... when you walk or exercise and improves with rest. The leg is black and blue. The leg is cold ... chap 81. Marcussen B, Hogrefe C, Amendola A. Leg pain and exertional compartment syndromes. In: Miller MD, Thompson SR, eds. DeLee & Drez's ...
Kongsted, Alice; Kent, Peter; Jensen, Tue Secher
BACKGROUND: Low back pain (LBP) patients with related leg pain have a more severe profile than those with local LBP and a worse prognosis. Pain location above or below the knee and the presence of neurological signs differentiate patients with different profiles, but knowledge about the prognosti...
Hartvigsen, Lisbeth; Hestbæk, Lise; Leboeuf-Yde, Charlotte
BACKGROUND: Low back pain (LBP) patients with related leg pain and signs of nerve root involvement are considered to have a worse prognosis than patients with LBP alone. However, it is unclear whether leg pain location above or below the knee and the presence of neurological signs are important...... in primary care patients. The objectives of this study were to explore whether the four Quebec Task Force categories (QTFC) based on the location of pain and on neurological signs have different characteristics at the time of care seeking, whether these QTFC are associated with outcome, and if so whether...
Hartvigsen, Lisbeth; Hestbæk, Lise; Leboeuf-Yde, Charlotte
Background Low back pain (LBP) patients with related leg pain and signs of nerve root involvement are considered to have a worse prognosis than patients with LBP alone. However, it is unclear whether leg pain location above or below the knee and the presence of neurological signs are important...... in primary care patients. The objectives of this study were to explore whether the four Quebec Task Force categories (QTFC) based on the location of pain and on neurological signs have different characteristics at the time of care seeking, whether these QTFC are associated with outcome, and if so whether...
Hartvigsen, Lisbeth; Hestbæk, Lise; Vach, W.
BACKGROUND: Low back pain (LBP) patients with related leg pain and signs of nerve root involvement are considered to have a worse prognosis than patients with LBP alone. However, it is unclear whether leg pain location above or below the knee and the presence of neurological signs are important...... in primary care patients. The objectives of this study were to explore whether the four Quebec Task Force categories (QTFC) based on the location of pain and on neurological signs have different characteristics at the time of care seeking, whether these QTFC are associated with outcome, and if so whether...... at presentation were statistically significantly associated with most of the baseline characteristics, with activity limitation at all follow-up time points, with global perceived effect at 2 weeks but not 3 months and 1 year, and with trajectories of LBP. Severity of outcomes in the QTFC increased from LBP alone...
Bronfort, Gert; Hondras, Maria; Schulz, Craig A
BACKGROUND: Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management. OBJECTIVE: To determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with HEA alone reduces leg pain in the short and long...... (difference, 7 percentage points [CI, -2 to 15]; P = 0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred....... LIMITATION: Patients and providers could not be blinded. CONCLUSION: For patients with BRLP, SMT plus HEA was more effective than HEA alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks. PRIMARY FUNDING SOURCE: U.S. Department of Health and Human Services....
Akesson, Nina; Oien, Rut Frank; Forssell, Henrik; Fagerström, Cecilia
The aim of this study was to compare venous leg ulcer patients with and without ulcer pain to see whether ulcer pain affected the use of antibiotic treatment and compression therapy throughout healing. A total of 431 patients with venous leg ulcers were included during the study period. Every patient was registered in a national quality registry for patients with hard-to-heal leg, foot, and pressure ulcers. A high incidence of ulcer pain (57%) was found when the patients entered the study. Patients with ulcer pain had been treated more extensively with antibiotics both before and during the study period. Throughout healing there was a significant reduction of antibiotic use among patients in the 'no pain' group, from 44% to 23% (P=0.008). There was no significant difference between the two groups concerning compression therapy (85% vs. 88%), but 12% of patients in the 'pain' group did not get their prescribed compression compared with 6% of patients in the 'no pain' group. The groups did not differ significantly in terms of ulcer duration, ulcer size or healing time. This study shows a high incidence of ulcer pain, confirming that pain has a great impact on patients with venous leg ulcers. Results further suggest that the presence of ulcer pain increases the prescription of antibiotics but does not affect the use of compression therapy. Several advantages were found from using a national quality registry. The registry is a valuable clinical tool showing the importance of accurate diagnosis and effective treatment.
Kiuru, Martti J; Mantysaari, Matti J; Pihlajamaki, Harri K; Ahovuo, Juhani A
The purpose of this work was to evaluate stress-related anterior lower leg pain with clinical examination, magnetic resonance imaging, and measurement of anterior tibial compartment pressure findings. All medical data were gathered from 24 conscripts with stress-related anterior lower leg pain. Twenty exhibited bilateral symptoms. In 22 of the 44 cases, the intracompartmental pressure was pathological. Symptoms were exhibited for longer periods by patients with chronic exertional compartment syndrome (CECS) than by other patients (p periostitis. On magnetic resonance imaging, there was no difference in bone findings between patients with and without CECS (p > 0.05). Stress-related anterior lower leg pain can be related to CECS, bone stress injury, and traction periostitis. Clinical diagnosis is unreliable. CECS and bone stress injury or traction periostitis can occur separately or together.
Full Text Available Question: In people with nerve-related leg pain, does adding neurodynamic treatment to advice to remain active improve leg pain, disability, low back pain, function, global perceived effect and location of symptoms? Design: Randomised trial with concealed allocation and intention-to-treat analysis. Participants: Sixty participants with nerve-related leg pain recruited from the community. Interventions: The experimental group received four sessions of neurodynamic treatment. Both groups received advice to remain active. Outcome measures: Leg pain and low back pain (0, none, to 10, worst, Oswestry Disability Index (0, none, to 100, worst, Patient-Specific Functional Scale (0, unable to perform, to 30, able to perform, global perceived effect (–5 to 5 and location of symptoms were measured at 2 and 4 weeks after randomisation. Continuous outcomes were analysed by linear mixed models. Location of symptoms was assessed by relative risk (95% CI. Results: At 2 weeks, the experimental group did not have significantly greater improvement than the control group in leg pain (MD –1.1, 95% CI –2.3 to 0.1 or disability (MD –3.3, 95% CI –9.6 to 2.9. At 4 weeks, the experimental group experienced a significantly greater reduction in leg pain (MD –2.4, 95% CI –3.6 to –1.2 and low back pain (MD –1.5, 95% CI –2.8 to –0.2. The experimental group also improved significantly more in function at 2 weeks (MD 5.2, 95% CI 2.2 to 8.2 and 4 weeks (MD 4.7, 95% CI 1.7 to 7.8, as well as global perceived effect at 2 weeks (MD 2.5, 95% CI 1.6 to 3.5 and 4 weeks (MD 2.9, 95% CI 1.9 to 3.9. No significant between-group differences occurred in disability at 4 weeks and location of symptoms. Conclusion: Adding neurodynamic treatment to advice to remain active did not improve leg pain and disability at 2 weeks. Trial registration: NCT01954199. [Ferreira G, Stieven F, Araujo F, Wiebusch M, Rosa C, Plentz R, et al. (2016 Neurodynamic treatment did not improve
Harrisson, Sarah A; Stynes, Siobhán; Dunn, Kate M; Foster, Nadine E; Konstantinou, Kika
This systematic review synthesizes literature describing prevalence, characteristics, and prognosis of low back-related leg pain (LBLP) patients with neuropathic pain in primary care and/or similar settings. Inclusion and exclusion criteria were developed and used by independent reviewers to screen citations for eligibility. The initial search yielded 24,948 citations; after screening 12 studies were included. Neuropathic pain was identified using case ascertainment tools (n = 5), clinical history with examination (n = 4), and using LBLP samples assumed neuropathic (n = 3). Neuropathic pain prevalence varied from 19% to 80%. There was consistent evidence for higher back-related disability (n = 3), poorer health-related quality of life (n = 2), and some evidence for more severe depression (n = 2), anxiety (n = 3), and pain intensity (n = 4) in patients with neuropathic pain. Results were less consistent when cases were identified through clinical history with examination than those identified using case ascertainment tools. Prognosis (n = 1) of LBLP patients with neuropathic pain was worse compared with those without, in all outcomes (leg pain intensity, leg and back-related disability, self-reported general health) except back pain intensity. No studies described prognostic factors. This systematic review highlights the evidence gap in neuropathic pain in LBLP in primary care, especially with respect to prognosis. Patients with LBLP may have neuropathic pain. This systematic review emphasizes the paucity of evidence describing the characteristics and prognosis of neuropathic pain in this patient population. Future research investigating prognosis of these patients with neuropathic pain is likely to contribute to better understanding and management. Copyright © 2017 American Pain Society. Published by Elsevier Inc. All rights reserved.
Heinen, M.M.; Achterberg, T. van; Reimer, W.S. op; Kerkhof, P.C.M. van de; Laat, H.E.W. de
BACKGROUND: Having a leg ulcer has a major impact on daily life. Lifestyle is mentioned in most leg ulcer guidelines but mostly without much emphasis on the subject. AIMS AND OBJECTIVES: Evidence for the effect of nutrition, leg elevation and exercise on the healing of leg ulcers was reconsidered. F
Hornyak, M; Stiasny-Kolster, K; Evers, S; Happe, S
Pain in the legs belongs to the five most frequent regional pain symptoms. Restless legs syndrome (RLS) presents a particular differential diagnosis for pain in the legs, which is characterized by a nocturnal urge to move the legs often associated with painful sensations in the legs. It is one of the most common neurological disorders and probably the leading cause of nocturnal pain in the legs. In this overview, the diagnosis and therapy of RLS as well as aspects of pain therapy of the disorder are presented. In addition, the differential diagnoses for exclusion of other specific causes of nocturnal pain in the legs are discussed.
... include: A muscle cramp (also called a charley horse), frequently caused by the following: Dehydration or low ... overstretched muscle (strain) Hairline crack in the bone (stress fracture) Inflamed tendon (tendinitis) Shin splints—pain in ...
