to the pharmacotherapy group. Conclusion: Occlusal splint therapy has better long-term results in reducing the symptoms of MPDS. It has better patient compliance, fewer side effects, and is more cost-effective than pharmacotherapy; hence, it can be chosen for the treatment of patients with MPDS.

Biospectral analysis of the bladder channel point in chronic low back pain patients

Science.gov (United States)

Vidal, Alberto Espinosa; Nava, Juan José Godina; Segura, Miguel Ángel Rodriguez; Bastida, Albino Villegas

2012-10-01

Chronic pain is the main cause of disability in the productive age people and is a public health problem that affects both the patient and society. On the other hand, there isn't any instrument to measure it; this is only estimated using subjective variables. The healthy cells generate a known membrane potential which is part of a network of biologically closed electric circuits still unstudied. It is proposed a biospectral analysis of a bladder channel point as a diagnosis method for chronic low back pain patients. Materials and methods: We employed a study group with chronic low back pain patients and a control group without low back pain patients. The visual analog scale (VAS) to determine the level of pain was applied. Bioelectric variables were measured for 10 seconds and the respective biostatistical analyses were made. Results: Biospectral analysis on frequency domain shows a depression in the 60-300 Hz frequency range proportional to the chronicity of low back pain compared against healthy patients.

Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome

DEFF Research Database (Denmark)

Ge, Hong-You; Nie, Hongling; Madeleine, Pascal

2009-01-01

The generalized hypersensitivity associated with fibromyalgia syndrome (FMS) may in part be driven by peripheral nociceptive sources. The aim of the study was to investigate whether local and referred pain from active myofascial trigger points (MTrPs) contributes to fibromyalgia pain. FMS patients...

A basis for modelling the costs of supplier selection: the economic tender quantity

NARCIS (Netherlands)

de Boer, L.; van Dijkhuizen, G.C.; Telgen, Jan

2000-01-01

In this paper, we consider the decision a purchaser must make regarding the number of suppliers that should be invited to submit a tender for a certain purchase. On the one hand, the costs of sending invitations to tender, the costs of evaluating the tenders received, and the costs of communicating

Liquefied natural gas tender crashworthiness research

Science.gov (United States)

2015-03-23

Research is being conducted to develop technical : information needed to formulate effective natural gas fuel : tender crashworthiness standards. This research is being : performed for the Federal Railroad Administrations (FRAs) : Office of Res...

17 CFR 240.14e-5 - Prohibiting purchases outside of a tender offer.

Science.gov (United States)

2010-04-01

...(s); (iv) The intention of the offeror to make purchases pursuant to the foreign tender offer(s) is... consideration paid outside of the tender offer that is greater than the tender offer price; and (G) Purchases or... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Prohibiting purchases outside...

Treatment of chronic Achilles tendon pain by Kinesio taping in an amateur badminton player.

Science.gov (United States)

Lee, Jung-hoon; Yoo, Won-gyu

2012-05-01

To evaluate the effects of Kinesio taping on a patient with chronic Achilles tendon pain. Case report. A 22-year-old male amateur badminton player slipped on the ground as he landed after jumping while playing badminton, resulting in chronic Achilles tendon pain of the dominant (right) leg. We performed Achilles tendon taping (ATT) over 5 weeks. The patient's ultrasonography showed that the tendon thickness was moderately reduced from 0.42 cm to 0.37 cm and that the angles of active dorsiflexion and active plantar flexion without pain increased from 15° to 20° and from 20° to 45°, respectively. The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire score increased from 64 to 95, and the load-induced pain assessment score decreased from 6 to 0. The pain threshold increased from 0.8 kg to 10 kg. The tenderness at 3 kg, assessed on a numeric rating scale, decreased from 7 to 0, and the patient was able to play badminton and soccer without pain. We verified the effect with an increase in the active ankle joint range of motion and the VISA-A questionnaire score, which was achieved by a decrease in tenderness and pain from repeated ATT application. Copyright © 2011 Elsevier Ltd. All rights reserved.

Overhead work and shoulder-neck pain in orchard farmers harvesting pears and apples.

Science.gov (United States)

Sakakibara, H; Miyao, M; Kondo, T; Yamada, S

1995-04-01

The effects of overhead work were studied by comparing orchard farmers' musculoskeletal symptoms while bagging pears with those same symptoms while bagging apples. The subjects were 52 Japanese female farmers, who were examined twice an evening in late June for bagging pears, and during another evening of late July for bagging apples, when each task had been almost finished. They were questioned about musculoskeletal complaints of stiffness and pain during each job, and examined for muscle tenderness and pain from joint movement. Arm elevation angles during the work were measured for each type of bagging. The prevalence of stiffness and pain in the neck and shoulder, muscle tenderness in the shoulder regions, and pain in neck motion were found to be significantly higher when bagging pears than apples. Musculoskeletal symptoms of parts other than the neck and shoulder did not differ between the two types of bagging. The working posture of elevating the arm more than 90 degrees was assumed to account for 75% of the time bagging pears, against 40% for bagging apples. Overhead work requiring arm elevation and head extension was considered to be closely related with shoulder-neck disorders among farmers.

Tenderness of pre- and post rigor lamb longissimus muscle.

Science.gov (United States)

Geesink, Geert; Sujang, Sadi; Koohmaraie, Mohammad

2011-08-01

Lamb longissimus muscle (n=6) sections were cooked at different times post mortem (prerigor, at rigor, 1dayp.m., and 7 days p.m.) using two cooking methods. Using a boiling waterbath, samples were either cooked to a core temperature of 70 °C or boiled for 3h. The latter method was meant to reflect the traditional cooking method employed in countries where preparation of prerigor meat is practiced. The time postmortem at which the meat was prepared had a large effect on the tenderness (shear force) of the meat (PCooking prerigor and at rigor meat to 70 °C resulted in higher shear force values than their post rigor counterparts at 1 and 7 days p.m. (9.4 and 9.6 vs. 7.2 and 3.7 kg, respectively). The differences in tenderness between the treatment groups could be largely explained by a difference in contraction status of the meat after cooking and the effect of ageing on tenderness. Cooking pre and at rigor meat resulted in severe muscle contraction as evidenced by the differences in sarcomere length of the cooked samples. Mean sarcomere lengths in the pre and at rigor samples ranged from 1.05 to 1.20 μm. The mean sarcomere length in the post rigor samples was 1.44 μm. Cooking for 3 h at 100 °C did improve the tenderness of pre and at rigor prepared meat as compared to cooking to 70 °C, but not to the extent that ageing did. It is concluded that additional intervention methods are needed to improve the tenderness of prerigor cooked meat. Copyright © 2011 Elsevier B.V. All rights reserved.

A Randomized Clinical Trial of Auricular Point Acupressure for Chronic Low Back Pain: A Feasibility Study

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Chao Hsing Yeh

2013-01-01

Full Text Available Objectives. This prospective, randomized clinical trial (RCT was designed to investigate the feasibility and effects of a 4-week auricular point acupressure (APA for chronic low back pain (CLBP. Methods. Participants were randomized to either true APA (true acupoints with taped seeds on the designated ear points for CLBP or sham APA (sham acupoints with taped seeds but on different locations than those designated for CLBP. The duration of treatment was four weeks. Participants were assessed before treatment, weekly during treatment, and 1 month following treatment. Results. Participants in the true APA group who completed the 4-week APA treatment had a 70% reduction in worst pain intensity, a 75% reduction in overall pain intensity, and a 42% improvement in disability due to back pain from baseline assessment. The reductions of worst pain and overall pain intensity in the true APA group were statistically greater than participants in the sham group (P<0.01 at the completion of a 4-week APA and 1 month followup. Discussion. The preliminary findings of this feasibility study showed a reduction in pain intensity and improvement in physical function suggesting that APA may be a promising treatment for patients with CLBP.

Improving Tenderness of Spent Layer Hens Meat Using Papaya Leaves (Carica papaya

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H. O. Abdalla, N. N. A. Ali, F. S. Siddig and S. A. M. Ali*

2013-01-01

Full Text Available Two experiments were performed to study the use of papaya leaves as a meat tenderizer. The first experiment was to evaluate the effect of papaya dry leaves added to hen’s diet before slaughter. Spent hens (n=48 were used, half of them were fed a concentrate ration containing10% dried papaya leaves powder (DPLP while others received layer ration (Control, for 10 days. The second experiment involved a comparison between papaya leaves juice (PLJ, fresh papaya leaves (FPL and vinegar solution (VS as marinades applied to meat for one or two hours before cooking. Spent layer hens (n=42 were used for tenderness evaluation method. After slaughtering and preparing the chickens two methods of cooking were used (oven and moist cooking. The cooked parts (breast, thigh and drumstick were subjected to a panel test evaluation according to a designed questionnaire. Addition of dried papaya leaves powder to spent layer hens ration significantly (P≤0.05 increased the level of meat tenderness. Moist cooking had significantly (P≤0.05 improved meat tenderization compared to oven cooking. Meat treated with fresh papaya leaves had significantly (P≤0.05 improved tenderness. It was concluded that wrapping the tough meat of spent layer hens with fresh papaya leaves for one hour and moist cooking improve tenderness of meat.

An analysis of project selection and assignment criteria of Danish tenders in Europe

Directory of Open Access Journals (Sweden)

Jasper Kranker Larsen

2013-12-01

Full Text Available Public construction agencies are one of the largest developers within the Danish construction industry, where such agencies own and develop new public construction projects. Most of these projects are put out in European tender. This study analyses the selection and assignment criteria employed by these agencies in different types of public sector projects. Some of the objectives pursued by the study include the determination of 1/ the selection and assignment criteria mostly used in Danish public tenders 2/ how different types of projects use selection and assignment criteria in the bidding process, and 3/ any significant difference between the use of selection and assignment criteria in Danish public construction projects. The study uses a quantitative research approach where 157 Danish public tender cases were selected from the European Tenders Electronic Daily database between the period: January 2010 to March 2013. Fisher's Exact Test was conducted to determine if there was any significant use of some selection and assignment criteria. The findings of the study showed that invited tenders with pre-qualification and lowest price in 69.8% of the tenders are the most used selection and assignment criteria, with little regard to project type.

TEMPOROMANDIBULAR PAIN DYSFUNCTION SYNDROME IN PATIENTS ATTENDING LAGOS UNIVERSITY TEACHING HOSPITAL, LAGOS, NIGERIA.

Science.gov (United States)

Eweka, O M; Ogundana, O M; Agbelusi, G A

2016-01-01

Temporomandibular joint pain dysfunction syndrome (TMJPDS) is the most common temporomandibular disorder. This condition presents with symptoms of pain, restricted jaw movement and joint noise. Other symptoms include otalgia, headache, neck pain and trismus. To determine the pattern of Temporomandibular joint pain dysfunction syndrome patients managed at the Lagos University Teaching Hospital, Lagos, Nigeria. A descriptive study of patients with signs and symptoms of Temporomandibular joint pain dysfunction syndrome attending the Oral Medicine Clinic of Lagos University Teaching Hospital. Twenty-one patients with Temporomandibular joint pain dysfunction syndrome were enrolled into the study, out of which 10(48%) were females and 11(52%) were males. The age range was 23-81years with a mean of 45.2 ± 18.9 years. Majority of the patients 20(95.2%) complained of pain around the joint, in the pre-auricular region, in the muscles of mastication and the ear. While 7(35%) complained of clicking sounds, 10(47.6%) complained of pain on mouth opening and during mastication only. In all 5(23.8%) had impaired movement of the jaws, mouth opening was normal in 18(85.7%) but reduced in 3(14.3%) patients. Over half of patients 12(57%) experienced clicking sounds, there was tenderness around the temporomandibular joint in 16(76.2%) cases, pain in the ear of 7(33.3%) patients and 13(61.9%) people presented with tenderness of the muscles of mastication. Conservative management of all the cases resulted in resolution of the symptoms. Temporomandibular joint pain dysfunction syndrome has diverse clinical presentation and though distressing, it responds to prompt and effective conservative management.

Relationship between mechanical sensitivity and postamputation pain: A prospective study

DEFF Research Database (Denmark)

Nikolajsen, Lone; IlKjær, Susanne; Jensen, Troels Staehelin

2000-01-01

of the limb and early (after 1 week) and late (after 6 months) phantom pain. Thirty-five patients scheduled for amputation of the lower limb were examined before, 1 week and 6 months after amputation. On all three examination days pressure-pain thresholds were measured and compared with the simultaneous...... recording of ongoing pain intensity assessed on a visual analogue scale (VAS). There was a weak but significant inverse relationship between preamputation thresholds and early stump and phantom pain. There was no relationship between preamputation thresholds and late stump and phantom pain. One week after...... amputation there was a significant and inverse relationship between mechanical thresholds and phantom pain but no relationship was found after 6 months. The findings suggest that although tenderness of the limb before and after amputation is related to early stump and phantom pain, the relationship is weak...

Adapting Rational Unified Process (RUP) approach in designing a secure e-Tendering model

Science.gov (United States)

Mohd, Haslina; Robie, Muhammad Afdhal Muhammad; Baharom, Fauziah; Darus, Norida Muhd; Saip, Mohamed Ali; Yasin, Azman

2016-08-01

e-Tendering is an electronic processing of the tender document via internet and allow tenderer to publish, communicate, access, receive and submit all tender related information and documentation via internet. This study aims to design the e-Tendering system using Rational Unified Process approach. RUP provides a disciplined approach on how to assign tasks and responsibilities within the software development process. RUP has four phases that can assist researchers to adjust the requirements of various projects with different scope, problem and the size of projects. RUP is characterized as a use case driven, architecture centered, iterative and incremental process model. However the scope of this study only focusing on Inception and Elaboration phases as step to develop the model and perform only three of nine workflows (business modeling, requirements, analysis and design). RUP has a strong focus on documents and the activities in the inception and elaboration phases mainly concern the creation of diagrams and writing of textual descriptions. The UML notation and the software program, Star UML are used to support the design of e-Tendering. The e-Tendering design based on the RUP approach can contribute to e-Tendering developers and researchers in e-Tendering domain. In addition, this study also shows that the RUP is one of the best system development methodology that can be used as one of the research methodology in Software Engineering domain related to secured design of any observed application. This methodology has been tested in various studies in certain domains, such as in Simulation-based Decision Support, Security Requirement Engineering, Business Modeling and Secure System Requirement, and so forth. As a conclusion, these studies showed that the RUP one of a good research methodology that can be adapted in any Software Engineering (SE) research domain that required a few artifacts to be generated such as use case modeling, misuse case modeling, activity

41 CFR 102-117.55 - What are the advantages and disadvantages of using a rate tender?

Science.gov (United States)

2010-07-01

... and disadvantages of using a rate tender? 102-117.55 Section 102-117.55 Public Contracts and Property... the advantages and disadvantages of using a rate tender? (a) Using a rate tender is an advantage when... volume to obtain favorable rates. (b) Using a rate tender may be a disadvantage when: (1) You have...

EFFECTIVENESS OF ISCHEMIC COMPRESSION ON TRAPEZIUS MYOFASCIAL TRIGGER POINTS IN NECK PAIN

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Pragnya Ravichandran

2016-04-01

Full Text Available Background: Neck pain is a common disorder prevailing among individuals of different populations. The myofascial pain syndrome is a disorder related to myofascial trigger points. It is defined as a hyperirritable locus in skeletal muscle and that is associated with a hypersensitive palpable nodule in a taut band of muscle. Manual therapy has got a profound role in treating and ischemic compression technique has been researched widely. Thus the study intends to analyse the effectiveness of Manual Therapy (Ischemic Compression on functional outcome in neck pain. Methods: A single blinded randomized control study was conducted for subjects of sample size 30 who met the inclusion criteria and random allocation was made. The baseline parameters as like pain severity using VAS, pain pressure threshold using pressure Algometer, active cervical lateral flexion using 360 degree goniometer and disability using NDI were recorded. Study group received ischemic compression followed by myofascial stretches while the control group received ultrasonic therapy of 1.4watts/cm2. Both received Cryotherapy post session. After 2 weeks the baseline parameters were again recorded for t-test analysis. Result: There was no statistical significance between groups (p≥0.05. But active cervical lateral flexion showed improved mobility in study group and a high statistical significance within groups (p≤0.01 in relation to all parameters. Conclusion: Both ultrasonic therapy and Ischemic compression technique was found to show better improvement in pain pressure threshold and functional outcome in neck pain.

A 58-year-old Man with Abdominal Pain; Acute Appendicitis due to an Appendicolith

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Seyed Mojtaba Aghili

2017-12-01

Full Text Available Case presentation: A 58-year-old man presented to the emergency department with abdominal pain, nausea and loss of appetite for the last 8 hours. He reported diffuse pain that had been localized to the right lower quadrant (RLQ. Physical examination revealed muscular defense and tenderness in the RLQ. Computed tomography (CT of the abdomen and pelvis confirmed luminal distension with a thickened enhancing wall with an appendicolith. Learning points: Appendicitis may be developed by an appendicolith, a calcified deposit within the appendix. It may be an incidental finding on an abdominal radiograph, ultrasound (US examination or CT. It appears as echogenic focus and casts an acoustic shadow on US examination and manifests as a calcified mass on plain radiograph or CT. The incidence of appendicolith is higher among patients with a retrocaecal appendix. In our patient, a clinical diagnosis of acute appendicitis was made and the patient was immediately transferred to the operating room and an appendectomy was performed.

Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial.

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Mejuto-Vázquez, María J; Salom-Moreno, Jaime; Ortega-Santiago, Ricardo; Truyols-Domínguez, Sebastián; Fernández-de-Las-Peñas, César

2014-04-01

Randomized clinical trial. To determine the effects of trigger point dry needling (TrPDN) on neck pain, widespread pressure pain sensitivity, and cervical range of motion in patients with acute mechanical neck pain and active trigger points in the upper trapezius muscle. TrPDN seems to be effective for decreasing pain in individuals with upper-quadrant pain syndromes. Potential effects of TrPDN for decreasing pain and sensitization in individuals with acute mechanical neck pain are needed. Methods Seventeen patients (53% female) were randomly assigned to 1 of 2 groups: a single session of TrPDN or no intervention (waiting list). Pressure pain thresholds over the C5-6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle; neck pain intensity; and cervical spine range-of-motion data were collected at baseline (pretreatment) and 10 minutes and 1 week after the intervention by an assessor blinded to the treatment allocation of the patient. Mixed-model analyses of variance were used to examine the effects of treatment on each outcome variable. Patients treated with 1 session of TrPDN experienced greater decreases in neck pain, greater increases in pressure pain threshold, and higher increases in cervical range of motion than those who did not receive an intervention at both 10 minutes and 1 week after the intervention (Ppain intensity and widespread pressure pain sensitivity, and also increase active cervical range of motion, in patients with acute mechanical neck pain. Changes in pain, pressure pain threshold, and cervical range of motion surpassed their respective minimal detectable change values, supporting clinically relevant treatment effects. Level of Evidence Therapy, level 1b-.

Anorectal and Pelvic Pain.

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Bharucha, Adil E; Lee, Tae Hee

2016-10-01

Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Gertrude Stein’s Tender Buttons (1911)

DEFF Research Database (Denmark)

Balle, Søren Hattesen

Gertrude Stein’s book of prose poems Tender Buttons has been characterized as a modernist literary work by most of its critics. As a distinctive feature of its modernist poetics critics in particular emphasize Stein’s denial of representation through verbal abstraction and autotelism. This paper......, however, intends to read Tender Buttons somewhat differently by suggesting that the poems may be viewed as an example of a displaced Rabbinic hermeneutics in the sense given the term by Susan Handelman. Inasmuch as Stein refuses to name the many objects properly that the titles of the poems introduce...... and instead – to employ her own term – “abuses” their names by way of wordplay, punning, syntactical ambiguity, and semantic disruption, she impersonates a secular Reb Stein, who stays faithful to the Scripture by sacred contempt of representation and obedience to (the play of) the letter. Perhaps...

Comparison between the effects of trigger point mesotherapy versus acupuncture points mesotherapy in the treatment of chronic low back pain: a short term randomized controlled trial.

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Di Cesare, Annalisa; Giombini, Arrigo; Di Cesare, Mariachiara; Ripani, Maurizio; Vulpiani, Maria Chiara; Saraceni, Vincenzo Maria

2011-02-01

The goal of this study was to compare the effects of trigger point (TRP) mesotherapy and acupuncture (ACP) mesotherapy in the treatment of patients with chronic low back pain. Short term randomized controlled trial. 62 subjects with chronic low back pain were recruited at outpatients Physical Medicine and Rehabilitation Clinic at the University of Rome "La Sapienza" in the period between July 2006 and May 2008. Study subjects were assigned to receive 4 weeks treatments with either trigger point mesotherapy (TRP mesotherapy, n=29) or acupoints mesotherapy (ACP mesotherapy, n=33). Pain intensity with a pain visual analogic scale (VAS) and verbal rating scale (VRS) and pain disability with McGill Pain Questionnaire Short Form (SFMPQ), Roland Morris Disability Questionnaire (RMQ) and Oswestry Low Back Pain Disability Questionaire (ODQ). ACP mesotherapy shows a more effective results in VRS and VAS measures in the follow-up (p(VRS)=mesotherapy group. Our results suggest that the response to ACP mesotherapy may be greater than the response to TRP mesotherapy in the short term follow-up. This technique could be nevertheless a viable option as an adjunct treatment in an overall treatment planning of CLBP. Copyright © 2010 Elsevier Ltd. All rights reserved.

The Effect of Acupressure on Sanyinjiao and Hugo Points on Labor Pain in Nulliparous Women : A Randomized Clinical Trial

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Reza Heshmat

2013-06-01

Full Text Available Introduction:Most women have experienced child birth and its pain, which is inevitable. If this pain is not controlled it leads to prolonged labor and injury to the mother and fetus. This study was conducted to identify the effect of acupressure on sanyinjiao and hugo points on delivery pain in nulliparous women. Methods:This was a randomized controlled clinical trial on 84 nulliparous women in hospitals of Ardebil, Iran. The participants were divided by randomized blocks of 4 and 6 into two groups. The intervention was in the form of applying pressure at sanyinjiao and hugo points based on different dilatations. The intensity of the pain before and after the intervention was recorded by visual scale of pain assessment. To determine the effect of pressure on the intensity of labor pain, analytical descriptive test was conducted in SPSS (version 13. Results:There was a significant decrease in mean intensity of pain after each intervention in the experimental group with different dilatations (4, 6, 8, and 10 cm. Moreover, the Student’s independent t-test results indicated that the mean intensity of pain in the experimental group after the intervention in all four dilatations was significantly lower than the control group. Repeated measures ANOVA test indicated that in both experimental and control groups in four time periods, there was a statistically significant difference. Conclusion:Acupressure on sanyinjiao and hugo points decreases the labor pain. Therefore, this method can be used effectively in the labor process.

Evaluation of tendered prices of natural mineral water, juice and non-alcoholic beer (public procurement research

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Nataša Pomazalová

2011-01-01

Full Text Available The purpose of this paper is to evaluate tender prices of chosen beverages according to public procurement based on secondary data analysis. The empirical results of analysis (t-test and F-test show that average annual prices of these beverages are different and collected data are not included in the same sample. Tender prices are different in each year of observed years, although are based on public tender. Important evidence is that for the public tenders in the abroad is obligatory use of the Czech public procurement law. According to this act the base evaluation criterion is the lowest offered price. Data were collected during the years 2005–2009. This study deals with empirical approach, variability of prices of chosen beverages based on public tenders between the Czech Republic (Ministry of Defence and local suppliers in Kosovo. Results show low variability of prices, which are based on public tender and legal approach, regulated public procurement. The research conclusion is the fact, that tender prices for piece of non-alcoholic beverage are less than 10 % from annual mean (pcs./CZK of tendered prices.

Headache children with temporomandibular disorders have several types of pain and other symptoms.

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Liljeström, M-R; Le Bell, Y; Anttila, P; Aromaa, M; Jämsä, T; Metsähonkala, L; Helenius, H; Viander, S; Jäppilä, E; Alanen, P; Sillanpää, M

2005-11-01

The aim was to investigate the association between temporomandibular disorders (TMD) and overall muscle tenderness, depressive symptoms, sleep difficulties, headache frequency and related symptoms in children with primary headache in comparison with controls. Based on an unselected population sample of 1135 Finnish schoolchildren classified according to the type of headache at age 12, altogether 297 children aged 13-14 from different headache groups and healthy controls were randomly selected for an interview and clinical examinations. Children with migraine had more TMD signs than children with nonmigrainous headaches or healthy controls. High TMD total scores were associated with palpation tenderness in other parts of the body and with frequent headache attacks. We conclude that children with overall headache, migraine in particular, and high total TMD scores showed an increased overall tenderness to muscle palpation and multiply manifested hypersensitivity pain.

Effects of music on pain in patients with fibromyalgia.

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Alparslan, Güler Balcı; Babadağ, Burcu; Özkaraman, Ayşe; Yıldız, Pınar; Musmul, Ahmet; Korkmaz, Cengiz

2016-05-01

Fibromyalgia syndrome (FMS) is a chronic syndrome characterized by diffuse musculoskeletal system pain and painful tender points in certain areas of the body. The aim of the investigation was to determine the effects of music on pain in fibromyalgia patients. This randomized clinical trial was carried out with 37 fibromyalgia outpatients as an experimental group (n = 21) and control group (n = 16) at a University Hospital Internal Medicine and Rheumatology Clinic between 1 June and 1 December 2014. The research instruments used were descriptive characteristics questionnaire, Visual Analogue Scale (VAS), music CD which includes water and wave sounds recommended by the Turkish Psychological Association for psychological relaxation, and pain evaluation form. According to the findings, the average age of patients was 43.59 years ± 10.30, 94.6 % were women and 81.1 % were married. The fibromyalgia patients had the disease ranged from 1 month to 20 years, the average of disease duration was 23.6 ± 45.5 months, and the average of pain intensity was 6.89 ± 1.64 on the VAS. Average pain was reported in the experimental group in VAS on day 1 (5.45 ± 2.73), day 7 (4.57 ± 2.71), and day 14 (4.14 ± 2.45), and significant reduction in pain in the listening music group was seen (p = 0.026). A repeated measure analysis of variance controlling for differences between days demonstrated a significant decrease in pain between day 1 and day 14 (p = 0.022). There was no significant decrease in pain among control group participants. The effect of music has been found to control pain in fibromyalgia patients. Music therapy should be suggested in pain management for fibromyalgia patients as an non-pharmacologic nursing intervention.

Clinicians' perspective of the current diagnostic criteria for myofascial pain syndrome.

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Grosman-Rimon, Liza; Clarke, Hance; Chan, Aaron K; Mills, Patricia Branco; Rathbone, Alasdair Timothy Llewelyn; Kumbhare, Dinesh

2017-01-01

Myofascial pain syndrome (MPS) is one of the most common chronic musculoskeletal pain disorders. However, MPS is often under-diagnosed. The purpose of this study was to characterize practicing clinicians' perspectives of the current diagnostic criteria for MPS. A cross-sectional study design was used with a self-administered questionnaire. The questionnaire evaluated clinicians' perspective of the current diagnostic criteria for MPS. The sample population (n= 119) consisted of 40% family physicians, 31% physical medicine (PM) and rehabilitation specialists, 11% rheumatologists, 10% emergency room (ER) physicians, and 8% anesthesiologists specializing in chronic pain. Our findings demonstrated that participating clinicians agree that ``point tenderness'' and ``pain reproduction'' are criteria for MPS. In contrast, the clinicians do not consider ``autonomic symptoms'' as an important criterion for MPS. The anesthesiologists view ``restricted range of motion'' as a criterion for MPS more than the other groups, and they tend to consider ``referred pain'' and ``pain reproduction'' as criteria. Physical medicine and rehabilitation specialists and anesthesiologists tend to view ``local twitch response'' more as a criterion for MPS compared with the other groups. Most groups of clinicians consider ``weakness without atrophy'' as an important MPS criterion except for family physicians. It is important to note that ``poor sleep'', ``daytime fatigue'' and ``cognitive symptoms'', which are not considered as MPS symptoms, are often mistaken for MPS among practicing clinicians. Our findings suggest that the diagnostic criteria are not well known, highlighting the need for an expert consensus to determine the importance of each criterion for MPS diagnosis.

Does a 3-month multidisciplinary intervention improve pain, body composition and physical fitness in women with fibromyalgia?

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Carbonell-Baeza, Ana; Aparicio, Virginia A; Ortega, Francisco B; Cuevas, Ana M; Alvarez, Inmaculada C; Ruiz, Jonatan R; Delgado-Fernandez, Manuel

2011-12-01

To determine the effects of a 3-month multidisciplinary intervention on pain (primary outcome), body composition and physical fitness (secondary outcomes) in women with fibromyalgia (FM). 75 women with FM were allocated to a low-moderate intensity 3-month (three times/week) multidisciplinary (pool, land-based and psychological sessions) programme (n=33) or to a usual care group (n=32). The outcome variables were pain threshold, body composition (body mass index and estimated body fat percentage) and physical fitness (30 s chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8 feet up and go and 6 min walk test). The authors observed a significant interaction effect (group*time) for the left (L) and right (R) side of the anterior cervical (pbody composition variables. A 3-month multidisciplinary intervention three times/week had a positive effect on pain threshold in several tender points in women with FM. Though no overall improvements were observed in physical fitness or body composition, the intervention had positive effects on lower-body flexibility.

The Anti-Inflammatory Actions of Auricular Point Acupressure for Chronic Low Back Pain

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Wei-Chun Lin

2015-01-01

Full Text Available Background. Auricular point acupressure (APA is a promising treatment for pain management. Few studies have investigated the physiological mechanisms of APA analgesics. Method. In this pilot randomized clinical trial (RCT, a 4-week APA treatment was used to manage chronic low back pain (CLBP. Sixty-one participants were randomized into a real APA group (n=32 or a sham APA group (n=29. Blood samples, pain intensity, and physical function were collected at baseline and after 4 weeks of treatment. Results. Subjects in the real APA group reported a 56% reduction of pain intensity and a 26% improvement in physical function. Serum blood samples showed (1 a decrease in IL-1β, IL-2, IL-6, and calcitonin gene-related peptide [CGRP] and (2 an increase in IL-4. In contrast, subjects in the sham APA group (1 reported a 9% reduction in pain and a 2% improvement in physical function and (2 exhibited minimal changes of inflammatory cytokines and neuropeptides. Statistically significant differences in IL-4 and CGRP expression between the real and sham APA groups were verified. Conclusion. These findings suggest that APA treatment affects pain intensity through modulation of the immune system, as reflected by APA-induced changes in serum inflammatory cytokine and neuropeptide levels.

73-year-old woman with abdominal pain in the right lower quadrant

International Nuclear Information System (INIS)

Bond, J.R.

1987-01-01

A 73-year-old woman presented with a six-day history of abdominal pain that had started in the epigastrium, but recently had become more intense in the right lower quadrant. Peptic ulcer had been diagnosed three years prior to presentation and had been managed medically. On physical examination, epigastric tenderness as well as guarding and rebound tenderness in the right lower quandrant were present. Mild leukocytosis was reported. Computed tomography demonstrated a 5-cm retrocecal mass with low attenuation (fluid content) surrounded by an irregularly thickened uncalcified wall. Multiple areas of tissue debris were seen extending into the mass, but no true separation was present

Treatment strategy for sacroiliac joint-related pain at or around the posterior superior iliac spine.

Science.gov (United States)

Murakami, Eiichi; Kurosawa, Daisuke; Aizawa, Toshimi

2018-02-01

Pain at or around the posterior superior iliac spine (PSIS) is characteristic of sacroiliac joint (SIJ) -related pain. This pain can be treated by either a peri- or intra-articular injection into the joint, with the former being much easier to perform. We investigated whether peri- or intra-articular injections were more frequently effective in patients with SIJ-related pain, and aimed to create an efficient treatment strategy for SIJ-related pain at or around the PSIS. Prospective case-control study. We evaluated 85 patients with pain at or around the posterior superior iliac spine as indicated by the one finger test. First, we performed a peri-articular sacroiliac joint injection. If it was ineffective, an intra-articular injection was later given. Groin pain, sitting pain, sacroiliac joint shear test results, and posterior superior iliac spine and sacro-tuberous ligament tenderness were also compared between patients for whom a peri- or intra-articular injection was effective. Seventy-two (85%) of 85 patients had an effective injection. Out of these 72 patients, 58 (81%) had a positive peri-articular injection and 14 (19%) had a positive intra-articular injection. Four items, excluding tenderness of the sacro-tuberous ligament had no significant difference between these two injection types. To treat sacroiliac joint-related pain at or around the posterior superior iliac spine, a peri-articular injection should be performed first, and only if it is not effective should an intra-articular injection be administered. Using this strategy, we expect that most patients with sacroiliac joint-related pain will be efficiently diagnosed and treated. Copyright © 2017 Elsevier B.V. All rights reserved.

Efficacy of the "body movement and perception" method in the treatment of fibromyalgia syndrome: an open pilot study.

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Maddali Bongi, S; Di Felice, C; Del Rosso, A; Landi, G; Maresca, M; Giambalvo Dal Ben, G; Matucci-Cerinic, M

2011-01-01

Group exercises may be useful in fibromyalgia syndrome (FMS). The 'Body movement and perception' (BMP) method is based on low impact exercises, awareness of body perception and relaxation, aimed at treating small groups of patients following the Resseguier method (RM) and integrating RM with exercises derived from soft gymnastics. We assessed the effects of BMP method on FMS. 40 women with FMS (age and disease duration: 51.7±7.2 and 4.9±3.8 years) participated in an open pilot study. BMP sessions were performer twice a week (50 minutes each) for 8 weeks. Patients were assessed at enrolment (T0) and at the end of the study (T1) by a self-administered questionnaire (temporal characteristics of pain, pain interference in working and recreational activities and in night-time rest, awareness of pain, fatigue, irritability, well-being, quality of movement, ability to focus on perception and to perceive whole body, postural selfcontrol, ability to relax) and a clinical evaluation (tender points, assumption of analgesics/NSAIDs, distribution of pain, pain in sitting and standing position, pain during postural passages and gait, postural body alignment, muscular contractures). At T1, FMS patients significantly improved with respect to T0 in pain, fatigue, irritability, well-being, quality of movement, postural self-control, ability to relax mind and body, movement perception, tender point scores, assumption of analgesic/NSAIDs, body alignment and muscle contractures (p<0.05 for all the comparisons T1 versus T0). In FMS patients, rehabilitation with BMP improves pain and well being, reduces the number of tender points and muscle contractures, thus it is useful in FMS management.

Price Determinants of the Tendering Process for Pharmaceuticals in the Cyprus Market.

Science.gov (United States)

Petrou, Panagiotis; Talias, Michael A

2015-09-01

Tendering has been a promising approach for procuring pharmaceuticals. Significant price reductions have been well documented by several authors. To our knowledge, there are limited data detailing the impact of variables in the tendering process. In this article, our objective was to evaluate the impact of potentially exploratory variables, which included innovation status, total value and volume of sales of each product, health care setting administration (hospital/outpatient), patent status (branded/generic), tendering type, and wholesale price, on price reduction in the tendering process. Financial data of public sector sales during 2011 were analyzed. On the basis of these data, we selected 178 medicines with corresponding sales of €49 million, out of a total market value of €104 million. Medicines were selected according to volume, value, and therapeutic value across all therapeutic areas. We performed a beta regression for the assessment of impact of variables and applied the same methodology to different subgroups. The generic status of medicines is statistically significantly associated with a higher price reduction. Tendering type by alternative, high wholesale prices, and high volume are robust estimators for price reduction. Innovation status does not have any effect on price reduction. Outpatient medicines reach lower prices as compared with hospital medicines. A rather unexpected finding is the negative correlation of high sales value with price reduction. These findings will lead to better understanding of the tendering framework, enabling us to further evolve its operational capacity, aiming to generate more savings. Moreover, our study indicates areas in which a more optimized approach is needed. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Predictors of upper trapezius pain with myofascial trigger points in food service workers

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Hwang, Ui-Jae; Kwon, Oh-Yun; Yi, Chung-Hwi; Jeon, Hye-Seon; Weon, Jong-Hyuck; Ha, Sung-Min

2017-01-01

Abstract Shoulder pain occurs commonly in food service workers (FSWs) who repetitively perform motions of the upper limbs. Myofascial trigger points (MTrPs) on the upper trapezius (UT) are among the most common musculoskeletal shoulder pain syndromes. This study determined the psychological, posture, mobility, and strength factors associated with pain severity in FSWs with UT pain due to MTrPs. In this cross-sectional study, we measured 17 variables in 163 FSWs with UT pain due to MTrPs: a visual analog scale (VAS) pain score, age, sex, Borg rating of perceived exertion (BRPE) scale, beck depression inventory, forward head posture angle, rounded shoulder angle (RSA), shoulder slope angle, scapular downward rotation ratio, cervical lateral-bending side difference angle, cervical rotation side difference angle, glenohumeral internal rotation angle, shoulder horizontal adduction angle, serratus anterior (SA) strength, lower trapezius (LT) strength, bicep strength, and glenohumeral external rotator strength, in 163 FSWs with UT pain due to MTrPs. The model for factors influencing UT pain with MTrPs included SA strength, age, BRPE, LT strength, and RSA as predictor variables that accounted for 68.7% of the variance in VAS (P < .001) in multiple regression models with a stepwise selection procedure. The following were independent variables influencing the VAS in the order of standardized coefficients: SA strength (β = −0.380), age (β = 0.287), BRPE (β = 0.239), LT strength (β = −0.195), and RSA (β = 0.125). SA strength, age, BRPE, LT strength, and RSA variables should be considered when evaluating and intervening in UT pain with MTrPs in FSWs. PMID:28658117

Construction Tender Subcontract Selection using Case-based Reasoning

Directory of Open Access Journals (Sweden)

Due Luu

2012-11-01

Full Text Available Obtaining competitive quotations from suitably qualified subcontractors at tender tim n significantly increase the chance of w1nmng a construction project. Amidst an increasingly growing trend to subcontracting in Australia, selecting appropriate subcontractors for a construction project can be a daunting task requiring the analysis of complex and dynamic criteria such as past performance, suitable experience, track record of competitive pricing, financial stability and so on. Subcontractor selection is plagued with uncertainty and vagueness and these conditions are difficul_t o represent in generalised sets of rules. DeciSIOns pertaining to the selection of subcontr:act?s tender time are usually based on the mtu1t1onand past experience of construction estimators. Case-based reasoning (CBR may be an appropriate method of addressing the chal_lenges of selecting subcontractors because CBR 1s able to harness the experiential knowledge of practitioners. This paper reviews the practicality and suitability of a CBR approach for subcontractor tender selection through the development of a prototype CBR procurement advisory system. In this system, subcontractor selection cases are represented by a set of attributes elicited from experienced construction estimators. The results indicate that CBR can enhance the appropriateness of the selection of subcontractors for construction projects.