Full Text Available Painful legs and moving toes syndrome (PLMT is a rare movement disorder with low diagnostic rate, which is characterized by lower limb pain with involuntary movements of feet or toes. Etiology and pathogenesis of this disease is still unclear. Patients have different clinical manifestations, so the diagnosis is difficult. Treatment methods for PLMT are numerous, but so far the treatment of this disease is still a major challenge for clinicians. Further research is still needed to guide clinical work. DOI: 10.3969/j.issn.1672-6731.2015.10.013
Henriet, J P
According to D. Reinharez, pain and edema are the commonest presenting symptoms in phlebology. Pain is one of the most classical symptoms of an ordinary deep venous thrombosis, a valuable feature when present, in the form of deep tension, heaviness, swelling and a feeling of dead weight. It is often absent or slight. It may consist merely of a dull cramp, or of an "undefinable" (C. Bourde) odd, heavy leg. It generally affects the calf but may involve the sole of the foot, the heel, the thigh, the groin or even the true pelvis. This feeling, although "imprecise and variable" (P. Wallois, P. Griton) is highly suggestive. It increases on standing and walking in the form of unilateral uncomfortable tension, heaviness or painful swelling, which maybe a source of worry or even anxiety to the patient. Tenderness on palpation of venous tracts and their stretching is more suggestive. In the opinion of M. Duruble, Neuhof's sign (feeling of tender fullness of the calf) is more reliable than Homans' sign (pain in the calf caused by passive dorsiflexion of the foot, with the lower limb in extension) which essentially stretches only the posterior tibial venous system. The value of Sigg's sign (pain in the popliteal fossa on passive extension of the knee) is controversial. Far more rare is phlegmasia coerulea dolens or Grégoire's blue leg, complicating phlegmasia alba dolens or of sudden onset, with initial very severe or even "intolerable" pain (J.J. Pinot) in Scarpa's triangle, rapidly spreading to the limb. In varicose phlebitis (M. Perrin) or superficial thrombophlebitis or varico-phlebitis (A.A. Ramelet) or superficial venitis (J.P. Henriet), pain most often consists of moderate burning tension overlying the thrombosed vein(s), increased by palpation and mobilisation. Sometimes severe initially, it is exacerbated by the slightest touch. In total, pain, regardless of its characteristics, its site and/or its severity, is one of the most constant clinical features of venous
Chapman Andrew R
Full Text Available Abstract Background Augmented low-Dye (ALD tape is frequently used in the management of lower limb musculoskeletal pain and injury, yet our knowledge of its effect is incomplete, especially in regard to its neuromotor effects. Methods We measured electromyographic (EMG activity of twelve lower limb muscles, three-dimensional kinematics of the ankle, knee, hip and pelvis, foot posture and foot mobility to determine the physiological effect of ALD tape. Fourteen females with exercise related leg pain and 14 matched asymptomatic females walked on a treadmill under three conditions: pre-tape, tape and post-tape. A series of repeated measure analysis of variance procedures were performed to investigate differences in EMG, kinematic, foot posture and mobility measurements. Results Application of ALD tape produced reductions in recruitment of tibialis anterior (7.3% and tibialis posterior (6.9%. Large reductions in midfoot mobility (0.45 to 0.63 cm and increases in arch height (0.58 cm, as well as moderate changes in ankle motion in the sagittal (2.0 to 5.3° and transverse planes (4.0 to 4.3° were observed. Reduced muscle activation ( Conclusions This study provides evidence that ALD tape influences muscle recruitment, movement patterns, foot posture and foot mobility. These effects occur in individuals with and without pain, and are dissipated up the kinetic chain. ALD tape should be considered in the management of individuals where increased arch height, reduced foot mobility, reduced ankle abduction and plantar flexion or reduced activation of leg muscles is desired.
Kongsted, Alice; Kent, Peter; Albert, Hanne
ABSTRACT: BACKGROUND: Leg pain associated with low back pain (LBP) is recognized as a risk factor for a poor prognosis, and is included as a component in most LBP classification systems. The location of leg pain relative to the knee and the presence of a positive straight leg raise test have been...... suggested to have clinical implications. To understand differences between such leg pain subgroups, and whether differences include potentially modifiable characteristics, the purpose of this paper was to describe characteristics of patients classified into the Quebec Task Force (QTF) subgroups of: 1) LBP...... observed across the subgroups from LBP only to LBP with signs of nerve root involvement although subgroup differences were small. LBP patients with leg pain differed from those with LBP only on a wide variety of parameters, and patients with signs of nerve root involvement had a more severe profile...
Rowell, Robert M; Rylander, Steven J
The purpose of this article is to report the case of a patient who had low-back pain, leg pain, and idiopathic chronic testicular pain and who sought chiropractic care for his low-back and leg pain and received pain relief including his testicular pain. A 36-year-old male patient had low-back pain, right leg pain, and testicular pain that was worsening. All had been present for 5 years. He had been seen by several medical physicians and had lumbar magnetic resonance imaging and x-rays performed. All were read as normal. Examination revealed tenderness of the testicles bilaterally with no masses or other abnormality of the testicles or scrotum. Orthopedic and neurological testing was unremarkable. Tenderness rated 8 out of 10 was noted at the L4 spinous process. The patient was treated with Cox Technic (flexion-distraction) of the lumbar spine, receiving a total of 19 treatments over an 8-week time period. After 4 weeks, the patient's low-back pain was decreased and his leg pain was gone. The testicular pain was improved after the first treatment and gone after 3 weeks of care. The patient was followed up by telephone at 3 and 6 months after discharge to find out if the testicle pain had returned, which it had not. This case was one of chronic idiopathic testicular pain. The patient was treated with the Cox Technic, and his low-back pain improved with complete remission of his leg and testicular pain. The testicular pain had not returned 6 months following his discharge from care.
... news/fullstory_164223.html Drug No Better Than Placebo for Lower Back, Leg Pain Pregabalin, commonly known ... name: Lyrica) may be no better than a placebo when it comes to treating the back and ...
F H Rossi
Full Text Available Report three cases of painful legs and moving toes (PLMT syndrome responsive to pregabalin along with a review of its literature. Three patients with PLMT syndrome improved with pregabalin. The first and third patient reported improvement in pain scores, quality of life, and quality of sleep sustained over time. The second and third patient had near complete remission of toe movements, but pregabalin was discontinued in the second patient due to aggravation of leg edema. PLMT is a rare and debilitating disorder characterized by lower limb pain and involuntary toes or feet movements. Its pathophysiology remains unknown and its therapy refractory to most drugs, except for pregabalin, as shown in this case series. PLMT is a rare and incapacitating syndrome due to the lack of an effective pain therapy. We report three patients with PLMT who favorable responded to pregabalin. We propose pregabalin be considered in the management of PLMT.
Jäckel, Kristian; Braschler, Thomas; Jochum, Wolfram; Hülder, Tanja; Knechtle, Beat
We report on a typical clinical course of pelvic actinomycosis: initial uncharacteristic discomfort develops into a systemic illness associated with a pelvic mass, which progresses so fast that along with the systemic infection further symptoms can be reduced to its growth rate--tiredness, abdominal pain, micturition deficiency, and leg pain. Distinction between malignancy and pelvic actinomycosis could be made only intraoperative. After hysterectomy and with antibiotics the patient recovered quickly.
Kahn, S R; Shapiro, S; Ducruet, T; Wells, P S; Rodger, M A; Kovacs, M J; Anderson, D; Tagalakis, V; Morrison, D R; Solymoss, S; Miron, M-J; Yeo, E; Smith, R; Schulman, S; Kassis, J; Kearon, C; Chagnon, I; Wong, T; Demers, C; Hanmiah, R; Kaatz, S; Selby, R; Rathbun, S; Desmarais, S; Opatrny, L; Ortel, T L; Galanaud, J-P; Ginsberg, J S
Acute deep venous thrombosis (DVT) causes leg pain. Elastic compression stockings (ECS) have potential to relieve DVT-related leg pain by diminishing the diameter of distended veins and increasing venous blood flow. It was our objective to determine whether ECS reduce leg pain in patients with acute DVT. We performed a secondary analysis of the SOX Trial, a multicentre randomised placebo controlled trial of active ECS versus placebo ECS to prevent the post-thrombotic syndrome.The study was performed in 24 hospital centres in Canada and the U.S. and included 803 patients with a first episode of acute proximal DVT. Patients were randomised to receive active ECS (knee length, 30-40 mm Hg graduated pressure) or placebo ECS (manufactured to look identical to active ECS, but lacking therapeutic compression). Study outcome was leg pain severity assessed on an 11-point numerical pain rating scale (0, no pain; 10, worst possible pain) at baseline, 14, 30 and 60 days after randomisation. Mean age was 55 years and 60% were male. In active ECS patients (n=409), mean (SD) pain severity at baseline and at 60 days were 5.18 (3.29) and 1.39 (2.19), respectively, and in placebo ECS patients (n=394) were 5.38 (3.29) and 1.13 (1.86), respectively. There were no significant differences in pain scores between groups at any assessment point, and no evidence for subgroup interaction by age, sex or anatomical extent of DVT. Results were similar in an analysis restricted to patients who reported wearing stockings every day. In conclusion, ECS do not reduce leg pain in patients with acute proximal DVT.
Restless legs syndrome (RLS) is a common neurological disorder. Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia after Alzheimer's disease. Both RLS and DLB can be effectively treated by dopaminergic medications, suggesting the role of dopamine dysfunction in the pathogenesis of both diseases. Here, I report on a Japanese woman with probable DLB and RLS who was treated with gabapentin enacarbil, a non-dopaminergic agent. Because a dopamine agonist, a first-line therapy for moderate to severe RLS, caused the occurrence of metamorphopsia, an alternative treatment of gabapentin enacarbil was used; this treatment improved the patient's RLS without worsening her psychiatric symptoms. An alternative treatment is desirable for DLB patients with RLS because they often experience intolerable side-effects with a dopamine agonist, especially visual hallucinations. Administering gabapentin enacarbil also improved the continuous leg pain that occurred in conjunction with the development of RLS. Although the neurobiological mechanism in the development of pain remains unclear, a range of non-dopaminergic structures likely mediated pain processing in DLB in the present case based on neuropharmacological results. This is the first report reporting the effects of gabapentin enacarbil for RLS and leg pain in a DLB patient with psychiatric symptoms.
Full Text Available Introduction. Statins have similar side effects that do not always occur at the same rate among the various statins. We present a case of simvastatin-induced muscle toxicity that disappeared when pravastatin was substituted for the original drug. Case Outline. A 74-year-old male, a nonsmoker, complained of severe nocturnal leg cramps. The patient also complained that similar painful cramping occurred when he walked rapidly or jogged. Because some components of his lipid panel exceeded the ‘desirable’ range, and as he had a history of myocardial infarction, his family physician prescribed simvastatin (40 mg/day. The patient had taken this medication for the past eight years. The painful nocturnal episodes started two years ago and affected either one or the other leg. Four months ago we discontinued his simvastatin and prescribed pravastatin (80 mg/day. At a follow-up visit six weeks later, the patient reported that his leg pains at night and the pain experienced after brisk walking had disappeared. Four months after the substitution of pravastatin for simvastatin, the patient reported that his complete lack of symptoms had continued. Conclusion. These painful muscle cramps were probably caused by an inadequate vascular supply to the calf and foot muscles. Perhaps a combination of advanced age and atherosclerotic changes created a predisposition for the simvastatin-induced leg cramps. Pravastatin differs from simvastatin in several ways. It is not metabolized by cytochrome P450 (CYP 3A4 oxidases, and thus is not influenced by CYP 3A4 inhibitors like simvastatin. Also, simvastatin is associated with single-nucleotide polymorphisms located within the SLCO1B1 gene on the chromosome 12 and established myopathy, while pravastatin lacks this association. These differences may contribute to increased tolerance to pravastatin in this particular case.
Prins, Maarten R.; van der Wurff, Peter; Groen, Gerbrand J.
Accompanying leg pain is commonly observed in patients with chronic low back pain (CLBP) and is assumed to be an indicator for the disorder severity. However, it is still unknown whether it is possible to estimate a patient's functional status by the extent of leg pain present. In a post rehabilitat
Prins, Maarten R.; van der Wurff, Peter; Groen, Gerbrand J.
Accompanying leg pain is commonly observed in patients with chronic low back pain (CLBP) and is assumed to be an indicator for the disorder severity. However, it is still unknown whether it is possible to estimate a patient's functional status by the extent of leg pain present. In a post rehabilitat
Winkelman, John W; Gagnon, Alison; Clair, Andrew G
Restless legs syndrome (RLS) is a common sensorimotor condition characterized by an urge to move the legs, worsening of symptoms at rest and during the evening/night, and improvement of symptoms with movement. Our review explores the role and impact of sensory symptoms in RLS. The phenomenology of RLS is discussed, highlighting the difficulty patients have in describing their sensations and in differentiating between sensory and motor symptoms. Sensory symptoms have a significant impact on quality of life but remain much less well understood than motor symptoms and sleep disturbances in RLS. Although RLS symptoms usually are not described as painful, sensory manifestations in RLS do share some similarities with chronic pain sensations, and RLS frequently occurs in chronic pain and neuropathic conditions. Peripheral neuropathies may account for some of the sensory disturbances in secondary RLS, while alterations in central somatosensory processing may be a more viable explanation for the sensory disturbances in primary RLS. The effectiveness of analgesics in treating RLS supports the concept of abnormal sensory modulation in RLS and suggests an overlap between pain modulatory pathways and sensory disturbances. Future studies are needed to better understand the experiential and biologic aspects of altered sensory experiences in RLS. Copyright © 2013 Elsevier B.V. All rights reserved.
Full Text Available The aims of this study were to compare the steadiness index of spinal regions during single-leg standing in older adults with and without chronic low back pain (LBP and to correlate measurements of steadiness index with the performance of clinical balance tests. Thirteen community-dwelling older adults (aged 55 years or above with chronic LBP and 13 age- and gender-matched asymptomatic volunteers participated in this study. Data collection was conducted in a university research laboratory. Measurements were steadiness index of spinal regions (trunk, thoracic spine, lumbar spine, and pelvis during single-leg standing including relative holding time (RHT and relative standstill time (RST, and clinical balance tests (timed up and go test and 5-repetition sit to stand test. The LBP group had a statistically significantly smaller RHT than the control group, regardless of one leg stance on the painful or non-painful sides. The RSTs on the painful side leg in the LBP group were not statistically significantly different from the average RSTs of both legs in the control group; however, the RSTs on the non-painful side leg in the LBP group were statistically significantly smaller than those in the control group for the trunk, thoracic spine, and lumbar spine. No statistically significant intra-group differences were found in the RHTs and RSTs between the painful and non-painful side legs in the LBP group. Measurements of clinical balance tests also showed insignificant weak to moderate correlations with steadiness index. In conclusion, older adults with chronic LBP demonstrated decreased spinal steadiness not only in the symptomatic lumbar spine but also in the other spinal regions within the kinetic chain of the spine. When treating older adults with chronic LBP, clinicians may also need to examine their balance performance and spinal steadiness during balance challenging tests.
Full Text Available Abstract Background Leg pain associated with low back pain (LBP is recognized as a risk factor for a poor prognosis, and is included as a component in most LBP classification systems. The location of leg pain relative to the knee and the presence of a positive straight leg raise test have been suggested to have clinical implications. To understand differences between such leg pain subgroups, and whether differences include potentially modifiable characteristics, the purpose of this paper was to describe characteristics of patients classified into the Quebec Task Force (QTF subgroups of: 1 LBP only, 2 LBP and pain above the knee, 3 LBP and pain below the knee, and 4 LBP and signs of nerve root involvement. Methods Analysis of routine clinical data from an outpatient department. Based on patient reported data and clinical findings, patients were allocated to the QTF subgroups and described according to the domains of pain, activity limitation, work participation, psychology, general health and clinical examination findings. Results A total of 2,673 patients aged 18–95 years (median 47 who were referred for assessment of LBP were included. Increasing severity was consistently observed across the subgroups from LBP only to LBP with signs of nerve root involvement although subgroup differences were small. LBP patients with leg pain differed from those with LBP only on a wide variety of parameters, and patients with signs of nerve root involvement had a more severe profile on almost all measures compared with other patients with back-related leg pain. Conclusion LBP patients with pain referral to the legs were more severely affected than those with local LBP, and patients with signs of nerve root involvement were the ones most severily affected. These findings underpin the concurrent validity of the Quebec Task Force Classification. However, the small size of many between-subgroup differences amid the large variability in this sample of cross
Morsø, Lars; Kent, Peter M; Albert, Hanne B
This study was designed to investigate whether the PainDETECT Questionnaire (PDQ) classification was predictive of outcomes at 3 and 12 months follow-up in low back pain (LBP) patients with associated leg pain. Identification of clinically important subgroups and targeted treatment is believed to...... to be important in LBP care. The PD-Q is designed to classify whether a person has neuropathic pain, based on their self-reported pain characteristics. However, it is unknown whether this classification is a prognostic factor or predicts treatment response....
Full Text Available Painful legs and moving toes (PLMT is a rare syndrome characterized by spontaneous neuropathic pain and peculiar involuntary movements in the lower limbs, especially the toes and feet. As it is a relatively rare disorder worldwide, the exact pathophysiology still remains a mystery. Until recently, numerous methods of clinical treatments have been tried; however, the success rate of the therapies is still very low. Here, we report a case of PLMT and also summarize the recent clinical and research literatures regarding clinical presentation, electrophysiological features, etiology, treatment methods, and prognosis of this disorder. Doctors should be aware of this rare syndrome in a patient with painful and/or restless legs. On the other hand, multiple clinical treatments should be tried, even those which usually produce a poor outcome.
Saito, Junya; Ohtori, Seiji; Kishida, Shunji; Nakamura, Junichi; Takeshita, Munenori; Shigemura, Tomonori; Takazawa, Makoto; Eguchi, Yawara; Inoue, Gen; Orita, Sumihisa; Takaso, Masashi; Ochiai, Nobuyasu; Kuniyoshi, Kazuki; Aoki, Yasuchika; Ishikawa, Tetsuhiro; Arai, Gen; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Kubota, Gou; Inage, Kazuhide; Sainoh, Takeshi; Yamauchi, Kazuyo; Toyone, Tomoaki; Takahashi, Kazuhisa
Case series. To present the difficulty of diagnosing the origin of lower leg pain in patients with lumbar spinal stenosis and hip joint arthritis. Pain arising from a degenerated hip joint is sometimes localized to the lower leg. Patients with lumbar spinal disease may also show radicular pain corresponding to the lower leg area. If patients present with both conditions and only pain at the lower leg, it is difficult to determine the origin of the pain. We reviewed 420 patients who had leg pain with lumbar spinal stenosis diagnosed by myelography, computed tomography after myelography, or magnetic resonance imaging. Pain only at the ipsilateral lateral aspect of the lower leg but slight low back pain or pain around the hip joint was shown in 4 patients who had lumbar spinal stenosis and hip osteoarthritis. The symptoms resolved after L5 spinal nerve block, but remained after lidocaine infiltration into the hip joint. We performed decompression and posterolateral fusion surgery for these 4 patients. Leg pain did not resolve after lumbar surgery in all patients. Conservative treatment was not effective from 6 to 12 months, so ultimately we performed ipsilateral total hip replacement for all patients and they became symptom-free. It is difficult to determine the origin of lower leg pain by spinal nerve block and hip joint block in patients with lumbar spinal stenosis and hip osteoarthritis. We take this into consideration before surgery.