Effect of the callipyge phenotype and cooking method on tenderness of several major lamb muscles.

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Shackelford, S D; Wheeler, T L; Koohmaraie, M

1997-08-01

We conducted three experiments to determine the effects of the callipyge phenotype on the tenderness of several major lamb muscles and to determine the effect of method of cookery on the tenderness of callipyge lamb at 7 d postmortem. In Exp. 1, chops from normal (n = 23) and callipyge (n = 16) carcasses were open-hearth-broiled. Warner-Bratzler shear force values of longissimus, gluteus medius, semimembranosus, biceps femoris, semitendinosus, adductor, and quadriceps femoris were 123, 44, 28, 26, 19, 16, and 13% greater, respectively, for callipyge (P lamb carcasses (n = 60). Callipyge chops were less tender than normal chops (P cooking method, callipyge samples were less juicy than normal samples (P < .05). These data demonstrate that the callipyge phenotype will likely reduce consumer satisfaction due to reduced tenderness and juiciness; however, reduced tenderness in callipyge leg muscles could be prevented by ovenroasting.

Pacific Fleet Submarine Tender Optimization

Science.gov (United States)

2013-06-01

worker(s) waits at DG Tender travel (FCB = USS Frank Cable, ESL = USS Emory S. Land) Day 1 FCB waits at GUAM Day 1 ESL ...Day 5 FCB waits at GUAM Day 6 FCB waits at GUAM Day 6 ESL waits at SINGAPORE Day 7 FCB waits...at GUAM Day 7 ESL waits at SINGAPORE Day 8 FCB waits at GUAM Day 8 ESL waits at SINGAPORE Day 9

Atypically localized glomus tumors

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Meric Ugurlar

2016-12-01

Conclusion: When a painful mass is found in the body, glomus tumors should be kept in mind. The consideration of symptoms, including pain, temperature sensitivity, point tenderness, and discoloration, common characteristics of glomus tumors, may aid diagnosis. [Hand Microsurg 2016; 5(3.000: 112-117

Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature.

Science.gov (United States)

Lucas, Nicholas; Macaskill, Petra; Irwig, Les; Moran, Robert; Bogduk, Nikolai

2009-01-01

Trigger points are promoted as an important cause of musculoskeletal pain. There is no accepted reference standard for the diagnosis of trigger points, and data on the reliability of physical examination for trigger points are conflicting. To systematically review the literature on the reliability of physical examination for the diagnosis of trigger points. MEDLINE, EMBASE, and other sources were searched for articles reporting the reliability of physical examination for trigger points. Included studies were evaluated for their quality and applicability, and reliability estimates were extracted and reported. Nine studies were eligible for inclusion. None satisfied all quality and applicability criteria. No study specifically reported reliability for the identification of the location of active trigger points in the muscles of symptomatic participants. Reliability estimates varied widely for each diagnostic sign, for each muscle, and across each study. Reliability estimates were generally higher for subjective signs such as tenderness (kappa range, 0.22-1.0) and pain reproduction (kappa range, 0.57-1.00), and lower for objective signs such as the taut band (kappa range, -0.08-0.75) and local twitch response (kappa range, -0.05-0.57). No study to date has reported the reliability of trigger point diagnosis according to the currently proposed criteria. On the basis of the limited number of studies available, and significant problems with their design, reporting, statistical integrity, and clinical applicability, physical examination cannot currently be recommended as a reliable test for the diagnosis of trigger points. The reliability of trigger point diagnosis needs to be further investigated with studies of high quality that use current diagnostic criteria in clinically relevant patients.

A 27-years-old Man with Abdominal Pain; Lead Toxicity

Directory of Open Access Journals (Sweden)

Maryam Kia

2017-12-01

Full Text Available Case presentation: A 27-year-old man came to our emergency department with chief complaints of abdominal pain, nausea and vomiting, colicky pain in all area of abdomen without any radiation and generalized myalgia. In his background, he had no previous medical problem. In his social history he had worked in an automobile battery-reclaiming factory for 5 years. During his physical examination, his appearance was pale with perioral priority, ill and agitated but not toxic with a blood pressure of 127/85 mmHg and a pulse of 80 beats/min, respiratory rate of 14 breaths/min and oral temperature of 37.3 °C, mild generalized abdominal tenderness without rebound. No obvious signs of sensory and motor neuropathy were found. In the head and neck examination, we found lead-lined teeth. Learning points: The most common cause of chronic metal poisoning is lead. Exposure occurs through inhalation or ingestion. Both inorganic and organic forms of lead that exist naturally produce clinical toxicity. Gastrointestinal manifestations occur more frequently with acute rather than with chronic poisoning, and concurrent hemolysis may cause the colicky abdominal pains. Patients may have complained of a metallic taste and, with long-term exposure, have bluish-gray gingival lead lines. In addition, constitutional symptoms, including arthralgia, generalized weakness, and weight loss raises the possibility of lead toxicity.

An analysis of project selection and assignment criteria of danish tenders in europe

DEFF Research Database (Denmark)

Larsen, Jesper Kranker; Ussing, Lene Faber; Brunø, Thomas Ditlev

2013-01-01

, and 3/ any significant difference between the use of selection and assignment criteria in Danish public construction projects. The study uses a quantitative research approach where 157 Danish public tender cases were selected from the European Tenders Electronic Daily database between the period...

Wound infiltration with ropivacaine and bupivacaine for pain after inguinal herniotomy

DEFF Research Database (Denmark)

Erichsen, C J; Vibits, H; Dahl, J B

1995-01-01

In a double-blind, randomized study, 32 patients scheduled for elective inguinal herniotomy under general anaesthesia received subcutaneous infiltration with 40 ml ropivacaine 2.5 mg/ml or bupivacaine. Postoperative pain intensity was assessed repeatedly for 24 hours at rest, during cough...... and movement on a visual analogue scale (VAS) and by means of pressure algometry. No differences between pain intensities or wound tenderness were found between the groups. The demand for analgesics was similar in the two groups. We conclude that incisional ropivacaine is as effective as bupivacaine...

A camera specification for tendering purposes

International Nuclear Information System (INIS)

Lunt, M.J.; Davies, M.D.; Kenyon, N.G.

1985-01-01

A standardized document is described which is suitable for sending to companies which are being invited to tender for the supply of a gamma camera. The document refers to various features of the camera, the performance specification of the camera, maintenance details, price quotations for various options and delivery, installation and warranty details. (U.K.)

17 CFR 240.14e-2 - Position of subject company with respect to a tender offer.

Science.gov (United States)

2010-04-01

... disclosing that the subject company: (1) Recommends acceptance or rejection of the bidder's tender offer; (2... accordance with such laws, regulations and policies. (d) Exemption for cross-border tender offers. The... with respect to a tender offer. 240.14e-2 Section 240.14e-2 Commodity and Securities Exchanges...

Evaluating acute pain intensity relief: challenges when using an 11-point numerical rating scale.

Science.gov (United States)

Chauny, Jean-Marc; Paquet, Jean; Lavigne, Gilles; Marquis, Martin; Daoust, Raoul

2016-02-01

Percentage of pain intensity difference (PercentPID) is a recognized way of evaluating pain relief with an 11-point numerical rating scale (NRS) but is not without flaws. A new metric, the slope of relative pain intensity difference (SlopePID), which consists in dividing PercentPID by the time between 2 pain measurements, is proposed. This study aims to validate SlopePID with 3 measures of subjective pain relief: a 5-category relief scale (not, a little, moderate, very, complete), a 2-category relief question ("I'm relieved," "I'm not relieved"), and a single-item question, "Wanting other medication to treat pain?" (Yes/No). This prospective cohort study included 361 patients in the emergency department who had an initial acute pain NRS > 3 and a pain intensity assessment within 90 minutes after analgesic administration. Mean age was 50.2 years (SD = 19.3) and 59% were women. Area under the curves of receiver operating characteristic curves analyses revealed similar discriminative power for PercentPID (0.83; 95% confidence interval [CI], 0.79-0.88) and SlopePID (0.82; 95% CI, 0.77-0.86). Considering the "very" category from the 5-category relief scale as a substantial relief, the average cutoff for substantial relief was a decrease of 64% (95% CI, 59-69) for PercentPID and of 49% per hour (95% CI, 44-54) for SlopePID. However, when a cutoff criterion of 50% was used as a measure of pain relief for an individual patient, PercentPID underestimated pain-relieved patients by 12.1% (P pain intensity at baseline was an odd number compared with an even number (32.9% vs 45.0%, respectively). SlopePID should be used instead of PercentPID as a metric to evaluate acute pain relief on a 0 to 10 NRS.

Drug tendering: drug supply and shortage implications for the uptake of biosimilars

Directory of Open Access Journals (Sweden)

Dranitsaris G

2017-09-01

Full Text Available George Dranitsaris,1 Ira Jacobs,2 Carol Kirchhoff,3 Robert Popovian,4 Lesley G Shane5 1Augmentium Pharma Consulting Inc., Toronto, ON, Canada; 2Global Medical Affairs, Pfizer Inc, New York, NY, 3Global Technology Services, Biotechnology and Aseptic Sciences Group, Pfizer Inc, Chesterfield, MO, 4US Government Relations, Pfizer Inc, Washington, DC, 5Outcomes and Evidence, Global Health and Value, Pfizer Inc, New York, NY, USA Abstract: Due to the continued increase in global spending on health care, payers have introduced a number of programs, policies, and agreements on pharmaceutical pricing in order to control costs. While incentives to increase generic drug use have achieved significant savings, other cost-containment measures are required. Tendering is a formal procedure to purchase medications using competitive bidding for a particular contract. Although useful for cost containment, tendering can lead to decreased competition in a given market. Consequently, drug shortages can occur, resulting in changes to treatment plans to products that may have lower efficacy and/or an increased risk of adverse effects. Therefore, care must be taken to ensure that tendering does not negatively impact patient care or the health care system. A large and expanding portion of total pharmaceutical expenditure is for biologic therapies. These agents have revolutionized the treatment of many diseases, including cancer and inflammatory conditions; however, patient access to biologic drugs can be limited due to availability, insurance coverage, and cost. As branded biologic therapies reach the end of patent- and data-protection periods, biosimilars are being approved as lower-cost alternatives. Biosimilars are products that are highly similar to the originator product with no clinically meaningful differences in terms of safety, purity, or potency. As more biosimilars receive regulatory approval and adoption increases, these therapies are expected to have an

The Effect of Dry Needling Compared With Ischemic Pressure on Pain Intensity on Active Trigger Point in Upper Trapezius Muscle

Directory of Open Access Journals (Sweden)

Maryam Ziaeifar

2013-07-01

Full Text Available Objective: Myofascial trigger point is one of the most common causes of musculoskeletal pain and disorders. Myofascial trigger point in upper trapezius has been reported as a frequent symptom in patients with neck and thoracic pain. The purpose of this study was to investigate the effect of dry needling compared with ischemic pressure on active trigger point in upper trapezius muscle. Materials & Methods: 32 women with active myofascial trigger point in upper trapezius muscle participated in this randomized clinical trial (RCT study. The subjects were randomly assigned into two groups: dry needling (N=15 and ischemic pressure (N=17. The visual analogue scale (VAS was used to assess the pain intensity before and after treatment in both groups. Paired t-test was used to determine any significant difference in pain intensity after treatment sessions compared with pre-treatment score in control and experimental group. Analysis of Covariance (ANCOVA was calculated to determine the significance of differences between the control and experimental groups in post-test scores, with pre-treatment scores used as covariates in the analysis. Results: Statistical analysis (paired t-test revealed significant decrease in pain intensity after treatment sessions in control and experimental group (P=0.00 compared with pre-treatment score. In the ANCOVA, controlling for pre-test scores, no significant difference was found between the two groups (P=0.8. Conclusion: It seems that that both dry needling and ischemic pressure are effective in improvement in the pain intensity in subjects with myofascial trigger points. However, dry needling can be used by clinicians and therapist in physiotherapy clinics.

Injection of marinade with actinidin increases tenderness of porcine M. biceps femoris and affects myofibrils and connective tissue

DEFF Research Database (Denmark)

Christensen, M.; Torngren, M. A.; Gunvig, A.

2009-01-01

BACKGROUND: Marination of beef muscles with brine solutions containing proteolytic enzymes from fruit extracts has been shown to tenderize meat. However, the effect of marination with actinidin on tenderness of pork muscles has not been investigated. Tenderness and eating quality of porcine M. bi...... indicate that actinidin tenderizes pork M. biceps femoris by affecting both the myofibrils and connective tissue....

Tendering and relationships in strategic logistics service provider selection for global supply chain organisations

DEFF Research Database (Denmark)

Tambo, Torben

of private enterprise purchase additionally relate to the acceptance of some level of dialogue before, during and after the tender due date. Tendering is viewed as an extreme case of relationship management, where newcomers and existing suppliers are put on an equal footing, decades of incorporated...... have an impact. During the tendering process, innovation, knowledge management and operational procedures in interaction with the business relationships are often overlooked and need active management and proper contingency planning. This paper contributes to a deeper understanding of both sides...

Evoked Pressure Pain Sensitivity Is Associated with Differential Analgesic Response to Verum and Sham Acupuncture in Fibromyalgia.

Science.gov (United States)

Zucker, Noah A; Tsodikov, Alex; Mist, Scott D; Cina, Stephen; Napadow, Vitaly; Harris, Richard E

2017-08-01

Fibromyalgia is a chronic pain condition with few effective treatments. Many fibromyalgia patients seek acupuncture for analgesia; however, its efficacy is limited and not fully understood. This may be due to heterogeneous pathologies among participants in acupuncture clinical trials. We hypothesized that pressure pain tenderness would differentially classify treatment response to verum and sham acupuncture in fibromyalgia patients. Baseline pressure pain sensitivity at the thumbnail at baseline was used in linear mixed models as a modifier of differential treatment response to sham versus verum acupuncture. Similarly, needle-induced sensation was also analyzed to determine its differential effect of treatment on clinical pain. A cohort of 114 fibromyalgia patients received baseline pressure pain testing and were randomized to either verum (N = 59) or sham (N = 55) acupuncture. Participants received treatments from once a week to three times a week, increasing in three-week blocks for a total of 18 treatments. Clinical pain was measured on a 101-point visual analog scale, and needle sensation was measured by questionnaire throughout the trial. Participants who had higher pain pressure thresholds had greater reduction in clinical pain following verum acupuncture while participants who had lower pain pressure thresholds showed better analgesic response to sham acupuncture. Moreover, patients with lower pressure pain thresholds had exacerbated clinical pain following verum acupuncture. Similar relationships were observed for sensitivity to acupuncture needling. These findings suggest that acupuncture efficacy in fibromyalgia may be underestimated and a more personalized treatment for fibromyalgia may also be possible. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Painful bladder syndrome/interstitial cystitis: Aetiology, evaluation and management

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William Rourke

2014-06-01

Full Text Available Interstitial cystitis or bladder pain syndrome (BPS is often a chronic debilitating condition characterised by predominantly storage symptoms and associated frequently with pelvic pain that varies with bladder filling. The aetiology is uncertain as the condition occurs in the absence of a urinary tract infection or other obvious pathology. Resulting discomfort may vary and ranges from abdominal tenderness to intense bladder spasms. Diagnosis and management of this syndrome may be difficult and is often made by its typical cystoscopic features. This review discusses the diagnosis and management of interstitial cystitis according to the current available best evidence and advises a multimodal approach in its management.

Masticatory muscle and temporomandibular joint pain in Croatian war veterans with posttraumatic stress disorder.

Science.gov (United States)

Uhac, Ivone; Tariba, Petra; Kovac, Zoran; Simonić-Kocijan, Suncana; Lajnert, Vlatka; Mesić, Vesna Fugosić; Kuis, Davor; Braut, Vedrana

2011-12-01

The aim of this study was to investigate the prevalence and intensity of masticatory muscle and temporomandibular joint (TMJ) pain in Croatian war veterans with posttraumatic stress disorder (PTSD). The examined group consisted of 100 Croatian war veterans, in whom PTSD had previously been diagnosed. Patients were compared with 92 subjects who had not taken part in the war and in whom PTSD was excluded by psychiatric examination. The clinical examination consisted of palpation of the masticatory muscles, the prominent neck musculature, and TMJ. The examination technique used and the definition of items were previously tested for reliability and validity. 93% of the subjects with PTSD had masticatory muscle tenderness compared to 45.65% of the subjects in the control group (chi2 = 51.46, p < 0.0001). The most frequent painful location in the subjects with PTSD was the left lateral pterygoid site in 88%, and in subjects of the control group the right lateral pterygoid site in 28.26% of cases. The most painful location in the PTSD group was the left lateral pterygoid site in 72%, and in the control group the left posterior digastric in 4.35% of cases. 58% of the subjects with PTSD had TMJ tenderness compared to 3.26% of subjects in the control group (chi2 = 66.23, p < 0.0001). The most frequent painful location of TMJ in both groups was the left posterior capsule; in the PTSD group 38% and in subjects in the control group 2.17% of cases. The most painful location was the left posterior capsule in 28% of subjects with PTSD, while not one subject in the control group reported severe painful sensitivity. The very high frequency and intensity of pain in subjects with PTSD confirms the effect of stress on muscle and joint sensitivity, i.e. perception of pain.

Observation-based assessment of functional ability in patients with chronic widespread pain

DEFF Research Database (Denmark)

Amris, Kirstine; Wæhrens, Eva Ejlersen; Jespersen, Anders

2011-01-01

Knowledge about functional ability, including activities of daily living (ADL), in patients with chronic widespread pain (CWP) and fibromyalgia (FMS) is largely based on self-report. The purpose of this study was to assess functional ability by using standardised, observation-based assessment...... of ADL performance and to examine the relationship between self-reported and observation-based measures of disability. A total of 257 women with CWP, 199 (77%) fulfilling the American College of Rheumatology tender point criteria for FMS, were evaluated with the Assessment of Motor and Process Skills...... (AMPS), an observation-based assessment providing linear measures of ADL motor and ADL process skill ability (unit: logits). A cutoff for effortless and independent ADL task performance is set at 2.0 for the motor scale and 1.0 for the process scale. A total of 248 (96.5%) had ability measures below...

Sacral insufficiency fractures: an easily overlooked cause of back pain in the ED.

LENUS (Irish Health Repository)

Galbraith, John G

2011-03-01

Sacral insufficiency fractures are an important and treatable cause of severe back pain. Despite publication of several case reports since its original description in 1982, awareness of these injuries remains inadequate in emergency medicine. Most patients are elderly women presenting with intractable lower back pain. Postmenopausal osteoporosis is the most significant risk factor. Marked sacral tenderness is common. Neurologic impairment is rarely detectable. Routine radiography of the spine and pelvis is usually inconclusive. Computed tomography remains the diagnostic modality of choice. Treatment is usually conservative.

The life cycle cost of a building from the point of view of environmental criteria of selecting the most beneficial offer in the area of competitive tendering

Directory of Open Access Journals (Sweden)

Grzyl Beata

2017-01-01

Full Text Available The article analyses environmental and ecological criteria of selecting the most beneficial offer in the aspect of LCC. Construction works contracts and the potential method of defining the above criteria, among others, is pondered on (for example by the recommendation of a material, which is supposed to be used, a ban on substances that are harmful for human health as well for the environment. In the relation to the above, it is necessary to define technical parameters that have an impact on the environment, for example the level of pollution and noise emission, electricity and water consumption, or stating the minimal involvement of a processed ingredient. In addition the article presents also an account of the life cycle cost of a building from the point of view of environmental criteria constituting an element of selecting the most beneficial offer in the area of competitive tendering.

The Nordic back pain subpopulation program: Can low back pain patterns be predicted from the first consultation with a chiropractor? A longitudinal pilot study

Directory of Open Access Journals (Sweden)

Leboeuf-Yde Charlotte

2010-04-01

Full Text Available Abstract Background It is widely believed that non-specific low back pain (LBP consists of a number of subgroups which should be identified in order to improve treatment effects. In order to identify subgroups, patient characteristics that relate to different outcomes are searched for. However, LBP is often fluctuating or recurring rather than clearly limited in time. Therefore it would be relevant to consider outcome after completed treatment from a longitudinal perspective (describing "course patterns" instead of defining it from an arbitrarily selected end-point. Aims The objectives of this pilot study were to investigate the interobserver reliability of a diagnostic classification system and to evaluate whether diagnostic classes or other baseline characteristics are associated with the LBP course pattern over a period of 18 weeks. Methods Patients visiting one of 7 chiropractors because of LBP were classified according to a diagnostic classification system, which includes end-range loading, SI-joint pain provocation tests, neurological examination and tests for muscle tenderness and abnormal nerve tension. In addition, age, gender, duration of pain and presence of leg pain were registered in the patient's file. By weekly SMS-messages on their mobile phones, patients were asked how many days they had LBP the preceding week, and these answers were transformed into pain course patterns and the total number of LBP days. Results A total of 110 patients were included and 76 (69% completed follow-up. Thirty-five patients were examined by two chiropractors. The agreement regarding diagnostic classes was 83% (95% CI: 70 - 96. The diagnostic classes were associated with the pain course patterns and number of LBP days. Patients with disc pain had the highest number of LBP days and patients with muscular pain reported the fewest (35 vs. 12 days, p Conclusions The study indicated that there is a clinically meaningful relationship between diagnostic

Contractor’s mistakes during tendering

Science.gov (United States)

Kamil, A. I. M.; Othman, N.; Adnan, H.; Zaki, ZA M.

2018-02-01

The occurrence of overrun in cost and time in a project that is usually caused by contractors, will generally make peopleput the blameonthem. This happensas a result of the lack of knowledge possessed by the contractors in determining the solution to be undertakendue totheir mistakes, especially when it comes to tendering process as what had happened in the cases that were reported in Supreme Court of Canada. This paper aims to identify the types of mistakes, factors that contribute to the mistakes and the responsiveness to the mistakes so that the contractor will be able to manage and control the mistakes, as well as the solution, along with preventing them from happening, and in making decision whether or notthey may withdraw from the bidding when the fault has been discovered or whether they should request for leniency from the client for a second chance in re-submitting the bid after the discovered inaccuracy. This research has been done based on cases that were related to the contractor’s mistakes during tendering which were collected from the Supreme Courts of Canada. The data have been analysed and interpreted by legal methodology, in which the result shows that the ability level of the contractors to respond to the mistake is unsatisfactory,and the fault is continuouslybeingmade. The findings are expected to educate and provide awareness to the contractors relating to the matters discussed.

A bench-top hyperspectral imaging system to classify beef from Nellore cattle based on tenderness

Science.gov (United States)

Nubiato, Keni Eduardo Zanoni; Mazon, Madeline Rezende; Antonelo, Daniel Silva; Calkins, Chris R.; Naganathan, Govindarajan Konda; Subbiah, Jeyamkondan; da Luz e Silva, Saulo

2018-03-01

The aim of this study was to evaluate the accuracy of classification of Nellore beef aged for 0, 7, 14, or 21 days and classification based on tenderness and aging period using a bench-top hyperspectral imaging system. A hyperspectral imaging system (λ = 928-2524 nm) was used to collect hyperspectral images of the Longissimus thoracis et lumborum (aging n = 376 and tenderness n = 345) of Nellore cattle. The image processing steps included selection of region of interest, extraction of spectra, and indentification and evalution of selected wavelengths for classification. Six linear discriminant models were developed to classify samples based on tenderness and aging period. The model using the first derivative of partial absorbance spectra (give wavelength range spectra) was able to classify steaks based on the tenderness with an overall accuracy of 89.8%. The model using the first derivative of full absorbance spectra was able to classify steaks based on aging period with an overall accuracy of 84.8%. The results demonstrate that the HIS may be a viable technology for classifying beef based on tenderness and aging period.

Spontaneous pain attacks: neuralgic pain

NARCIS (Netherlands)

de Bont, L.G.

2006-01-01

Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either

Tender Notices | About IASc | Indian Academy of Sciences

Indian Academy of Sciences (India)

... Tender for works related to expansion to main building of Indian Academy of ... for building Hostel Block at Indian Academy of Sciences Fellows Residency, ... the Three Science Academies of India on the teaching of the theory of evolution

Does Deep Cervical Flexor Muscle Training Affect Pain Pressure Thresholds of Myofascial Trigger Points in Patients with Chronic Neck Pain? A Prospective Randomized Controlled Trial

Directory of Open Access Journals (Sweden)

Pavlos Bobos

2016-01-01

Full Text Available Background. We need to understand more about how DNF performs in different contexts and whether it affects the pain threshold over myofascial trigger points (MTrPs. Purpose. The objectives were to investigate the effect of neck muscles training on disability and pain and on pain threshold over MTrPs in people with chronic neck pain. Methods. Patients with chronic neck pain were eligible for participation with a Neck Disability Index (NDI score of over 5/50 and having at least one MTrP on either levator scapulae, upper trapezoid, or splenius capitis muscle. Patients were randomly assigned into either DNF training, superficial neck muscle exercise, or advice group. Generalized linear model (GLM was used to detect differences in treatment groups over time. Results. Out of 67 participants, 60 (47 females, mean age: 39.45 ± 12.67 completed the study. Neck disability and neck pain were improved over time between and within groups (p<0.05. However, no differences were found within and between the therapeutic groups (p<0.05 in the tested muscles’ PPTs and in cervicothoracic angle over a 7-week period. Conclusion. All three groups improved over time. This infers that the pain pathways involved in the neck pain relief are not those involved in pain threshold.

41 CFR 102-117.35 - What are the advantages and disadvantages of using GSA's tender of service?

Science.gov (United States)

2010-07-01

... and disadvantages of using GSA's tender of service? 102-117.35 Section 102-117.35 Public Contracts and...-117.35 What are the advantages and disadvantages of using GSA's tender of service? (a) It is an... damage claims. (b) It is a disadvantage to use GSA's tender of service when: (1) You want an agreement...

[Sacroiliac joint dysfunction with groin pain after an operation for lumbar spinal disorder. A case report].

Science.gov (United States)

Shimoda, Yusuke; Morimoto, Daijiro; Isu, Toyohiko; Motegi, Hiroaki; Imai, Tetsuaki; Matsumoto, Ryouji; Isobe, Masanori; Kim, Kyongsong; Sugawara, Atsushi

2010-11-01

A 75-year-old male presented with groin pain after an operation to treat lumbar spondylolisthesis (L5). Groin tenderness was localized to the medial border of the anterior superior iliac spine (ASIS). Radiographical and physical examination raised the suspicion of sacroiliac joint (SIJ) dysfunction. Injection of a painkiller into the SIJ relieved symptoms, including groin tenderness. Symptoms improved gradually, and finally disappeared after five SIJ injections. Groin pain has been reported as a referred symptom of SIJ dysfunction in 9.3-23% of patients. Prior to the patient undergoing surgery to treat lumbar spondylolisthesis, SIJ dysfunction had not been noted on physical examination. Long periods spent in the abnormal posture due to lumbar spondylolisthesis induced SIJ stress. After the operation, an improvement in daily activity actually increased stress on the SIJ, resulting in SIJ dysfunction. Certain pathologies, including SIJ dysfunction, should be considered as residual symptoms after operations for lumbar spinal diseases.

Can Ashi points stimulation have specific effects on shoulder pain? A systematic review of randomized controlled trials.

Science.gov (United States)

Wang, Kang-Feng; Zhang, Li-Juan; Lu, Feng; Lu, Yong-Hui; Yang, Chuan-Hua

2016-06-01

To provide an evidence-based overview regarding the efficacy of Ashi points stimulation for the treatment of shoulder pain. A comprehensive search [PubMed, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Chongqing Weipu Database for Chinese Technical Periodicals (VIP) and Wanfang Database] was conducted to identify randomized or quasi-randomized controlled trials that evaluated the effectiveness of Ashi points stimulation for shoulder pain compared with conventional treatment. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. RevMan 5.0 was used for data synthesis. Nine trials were included. Seven studies assessed the effectiveness of Ashi points stimulation on response rate compared with conventional acupuncture. Their results suggested significant effect in favour of Ashi points stimulation [odds ratio (OR): 5.89, 95% confidence interval (CI): 2.97 to 11.67, Pfirm conclusion could not be reached until further studies of high quality are available.

Acupuncture-Point Stimulation for Postoperative Pain Control: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Directory of Open Access Journals (Sweden)

Xian-Liang Liu

2015-01-01

Full Text Available The purpose of this study was to evaluate the effectiveness of Acupuncture-point stimulation (APS in postoperative pain control compared with sham/placebo acupuncture or standard treatments (usual care or no treatment. Only randomized controlled trials (RCTs were included. Meta-analysis results indicated that APS interventions improved VAS scores significantly and also reduced total morphine consumption. No serious APS-related adverse effects (AEs were reported. There is Level I evidence for the effectiveness of body points plaster therapy and Level II evidence for body points electroacupuncture (EA, body points acupressure, body points APS for abdominal surgery patients, auricular points seed embedding, manual auricular acupuncture, and auricular EA. We obtained Level III evidence for body points APS in patients who underwent cardiac surgery and cesarean section and for auricular-point stimulation in patients who underwent abdominal surgery. There is insufficient evidence to conclude that APS is an effective postoperative pain therapy in surgical patients, although the evidence does support the conclusion that APS can reduce analgesic requirements without AEs. The best level of evidence was not adequate in most subgroups. Some limitations of this study may have affected the results, possibly leading to an overestimation of APS effects.

Children Presenting at the Emergency Department With Right Lower Quadrant Pain

Directory of Open Access Journals (Sweden)

Chien-Heng Lin

2009-01-01

Full Text Available Right lower quadrant (RLQ pain is a common complaint in children presenting at emergency departments. This study analyzed the etiologies of RLQ pain, and compared the clinical presentations, laboratory test results and imaging findings in patients with appendicitis with those in other groups of patients. We also investigated if active observation resulted in delayed diagnosis, to the detriment of patients. Medical records for the period January 2006 to July 2006 were reviewed for children (age < 18 years who presented to the emergency department of one medical center, complaining of RLQ pain. Out of a total of 100 patients (age range: 2–17 years; mean: 11 years, 46 patients presented with only one symptom of RLQ pain, while 32 patients had ≥ 2 associated signs or symptoms, including fever, nausea/vomiting, diarrhea, or rebound tenderness. Imaging studies, including abdominal sonography and/or computed tomography, were performed in 73 patients; 44 underwent surgery for presumed appendicitis and one received surgery for a right paraduodenal hernia. Eleven patients underwent surgery because of peritoneal signs, and eight because of persistent or aggravated RLQ pain. Postoperative pathologic examinations revealed 53 cases of appendicitis, six normal appendices, and other morbidities (1 perforated peptic ulcer, 1 pelvic inflammatory disease, 1 ovarian cyst, 1 diverticulitis, and 1 right paraduodenal hernia. Thirty-three patients were discharged after several hours of observation (range: 0.5–18 hours; mean: 4 hours, and three patients were admitted for further observations. All were discharged without operation. There were significant differences in the incidences of fever (p = 0.004 and rebound tenderness (p = 0.019, and in white cell counts (p < 0.001, neutrophil percentages (p < 0.001, and C-reactive protein levels (p < 0.001 between patients with appendicitis and patients with other causes of RLQ pain. Clinical signs and symptoms, laboratory

The local and referred pain from myofascial trigger points in the temporalis muscle contributes to pain profile in chronic tension-type headache.

Science.gov (United States)

Fernández-de-Las-Peñas, César; Ge, Hong-You; Arendt-Nielsen, Lars; Cuadrado, Maria Luz; Pareja, Juan A

2007-01-01

To assess the local and referred pain areas and pain characteristics evoked from temporalis muscle trigger points (TrPs) in chronic tension-type headache (CTTH). Thirty CTTH patients and 30 age and sex-matched controls were studied. A headache diary was kept for 4 weeks to substantiate the diagnosis and record the pain history. Both temporalis muscles were examined for the presence of myofascial TrPs in a blinded fashion. The local and referred pain intensities, referred pain pattern, and pressure pain threshold were recorded. Referred pain was evoked in 87% and 54% on the dominant and nondominant sides in CTTH patients, which was significantly higher (P<0.001) than in controls (10% vs. 17%, respectively). Referred pain spread to the temple ipsilateral to the stimulated muscle in both patients and controls, with additional referral behind the eyes in most patients, but none in controls. CTTH patients reported a higher local [visual analog scale (VAS): 5.6+/-1.2 right side, 5.3+/-1.4 left side] and referred pain (VAS: 4.7+/-2 right side, 3.5+/-2.8 left side) intensity than healthy controls (VAS: 0.8+/-0.7 right side, 0.7+/-0.7 left side for local pain; and 0.3+/-0.2 right side, 0.4+/-0.3 left side for referred pain) in both temporalis muscles (both, P<0.001). The local and referred pain areas were larger in patients than in controls (P<0.001). Twenty-three out of 30 CTTH patients (77%) had active TrPs in the temporalis muscle leading to their usual headache (17 patients on the right side; 12 on the left side, whereas 6 with bilateral active TrPs). CTTH patients with active TrPs in either right or left temporalis muscle showed longer headache duration than those with latent TrPs (P=0.004). CTTH patients showed significantly (P<0.001) lower pressure pain threshold (1.1+/-0.2 right side, 1.2+/-0.3 left side) as compared with controls (2.5+/-0.5 right side, 2.6+/-0.4 left side). In CTTH patients, the evoked local and referred pain from active TrPs in the temporalis

[Suppression of visceral pain by action of the low intensity polarized light on acupuncture antinociceptive points].

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Lymans'kyĭ, Iu P; Tamarova, Z A; Huliar, S O

2003-01-01

In experiments on mice, statistically authentic weakening of visceral pain has been shown after an action of low intensity polarized light from a device Bioptron on antinociceptive acupuncture points (AP). Pain was caused by an intraperitoneal injection of 2% acetic acid (0.1 ml/10 g). The intensity of pain was judged on duration and frequency of painful behavioral reactions (writhing, licking of abdomen), as well as on duration of sleep, eating and motor activity. In animals which immediately after injections of acetic acid were exposed to polarized light of low intensity for 10 min, applied on any of antinociceptive APs (E-36, E-43, VC-8, RP-6), the duration of painful behavioral reaction was determined to be reduced, while that of non-painful one increased. The comparison of the total duration of the writhing at control and experimental mice showed that an activation of AP E-43 induced the greatest analgesic effect (76.5%), from AP VC-8 it was 76.3%, from RP-6--46.8%, and from E-36--41.4%. We have concluded that the effect of polarized light of low intensity on APs was a convenient non-pharmacological method of treating visceral pain.

Medial abrasion syndrome: a neglected cause of knee pain in middle and old age.

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Lyu, Shaw-Ruey; Lee, Ching-Chih; Hsu, Chia-Chen

2015-04-01

Knee pain is a prevailing health problem of middle and old age. Medial plica-related medial abrasion syndrome (MAS), although a well-known cause of knee pain in younger individuals, has rarely been investigated in older individuals. This prospective study was conducted to investigate the prevalence and clinical manifestations of this syndrome as a cause of knee pain in middle and old age. The outcomes of arthroscopic treatment for this syndrome were also evaluated.A total of 232 knees of 169 patients >40 years of age (41-82, median: 63 years old) suffering from chronic knee pain were analyzed. The clinical diagnosis, predisposing factors, presenting symptoms, and physical signs were investigated. The sensitivity and specificity of each parameter of the clinical presentation for the diagnosis of MAS were evaluated after confirmation by arthroscopy. For patients with MAS, the roentgenographic and arthroscopic manifestations were investigated, and arthroscopic medial release (AMR) was performed. The outcomes were evaluated by the changes in the pain domain of the Knee Society scoring system and by patient satisfaction. The prevalence of medial plica was 95%, and osteoarthritis (OA) was the most common clinical diagnosis. Symptoms of pain and crepitus in motion and local tenderness during physical examination were the most sensitive parameters for the diagnosis. A history of a single knee injury combined with local tenderness and a palpable band found during physical examination were the most specific parameters for the diagnosis. The majority of patients suffering from this syndrome were successfully treated using AMR, yielding a satisfaction rate of 85.5% after a minimum of 3 years.MAS is a common cause of knee pain in middle and old age and can be effectively treated by AMR. Its concomitance with OA warrants further investigation.

Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache.

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Fernández-de-las-Peñas, César; Fernández-Mayoralas, Daniel M; Ortega-Santiago, Ricardo; Ambite-Quesada, Silvia; Palacios-Ceña, Domingo; Pareja, Juan A

2011-02-01

Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children's condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured. The total number of TrPs was significantly greater in children with CTTH as compared to healthy children (P < 0.001). Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children.

The Role Of Transparency In Tenders In Order To Maintain The Public Interest And The Rights Of Suppliers

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Reza Tajarlou

2017-09-01

Full Text Available The public tenders are very important instrument which the public sector uses to the allocation of great part of public expenditure for Welfare of citizens. Due to the the lack of resources and the optimal use of it in line with the public interest and the rights of tenderers tenders play a key role in the public sector operations they can be defined as an instrument to increase the effectiveness of the public sector as a whole. But with the conflict of interests of the public and private sector there needs to be transparency so that the rights of the parties to maintain and public confidence in the state increase. Transparency in Tenders cause the Suppliers that win the bids are those with the best product at the best price targeted at achieving the best outcome. This paper examines the concept and types of tenders for the effects of transparency in government tenders.

Tender frequency and market concentration in balancing power markets

International Nuclear Information System (INIS)

Knaut, Andreas; Obermueller, Frank; Weiser, Florian

2017-01-01

Balancing power markets ensure the short-term balance of supply and demand in electricity markets and their importance may increase with a higher share of fluctuating renewable electricity production. While it is clear that shorter tender frequencies, e.g. daily or hourly, are able to increase the efficiency compared to a weekly procurement, it remains unclear in which respect market concentration will be affected. Against this background, we develop a numerical electricity market model to quantify the possible effects of shorter tender frequencies on costs and market concentration. We find that shorter time spans of procurement are able to lower the costs by up to 15%. While market concentration decreases in many markets, we - surprisingly - identify cases in which shorter time spans lead to higher concentration.