Smart, Keith M
As a mechanisms-based classification of pain \\'peripheral neuropathic pain\\' (PNP) refers to pain arising from a primary lesion or dysfunction in the peripheral nervous system. Symptoms and signs associated with an assumed dominance of PNP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of PNP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol. Patients\\' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of two symptoms and one sign predictive of PNP, including: \\'Pain referred in a dermatomal or cutaneous distribution\\
Smart, Keith M
As a mechanisms-based classification of pain \\'nociceptive pain\\' (NP) refers to pain attributable to the activation of the peripheral receptive terminals of primary afferent neurones in response to noxious chemical, mechanical or thermal stimuli. The symptoms and signs associated with clinical classifications of NP have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of NP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol after which their pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist indicating the presence\\/absence of various symptoms and signs. A regression analysis identified a cluster of seven clinical criteria predictive of NP, including: \\'Pain localised to the area of injury\\/dysfunction\\
ten Brinke, Albert P.T.; van der Aa, Hans E.; van der Palen, Jacobus Adrianus Maria; Oosterveld, Frits P.T.
Study Design. The association between leg length discrepancy and the side of the radiating pain in lumbar disc herniation was investigated in a case series. Objectives. To investigate whether pain tends to radiate into the longer or shorter leg in patients with a lumbar herniated disc. Summary of Ba
Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with 'nociceptive', 'peripheral neuropathic' and 'central sensitisation' pain. The discriminant validity of mechanisms-based classifications of low back (±leg) pain.
Smart, Keith M
Evidence of validity is required to support the use of mechanisms-based classifications of pain clinically. The purpose of this study was to evaluate the discriminant validity of \\'nociceptive\\' (NP), \\'peripheral neuropathic\\' (PNP) and \\'central sensitisation\\' (CSP) as mechanisms-based classifications of pain in patients with low back (±leg) pain by evaluating the extent to which patients classified in this way differ from one another according to health measures associated with various dimensions of pain. This study employed a cross-sectional, between-subjects design. Four hundred and sixty-four patients with low back (±leg) pain were assessed using a standardised assessment protocol. Clinicians classified each patient\\'s pain using a mechanisms-based classification approach. Patients completed a number of self-report measures associated with pain severity, health-related quality of life, functional disability, anxiety and depression. Discriminant validity was evaluated using a multivariate analysis of variance. There was a statistically significant difference between pain classifications on the combined self-report measures, (p = .001; Pillai\\'s Trace = .33; partial eta squared = .16). Patients classified with CSP (n = 106) reported significantly more severe pain, poorer general health-related quality of life, and greater levels of back pain-related disability, depression and anxiety compared to those classified with PNP (n = 102) and NP (n = 256). A similar pattern was found in patients with PNP compared to NP. Mechanisms-based pain classifications may reflect meaningful differences in attributes underlying the multidimensionality of pain. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.
Kurniawan, I T; Seymour, B; Vlaev, I; Trommershäuser, J; Dolan, R J; Chater, N
Motivational theories of pain highlight its role in people's choices of actions that avoid bodily damage. By contrast, little is known regarding how pain influences action implementation. To explore this less-understood area, we conducted a study in which participants had to rapidly point to a target area to win money while avoiding an overlapping penalty area that would cause pain in their contralateral hand. We found that pain intensity and target-penalty proximity repelled participants' movement away from pain and that motor execution was influenced not by absolute pain magnitudes but by relative pain differences. Our results indicate that the magnitude and probability of pain have a precise role in guiding motor control and that representations of pain that guide action are, at least in part, relative rather than absolute. Additionally, our study shows that the implicit monetary valuation of pain, like many explicit valuations (e.g., patients' use of rating scales in medical contexts), is unstable, a finding that has implications for pain treatment in clinical contexts.
Zhang Zhao-xing; Zhu Hong; Wang Rui-hui; Du Xu; Qu Hong-yan
Objective: To observe theclinical effect of tuina reduction manipulation on leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation. Methods: A total of 60eligible cases were randomly allocated into an observation group and a control group, 30 in each group. Cases in the observation group were treated with conventional tuina plus reduction manipulation of sacroiliac joint subluxation; whereas cases in the control group were treated with conventional tuina plus acupuncture. The clinical effects were observed after 10 times of treatment. In addition, the relapse rates were observed 2 months after treatment. Results: The total effective rate in the observation group was 80.0%, versus 50.0% in the control group, showing a statistically significant difference (P Conclusion: Tuina reduction manipulation can obtain substantial therapeutic effect for leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation, coupled with a low relapse rate.
Full Text Available Objectives: The purpose of the present retrospective study is to draw attention to symptomatic low back pain in adolescent patients, in order to encourage earlier diagnosis and surgical treatment. The study assessed the radiological, clinical features and surgical outcomes of 13of this kind of patient. Materials and Methods: Out of a series of 983 consecutive cases (1999-2011 of lumbar disc excisions from our neurosurgical institution, 13-1,32% of the patients were between the ages of 15 and 20 mean 17,84. Fifteen operations, including two reoperations, were performed on this patient group, by a conventional microsurgical procedure. The indications for surgery were failure of conservative treatment, intractable pain and/or progressive neurological impairment. Results: Low back pain and monoradicular sciatica were the main complaints in 77%, but findings of neurological deficits were rare - 1 case. The surgical findings revealed a protruding disc in eleven cases, one lateral recess stenosis and one lumbar synovial cyst. Initially, all patients were treated conservatively by their physicians more than 3 months without success. On the day of discharge, Kirkaldy-Willis criteria results were excellent or good in 92% of patients. The follow-up period ranged from 6 months to 2 years with an average of 1 year and 2 months. The results were excellent in 10 patients and good in 3 patients. Discussion: We demonstrate that the cause of low back pain and monoradicular leg pain in adolescent patients may not only be a cause of herniated lumbar disc or lateral recess narrowing. Very rarely these symptoms may be caused by lumbar synovial cysts. Conclusion: Surgical treatment of adolescent patients is able to relieve the clinical symptoms quickly. Clinical symptoms such as low back pain and leg pain and the neurologic deficit disappear within 3 months after surgery.
Full Text Available Objectives: The purpose of the present retrospective study is to draw attention to symptomatic low back pain in adolescent patients, in order to encourage earlier diagnosis and surgical treatment. The study assessed the radiological, clinical features and surgical outcomes of 13 of this kind of patient. Materials and Methods: Out of a series of 983 consecutive cases (1999–2011 of lumbar disc excisions from our neurosurgical institution, 13–1,32% of the patients were between the ages of 15 and 20 mean 17,84. Fifteen operations, including two reoperations,were performed on this patient group, by a conventional microsurgical procedure. The indications for surgery were failure of conservative treatment, in tractable pain and/or progressive neurological impairment. Results: Low back pain and monoradicular sciatica were the main complaints in 77%, but findings of neurological deficits were rare — 1 case. The surgical findings revealed a protruding disc in eleven cases, one lateral recess stenosis and one lumbar synovial cyst. Initially, all patients were treated conservatively by their physicians more than 3 months without success. On the day of discharge, Kirkaldy-Willis criteria results were excellent or good in 92% of patients. The follow-up period ranged from 6 months to 2 years with an average of 1 year and 2 months. The results were excellent in 10 patients and good in 3 patients. Discussion: We demonstrate that the cause of low back pain and monoradicular leg pain in adolescent patients may not only be a cause of herniated lumbar disc or lateral recess narrowing. Very rarely these symptoms may be caused by lumbar synovial cysts. Conclusion: Surgical treatment of adolescent patients is able to relieve the clinical symptoms quickly. Clinical symptoms such as low back pain and leg pain and the neurologic deficit disappear within 3 months after surgery.
Full Text Available Background: Chronic low back pain is a common problem in the present time. It is commonly associated with altered mechanical tension in the peripheral nerves as tested by straight leg raising or slump tests. These maneuvers are used for treatment of such disorders. Both the straight leg raise and slump stretching techniques have been found to be beneficial in the treatment of low back pain with distal symptoms. A comparison of the two techniques will determine if one technique is better than the other. Also, it will add to the evidence for their effectiveness in managing symptoms in patients with low back pain. Objective: To evaluate the comparative effectiveness of straight leg raise and slump stretching on pain and range of passive straight leg raise in subjects with low back pain. Methods and measures: 50 patients with low back pain, satisfying the inclusion and exclusion criteria were randomly assigned to three groups. Group 1 was the straight leg raise group (n=15. Group 2 was the slump group (n=13. Group 3 was the control group (n=12. Baseline measurements of pain intensity as measured by the Numeric Pain Rating Scale (NPRS and range of passive straight leg raise (PSLR were taken. Group 1 received 6 sessions of straight leg raise stretching and lumbar stabilization exercises. Group 2 received 6 sessions of slump stretching and lumbar stabilization exercises. Group 3 received 6 sessions of lumbar stabilization exercises only. Statistical analysis: Paired t-test was used for within group analysis of NPRS and PSLR. ANOVA followed by post hoc analysis was employed for between group comparisons. Results: No significant difference was found in NPRS between straight leg raise and slump groups (p > 0.05 while they differed significantly in PSLR (p < 0.05. Both the groups showed significantly better results in PSLR when compared to the control group (P<0.05. Statistically significant improvements were found in all the 3 groups for both the outcome
Full Text Available Aim: Mechanical problems are frequently encountered and may cause low back pain (LBP and leg pain by pressure on nerve roots. Neurologic findings like decreased deep tendon reflexes may be found during the physical examination. There are many etiologic factors in the pathogenesis of LBP and metabolic bone diseases like osteoporosis and osteomalacia also may cause mecanical LBP. Materials and Methods: In this study, 25 patients between 30-65 years were evaluated. In the patients, sensorial changes, deep tendon reflexes and muscle strength were correlated with dual x-ray absorbsiometry (DXA results. Demographic findings (age, sex, occupation, education and clinical results (pain duration, pain severity, height, weight were evaluated. In DXA evaluation, L1-L4 total, femur neck and femur total bone mineral density (BMD and T-scores were reported. Results: Pain severity, according to visual analog scale (VAS was higher than six. Muscle strength, sensation and deep tendon reflex averages were found to be normal. DXA results were found to be osteopenic in femoral neck region of our patients. DXA results and clinical findings showed a weak and negative statistically significant correlation only between BMD at L1-L4 and pain severity. Conclusion: This study should be performed comparatively, multicenter, in a larger number of patients with LBP, for a longer period of follow-up. (Turkish Journal of Osteoporosis 2012;18:19-23
Sturm, C; Witte, T
Approximately 10-50% of chest pains are caused by musculoskeletal disorders. The association is twice as frequent in primary care as in emergency admissions. This article provides an overview of the most important musculoskeletal causes of chest pain and on the diagnostics and therapy. A selective search and analysis of the literature related to the topic of musculoskeletal causes of chest pain were carried out. Non-inflammatory diseases, such as costochondritis and fibromyalgia are frequent causes of chest pain. Inflammatory diseases, such as rheumatoid arthritis, spondyloarthritis and systemic lupus erythematosus are much less common but are more severe conditions and therefore have to be diagnosed and treated. The diagnostics and treatment often necessitate interdisciplinary approaches. Chest pain caused by musculoskeletal diseases always represents a diagnosis by exclusion of other severe diseases of the heart, lungs and stomach. Physiotherapeutic and physical treatment measures are particularly important, including manual therapy, transcutaneous electrical stimulation and stabilization exercises, especially for functional myofascial disorders.