Tender frequency and market concentration in balancing power markets

Energy Technology Data Exchange (ETDEWEB)

Knaut, Andreas; Obermueller, Frank; Weiser, Florian

2017-01-15

Balancing power markets ensure the short-term balance of supply and demand in electricity markets and their importance may increase with a higher share of fluctuating renewable electricity production. While it is clear that shorter tender frequencies, e.g. daily or hourly, are able to increase the efficiency compared to a weekly procurement, it remains unclear in which respect market concentration will be affected. Against this background, we develop a numerical electricity market model to quantify the possible effects of shorter tender frequencies on costs and market concentration. We find that shorter time spans of procurement are able to lower the costs by up to 15%. While market concentration decreases in many markets, we - surprisingly - identify cases in which shorter time spans lead to higher concentration.

The Role of Quality in the Adjudication of Public Tenders

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Geo Quinot

2014-08-01

Full Text Available The quality of the goods or services that government procures is obviously a very important consideration in deciding which supplier should be awarded a particular public tender. It follows that in the regulation of public procurement, particular attention should be given to the role of quality (also called functionality in the adjudication of public tenders and the final award decision. In South African public procurement law, the role of functionality in public tender adjudication has been a fairly controversial issue that has resulted in a continuing interaction between courts and law-makers on how and when quality should be assessed and should impact on the final award decision within the framework for public procurement found in section 217 of the Constitution. This contribution tracks the development of the role of functionality in public tender adjudication as prescribed by public procurement regulation since the enactment of the Preferential Procurement Policy Framework Act 5 of 2000, which spearheaded the development of contemporary public procurement regulation in South Africa. The analysis shows how the role of functionality has constantly changed since the enactment of the PPPFA and remains uncertain. This uncertainty relates to different interpretations of the constitutional requirements for public procurement primarily contained in section 217(1 of the Constitution. Whether functionality is used as a qualification criterion, an award criterion or both holds particular practical implications for both suppliers and contracting authorities. It is accordingly important to have certainty on this question. However, it cannot be said that the Constitution and section 217 in particular dictates one approach rather than another. The issue should thus be resolved with reference to the statutory scheme adopted under the PPPFA.

Pain perception studies in tension-type headache.

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Bezov, David; Ashina, Sait; Jensen, Rigmor; Bendtsen, Lars

2011-02-01

Tension-type headache (TTH) is a disorder with high prevalence and significant impact on society. Understanding of pathophysiology of TTH is paramount for development of effective treatments and prevention of chronification of TTH. Our aim was to review the findings from pain perception studies of pathophysiology of TTH as well as to review the research of pathophysiology of TTH. Pain perception studies such as measurement of muscle tenderness, pain detection thresholds, pain tolerance thresholds, pain response to suprathreshold stimulation, temporal summation and diffuse noxious inhibitory control (DNIC) have played a central role in elucidating the pathophysiology of TTH. It has been demonstrated that continuous nociceptive input from peripheral myofascial structures may induce central sensitization and thereby chronification of the headache. Measurements of pain tolerance thresholds and suprathreshold stimulation have shown presence of generalized hyperalgesia in chronic tension-type headache (CTTH) patients, while DNIC function has been shown to be reduced in CTTH. One imaging study showed loss of gray matter structures involved in pain processing in CTTH patients. Future studies should aim to integrate pain perception and imaging to confirm this finding. Pharmacological studies have shown that drugs like tricyclic anti-depressant amitriptyline and nitric oxide synthase inhibitors can reverse central sensitization and the chronicity of headache. Finally, low frequency electrical stimulation has been shown to rapidly reverse central sensitization and may be a new modality in treatment of CTTH and other chronic pain disorders. © 2010 American Headache Society.

Determinants of Ownership Concentration and Tender Offer Law in the Chilean Stock Market

OpenAIRE

Morales, Marco

2009-01-01

This paper analyzes econometrically the determinants of ownership concentration in the Chilean stock market, with particular attention to the e¤ects of the Tender Offer Law (OPA law). Even though the central pourpose of OPAs Law is achieved, the tender offer mechanism increases the ownership concentration. The main reason for this effect has to do with the "residual OPA" obligation considered by the law.

Noninvasive monopolar capacitive-coupled radiofrequency for the treatment of pain associated with lateral elbow tendinopathies: 1-year follow-up.

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Weber, Tobias; Kabelka, Bernd

2012-03-01

To evaluate noninvasive monopolar capacitive-coupled radiofrequency (mcRF) for the treatment of pain associated with lateral elbow tendinopathies. Prospective, single-center, single-arm, 1-year follow-up. Private sports medicine practice. Thirty-nine consecutive patients with diagnosis of lateral elbow tendinopathy (including 3 bilateral cases, for a total of 42 elbows) participated in the study. All patients had been unsuccessfully treated with a variety of nonoperative therapies (eg, nonsteroidal anti-inflammatory drugs, corticosteroid injections, and braces) for at least 3 months before they were enrolled in the study. Patients were treated with mcRF technology in the office without local anesthetic or any particular preparation. Anatomic landmarks and careful determination of the most tender point defined the area treated; rapid and precise mcRF pulses were delivered covering the area in a staggered fashion; and 10 additional pulses were delivered directly to the point of maximum tenderness (total of 100 pulses). Patients returned to activities of daily living without restriction and were instructed to avoid nonsteroidal anti-inflammatory drugs and/or ice over the treated area. Physical therapy or other treatment modalities were disallowed. The presence of pain before enrollment ranged from 15 weeks to 2 years (average, 32 weeks). Visual analog scores at rest, with regular activity, and with triggering events were gathered at 3, 6, and 12 months. The Nirschl Tennis Elbow Questionnaire and patient satisfaction also were used to evaluate study outcomes. Follow-up average was 423 days (range, 330-487 days). On the basis of the study's multifactorial success criteria, 81% of participants had successful outcomes. Furthermore, 89% of the patients who completed the study were completely or moderately satisfied with the outcome. Outcomes of this study suggest that noninvasive mcRF may have a role in the treatment of pain associated with lateral elbow tendinopathies

Effects of timing of prednisolone on the duration of early morning stiffness, pain and disease activity score (das-28) in patients with rheumatoid arthritis

International Nuclear Information System (INIS)

Gul, H.; Nasim, A.; Salim, B.

2017-01-01

To determine the effects of timing of prednisolone on duration of early morning stiffness, pain score, number of swollen and tender joints, erythrocyte sedimentation rate (ESR) and disease activity score 28 (DAS-28) in joints in patients with rheumatoid arthritis. Study Design: It was quasi experimental study. Place and Duration of Study: This study was conducted in the department of rheumatology Fauji Foundation Hospital Rawalpindi over a period of 3 months, from Dec 2015 to Feb 2016. Material and Methods: Total sample size of 85 was calculated by using non probability consecutive sampling technique. Patients with established rheumatoid arthritis diagnosed on the basis of ACR 1987 criteria were included in the study. All these patients had a disease duration of minimum 6 months and were on disease modifying anti rheumatic drugs and were taking =7.5mg of prednisolone and these patients were treated with the same dose of prednisolone given in morning at 8:00 A.M. for the first 15 days followed by treatment with same single daily dose of prednisolone given at the night 10:00 P.M. for next 15 days. This study compared duration of early morning stiffness, pain scores, number of swollen and tender joints, DAS-28 and ESR on day 15th and day 30th. Results: A total of 85 patients of established rheumatoid arthritis were included in the study. All patients were female with a mean duration of disease of 7.87 +- 6.41 years. The mean age of patients was 49.39 +- 10.24 years. Mean of pain score, duration of morning stiffness, DAS-28, number of tender and swollen joint count, and ESR was decreased in patients who took prednisolone at 10:00 pm and had significant statistical difference (p-value<0.001). Conclusions: Administration of low dose of prednisolone at night has good effects on duration of early morning stiffness, pain scores, number of swollen and tender joints, ESR and DAS-28. (author)

Efficacy of Biodanza for treating women with fibromyalgia.

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Carbonell-Baeza, Ana; Aparicio, Virginia A; Martins-Pereira, Clelia M; Gatto-Cardia, Claudia M; Ortega, Francisco B; Huertas, Francisco J; Tercedor, Pablo; Ruiz, Jonatan R; Delgado-Fernandez, Manuel

2010-11-01

The objective of this study was to determine the effects of a 3-month Biodanza intervention in women with fibromyalgia (FM). This was a controlled trial. The study was conducted at a university research laboratory and social center. The study comprised 59 women with FM recruited from a local association of patients with FM. Participants were allocated to the Biodanza intervention group (n = 27) or usual-care group (n = 32). The Biodanza intervention was carried out once a week for 3 months. The outcome measures included the following: Pain threshold, body composition (body-mass index and estimated body fat percentage), physical fitness (30-second chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8 feet up and go, and 6-minute walk test) and psychologic outcomes (Fibromyalgia Impact Questionnaire [FIQ], Short-Form Health Survey 36, Vanderbilt Pain Management Inventory, Hospital Anxiety and Depression Scale, General Self-Efficacy Scale, and Rosenberg Self-Esteem Scale). We observed a significant interaction effect (group*time) for pain threshold of several tender points (left [L] and right [R] side of the anterior cervical and supraspinatus, trapezius L and lateral epicondyle R, algometer score, tender points count), body fat percentage, and FIQ total score. In the intervention group, post hoc analysis revealed a significant improvement in pain threshold of the anterior cervical R and L and supraspinatus R and L tender points (all p body fat percentage (p = 0.001), and FIQ total score (p = 0.003). A 3-month (one session per week) Biodanza intervention shows improvements on pain, body composition, and FM impact in female patients.

Beef tenderness improvement by dietary vitamin D3 supplementation in the last stage of fattening of cattle

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Półtorak Andrzej

2017-03-01

Full Text Available Tenderness is the most important characteristic of meat, determining consumer approval. There are numerous methods of its improvement, although of diverse effectiveness. addition of vitamin D3 to the feed for a short period before slaughter (7–10 days is one of the natural ways to enhance the tenderness. Vitamin D3 is responsible for Ca2+ mobilisation in serum and increase in activity of proteolytic enzymes belonging to calpains, which results in significant improvement of beef tenderness and reduction of ageing time. The use of vitamin D3 is an application tool determining tenderness improvement of beef with substantial reduction in processing costs. Moreover, shorter post mortem ageing process will exceed the retail display time, which will consequently reduce losses due to unsold meat being returned from shops to the manufacturers. Based on the results of studies conducted over the last 15 years, this paper presents the possibility and the effects of the use of vitamin D3 to improve beef tenderness.

An Unusual Case of Abdominal Pain and Hyponatremia in a 16-Year-Old Girl With Disordered Eating.

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Hunter, Grace; Blankenburg, Rebecca; Andrews, Jennifer; Stevenson, Terrell

2018-01-01

A previously healthy 16-year-old girl presented to the emergency department with 1 week of severe, diffuse abdominal pain and constipation, as well as several episodes of nonbloody, nonbilious emesis. Her symptoms began several days after she decreased her caloric intake in an attempt to lose weight. She had been drinking 48 to 60 oz of water per day for several days before admission in an attempt to ameliorate her constipation. She also admits to drinking alcohol the night before her pain began. She had visited several other emergency departments before her presentation to our hospital, and she had been sent home on a bowel regimen without amelioration of her symptoms. On arrival to our emergency department, she described severe diffuse abdominal pain. Her abdomen was tender to palpation throughout but soft with no rebound tenderness or peritoneal signs. The remainder of her physical examination yielded normal results. She was found to have hyponatremia with a sodium level of 122 and no neurologic sequelae. Abdominal radiograph showed moderate constipation but her abdominal pain continued even after bowel cleanout. The home, education, activities, drugs, sex, suicide, and safety assessment revealed several stressors, including a recent suicide in the family and a history of disordered eating and anxiety. Here, we present her case, diagnostic evaluation, ultimate diagnosis, and complications. Copyright © 2018 by the American Academy of Pediatrics.

Injection therapy for subacute and chronic low back pain: an updated Cochrane review.

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Staal, J Bart; de Bie, Rob A; de Vet, Henrica C W; Hildebrandt, Jan; Nelemans, Patty

2009-01-01

A systematic review of randomized controlled trials (RCTs). To determine if injection therapy is more effective than placebo or other treatments for patients with subacute or chronic low back pain. The effectiveness of injection therapy for low back pain is still debatable. Heterogeneity of target tissue, pharmacological agent, and dosage, generally found in RCTs, point to the need for clinically valid comparisons in a literature synthesis. We updated the search of the earlier systematic review and searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases up to March 2007 for relevant trials reported in English, French, German, Dutch, and Nordic languages. We also screened references from trials identified. RCTs on the effects of injection therapy involving epidural, facet, or local sites for subacute or chronic low back pain were included. Studies that compared the effects of intradiscal injections, prolotherapy, or ozone therapy with other treatments were excluded unless injection therapy with another pharmaceutical agent (no placebo treatment) was part of one of the treatment arms. Studies about injections in sacroiliac joints and studies evaluating the effects of epidural steroids for radicular pain were also excluded. Eighteen trials (1179 participants) were included in this review. The injection sites varied from epidural sites and facet joints (i.e. intra-articular injections, peri-articular injections and nerve blocks) to local sites (i.e. tender-and trigger points). The drugs that were studied consisted of corticosteroids, local anesthetics, and a variety of other drugs. The methodologic quality of the trials was limited with 10 of 18 trials rated as having a high methodologic quality. Statistical pooling was not possible because of clinical heterogeneity in the trials. Overall, the results indicated that there is no strong evidence for or against the use of any type of injection therapy. There is insufficient evidence to

Spinous Process Osteochondroma as a Rare Cause of Lumbar Pain

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Bárbara Rosa

2016-01-01

Full Text Available We present a case of a 5th Lumbar Vertebra (L5 spinous process osteochondroma as a rare cause of lumbar pain in an old patient. A 70-year-old male presented with progressive and disabling lower lumbar pain. Tenderness over the central and left paraspinal area of the lower lumbar region and a palpable mass were evident. CT scan showed a mass arising from the spinous process of L5. Marginal resection of the tumor was performed through a posterior approach. The histological study revealed an osteochondroma. After surgery, pain was completely relieved. After one year there was no evidence of local recurrence or symptoms. Osteochondromas rarely involve the spine, but when they do symptoms like pain, radiculopathy/myelopathy, or cosmetic deformity may occur. The imagiologic exam of election for diagnosis is CT scan. When symptomatic the treatment of choice is surgical resection. The most concerning complication of osteochondromas is malignant transformation, a rare event.

Effect of low-level laser therapy on pain, quality of life and sleep in patients with fibromyalgia: study protocol for a double-blinded randomized controlled trial.

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de Carvalho, Paulo de Tarso Camillo; Leal-Junior, Ernesto Cesar Pinto; Alves, Ana Carolina Araruna; Rambo, Caroline Sobral de Melo; Sampaio, Luciana Maria Malosa; Oliveira, Claudia Santos; Albertini, Regiane; de Oliveira, Luis Vicente Franco

2012-11-21

Low-level laser therapy (LLLT) has been widely used as adjuvant strategy for treatment of musculoskeletal disorders. The light-tissue interaction (photobiostimulation) promotes analgesic and anti-inflammatory effects and improves tissue healing, which could justify the recommendation of this therapy for patients with fibromyalgia, leading to an improvement in pain and possibly minimizing social impact related to this disease. The present study proposes to evaluate the effect of LLLT on tender points in patients with fibromyalgia, correlating this outcome with quality of life and sleep. One hundred and twenty patients with fibromyalgia will be treated at the Integrated Health Center and the Sleep Laboratory of the Post Graduate Program in Rehabilitation Sciences of the Nove de Julho University located in the city of Sao Paulo, Brazil. After fulfilling the eligibility criteria, a clinical evaluation and assessments of pain and sleep quality will be carried out and self-administered quality of life questionnaires will be applied. The 120 volunteers will be randomly allocated to an intervention group (LLLT, n = 60) or control group (CLLLT, n = 60). Patients from both groups will be treated three times per week for four weeks, totaling twelve sessions. However, only the LLLT group will receive an energy dose of 6 J per tender point. A standardized 50-minute exercise program will be performed after the laser application. The patients will be evaluated regarding the primary outcome (pain) using the following instruments: visual analog scale, McGill Pain Questionnaire and pressure algometry. The secondary outcome (quality of life and sleep) will be assessed with the following instruments: Medical Outcomes Study 36-item Short-Form Health Survey, Fibromyalgia Impact Questionnaire, Berlin Questionnaire, Epworth Sleepiness Scale and polysomnography. ANOVA test with repeated measurements for the time factor will be performed to test between-groups differences (followed by the

Quality of life and associated clinical distress in fibromyalgia

OpenAIRE

G. Perpignano; L. Minerba; A. Denotti; C. Anedda; V. Ruggiero; E. Cacace

2011-01-01

Objectives: Fibromyalgia (FM) is a syndrome characterized by chronic, diffuse musculoskeletal pain and by a low pain threshold at specific anatomical points (tender points). Numerous other conditions (Irritable bowel syndrome, tension-type headache, migraine headaches, etc.) may overlap with FM. Aim of this study was to evaluate the quality of life and associated clinical distress in patients with FM. Methods: 53 females affected by primary fibromyalgia and 40 healthy females were examined we...

Pain in interstitial cystitis/bladder pain syndrome: do characteristics differ in ulcerative and non-ulcerative subtypes?

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Killinger, Kim A; Boura, Judith A; Peters, Kenneth M

2013-08-01

Key differences between interstitial cystitis/bladder pain syndrome (IC/BPS) subtypes (with and without Hunner's ulcer) have been noted. We hypothesized that pain characteristics in women grouped by IC/BPS subtype would differ. A survey was mailed to 749 women to assess IC/BPS pain and other characteristics. Cystoscopy/hydrodistention reports were reviewed for presence/absence of Hunner's ulcer. The McGill Pain Questionnaire Short Form© (MPQ-SF), Brief Pain Inventory (BPI), and Interstitial Cystitis Symptom and Problem Indices (ICSI-PI) assessed symptoms. Data were analyzed with Pearson's chi-square, Fisher's exact, t tests, and Wilcoxon rank tests. Of the 214 women that returned a survey (36 ulcerative and 178 non-ulcerative IC/BPS), similar proportions in each group reported that certain foods, exercise, and/or stress triggered symptoms. Fewer ulcerative patients reported pain with vaginal penetration than non-ulcerative (5/33, 15.2 % vs 76/160, 47.5 %; p = 0.0006). On the BPI, the ulcerative and non-ulcerative groups reported similar numbers of painful areas (mean 4.1 ± 6.1 and 4.1 ± 3.8; p = 0.33), and lower abdominal/pelvic pain was reported most (13/35, 37 % vs 79/172, 46 %; p = 0.34) followed by lower back pain (12/35, 34 % vs 69/172, 40 %; p = 0.52). Even though ICSI-PI, MPQ-SF, and BPI scores/responses did not differ, on the MPQ-SF the three words most frequently used by ulcerative patients to describe their pain were sharp, stabbing, and hot burning, and in non-ulcerative were aching, cramping, and tender. These measures did not reveal any significant differences in pain between subtypes. More research is needed in larger samples to determine whether differences exist.

Estimation of Sensory Pork Loin Tenderness Using Warner-Bratzler Shear Force and Texture Profile Analysis Measurements.

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Choe, Jee-Hwan; Choi, Mi-Hee; Rhee, Min-Suk; Kim, Byoung-Chul

2016-07-01

This study investigated the degree to which instrumental measurements explain the variation in pork loin tenderness as assessed by the sensory evaluation of trained panelists. Warner-Bratzler shear force (WBS) had a significant relationship with the sensory tenderness variables, such as softness, initial tenderness, chewiness, and rate of breakdown. In a regression analysis, WBS could account variations in these sensory variables, though only to a limited proportion of variation. On the other hand, three parameters from texture profile analysis (TPA)-hardness, gumminess, and chewiness-were significantly correlated with all sensory evaluation variables. In particular, from the result of stepwise regression analysis, TPA hardness alone explained over 15% of variation in all sensory evaluation variables, with the exception of perceptible residue. Based on these results, TPA analysis was found to be better than WBS measurement, with the TPA parameter hardness likely to prove particularly useful, in terms of predicting pork loin tenderness as rated by trained panelists. However, sensory evaluation should be conducted to investigate practical pork tenderness perceived by consumer, because both instrumental measurements could explain only a small portion (less than 20%) of the variability in sensory evaluation.

Effectiveness of a tai-chi training and detraining on functional capacity, symptomatology and psychological outcomes in women with fibromyalgia.

Science.gov (United States)

Romero-Zurita, Alejandro; Carbonell-Baeza, Ana; Aparicio, Virginia A; Ruiz, Jonatan R; Tercedor, Pablo; Delgado-Fernández, Manuel

2012-01-01

Background. The purpose was to analyze the effects of Tai-Chi training in women with fibromyalgia (FM). Methods. Thirty-two women with FM (mean age, 51.4 ± 6.8 years) attended to Tai-Chi intervention 3 sessions weekly for 28 weeks. The outcome measures were: tenderness, body composition, functional capacity and psychological outcomes (Fibromyalgia impact questionnaire (FIQ), Short Form Health Survey 36 (SF-36)). Results. Patients showed improvements on pain threshold, total number of tender points and algometer score (all P Tai-Chi group improved the FIQ total score (P Tai-Chi intervention showed improvements on pain, functional capacity, symptomatology and psychological outcomes in female FM patients.

Is bone tenderness, as measured by manual algometry, associated with vitamin D deficiency?

Science.gov (United States)

Dresser, Jocelyn; MacIntyre, Mike; Chisholm, Brittney; Lawson, G E

2014-09-01

To explore the relationship between serum 25-hydroxycholecalciferol (25[OH]D3) and pressure-pain thresholds, as measured by algometer, in advance of a main study to determine whether PPT is a potentially cost-effective proxy measure of 25[OH]D3 status in the general population. The cross-sectional pilot study involved a convenience sample of twenty-two subjects (10 males, 12 females), aged 18 to 67 years. All subjects consented to three trials of pressure-pain threshold readings on both tibiae and the manubrium. Serum 25[OH]D3 levels were determined from blood samples drawn post-algometry. The average pressure pain thresholds were 14.92 (±6.03), 15.07(±6.07), 11.10 (±6.68) for the left and right tibia and sternum, respectively. The stability between the measurements was very high with the interclass correlation coefficient (95% CI) calculated as 0.94 (0.62-1.00), 0.9 (0.81-1.00), 0.96(0.93-1.00). The Pearson correlation coefficients were 0.03 for the left tibia, 0.17 for the right tibia and 0.20 for the sternum, J Dresser, M MacIntyre, B Chisholm, GE Lawson showing a negligible correlation for the left and right tibia, but a low positive correlation for the sternum. We did not find preliminary evidence of a strong or otherwise clinically meaningful correlation between bone tenderness and manual algometry in this pilot study. Only a weak linear relationship between PPT in the sternum and serum 25[OH]D3 concentrations was found. Replication of this study is warranted in larger and more representative study populations of interest. Discussion on a number of feasibility issues is provided to inform those future studies.

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 < 0.001), and VAS (p < 0.001) in the EG. The EG shows better results in leg strength (p < 0.001), handgrip strength (p = 0.025), agility/dynamic balance (p = 0.032) and balance (p = 0.006). An 18-week intervention consisting in two sessions of in-water exercise and one session of on-land exercise of FT reduces 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.

Low 25-Hydroxyvitamin D and Myofascial Pain: Association of Cancer, Colon Polyps, and Tendon Rupture.

Science.gov (United States)

Hightower, Jane M; Dalessandri, Kathie M; Pope, Karl; Hernández, Germán T

2017-08-01

Myofascial pain that has been associated with cancer and increased risk of morbidity and mortality in cancer patients is intrinsically associated with low magnesium and low 25-hydroxyvitamin D (25(OH)D). Therefore, this physical finding was used as a clinical diagnostic proxy. The objective of this study was to assess the association and prevalence of disease in individuals with myofascial pain and low 25(OH)D in a county with low magnesium in the drinking water. This is a retrospective cross-sectional study of a chart review of 269 subjects to assess subjects presenting with myofascial pain (assessed by tender trigger points) and 25(OH)D concentrations below 30 ng/mL or a history of 25(OH)D deficiency compared to those without these exposures. The association between the exposure of low 25(OH)D levels and myofascial pain was compared to all cancers, colon polyps, and tendon ruptures. The odds of having cancer with the combined exposures was 10.14 times the odds of not having either exposure (95% confidence interval [CI], 5.08, 20.25, p D less than 30 ng/mL, 74 were tested for red blood cell (RBC) magnesium. Half of those subjects had RBC magnesium concentrations D deficiency showed a significant association with cancer, adenomatous colon polyps, and tendon rupture. Further studies to verify these results are needed, especially in areas where there is low magnesium in the drinking water.

41 CFR 102-118.260 - Must my agency send all quotations, tenders, or contracts with a TSP to GSA?

Science.gov (United States)

2010-07-01

... quotations, tenders, or contracts with a TSP to GSA? 102-118.260 Section 102-118.260 Public Contracts and... REGULATION TRANSPORTATION 118-TRANSPORTATION PAYMENT AND AUDIT Use of Government Billing Documents Quotations, Tenders Or Contracts § 102-118.260 Must my agency send all quotations, tenders, or contracts with a TSP to...

Acute pain management efficiency improves with point-of-care handheld electronic billing system.

Science.gov (United States)

Fahy, Brenda G

2009-02-01

Technology advances continue to impact patient care and physician workflow. To enable more efficient performance of billing activities, a point-of-care (POC) handheld computer technology replaced a paper-based system on an acute pain management service. Using a handheld personal digital assistant (PDA) and software from MDeverywhere (MDe, MDeverywhere, Long Island, NY), we performed a 1-yr prospective observational study of an anesthesiology acute pain management service billings and collections. Seventeen anesthesiologists providing billable acute pain services were trained and entered their charges on a PDA. Twelve months of data, just before electronic implementation (pre-elec), were compared to a 12-m period after implementation (post-elec). The total charges were 4883 for 890 patients pre-elec and 5368 for 1128 patients post-elec. With adoption of handheld billing, the charge lag days decreased from 29.3 to 7.0 (P billing using PDAs to replace a paper-based billing system improved the collection rate and decreased the number of charge lag days with a positive return on investment. The handheld PDA billing system provided POC support for physicians during their daily clinical (e.g., patient locations, rounding lists) and billing activities, improving workflow.

Ischemic colitis in five points: an update 2013.

Science.gov (United States)

Rania, Hefaiedh; Mériam, Sabbah; Rym, Ennaifer; Hyafa, Romdhane; Amine, Attaoui; Najet, Bel Hadj; Lassad, Gharbi; Mohamed, Taher Khalfallah

2014-05-01

Ischemic colitis is the most common form of intestinal ischemia. The presence of diarrhea and mild lower gastrointestinal bleeding should guide the diagnosis. Although many laboratory tests and radiographic images may suggest the diagnosis, colonic endoscopic with histological analysis of biopsies is the gold standard for identification of colonic ischemia. aim : The aim of this study was to resume in 5 points: the epidemiology, the clinical features, the diagnostic approach and the management of ischemic colitis in five points. methods: Review of literature. results: Incidence of ischemic colitis was between 3 and 10%. The clinical presentation is predominated by the non gangrenous form associating abdominal pain, tenderness, diarrhea and lower gastrointestinal bleeding. The most frequent causes are represented by systemic hypoperfusion. Laboratory tests can orientate the diagnosis but are unspecific. Radiographic images based on computed tomography or more recently magnetic resonance imaging may suggest the diagnosis, but the confirmation will be given by endoscopic visualization of colonic mucosa with histological analysis of biopsies. Conservative treatment is the most often sufficient to improve colonic lesions. Surgical treatment is reserved for perforations and strictures. The incidence of colonic ischemia is difficult to ascertain. The diagnosis is usually made by medical history, examination, and endoscopy which have become the diagnostic procedure of choice. A high index of suspicion and prompt management are essential for optimum outcomes in patients with colonic ischemia.

Assessment of prevalence study of 40 variables related to painful dysfunction syndrome of masticatory muscles in patients referred to faculty of dentistry in Mashhad, Northeast of Iran

OpenAIRE

Hamed Mortazavi; Abbas Javadzadeh; Zahra Delavarian; Zare Mahmoodabadi

2010-01-01

Introduction: Painful dysfunction syndrome of masticatory muscles is one of the most important causes of pain in orofacial region. Therefore, the aim of this study was to evaluate the prevalency of 40 variables related to this disorder. Materials and Methods: A total 39 patients (32 females, 7 males) with painful dysfunction syndrome of masticatory muscles were studied. Patients were evaluated for prevalence of age, sex, job, marriage status, masticatory muscles tenderness, maximum mouth open...

More cost effectiveness from public tendering of energy

International Nuclear Information System (INIS)

Smith, E.

2006-01-01

From the results of an energy market analysis it appears that parties which are obliged to tender for energy contracts do not make the most of it. Timing is crucial in a liberalized market. Contracting in spring seems to deliver the best prices for energy in combination with tailor-made contracts [nl

Genome-Wide H3K4me3 Analysis in Angus Cattle with Divergent Tenderness.

Directory of Open Access Journals (Sweden)

Chunping Zhao

Full Text Available Tenderness is one of the most important properties of meat quality, which is influenced by genetic and environmental factors. As an intensively studied epigenetic marker, histone methylation, occurring on arginine and lysine residues, has pivotal regulatory functions on gene expression. To examine whether histone methylation involves in beef tenderness variation, we analyzed the transcriptome and H3K4me3 enrichment profiles of muscle strips obtained from the longissimus dorsi (LD of Angus steers previously classify to the tender or tough group. We first plotted a global bovine H3K4me3 map on chromosomes and called peak-enriched regions and genes. We found that majorities of H3K4me3 on genes were occupying the first intron and intergenic regions and its maps displayed similar patterns in tender and tough groups, with high H3K4me3 enrichment surrounding the transcription start site (TSS. We also explored the relationship of H3K4me3 and gene expression. The results showed that H3K4me3 enrichment is highly positively correlated with gene expression across the whole genome. Cluster analysis results confirmed the relationship of H3K4me3 enrichment and gene expression. By using a pathway-based approach in genes with H3K4me3 enrichment in promoter regions from the tender cluster, we revealed that those genes involved in the development of different tissues-connective tissue, skeletal and muscular system and functional tissues-; while in tough group those genes engaged in cell death, lipid metabolism and small molecule biochemistry. The results from this study provide a deep insight into understanding of the mechanisms of epigenetic regulations in meat quality and beef tenderness.

Protein degradation and post-deboning tenderization in broiler breast meat with different degrees of muscle shortening

Science.gov (United States)

Deboning broiler breast fillets prior to rigor mortis negatively influences tenderness due to sarcomere shortening. The effects of sarcomere shortening on muscle protein degradation and breast meat tenderization during post-deboning aging are not well understood. The objective of this study was to m...

Observation-based assessment of functional ability in patients with chronic widespread pain: A cross-sectional study

DEFF Research Database (Denmark)

Amris, Kirstine; Wæhrens, Eva Elisabet Ejlersen; Jespersen, Anders

2011-01-01

Knowledge about functional ability, including activities of daily living (ADL), in patients with chronic widespread pain (CWP) and fibromyalgia (FMS) is largely based on self-report. The purpose of this study was to assess functional ability by using standardised, observation-based assessment...... of ADL performance and to examine the relationship between self-reported and observation-based measures of disability. A total of 257 women with CWP, 199 (77%) fulfilling the American College of Rheumatology tender point criteria for FMS, were evaluated with the Assessment of Motor and Process Skills...... (AMPS), an observation-based assessment providing linear measures of ADL motor and ADL process skill ability (unit: logits). A cutoff for effortless and independent ADL task performance is set at 2.0 for the motor scale and 1.0 for the process scale. A total of 248 (96.5%) had ability measures below...

Predictors of upper trapezius pain with myofascial trigger points in food service workers: The STROBE study.

Science.gov (United States)

Hwang, Ui-Jae; Kwon, Oh-Yun; Yi, Chung-Hwi; Jeon, Hye-Seon; Weon, Jong-Hyuck; Ha, Sung-Min

2017-06-01

Shoulder pain occurs commonly in food service workers (FSWs) who repetitively perform motions of the upper limbs. Myofascial trigger points (MTrPs) on the upper trapezius (UT) are among the most common musculoskeletal shoulder pain syndromes. This study determined the psychological, posture, mobility, and strength factors associated with pain severity in FSWs with UT pain due to MTrPs.In this cross-sectional study, we measured 17 variables in 163 FSWs with UT pain due to MTrPs: a visual analog scale (VAS) pain score, age, sex, Borg rating of perceived exertion (BRPE) scale, beck depression inventory, forward head posture angle, rounded shoulder angle (RSA), shoulder slope angle, scapular downward rotation ratio, cervical lateral-bending side difference angle, cervical rotation side difference angle, glenohumeral internal rotation angle, shoulder horizontal adduction angle, serratus anterior (SA) strength, lower trapezius (LT) strength, bicep strength, and glenohumeral external rotator strength, in 163 FSWs with UT pain due to MTrPs.The model for factors influencing UT pain with MTrPs included SA strength, age, BRPE, LT strength, and RSA as predictor variables that accounted for 68.7% of the variance in VAS (P < .001) in multiple regression models with a stepwise selection procedure. The following were independent variables influencing the VAS in the order of standardized coefficients: SA strength (β = -0.380), age (β = 0.287), BRPE (β = 0.239), LT strength (β = -0.195), and RSA (β = 0.125).SA strength, age, BRPE, LT strength, and RSA variables should be considered when evaluating and intervening in UT pain with MTrPs in FSWs.

Suicidality in chronic pain: predictors of suicidal ideation in fibromyalgia.

Science.gov (United States)

Triñanes, Yolanda; González-Villar, Alberto; Gómez-Perretta, Claudio; Carrillo-de-la-Peña, María T

2015-04-01

Fibromyalgia (FM) has been associated with a higher prevalence of suicidal behavior. Nevertheless, much remains unknown about suicide risk factors for this chronic pain disorder. In the present study, the relationship of suicidal ideation in FM with a number of sociodemographic, clinical, and psychological variables was analyzed. One hundred seventeen women with Fibromyalgia were assessed. The procedure included the exploration of sleep problems (Pittsburgh Sleep Quality Index), depression (Beck Depression Inventory [BDI]), health-related quality of life (SF-36 and Fibromyalgia Impact Questionnaire), the core symptoms of FM (visual analogue scales), and algometry of tender points. Suicidal ideation was evaluated by item 9 of the BDI. Patients with presence vs. absence of suicidal ideation were compared in all the variables studied. The prevalence of suicidal ideation among FM patients was 32.5%. Significant differences between patients with vs. without suicidal ideas emerged mainly for the various indices of depression. Patients with suicidal ideation also reported higher levels of anxiety, more day dysfunction due to sleepiness and more limitations due to emotional and physical problems. Logistic regression analysis revealed that cognitive depression symptoms such as BDI Self-Blame cluster are the more closely related to suicide ideation. The presence of suicidal ideation in FM patients is closely related to comorbid depression, anxiety and to a higher impact of the disease in daily life. © 2014 World Institute of Pain.

New treatment options for fibromyalgia: critical appraisal of duloxetine

Directory of Open Access Journals (Sweden)

Nurcan Üçeyler

2008-06-01

Full Text Available Nurcan Üçeyler1, Martin Offenbächer2, Frank Petzke3, Winfried Häuser4, Claudia Sommer11Department of Neurology, University of Würzburg, Germany; 2GRP – Generation Research Program, Human Science Center, University of Munich, Germany; 3Department of Anesthesiology, University of Cologne, Germany; 4Center of Pain Therapy, Klinikum Saarbrücken gGmbH, Winterberg 1, Saarbrücken, GermanyAbstract: Fibromyalgia syndrome (FMS is a chronic condition characterized by widespread pain, tender points, fatigue, and sleep disturbance. FMS leads to high disability levels, poor quality of life, and extensive use of medical care. Effective pharmacological treatment options are rare, and treatment effects are often of limited duration. Duloxetine is a new selective serotonin and norepinephrine reuptake inhibitor that is licensed for the treatment of pain in diabetic neuropathy. So far two randomized, placebo-controlled trials have investigated the short-term safety and efficacy of duloxetine 60 mg/day and 120 mg/day in patients suffering from FMS over a period of 12 weeks. Both dosages were superior to placebo in pain relief, and improvement in quality of life and depressive symptoms. The analgesic effect was largely independent of the antidepressant action of duloxetine. The higher dose of 120 mg/day further reduced the tender point count and elevated the tender point pain thresholds. Only mild to moderate adverse effects were reported. Duloxetine 60 mg/day and 120 mg/day has proven to be beneficial in the treatment of FMS symptoms. As true for other antidepressants further studies are needed to assess the long-term efficacy and safety of duloxetine as an additional pharmacological treatment option in FMS.Keywords: fibromyalgia syndrome, duloxetine, antidepressant, review, SNRI

Role expectations and agency in the audit tendering process

NARCIS (Netherlands)

Taminiau, Y.T.A.; Heusinkveld, H.S.

2017-01-01

Purpose – Tenders are generally considered an important in auditing research and practice, and are associated with significant difficulties for the auditing profession, as well as for individual auditors in the context of client relationships. The paper aims to explore the way auditors respond to

Injection therapy for subacute and chronic low-back pain.

Science.gov (United States)

Staal, J Bart; de Bie, Rob; de Vet, Henrica Cw; Hildebrandt, Jan; Nelemans, Patty

2008-07-16

The effectiveness of injection therapy for low-back pain is still debatable. Heterogeneity of target tissue, pharmacological agent and dosage generally found in randomized controlled trials (RCTs) points to the need for clinically valid comparisons in a literature synthesis. To determine if injection therapy is more effective than placebo or other treatments for patients with subacute or chronic low-back pain. We updated the search of the earlier systematic review and searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE databases from January 1999 to March 2007 for relevant trials reported in English, French, German, Dutch and Nordic languages. We also screened references from trials identified. RCTs on the effects of injection therapy involving epidural, facet or local sites for subacute or chronic low-back pain were included. Studies which compared the effects of intradiscal injections, prolotherapy or Ozone therapy with other treatments, were excluded unless injection therapy with another pharmaceutical agent (no placebo treatment) was part of one of the treatment arms. Studies about injections in sacroiliac joints and studies evaluating the effects of epidural steroids for radicular pain were also excluded. Two review authors independently assessed the quality of the trials. If study data were clinically and statistically too heterogeneous to perform a meta-analysis, we used a best evidence synthesis to summarize the results. The evidence was classified into five levels (strong, moderate, limited, conflicting or no evidence), taking into account the methodological quality of the studies. 18 trials (1179 participants) were included in this updated review. The injection sites varied from epidural sites and facet joints (i.e. intra-articular injections, peri-articular injections and nerve blocks) to local sites (i.e. tender- and trigger points). The drugs that were studied consisted of corticosteroids, local anesthetics and a variety of

Predictors of satisfactory improvements in pain for patients with early rheumatoid arthritis in a treat-to-target study.

Science.gov (United States)

Ten Klooster, Peter M; Vonkeman, Harald E; Oude Voshaar, Martijn A H; Siemons, Liseth; van Riel, Piet L C M; van de Laar, Mart A F J

2015-06-01

The aim of this study was to identify baseline predictors of achieving patient-perceived satisfactory improvement (PPSI) in pain after 6 months of treat to target in patients with early RA. Baseline and 6 month data were used from patients included in the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Simple and multivariable logistic regression analyses were used to identify significant predictors of achieving an absolute improvement of 30 mm or a relative improvement of 50% on a visual analogue scale for pain. At 6 months, 125 of 209 patients (59.8%) achieved an absolute PPSI and 130 patients (62.2%) achieved a relative PPSI in pain. Controlling for baseline pain, having symmetrical arthritis was the strongest independent predictor of achieving an absolute [odds ratio (OR) 3.17, P = 0.03] or relative (OR 3.44, P = 0.01) PPSI. Additionally, anti-CCP positivity (OR 2.04, P = 0.04) and having ≤12 tender joints (OR 0.29, P = 0.01) were predictive of achieving a relative PPSI. The total explained variance of baseline predictors was 30% for absolute and 18% for relative improvements, respectively. Symmetrical joint involvement, anti-CCP positivity and fewer tender joints at baseline are prognostic signs for achieving satisfactory improvement in pain after 6 months of treat to target in patients with early RA. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

History of Pain Research and Management in Canada

Directory of Open Access Journals (Sweden)

Harold Merskey

1998-01-01

and Smythe was probably responsible for turning ideas about fibromyalgia from the quaint concept of 'psychogenic rheumatism' into the more fruitful avenue of empirical exploration of brain function, muscle tender points and clinical definition of disease. Tasker and others in Toronto made important advances in the neurophysiology of nociception by the thalamus and cingulate regions. Their work continues while a variety of basic and clinical studies are advancing knowledge of fundamental mechanisms, including work by Henry and by Sawynok on purines; by Salter and by Coderre on spinal cord mechanisms and plasticity; by Katz on postoperative pain; by several workers on children's pain; and by Bushnell and others in Montreal on cerebral imaging. Such contributions reflect work done in a country that would not want to claim that its efforts are unique, but would hope to be seen as maintaining some of the best standards in the developed world.

Possibilities concerning the procurement of a tender for a new nuclear power plant

International Nuclear Information System (INIS)

Winkler, Thomas; Streit, Marco

2010-01-01

The authors describe the legal frame for the licensing of a new nuclear power plant in Switzerland. The possibilities for a company to perform the procurement of a tender are discussed with respect to the decision to assign the project to a single contractor or to a consortium. The requirements to the contractor may be grouped in the categories cost, time schedule, function, volume and quality. Another topic in the discussion covers risks with respect to the tender and the contract and the appropriate solution strategies.

Pain in the chest in a user of cocaine

International Nuclear Information System (INIS)

Wiener, M.D.; Putnam, C.E.

1987-01-01

A 21-year-old man presented with pleuritic substernal chest pain of one hour's duration. The pain was exacerbated in a supine position and did not radiate. Questioning revealed that he was a recreational user of cocaine and had inhaled free-based cocaine via a pipe the previous evening and as recently as two hours before admission to the hospital. Physical examination demonstrated an anxious young man with a respiratory rate of 26 breaths per minute and shallow. He was afebrile with normal heart rate and blood pressure. His sternum was tender to palpation, and auscultation revealed precordial crepitus synchronous with systole. His electrocardiogram showed sinus rhythm at a rate of 62 beats per minute. Posteroanterior and lateral roentgenograms of the chest were obtained. A diagnosis of spontaneous pneumomediastinum was made

Renewable Energy Tenders and Community [Em]power[ment]: Latin America and the Caribbean

International Nuclear Information System (INIS)

Lucas, Hugo; Munoz Cabre, Miquel; Gomez, Juan Carlos; Leidreiter, Anna; Ranalder, Lea; Williamson, Laura E.; Adib, Rana; Lins, Christine; Ranalder, Lea; Mastny, Lisa; Acuna, Francisco; Arroyo, Tabare; Bayao, Joao; Bonotto, Adriano; Konzen, Gabriel; Vasconcellos Barral Ferreira, Thiago; Bayer, Benjamin; Bravo, Gonzalo; Furlano, Lukas; Camacho, Luis; Carrasco Gonzalez, Fidel; Coronado, Juan; Escobar, Rafael; Gamarra, Alba; Garcia, Henry; Goni, Sebastian; Raquet, Francis; Gsaenger, Stefan; Schenk, Fabian; Mitma, Riquel; Munozcano Alvarez, Luis Alfonso; Ramirez, Michelle; Rodriguez Aguilar, Jessica Susana; Ruiz Carmona, Oscar; Villarreal Singer, Diego; Oceransky, Sergio; Perez, Juan Esteban; Puig, Pep; Trujillo, Ramiro; Chavez, Sandra; Gonzalez, Alaide; Luna, Nestor; Moreno, Adrian

2017-01-01

. The main renewable energy markets in Latin America and the Caribbean are dominated by tendering processes, a trend that is likely to continue in the coming years. But whereas tenders are predicated on competition, community-driven projects are based on collaboration. Participating in tendering processes - and winning - requires, among others, significant expertise and access to large reserves of capital, which smaller actors do not have to the same degree as large, specialist renewable energy developers. Under the tendering process, even if their projects are financially viable, actors that take a one-project approach - including community-driven renewable energy projects - are penalised against large developers, which can distribute the costs and risks of tendering to several projects. Tenders can be modified to favour a diversity of actors and community-driven renewable energy projects through the use of various tendering design options. Applying these design options often results in a trade-off between the primary objective - contracting the cheapest electricity from renewables - and the secondary objective of promoting a diversity of actors. As one solution, in the accession process following the tender, community-driven projects can be offered a power purchase agreement at a tariff based on the result of the tender. The accession process captures both the efficiency of tenders and the effectiveness of feed-in tariffs for community projects. Setting limits, in time and quantity, for the implementation of the accession process is necessary to ensure its dynamic efficiency. The accession process would be greatly strengthened and accelerated by the establishment of ambitious, but realistic, mid- and long-term targets for community-driven renewable energy projects. Complementing the accession process, it is proposed that a community power authority be established, with the roles of providing technical, legal and business support; assigning official &apos

A rare diagnosis of abdominal pain presentation in the emergency department: Idiopathic omental bleeding: A case report.

Science.gov (United States)

Wu, Yen-Hung; Liu, Kuan-Ting; Wen, Chun-Kai

2017-12-01

Idiopathic omental bleeding is a rare cause of acute abdomen, with only a few reported cases. It usually presents with abdominal pain and may be life-threatening. As it rarely occurs, it may not be considered initially during patient presentation. A 35-year-old male came to our emergency department with abdominal pain present for around 5 to 6 hours. The patient complained of left upper quadrant abdominal pain after eating breakfast. The only associated symptom was 3 episodes of vomiting up food. Physical examination revealed mild left upper quadrant abdominal tenderness without muscle guarding or rebounding pain. Blood examination showed leukocytosis with neutrophil predominance and C reactive protein elevation. The pain was persistent and relief was not obtained by medication. Computed tomography showed a large lobular-contour homogenous slightly hyperdense lesion without enhancement along the greater curvature of the stomach in the lesser sac. A surgeon was consulted and laparotomy was suggested. Hematoma was found at Morrison pouch, subsplenic fossa, and lesser sac under operation. Laparotomy and ligation for hemostasis. The patient was discharged with stable condition after 7 days of hospitalization. This diagnosis should be considered in patients presenting with epigastric pain and vomiting after eating while in the emergency department because this disease might be life-threatening. This case highlights 2 important learning points. First, idiopathic omental bleeding could occur after eating in patients without underlying disease or trauma history, and this disease should be taken into consideration when acute abdomen occurs. Second, emergent laparotomy is indicated if the cause of acute abdomen is not clear. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

The evolving clinical picture of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): A look at 1310 patients over 16 years.

Science.gov (United States)

Doiron, R Christopher; Tripp, Dean A; Tolls, Victoria; Nickel, J Curtis

2018-06-01

Two decades of increasing understanding of etiopathogenesis and clinical phenotyping produces an impression the clinical face of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is changing. We sought to retrospectively analyze trends in CP/CPPS patients presenting to our clinic for evaluation over a 16-year period. Patients with CP/CPPS presenting to a tertiary clinic were evaluated prospectively from 1998-2014 with Chronic Prostatitis Symptom Index (CPSI) and UPOINT (urinary, psychosocial, organ-specific, infection, neurogenic, and tenderness) categorization. Patients were stratified in four cohorts, based on year of presentation, and we retrospectively analyzed variations in symptom scores and patterns, UPOINT categorization, and treatment modalities amongst cohorts. Mean age of the 1310 CP/CPPS patients was 44.7 years, while mean CPSI pain, urination, and total scores were 10.6, 4.8, and 23.3, respectively. The most prevalent UPOINT domain, urinary (U) (71.8%) was associated with a higher CPSI urination score (6.3), more frequent penile tip pain (37%), dysuria (48%), and more treatment with alpha-blockers (70%). Increase in UPOINT domains was associated with higher CPSI pain, quality of life (QoL), and total scores. Trends over time included increased prevalence of psychosocial (P), organ (O), and tenderness (T) domains, as well as increased use of alpha-blockers, neuromodulation, and phytotherapy as treatment modalities. There was little variation in age, CPSI scores, and pain locations over time. The changing clinical face of CP/CPPS reflects the increased recognition of psychosocial (P domain) and pelvic floor pain (T domain), along with the concomitant use of associated therapies. There was little variation of pain/urinary symptom patterns and QoL.

Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain.

Science.gov (United States)

Ohrbach, R; Gale, E N

1989-11-01

Four studies are presented testing the validity and reliability of pressure pain thresholds (PPTs) and of examination parameters believed to be important in the clinical assessment of sites commonly used for such measures in patient samples. Forty-five patients with a myogenous temporomandibular disorder were examined clinically prior to PPT measures. Criteria for history and examination included functional aspects of the pain, tissue quality of the pain site, and the type of pain elicited from palpation. Control sites within the same muscle and in the contralateral muscle were also examined. PPTs were measured as an index of tenderness using a strain gauge algometer at these sites. The data from the 5 male subjects were excluded from subsequent analyses due to the higher PPT in the males and to their unequal distribution among the various factorial conditions. The first study demonstrated strong validity in PPT measures between patients (using pain sites replicating the patients' pain) and matched controls (n = 11). The PPT was not significantly different between the primary pain site (referred pain and non-referred pain collapsed) and the no-pain control site in the same muscle (n = 16). The PPT was significantly lower at the pain site compared to the no-pain control site in the contralateral muscle (n = 13). The second study indicated adequate reliability in patient samples of the PPT measures. In the third study, the PPT was significantly lower at sites producing referred pain on palpation compared to sites producing localized pain on palpation. The PPT findings from the control sites were inconsistent on this factor. The fourth study presented preliminary evidence that palpable bands and nodular areas in muscle were most commonly associated with muscle regions that produce pain; such muscle findings were not specific, however, for regions that produce pain. Further, the intraexaminer reliability in reassessing these pain sites qualitatively was only fair

Chronic abdominal wall pain misdiagnosed as functional abdominal pain.

Science.gov (United States)

van Assen, Tijmen; de Jager-Kievit, Jenneke W A J; Scheltinga, Marc R; Roumen, Rudi M H

2013-01-01

The abdominal wall is often neglected as a cause of chronic abdominal pain. The aim of this study was to identify chronic abdominal wall pain syndromes, such as anterior cutaneous nerve entrapment syndrome (ACNES), in a patient population diagnosed with functional abdominal pain, including irritable bowel syndrome, using a validated 18-item questionnaire as an identification tool. In this cross-sectional analysis, 4 Dutch primary care practices employing physicians who were unaware of the existence of ACNES were selected. A total of 535 patients ≥18 years old who were registered with a functional abdominal pain diagnosis were approached when they were symptomatic to complete the questionnaire (maximum 18 points). Responders who scored at least the 10-point cutoff value (sensitivity, 0.94; specificity, 0.92) underwent a diagnostic evaluation to establish their final diagnosis. The main outcome was the presence and prevalence of ACNES in a group of symptomatic patients diagnosed with functional abdominal pain. Of 535 patients, 304 (57%) responded; 167 subjects (31%) recently reporting symptoms completed the questionnaire. Of 23 patients who scored above the 10-point cutoff value, 18 were available for a diagnostic evaluation. In half of these subjects (n = 9) functional abdominal pain (including IBS) was confirmed. However, the other 9 patients were suffering from abdominal wall pain syndrome, 6 of whom were diagnosed with ACNES (3.6% prevalence rate of symptomatic subjects; 95% confidence interval, 1.7-7.6), whereas the remaining 3 harbored a painful lipoma, an abdominal herniation, and a painful scar. A clinically relevant portion of patients previously diagnosed with functional abdominal pain syndrome in a primary care environment suffers from an abdominal wall pain syndrome such as ACNES.

48 CFR 47.104-1 - Government rate tender procedures.

Science.gov (United States)

2010-10-01

... and 13712 rates are published in Government rate tenders and apply to shipments moving for the account of the Government on— (1) Commercial bills of lading endorsed to show that total transportation charges are assignable to, and will be reimbursed by, the Government (see the clause at 52.247-1...

Pain Catastrophizing and Anxiety are Associated With Heat Pain Perception in a Community Sample of Adults With Chronic Pain.

Science.gov (United States)

Terry, Marisa J; Moeschler, Susan M; Hoelzer, Bryan C; Hooten, W Michael

2016-10-01

The principle aim of this study was to investigate the associations between heat pain (HP) perception, pain catastrophizing, and pain-related anxiety in a heterogenous cohort of community-dwelling adults with chronic pain admitted to a 3-week outpatient pain rehabilitation program. All adults consecutively admitted to an outpatient pain rehabilitation program from July 2009 through January 2011 were eligible for study recruitment (n=574). Upon admission, patients completed the Pain Catastrophizing Scale (PCS), the short version of the Pain Anxiety Symptoms Scale (PASS-20), and HP perception was assessed using a standardized quantitative sensory testing (QST) method of levels. Greater PCS scores were significantly correlated with lower standardized values of HP threshold (HP 0.5) (P=0.006) and tolerance (HP 5) (P=0.003). In a multiple variable model adjusted for demographic and clinical factors known to influence HP perception, every 10-point increase in the PCS was associated with a -0.124 point change in HP 0.5 (P=0.014) and a -0.142 change in HP 5 (P=0.014) indicating that participants with higher PCS scores had lower HP thresholds and tolerances, respectively. Similarly, greater PASS-20 scores significantly correlated with lower standardized values of HP 0.5 and HP 5. In a multiple variable model, every 10-point increase in the PASS-20 was associated with a -0.084 point change in HP 0.5 (P=0.005) and a -0.116 point change in HP 5 (P=0.001) indicating that participants with higher PASS-20 scores had lower HP thresholds and tolerances, respectively. The findings of this study extend the use of a standardized method for assessing HP in a heterogenous sample of adults with chronic pain. Although pain catastrophizing shares significant variance with pain-related anxiety, our findings suggest that either measure would be appropriate for use in future studies that incorporate the QST method of levels.

Invitations to tenders from Hydro-Quebec: many projects, little MW?

International Nuclear Information System (INIS)

Turmel, A.

2004-01-01

Topics discussed include the regulatory and jurisdictional framework governing the tendering process, and the difficulties involved in filing applications. The roles of Hydro-Quebec, the Quebec government, and the Quebec government's economic regulation agency, Regie de l'energie were covered

The Role of Quality in the Adjudication of Public Tenders | Quinot ...

African Journals Online (AJOL)

Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad ... The quality of the goods or services that government procures is obviously a ... tender adjudication as prescribed by public procurement regulation since the ...

Effect of physical training on function of chronically painful muscles: A randomized controlled trial

DEFF Research Database (Denmark)

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

2008-01-01

.01-0.05). While EMG activity of the unaffected deltoid remained unchanged during the maximal contractions, an increase in EMG amplitude (42-86%, Ppower frequency (19%, Ppainful trapezius muscle. Correspondingly, torque increased 18-53% (P...Purpose: Pain and tenderness of the upper trapezius muscle is frequent in several occupational groups. The objective of this study is to investigate the effect of three contrasting interventions on muscle function and pain in women with trapezius myalgia. Methods: A group of employed women (n=42...... and electromyography (EMG) were recorded during maximal shoulder abductions in an isokinetic dynamometer at -60, 60, 0 and 180 degrees (.)s(-1). Further, a submaximal reference contraction with only the load of the arms was performed. Results: Significant changes were observed only in SST. Pain decreased 42-49% (P

[Pain in children: a pediatrician's point of view].

Science.gov (United States)

Bernard, J L; Lautraite, C; Reyes, P; Portas, M

2001-01-01

The interest in the topic of pain in children is increasing within the paediatric community after a long period of misrecognition, often under-valuation, sometimes negligent or even denial. A lack of knowledge concerning pharmacology and toxicity of antalgic drugs and poorly adapted galenic presentations induced delay and complications in their use in children. The recent progress is supported by a better semiology, development of adequate pain scales, availability of adapted drugs, an effort at education of caregivers and public sensitization. In primary care the objective is to lead the practitioner to identify and consider pain in his/her preventive and curative strategies. In hospitals efforts are needed to improve the use of protocols and evaluations, the systematic practice of preventive analgesia and the quality of interprofessional cooperation within care teams. Managed care organizations are today an effective system to promote these practices.

Distinguishing fibromyalgia from rheumatoid arthritis and systemic lupus in clinical questionnaires: an analysis of the revised Fibromyalgia Impact Questionnaire (FIQR) and its variant, the Symptom Impact Questionnaire (SIQR), along with pain locations

Science.gov (United States)

2011-01-01

Introduction The purpose of this study was to explore a data set of patients with fibromyalgia (FM), rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who completed the Revised Fibromyalgia Impact Questionnaire (FIQR) and its variant, the Symptom Impact Questionnaire (SIQR), for discriminating features that could be used to differentiate FM from RA and SLE in clinical surveys. Methods The frequency and means of comparing FM, RA and SLE patients on all pain sites and SIQR variables were calculated. Multiple regression analysis was then conducted to identify the significant pain sites and SIQR predictors of group membership. Thereafter stepwise multiple regression analysis was performed to identify the order of variables in predicting their maximal statistical contribution to group membership. Partial correlations assessed their unique contribution, and, last, two-group discriminant analysis provided a classification table. Results The data set contained information on the SIQR and also pain locations in 202 FM, 31 RA and 20 SLE patients. As the SIQR and pain locations did not differ much between the RA and SLE patients, they were grouped together (RA/SLE) to provide a more robust analysis. The combination of eight SIQR items and seven pain sites correctly classified 99% of FM and 90% of RA/SLE patients in a two-group discriminant analysis. The largest reported SIQR differences (FM minus RA/SLE) were seen for the parameters "tenderness to touch," "difficulty cleaning floors" and "discomfort on sitting for 45 minutes." Combining the SIQR and pain locations in a stepwise multiple regression analysis revealed that the seven most important predictors of group membership were mid-lower back pain (29%; 79% vs. 16%), tenderness to touch (11.5%; 6.86 vs. 3.02), neck pain (6.8%; 91% vs. 39%), hand pain (5%; 64% vs. 77%), arm pain (3%; 69% vs. 18%), outer lower back pain (1.7%; 80% vs. 22%) and sitting for 45 minutes (1.4%; 5.56 vs. 1.49). Conclusions A

Characterizing neuropathic pain profiles: enriching interpretation of painDETECT

Directory of Open Access Journals (Sweden)

Cappelleri JC

2016-07-01

Full Text Available Joseph C Cappelleri,1 Vijaya Koduru,2 E Jay Bienen,3 Alesia Sadosky4 1Pfizer Inc, Groton, CT, USA; 2Eliassen Group, New London, CT, USA; 3Outcomes Research Consultant, New York, NY, USA; 4Pfizer Inc, New York, NY, USA Purpose: To psychometrically evaluate painDETECT, a patient-reported screening questionnaire for neuropathic pain (NeP, for discriminating among sensory pain symptoms (burning, tingling/prickling, light touching, sudden pain attacks/electric shock-type pain, cold/heat, numbness, and slight pressure. Methods: The seven-item version of painDETECT provides an overall score that targets only sensory symptoms, while the nine-item version adds responses on two items to the overall score, covering pain course pattern and pain radiation. Both versions have relevance in terms of characterizing broad NeP. The nine- and seven-item versions of painDETECT were administered to subjects with confirmed NeP across six conditions identified during office visits to US community-based physicians. Responses on the sensory symptom items were dichotomized into “at least moderate” (ie, moderate, strongly, very strongly relative to the combined other responses (never, hardly noticed, slightly. Logistic regression of dichotomized variables on the total painDETECT score provided probabilities of experiencing each symptom across the range of painDETECT scores. Results: Both painDETECT versions discriminated among the symptoms with similar probabilities across the score ranges. Using these data, the probability of moderately experiencing each pain sensory item was estimated for a particular score, providing a pain profile. Additionally, the likelihood of experiencing each sensation was determined for a discrete increase in score, ie, the odds of at least a moderate sensation of burning (versus less than a moderate sensation was 1.29 for a 1-point increase, 3.52 for a 5-point increase, and 12.42 for every 10-point increase in the nine-item painDETECT score

Sexual Activity and Physical Tenderness in Older Adults: Cross-Sectional Prevalence and Associated Characteristics.

Science.gov (United States)

Freak-Poli, Rosanne; Kirkman, Maggie; De Castro Lima, Gustavo; Direk, Nese; Franco, Oscar H; Tiemeier, Henning

2017-07-01

Despite a common misconception, older adults engage in sexual behavior. However, there is limited sexual behavior research in older adults, which is often restricted to small samples, to cohorts recruiting adults from 45 years old, and to questions regarding only sexual intercourse. To assess the cross-sectional prevalence of and characteristics associated with sexual activity and physical tenderness in community-dwelling older adults. From the Rotterdam Study, sexual activity and physical tenderness were assessed in 2,374 dementia-free, community-dwelling men and women at least 65 years old from 2009 through 2012 in the Netherlands. Analyses were stratified by sex and partner status. Sexual activity and physical tenderness (eg, fondling or kissing) in the last 6 months. Potential associated characteristics included measurements of demographics, socioeconomic position, health behavior, and health status. The vast majority of partnered participants (men, n = 858; women, n = 724) had experienced physical tenderness in the previous 6 months (83.7% of men and 82.9% of women) and nearly half had engaged in sexual activity (49.5% and 40.4% respectively). Very few unpartnered women (n = 675) had engaged in sexual activity (1.3%) or physical tenderness (5.2%), whereas prevalence rates were slightly higher for unpartnered men (n = 117; 13.7% or 17.1%). Engaging in sexual behavior was generally associated with younger age, greater social support, healthier behaviors, and better physical and psychological health. Findings show that older adults engage in sexual activity. It is important not to assume that an older person is not interested in sexual pleasure or that an older person is unhappy with not having a sexual partner. Offering an opportunity for open discussion of sexuality and medical assistance without imposing is a difficult balance. We encourage health care professionals to proactively address sexuality and extend knowledge about safe sex and sexual function

LEGAL AND TAX TREATMENT OF THE ASSOCIATIONS FOR THE PARTICIPATION IN TENDERS

Directory of Open Access Journals (Sweden)

Alina Bilan

2017-12-01

Full Text Available The participation of groups of economic operators with joint tender to public procurement procedures requires the conclusion of association agreements published together with the procurement documents by the contracting authorities. The contracting authorities often require these temporary associations specific legal forms, similar to joint ventures, or certain conditions concerning their organisation and functioning. This present study analyses the associations for participation to public tenders in light of public procurement and fiscal legislation, trying to asses if these contracts are joint venture agreements, to what extent the clauses comprised in the drafts imposed in the procuremnt documents are compatible with the public procurement and fiscal laws and if they may be challenged by the economic operators.

The London Fibromyalgia Epidemiology Study: comparing the demographic and clinical characteristics in 100 random community cases of fibromyalgia versus controls.

Science.gov (United States)

White, K P; Speechley, M; Harth, M; Ostbye, T

1999-07-01

To identify demographic and clinical features that distinguish fibromyalgia (FM) from other chronic widespread pain. We identified 100 confirmed FM cases, 76 widespread pain controls, and 135 general controls in a random community survey of 3395 noninstitutionalized adults living in London, Ontario. FM cases were distinguished from pain controls using the 1990 American College of Rheumatology (ACR) classification criteria for FM. The mean age of FM cases was 47.8 years (range 19 to 86), the same as for pain controls; 86% of FM cases were female versus 67.1% of pain controls (p < 0.01). FM cases were less educated than general controls (p = 0.03). Male and female FM cases were similar, except females were older and reported more major symptoms (both p = 0.02). FM cases reported more severe pain and fatigue, more symptoms, more major symptoms, and worse overall health than pain controls or general controls. The most commonly reported major symptoms among FM cases were musculoskeletal pain (77.3%), fatigue (77.3%), severe fatigue lasting 24 h after minimal activity (77.0%), nonrestorative sleep (65.7%), and insomnia (56.0%). Subjects with 11-14 tender points were more similar to those with 15-18 tender points than to those with 7-10 points in 11 of 14 clinical variables. On multivariate analysis, 4 symptoms distinguished FM cases from pain controls: pain severity (p = 0.004), severe fatigue lasting 24 h after minimal activity (p = 0.006), weakness (p = 0.008), and self-reported swelling of neck glands (p = 0.01). In the general population, adults who meet the ACR definition of FM appear to have distinct features compared to those with chronic widespread pain who do not meet criteria.

Mechanical pain sensitivity of deep tissues in children - possible development of myofascial trigger points in children

Directory of Open Access Journals (Sweden)

Han Ting-I

2012-02-01

Full Text Available Abstract Background It is still unclear when latent myofascial trigger points (MTrPs develop during early life. This study is designed to investigate the mechanical pain sensitivity of deep tissues in children in order to see the possible timing of the development of latent MTrPs and attachment trigger points (A-TrPs in school children. Methods Five hundreds and five healthy school children (age 4- 11 years were investigated. A pressure algometer was used to measure the pressure pain threshold (PPT at three different sites in the brachioradialis muscle: the lateral epicondyle at elbow (site A, assumed to be the A-TrP site, the mid-point of the muscle belly (site B, assumed to be the MTrP site, and the muscle-tendon junction as a control site (site C. Results The results showed that, for all children in this study, the mean PPT values was significantly lower (p p Conclusions It is concluded that a child had increased sensitivity at the tendon attachment site and the muscle belly (endplate zone after age of 4 years. Therefore, it is likely that a child may develop an A-Trp and a latent MTrP at the brachioradialis muscle after the age of 4 years. The changes in sensitivity, or the development for these trigger points, may not be related to the activity level of children aged 7-11 years. Further investigation is still required to indentify the exact timing of the initial occurrence of a-Trps and latent MTrPs.

Proposal to negotiate, without competitive tendering, a blanket contract for an instant-reading dosimeter system

CERN Document Server

2003-01-01

This document concerns the award of a contract, without competitive tendering, for the supply, installation and maintenance of an instant-reading dosimeter system. Following a market survey (MS-3118/TIS) carried out among 28 firms in eleven Member States, a request for a quotation was sent to one firm on 3 October 2003. The Finance Committee is invited to agree to the negotiation of a blanket contract, without competitive tendering, with RADOS TECHNOLOGY (FI) for the supply, installation and maintenance of an instant-reading dosimeter system for a total amount not exceeding 2 100 000 euros (3 252 284 Swiss francs), subject to revision for inflation after 1 January 2007. The rate of exchange used is that stipulated in the tender. The firm has indicated the following distribution by country of the contract value covered by this adjudication proposal: FI - 58%; CH - 38%; GB - 4%.

Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods.

Science.gov (United States)

Gerbershagen, H J; Rothaug, J; Kalkman, C J; Meissner, W

2011-10-01

Cut-off points (CPs) of the numeric rating scale (NRS 0-10) are regularly used in postoperative pain treatment. However, there is insufficient evidence to identify the optimal CP between mild and moderate pain. A total of 435 patients undergoing general, trauma, or oral and maxillofacial surgery were studied. To determine the optimal CP for pain treatment, four approaches were used: first, patients estimated their tolerable postoperative pain intensity before operation; secondly, 24 h after surgery, they indicated if they would have preferred to receive more analgesics; thirdly, satisfaction with pain treatment was analysed, and fourthly, multivariate analysis was used to calculate the optimal CP for pain intensities in relation to pain-related interference with movement, breathing, sleep, and mood. The estimated tolerable postoperative pain before operation was median (range) NRS 4.0 (0-10). Patients who would have liked more analgesics reported significantly higher average pain since surgery [median NRS 5.0 (0-9)] compared with those without this request [NRS 3.0 (0-8)]. Patients satisfied with pain treatment reported an average pain intensity of median NRS 3.0 (0-8) compared with less satisfied patients with NRS 5.0 (2-9). Analysis of average postoperative pain in relation to pain-related interference with mood and activity indicated pain categories of NRS 0-2, mild; 3-4, moderate; and 5-10, severe pain. Three of the four methods identified a treatment threshold of average pain of NRS≥4. This was considered to identify patients with pain of moderate-to-severe intensity. This cut-off was indentified as the tolerable pain threshold.

Effects of natural plant tenderizers on proteolysis and texture of dry ...

African Journals Online (AJOL)

, and overall acceptability. From these results, it is shown that those enzymes as a raw plant juices could be used as tenderizers in dry sausage production. Keywords: Dry sausages, wild boar meat, plant enzymes, proteolysis, texture, sensory ...

Do sarcomere length, collagen content, pH, intramuscular fat and desmin degradation explain variation in the tenderness of three ovine muscles?

Science.gov (United States)

Starkey, Colin P; Geesink, Geert H; Collins, Damian; Hutton Oddy, V; Hopkins, David L

2016-03-01

The longissimus (n=118) (LL), semimembranosus (n=104) (SM) and biceps femoris (n=134) (BF) muscles were collected from lamb and sheep carcases and aged for 5days (LL and SM) and 14days (BF) to study the impact of muscle characteristics on tenderness as assessed by shear force (SF) and sensory evaluation. The impact of gender, animal age, collagen content, sarcomere length (SL), desmin degradation, ultimate pH and intramuscular fat (IMF) on tenderness was examined. The main factors which influenced SF of the LL were IMF, SL and desmin degradation, but for sensory tenderness, IMF, ultimate pH and gender were the main factors. The SF and sensory tenderness of the SM was best predicted by the degree of desmin degradation. For the BF soluble collagen and animal age both influenced SF. Different factors affect tenderness across muscles and not one prediction model applied across all muscles equally well. Copyright © 2015 Elsevier Ltd. All rights reserved.

Culture, science and the changing nature of fibromyalgia.

Science.gov (United States)

Wolfe, Frederick; Walitt, Brian

2013-12-01

Fibromyalgia is a common but contested illness. Its definition and content have changed repeatedly in the 110 years of its existence. The most important change was the requirement for multiple tender points and extensive pain that arose in the 1980s, features that were not required previously. By 2010, a second shift occurred that excluded tender points, allowed less extensive pain, and placed reliance on patient-reported somatic symptoms and cognitive difficulties ('fibro fog') that had never been part of past definitions or content. Fibromyalgia is closely allied with and often indistinguishable from neurasthenia, a disorder of the late 19th and early 20th centuries that lost favour when it was perceived as being a psychological illness. Fibromyalgia's status as a 'real disease', rather than a psychocultural illness, is buttressed by social forces that include support from official criteria, patient and professional organizations, pharmaceutical companies, disability access, and the legal and academic communities.

Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder?

Science.gov (United States)

Bagis, Selda; Tamer, Lulufer; Sahin, Gunsah; Bilgin, Ramazan; Guler, Hayal; Ercan, Bahadir; Erdogan, Canan

2005-04-01

The role of free radicals in fibromyalgia is controversial. In this study, 85 female patients with primary fibromyalgia and 80 age-, height-, and weight-matched healthy women were evaluated for oxidant/antioxidant balance. Malondialdehyde is a toxic metabolite of lipid peroxidation used as a marker of free radical damage. Superoxide dismutase is an intracellular antioxidant enzyme and shows antioxidant capacity. Pain was assessed by visual analog scale. Tender points were assessed by palpation. Age, smoking, body mass index (BMI), and duration of disease were also recorded. Malondialdehyde levels were significantly higher and superoxide dismutase levels significantly lower in fibromyalgic patients than controls. Age, BMI, smoking, and duration of disease did not affect these parameters. We found no correlation between pain and number of tender points. In conclusion, oxidant/antioxidant balances were changed in fibromyalgia. Increased free radical levels may be responsible for the development of fibromyalgia. These findings may support the hypothesis of fibromyalgia as an oxidative disorder.

The Effect of Dry Needling of the Trigger Points of Shoulder Muscles on Pain and Grip Strength in Patients with Lateral Epicondylitis: A Pilot Study

Directory of Open Access Journals (Sweden)

Alireza Kheradmandi

2015-09-01

Full Text Available Background: Lateral epicondylitis, also known as tennis elbow, is the most common overuse syndrome of the elbow. The severity of pain may not be directly caused by tendinopathy of wrist extensors since trigger points of the shoulder muscles have a referral zone in the arm and elbow. Therefore the aim of this study was to evaluate the effect of dry needling of shoulder myofascial trigger points on wrist extensors muscles pain and function. Methods: Fourteen female patients with tennis elbow (aged 20 - 45 years old were recruited after primary evaluation by an orthopedist. They entered the study if they had pain in the lateral aspect of elbow of the dominant hand for more than 3 months along with the presence of myofascial trigger points in any muscles of supra spinatus, infra spinatus, sub scapularis or scalenes. Pain pressure threshold, maximal grip force and pain intensity of the hand extensors on lateral epicondyle of elbow were measured before and after treatment. Pain intensity was measured on a one to ten scale of visual analogue scale (VAS. A hand dynamometer used to measure the maximal grip force value of the affected hand in 0˚shoulder flexion/ abduction, 90˚ elbow extension and mid-poison of forearm in sitting position. A pressure algometer was applied on hand extensor muscles to define their trigger point sensitivity. For the control group, treatment regimens consisted of routine physical therapy of tennis elbow. This regime was accompanied by dry needling of mentioned muscles for the intervention group. Wilcoxon and Mann-Whitney non-parametric tests were used for statistical analysis. Results: Comparison of the results after intervention showed that the patients’ pain significantly decreased in both groups (P<0.001; but the patient’s PPT and grip force significantly increased solely in the intervention group (P<0.05. Mann Whitney test showed significant pain differences in both groups (P=0.001. The comparison of differences

Examining Changes in Central and Peripheral Pain as Mediates of Fatigue Improvement: Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis.

Science.gov (United States)

Druce, Katie L; Jones, Gareth T; Macfarlane, Gary J; Basu, Neil

2016-07-01

Following anti-tumor necrosis factor (anti-TNF) therapy, improvements in rheumatoid arthritis (RA) fatigue are driven by reductions in pain. However, therapies may modify both central and peripheral pain. This study sought to examine the hypothesis that reductions in fatigue after anti-TNF therapy reflect changes in central, not peripheral, pain mechanisms. Data came from patients with severe baseline fatigue (Short Form 36 health survey [SF-36] vitality scale ≤12.5; n = 2,652), recruited to the British Society for Rheumatology Biologics Register for RA for commencing anti-TNF therapies between October 2000 and November 2008. Data of interest comprised change over 6 months in fatigue, pain (SF-36 bodily pain scale), and disease activity constituents (Disease Activity Score in 28 joints, erythrocyte sedimentation rate [ESR], global health, swollen joints, and tender joints). Principal components factor analysis with varimax rotation determined latent variables of symptom change; variables were accepted provided they had eigenvalues ≥1. Six factors were identified, of which 2 met acceptance criteria (eigenvalues of 2.39 and 1.14, respectively). Following rotation, loadings indicated that factor 1 comprised markers of peripheral inflammation: change in ESR, swollen joints, tender joints, and global health. This distinct loading led to factor 1 being labeled peripheral inflammation. Conversely, factor 2 comprised change in pain, fatigue, and global health and an absence of peripheral inflammation markers and was therefore labeled central inflammation. Following anti-TNF therapies, reductions in fatigue and pain appear to reflect improvements in central, rather than peripheral, inflammation. Therefore, for those seeking to treat fatigue via pain mechanisms, improvements may be maximized by the application of treatment modalities that effectively target central mechanisms. © 2016, American College of Rheumatology.

[Sacroiliac joint dysfunction presented with acute low back pain: three case reports].

Science.gov (United States)

Hamauchi, Shuji; Morimoto, Daijiro; Isu, Toyohiko; Sugawara, Atsushi; Kim, Kyongsong; Shimoda, Yusuke; Motegi, Hiroaki; Matsumoto, Ryoji; Isobe, Masanori

2010-07-01

Sacroiliac joint (SIJ) can cause low back pain when its joint capsule and ligamentous tissue are damaged. We report our experience in treating three SIJ dysfunction patients presenting with acute low back pain (a 38 year-old male, a 24 year-old male, and a 32 year-old female). SIJ dysfunction was diagnosed using the one-finger test, the modified Newton test, and SIJ injection. In all three patients, lumbar MRI demonstrated slightly degenerated lumbar lesions (lumbar canal stenosis, lumbar disc hernia). Two patients had paresthesia or pain in the leg and all three patients showed iliac muscle tenderness in the groin, which was thought to be a referred symptom because of improvement after SIJ injection. The two male patients returned to work and the problems have not recurred. Although our female patient resumed daily life as a housewife, her condition recurred at intervals of 2-3 months and she required regular SIJ injections. The prevalence of SIJ dysfunction of low back pain is about 10%, so it should be considered as a differential diagnosis when treating low back pain and designing treatment for lumbar spinal disorders.