We report on a 74-year-old woman visually impaired and under treatment with amlodipine, valsartan and thyroid hormone. The patient complained of her unique, edematous and painful leg after a local trauma. The worsening was slow and gradual, affecting walk and state of mind. Several unsuccessful diagnoses were done before suspecting and confirming a Complex Regional Pain Syndrome. Edema disappeared dramatically after amlodipine empirical discontinuation. Pain improved gradually with rehabilitation exercises but, mainly, after gaining skills and self-esteem due to cataract surgery of her unique functional eye. It was necessary to decrease thyroid hormone dosage after a long lasting balance. The sympathetic nervous system role of the case is discussed. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.
Vos, de Cecile C.; Dijkstra, Cindy; Lenders, Mathieu W.P.M.; Holsheimer, Jan; Levy, R.M.
Objective: The failed back surgery syndrome (FBSS) is the most common chronic pain syndrome. Whereas it is relatively easy to achieve pain relief in the lower limbs of FBSS patients with spinal cord stimulation (SCS), it is difficult to manage low back pain with SCS. The performance of a paddle-shap
Gere S. diZerega
Full Text Available The principle etiology of leg pain (sciatica from lumbar disc herniation is mechanical compression of the nerve root. Sciatica is reduced by decompression of the herniated disc, i.e., removing mechanical compression of the nerve root. Decompression surgery typically reduces sciatica more than lumbar back pain (LBP. Decompression surgery reduces mechanical compression of the nerve root. However, decompression surgery does not directly reduce sensitization of the sensory nerves in the epidural space and disc. In addition, sensory nerves in the annulus fibrosus and epidural space are not protected from topical interaction with pain mediators induced by decompression surgery. The secondary etiology of sciatica from lumbar disc herniation is sensitization of the nerve root. Sensitization of the nerve root results from a mechanical compression, b exposure to cellular pain mediators, and/or c exposure to biochemical pain mediators. Although decompression surgery reduces nerve root compression, sensory nerve sensitization often persists. These observations are consistent with continued exposure of tissue in the epidural space, including the nerve root, to increased cellular and biochemical pain mediators following surgery. A potential contributor to lumbar back pain (LBP is stimulation of sensory nerves in the annulus fibrosus by a cellular pain mediators and/or b biochemical pain mediators that accompany annular tears or disruption. Sensory fibers located in the outer one-third of the annulus fibrosus increase in number and depth as a result of disc herniation. The nucleus pulposus is comprised of material that can produce an autoimmune stimulation of the sensory nerves located in the annulus and epidural space leading to LBP. The sensory nerves of the annulus fibrosus and epidural space may be sensitized by topical exposure to cellular and biochemical pain mediators induced by lumbar surgery. Annulotomy or annular rupture allows the nucleus pulposus
Simakajornboon, Narong; Dye, Thomas J; Walters, Arthur S
Recent studies have shown that restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are common in pediatric population. The diagnostic criteria for Pediatric RLS have recently been updated to simplify and integrate with newly revised adult RLS criteria. Management of RLS and PLMD involves pharmacologic and nonpharmacologic interventions. Children with low iron storage are likely to benefit from iron therapy. Although, there is limited information on pharmacologic therapy, there are emerging literatures showing the effectiveness of dopaminergic medications in the management of RLS and PLMD in children. This article covers clinical evaluation of RLS and PLMD in children and the relationship with growing pains.
Full Text Available Tarantulas have recently become as pets in most parts of the world that increased the probability of encountering emergency physicians with patients hurt with these spiders. Their attacks usually do not cause general manifestation, however there are some case reports in this regard. Here, a 40-year-old man was reported who was referred to the emergency department with severe periumbilical pain that radiated to both legs and diagnosed as a victim of tarantula bite. Such symptoms usually are belonging to other spiders like Black Widow spider, but it seems that tarantula can mimic them in some cases, too.
Pouraghaei, Mahboob; Shams Vahdati, Samad; Mashhadi, Ibrahim; Mahmoudieh, Taranoom
Tarantulas have recently become as pets in most parts of the world that increased the probability of encountering emergency physicians with patients hurt with these spiders. Their attacks usually do not cause general manifestation, however there are some case reports in this regard. Here, a 40-year-old man was reported who was referred to the emergency department with severe periumbilical pain that radiated to both legs and diagnosed as a victim of tarantula bite. Such symptoms usually are belonging to other spiders like Black Widow spider, but it seems that tarantula can mimic them in some cases, too.
Full Text Available Introduction: Radicular low back pain is a disorder involving the dysfunction of the lumbosacral nerve roots. Clinical rehabilitation approaches for low back pain include kinesiotherapy, and physical therapyprocedures: ice , rest , heat, ultrasound, TENS, but evidences regarding their effectiveness are lacking. The purpose of this study was to determine if nerve mobilization brings better improvements in pain, SLR testand functional disability in patients with radicular low back pain compared to standard physical therapy.Methods: The study was conducted on a 60 patients with Radicular low back pain, treated in Regional medical center "Dr Safet Mujić", Mostar, during the period from 01.04.2010 untill 31.04.2011. Patientswere divided into two groups. First group (n=30 received a 4-week rehabilitation program including neural mobilization and lumbar stabilization program. Second group (n=30 received a 4-week rehabilitation program including active range of motion (ROM exercises and lumbar stabilization program.Results: At the beginning, the two groups were not signifi cantly different in terms of score or SLR. After therapy there was statistically signifi cant improvement between groups in both VAS scores[Group A: 1.16±1.5; Group B: 2.25±2.2] and SLR [Group A: 80.9±17.4; Group B: 65.9±16.4]. ]. After the treatment, in group A, 46.6% (14 participants had been rated with 4, but in Group B: 33.3% (10 participants had been rated with 3.Conclusions: Patients treated with neural mobilization and lumbar stabilization showed better VAS scores and Straight Leg Test scores compared to patients treated with active range of motion exercises and lumbar stabilization. Further research to investigate their long term effi cacy is warranted, with emphasis on greater number of participants.
Howell, Michael J
Restless legs syndrome (RLS) often presents with a primary complaint of sleep initiation difficulty with only ambiguous allusions to motor symptoms. This may result in the condition being misdiagnosed as a psychophysiological insomnia. Further, nocturnal eating is common in RLS and like the classic motor symptoms, patients will describe an inability to initiate sleep until their urge (to eat) is addressed. Restless nocturnal eating arises, intensifies, and subsides in parallel to motor symptoms. Once misdiagnosed as psychophysiological insomnia, RLS patients are frequently treated with benzodiazepine receptor agonists. The CNS actions of these sedating agents, suppression of memory and executive function, unleash predisposed amnestic behaviors. In the case of RLS this would be expected to include the inappropriate ambulatory and eating behaviors of sleep related eating disorder (SRED). The evidence and implications of a link between the restless eating of RLS and SRED is presented here.
Full Text Available Introduction: Mononeuropathies, in general, are very uncommon in childhood. Sciatic neuropathy (SN is probably underappreciated in childhood and likely to represent nearly one quarter of childhood mononeuropathies. Materials and Methods: We present a 7-year-old girl who presented with painful right lower limb and abnormal gait. Detailed investigation revealed transient eosinophilia, abnormal neurophysiology, and magnetic resonance imaging (MRI suggestive of isolated sciatic neuropathy. Results: She has responded very well to physiotherapy and has made a complete motor recovery, although she is left with an area of abnormal sensation affecting the lateral border of her right leg and the dorsum of her foot. Discussion: Differential diagnoses for pediatric SN have been discussed including compressive neuropathies in children and various hyper-eosinophilia syndromes. Compressive neuropathies in childhood are very rare and compression of the sciatic nerve is the second most common group after peroneal nerve lesion.
Vaegter, Henrik Bjarke; Andersen, Tonny Elmose; Harvold, Mathea
of pain (TSP: increase in pain scores to ten repeated stimulations), and conditioning pain modulation (CPM: increase in cPPT during cuff pain conditioning on the contralateral leg). Warmth detection threshold (WDT) and heat pain threshold (HPT) at the hand were also assessed. Clinical pain intensity...... demonstrated increased pain intensity, and psychological distress as well as reduced WDT and cPTT compared with patients without PTSD (PCPM were found. The association between PTSD and pain intensity was mediated by pain catastrophizing, and fear...
Maribo, Thomas; Iversen, Elena; Andersen, Niels Trolle
to stand for the maximum time, and no further analysis was done. Eyes closed: intra-observer reliability was tested in 21 patients; absolute reliability showed a standard error of the measurement (SEM) of 2.48 s and a minimal detectable change (MDC) of 6.88. The relative reliability was acceptable......Objective: To determine the absolute and relative reliability of intra-observer and interobserver To determine the absolute and relative reliability of intra-observer and interobserver measurements of postural balance using the One Leg Stand Test in patients with low back pain. Patients and methods...... with an intra class correlation coefficient (ICC) of 0.86. Interobserver reliability was tested in 27 patients; absolute reliability showed a SEM of 1.42 s and a MDC of 3.95. The relative reliability was acceptable with an ICC of 0.91. Conclusions: The One Leg Stand Test can be used to test postural balance...