Multiple active myofascial trigger points and pressure pain sensitivity maps in the temporalis muscle are related in women with chronic tension type headache.

Science.gov (United States)

Fernández-de-las-Peñas, César; Caminero, Ana B; Madeleine, Pascal; Guillem-Mesado, Amparo; Ge, Hong-You; Arendt-Nielsen, Lars; Pareja, Juan A

2009-01-01

To describe the common locations of active trigger points (TrPs) in the temporalis muscle and their referred pain patterns in chronic tension type headache (CTTH), and to determine if pressure sensitivity maps of this muscle can be used to describe the spatial distribution of active TrPs. Forty women with CTTH were included. An electronic pressure algometer was used to assess pressure pain thresholds (PPT) from 9 points over each temporalis muscle: 3 points in the anterior, medial and posterior part, respectively. Both muscles were examined for the presence of active TrPs over each of the 9 points. The referred pain pattern of each active TrP was assessed. Two-way analysis of variance detected significant differences in mean PPT levels between the measurement points (F=30.3; P<0.001), but not between sides (F=2.1; P=0.2). PPT scores decreased from the posterior to the anterior column (P<0.001). No differences were found in the number of active TrPs (F=0.3; P=0.9) between the dominant side the nondominant side. Significant differences were found in the distribution of the active TrPs (chi2=12.2; P<0.001): active TrPs were mostly found in the anterior column and in the middle of the muscle belly. The analysis of variance did not detect significant differences in the referred pain pattern between active TrPs (F=1.1, P=0.4). The topographical pressure pain sensitivity maps showed the distinct distribution of the TrPs indicated by locations with low PPTs. Multiple active TrPs in the temporalis muscle were found, particularly in the anterior column and in the middle of the muscle belly. Bilateral posterior to anterior decreased distribution of PPTs in the temporalis muscle in women with CTTH was found. The locations of active TrPs in the temporalis muscle corresponded well to the muscle areas with lower PPT, supporting the relationship between multiple active muscle TrPs and topographical pressure sensitivity maps in the temporalis muscle in women with CTTH.

Effectiveness of trigger point dry needling for plantar heel pain: study protocol for a randomised controlled trial

Directory of Open Access Journals (Sweden)

Landorf Karl B

2011-01-01

be reported in accordance with the Consolidated Standards of Reporting Trials and the Standards for Reporting Interventions in Clinical Trials of Acupuncture guidelines. The findings from this trial will provide evidence for the effectiveness of trigger point dry needling for plantar heel pain. Trial registration Australian New Zealand 'Clinical Trials Registry'. ACTRN12610000611022.

Extent and characteristics of self-reported pain in patients with systemic lupus erythematosus.

Science.gov (United States)

Waldheim, E; Elkan, A-C; Bergman, S; Frostegård, J; van Vollenhoven, R; Henriksson, E Welin

2013-02-01

Patients' own experiences of subjective symptoms are scarcely covered, and the objective of this study was to investigate the extent and characteristics of self-reported pain in patients with systemic lupus erythematosus (SLE). This study comprised a cross-sectional design where 84 patients with SLE were asked to complete self-assessments: visual analogue scale of pain and the Short-Form McGill Pain Questionnaire. Medical assessments, including ESR, SLAM, SLEDAI, and SLICC, were also performed. Of the study population, 24% reported higher levels of SLE-related pain (≥40 mm on VAS). This group had a significantly shorter disease duration, higher ESR, and higher disease activity, according to the SLAM and SLEDAI, compared to the rest of the study population. This group mainly used the words "tender," "aching," and "burning" to describe moderate and severe pain, and they used a greater number of words to describe their pain. Of the patients with higher levels of pain, 70% reported their present pain as "distressing." The most common pain location for the whole patient population was the joints. Patients rated their disease activity significantly higher than physicians did. These findings expand the current knowledge of the extent of SLE-related pain and how patients perceive this pain. The results can contribute to affirmative, supportive and caring communication and especially highlight SLE-related pain in patients with a short disease duration and high disease activity.

The transformation of the tender evaluation process in public procurement in Poland

Science.gov (United States)

Plebankiewicz, E.; Kozik, R.

2017-10-01

Procedures regarding the evaluation of tenders have been changed since the public procurement law was enacted (it came into force in January 1, 1995). The contracting authority could apply both the criteria related to the qualities of the contractor and those related to the to the subject - matter of public contract. Two extensive amendments in 2001 and a government project introduced vital regulations and excluded the possibility of applying criteria related to the qualities of the contractor. Act of 29 January 2004 Public Procurement Law allowed to use price as the sole contract award criterion. The changes in the Law in 2014 restricted that possibility to the situation in which the subject matter of a contract is commonly available and has established quality standards. The Act of 22 June 2016 amending the Public Procurement Law Act and some other laws introduced the new criteria list and limited the importance of the price criterion in the certain situations. Instead of price, the cost can also be a criterion for tender evaluation. The cost criterion can be determined using life cycle costing. In the paper, based on contract notices of open tendering published in the Public Procurement Bulletin, the criteria of construction contract selection will be analysed. In particular the effectiveness of changes in the Procurement Law will be researched.

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

Science.gov (United States)

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

2015-01-01

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

McMurray's Test and Joint Line Tenderness for Medial Meniscus ...

African Journals Online (AJOL)

The wide variations reported have an impact on clinical decision concerning whether to go for other diagnostic tests before going for diagnostic arthroscopy, which is considered as the gold standard.The purpose of this study was to determine the diagnostic value of Joint line tenderness and McMurray's test, as clinical signs ...

Electrical stimulation affects metabolic enzyme phosphorylation, protease activation and meat tenderization in beef

DEFF Research Database (Denmark)

Li, C.B.; Li, J.; Zhou, G.H.

2012-01-01

The objective of this study was to investigate the response of sarcoplasmic proteins in bovine longissimus muscle to low-voltage electrical stimulation (ES, 80 V, 35 s) after dressing and its contribution to meat tenderization at early postmortem time. Proteome analysis showed that ES resulted...... muscles up to 24 h. Immunohistochemistry and transmission electron microscopy further indicated that lysosomal enzymes were released at early postmortem time. ES also induced ultrastructural disruption of sarcomeres. In addition, ES accelerated (P ..., as well as pH decline and more preferred pH/temperature decline mode. Finally, ES accelerated meat tenderization with lower (P time. A possible relationship was suggested between change in phosphorylation level of energy metabolic enzymes and postmortem...

Prevalence of and referred pain from myofascial trigger points in the forearm muscles in patients with lateral epicondylalgia.

Science.gov (United States)

Fernández-Carnero, Josué; Fernández-de-Las-Peñas, César; de la Llave-Rincón, Ana Isabel; Ge, Hong-You; Arendt-Nielsen, Lars

2007-05-01

Referred pain and pain characteristics evoked from the extensor carpi radialis brevis, extensor carpi radialis longus, extensor digitorum communis, and brachioradialis muscles was investigated in 20 patients with lateral epicondylalgia (LE) and 20-matched controls. Both groups were examined for the presence of myofascial trigger points (TrPs) in a blinded fashion. The quality and location of the evoked referred pain, and the pressure pain threshold (PPT) at the lateral epicondyle on the right upper extremity (symptomatic side in patients, and dominant-side on controls) were recorded. Several lateral elbow pain parameters were also evaluated. Within the patient group, the elicited referred pain by manual exploration of 13 out of 20 (65%) extensor carpi radialis brevis muscles, 12/20 (70%) extensor carpi radialis longus muscles, 10/20 (50%) brachioradialis muscles, and 5/20 (25%) extensor digitorum communis muscles, shares similar pain patterns as their habitual lateral elbow and forearm pain. The mean number of muscles with TrPs for each patient was 2.9 [95% confidence interval (CI) 1,4] of which 2 (95% CI 1,3) were active, and 0.9 (95% CI 0,2) were latent TrPs. Control participants only had latent TrPs (mean: 0.4; 95% CI 0,2). TrP occurrence between the 2 groups was significantly different for active TrPs (P0.05). The referred pain pattern was larger in patients than in controls, with pain referral to the lateral epicondyle (proximally) and to the dorso-lateral aspect of the forearm in the patients, and confined to the dorso-lateral aspect of the forearm in the controls. Patients with LE showed a significant (Plateral epicondyle was negatively correlated with both the total number of TrPs (rs=-0.63; P=0.003) and the number of active TrPs (rs=-0.5; P=0.02): the greater the number of active TrPs, the lower the PPT at the lateral epicondyle. Our results suggest that in patients with LE, the evoked referred pain and its sensory characteristics shared similar patterns

Analgesic efficacy of ultrasound identified trigger point injection in myofascial pain syndrome: A pilot study in Indian patients

Directory of Open Access Journals (Sweden)

S Parthasarathy

2016-01-01

Full Text Available Background: Myofascial pain syndrome (MPS is described as sensory symptoms, sometimes with motor and autonomic symptoms caused by myofascial trigger points (TPs. Injection at TPs is most likely to benefit patients with such disorder. The identification of TPs is usually clinical. However, in sites where there are major vital structures, ultrasound guidance and real-time visualization may help in decreasing complications. Methodology: Twenty patients who presented to pain clinic with classic symptoms of MPS in the neck and shoulder area with clinically detectable TPs were selected. The points were imaged with ultrasound to find correlation with clinical positions. They were injected with a mixture of local anesthetic and steroid on TPs with real-time ultrasound guidance and needle visualization. Pretreatment visual analog scale (VAS scores and posttreatment (immediate and after 1 month were noted. The mean reduction in VAS scores was analyzed with paired Student′s t-test. Any side effect was observed and managed. Results: Clinically detectable TPs coincided with an echogenic point on the undersurface of the trapezius. There was a significant reduction in pain scores at both times. The needle sign was positive in all the cases. There were no major complications. Conclusion: The clinically identified TPs in trapezius muscle coincided well with ultrasound imaged echogenic structure in the muscle in all the cases. Ultrasound-assisted injections also produced the needle sign in all the cases. The achieved analgesia both immediately after the injection and a month later was satisfactory in the majority of cases. The echogenic mass corresponding to the TP is found to be on the undersurface of the muscle rather than inside the mass of the muscle.

Tendering by municipalities of wind turbines; Aanbesteding door gemeenten van windmolens

Energy Technology Data Exchange (ETDEWEB)

NONE

2013-04-15

This manual provides municipalities answers to the questions of how the municipality must do the tendering for wind turbines and what choices they have [Dutch] Deze handleiding biedt gemeenten antwoorden op de vragen hoe de gemeente moet aanbesteden en welke keuzes zij daarin heeft.

Abnormal muscle membrane function in fibromyalgia patients and its relationship to the number of tender points

NARCIS (Netherlands)

Klaver-Krol, E.G.; Zwarts, M.J.; ten Klooster, Peter M.; Rasker, Johannes J.

2012-01-01

Objective. Fibromyalgia (FM) is a disorder characterised by chronic widespreadpain in soft tissues, especially in muscles. Previous research has demonstrateda higher muscle fibre conduction velocity (CV) in painful muscles of FM patients. The primary goal of this study was to investigate whether

Tenderization effect of soy sauce on beef M. biceps femoris.

Science.gov (United States)

Kim, Hyun-Wook; Choi, Yun-Sang; Choi, Ji-Hun; Kim, Hack-Youn; Lee, Mi-Ai; Hwang, Ko-Eun; Song, Dong-Heon; Lim, Yun-Bin; Kim, Cheon-Jei

2013-08-15

This study was conducted to evaluate the tenderization effect of soy sauce on beef M. biceps femoris (BF). Five marinades were prepared with 4% (w/v) sodium chloride and 25% (w/v) soy sauce solutions (4% salt concentration) and mixed with the ratios of 100:0 (S0, pH 6.52), 75:25 (S25, 5.40) 50:50 (S50, 5.24), 25:75 (S75, 5.05), and 0:100 (S100, 4.85), respectively. The BF samples which were obtained from Hanwoo cows at 48 h postmortem (n=24) were marinated with five marinades for 72 h at 4°C (1:4 w/w), and the effects of soy sauce on tenderness were evaluated. Soy sauce marination resulted in a decrease in the pH value of the BF sample. However, there were no significant differences in the water holding capacity (Psauce may attribute various mechanisms such as increased collagen solubility or proteolysis which depend on soy sauce level in marinade. Copyright © 2013 Elsevier Ltd. All rights reserved.

Supply Chain Planning for a Timber Harvesting Plus Sale Tender

Directory of Open Access Journals (Sweden)

Josef Holoubek

2015-01-01

Full Text Available Since 2010, the Czech State Forest Enterprise has been inviting timber-harvesting tenders while insisting on the forestry company purchasing the timber from the felled trees as well. To win, a tender must offer the greatest difference between the price of the timber purchased and the cost of the operations. Thus, the forest companies are now facing new problem: apart from minimizing the logging costs they are searching for a cross-cutting and mill-distribution strategy that maximizes the selling price of the harvested timber. The optimization model devised by the present paper provides support for finding an optimal timber selling strategy and, as an important contribution, include a detailed plan for cross-cutting the logs and assign them to the particular customers. We keep the support accessible via common office software and the cross-cutting and customer-assigning problem is formulated as a linear programming model for EXCEL, a particular real-world problem is solved and, using expert comparison, the model appears to provide very good results.

Effectiveness of trigger point dry needling for plantar heel pain: a meta-analysis of seven randomized controlled trials

Directory of Open Access Journals (Sweden)

He C

2017-08-01

Full Text Available Chunhui He,1,* Hua Ma2,* 1Internal Medicine of Traditional Chinese Medicine, 2Medical Image Center, The First Affiliated Hospital of Xinjiang Medical University, Wulumuqi, People’s Republic of China *These authors contributed equally to this work Background: Plantar heel pain can be managed with dry needling of myofascial trigger points (MTrPs; however, whether MTrP needling is effective remains controversial. Thus, we conducted this meta-analysis to evaluate the effect of MTrP needling in patients with plantar heel pain. Materials and methods: PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, People’s Republic of China, and CNKI (National Knowledge Infrastructure, People’s Republic of China databases were systematically reviewed for randomized controlled trials (RCTs that assessed the effects of MTrP needling. Pooled weighted mean difference (WMD with 95% CIs were calculated for change in visual analog scale (VAS score, and pooled risk ratio (RR with 95% CIs were calculated for success rate for pain and incidence of adverse events. A fixed-effects model or random-effects model was used to pool the estimates, depending on the heterogeneity among the included studies. Results: Extensive literature search yielded 1,941 articles, of which only seven RCTs met the inclusion criteria and were included in this meta-analysis. The pooled results showed that MTrP needling significantly reduced the VAS score (WMD =–15.50, 95% CI: –19.48, –11.53; P<0.001 compared with control, but it had a similar success rate for pain with control (risk ratio [RR] =1.15, 95% CI: 0.87, 1.51; P=0.320. Moreover, MTrP needling was associated with a similar incidence of adverse events with control (RR =1.89, 95% CI: 0.38, 9.39; P=0.438. Conclusion: MTrP needling effectively reduced the heel pain due to plantar fasciitis. However, considering the potential limitations in this study, more large-scale, adequately powered, good

Arthroscopic resection of humeroradial synovial plica for persistent lateral elbow pain.

Science.gov (United States)

Rajeev, Aysha; Pooley, Joesph

2015-04-01

To review the outcome of 121 patients who underwent arthroscopic resection of a humeroradial synovial plica for persistent lateral elbow pain. 92 men and 29 women aged 24 to 56 (mean, 38) years with chronic lateral elbow pain underwent arthroscopic resection of a humeroradial synovial plica using a motorised soft tissue shaver, followed by intensive physiotherapy. The modified elbow score and range of motion were assessed, as were wound healing, infection, soft tissue swelling or effusion, tenderness, ligamentous instability, and motor strength. No patient had any ligamentous instability. 80 patients were pain-free at 3 months; only 3 patients were taking pain medication at 6 months. All patients had full pronation and supination; the mean range of motion was 3º to 135º of flexion. The mean modified elbow score at 12 months was 93.2 (range, 72-100). The percentages of patients with excellent, good, fair, and poor score were 70%, 17%, 8%, and 5% at 3 months, 74%, 20%, 3%, and 3% at 6 months, and 76%, 18%, 3%, and 3% at 12 months, respectively. A humeroradial synovial plica is one of the causes of chronic lateral elbow pain. Arthroscopic resection of the synovial plica followed by intensive physiotherapy achieved good outcome.

Trajectory of phantom limb pain relief using mirror therapy: Retrospective analysis of two studies.

Science.gov (United States)

Griffin, Sarah C; Curran, Sean; Chan, Annie W Y; Finn, Sacha B; Baker, Chris I; Pasquina, Paul F; Tsao, Jack W

2017-04-01

Research indicates that mirror therapy reduces phantom limb pain (PLP). Objectives were to determine when mirror therapy works in those who respond to treatment, the relevance of baseline PLP to when pain relief occurs, and what pain symptoms respond to mirror therapy. Data from two independent cohorts with unilateral lower limb amputation were analyzed for this study (n=33). Mirror therapy consisted of 15-min sessions in which amputees performed synchronous movements of the phantom and intact legs/feet. PLP was measured using a visual analogue scale and the Short-Form McGill Pain Questionnaire. The severity of PLP at the beginning of treatment predicted when pain relief occurred. Those with low baseline PLP experienced a reduction (ppain relief by session 14 of treatment, and those with high baseline PLP experienced pain relief by session 21 of treatment. Mirror therapy reduced throbbing, shooting, stabbing, sharp, cramping, aching, tender, splitting, tiring/exhausting, and punishing-cruel pain symptoms. The degree of PLP at baseline predicts when mirror therapy relieves pain. This article indicates that the degree of baseline PLP affects when mirror therapy relieves pain: relief occurs by session 7 in patients with low PLP but by session 21 in patients with high PLP. Clinicians should anticipate slower pain relief in patients who begin treatment with high levels of pain. ClinicalTrials.gov numbers:NCT00623818 and NCT00662415. Copyright © 2017 Scandinavian Association for the Study of Pain. All rights reserved.

SHORT-TERM EFFECTS OF INSTRUMENT-ASSISTED SOFT TISSUE MOBILIZATION ON PAIN FREE RANGE OF MOTION IN A WEIGHTLIFTER WITH SUBACROMIAL PAIN SYNDROME.

Science.gov (United States)

Coviello, Joseph Paul; Kakar, Rumit Singh; Reynolds, Timothy James

2017-02-01

While there is limited evidence supporting the use of soft tissue mobilization techniques for Subacromial Pain Syndrome (SAPS), synonymous with subacromial impingement syndrome, previous studies have reported successful outcomes using soft tissue mobilization as a treatment technique. The purpose of this case report is to document the results of Instrument-Assisted Soft Tissue Mobilization (IASTM) for the treatment of SAPS. Diagnosis was reached based on the subject's history, tenderness to palpation, and four out of five positive tests in the diagnostic cluster. Treatment consisted of three visits where the IASTM technique was applied to the pectoral muscles as well as periscapular musculature followed by retesting pain-free shoulder flexion active range of motion (AROM) and Numerical Pain Rating Scale (NPRS) during active shoulder flexion. Scapulothoracic mobilization and stretching were performed after AROM measurement. The subject reported an NPRS of 0/10 and demonstrated improvements in pain free flexion AROM in each of the three treatment sessions post-IASTM: 85 ° to 181 °, 110 ° to 171 °, and 163 ° to 174 ° with some carryover in pain reduction and pain free AROM to the next treatment. Through three treatments, DASH score improved by 17.34%, Penn Shoulder Score improved 29%, worst NPRS decreased from 4/10 to 0/10, and a GROC score of 6. IASTM may have a beneficial acute effect on pain free shoulder flexion. In conjunction with scapulothoracic mobilizations and stretching, IASTM may improve function, decrease pain, and improve patient satisfaction. While this technique will not ameliorate the underlying pathomechanics contributing to SAPS, it may serve as a valuable tool to restore ROM and decrease pain allowing the patient to reap the full benefits of a multi-modal treatment approach. 5.

Ripasa score: a new diagnostic score for diagnosis of acute appendicitis

International Nuclear Information System (INIS)

Butt, M.Q.

2014-01-01

Objective: To determine the usefulness of RIPASA score for the diagnosis of acute appendicitis using histopathology as a gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Kohat, from September 2011 to March 2012. Methodology: A total of 267 patients were included in this study. RIPASA score was assessed. The diagnosis of appendicitis was made clinically aided by routine sonography of abdomen. After appendicectomies, resected appendices were sent for histopathological examination. The 15 parameters and the scores generated were age (less than 40 years = 1 point; greater than 40 years = 0.5 point), gender (male = 1 point; female = 0.5 point), Right Iliac Fossa (RIF) pain (0.5 point), migration of pain to RIF (0.5 point), nausea and vomiting (1 point), anorexia (1 point), duration of symptoms (less than 48 hours = 1 point; more than 48 hours = 0.5 point), RIF tenderness (1 point), guarding (2 points), rebound tenderness (1 point), Rovsing's sign (2 points), fever (1 point), raised white cell count (1 point), negative urinalysis (1 point) and foreign national registration identity card (1 point). The optimal cut-off threshold score from the ROC was 7.5. Sensitivity analysis was done. Results: Out of 267 patients, 156 (58.4%) were male while remaining 111 patients (41.6%) were female with mean age of 23.5 +- 9.1 years. Sensitivity of RIPASA score was 96.7%, specificity 93.0%, diagnostic accuracy was 95.1%, positive predictive value was 94.8% and negative predictive value was 95.54%. Conclusion: RIPASA score at a cut-off total score of 7.5 was a useful tool to diagnose appendicitis, in equivocal cases of pain. (author)

Comparison of the Effect of Dry Cupping Therapy and Acupressure at BL23 Point on Intensity of Postpartum Perineal Pain Based on the Short Form of McGill Pain Questionnaire.

Science.gov (United States)

Akbarzade, Marzieh; Ghaemmaghami, Mehrnoush; Yazdanpanahi, Zahra; Zare, Najaf; Mohagheghzadeh, Abdolali; Azizi, Amir

2016-01-01

Perineal pain is a major morbidity in the first few days after delivery. This study aimed to investigate the effect of dry cupping therapy and acupressure at BL23 point on the intensity of postpartum perineal pain based on the short-form of McGill pain questionnaire (SMPQ). The present clinical trial was conducted on 150 subjects in 3 groups of 50 cases. After at least 4-8 hr of delivery, cupping therapy was performed for 15-20 min up to 3 times a week (once a day) and acupressure was performed for 15-20 min based on clockwise model. The short-form of McGill pain questionnaire was completed both before and after the intervention. The SPSS statistical software was used to analyze the data using repeated measures ANOVA. Besides, pcupping therapy group, mean of the perineal pain intensity reduced from 37.5±6.8 before the intervention to 11.1±6.1, 6.9±4.7, and 3.8±3.6 immediately, 24 hr, and 2 weeks after the intervention, respectively. The results of study showed that the differences between the intervention and control groups were statistically significant (pcupping therapy and acupressure reduced perineal pain. Therefore, they may be considered as effective treatments for reducing pain intensity of allowing delivery.

Determination of fibromyalgia syndrome after whiplash injuries: methodologic issues.

Science.gov (United States)

Robinson, James P; Theodore, Brian R; Wilson, Hilary D; Waldo, Peter G; Turk, Dennis C

2011-06-01

Problems in diagnosing fibromyalgia syndrome (FM) among motor vehicle collision (MVC) patients with whiplash (WL) include the following: the predominance of tender points (TPs) in the neck/shoulder girdle region; the 3-month duration of widespread pain criterion; and, the stability of diagnosis. The present study examined the prevalence of FM in a cohort (N = 326) patients with persistent neck pain 3 months after WL injury who were enrolled in a treatment program. Physical examinations were performed at baseline and at the end of treatment. Results indicated that WL patients had a greater proportion of neck/shoulder girdle TPs, relative to distal TPs. Compared with a matched cohort of treatment-seeking FM patients, WL patients indicated less distal TPs (mean = 7.3 TPs vs. mean = 5.6 TPs, P whiplash patients because of persistent localized tenderness after motor vehicle collisions. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

A Comprehensive Evaluation of Standardized Assessment Tools in the Diagnosis of Fibromyalgia and in the Assessment of Fibromyalgia Severity

Directory of Open Access Journals (Sweden)

Chad S. Boomershine

2012-01-01

Full Text Available Standard assessments for fibromyalgia (FM diagnosis and core FM symptom domains are needed for biomarker development and treatment trials. Diagnostic and symptom assessments are reviewed and recommendations are made for standards. Recommendations for existing assessments include the American College of Rheumatology FM classification criteria using the manual tender point Survey for diagnosis, the brief pain inventory average pain visual analogue scale for pain intensity, the function subscale of the revised fibromyalgia impact questionnaire (FIQR for physical function, the patient global impression of change and FIQR for overall/global improvement, the hospital anxiety and depression scale depression subscale for depression, the multiple ability self-report questionnaire for cognitive dysfunction, the fatigue severity scale for fatigue, the FIQR for multidimensional function/health-related quality of life, the jenkins sleep scale for sleep disturbance, and the fibromyalgia intensity score for tenderness. Forthcoming assessments including the FIQR for diagnosis, NIH PROMIS, and FIBRO Change scales are discussed.

PAIN IN RHEUMATOID ARTHRITIS: SPECIFIC FEATURES OF ITS DEVELOPMENT AND METHODS OF CORRECTION

Directory of Open Access Journals (Sweden)

Yuri Aleksandrovich Olyunin

2010-06-01

Full Text Available The pain syndrome holds a central position in the clinical picture of rheumatoid arthritis (RA. Articular inflammation is an essential, but not the only, factor that determines the occurrence of pain. Extraarticular soft tissue pathology can play an important role in the formation of pain perceptions in RA. The pain that increases on movement with involvement of affected structures, as well as local tenderness on palpation and dysfunction of an altered segment are the major clinical manifestations of extraarticular soft tissue involvement in RA. Swelling in the area of appropriate tendons and synovial bursae can be seen when superficially located anatomic formations are involved. Magnetic resonance imaging and ultrasonography permit more accurate determination of the site and pattern of an involvement. The pain and functional impairments associated with extraarticular soft tissue pathology determine a need for additional therapy that can correct the existing disorders and improve the quality of life in patients. The major components of this treatment are sparing routine and systemic and local drug therapy. Diclofenac sodium is one of the most universal agents that allow simultaneous monitoring of various pathogenetic mechanisms of the disease. Local glucocorticoids may be used if the sparing routine and nonsteroidal anti-inflammatory drugs fail to control the pain syndrome effectively.

The influence of low temperature, type of muscle and electrical stimulation on the course of rigor mortis, ageing and tenderness of beef muscles.

Science.gov (United States)

Olsson, U; Hertzman, C; Tornberg, E

1994-01-01

The course of rigor mortis, ageing and tenderness have been evaluated for two beef muscles, M. semimembranosus (SM) and M. longissimus dorsi (LD), when entering rigor at constant temperatures in the cold-shortening region (1, 4, 7 and 10°C). The influence of electrical stimulation (ES) was also examined. Post-mortem changes were registered by shortening and isometric tension and by following the decline of pH, ATP and creatine phosphate. The effect of ageing on tenderness was recorded by measuring shear-force (2, 8 and 15 days post mortem) and the sensory properties were assessed 15 days post mortem. It was found that shortening increased with decreasing temperature, resulting in decreased tenderness. Tenderness for LD, but not for SM, was improved by ES at 1 and 4°C, whereas ES did not give rise to any decrease in the degree of shortening during rigor mortis development. This suggests that ES influences tenderization more than it prevents cold-shortening. The samples with a pre-rigor mortis temperature of 1°C could not be tenderized, when stored up to 15 days, whereas this was the case for the muscles entering rigor mortis at the other higher temperatures. The results show that under the conditions used in this study, the course of rigor mortis is more important for the ultimate tenderness than the course of ageing. Copyright © 1994. Published by Elsevier Ltd.

The management of right iliac fossa pain - is timing everything?

LENUS (Irish Health Repository)

McCartan, D P

2012-01-31

BACKGROUND: Right iliac fossa (RIF) pain remains the commonest clinical dilemma encountered by general surgeons. We prospectively audited the management of acute RIF pain, examining the relationship between symptom duration, use of pre-operative radiological imaging and patient outcome. METHODS: Over a six-month period, 302 patients, median age 18 years, 59% female, were admitted with RIF pain. Symptoms, clinical findings and laboratory results were documented. Patient management, timing of radiological investigations and operations, and outcome were recorded prospectively. RESULTS: Non-specific abdominal pain (26%), gynaecological (22%) and miscellaneous causes (14%) accounted for most admissions. Ultimately, 119 patients (39%) had appendicitis. Anorexia, tachycardia or rebound tenderness in the RIF significantly predicted a final diagnosis of appendicitis. Patients with perforated appendicitis (n = 29) had a longer duration of pre-hospital symptoms (median 50h) compared to those with simple appendicitis (median 17 h) (p<0.001). The use of pre-operative imaging resulted in an increased time to surgery but was not associated with increased post-operative morbidity or perforated appendicitis. CONCLUSION: The majority of patients presenting to hospital with RIF pain did not have appendicitis. Increased duration of pre-hospital symptoms was the main factor associated with perforated appendicitis. However, increased in-hospital time to theatre was not associated with perforated appendicitis or post-operative morbidity.

Chronic Pelvic Pain

Science.gov (United States)

... NSAIDs) are helpful in relieving pelvic pain, especially dysmenorrhea . Physical therapy—Acupuncture, acupressure, and nerve stimulation therapies may be useful in treating pain caused by dysmenorrhea. Physical therapy that eases trigger points may give ...

Effect of packaging and storage time on survival of Listeria monocytogenes on kippered beef steak and turkey tenders.

Science.gov (United States)

Uppal, Kamaldeep K; Getty, Kelly J K; Boyle, Elizabeth A E; Harper, Nigel M; Lobaton-Sulabo, April Shayne S; Barry, Bruce

2012-01-01

The objective of our study was to determine effect of packaging method and storage time on reducing Listeria monocytogenes in shelf-stable meat snacks. Commercially available kippered beef steak strips and turkey tenders were dipped into a 5-strain L. monocytogenes cocktail, and dried at 23 °C until a water activity of 0.80 was achieved. Inoculated samples were packaged with 4 treatments: (1) vacuum, (2) nitrogen flushed with oxygen scavenger, (3) heat sealed with oxygen scavenger, and (4) heat sealed without oxygen scavenger. Samples were stored at 23 °C and evaluated for L. monocytogenes levels at 0, 24, 48, and 72 h. Initial levels (time 0) of L. monocytogenes were approximately 5.7 log CFU/cm² for steak and tenders. After 24 h of storage time, a 1 log CFU/cm² reduction of L. monocytogenes was observed for turkey tenders for all packaging treatments. After 48 h, turkey tenders showed >1 log CFU/cm² reduction of L. monocytogenes for all packaging treatments except for vacuum, where only 0.9 log CFU/cm² reduction was observed. After 72 h, reductions for all packaging treatments for turkey tenders ranged from 1.5 to 2.4 log CFU/cm². For kippered beef steak, there was no interaction between the packaging treatments and all storage times (P > 0.05) whereas, time was different (P packaging treatments and a 2.1 log CFU/ cm² L. monocytogenes reduction at 72 h of storage time. Processors of kippered beef steak and turkey tenders could use a combination of vacuum or nitrogen-flushing or heat sealed with an oxygen scavenger packaging methods and a holding time of 24 h prior to shipping to reduce potential L. monocytogenes numbers by ≥1 log. However, processors should be encouraged to hold packaged product a minimum of 72 h to enhance the margin of safety for L. monocytogenes control. © 2011 Institute of Food Technologists®

Power Doppler ultrasonography of painful Achilles tendons and entheses in patients with and without spondyloarthropathy-a comparison with clinical examination and contrast-enhanced MRI

DEFF Research Database (Denmark)

Wiell, Charlotte; Szkudlarek, Marcin; Hasselquist, Maria

2013-01-01

The objective of this study was to describe ultrasonography (US) and magnetic resonance imaging (MRI) findings at painful Achilles tendons and entheses in patients with and without spondyloarthropathy (SpA and non-SpA) and healthy control persons (CTRLs). Particularly, we aimed to investigate...... if any changes differentiate SpA from non-SpA. Finally, we investigated the reliability of US compared to clinical examination of Achilles tendinopathy, using MRI as gold standard reference. Twelve SpA patients and 15 non-SpA patients with pain and tenderness at at least one Achilles tendon and...

Meta-analysis: exercise therapy for nonspecific low back pain.

Science.gov (United States)

Hayden, Jill A; van Tulder, Maurits W; Malmivaara, Antti V; Koes, Bart W

2005-05-03

Exercise therapy is widely used as an intervention in low back pain. To evaluate the effectiveness of exercise therapy in adult nonspecific acute, subacute, and chronic low back pain versus no treatment and other conservative treatments. MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews. Randomized, controlled trials evaluating exercise therapy for adult nonspecific low back pain and measuring pain, function, return to work or absenteeism, and global improvement outcomes. Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short-, intermediate-, and long-term follow-up. 61 randomized, controlled trials (6390 participants) met inclusion criteria: acute (11 trials), subacute (6 trials), and chronic (43 trials) low back pain (1 trial was unclear). Evidence suggests that exercise therapy is effective in chronic back pain relative to comparisons at all follow-up periods. Pooled mean improvement (of 100 points) was 7.3 points (95% CI, 3.7 to 10.9 points) for pain and 2.5 points (CI, 1.0 to 3.9 points) for function at earliest follow-up. In studies investigating patients (people seeking care for back pain), mean improvement was 13.3 points (CI, 5.5 to 21.1 points) for pain and 6.9 points (CI, 2.2 to 11.7 points) for function, compared with studies where some participants had been recruited from a general population (for example, with advertisements). Some evidence suggests effectiveness of a graded-activity exercise program in subacute low back pain in occupational settings, although the evidence for other types of exercise therapy in other populations is inconsistent. In acute low back pain, exercise therapy and other programs were equally effective (pain, 0.03 point [CI, -1.3 to 1.4 points]). Limitations of the literature, including low-quality studies with heterogeneous outcome measures inconsistent

Fine-mapping of a QTL influencing pork tenderness on porcine chromosome 2

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Beever Jonathan E

2007-10-01

Full Text Available Abstract Background In a previous study, a quantitative trait locus (QTL exhibiting large effects on both Instron shear force and taste panel tenderness was detected within the Illinois Meat Quality Pedigree (IMQP. This QTL mapped to the q arm of porcine chromosome 2 (SSC2q. Comparative analysis of SSC2q indicates that it is orthologous to a segment of human chromosome 5 (HSA5 containing a strong positional candidate gene, calpastatin (CAST. CAST polymorphisms have recently been shown to be associated with meat quality characteristics; however, the possible involvement of other genes and/or molecular variation in this region cannot be excluded, thus requiring fine-mapping of the QTL. Results Recent advances in porcine genome resources, including high-resolution radiation hybrid and bacterial artificial chromosome (BAC physical maps, were utilized for development of novel informative markers. Marker density in the ~30-Mb region surrounding the most likely QTL position was increased by addition of eighteen new microsatellite markers, including nine publicly-available and nine novel markers. Two newly-developed markers were derived from a porcine BAC clone containing the CAST gene. Refinement of the QTL position was achieved through linkage and haplotype analyses. Within-family linkage analyses revealed at least two families segregating for a highly-significant QTL in strong positional agreement with CAST markers. A combined analysis of these two families yielded QTL intervals of 36 cM and 7 cM for Instron shear force and taste panel tenderness, respectively, while haplotype analyses suggested further refinement to a 1.8 cM interval containing CAST markers. The presence of additional tenderness QTL on SSC2q was also suggested. Conclusion These results reinforce CAST as a strong positional candidate. Further analysis of CAST molecular variation within the IMQP F1 boars should enhance understanding of the molecular basis of pork tenderness, and thus

Neuropathic Pain and Psychological Morbidity in Patients with Treated Leprosy: A Cross-Sectional Prevalence Study in Mumbai

Science.gov (United States)

Lasry-Levy, Estrella; Hietaharju, Aki; Pai, Vivek; Ganapati, Ramaswamy; Rice, Andrew S. C.; Haanpää, Maija; Lockwood, Diana N. J.

2011-01-01

Background Neuropathic pain has been little studied in leprosy. We assessed the prevalence and clinical characteristics of neuropathic pain and the validity of the Douleur Neuropathique 4 questionnaire as a screening tool for neuropathic pain in patients with treated leprosy. The association of neuropathic pain with psychological morbidity was also evaluated. Methodology/Principal Findings Adult patients who had completed multi-drug therapy for leprosy were recruited from several Bombay Leprosy Project clinics. Clinical neurological examination, assessment of leprosy affected skin and nerves and pain evaluation were performed for all patients. Patients completed the Douleur Neuropathique 4 and the 12-item General Health Questionnaire to identify neuropathic pain and psychological morbidity. Conclusions/Significance One hundred and one patients were recruited, and 22 (21.8%) had neuropathic pain. The main sensory symptoms were numbness (86.4%), tingling (68.2%), hypoesthesia to touch (81.2%) and pinprick (72.7%). Neuropathic pain was associated with nerve enlargement and tenderness, painful skin lesions and with psychological morbidity. The Douleur Neuropathique 4 had a sensitivity of 100% and specificity of 92% in diagnosing neuropathic pain. The Douleur Neuropathique 4 is a simple tool for the screening of neuropathic pain in leprosy patients. Psychological morbidity was detected in 15% of the patients and 41% of the patients with neuropathic pain had psychological morbidity. PMID:21408111

Radicular lower extremity pain as the first symptom of primary hyperparathyroidism

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Mustonen, Antti O.T.; Kiuru, Martti J.; Koskinen, Seppo K. [Toolo Trauma Center, Helsinki University Central Hospital, Topeliuksenkatu 5, 00029, Helsinki (Finland); Stahls, Anders; Bohling, Tom [Department of Pathology, Haartman Institute, University of Helsinki, 00014, Helsinki (Finland); Kivioja, Aarne [Department of Orthopedics and Traumatology, Helsinki University Central Hospital, 00029, Helsinki (Finland)

2004-08-01

Clinical symptoms of hyperparathyroidism are generally nausea, vomiting, fatigue, constipation, and hypotonicity of the muscles and ligaments; bone pain and tenderness are also seen but are more common in secondary hyperparathyroidism. We report a histologically confirmed case of a 28-year-old man whose sole symptom of primary hyperparathyroidism was lower extremity radicular pain due to a vertebral brown tumor. Magnetic resonance imaging demonstrated brown tumor to be hyperintense on T2-weighted and slightly hypointense on T1-weighted sequences; it showed intense contrast enhancement with gadolinium. Because brown tumors usually contain hemosiderin a short T2 should have been expected, but this was not seen in our case. Healing resulted in decreasing contrast enhancement on T1-weighted sequences and increasingly short T2. To our knowledge, this is the first report of a lumbar vertebral brown tumor associated with primary hyperparathyroidism. (orig.)