Kalytczak, Marcelo Martins; Lucareli, Paulo Roberto Garcia; Dos Reis, Amir Curcio; Bley, André Serra; Biasotto-Gonzalez, Daniela Aparecida; Correa, João Carlos Ferrari; Politti, Fabiano
Possible delays in pre-activation or deficiencies in the activity of the dynamic muscle stabilizers of the knee and hip joints are the most common causes of the patellofemoral pain syndrome (PFPS). The aim of the study was to compare kinematic variables and electromyographic activity of the vastus lateralis, biceps femoris, gluteus maximus and gluteus medius muscles between patients with PFPS and health subjects during the single leg triple hop test (SLTHT). This study included 14 female with PFPS (PFPS group) and 14 female healthy with no history of knee pain (Healthy group). Kinematic and EMG data ware collected through participants performed a single session of the SLTHT. The PFPS group exhibited a significant increase (p<0.05) in the EMG activity of the biceps femoris and vastus lateralis muscles, when compared with the healthy group in pre-activity and during the stance phase. This same result was also found for the vastus lateralis muscle (p<0.05) when analyzing the EMG activity during the eccentric phase of the stance phase. In kinematic analysis, no significant differences were found between the groups. These results indicate that biceps femoris and vastus lateralis muscles mainly during the pre-activation phase and stance phases of the SLTHT are more active in PFPS group among healthy group.
Lu, Weidong; Rosenthal, David S
Cancer pain is one of most prevalent symptoms in patients with cancer. Acupuncture and related techniques have been suggested for the management of cancer pain. The National Comprehensive Cancer Network guidelines for adult cancer pain recommends acupuncture, as one of several integrative interventions, in conjunction with pharmacologic intervention as needed. This review presents the latest available evidence regarding the use of acupuncture for cancer pain. It also provides "actionable" acupuncture protocols for specific cancer pain conditions and related symptoms in order to provide more clinically relevant solutions for clinicians and cancer patients with pain. These conditions include postoperative cancer pain, postoperative nausea and vomiting, postsurgical gastroparesis syndrome, opioid-induced constipation, opioid-induced pruritus, chemotherapy-induced neuropathy, aromatase inhibitor-associated joint pain, and neck dissection-related pain and dysfunction.
Smart, Keith M
As a mechanisms-based classification of pain \\'central sensitisation pain\\' (CSP) refers to pain arising from a dominance of neurophysiological dysfunction within the central nervous system. Symptoms and signs associated with an assumed dominance of CSP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of CSP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol. Patients\\' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of three symptoms and one sign predictive of CSP, including: \\'Disproportionate, non-mechanical, unpredictable pattern of pain provocation in response to multiple\\/non-specific aggravating\\/easing factors\\
刘侃; 任东风; 吴闻文
Back and leg pain is a set of common clinical syndrome in pilots. It is also a kind of common occupational disease which influences pilots’ health and normal training seriously. Back and leg pain is not an independent disease, it is a group of diseases consisting of spine, nerve root and soft tissue. The reasons of back and leg pain include lumbar disc herniation, lumbar muscle strain, bone hyperplasia, benign arthritis, spinal stenosis, lumbar fractures and so on. The prevalence of back and leg pain in pilots is high, especially in fighter pilots due to their special working environment such as the cramped cockpit and aerial aerobatics. Fighter pilots form a major part which could influence combat effectiveness of air force. The cause of back and leg pain in fighter pilots may be the pilot’s position, the high load of fighter plane, flight time, age and so on. Back and leg pain of fighter pilots can lead to the dysphoria and affect the quality of flight directly. It is an important factor which affects combat effectiveness of flight troops and flight safety. Back and leg pain also influences the health, training and implementation tasks of fighter pilots. Therefore, propaganda, education, training of psoas, and research on protective measures are all of great significance. Now in this paper, the works done concerning epidemiology, etiology, and the prevention and treatment of back and leg pain in fighter pilots are reviewed and discussed to attract enough attention of flight surgeons for the enhancement of understanding and treatment of back and leg pain in fighter pilots, and to improve aviation medical support.
Andre Serra Bley
Full Text Available Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS, caused by an increase in patellofemoral (PF joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT, which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM, gluteus medius (GMed, biceps femoris (BF and vastus lateralis (VL. Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress.
Williams, John G; Phan, Huy; Winston, Helena R; Fugit, Randolph V; Graney, Bridget; Jamroz, Brant; English, Benjamin; Chan, Edward D
A 27-year-old man with OSA, posttraumatic stress disorder, and chronic mechanical back pain presented with a 3-day history of acute atraumatic worsening of his low back pain as well as right groin numbness that was exacerbated by walking. He also complained of bilateral leg "heaviness," pain, and swelling, all becoming so severe that he rented a wheelchair for mobility.
Cassisi, G; Sarzi-Puttini, P; Casale, R; Cazzola, M; Boccassini, L; Atzeni, F; Stisi, S
Pain is the hallmark symptom of fibromyalgia (FM) and other related syndromes, but quite different from that of other rheumatic diseases, which depends on the degree of damage or inflammation in peripheral tissues. Sufferers are often defined as patients with chronic pain without an underlying mechanistic cause, and these syndromes and their symptoms are most appropriately described as "central pain", "neuropathic pain", "nonnociceptive pain" or "central sensitivity syndromes". The pain is particular, regional or widespread, and mainly relates to the musculoskeletal system; hyperalgesia or allodynia are typical. Its origin is currently considered to be distorted pain or sensory processing, rather than a local or regional abnormality. FM is probably the most important and extensively described central pain syndrome, but the characteristics and features of FM-related pain are similar in other disorders of particular interest for rheumatologists, such as myofascial pain syndromes and temporo-mandibular joint disorders, and there is also an intriguing overlap between FM and benign joint hypermobility syndrome. This suggests that the distinctive aspects of pain in these idiopathic or functional conditions is caused by central nervous system hypersensitivity and abnormalities. Pharmacological and non-pharmacological therapies have been suggested for the treatment of these conditions, but a multidisciplinary approach is required in order to reduce the abnormal cycle of pain amplification and the related maladaptive and self-limiting behaviours.
Cancer pain is one of most prevalent symptoms in patients with cancer. Acupuncture and related techniques have been suggested for the management of cancer pain. The National Comprehensive Cancer Network (NCCN®) guidelines for adult cancer pain recommends acupuncture, as one of integrative interventions, in conjunction with pharmacologic intervention as needed. This review presents the latest available evidence regarding the use of acupuncture for cancer pain. It also provides “actionable” acu...
Aasvang, Eske Kvanner; Møhl, Bo; Bay-Nielsen, Morten
To determine the incidence of pain related sexual dysfunction 1 year after inguinal herniorrhaphy and to assess the impact pain has on sexual function. In contrast to the well-described about 10% risk of chronic wound related pain after inguinal herniorrhaphy, chronic genital pain, dysejaculation......, and sexual dysfunction have only been described sporadically. The aim was therefore to describe these symptoms in a questionnaire study. A nationwide detailed questionnaire study in September 2004 of pain related sexual dysfunction in all men aged 18-40 years undergoing inguinal herniorrhaphy between October...... 2002 and June 2003 (n=1015) based upon the nationwide Danish Hernia Database collaboration. The response rate was 68.4%. Combined frequent and moderate or severe pain from the previous hernia site during activity was reported by 187 patients (18.4%). Pain during sexual activity was reported by 224...
Full Text Available Chronic pain after dental implantation is rare but difficult issue for the implant practitioner. Patients with chronic pain who had been performed previous implant surgery or related surgical intervention sometimes accompany with psychological problem and difficult to adequately manage. According to the International Classification of Headache Disorders (ICHD 3rd eds, Cepalagia 2013, painful neuropathies and other facial pains are subdivided into the 12 subcategories; 13.1. Trigeminal neuralgia; 13.2 Glossopharyngeal neuralgia; 13.3 Nervus intermedius (facial nerve neuralgia; 13.4 Occipital neuralgia; 13.5 Optic neuritis; 13.6 Headache attributed to ischaemic ocular motor nerve palsy; 13.7 Tolosa-Hunt syndrome; 13.8 Paratrigeminal oculo-sympathetic (Raeder’s syndrome; 13.9 Recurrent painful ophthalmoplegic neuropathy; 13.10 Burning Mouth Syndrome (BMS; 13.11 Persistent Idiopathic Facial Pain (PIFP; 13.12 Central neuropathic pain. Chronic orofacial pain after dental implant surgery can be largely into the two main categories that can be frequently encountered in clinical basis ; 1 Neuropathic pain, 2 Idiopathic pain. If there is no direct evidence of the nerve injury related with the implant surgery, the clinician need to consider the central cause of pain instead of the peripheral cause of the pain. There might be several possibilities; 1 Anaesthesia dolorosa, 2 Central post-stroke pain, 3 Facial pain attributed to multiple sclerosis, 4 Persistent idiopathic facial pain (PIFP, 5 Burning mouth syndrome. In this presentation, Persistent idiopathic facial pain (PIFP, the disease entity that can be frequently encountered in the clinic would be discussed. Persistent idiopathic facial pain (PIFP can be defined as “persistent facial and/or oral pain, with varying presentations but recurring daily for more than 2 hours per day over more than 3 months, in the absence of clinical neurological deficit”. ‘Atypical’ pain is a diagnosis of
Roelofs, J.; Peters, M.L.; Patijn, J.; Schouten, E.G.; Vlaeyen, J.W.
The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40 chro
Roelofs, J.; Peters, M.L.; Patijn, J.; Schouten, E.G.; Vlaeyen, J.W.