Radicular lower extremity pain as the first symptom of primary hyperparathyroidism

International Nuclear Information System (INIS)

Mustonen, Antti O.T.; Kiuru, Martti J.; Koskinen, Seppo K.; Stahls, Anders; Bohling, Tom; Kivioja, Aarne

2004-01-01

Clinical symptoms of hyperparathyroidism are generally nausea, vomiting, fatigue, constipation, and hypotonicity of the muscles and ligaments; bone pain and tenderness are also seen but are more common in secondary hyperparathyroidism. We report a histologically confirmed case of a 28-year-old man whose sole symptom of primary hyperparathyroidism was lower extremity radicular pain due to a vertebral brown tumor. Magnetic resonance imaging demonstrated brown tumor to be hyperintense on T2-weighted and slightly hypointense on T1-weighted sequences; it showed intense contrast enhancement with gadolinium. Because brown tumors usually contain hemosiderin a short T2 should have been expected, but this was not seen in our case. Healing resulted in decreasing contrast enhancement on T1-weighted sequences and increasingly short T2. To our knowledge, this is the first report of a lumbar vertebral brown tumor associated with primary hyperparathyroidism. (orig.)

Reliability of four experimental mechanical pain tests in children

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Soee AL

2013-02-01

Full Text Available Ann-Britt L Soee,1 Lise L Thomsen,2 Birte Tornoe,1,3 Liselotte Skov11Department of Pediatrics, Children’s Headache Clinic, Copenhagen University Hospital Herlev, Copenhagen, Denmark; 2Department of Neuropediatrics, Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, København Ø, Denmark; 3Department of Physiotherapy, Medical Department O, Copenhagen University Hospital Herlev, Herlev, DenmarkPurpose: In order to study pain in children, it is necessary to determine whether pain measurement tools used in adults are reliable measurements in children. The aim of this study was to explore the intrasession reliability of pressure pain thresholds (PPT in healthy children. Furthermore, the aim was also to study the intersession reliability of the following four tests: (1 Total Tenderness Score; (2 PPT; (3 Visual Analog Scale score at suprapressure pain threshold; and (4 area under the curve (stimulus–response functions for pressure versus pain.Participants and methods: Twenty-five healthy school children, 8–14 years of age, participated. Test 2, PPT, was repeated three times at 2 minute intervals on the same day to estimate PPT intrasession reliability using Cronbach’s alpha. Tests 1–4 were repeated after median 21 (interquartile range 10.5–22 days, and Pearson’s correlation coefficient was used to describe the intersession reliability.Results: The PPT test was precise and reliable (Cronbach’s alpha ≥ 0.92. All tests showed a good to excellent correlation between days (intersessions r = 0.66–0.81. There were no indications of significant systematic differences found in any of the four tests between days.Conclusion: All tests seemed to be reliable measurements in pain evaluation in healthy children aged 8–14 years. Given the small sample size, this conclusion needs to be confirmed in future studies.Keywords: repeatability, intraindividual reliability, pressure pain threshold, pain measurement, algometer

STUDY ON THE INTERRELATION BETWEEN AURICULAR GOOD CONDUCTION POINT STIMULATION AND THE THERAPEUTIC EFFECT

Institute of Scientific and Technical Information of China (English)

胡智慧; 陈巩荪

2001-01-01

Although, the essence of otopoints remains unknown at the moment, many medical workers have termed them temporarily as "auricular specific stimulating points". They give an explanation that when the internal organs or the body trunk is out of order, tender points, changes of the cutaneous electrical resistance, appearance, colour, etc. may occur at some sites of the auri-cle. The medical workers can use these reactions as a reference for making a diagnosis and stimulate these sites to prevent and treat diseases. These reaction points are also the otopoint. Therefore, the otopoint is also called as tenderpoint, or good conduction point, reaction point, stimulating point or treatment point.

Deciding about Design Quality : Value judgements and decision making in the selection of architects by public clients under European tendering regulations

NARCIS (Netherlands)

Volker, L.

2010-01-01

In the past few years the image of tender procedures in which Dutch public clients selected an architect has been dominated by distressing newspaper headlines. Architects fear that the current tender culture will harm the quality of our built environment due to a potential lack of diversity,

Should neck pain in a patient with Hashimoto′s thyroiditis be underestimated? A case and review of the literature

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Umut Mousa

2012-01-01

Full Text Available Hashimoto′s Thyroiditis (HT is an autoimmune disease and the most frequent cause of hypothyroidism. Subacute thyroiditis (SAT overlapping HT is a rare entity. A 69-year-old female patient with HT and multinodular goiter has been followed on levothyroxine replacement therapy for 7 years. She presented with neck pain radiating to the right ear persisting for 2 months. She was prescribed analgesics and antibiotics by other physicians during that period, which did not work. Her vital signs were stable with no tachycardia or fever. The right lobe of the thyroid gland was tender on palpation. Her TSH level was 3.94 mIU/ml, ESR 23 mm/h, CRP 3.2 mg/l, WBC 4900/μl at presentation. Thyroid ultrasonography revealed a hypoechoic area over the tender lobe. Power Doppler imaging revealed almost no blood flow in that area. She was started on methylprednisolone 32 mg/day. At day 10 of therapy, her symptoms had completely resolved. Ultrasonography repeated showed that the hypoechoic area had disappeared. Glucocorticoid dosage was tapered and stopped. Emergence of subacute thyroiditis in a case with preexisting Hashimoto′s thyroiditis is a quite rare condition, but should be kept in mind along with a painful attack of HT in the differential diagnosis.

Orbital Infarction due to Sickle Cell Disease without Orbital Pain

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Cameron L. McBride

2016-01-01

Full Text Available Sickle cell disease is a hemoglobinopathy that results in paroxysmal arteriolar occlusion and tissue infarction that can manifest in a plurality of tissues. Rarely, these infarcted crises manifest in the bony orbit. Orbital infarction usually presents with acute onset of periorbital tenderness, swelling, erythema, and pain. Soft tissue swelling can result in proptosis and attenuation of extraocular movements. Expedient diagnosis of sickle cell orbital infarction is crucial because this is a potentially sight-threatening entity. Diagnosis can be delayed since the presentation has physical and radiographic findings mimicking various infectious and traumatic processes. We describe a patient who presented with sickle cell orbital crisis without pain. This case highlights the importance of maintaining a high index of suspicion in patients with known sickle cell disease or of African descent born outside the United States in a region where screening for hemoglobinopathy is not routine, even when the presentation is not classic.

Headache attributed to masticatory myofascial pain: impact on facial pain and pressure pain threshold.

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Costa, Y M; Porporatti, A L; Stuginski-Barbosa, J; Bonjardim, L R; Speciali, J G; Conti, P C R

2016-03-01

There is no clear evidence on how a headache attributed to temporomandibular disorder (TMD) can hinder the improvement of facial pain and masticatory muscle pain. The aim of this study was to measure the impact of a TMD-attributed headache on masticatory myofascial (MMF) pain management. The sample was comprised of adults with MMF pain measured according to the revised research diagnostic criteria for temporomandibular disorders (RDC/TMD) and additionally diagnosed with (Group 1, n = 17) or without (Group 2, n = 20) a TMD-attributed headache. Both groups received instructions on how to implement behavioural changes and use a stabilisation appliance for 5 months. The reported facial pain intensity (visual analogue scale--VAS) and pressure pain threshold (PPT--kgf cm(-2)) of the anterior temporalis, masseter and right forearm were measured at three assessment time points. Two-way anova was applied to the data, considering a 5% significance level. All groups had a reduction in their reported facial pain intensity (P 0·100). A TMD-attributed headache in patients with MMF pain does not negatively impact pain management, but does change the pattern for muscle pain improvement. © 2015 John Wiley & Sons Ltd.

Effects of Maitland manual therapy on the treatment of pain syndromes of the cervical spine

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Ireneusz Dzierżek

2017-03-01

Full Text Available Introduction: The aim of this study was evaluate the effect of Maitland's manual therapy on selected motor function parameters in cervical spine pain syndromes. Material and Methods: 30 subjects were enrolled, in the age from 27 to 66, including 15 men and 15 women with chronic functional cervical spine syndrome who had a 10-day physiotherapy cycle that did not produce the expected results. The study included: pain assessment in the Dziak scale, measurements of mobility of the cervical spine and shoulder joints, functional evaluation by Hautanta, De`Klein, Jackson, and palpation of muscle irritation. Results: A comparison of average pain scores before and after therapy indicated that the pain level after treatment decreased (p 0.05. There has been a decrease in positive clinical trials and muscle irritation after therapy. Conclusions: Maitland manual therapy is effective in the treatment of cervical spine pain syndromes. The technique results in a significant increase in the mobility of the cervical spine as well as an improvement in the functional state of the cervical segment without affecting the mobility of the shoulder ridge. There was a decrease in palpate tenderness of the soft tissue studied.

Comparison between Epidural Block vs. High Intensity Laser Therapy for Controlling Chronic Low Back Pain

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Badiozaman Radpay

2016-01-01

Full Text Available Background: Chronic low back pain is among a wide spread musculoskeletal conditions that is related to disability with high economy cost. There are several treatment modalities for controlling chronic low back pain (CLBP, among them high intensity laser therapy (HILT and epidural blocks (EB use more commonly. This study aimed to evaluate the benefits and hazards of each of these two methods.Materials and Methods: We designed a randomized controlled double blind study during 24 months.101 patients divided in 2 groups (52 in EB and 49 in HILT group. Pain intensity was assessed by using faces pain scales (FPS and LINKERT questionaries' before procedure and during one, four, 12, and 24 weeks after beginning the procedures.Results: There were no differences between two groups in FPS lumber tenderness, straight leg rising test (SLRT, paresthesia, deep tendon reflex (DTR, and imaging changes. Motor problems seem was less in HILT group comparing EB.Conclusion: This study showed both EB and HILT approaches can control the pain intensity and motor activities in CLBP patients. Future studies will clarify the precise importance of each these methods.

Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis.

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Long, Suzanne S; Surrey, David E; Nazarian, Levon N

2013-11-01

Greater trochanteric pain syndrome is a common condition with clinical features of pain and tenderness at the lateral aspect of the hip. Diagnosing the origin of greater trochanteric pain is important because the treatment varies depending on the cause. We hypothesized that sonographic evaluation of sources for greater trochanteric pain syndrome would show that bursitis was not the most commonly encountered abnormality. We performed a retrospective review of musculoskeletal sonographic examinations performed at our institution over a 6-year period for greater trochanteric pain syndrome; completed a tabulation of the sonographic findings; and assessed the prevalence of trochanteric bursitis, gluteal tendon abnormalities, iliotibial band abnormalities, or a combination of findings. Prevalence of abnormal findings, associations of bursitis, gluteal tendinosis, gluteal tendon tears, and iliotibial band abnormalities were calculated. The final study population consisted of 877 unique patients: 602 women, 275 men; average age, 54 years; and age range, 15-87 years). Of the 877 patients with greater trochanteric pain, 700 (79.8%) did not have bursitis on ultrasound. A minority of patients (177, 20.2%) had trochanteric bursitis. Of the 877 patients with greater trochanteric pain, 438 (49.9%) had gluteal tendinosis, four (0.5%) had gluteal tendon tears, and 250 (28.5%) had a thickened iliotibial band. The cause of greater trochanteric pain syndrome is usually some combination of pathology involving the gluteus medius and gluteus minimus tendons as well as the iliotibial band. Bursitis is present in only the minority of patients. These findings have implications for treatment of this common condition.

Audit market competition: auditor changes and the impact of tendering

OpenAIRE

Beattie, V.; Fearnley, S.

1998-01-01

Increased competition within the external audit market and the recent phenomenon of audit tendering has renewed interest in the factors influencing auditor changes. In this paper, a questionnaire instrument is used to elicit perceptions of the factors which influence auditor-client realignments in this new environment and to indicate the relative influence of economic and behavioural factors. Positive, statistically significant associations were found between unsolicited approaches and the co...

Are People With Whiplash-Associated Neck Pain Different From People With Nonspecific Neck Pain?

Science.gov (United States)

Anstey, Ricci; Kongsted, Alice; Kamper, Steven; Hancock, Mark J

2016-10-01

Study Design Secondary analysis of a prospective cohort study with cross-sectional and longitudinal analyses. Background The clinical importance of a history of whiplash-associated disorder (WAD) in people with neck pain remains uncertain. Objective To compare people with WAD to people with nonspecific neck pain, in terms of their baseline characteristics and pain and disability outcomes over 1 year. Methods Consecutive patients with neck pain who presented to a secondary-care spine center answered a comprehensive self-report questionnaire and underwent a physical examination. Patients were classified into a group of either those with WAD or those with nonspecific neck pain. We compared the outcomes of baseline characteristics of the 2 groups, as well as pain intensity and activity limitation at follow-ups of 6 and 12 months. Results A total of 2578 participants were included in the study. Of these, 488 (19%) were classified as having WAD. At presentation, patients with WAD were statistically different from patients without WAD for almost all characteristics investigated. While most differences were small (1.1 points on an 11-point pain-rating scale and 11 percentage points on the Neck Disability Index), others, including the presence of dizziness and memory difficulties, were substantial. The between-group differences in pain and disability increased significantly (Pneck pain. Conclusion People referred to secondary care with WAD typically had more self-reported pain and disability and experienced worse outcomes than those with nonspecific neck pain. Caution is required when interpreting the longitudinal outcomes due to lower-than-optimal follow-up rates. Level of Evidence Prognosis, level 2. J Orthop Sports Phys Ther 2016;46(10):894-901. Epub 3 Sep 2016. doi:10.2519/jospt.2016.6588.

Effect of a 24-week physical training programme (in water and on land) on pain, functional capacity, body composition and quality of life in women with fibromyalgia.

Science.gov (United States)

Latorre, Pedro Ángel; Santos, María Aparecida; Heredia-Jiménez, Jose Maria; Delgado-Fernández, Manuel; Soto, Víctor Manuel; Mañas, Alfonso; Carbonell-Baeza, Ana

2013-01-01

To analyse the effect of a 24-week physical training programme in water and on land on women with fibromyalgia. A controlled study was conducted from December 2009 to May 2010. Seventy-two women with fibromyalgia (age: 51.79±7.87 years) were assigned to an exercise group (3 sessions/week, 2 sessions in water, 1 session on land) (n=42) and to a control group (n=30). The variables analysed were: number of tender points, visual analogue scale (VAS) of pain, algometer score, functional capacity (leg strength, hand-grip dynamometry, flexibility, agility, balance, aerobic endurance, heart response), body composition (body mass index, fat mass index, skeletal muscle mass index and percentage of body fat) and psychological variables (Fibromyalgia Impact Questionnaire [FIQ] and Short Form Health Survey 36 [SF-36]). The exercise group improved in the algometer score (pfibromyalgia.

What impact has tendering had on trainees? Results of a national survey by British Association for Sexual Health and HIV Trainees' Collaborative for audit, research and quality improvement projects.

Science.gov (United States)

Wiggins, Helen; Hartley, Anna; Clarke, Emily; Foley, Elizabeth; Nandwani, Rak; Carlin, Elizabeth; Waters, Laura; Ahmed, Nadia

2018-01-01

In April 2013, local authorities gained responsibility for commissioning sexual health services in England. With many services going out to tender and resultant change in services or service provider, there is anecdotal evidence that this has impacted on the education, training and morale of genitourinary medicine (GUM) trainees. The aim of this study was to evaluate the impact of tendering on GUM trainees. An electronic survey designed by the British Association for Sexual Health and HIV Trainees' Collaborative for Audit, Research and Quality Improvement Projects (T-CARQ) was distributed to GUM trainees and newly appointed consultants. Eighty-two individuals responded (74% GUM trainees, 25% newly appointed consultants, 1% locum appointed for service). Sixty-three per cent (45/72) had experience of training within a service which was being tendered. Of these, 59% (24/41) felt their training was not considered during the tendering process and 20% (8/41) felt that it was. Forty-four per cent (18/41) felt adequately supported. Thirty per cent (12/40) reported active participation in the tendering process. On a scale of 0 (no impact) to 5 (major impact), the median score for impact of tendering on training was 2. The positive/negative impact of tendering on different training elements was rated: other than management experience the overall impact on all parameters was negative, namely morale, senior support and education. In conclusion, this survey describes the variable impact of service tendering on GUM training. Our recommendations for maintaining training standards despite tendering include actively involving trainees and education partners, inclusion of specialist GUM training in service specifications, development of guidance for commissioners and services for the management of GUM training within tendering.

Approval Procedure for Technical Specifications for Procurement by Quotation and Tender

International Nuclear Information System (INIS)

Shaharum Ramli; Izhar Abu Hussin; Ying, K.K.

2015-01-01

Technical specifications for procurement requires the approval of the Jawatankuasa Penyemak Spesifikasi Teknikal Tender/ Sebutharga Agensi Nuklear Malaysia. This paper provides guidance for those who have to prepare a technical specification. In addition, the technical specification online library is introduced to facilitate them to re-use old technical specifications for new procurements or to make those the bases for drafting new specifications. (author)

Central mechanisms of stress-induced headache.

Science.gov (United States)

Cathcart, S; Petkov, J; Winefield, A H; Lushington, K; Rolan, P

2010-03-01

Stress is the most commonly reported trigger of an episode of chronic tension-type headache (CTTH); however, the causal significance has not been experimentally demonstrated to date. Stress may trigger CTTH through hyperalgesic effects on already sensitized pain pathways in CTTH sufferers. This hypothesis could be partially tested by examining pain sensitivity in an experimental model of stress-induced headache in CTTH sufferers. Such examinations have not been reported to date. We measured pericranial muscle tenderness and pain thresholds at the finger, head and shoulder in 23 CTTH sufferers (CTH-S) and 25 healthy control subjects (CNT) exposed to an hour-long stressful mental task, and in 23 CTTH sufferers exposed to an hour-long neutral condition (CTH-N). Headache developed in 91% of CTH-S, 4% of CNT, and 17% of CTH-N subjects. Headache sufferers had increased muscle tenderness and reduced pain thresholds compared with healthy controls. During the task, muscle tenderness increased and pain thresholds decreased in the CTH-S group compared with CTH-N and CNT groups. Pre-task muscle tenderness and reduction in pain threshold during task were predictive of the development and intensity of headache following task. The main findings are that stress induced a headache in CTTH sufferers, and this was associated with pre-task muscle tenderness and stress-induced reduction in pain thresholds. The results support the hypothesis that stress triggers CTTH through hyperalgesic effects on already increased pain sensitivity in CTTH sufferers, reducing the threshold to noxious input from pericranial structures.

TREATMENT OF SUBACUTE POSTERIOR KNEE PAIN IN AN ADOLESCENT BALLET DANCER UTILIZING TRIGGER POINT DRY NEEDLING: A CASE REPORT

Science.gov (United States)

Tansey, Kimberly A.; Westrick, Richard B.

2014-01-01

Study Design: Case Report. Background and Purpose: Dry needling (DN) is an increasingly popular intervention used by clinicians as a treatment of regional neuromusculoskeletal pain. DN is an invasive procedure that involves insertion of a thin monofilament needle directly into a muscle trigger point (MTP) with the intent of stimulating a local twitch response. Current evidence is somewhat limited, but recent literature supports the use of this intervention in specific neuromusculoskeletal conditions. The purpose of this case report is to present the outcomes of DN as a primary treatment intervention in an adolescent subject with subacute posterior knee pain. Case Description: The subject was a 16‐year‐old female competitive ballet dancer referred to physical therapy with a two month history of right posterior knee pain. Palpation identified MTPs which reproduced the patient’s primary symptoms. In addition to an exercise program promoting lower extremity flexibility and hip stability, the subject was treated with DN to the right gastrocnemius, soleus, and popliteus muscles. Outcomes: The subject reported being pain free on the Numerical Pain Scale and a +7 improvement in perceived change in recovery on the Global Rating of Change at final follow‐up. Physical examination demonstrated no observed impairments or functional limitations, including normal mobility, full strength, and unrestricted execution of dance maneuvers. Discussion: The patient was able to return to high level dance training and competition without physical limitations and resumed pre‐injury dynamic movement activities including dancing, running, jumping, and pivoting without pain. DN can be an effective and efficient intervention to assist patients in decreasing pain and returning to high intensity physical activity. Additional research is needed to determine if DN is effective for other body regions and has long‐term positive outcomes. Level of Evidence: Level 4 PMID:24567862

Dysfunctional pain modulation in somatoform pain disorder patients.

Science.gov (United States)

Klug, Stefanie; Stefanie, Klug; Anderer, Peter; Peter, Anderer; Saletu-Zyhlarz, Gerda; Gerda, Saletu-Zyhlarz; Freidl, Marion; Marion, Freidl; Saletu, Bernd; Bernd, Saletu; Prause, Wolfgang; Wolfgang, Prause; Aigner, Martin; Martin, Aigner

2011-06-01

To date, pain perception is thought to be a creative process of modulation carried out by an interplay of pro- and anti-nociceptive mechanisms. Recent research demonstrates that pain experience constitutes the result of top-down processes represented in cortical descending pain modulation. Cortical, mainly medial and frontal areas, as well as subcortical structures such as the brain stem, medulla and thalamus seem to be key players in pain modulation. An imbalance of pro- and anti-nociceptive mechanisms are assumed to cause chronic pain disorders, which are associated with spontaneous pain perception without physiologic scaffolding or exaggerated cortical activation in response to pain exposure. In contrast to recent investigations, the aim of the present study was to elucidate cortical activation of somatoform pain disorder patients during baseline condition. Scalp EEG, quantitative Fourier-spectral analyses and LORETA were employed to compare patient group (N = 15) to age- and sex-matched controls (N = 15) at rest. SI, SII, ACC, SMA, PFC, PPC, insular, amygdale and hippocampus displayed significant spectral power reductions within the beta band range (12-30 Hz). These results suggest decreased cortical baseline arousal in somatoform pain disorder patients. We finally conclude that obtained results may point to an altered baseline activity, maybe characteristic for chronic somatoform pain disorder.

Randomized, blinded, controlled trial on effectiveness of photobiomodulation therapy and exercise training in the fibromyalgia treatment.

Science.gov (United States)

da Silva, Mariana Moreira; Albertini, Regiane; de Tarso Camillo de Carvalho, Paulo; Leal-Junior, Ernesto Cesar Pinto; Bussadori, Sandra Kalil; Vieira, Stella Sousa; Bocalini, Danilo Sales; de Oliveira, Luis Vicente Franco; Grandinetti, Vanessa; Silva, José Antonio; Serra, Andrey Jorge

2018-02-01

This study evaluated the role of the phototherapy and exercise training (EXT) as well as the combined treatment in general symptoms, pain, and quality of life in women suffering from fibromyalgia (FM). A total of 160 women were enrolled and measures were carried out in two sets: it was sought to identify the acute effect for a single phototherapy and EXT session (Set 1); long-term effect (10 weeks) of the interventions (Set 2). Phototherapy irradiation was performed at 11 locations in their bodies, employing a cluster with nine diodes (one super-pulsed infrared 905 nm, four light-emitting diodes [LEDs] of 640 nm, and four LEDs of 875 nm, 39.3 J per location). Algometry and VAS instrument were applied to evaluate pain. The FM symptoms were evaluated with Fibromyalgia Impact Questionnaire (FIQ) and Research Diagnostic Criteria (RDC) instruments. Quality of life was assessed through SF-36 survey. Set 1: pain threshold was improved with the phototherapy, and EXT improved the pain threshold for temporomandibular joint (right and left body side) and occipital site (right body side). Set 2: there was improved pain threshold in several tender points with the phototherapy and EXT. There was an overlap of therapies to reduce the tender point numbers, anxiety, depression, fatigue, sleep, and difficulty sleeping on FIQ/RDC scores. Moreover, quality of life was improved with both therapies. The phototherapy and EXT improved the pain threshold in FM women. A more substantial effect was noticed for the combined therapy, in which pain relief was accomplished by improving VAS and FIQ scores as well as quality of life.

Comparison between newer local anesthetics for myofascial pain syndrome management.

Science.gov (United States)

Zaralidou, A Th; Amaniti, E N; Maidatsi, P G; Gorgias, N K; Vasilakos, D F

2007-06-01

Myofascial pain syndromes are characterized by the presence of painful loci within muscles, tendons or ligaments, called trigger points. Infiltration of these points with local anesthetics is often used as a treatment modality. The aim of the study was to comparatively evaluate 0.25% levobupivacaine and 0.25% ropivacaine for trigger point injection regarding pain on injection, treatment efficacy and duration of symptoms remission. Sixty-eight patients, suffering from myofascial pain syndromes, were randomly assigned to two groups to receive either levobupivacaine or ropivacaine for trigger-point injection. After completion of the procedure, patients were asked to rate pain during injection and efficacy of the treatment, based on immediate relief. Two weeks later, they were asked about the duration of this relief. Statistical analysis did not reveal significant differences between groups with respect to pain during injection, efficacy of the treatment and duration of pain relief. The two local anesthetics seem to be equally effective for trigger point infiltration. (c) 2007 Prous Science. All rights reserved.

Effectiveness of a Tai-Chi Training and Detraining on Functional Capacity, Symptomatology and Psychological Outcomes in Women with Fibromyalgia

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Alejandro Romero-Zurita

2012-01-01

Full Text Available Background. The purpose was to analyze the effects of Tai-Chi training in women with fibromyalgia (FM. Methods. Thirty-two women with FM (mean age, 51.4±6.8 years attended to Tai-Chi intervention 3 sessions weekly for 28 weeks. The outcome measures were: tenderness, body composition, functional capacity and psychological outcomes (Fibromyalgia impact questionnaire (FIQ, Short Form Health Survey 36 (SF-36. Results. Patients showed improvements on pain threshold, total number of tender points and algometer score (all <0.001. The intervention was effective on 6-min walk (=0.006, back scratch (=0.002, handgrip strength (=0.006, chair stand, chair sit & reach, 8 feet up & go and blind flamingo tests (all <0.001. Tai-Chi group improved the FIQ total score (<0.001 and six subscales: stiffness (=0.005, pain, fatigue, morning tiredness, anxiety, and depression (all <0.001. The intervention was also effective in six SF-36 subscales: bodily pain (=0.003, vitality (=0.018, physical functioning, physical role, general health, and mental health (all <0.001. Conclusions. A 28-week Tai-Chi intervention showed improvements on pain, functional capacity, symptomatology and psychological outcomes in female FM patients.

Meat tenderness genetic polymorphisms occurrence and distribution in five Zebu breeds in Mexico

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Gaspar Manuel Parra-Bracamonte

2015-09-01

Conclusions: Although the relatively low occurrence of favorable alleles in assessed loci may limit their use in selection programs, genotyping availability might be a practical and comprehensive tool for introgression programs by marker assisted selection and management as to improve meat tenderness of Zebu breeds.

Evaluating the Impact of Risk on Contractor’s Tender Figure in Public Buildings Projects in Northern Nigeria

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L. O. Oyewobi

2012-01-01

Full Text Available It has become almost impossible to have projects completed within the initial cost and time in Nigeria; this is as a result of many factors the construction industry is being plagued with ranging from estimating risk to time and cost overruns. The construction industry is widely associated with a high degree of risk and uncertainty due to the nature of its operating heterogeneous environment. The paper aimed at evaluating the impact of estimating risk on contractor’s tender sum with a view of ensuring efficient delivery of projects in the Northern part of Nigeria. A survey was conducted using questionnaire and a total of four headings of risk factors were identified. Research findings showed defects in design, inflation, contractor’s competence and political uncertainty as well as changes in government had greatest impact on contractor’s tender figure whereas likely trend in wages rates over the period, excessive approval procedure in administration government department, unavailability of sufficient amount of unskilled labor and technical manpower and resources of the company were the most significant factors to be considered by contractors when estimating the pricing risk. The paper recommends that construction professionals should identify and adequately quantify project estimating risk factors. Adding a risk premium to quotation and time estimation has to be supported by governmental owner organizations and other agencies in the local construction sector. Competent contractors should be allowed to tender so as to see the incidence of these estimating risks as an important aspect that requires attention while evaluating contractor’s tender sum.

Technical note: use of belt grill cookery and slice shear force for assessment of pork longissimus tenderness.

Science.gov (United States)

Shackelford, S D; Wheeler, T L; Koohmaraie, M

2004-01-01

The present experiments were conducted to determine whether improved beef longissimus shear force methodology could be used to assess pork longissimus tenderness. Specifically, three experiments were conducted to: 1) determine the effect of belt grill (BG) cookery on repeatability of pork longissimus Warner-Bratzler shear force (WBSF), 2) compare the correlation of WBSF and slice shear force (SSF) with trained sensory panel tenderness ratings, and 3) estimate the repeatability of pork longissimus SSF for chops cooked with a BG. In Exp. 1 and 2, the longissimus was removed from the left side of each carcass (Exp. 1, n = 25; Exp. 2, n = 23) at 1 d postmortem and immediately frozen to maximize variation in tenderness. In Exp. 1, chops were cooked with either open-hearth electric broilers (OH) or BG, and WBSF was measured. Percentage of cooking loss was lower (P cooked with a BG (23.2%; SD = 1.7%) vs. OH (27.6%; SD = 3.0%). Estimates of the repeatability of WBSF were similar for chops cooked with OH (0.61) and BG (0.59). Although significant (P cooking methods accounted for less than 5% of the total variation in WBSF. In Exp. 2, the correlation of SSF (r = -0.72; P cooked with BG, and SSF was determined. The repeatability of SSF was 0.90, which is comparable to repeatability estimates for beef and lamb. Use of BG cookery and SSF could facilitate the collection of accurate pork longissimus tenderness data. Time and labor savings associated with BG cookery and the SSF technique should help to decrease research costs.

Peroneus Brevis Attrition & Longitudinal Split Tear without Subluxation and Associated Hypertrophy of Peronal Tubercle" - Treatment of an Uncommon Lesion.

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Tiwari, Mukesh; Singh, Varun; Bhargava, Rakesh

2015-01-01

Peroneus brevis tendinitis with its attritional longitudinal split rupture without any subluxation from peroneal groove and associated enlarged peroneal tubercle is un common presentation. A 40 year old female presented with moderate swelling and tenderness over the lateral and dorso-lateral aspect of left ankle with history of old trauma to ankle with swelling, persistant pain and difficulty in walking. On physical examination during passive eversion and inversion the excursion of the peroneal tendons was painful. Most tender point was just posterior to the tip of the fibula. During surgery we found the intact superior peroneal ligament with both peroneal tendons placed at normal site without subluxation, tendon sheath was inflamed and swollen, on further dissection we could see the attrition of inner surface of the peroneus brevis and a 2 cm longitudinal split tear of the same. Although rare but peroneus brevis tendon attrition and tear can occur without subluxation from peronal groove. Refractory ankle pain on lateral aspect presenting with on and off swelling should arise suspicion of peroneal tendon tear. Correct diagnosis and proper surgical repair can produce excellent results.

PS-109 Barriers and facilitators to implementing drug changes caused by drug tenders and shortages

DEFF Research Database (Denmark)

Rishøj, Rikke Mie; Christrup, Lona Louring; Clemmensen, Marianne H

2015-01-01

. Purpose To identify barriers and facilitators for implementing drug changes due to drug tenders and shortages in Danish public hospitals. Material and methods Six focus group interviews were conducted at three hospitals in different regions of the country. At each hospital two focus group interviews were...... thematically through content analysis. Results Barriers Identified included: frequent changes of labelling, packages and drug names. Furthermore, implementing drug changes requires extra resources and finance. Technologies such as computerised physician order entry and barcode scanning systems were perceived...... as potential facilitators, but also as barriers in cases where the quality and implementation of the systems were not adequate. Facilitators included: hospital pharmacy services and lower drug prices. Furthermore recommendations on generic prescription, optimisation of the tendering process and support...

[The pain-emotion: Advocating pain as an emotion].

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Fonseca Das Neves, J; Sule, N; Serra, E

2017-12-01

Pain is a common experience, both physical and emotional. However we often feel powerless with our patients suffering pain. This paper aims to give a new heuristic and psychological understanding of pain. According to new theories, recent researches as well as different points of view, we form an analogy between pain and emotion. Throughout historical considerations pain has always been perceived through theories and beliefs, changing its definition. This is also the case for emotion. Could they be two ways of expressing a single phenomenon? First, we must clarify the definition of emotion. In past, emotion was considered as a multiple-conditioned notion. To be considered as an emotion the pain had to fill numerous features, which differ according to the scientific opinions. The emotion may be considered as a physical expression or perceived only as the consequences of a real emotion, i.e., the subjective feeling. We propose as a way of thinking that emotion brings together these two concepts. We support a flexible vision of emotion. To investigate the field of the emotion different mental steps may be thought of: we should conceive of the emotion as a stimulus, as an emotional evaluation and as a tendency to action, which becomes an emotional response. These steps are colored by subjective feelings. It can be summarized in three levels: the situation decoding (1), the response organization (2) and the effectiveness of the response (3). Second pain can be considered as a complex notion involving personal and subjective feelings. We can use multidimensional patterns and consider emotion with its multiple features: the generating mechanisms, the pain perception, the pain behavior and the environment. Each stage can be divided in different ways. Hence pain treatment could be approached as an emotional treatment. Indeed, we can make a link between generating mechanisms and emotion situation decoding, between pain perception and emotion situation decoding and response

The effect of adenosine 5'-monophosphate (AMP) on tenderness, microstructure and chemical-physical index of duck breast meat.

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Wang, Daoying; Deng, Shaoying; Zhang, Muhan; Geng, Zhiming; Sun, Chong; Bian, Huan; Xu, Weimin; Zhu, Yongzhi; Liu, Fang; Wu, Haihong

2016-03-30

Adenosine 5'-monophosphate (AMP) is often used in meat and poultry soups as a flavor enhancer (flavor modifier), or as food additives for specific nutritional purposes. Our previous research as well as evidence from others showed that actomyosin could be dissociated into myosin and actin by AMP in extracted muscle solution. However, there is no report available on the application of AMP to dissociate actomyosin and to improve meat tenderness. The objectives of this study were to evaluate the effect of AMP on duck meat tenderness and other quality traits and to explore the mechanism of the action of AMP on meat tenderness. Duck breast muscle was treated with 0, 10, 20, 30, 40 mmol L(-1) AMP at 5 °C for 10 h and examined for shear force, microstructure, actomyosin dissociation, myofibril fragmentation index (MFI), pH, water content, cooking loss, CIE* color (L*, a*, b*), inosine monophosphate (IMP) and free amino acid (FAA) contents. Results showed that shear force, cooking loss, L* and b* of the muscles significantly decreased after AMP treatment (P 0.05), and muscle shrinkage in transverse and longitudinal directions were restrained after AMP treatment. The results suggest that AMP could notably improve meat tenderness, and this effect was probably mainly through increasing muscle pH, promoting actomyosin dissociation and disrupting the Z-line; meanwhile, the conversion of AMP to IMP may contribute to the flavor of meat. © 2015 Society of Chemical Industry.

Interspinous bursitis is common in polymyalgia rheumatica, but is not associated with spinal pain.

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Camellino, Dario; Paparo, Francesco; Morbelli, Silvia; Cutolo, Maurizio; Sambuceti, Gianmario; Cimmino, Marco A

2014-12-01

Polymyalgia rheumatica (PMR) is a common inflammatory disease in older people characterized by shoulder and/or pelvic girdle, and cervical and, occasionally, lumbar pain. Interspinous bursitis has been suggested as a potential cause of spinal symptoms. We evaluated, by 18 F-fluorodeoxyglucose (FDG) positron emission tomography integrated with computed tomography (PET/CT), the vertebral structures involved in PMR in a cohort of consecutive, untreated patients. Sixty-five consecutive patients with PMR were studied. After a standardized physical examination, which included evaluation of pain and tenderness in the vertebral column, they underwent FDG-PET/CT. Sites of increased uptake and their correlation with spontaneous and provoked pain were recorded. For comparison, FDG-PET/CT was performed also in 65 age- and sex-matched controls and in 10 rheumatoid arthritis (RA) patients. The most frequent site of spontaneous and provoked pain was the cervical portion. FDG uptake was more frequent in the lumbar portion than at any other location, and in the cervical rather than in the thoracic portion (P bursitis (r = 0.34, P = 0.007). None of the control patients and one out of ten RA patients showed interspinous bursitis. Interspinous bursitis is a frequent finding in the lumbar spine of patients with PMR. However, it is not associated with clinical symptoms and can hardly explain the spinal pain reported by the patients. Cervical pain is more frequent than lumbar pain in PMR patients and may be caused by shoulder girdle involvement.

Unusual cause of a painful right testicle in a 16-year-old man: a case report

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Riaz Amjid A

2011-01-01

Full Text Available Abstract Introduction Urgent surgical exploration of the scrotum of a child or teenager who presents with a painful and swollen testicle is paramount if testicular torsion is not to be missed. It is extremely rare for a non-scrotal pathology to present with acute scrotal signs. Here we present such a rare case and emphasize the importance of being aware of this potential clinical pitfall. Case presentation A 16-year-old Caucasian man presented as a surgical emergency with a five to six hour history of a painful, red, and swollen right hemiscrotum. He also complained of vague lower abdominal pain, vomiting, and watery diarrhea. He had a temperature of 38.5°C and a tender, red, and swollen right hemiscrotum. The right testicle appeared elevated. He was mildly tender in his central and upper abdomen and less so in the lower abdomen. No convincing localizing abdominal signs were noted. He had an increased white cell count (15 × 109/L and C-reactive protein (CRP; 300 mg/L. Urgent right hemiscrotal exploration revealed about 5 ml of pus in the tunica vaginalis and a normal testicle. A right iliac fossa incision identified the cause: a perforated retrocecal appendix. Appendectomy was performed, and both the abdomen and scrotum washed copiously with saline before closure. The patient made an uneventful recovery. Conclusion Acute appendicitis presenting with scrotal signs due to a patent processus vaginalis is an extremely rare clinical entity. To date, fewer than five such cases have been reported in the medical literature. It is, therefore, extremely important to be aware of this unusual clinical scenario, as only a high index of suspicion will enable prompt, successful management of both the appendicitis and the scrotal abscess.