The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40 chro
Renton, Tara; Egbuniwe, Obi
In order to understand the underlying principles of orofacial pain it is important to understand the corresponding anatomy and mechanisms. Paper 1 of this series explains the central nervous and peripheral nervous systems relating to pain. The trigeminal nerve is the 'great protector' of the most important region of our body. It is the largest sensory nerve of the body and over half of the sensory cortex is responsive to any stimulation within this system. This nerve is the main sensory system of the branchial arches and underpins the protection of the brain, sight, smell, airway, hearing and taste, underpinning our very existence. The brain reaction to pain within the trigeminal system has a significant and larger reaction to the threat of, and actual, pain compared with other sensory nerves. We are physiologically wired to run when threatened with pain in the trigeminal region and it is a 'miracle' that patients volunteer to sit in a dental chair and undergo dental treatment. Clinical Relevance: This paper aims to provide the dental and medical teams with a review of the trigeminal anatomy of pain and the principles of pain assessment.
Full Text Available Pain is the hallmark symptom of fibromyalgia (FM and other related syndromes, but quite different from that of other rheumatic diseases, which depends on the degree of damage or inflammation in peripheral tissues. Sufferers are often defined as patients with chronic pain without an underlying mechanistic cause, and these syndromes and their symptoms are most appropriately described as “central pain”, “neuropathic pain”, “nonnociceptive pain” or “central sensitivity syndromes”. The pain is particular, regional or widespread, and mainly relates to the musculoskeletal system; hyperalgesia or allodynia are typical. Its origin is currently considered to be distorted pain or sensory processing, rather than a local or regional abnormality. FM is probably the most important and extensively described central pain syndrome, but the characteristics and features of FM-related pain are similar in other disorders of particular interest for rheumatologists, such as myofascial pain syndromes and temporo-mandibular joint disorders, and there is also an intriguing overlap between FM and benign joint hypermobility syndrome. This suggests that the distinctive aspects of pain in these idiopathic or functional conditions is caused by central nervous system hypersensitivity and abnormalities. Pharmacological and non-pharmacological therapies have been suggested for the treatment of these conditions, but a multidisciplinary approach is required in order to reduce the abnormal cycle of pain amplification and the related maladaptive and self-limiting behaviours.
Sung, Paul S; Yoon, BumChul; Lee, Dongchul C
An experimental design comparing kinematic changes in the lumbar spine axis in subjects with and without low back pain (LBP) while standing on one leg with and without visual feedback. The purpose of this study was to evaluate the lumbar stability index, which includes relative holding time (RHT) and relative standstill time (RST), in subjects with and without LBP. Even though a number of studies have evaluated postural adjustments based on kinematic changes in subjects with LBP, lumbar spine stability has not been examined for abnormal postural responses with visual feedback. All participants were asked to maintain the stork test position (standing on one leg with the contra lateral hip flexed 90 degrees) for 25 seconds. The outcome measures included RHT and RST for the axes of the core spine and lumbar spine. Independent t tests were used to compare the differences between groups. Two-way repeated measure analysis of variance was used to compare the differences for both axes. The age variable was used as a covariate to control confounding effects for the data analyses. The RHT was longer for the lumbar spine axis in subjects without LBP than those with LBP, especially without visual feedback. There was also significant interaction in RST between subjects with and without LBP (F = 7.18, P = 0.01). For the core axis of the trunk, significant differences existed based on the main effect of side (F = 9.07, P = 0.004), trunk rotation (F = 24.30, P = 0.001), and both of these interactions (F = 8.93, P = 0.004). However, there was a lack of significant interaction with age for the lumbar and core spine axes (F = 0.06, P = 0.81). Although the control group included slightly younger volunteers compared with the LBP group, the stability index of the core spine significantly decreased in RHT and RST, especially when visual feedback was blocked for subjects with LBP. The interaction between visual feedback and trunk rotation indicated that core spine stability is critical in
Walters, Arthur S; Gabelia, David; Frauscher, Birgit
There has been no previous side-by-side comparison of the diagnostic criteria for restless legs syndrome (RLS) (Willis-Ekbom disease) and growing pains. In our review, we explore this comparison emphasizing overlaps and disconnects, summarize recent literature exploring the relationship between the 2 entities, and make suggestions for future research. There is considerable overlap in the diagnostic criteria for childhood RLS and growing pains. The literature also indicates that RLS and growing pains more commonly occur together than one would expect based on chance alone, and the family histories of RLS and growing pains often are overlapping. Leg rubbing to obtain relief from leg discomfort is common to both disorders, though walking to obtain relief seems unique to RLS. Childhood RLS also has been reported to be painful in up to 45% of cases. The development of standard diagnostic criteria is necessary to move forward in the field of growing pains research. A quantitative and validated rating scale for growing pains severity already exists. Because of the clinical and genetic similarity between RLS and growing pains, studies that parallel those previously performed in RLS patients are recommended for growing pains patients. For example, a genome wide association study in growing pains patients of all possible genes with particular attention to those identified as related to RLS and a therapeutic trial of medications known to be effective in RLS would be welcome. Abnormalities in vitamin D metabolism also may be common to both disorders. Copyright © 2013 The Authors. Published by Elsevier B.V. All rights reserved.
Marche, Tammy A; Briere, Jennifer L; von Baeyer, Carl L
Given that forgetting negative experiences can help children cope with these experiences, we examined their ability to forget negative aspects of painful events. 86 children aged 7-15 years participated in a retrieval-induced forgetting task whereby they repeatedly retrieved positive details of a physically painful experience, and an experimental pain task (cold-pressor task). Repeatedly retrieving positive details of a prior pain experience produced forgetting of the negative aspects of that experience. Pain-related self-efficacy predicted retrieval-induced forgetting; children with a poorer belief in their ability to cope with pain experienced less forgetting. Children who had a more difficult time forgetting prior negative experiences were more anxious about the pain task and reported higher pain thresholds. Understanding children's memory for painful experiences may help improve their pain management and coping ability. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Hartvigsen, Lisbeth; Kongsted, Alice; Hestbæk, Lise
BackgroundLow back pain (LBP) patients with related leg pain and signs of nerve root involvement (NRI) are considered to have a worse prognosis than patients with LBP alone. However, knowledge is limited about the importance of distinguishing between leg pain above or below the knee and leg pain ...
Hartvigsen, Lisbeth; Hestbæk, Lise; Leboeuf-Yde, Charlotte
Background Low back pain (LBP) patients with related leg pain and signs of nerve root involvement (NRI) are considered to have a worse prognosis than patients with LBP alone. However, knowledge is limited about the importance of distinguishing between leg pain above or below the knee and leg pain...
Wolff, AP; Groen, G J; Wilder-Smith, O H G; Richardson, J; van Egmond, J; Crul, B J P
Background. The present preliminary study documents the effects of a selective nerve root block (SNB) with short or long acting local anaesthetic compared with baseline measurements in patients with chronic low back pain radiating to the leg with maximum pain in one dermatome (1-4). Methods. Ten con
Katonis, P; Kampouroglou, A; Aggelopoulos, A; Kakavelakis, K; Lykoudis, S; Makrigiannakis, A; Alpantaki, K
Pregnancy related low back pain is a common complaint among pregnant women. It can potentially have a negative impact on their quality of life. The aim of this article is to present a current review of the literature concerning this issue.By using PubMed database and low back pain, pelvic girdle pain, pregnancy as keywords, abstracts and original articles in English investigating the diagnosis treatment of back pain during pregnancy were searched and analyzedLow back pain could present as either a pelvic girdle pain between the posterior iliac crest and the gluteal fold or as a lumbar pain over and around the lumbar spine. The source of the pain should be diagnosed and differentiated early.The appropriate treatment aims to reduce the discomfort and the impact on the pregnant womans quality of life. This article reveals the most common risk factors, as well as treatment methods, which may help to alleviate the pain. Some suggestions for additional research are also discussed.
Peter M. Tiidus
Full Text Available Massage therapy is commonly used following endurance running races with the expectation that it will enhance post-run recovery of muscle function and reduce soreness. A limited number of studies have reported little or no influence of massage therapy on post-exercise muscle recovery. However, no studies have been conducted in a field setting to assess the potential for massage to influence muscle recovery following an actual endurance running race. To evaluate the potential for repeated massage therapy interventions to influence recovery of quadriceps and hamstring muscle soreness, recovery of quadriceps and hamstring muscle strength and reduction of upper leg muscle swelling over a two week recovery period following an actual road running race. Twelve adult recreational runners (8 male, 4 female completed a half marathon (21.1 km road race. On days 1,4, 8, and 11 post-race, subjects received 30 minutes of standardized massage therapy performed by a registered massage therapist on a randomly assigned massage treatment leg, while the other (control leg received no massage treatment. Two days prior to the race (baseline and preceding the treatments on post-race days 1, 4, 8, and 11 the following measures were conducted on each of the massage and control legs: strength of quadriceps and hamstring muscles, leg swelling, and soreness perception. At day 1, post-race quadriceps peak torque was significantly reduced (p 0.05. All measures had returned to baseline at day 11. Massage did not affect the recovery of muscles in terms of physiological measures of strength, swelling, or soreness. However, questionnaires revealed that 7 of the 12 participants perceived that the massaged leg felt better upon recovery.