Ketoprofen gel improves low back pain in addition to IV dexketoprofen: a randomized placebo-controlled trial.

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Serinken, Mustafa; Eken, Cenker; Tunay, Kamil; Golcuk, Yalcin

2016-08-01

Oligoanalgesia is common in emergency departments (EDs), and pain management is of concern for ED physicians. The aim of this study was to reveal the effect of ketoprofen gel in patients presenting with mechanical low back pain to the ED. All the study patients received intravenous dexketoprofen additional to study drugs. After dexketoprofen, 2 g of 2.5% ketoprofen gel or placebo was administered to the site with pain and tenderness. Pain relief at 15 and 30 minutes was measured by visual analog scale scores. Rescue drug need and adverse effects were also recorded. A total of 140 patients were enrolled into the study. The mean age of the study patients was 35±12, and 56% (n=79) of them were male. The mean pain reduction at 30 minutes was 52±18 for ketoprofen gel and 37±17 for placebo, and ketoprofen gel was better than placebo at 30 minutes (mean difference, 16 mm; 95% confidence interval, 10-21). Ten patients (14%) in the placebo group and 2 patients (3%) in the ketoprofen gel group needed rescue drug (P=.35). Ketoprofen gel improves pain in patients presenting with mechanical low back pain to ED at 30 minutes in addition to intravenous dexketoprofen when compared to placebo. Copyright © 2016 Elsevier Inc. All rights reserved.

Sensory dissociation in chronic low back pain: Two case reports.

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Adamczyk, Wacław M; Luedtke, Kerstin; Saulicz, Oskar; Saulicz, Edward

2018-08-01

Patients with chronic low back pain often report that they do not perceive their painful back accurately. Previous studies confirmed that sensory dissociation and/or discrepancy between perceived body image and actual size is one of the specific traits of patients with chronic pain. Current approaches for measuring sensory dissociation are limited to two-point-discrimination or rely on pain drawings not allowing for quantitative analysis. This case study reports the sensory dissociation of two cases with chronic low back pain using a recently published test (point-to-point-test (PTP)) and a newly developed test (two-point-estimation (TPE)). Both patients mislocalized tactile stimuli delivered to the painful location compared to non-painful locations (PTP test). In addition, both patients perceived their painful lumbar region differently from non-painful sites above and below and contralateral to the painful site. TPE data showed two distinct clinical patterns of sensory dissociation: one patient perceived the two-point distance in the painful area as expanded, while the other patient perceived it as shrunk. The latter pattern of sensory dissociation (i.e., pattern shrunk) is likely to respond to sensory training. Whether enlarged patterns of sensory dissociation are more resistant to treatment remains unknown but would explain the low effectiveness of previous studies using sensory training in chronic low back pain populations. Subgrouping patients according to their sensory discrimination pattern could contribute to the choice and effectiveness of the treatment approach.

Spinal Manipulation for Low-Back Pain

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... V W X Y Z Spinal Manipulation for Low-Back Pain Share: On This Page Introduction Key Points About ... will help ensure coordinated and safe care. About Low-Back Pain Back pain is one of the most common ...

Proposal for the award of a blanket purchase agreement, without competitive tendering, for the supply of Burndy connectors

CERN Document Server

2004-01-01

This document concerns the award of a blanket purchase agreement, without competitive tendering, for the supply of Burndy connectors. The Finance Committee is invited to agree to the negotiation of a blanket purchase agreement, without competitive tendering, with SOURIAU (CH), for the supply of Burndy connectors over a period of three years, for a total amount not exceeding 600 000 euros (932 000 Swiss francs), subject to revision for inflation from 1st January 2006. The amount in Swiss francs has been calculated using the present rate of exchange.

Criteria procedure development for tender in construction design

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Malykha Galina Gennad’evna

Full Text Available This article deals with the problem of criteria optimization in order to objectively evaluate the experience of an applicant (a project organization and the quality of a design product (project documentation. The methodology to be developed is based on introduction of new evaluation criteria (sub-criteria that in conjunction with the applicable criteria specified by the Law on the Contract System will allow developing the optimal procedure to evaluate competitive bids of the participants in tenders and determining the most appropriate candidate, with whom the contract will be further concluded. The article analyzes the existing criteria and their interaction with each other and describes the specifics of tenders for design in the form of open competition. The list decreases to three criteria, such as "contract price", "quality, functional and environmental characteristics of a procurement facility", "qualification of procurement participants, including availability of financial resources, equipment and other material resources necessary for the execution of the contract material resources, the presence of goodwill, professionals and other employees of a certain experience level". However, in order to upgrade the quality of assurance procedures for the design works to be performed, it was decided to apply new evaluation criteria (sub-criteria components, such as "availability of positive findings of the state out-of-departmental examination that are similar to the subject of competition, on a participant in placement of order", "availability of the certificate on approval of architectural and urban planning decisions that are similar to the subject of competition, on a participant in placement of order", "availability of the permit for the commissioning of facilities that are similar to the subject of competition, on a participant in placement of order", "availability of the contract for designer's supervision with a participant in placement of

Effectiveness of transcutaneous electrical nerve stimulation and microcurrent electrical nerve stimulation in bruxism associated with masticatory muscle pain - A comparative study

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Rajpurohit Bharat

2010-01-01

Full Text Available Objectives: To compare the effectiveness of transcutaneous electrical nerve stimulation (TENS and microcurrent electrical nerve stimulation (MENS on masticatory muscles pain bruxism patient. Materials and Methods : A total of 60 subjects with the clinical diagnosis of bruxism were randomly allocated to two study groups. Group A received TENS (50 Hz, pulse width 0.5 mSec, intensity 0-60 mA for 20 minutes for a period of seven days and Group B received MENS (0.5 Hz, intensity 1,000 μA for 20 minutes for a period of seven days. The outcome measures were assessed in term of Visual Analog Scale (VAS and digital pressometer of 2 Kgf. Results : The study showed significant change in intensity of pain as per VAS score ( P ≤ 0.0001 and tenderness as per digital pressometer ( P ≤ 0.0001. Conclusion : MENS could be used as an effective pain-relieving adjunct to TENS in the treatment of masticatory muscle pain due to bruxism.

Pulsed electric field processing of functional drink based on tender coconut water (Cococus nucifera L. - nannari (Hemidesmus indicus blended beverage

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R. Kumar

2014-01-01

Full Text Available Tender coconut water (Cocos nucifera L. Nannari extract (Hemidesmus indicus L. ready-to serve (RTS blended beverage were optimised. Response Surface Methodology (RSM was employed to optimize the levels of independent variables (levels of tender coconut water, nannari extract and sugar. The responses of pH, ºBrix, CIE colour (L*, a* and b* value and OAA were studied. The data obtained were analysed by multiple regression technique to generate suitable mathematical models. The developed blended beverage was processed using pulsed electric field (PEF with electric field 31.2 kV/cm, 20 pulse widths at 100 Hz frequency to minimise nutritional and sensory attributes losses and compared with conventional thermal pasteurization (96 ºC for 360 s with p-value of 8.03. Thermal pasteurization showed a significant (p<0.05 decrease in colour value, radical scavenging activity and overall acceptability after treatment and also during storage, when compared to PEF treated tender coconut water-nannari blended beverage. PEF treatment also achieved a 3.01 ± 0.69 log inactivation, similar to thermal pasteurization of native micro flora. PEF treated tender coconut water-nannari blended beverage was stable up to 120 days under ambient storage condition (27-30 °C.

An unusual cause of abdominal pain.

LENUS (Irish Health Repository)

Mc Cabe, Aileen

2011-01-01

A 26-year-old man presented to the Emergency Department with abdominal pain, diarrhoea, anorexia and haematemesis. The patient was previously diagnosed with latent tuberculosis (TB). On examination, his abdomen was diffusely tender, with localised guarding in the right iliac fossa. CT imaging of his abdomen and pelvis demonstrated a low volume of ascites, diffuse studding of the peritoneum, omental caking and several bulky low-density lymph nodes in the retroperitoneum. A laparoscopy was performed to obtain a peritoneal biopsy. Histology demonstrated fragments of peritoneum with necrotising granulomatous inflammatory infiltrate in keeping with an infectious process, favouring TB. He was commenced on rifampicin, isoniazid, pyrazinamide, ethambutol and pyridoxine under the direct observed therapy by the infectious diseases team. In view of his extensive peritoneal involvement, he was empirically started on high-dose prednisolone for symptomatic control and to reduce complications related to peritoneal adhesions.

A comprehensive protocol to diagnose and treat pain of muscular origin may successfully and reliably decrease or eliminate pain in a chronic pain population.

Science.gov (United States)

Marcus, Norman J; Gracely, Edward J; Keefe, Kelly O

2010-01-01

A comprehensive protocol is presented to identify muscular causes of regional pain syndromes utilizing an electrical stimulus in lieu of palpation, and combining elements of Prolotherapy with trigger point injections. One hundred seventy-six consecutive patients were evaluated for the presence of muscle pain by utilizing an electrical stimulus produced by the Muscle Pain Detection Device. The diagnosis of "Muscle Pain Amenable to Injection" (MPAI), rather than trigger points, was made if pain was produced for the duration of the stimulation. If MPAI was found, muscle tendon injections (MTI) were offered to patients along with post-MTI physical therapy, providing neuromuscular electrical stimulation followed by a validated exercise program [1]. A control group, evaluated 1 month prior to their actual consultation/evaluation when muscle pain was identified but not yet treated, was used for comparison. Forty-five patients who met criteria completed treatment. Patients' scores on the Brief Pain Inventory decreased an average of 62%; median 70% (P < 0.001) for pain severity and 68%; median 85% (P < 0.001) for pain interference one month following treatment. These changes were significantly greater (P < 0.001) than those observed in the untreated controls. A protocol incorporating an easily reproducible electrical stimulus to diagnose a muscle causing pain in a region of the body followed by an injection technique that involves the entirety of the muscle, and post injection restoration of muscle function, can successfully eliminate or significantly reduce regional pain present for years.

Forecasting Construction Tender Price Index in Ghana using Autoregressive Integrated Moving Average with Exogenous Variables Model

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Ernest Kissi

2018-03-01

Full Text Available Prices of construction resources keep on fluctuating due to unstable economic situations that have been experienced over the years. Clients knowledge of their financial commitments toward their intended project remains the basis for their final decision. The use of construction tender price index provides a realistic estimate at the early stage of the project. Tender price index (TPI is influenced by various economic factors, hence there are several statistical techniques that have been employed in forecasting. Some of these include regression, time series, vector error correction among others. However, in recent times the integrated modelling approach is gaining popularity due to its ability to give powerful predictive accuracy. Thus, in line with this assumption, the aim of this study is to apply autoregressive integrated moving average with exogenous variables (ARIMAX in modelling TPI. The results showed that ARIMAX model has a better predictive ability than the use of the single approach. The study further confirms the earlier position of previous research of the need to use the integrated model technique in forecasting TPI. This model will assist practitioners to forecast the future values of tender price index. Although the study focuses on the Ghanaian economy, the findings can be broadly applicable to other developing countries which share similar economic characteristics.

Additional Effect of Static Ultrasound and Diadynamic Currents on Myofascial Trigger Points in a Manual Therapy Program for Patients With Chronic Neck Pain: A Randomized Clinical Trial.

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Dibai-Filho, Almir Vieira; de Oliveira, Alessandra Kelly; Girasol, Carlos Eduardo; Dias, Fabiana Rodrigues Cancio; Guirro, Rinaldo Roberto de Jesus

2017-04-01

To assess the additional effect of static ultrasound and diadynamic currents on myofascial trigger points in a manual therapy program to treat individuals with chronic neck pain. A single-blind randomized trial was conducted. Both men and women, between ages 18 and 45, with chronic neck pain and active myofascial trigger points in the upper trapezius were included in the study. Subjects were assigned to 3 different groups: group 1 (n = 20) was treated with manual therapy; group 2 (n = 20) was treated with manual therapy and static ultrasound; group 3 (n = 20) was treated with manual therapy and diadynamic currents. Individuals were assessed before the first treatment session, 48 hours after the first treatment session, 48 hours after the tenth treatment session, and 4 weeks after the last session. There was no group-versus-time interaction for Numeric Rating Scale, Neck Disability Index, Pain-Related Self-Statement Scale, pressure pain threshold, cervical range of motion, and skin temperature (F-value range, 0.089-1.961; P-value range, 0.106-0.977). Moreover, we found no differences between groups regarding electromyographic activity (P > 0.05). The use of static ultrasound or diadynamic currents on myofascial trigger points in upper trapezius associated with a manual therapy program did not generate greater benefits than manual therapy alone.

Standardized manual palpation of myofascial trigger points in relation to neck/shoulder pain; the influence of clinical experience on inter-examiner reproducibility

DEFF Research Database (Denmark)

Myburgh, Corrie; Lauridsen, Henrik Hein; Larsen, Anders H

2011-01-01

A diagnosis of Myofascial Pain Syndrome (MPS) requires palpation for the identification of at least one clinically relevant trigger point (TP). However, few comparable, high quality studies currently exist from which to draw firm conclusions regarding the robustness of TP examination. An inter-ob...

The periodontal pain paradox: Difficulty on pain assesment in dental patients (The periodontal pain paradox hypothesis

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Haryono Utomo

2006-12-01

Full Text Available In daily dental practice, the majority of patients’ main complaints are related to pain. Most patients assume that all pains inside the oral cavity originated from the tooth. One particular case is thermal sensitivity; sometimes patients were being able to point the site of pain, although there is neither visible caries nor secondary caries in dental radiograph. In this case, gingival recession and dentin hypersensitivity are first to be treated to eliminate the pain. If these treatments failed, pain may misdiagnose as pulpal inflammation and lead to unnecessary root canal treatment. Study in pain during periodontal instrumentation of plaque-related periodontitis revealed that the majority of patients feel pain and discomfort during probing and scaling. It seems obvious because an inflammation, either acute or chronic is related to a lowered pain threshold. However, in contrast, in this case report, patient suffered from chronic gingivitis and thermal sensitivity experienced a relative pain-free sensation during probing and scaling. Lowered pain threshold which accompanied by a blunted pain perception upon periodontal instrumentation is proposed to be termed as the periodontal pain paradox. The objective of this study is to reveal the possibility of certain factors in periodontal inflammation which may involved in the periodontal pain paradox hypothesis. Patient with thermal hypersensitivity who was conducted probing and scaling, after the relative pain-free instrumentation, thermal hypersensitivity rapidly disappeared. Based on the successful periodontal treatment, it is concluded that chronic gingivitis may modulate periodontal pain perception which termed as periodontal pain paradox

Multidimensional features of pain in patients with chronic neck pain

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Fabianna Resende de Jesus-Moraleida

Full Text Available Abstract Introduction: Chronic neck pain is associated with significant health costs and loss of productivity at work. Objective: to assess pain and disability in individuals with chronic neck pain. Methods: 31 volunteers with chronic neck pain, mean age 29, 65 years, were assessed using the McGill Pain Questionnaire in Brazilian version (Br-MPQ and Neck Disability Index (NDI. The Br-MPQ analysis was performed based on the numerical values associated with the words selected to describe the experience of pain (Pain Rating Index - PRI, and present pain intensity (PPI. NDI was used to evaluate the influence of neck pain in performance of everyday tasks. Finally, we investigated the association between PPI and NDI. Results: PRI revealed that the most significant dimension was the sensory pain (70%, and the number of chosen words was 10 (2,62 out of 20 words. Mean PPI value was 1,23 (0,76 in five points; 40% of participants described pain intensity as moderate. NDI score was 9,77 (3,34, indicating mild disability. There was a positive association between disability and pain intensity (r = 0,36; p =0,046. Pain intensity and duration of pain were not associated. Conclusions: Findings of this study identified important information related to neck pain experienced by patients when suffering from chronic neck pain, moreover, the association between disability and pain intensity reinforces the importance of complementary investigation of these aspects to optimize function in them.

Tenderness, pH and Water Activity (Aw of Spices Dried Meat on Various Concentrate of Ginger Extract (Zingiber Officinale Roscoe and Different Soaking Time

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Akhadiyah Afrila

2012-09-01

Full Text Available The objectives of current research were to find out the concentrate of Ginger extract (Zingiber officinale Roscoe and different soaking time of to tenderness, pH, and water activity (Aw, microbial count and sensory evaluation of spices dried meat. The result showed that higher the ginger extract (Zingiber officinale Roscoe concentrate and longer the soaking time, it would give more tenderness, pH, and water activity (Aw to spices dried meat with 15% ginger extract (Zingiber officinale Roscoe extract and 20 minutes length of soaking time. Key Words : Dendeng, ginger, soaking time, tenderness, pH and Aw

Pain Sensitivity and Pain Catastrophizing are Associated with Persistent Pain and Disability after Lumbar Spine Surgery

Science.gov (United States)

Coronado, Rogelio A.; George, Steven Z.; Devin, Clinton J.; Wegener, Stephen T.; Archer, Kristin R.

2015-01-01

Objective To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. Design Prospective observational cohort study. Setting Academic medical center. Participants Patients (N = 68, mean ± SD age = 57.9 ± 13.1 years, N female = 40 (58.8%)) undergoing spine surgery for a degenerative condition from March 1, 2012 to April 30, 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. Interventions Not applicable. Main Outcome Measure(s) The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥ 4 and Oswestry Disability Index scores ≥ 21 at all postoperative time points. Results From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated with having persistent back pain intensity (OR = 2.0, 95% CI = 1.0; 4.1) after surgery. Increased pain catastrophizing at 6 weeks was associated with having persistent back pain intensity (OR = 1.1, 95% CI = 1.0; 1.2), pain interference (OR = 1.1, 95% CI = 1.0; 1.2), and disability (OR = 1.3, 95% CI = 1.1; 1.4). An interaction effect was not found between pain sensitivity and pain catastrophizing on persistent outcomes (p > 0.05). Conclusion(s) Findings suggest the importance of early postoperative screening for pain sensitivity and pain catastrophizing in order to identify patients at-risk for poor postoperative pain intensity, interference, and/or disability outcomes. Future research should consider the benefit of targeted therapeutic strategies for patients with these postoperative prognostic factors. PMID:26101845

The effect of extracorporeal shock wave therapy for the treatment of plantar fasciitis in regard to middle-aged patients' activity level and pain localization

Science.gov (United States)

Hanada, M.; Takahashi, M.; Matsuyama, Y.

2017-12-01

In this retrospective cohort study, we compared the efficacy of extracorporeal shock wave therapy (ESWT) for plantar fasciitis in patients with different activity levels and different pain locations. In total, 92 patients (99 feet) who were over 40 years old with chronic plantar fasciitis were treated with ESWT after being categorized as participating in recreational sports(group R) or only activities of daily living (group D). On the other hand, patients were categorized as having pain in the plantar fascia enthesis (group E) or the entire plantar fascia (group W). Pain during activity and general tenderness were evaluated by using the visual analog scale (VAS) before and after ESWT. Although the VAS for pain score during activity significantly improved in both groups R and D after ESWT (Pplantar fasciitis in middle-aged patients and ESWT was effective in patients not only playing recreational sports but also having activities of daily living. ESWT was more effective in patients with pain in the plantar fascia enthesis than in patients with pain in the entire plantar fascia.

Pediatric fibromyalgia.

Science.gov (United States)

Buskila, Dan

2009-05-01

Fibromyalgia is an idiopathic chronic pain syndrome defined by widespread nonarticular musculoskeletal pain and generalized tender points. The syndrome is associated with a constellation of symptoms, including fatigue, nonrefreshing sleep, irritable bowel, and more. Central nervous system sensitization is a major pathophysiologic aspect of fibromyalgia; in addition, various external stimuli such as trauma and stress may contribute to development of the syndrome. Fibromyalgia is most common in midlife, but may be seen at any age. This article reviews the epidemiology, clinical characteristics, etiology, management, and outcome of pediatric fibromyalgia.

Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain

Science.gov (United States)

2013-01-01

Background Despite numerous methodological flaws in previous study designs and the lack of validation in primary care populations, clinical tests for identifying acromioclavicular joint (ACJ) pain are widely utilised without concern for such issues. The aim of this study was to estimate the diagnostic accuracy of traditional ACJ tests and to compare their accuracy with other clinical examination features for identifying a predominant ACJ pain source in a primary care cohort. Methods Consecutive patients with shoulder pain were recruited prospectively from primary health care clinics. Following a standardised clinical examination and diagnostic injection into the subacromial bursa, all participants received a fluoroscopically guided diagnostic block of 1% lidocaine hydrochloride (XylocaineTM) into the ACJ. Diagnostic accuracy statistics including sensitivity, specificity, predictive values, positive and negative likelihood ratios (LR+ and LR-) were calculated for traditional ACJ tests (Active Compression/O’Brien’s test, cross-body adduction, localised ACJ tenderness and Hawkins-Kennedy test), and for individual and combinations of clinical examination variables that were associated with a positive anaesthetic response (PAR) (P≤0.05) defined as 80% or more reduction in post-injection pain intensity during provocative clinical tests. Results Twenty two of 153 participants (14%) reported an 80% PAR. None of the traditional ACJ tests were associated with an 80% PAR (P0.05). Five clinical examination variables (repetitive mechanism of pain onset, no referred pain below the elbow, thickened or swollen ACJ, no symptom provocation during passive glenohumeral abduction and external rotation) were associated with an 80% PAR (P<0.05) and demonstrated an ability to accurately discriminate between an PAR and NAR (AUC 0.791; 95% CI 0.702, 0.880; P<0.001). Less than two positive clinical features resulted in 96% sensitivity (95% CI 0.78, 0.99) and a LR- 0.09 (95% CI 0.02, 0

Proposal for the award of a contract without competitive tendering for the supply of coaxial high-voltage cable for the LHC beam dumping system

CERN Document Server

2002-01-01

This document concerns the award of a contract without competitive tendering for the supply of two types of coaxial high-voltage cable for the LHC beam dumping system. Following a market survey carried out among 14 firms in four Member States, a call for tenders (IT-2969/SL/LHC) was sent on 10 July 2001 to one firm. By the closing date, CERN had received one tender. The Finance Committee is invited to agree to the negotiation of a contract with DRAKA MULTIMEDIA CABLE (DE), the only bidder, for the supply of 14 km of coaxial high-voltage cable for the LHC beam dumping system for a total amount of 530 488 euros (779 900 Swiss francs), not subject to revision. The rate of exchange which has been used is that stipulated in the tender. The firm has indicated the following distribution by country of the contract value covered by this adjudication proposal: DE - 100%.

Public-Private partnership procurement: Game-theoretic studies of the tender process.

OpenAIRE

De Clerck, Dennis

2015-01-01

A Public-private partnership (PPP) is a settlement between a public party and a contractor or private sector consortium to engage in a long-term contractual agreement for designing, building, operating and/or maintaining capital intensive projects, while trying to attain value for money. PPPs are globally gaining importance in the construction industry. The risk transfer from the contracting government towards the private entity has important repercussions on the tender. Contractors need to c...

Role of laparoscopy in evaluation of chronic pelvic pain

Directory of Open Access Journals (Sweden)

Hebbar Shripad

2005-01-01

Full Text Available Introduction: Chronic pelvic pain (CPP is a common medical problem affecting women. Too often the physical signs are not specific. This study aims at determining the accuracy of diagnostic laparoscopy over clinical pelvic examination. Settings and Design: A retrospective study of patients who underwent diagnostic laparoscopy for CPP. Materials and Methods: The medical records of 86 women who underwent laparoscopic evaluation for CPP of at least 6-month duration were reviewed for presentation of symptoms, pelvic examination findings at the admission, operative findings and follow up when available. Statistical analysis used: McNemar Chi-square test for frequencies in a 2 x 2 table. Results: The most common presentation was acyclic lower abdominal pain (79.1%, followed by congestive dysmenorrhoea (26.7%. 61.6% of women did not reveal any significant signs on pelvic examination. Pelvic tenderness was elicited in 27.9%. Diagnostic laparoscopy revealed significant pelvic pathology in 58% of those who essentially had normal pervaginal findings. The most common pelvic pathology by laparoscopy was pelvic adhesions (20.9%, followed by pelvic congestion (18.6%. Laparoscopic adhesiolyis achieved pain relief only in one-third of the women. Conclusion: The study revealed very low incidence of endometriosis (4.7%. Overall clinical examination could detect abnormality in only 38% of women, where as laparoscopy could detect significant pathology in 66% of women with CPP. This shows superiority of diagnostic laparoscopy over clinical examination in detection of aetiology in women with CPP (P < 0.001. Adhesiolysis helps only small proportion of women in achieving pain control.

Characterizing individual painDETECT symptoms by average pain severity

Directory of Open Access Journals (Sweden)

Sadosky A

2016-07-01

Full Text Available Alesia Sadosky,1 Vijaya Koduru,2 E Jay Bienen,3 Joseph C Cappelleri4 1Pfizer Inc, New York, NY, 2Eliassen Group, New London, CT, 3Outcomes Research Consultant, New York, NY, 4Pfizer Inc, Groton, CT, USA Background: painDETECT is a screening measure for neuropathic pain. The nine-item version consists of seven sensory items (burning, tingling/prickling, light touching, sudden pain attacks/electric shock-type pain, cold/heat, numbness, and slight pressure, a pain course pattern item, and a pain radiation item. The seven-item version consists only of the sensory items. Total scores of both versions discriminate average pain-severity levels (mild, moderate, and severe, but their ability to discriminate individual item severity has not been evaluated.Methods: Data were from a cross-sectional, observational study of six neuropathic pain conditions (N=624. Average pain severity was evaluated using the Brief Pain Inventory-Short Form, with severity levels defined using established cut points for distinguishing mild, moderate, and severe pain. The Wilcoxon rank sum test was followed by ridit analysis to represent the probability that a randomly selected subject from one average pain-severity level had a more favorable outcome on the specific painDETECT item relative to a randomly selected subject from a comparator severity level.Results: A probability >50% for a better outcome (less severe pain was significantly observed for each pain symptom item. The lowest probability was 56.3% (on numbness for mild vs moderate pain and highest probability was 76.4% (on cold/heat for mild vs severe pain. The pain radiation item was significant (P<0.05 and consistent with pain symptoms, as well as with total scores for both painDETECT versions; only the pain course item did not differ.Conclusion: painDETECT differentiates severity such that the ability to discriminate average pain also distinguishes individual pain item severity in an interpretable manner. Pain

Effects of chronic widespread pain on the health status and quality of life of women after breast cancer surgery

Directory of Open Access Journals (Sweden)

Jones Kim D

2005-04-01

Full Text Available Abstract Background Most research and treatment of post-breast cancer chronic pain has focused on local or regional pain problems in the operated area. The purpose of this pilot study was to compare and contrast the pain characteristics, symptom impact, health status, and quality of life of post-breast cancer surgery women with regional chronic pain versus those with widespread chronic pain. Methods A cross-sectional, descriptive design compared two groups of women with chronic pain that began after surgery: regional pain (n = 11 and widespread pain (n = 12. Demographics, characteristics of the surgery, as well as standardized questionnaires that measured pain (Brief Pain Inventory (BPI, Short Form McGill Pain Questionnaire (MPQ-SF, disease impact (Fibromyalgia Impact Questionnaire (FIQ, Functional Assessment of Cancer Therapy-Breast (FACT-B, health status (Medical Outcomes Short Form (SF-36 and quality of life (Quality of Life Scale (QOLS were gathered. Results There were no significant differences between the groups on any demographic or type of surgery variable. A majority of both groups described their pain as aching, tender, and sharp on the MPQ-SF. On the BPI, intensity of pain and pain interference were significantly higher in the widespread pain group. Differences between the two groups reached statistical significance on the FIQ total score as well as the FACT-B physical well-being, emotional well-being and breast concerns subscales. The SF-36 physical function, physical role, and body pain subscales were significantly lower in the widespread pain group. QOLS scores were lower in the widespread pain group, but did not reach statistical significance. Conclusion This preliminary work suggests that the women in this study who experienced widespread pain after breast cancer surgery had significantly more severity of pain, pain impact and lower physical health status than those with regional pain.

Pain relief with lidocaine 5% patch in localized peripheral neuropathic pain in relation to pain phenotype

DEFF Research Database (Denmark)

Torgaard Demant, Dyveke; Lund, Karen; Finnerup, Nanna B

2015-01-01

In neuropathic pain with irritable nociceptor phenotype, up-regulation of sodium channels on nociceptors is supposed to be an important pain mechanism that may be targeted by topical sodium channel blockade. This randomised, double-blind, phenotype-panel, cross-over study with 4-week treatment pe...... had an effect on peripheral neuropathic pain, and it may be most efficacious in patients with irritable nociceptor phenotype. The lack of significant phenotype differences may be caused by too low statistical power.......In neuropathic pain with irritable nociceptor phenotype, up-regulation of sodium channels on nociceptors is supposed to be an important pain mechanism that may be targeted by topical sodium channel blockade. This randomised, double-blind, phenotype-panel, cross-over study with 4-week treatment...... periods of lidocaine 5% patch and placebo was performed to search for phenotype differences in effect. The primary efficacy measure was the total pain intensity on an 11-point numeric rating scale (NRS), and the primary objective was to compare the effect of lidocaine in patients with and without...

Regulatory polymorphisms in the bovine Ankyrin 1 gene promoter are associated with tenderness and intramuscular fat content

Directory of Open Access Journals (Sweden)

Sweeney Torres

2010-12-01

Full Text Available Abstract Background Recent QTL and gene expression studies have highlighted ankyrins as positional and functional candidate genes for meat quality. Our objective was to characterise the promoter region of the bovine ankyrin 1 gene and to test polymorphisms for association with sensory and technological meat quality measures. Results Seven novel promoter SNPs were identified in a 1.11 kb region of the ankyrin 1 promoter in Angus, Charolais and Limousin bulls (n = 15 per breed as well as 141 crossbred beef animals for which meat quality data was available. Eighteen haplotypes were inferred with significant breed variation in haplotype frequencies. The five most frequent SNPs and the four most frequent haplotypes were subsequently tested for association with sensory and technological measures of meat quality in the crossbred population. SNP1, SNP3 and SNP4 (which were subsequently designated regulatory SNPs and SNP5 were associated with traits that contribute to sensorial and technological measurements of tenderness and texture; Haplotype 1 and haplotype 4 were oppositely correlated with traits contributing to tenderness (P Conclusion The conclusion from this study is that alleles defining haplotypes 2 and 4 could usefully contribute to marker SNP panels used to select individuals with improved IMF/juiciness or tenderness in a genome-assisted selection framework.

The effects of degree of dark cutting on tenderness and sensory attributes of beef

Science.gov (United States)

The objective of this study was to determine the effect of degree of dark cutting (DC) on the tenderness, juiciness, and flavor attributes of beef. During carcass grading at a large U.S. commercial beef harvesting facility, DC carcasses (n = 160) and matching normal control (NC) carcasses (n = 160)...

Fibromyalgia and headache: an epidemiological study supporting migraine as part of the fibromyalgia syndrome.

Science.gov (United States)

Marcus, Dawn A; Bernstein, Cheryl; Rudy, Thomas E

2005-11-01

Fibromyalgia is defined by widespread body pain, tenderness to palpation of tender point areas, and constitutional symptoms. The literature reports headache in about half of fibromyalgia patients. The current epidemiological study was designed to determine the prevalence and characteristics of headache in fibromyalgia patients. Treatment-seeking fibromyalgia patients were evaluated with measures for fibromyalgia, chronic headache, quality of life, and psychological distress. Multivariate analysis of variance (MANOVA) and t-tests were used to identify significant differences, as appropriate. A total of 100 fibromyalgia patients were screened (24 fibromyalgia without headache and 76 fibromyalgia with headache). International Headache Society diagnoses included: migraine alone (n = 15 with aura, n = 17 without aura), tension-type alone (n = 18), combined migraine and tension-type (n = 16), post-traumatic (n = 4), and probable analgesic overuse headache (n = 6). Fibromyalgia tender point scores and counts and most measures of pain severity, sleep disruption, or psychological distress were not significantly different between fibromyalgia patients with and without headache. As expected, the fibromyalgia patients with headache scored higher on the Headache Impact Test (HIT-6) (62.1 +/- 0.9 vs 48.3 +/- 1.6, p 60 in 80% of fibromyalgia plus headache patients, representing severe impact from headache, and 56-58 in 4%, representing substantial impact. In summary, chronic headache was endorsed by 76% of treatment-seeking fibromyalgia patients, with 84% reporting substantial or severe impact from their headaches. Migraine was diagnosed in 63% of fibromyalgia plus headache patients, with probable analgesic overuse headache in only 8%. General measures of pain, pain-related disability, sleep quality, and psychological distress were similar in fibromyalgia patients with and without headache. Therefore, fibromyalgia patients with headache do not appear to represent a significantly

Cerebral interactions of pain and reward and their relevance for chronic pain.

Science.gov (United States)

Becker, Susanne; Gandhi, Wiebke; Schweinhardt, Petra

2012-06-29

Pain and reward are opponent, interacting processes. Such interactions are enabled by neuroanatomical and neurochemical overlaps of brain systems that process pain and reward. Cerebral processing of hedonic ('liking') and motivational ('wanting') aspects of reward can be separated: the orbitofrontal cortex and opioids play an important role for the hedonic experience, and the ventral striatum and dopamine predominantly process motivation for reward. Supported by neuroimaging studies, we present here the hypothesis that the orbitofrontal cortex and opioids are responsible for pain modulation by hedonic experience, while the ventral striatum and dopamine mediate motivational effects on pain. A rewarding stimulus that appears to be particularly important in the context of pain is pain relief. Further, reward, including pain relief, leads to operant learning, which can affect pain sensitivity. Indirect evidence points at brain mechanisms that might underlie pain relief as a reward and related operant learning but studies are scarce. Investigating the cerebral systems underlying pain-reward interactions as well as related operant learning holds the potential of better understanding mechanisms that contribute to the development and maintenance of chronic pain, as detailed in the last section of this review. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Exploring Factors of Successful Tendering Practices using Qualitative Comparative Analysis (QCA): The Study of Organizational Repetitions

DEFF Research Database (Denmark)

Bekdik, Baris; Thuesen, Christian

2015-01-01

combinations of factors leading to particular results of tendering practices. Empirical material collected through data mining in previously completed project records (quantitative data) is supported by data obtained from project managers of a general contractor company (qualitative data) in order...... to holistically describe the combination of conditions resulting in particular tender results. As a result of the analysis, a solution set is found explaining the path leading to project contract winning; previous work experience between client and general contractor together with either previous work experience...... between architect and general contractor for design-bid-build projects or senior project responsible involvement from the contractors side in design-build projects. The analysis illustrates how QCA is a powerful strategy for exploring the complexity of project practices being able to bridge the divide...

Pain: Postoperative Analgesia in Infants and Neonates

NARCIS (Netherlands)

I. Ceelie (Ilse)

2011-01-01

textabstractPain affects almost everyone at some point in his or her life. A definition drawn up by the International Association for the Study of Pain (IASP) has it that pain is always subjective This would seem to imply that the way in which pain is perceived varies from person to person and may

Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia.

Science.gov (United States)

Taylor, D C; Meyers, W C; Moylan, J A; Lohnes, J; Bassett, F H; Garrett, W E

1991-01-01

There has been increasing interest within the European sports medicine community regarding the etiology and treatment of groin pain in the athlete. Groin pain is most commonly caused by musculotendinous strains of the adductors and other muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. Cases may be termed "pubalgia" if physical examination does not reveal inguinal hernia and there is an absence of other etiology for groin pain. We present nine cases of patients who underwent herniorrhaphies for groin pain. Two patients had groin pain without evidence of a hernia preoperatively (pubalgia). In the remaining seven patients we determined the presence of a hernia by physical examination. At operation, eight patients were found to have inguinal hernias. One patient had no hernia but had partial avulsion of the internal oblique fibers from their insertion at the public tubercle. The average interval from operation to return to full activity was 11 weeks. All patients returned to full activity within 3 months of surgery. One patient had persistent symptoms of mild incisional tenderness, but otherwise there were no recurrences, complications, or persistence of symptoms. Abnormalities of the abdominal wall, including inguinal hernias and microscopic tears or avulsions of the internal oblique muscle, can be an overlooked source of groin pain in the athlete. Operative treatment of this condition with herniorrhaphy can return the athlete to his sport within 3 months.

关节对应取穴法配合运动针刺治疗急性踝关节扭伤疗效分析%Analysis of the Efficacy of Joint-corresponding Point Selection plus Exercise Acupuncture in Treating Acute Ankle Sprain

Institute of Scientific and Technical Information of China (English)

裴春勤; 魏瑛

2017-01-01

目的 观察关节对应取穴法配合运动针刺治疗急性踝关节扭伤的临床疗效.方法 选取70例急性踝关节扭伤的患者,随机分为两组,每组35例.治疗组采用关节对应取穴配合运动针刺法治疗,对照组采用弹力绷带固定,两组均配合冰敷、制动抬高等辅助措施.7d为1个疗程,共治疗2个疗程.观察并记录治疗前后两组患者疼痛、压痛、肿胀、活动范围评分变化,并比较疗效.结果 治疗组愈显率为88.6%,对照组愈显率为54.3%,治疗组明显优于对照组(P<0.01).治疗后两组关节疼痛、压痛、肿胀、活动范围评分减少(P<0.01);治疗后治疗组关节压痛、活动范围评分低于对照组(P<0.05).结论 应用关节对应取穴法配合运动针刺治疗急性踝关节扭伤临床疗效明显.%Objective To investigate the clinical efficacy of joint-corresponding point selection plus exercise acupuncture in treating acute ankle sprain.Method Enrolled 70 patients with acute ankle sprain were randomly allocated to two groups.The treatment group received joint-corresponding point selection plus exercise acupuncture and the control group,elastic bandage fixation.Both groups were given ice compress,mobilizationand elevation as auxiliary measures.Treatment was provided seven days as one coursefor a total of two courses.The pain, tenderness, swelling andrange of activitieswere scored in the two groups of patients before and after treatment.Thetherapeutic effects were compared.Result The total efficacy rate was 88.6% in the treatment groupand54.3% in the control group.The therapeutic effect was significantly better in the treatment group than in the control group (P<0.01). Joint pain, tenderness, swelling and activity scores decreased in the two groups after treatment (P<0.01). Joint tenderness and activity scores were lower in the treatment group than in the control group after treatment (P<0.01).Conclusion Joint-corresponding point selection plus exercise

Shared genetic factors underlie chronic pain syndromes

NARCIS (Netherlands)

Vehof, Jelle; Zavos, Helena M. S.; Lachance, Genevieve; Hammond, Christopher J.; Williams, Frances M. K.

Chronic pain syndromes (CPS) are highly prevalent in the general population, and increasingly the evidence points to a common etiological pathway. Using a large cohort of twins (n = 8564) characterized for chronic widespread musculoskeletal pain (CWP), chronic pelvic pain (PP), migraine (MIG), dry

Pain management intervention targeting nursing staff and general practitioners: Pain intensity, consequences and clinical relevance for nursing home residents.

Science.gov (United States)

Dräger, Dagmar; Budnick, Andrea; Kuhnert, Ronny; Kalinowski, Sonja; Könner, Franziska; Kreutz, Reinhold

2017-10-01

Although chronic pain is common in older adults, its treatment is frequently inappropriate. This problem is particularly prevalent in nursing home residents. We therefore developed an intervention to optimize pain management and evaluated its effects on pain intensity and pain interference with function in nursing home residents in Germany. In a cluster-randomized controlled intervention, 195 residents of 12 Berlin nursing homes who were affected by pain were surveyed at three points of measurement. A modified German version of the Brief Pain Inventory was used to assess pain sites, pain intensity and pain interference with function in various domains of life. The intervention consisted of separate training measures for nursing staff and treating physicians. The primary objective of reducing the mean pain intensity by 2 points was not achieved, partly because the mean pain intensity at baseline was relatively low. However, marginal reductions in pain were observed in the longitudinal assessment at 6-month follow up. The intervention and control groups differed significantly in the intensity sum score and in the domain of walking. Furthermore, the proportion of respondents with pain scores >0 on three pain intensity items decreased significantly. Given the multifocal nature of the pain experienced by nursing home residents, improving the pain situation of this vulnerable group is a major challenge. To achieve meaningful effects not only in pain intensity, but especially in pain interference with function, training measures for nursing staff and physicians need to be intensified, and long-term implementation appears necessary. Geriatr Gerontol Int 2017; 17: 1534-1543. © 2016 Japan Geriatrics Society.

Functional Movement Screen: Pain versus composite score and injury risk.

Science.gov (United States)

Alemany, Joseph A; Bushman, Timothy T; Grier, Tyson; Anderson, Morgan K; Canham-Chervak, Michelle; North, William J; Jones, Bruce H

2017-11-01

The Functional Movement Screen (FMS™) has been used as a screening tool to determine musculoskeletal injury risk using composite scores based on movement quality and/or pain. However, no direct comparisons between movement quality and pain have been quantified. Retrospective injury data analysis. Male Soldiers (n=2154, 25.0±1.3years; 26.2±.7kg/m 2 ) completed the FMS (scored from 0 points (pain) to 3 points (no pain and perfect movement quality)) with injury data over the following six months. The FMS is seven movements. Injury data were collected six months after FMS completion. Sensitivity, specificity, receiver operator characteristics and positive and negative predictive values were calculated for pain occurrence and low (≤14 points) composite score. Risk, risk ratios (RR) and 95% confidence intervals were calculated for injury risk. Pain was associated with slightly higher injury risk (RR=1.62) than a composite score of ≤14 points (RR=1.58). When comparing injury risk between those who scored a 1, 2 or 3 on each individual movement, no differences were found (except deep squat). However, Soldiers who experienced pain on any movement had a greater injury risk than those who scored 3 points for that movement (pmovements in which pain occurrence increased, so did injury risk (p<0.01). Pain occurrence may be a stronger indicator of injury risk than a low composite score and provides a simpler method of evaluating injury risk compared to the full FMS. Published by Elsevier Ltd.

Proposal for the award of a contract, without competitive tendering, for the maintenance of low-voltage switchgear

CERN Document Server

2003-01-01

This document concerns the award of a contract, without competitive tendering, for the maintenance of low-voltage switchgear. The Finance Committee is invited to agree to the negotiation of a contract, without competitive tendering, for the maintenance of low-voltage switchgear with HAZEMEYER (FR) for a total amount of 385 000 euros (610 000 Swiss francs), covering an initial period of five years, subject to revision for inflation after 1 January 2007. The contract will include options for two one-year extensions beyond the initial five-year period. The amount in Swiss francs has been calculated using the present rate of exchange. The firm has indicated the following distribution by country of the contract value covered by this adjudication proposal: FR - 100%.

Pain over speed bumps in diagnosis of acute appendicitis: diagnostic accuracy study.

Science.gov (United States)

Ashdown, Helen F; D'Souza, Nigel; Karim, Diallah; Stevens, Richard J; Huang, Andrew; Harnden, Anthony

2012-12-14

To assess the diagnostic accuracy of pain on travelling over speed bumps for the diagnosis of acute appendicitis. Prospective questionnaire based diagnostic accuracy study. Secondary care surgical assessment unit at a district general hospital in the UK. 101 patients aged 17-76 years referred to the on-call surgical team for assessment of possible appendicitis. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for pain over speed bumps in diagnosing appendicitis, with histological diagnosis of appendicitis as the reference standard. The analysis included 64 participants who had travelled over speed bumps on their journey to hospital. Of these, 34 had a confirmed histological diagnosis of appendicitis, 33 of whom reported increased pain over speed bumps. The sensitivity was 97% (95% confidence interval 85% to 100%), and the specificity was 30% (15% to 49%). The positive predictive value was 61% (47% to 74%), and the negative predictive value was 90% (56% to 100%). The likelihood ratios were 1.4 (1.1 to 1.8) for a positive test result and 0.1 (0.0 to 0.7) for a negative result. Speed bumps had a better sensitivity and negative likelihood ratio than did other clinical features assessed, including migration of pain and rebound tenderness. Presence of pain while travelling over speed bumps was associated with an increased likelihood of acute appendicitis. As a diagnostic variable, it compared favourably with other features commonly used in clinical assessment. Asking about speed bumps may contribute to clinical assessment and could be useful in telephone assessment of patients.

Pain flare following external beam radiotherapy and meaningful change in pain scores in the treatment of bone metastases

International Nuclear Information System (INIS)

Chow, Edward; Ling, Alison; Davis, Lori; Panzarella, Tony; Danjoux, Cyril

2005-01-01

Background and purpose: To examine the incidence of pain flare following external beam radiotherapy and to determine what constitutes a meaningful change in pain scores in the treatment of bone metastases. Patients and methods: Patients with bone metastases treated with external beam radiotherapy were asked to score their pain on a scale of 0-10 before the treatment (baseline), daily during the treatment and for 10 days after completion of external beam radiation. Pain flare was defined as a two-point increase from baseline pain in the pain scale of 0-10 with no decrease in analgesic intake or a 25% increase in analgesic intake employing daily oral morphine equivalent with no decrease in pain score. To distinguish pain flare from progression of pain, we required the pain score and analgesic intake to return back to baseline levels after the increase/flare. They were also asked to indicate if their pain changed during that time compared to pre-treatment level. The change in pain score was compared with patient perception. Results: Eighty-eight patients were evaluated in this study. There were 49 male and 39 female patients with the median age of 70 years. Twelve of 88 patients (14%) had pain flare on day 1. The overall incidence of pain flare during the study period ranged from 2 to 16%. A total of 797 pain scorings were obtained. Patients perceived an improvement in pain when their self-reported pain score decreased by at least two points. Conclusions: Our study confirms the occurrence of pain flare following the external beam radiotherapy in the treatment of bone metastases. Further studies are required to predict who are at risk for flare. Appropriate measures can be taken to alleviate the pain flare. The finding in the meaningful change in pain scores supports the investigator-defined partial response used in some clinical trials

Fear of pain in the context of intensive pain rehabilitation among children and adolescents with neuropathic pain: associations with treatment response.

Science.gov (United States)

Simons, Laura E; Kaczynski, Karen J; Conroy, Caitlin; Logan, Deirdre E

2012-12-01

Recent research has implicated pain-related fear in relation to functional outcomes in children with chronic pain. The current study examined fear of pain, disability, and depression within the context of an intensive pain rehabilitation program. One hundred forty-five children and adolescents who participated in an intensive interdisciplinary pediatric pain rehabilitation day program were assessed in this study. Patients completed measures of pain intensity, pain-related fears, functional disability, and depressive symptoms at admission, discharge, and on average, 2 months postdischarge. After controlling for pain intensity, pain-related fear was significantly related to disability and depressive symptoms at all time points. As predicted, a decline in pain-related fear was significantly associated with a decrease in disability and depressive symptoms. Interestingly, high levels of pain-related fears at admission predicted less reduction in functional disability and depression at discharge, suggesting that high levels of pain-related fear may be a risk factor in relation to treatment outcomes. Overall, results indicate that the relationship between fear of pain and changes in disability and depressive symptoms are closely linked, with fear of pain playing an important role in treatment. This paper presents results underscoring the importance of pain-related fear in relation to treatment response for children and adolescents with chronic pain. These findings support the need to develop and implement interventions that target reductions in pain-related fear. Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

Hip pain from the orthopeadic point of view

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Fernandez, E., E-mail: efernandez@hospital-ribera.com [Orthopaedic Department, Hospital Universitario de la Ribera, Alzira (Spain); Gastaldi, P. [Hospital de la Malvarrosa, Valencia (Spain)

2012-12-15

The hip and its disorders represent a clinical, diagnostic and therapeutic challenge greater than any other joints. Clinical symptoms are usually non specific and provocative maneuvers are sometimes unreliable, pain might be referred even from other joints and many times accurate assessment need imaging techniques. New surgical options, especially the latest development of hip arthroscopy has open horizons for treating intraarticular disorders. In this review article we will review basic clinical assessment and what we need as orthopeadic surgeons from radiology.

Variation at the Calpain 3 gene is associated with meat tenderness in zebu and composite breeds of cattle

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Bunch Rowan J

2008-07-01

Full Text Available Abstract Background Quantitative Trait Loci (QTL affecting meat tenderness have been reported on Bovine chromosome 10. Here we examine variation at the Calpain 3 (CAPN3 gene in cattle, a gene located within the confidence interval of the QTL, and which is a positional candidate gene based on the biochemical activity of the protein. Results We identified single nucleotide polymorphisms (SNP in the genomic sequence of the CAPN3 gene and tested three of these in a sample of 2189 cattle. Of the three SNP genotyped, the CAPN3:c.1538+225G>T had the largest significant additive effect, with an allele substitution effect in the Brahman of α = -0.144 kg, SE = 0.060, P = 0.016, and the polymorphism explained 1.7% of the residual phenotypic variance in that sample of the breed. Significant haplotype substitution effects were found for all three breeds, the Brahman, the Belmont Red, and the Santa Gertrudis. For the common haplotype, the haplotype substitution effect in the Brahman was α = 0.169 kg, SE = 0.056, P = 0.003. The effect of this gene was compared to Calpastatin in the same sample. The SNP show negligible frequencies in taurine breeds and low to moderate minor allele frequencies in zebu or composite animals. Conclusion These associations confirm the location of a QTL for meat tenderness in this region of bovine chromosome 10. SNP in or near this gene may be responsible for part of the overall difference between taurine and zebu breeds in meat tenderness, and the greater variability in meat tenderness found in zebu and composite breeds. The evidence provided so far suggests that none of these tested SNP are causative mutations.

Species of Compassion: Aesthetics, Anaesthetics, and Pain in the Physiological Laboratory

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Rob Boddice

2012-12-01

Full Text Available This essay explores the interplay of different species of compassion with regard to physiological practices in the final decades of the nineteenth century. Drawing on the lexicon from which ideals of late-Victorian compassion were formed, it illustrates their contested nature, demonstrating how physiologists developed their own concepts of compassion based on the theories of Darwin and Spencer. Within this purview, the essay examines the historical specificity of antivivisectionist compassion as well as ways in which pain in the laboratory was conceptualized, experienced, and managed ethically. This article explores the interplay of different species of compassion with regard to physiological practices in the last quarter of the nineteenth century in Britain. The lexicographical web of late-Victorian compassion included ‘humanity’, ‘pity’, ‘commiseration’, ‘tenderness’ (or ‘tender sympathy’, and ‘sympathetic pain’, all of which projected contested ideals of both individual character and moral conduct. As well as showing the historical specificity of antivivisectionist compassion – a complex aesthetic of pain closely linked to disgust – the article will principally demonstrate that physiologists (and the community of evolutionary scientists in general were applying their own newly, but no less highly, developed form of compassion that emerged straight from the pages of Darwin and Spencer. There is a story here of pain awareness and pain imagination within physiology, specifically connected to feelings of ‘humanity’. In practice, this story centres on anaesthesia and its role in allowing physiologists to live up to an ideal of ‘imperturbability’. It includes an investigation into what physiologists thought about causing pain in animals, as well as analysis of what changed after the use of anaesthetics became widespread. The article inquires anew about the ways in which pain in the laboratory was conceptualized

Fibromyalgia revisited: the challenge to a diagnoses remains

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José Eduardo Martinez

2010-12-01

Full Text Available ABSTRACT Fibromyalgia is a clinical syndrome characterized by widespread musculoskeletal pain associated with areas of the body known as tender points which, when pressured gently, cause an exaggerated pain response. The most accepted physiopathological theory is that the pain in fibromyalgia results from an unbalance between the pain transmission stimulus mechanism and the pain inhibition one. The symptoms range from widespread musculoskeletal pain; disruptive sleep patterns; fatigue; short-lived generalized stiffness (generally in the morning; edema sensation and paresthesia. There is a constant association with other functional syndrome such as: depression, anxiety, migraine and irritable bowel syndrome. In 1990 The American College of Rheumatology developed a set of criteria to diagnose fibromyalgia and include it in scientific studies so as to help with the upcoming of a patient´s diagnosis and its follow up.

Treatment of Myofascial Trigger Points of Pelvic Floor with Physiotherapeutic Package: A Case Report

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Esmaeil Shokri

2015-03-01

Full Text Available Background: There are various factors that may cause pain and dysfunction in the pelvic region. Myofascial trigger points can likewise contribute in pelvic pain. Common treatments for myofascial trigger points include electrotherapy, laser therapy, massage, ischemic compression, dry-needling, stretch, icing, heating, and biofeedback. Case Report: A 26 year old man with an exertion-related pain that lasted 5 months was referred for physiotherapy consultation. He had no pain at rest but reported a referral pain from perineal region to the anus and muscular stiffness following a bout of physical activity. On palpation there was a trigger point in the perineal region with referral pain to anus. At the beginning of the treatment, the patient was asked to stop his physical activities. The patient received a treatment package which was useful in the management of trigger points. After 7 sessions of treatment the pain was diminished and there was no exercise induced stiffness. The patient was followed for 10 months later and no pain and stiffness was reported. Conclusion: The application of heat, friction massage, stretching, combined with endurance exercise could be an effective treatment for reliving the pain and muscular stiffness caused by trigger points.

Neuroscience education in addition to trigger point dry needling for the management of patients with mechanical chronic low back pain: A preliminary clinical trial.

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Téllez-García, Mario; de-la-Llave-Rincón, Ana I; Salom-Moreno, Jaime; Palacios-Ceña, Maria; Ortega-Santiago, Ricardo; Fernández-de-Las-Peñas, César

2015-07-01

The objective of the current study was to determine the short-term effects of trigger point dry needling (TrP-DN) alone or combined with neuroscience education on pain, disability, kinesiophobia and widespread pressure sensitivity in patients with mechanical low back pain (LBP). Twelve patients with LBP were randomly assigned to receive either TrP-DN (TrP-DN) or TrP-DN plus neuroscience education (TrP-DN + EDU). Pain intensity (Numerical Pain Rating Scale, 0-10), disability (Roland-Morris Disability Questionnaire-RMQ-, Oswestry Low Back Pain Disability Index-ODI), kinesiophobia (Tampa Scale of Kinesiophobia-TSK), and pressure pain thresholds (PPT) over the C5-C6 zygapophyseal joint, transverse process of L3 vertebra, second metacarpal, and tibialis anterior muscle were collected at baseline and 1-week after the intervention. Patients treated with TrP-DN + EDU experienced a significantly greater reduction of kinesiophobia (P = 0.008) and greater increases in PPT over the transverse process of L3 (P = 0.049) than those patients treated only with TrP-DN. Both groups experienced similar decreases in pain, ODI and RMQ, and similar increases in PPT over the C5/C6 joint, second metacarpal, and tibialis anterior after the intervention (all, P > 0.05). The results suggest that TrP-DN was effective for improving pain, disability, kinesiophobia and widespread pressure sensitivity in patients with mechanical LBP at short-term. The inclusion of a neuroscience educational program resulted in a greater improvement in kinesiophobia. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mixed-methods development of a new patient-reported outcome instrument for chronic low back pain: part 1-the Patient Assessment for Low Back Pain - Symptoms (PAL-S).

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Martin, Mona L; Blum, Steven I; Liedgens, Hiltrud; Bushnell, Donald M; McCarrier, Kelly P; Hatley, Noël V; Ramasamy, Abhilasha; Freynhagen, Rainer; Wallace, Mark; Argoff, Charles; Eerdekens, Mariёlle; Kok, Maurits; Patrick, Donald L

2018-06-01

We describe the mixed-methods (qualitative and quantitative) development and preliminary validation of the Patient Assessment for Low Back Pain-Symptoms (PAL-S), a patient-reported outcome measure for use in chronic low back pain (cLBP) clinical trials. Qualitative methods (concept elicitation and cognitive interviews) were used to identify and refine symptom concepts and quantitative methods (classical test theory and Rasch measurement theory) were used to evaluate item- and scale-level performance of the measure using an iterative approach. Patients with cLBP participated in concept elicitation interviews (N = 43), cognitive interviews (N = 38), and interview-based assessment of paper-to-electronic mode equivalence (N = 8). A web-based sample of patients with self-reported cLBP participated in quantitative studies to evaluate preliminary (N = 598) and revised (n = 401) drafts and a physician-diagnosed cohort of patients with cLBP (N = 45) participated in preliminary validation of the measure. The PAL-S contained 14 items describing symptoms (overall pain, sharp, prickling, sensitive, tender, radiating, shocking, shooting, burning, squeezing, muscle spasms, throbbing, aching, and stiffness). Item-level performance, scale structure, and scoring seemed to be appropriate. One-week test-retest reproducibility was acceptable (intraclass correlation coefficient 0.81 [95% confidence interval, 0.61-0.91]). Convergent validity was demonstrated with total score and MOS-36 Bodily Pain (Pearson correlation -0.79), Neuropathic Pain Symptom Inventory (0.73), Roland-Morris Disability Questionnaire (0.67), and MOS-36 Physical Functioning (-0.65). Individual item scores and total score discriminated between numeric rating scale tertile groups and painDETECT categories. Respondent interpretation of paper and electronic administration modes was equivalent. The PAL-S has demonstrated content validity and is potentially useful to assess treatment benefit in cLBP clinical trials.

Potentiation of antioxidant effect of dietary tender cluster beans (Cyamopsis tetragonoloba) by garlic (Allium sativum) in high-cholesterol-fed rats.

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Pande, Shubhra; Srinivasan, Krishnapura

2013-10-01

The antioxidant role of tender cluster beans (Cyamopsis tetragonoloba, CB), a rich source of soluble fibre, was investigated in a hypercholesterolemia-induced oxidative stress situation in rats. In the context of dietary garlic (Allium sativa) potentiating the hypocholesterolemic influence of CB, we also examined if dietary garlic enhances the antioxidant potential of CB. Groups of Wistar rats were rendered hypercholesterolemic by feeding them a 0.5% cholesterol diet for 8 weeks. Dietary interventions were made by inclusion of 15% tender CB powder or 1% garlic powder or their combination in a high-cholesterol diet. Concentrations of antioxidant molecules and activities of antioxidant enzymes in blood and liver were examined. Dietary CB displayed an antioxidant influence in terms of elevating ascorbic acid and glutathione concentrations and stimulating the activities of antioxidant enzymes both in blood and liver. The antioxidant effect of dietary CB was generally potentiated by co-administration of garlic. Thus, consumption of tender CB and garlic together could form a strategy for improving the body's antioxidant status.

Fibromyalgia syndrome: definition and diagnostic aspects

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A. Alciati

2011-09-01

Full Text Available Although the term “fibromyalgia” (FM is relatively new, the condition characterised by chronic musculoskeletal pain that is accompanied by numerous extra-skeletal symptoms has been described in the medical literature for many years under different names. The term “fibrositis,” which was originally used in 1904 by Sir William Gowers to define a type of lumbalgia, became a synonym for diffuse musculoskeletal pain until 1976 (1. In the mid-1970s, Smythe and Moldofsky used the term “fibrositic syndrome” to describe the presence of tender points (TPs, sleep disturbances and other accompanying symptoms such as asthenia...

Linear interictal pain in Epicrania Fugax.

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Pareja, Juan A; Bandrés, Pablo

2015-01-01

Epicrania Fugax is a paroxysmal, short-lasting, head pain moving across one hemicranium, describing a linear or zag trajectory, starting and ending in territories of different nerves. Between attacks, patients are usually free of symptoms. We describe an Epicrania Fugax patient complaining of interictal pain. The interictal pain was line-shaped and extended across the usual starting and ending points of the typical Epicrania Fugax paroxysms. Although rarely encountered, persistent linear pain may be a feature of Epicrania Fugax.

Health service utilisation by people living with chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study.

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Nielsen, Suzanne; Campbell, Gabrielle; Peacock, Amy; Smith, Kimberly; Bruno, Raimondo; Hall, Wayne; Cohen, Milton; Degenhardt, Louisa

2016-11-01

Objective The aims of the present study were to describe the use, and barriers to the use, of non-medication pain therapies and to identify the demographic and clinical correlates of different non-opioid pain treatments. Methods The study was performed on a cohort (n=1514) of people prescribed pharmaceutical opioids for chronic non-cancer pain (CNCP). Participants reported lifetime and past month use of healthcare services, mental and physical health, pain characteristics, current oral morphine equivalent daily doses and financial and access barriers to healthcare services. Results Participants reported the use of non-opioid pain treatments, both before and after commencing opioid therapy. Services accessed most in the past month were complementary and alternative medicines (CAMs; 41%), physiotherapy (16%) and medical and/or pain specialists (15%). Higher opioid dose was associated with increased financial and access barriers to non-opioid treatment. Multivariate analyses indicated being younger, female and having private health insurance were the factors most commonly associated with accessing non-opioid treatments. Conclusions Patients on long-term opioid therapy report using multiple types of pain treatments. High rates of CAM use are concerning given limited evidence of efficacy for some therapies and the low-income status of most people with CNCP. Financial and insurance barriers highlight the importance of considering how different types of treatments are paid for and subsidised. What is known about the topic? Given concerns regarding long-term efficacy, adverse side-effects and risk of misuse and dependence, prescribing guidelines recommend caution in prescribing pharmaceutical opioids in cases of CNCP, typically advising a multidisciplinary approach to treatment. There is a range of evidence supporting different (non-drug) treatment approaches for CNCP to reduce pain severity and increase functioning. However, little is known about the non-opioid treatments

Topical glyceryl trinitrate for chronic Achilles tendinopathy.

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Hunte, Garth; Lloyd-Smith, Rob

2005-03-01

To determine whether continuous application of topical glyceryl trinitrate decreases pain and symptoms in chronic noninsertional Achilles tendinopathy. Randomized double-blind placebo-controlled study of 6-months' duration. Community and referral study at an Australian University Hospital. Recruitment was through newspaper advertisements and private consulting rooms. Eligibility criteria were age >18 years, a history of insidious onset of Achilles tendon pain, a tender nodule localized to the region of the calcaneal insertion, and an ultrasound examination that excluded a tendon tear. Exclusion criteria were Achilles tendinopathy of calf muscle-strengthening program. At the baseline, 2, 6, 12, and 24-week examinations the patient completed a symptom assessment sheet to rate the severity of Achilles pain with activity, at rest, and at night (0 = no pain, 4 = very severe pain). The single assessor used the same scale to measure local tenderness; an 11-point scale for the patient to report pain after the single-leg 10-hop test; and also measured the ankle plantar flexor mean peak force and ankle plantar flexor work. Follow-up was 89% complete. The groups did not differ in pain with activity, night pain, or local tenderness until the 12-week assessment when participants in the glyceryl trinitrate group reported less pain on each measure (mean scores, 0.9 vs. 1.6 [P = 0.02]; 0.2 vs. 0.7 [P = 0.04]; and 0.9 vs. 1.6 [P = 0.02], respectively). The difference was maintained at 24 weeks for pain with activity (mean scores, 0.4 vs. 1.0 [P = 0.03]). At 24 weeks the glyceryl trinitrate group reported less pain on the 10-hop test than the placebo group (mean scores, 0.5 vs. 1.6 [P = 0.005]). Although the intervention group showed a greater increase in plantar flexor mean total work at 24 weeks than the placebo group, the baseline scores were significantly different. The groups did not differ in pain at rest or in ankle plantar flexor peak force. Combining all the measures showed

Functional abdominal pain.

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Grover, Madhusudan; Drossman, Douglas A

2010-10-01

Functional abdominal pain syndrome (FAPS) is a relatively less common functional gastrointestinal (GI) disorder defined by the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits, or menstrual periods (Drossman Gastroenterology 130:1377-1390, 2006), which points to a more centrally targeted (spinal and supraspinal) basis for the symptoms. However, FAPS is frequently confused with irritable bowel syndrome and other functional GI disorders in which abdominal pain is associated with eating and bowel movements. FAPS also differs from chronic abdominal pain associated with entities such as chronic pancreatitis or chronic inflammatory bowel disease, in which the pain is associated with peripherally acting factors (eg, gut inflammation or injury). Given the central contribution to the pain experience, concomitant psychosocial disturbances are common and strongly influence the clinical expression of FAPS, which also by definition is associated with loss of daily functioning. These factors make it critical to use a biopsychosocial construct to understand and manage FAPS, because gut-directed treatments are usually not successful in managing this condition.

Italian mission. Found a consortium with Italgas and win a Greek tender

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Matejovic, R.; Kinces, P.

1999-01-01

In this interview two projects of the company Slovak Gas Industry (SPP) are discussed. The first project is SPP's joint participation in the international tender on introduction of gas in Greece. The second project regards the construction of a steam-gas power plant nearby the town of Lucenec. This project has already entered a certain stage of solution and a third partner that has been approached - Russian gas company Gazprom - is to become involved in it. (authors)

Pain and Satisfaction With Pain Management Among Older Patients During the Transition From Acute to Skilled Nursing Care.

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Simmons, Sandra F; Schnelle, John F; Saraf, Avantika A; Simon Coelho, Chris; Jacobsen, J Mary Lou; Kripalani, Sunil; Bell, Susan; Mixon, Amanda; Vasilevskis, Eduard E

2016-12-01

Approximately 20% of hospitalized Medicare beneficiaries are discharged from the hospital to skilled nursing facilities (SNFs); and up to 23% of SNF patients return to the hospital within 30 days of hospital discharge, with pain as one of the most common symptoms precipitating hospital readmission. We sought to examine the prevalence of moderate to severe pain at hospital discharge to SNF, the incidence of new moderate to severe pain (relative to prehospitalization), and satisfaction with pain management among older acute care patients discharged to SNF. Structured patient interviews were conducted with 188 Medicare beneficiaries discharged to 23 area SNFs from an academic medical center. Pain level (0-10) and satisfaction with pain management were assessed upon hospital admission, discharge, and within 1 week after transition to SNF. There was a high prevalence of moderate to severe pain at each time point including prehospital (51%), hospital discharge (38%), and following SNF admission (53%). Twenty-eight percent of participants reported new moderate to severe pain at hospital discharge, whereas 44% reported new moderate to severe pain following SNF admission. Most participants reported being "satisfied" with their pain treatment, even in the context of moderate to severe pain. Moderate to severe pain is a common problem among hospitalized older adults discharged to SNF and continues during their SNF stay. Pain assessment and management should involve a specific, planned process between hospital and SNF clinicians at the point of care transition, even if patients express "satisfaction" with current pain management. © 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.

Pain intensity, disability and depression in individuals with chronic back pain1

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Garbi, Márcia de Oliveira Sakamoto Silva; Hortense, Priscilla; Gomez, Rodrigo Ramon Falconi; da Silva, Talita de Cássia Raminelli; Castanho, Ana Carolina Ferreira; Sousa, Fátima Aparecida Emm Faleiros

2014-01-01

OBJECTIVES: to measure the pain intensity, identify the disability and depression levels in people with chronic back pain and to correlate these variables. A cross-sectional, descriptive and exploratory study was undertaken at the Pain Treatment Clinic of the University of São Paulo at Ribeirão Preto Hospital das Clínicas, between February and June 2012, after receiving approval from the Ethics Committee at the University of São Paulo at Ribeirão Preto College of Nursing. METHOD: sixty subjects with chronic back pain participated. The instruments used were: the 11-point Numerical Category Scale, the Roland-Morris Disability Questionnaire and the Beck Depression Inventory. To analyze the data, the arithmetic means, standard deviations and Spearman's correlation coefficient were calculated. RESULTS: the findings show that the participants presented high pain, disability and depression levels. The correlation between pain intensity and disability and between pain intensity and depression was positive and weak and, between disability and depression, positive and moderate. CONCLUSION: the study variables showed moderate and weak indices and the mutual correlations were positive. PMID:25296139

BounceBack™ capsules for reduction of DOMS after eccentric exercise: a randomized, double-blind, placebo-controlled, crossover pilot study

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Singh Betsy B

2009-06-01

Full Text Available Abstract Background Delayed onset muscle soreness (DOMS is muscle pain and discomfort experienced approximately one to three days after exercise. DOMS is thought to be a result of microscopic muscle fiber tears that occur more commonly after eccentric exercise rather than concentric exercise. This study sought to test the efficacy of a proprietary dietary supplement, BounceBack™, to alleviate the severity of DOMS after standardized eccentric exercise. Methods The study was a randomized, double-blind, placebo-controlled, crossover study. Ten healthy community-dwelling untrained subjects, ranging in age from 18–45 years, were enrolled. Mean differences within and between groups were assessed inferentially at each data collection time-point using t-tests for all outcome measures. Results In this controlled pilot study, intake of BounceBack™ capsules for 30 days resulted in a significant reduction in standardized measures of pain and tenderness post-eccentric exercise compared to the placebo group. There were trends towards reductions in plasma indicators of inflammation (high sensitivity C-reactive protein and muscle damage (creatine phosphokinase and myoglobin. Conclusion BounceBack™ capsules were able to significantly reduce standardized measures of pain and tenderness at several post-eccentric exercise time points in comparison to placebo. The differences in the serological markers of DOMS, while not statistically significant, appear to support the clinical findings. The product appears to have a good safety profile and further study with a larger sample size is warranted based on the current results.

BounceBack capsules for reduction of DOMS after eccentric exercise: a randomized, double-blind, placebo-controlled, crossover pilot study.

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Udani, Jay K; Singh, Betsy B; Singh, Vijay J; Sandoval, Elizabeth

2009-06-05

Delayed onset muscle soreness (DOMS) is muscle pain and discomfort experienced approximately one to three days after exercise. DOMS is thought to be a result of microscopic muscle fiber tears that occur more commonly after eccentric exercise rather than concentric exercise. This study sought to test the efficacy of a proprietary dietary supplement, BounceBack, to alleviate the severity of DOMS after standardized eccentric exercise. The study was a randomized, double-blind, placebo-controlled, crossover study. Ten healthy community-dwelling untrained subjects, ranging in age from 18-45 years, were enrolled. Mean differences within and between groups were assessed inferentially at each data collection time-point using t-tests for all outcome measures. In this controlled pilot study, intake of BounceBack capsules for 30 days resulted in a significant reduction in standardized measures of pain and tenderness post-eccentric exercise compared to the placebo group. There were trends towards reductions in plasma indicators of inflammation (high sensitivity C-reactive protein) and muscle damage (creatine phosphokinase and myoglobin). BounceBack capsules were able to significantly reduce standardized measures of pain and tenderness at several post-eccentric exercise time points in comparison to placebo. The differences in the serological markers of DOMS, while not statistically significant, appear to support the clinical findings. The product appears to have a good safety profile and further study with a larger sample size is warranted based on the current results.

BounceBack™ capsules for reduction of DOMS after eccentric exercise: a randomized, double-blind, placebo-controlled, crossover pilot study

Science.gov (United States)

Udani, Jay K; Singh, Betsy B; Singh, Vijay J; Sandoval, Elizabeth

2009-01-01

Background Delayed onset muscle soreness (DOMS) is muscle pain and discomfort experienced approximately one to three days after exercise. DOMS is thought to be a result of microscopic muscle fiber tears that occur more commonly after eccentric exercise rather than concentric exercise. This study sought to test the efficacy of a proprietary dietary supplement, BounceBack™, to alleviate the severity of DOMS after standardized eccentric exercise. Methods The study was a randomized, double-blind, placebo-controlled, crossover study. Ten healthy community-dwelling untrained subjects, ranging in age from 18–45 years, were enrolled. Mean differences within and between groups were assessed inferentially at each data collection time-point using t-tests for all outcome measures. Results In this controlled pilot study, intake of BounceBack™ capsules for 30 days resulted in a significant reduction in standardized measures of pain and tenderness post-eccentric exercise compared to the placebo group. There were trends towards reductions in plasma indicators of inflammation (high sensitivity C-reactive protein) and muscle damage (creatine phosphokinase and myoglobin). Conclusion BounceBack™ capsules were able to significantly reduce standardized measures of pain and tenderness at several post-eccentric exercise time points in comparison to placebo. The differences in the serological markers of DOMS, while not statistically significant, appear to support the clinical findings. The product appears to have a good safety profile and further study with a larger sample size is warranted based on the current results. PMID:19500355

Pain management: association with patient satisfaction among emergency department patients.

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Bhakta, Hemangini C; Marco, Catherine A

2014-04-01

Patient satisfaction with emergency care is associated with timeliness of care, empathy, technical competence, and information delivery. Previous studies have demonstrated inconsistent findings regarding the association between pain management and patient satisfaction. This study was undertaken to determine the association between pain management and patient satisfaction among Emergency Department (ED) patients presenting with acute painful conditions. In this survey study, a standardized interview was conducted at the Emergency Department at the University of Toledo Medical Center in May-July 2011. Participants were asked to answer 18 questions pertaining to patient satisfaction. Additional data collected included demographic information, pain scores, and clinical management. Among 328 eligible participants, 289 (88%) participated. The mean triage pain score on the verbal numeric rating scale was 8.2 and the mean discharge score was 6.0. The majority of patients (52%) experienced a reduction in pain of 2 or more points. Participants received one pain medication dose (44%), two medication doses (14%), three medication doses (5%), or four medication doses (2%). Reduction in pain scores of 2 or more points was associated with a higher number of medications administered. Reduction in pain scores was associated with higher satisfaction as scored on questions of patient perceptions of adequate assessment and response to pain, and treatment of pain. There was a significant association between patient satisfaction and a reduction in pain of 2 or more points and number of medications administered. Effective pain management is associated with improved patient satisfaction among ED patients with painful conditions. Copyright © 2014 Elsevier Inc. All rights reserved.

Proposal for the award of a contract, without competitive tendering, for the maintenance of uninterruptable power supply systems

CERN Document Server

2003-01-01

This document concerns the award of a contract, without competitive tendering, for the maintenance of uninterruptable power supply systems. The Finance Committee is invited to agree to the negotiation of a contract, without competitive tendering, for the maintenance of uninterruptable power supply systems with MGE (FR) for a total amount of 575 000 euros (911 000 Swiss francs), covering an initial period of five years, subject to revision for inflation after 1 January 2007. The contract will include options for two one-year extensions beyond the initial five-year period. The amount in Swiss francs has been calculated using the present rate of exchange. The firm has indicated the following distribution by country of the contract value covered by this adjudication proposal: FR - 100%.

Preliminary findings of a 4-month Tai Chi intervention on tenderness, functional capacity, symptomatology, and quality of life in men with fibromyalgia.

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Carbonell-Baeza, Ana; Romero, Alejandro; Aparicio, Virginia A; Ortega, Francisco B; Tercedor, Pablo; Delgado-Fernández, Manuel; Ruiz, Jonatan R

2011-09-01

The study aimed to determine the effects of a 4-month Tai Chi intervention on tenderness, functional capacity, symptomatology, and quality of life in men with fibromyalgia. The effect of a 3-month detraining period was also analyzed. Six men with fibromyalgia (age 52.3 ± 9.3 years) followed a 4-month Tai Chi intervention. The outcome variables were tenderness, functional capacity (30-second chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8 feet up and go, and 6-minute walk tests), and self-administered questionnaires. A significant improvement (p = .028) after the intervention period for the chair sit and reach test was found, such improvement was maintained after the detraining phase. Tenderness, symptomatology, and quality of life did not significantly change after the intervention period or the detraining phase. In summary, a 4-month Tai Chi intervention improved lower body flexibility in men with fibromyalgia. This improvement persisted after the detraining period.

A RANDOMIZED TRIAL TO STUDY THE COMPARISON OF TRIGGER POINT DRY NEEDLING VERSUS KINESIO TAPING TECHNIQUE IN MYOFASCIAL PAIN SYNDROME DURING A 3-MONTH FOLLOW UP

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Emrullah Hayta

2016-10-01

Full Text Available Background: Managemen of myofascial pain syndrome (MPS is a current research subject since there is a small number of randomized studies comparing different management techniques. Multiple studies attempted to assess various treatment options including trigger point dry needling and kinesiotaping. We compared the effects of trigger point dry needling and kinesiotaping in the management of myofascial pain syndome during a 3-month follow-up period. Methods: In this prospective randomized studyin MPS patients with upper trapezius muscle trigger points, the effects of dry needling (n=28 and kinesiotaping (n=27 was compared with regard to the visual analog scale (VAS, neck disability index (NDI, and Nottingham health profile (NHP scores measured at the weeks 0, 4, and 12. Results: Both dry needling and kinesiotaping comparably reduced VAS scores measured at the weeks 4 and 12 and their efficacies were more remarkable at the week 12 (p<0.05. These interventions significantly reduced the NDI and NHP score and their effects were also more remarkable at the week 12; however, dry needling was found more effective (p<0.05. Conclusion: Overall, in current clinical settings, during the management of MPS, pain can be reduced comparably by both dry needling and kinesiotaping; however, restriction in the range of motionin neck region and quality of life are more remarkably reduced by dry needling. Both dry needling and kinesiotaping can provide an increasing effectiveness up to 12 weeks.