Edna Aparecida Bussotti
Full Text Available AbstractObjective: to perform the translation into Brazilian Portuguese and cultural adaptation of the Face, Legs, Activity, Cry, Consolability revised (FLACCr scale, with children under 18 years old, affected by cerebral palsy, presenting or not cognitive impairment and unable to report their pain.Method: methodological development study of translation into Portuguese and cultural adaptation of the FLACCr. After approval by the ethics committee, the process aimed at translation and back-translation, evaluation of translation and back-translation using the Delphi technique and assessment of cultural equivalence. The process included the five categories of the scale and the four application instructions, considering levels of agreement equal to or greater than 80%.Results: it was necessary three rounds of the Delphi technique to achieve consensus among experts. The agreement achieved for the five categories was: Face 95.5%, Legs 90%, Activity 94.4%, Cry 94.4% and Consolability 99.4%. The four instructions achieved the following consensus levels: 1st 99.1%, 2nd 99.2%, 3rd 99.1% and 4th 98.3%.Conclusion: the method enabled the translation and cultural adaptation of the FLACCr. This is a study able to expand the knowledge of Brazilian professionals on pain assessment in children with CP
Jetté, Fanny; Côté, Isabelle; Meziane, Hadj Boumediene; Mercier, Catherine
Neuropathic pain often follows spinal cord injury (SCI). To compare the effect of repetitive transcranial magnetic stimulation (rTMS) applied over different motor cortex targets (hand vs leg area) versus sham stimulation on neuropathic pain and local neurophysiological changes in patients with SCI. A total of 16 patients with complete or incomplete motor SCI and chronic neuropathic pain participated in a double-blind, cross-over randomized study. Three single sessions of sham or active rTMS (10 Hz, total of 2000 stimuli) were applied in random order over the hand or leg area with a minimal 2-week interval. THE MAIN OUTCOME MEASURES: were the numeric rating scale for pain sensation and parameters derived from motor mapping of the first dorsal interosseous muscle, including maximal amplitude of evoked response as well as map area, volume, and location. rTMS applied to either the hand or the leg area, but not sham stimulation, induced a significant but equivalent reduction in pain for the first 48 hours postintervention (P stimulation of the hand area (P = .04) but not for the other conditions. rTMS applied over the hand or leg motor cortex decreased neuropathic pain regardless of any change in cortical excitability, suggesting that the analgesic effect is not associated with local changes at the motor cortex level itself.
Jørgensen, Bo; Friis, Gitte Juel; Gottrup, Finn
Wound pain is a serious problem for elderly patients suffering from chronic leg ulcers, and it may lead to reduced wound healing rates and reduced quality of life. Biatain-Ibu Non-adhesive (Coloplast A/S), a new pain-reducing moist wound healing dressing containing ibuprofen was tested for pain reduction, safety, and efficacy on 10+2 patients in a single-blinded crossover study against Biatain Non-adhesive (Coloplast A/S). Pain was measured with a Numeric Box Scale before, during, and after dressing change. Quality of life was measured using the World Health Organization-5 Well-Being Index. Dressing moist wound healing properties such as absorption capacity and leakage were tested together with assessment of wound exudate and blood plasma content of ibuprofen. Use of the Biatain-Ibu foam dressing correlated with a decrease in pain intensity scores from 7 in the run-in period to approximately 2.5 in the Biatain-Ibu treatment phase. Quality of life measures were improved which together with the reduced pain could contribute to faster wound healing. The moist wound healing properties of Biatain-Ibu were similar to that of the Biatain Non-adhesive and ulcer size was reduced by 24% during the treatment period. Neither side effects nor systemic plasma concentrations of ibuprofen were observed. These data indicate that Biatain-Ibu could reduce persistent and temporary wound pain, increase Quality of life, was found safe to use, and had excellent moist wound healing properties.
Pedro G. Morouço
Full Text Available The relative contribution of arm stroke and leg kicking to maximal fully tethered front crawl swimming performance remains to be solved. Twenty-three national level young swimmers (12 male and 11 female randomly performed 3 bouts of 30 s fully tethered swimming (using the whole body, only the arm stroke, and only the leg kicking. A load-cell system permitted the continuous measurement of the exerted forces, and swimming velocity was calculated from the time taken to complete a 50 m front crawl swim. As expected, with no restrictions swimmers were able to exert higher forces than that using only their arm stroke or leg kicking. Estimated relative contributions of arm stroke and leg kicking were 70.3% versus 29.7% for males and 66.6% versus 33.4% for females, with 15.6% and 13.1% force deficits, respectively. To obtain higher velocities, male swimmers are highly dependent on the maximum forces they can exert with the arm stroke (r=0.77, P<0.01, whereas female swimmers swimming velocity is more related to whole-body mean forces (r=0.81, P<0.01. The obtained results point that leg kicking plays an important role over short duration high intensity bouts and that the used methodology may be useful to identify strength and/or coordination flaws.
Full Text Available Franco Gemignani,1 Andrea Melpignano,1,2 Giulia Milioli,1,2 Silvia Riccardi,1,2 Liborio Parrino1,2 1Neurology Unit, Department of Neurosciences, University of Parma, Parma, Italy; 2Sleep Disorders Center, Department of Neurosciences, University of Parma, Parma, Italy Abstract: Restless legs syndrome (RLS is a disorder of sensorimotor integration characterized by an urge to move the legs when at rest, especially at night or in the evening, which is relieved by movement. Sensory symptoms may be prominent, often exhibiting features consistent with neuropathic pain. Iron deficiency and genetic factors are implicated in RLS causation in most patients. The pathogenetic model of impaired circadian dopaminergic modulation of sensorimotor integration circuitry at the spinal level is fitting with the co-occurrence of movement disorders, sensory symptoms, and sleep disruption in RLS. Accordingly, levodopa and dopamine agonists are effective for RLS symptoms, which compensate for the impaired descending control by diencephalo-spinal dopa(minergic pathway. Dopamine agonists are usually indicated as the first-line therapy, but their use in long-term treatment is often complicated by augmentation and impulse control disorder, thus alpha-2-delta ligands also are now considered the first line of treatment. It has been recognized that endogenous opioid system is also involved in the mechanisms generating RLS, possibly through an impaired modulation of pain pathways. Opioids can be considered as an alternative therapy, particularly in patients with augmentation and/or refractory to other treatments. Recently introduced prolonged-release oxycodone–naloxone was efficacious for short-term treatment of patients with severe RLS inadequately controlled with previous treatment. It will be important to assess whether opioids, as well as other drugs, are especially effective in definite RLS subtypes such as the painful phenotype. Keywords: small fiber neuropathy
Persson Ann L
Full Text Available Abstract Background Neck-shoulder pain conditions, e.g., chronic trapezius myalgia, have been associated with sensory disturbances such as increased sensitivity to experimentally induced pain. This study investigated pain sensitivity in terms of bilateral pressure pain thresholds over the trapezius and tibialis anterior muscles and pain responses after a unilateral hypertonic saline infusion into the right legs tibialis anterior muscle and related those parameters to intensity and area size of the clinical pain and to psychological factors (sleeping problems, depression, anxiety, catastrophizing and fear-avoidance. Methods Nineteen women with chronic non-traumatic neck-shoulder pain but without simultaneous anatomically widespread clinical pain (NSP and 30 age-matched pain-free female control subjects (CON participated in the study. Results NSP had lower pressure pain thresholds over the trapezius and over the tibialis anterior muscles and experienced hypertonic saline-evoked pain in the tibialis anterior muscle to be significantly more intense and locally more widespread than CON. More intense symptoms of anxiety and depression together with a higher disability level were associated with increased pain responses to experimental pain induction and a larger area size of the clinical neck-shoulder pain at its worst. Conclusion These results indicate that central mechanisms e.g., central sensitization and altered descending control, are involved in chronic neck-shoulder pain since sensory hypersensitivity was found in areas distant to the site of clinical pain. Psychological status was found to interact with the perception, intensity, duration and distribution of induced pain (hypertonic saline together with the spreading of clinical pain. The duration and intensity of pain correlated negatively with pressure pain thresholds.
Møiniche, S; Dahl, J B; Erichsen, C J;
BACKGROUND: Little information is available on time course of wound tenderness and relationship to subjective pain ratings following surgery. Furthermore, it is not clarified whether surgical procedures may induce hyperalgesia to mechanical stimulation outside the area of the surgical incision. We...... have therefore assessed postoperative pain and pressure pain thresholds (PPT) adjacent to and remote from the surgical incision in 16 patients undergoing hysterectomy. METHODS: Pressure pain threshold was assessed with pressure algometry preoperatively, 4 and 6 and 1, 4 and 8 d after surgery...... on the abdominal wall 0.05, 5, 10 and 15 cm perpendicular to the wound, and on the anterior surface of the left thigh and tuberositas tibia. Furthermore, pain was assessed on a visual analogue scale (VAS) at rest and during cough. RESULTS: PPT decreased significantly 0.5, 5, 10 and 15 cm from skin incision up...
Loggia, Marco L.; Berna, Chantal; Kim, Jieun; Cahalan, Christine M.; Gollub, Randy L.; Wasan, Ajay D.; Harris, Richard E.; Edwards, Robert R.; Napadow, Vitaly
Objective While patients suffering from fibromyalgia (FM) are known to exhibit hyperalgesia, the central mechanisms contributing to this altered pain processing are not fully understood. In this study we investigate potential dysregulation of the neural circuitry underlying cognitive and hedonic aspects of the subjective experience of pain such as anticipation of pain and of pain relief. Methods FMRI was performed on 31 FM patients and 14 controls while they received cuff pressure pain stimuli on their leg, calibrated to elicit a pain rating of ∼50/100. During the scan, subjects also received visual cues informing them of impending pain onset (pain anticipation) and pain offset (relief anticipation). Results Patients exhibited less robust activations during both anticipation of pain and anticipation of relief within regions commonly thought to be involved in sensory, affective, cognitive and pain-modulatory processes. In healthy controls, direct searches and region-of-interest analyses in the ventral tegmental area (VTA) revealed a pattern of activity compatible with the encoding of punishment: activation during pain anticipation and pain stimulation, but deactivation during relief anticipation. In FM patients, however, VTA activity during pain and anticipation (of both pain and relief) periods was dramatically reduced or abolished. Conclusion FM patients exhibit disrupted brain responses to reward/punishment. The VTA is a source for reward-linked dopaminergic/GABAergic neurotransmission in the brain and our observations are compatible with reports of altered dopaminergic/GABAergic neurotransmission in FM. Reduced reward/punishment signaling in FM may relate to the augmented central processing of pain and reduced efficacy of opioid treatments in these patients. PMID:24449585
M. Roerdink; A.C.H. Geurts; M. de Haart; P.J. Beek
Background. Reduced postural steadiness and asymmetry of weight bearing are characteristic for posture after stroke. Objective. To examine the relative contribution of each leg to postural control in a cohort of 33 stroke patients at 5 stages during 3 months of inpatient rehabilitation, while taking
... include: A muscle cramp (also called a charley horse), frequently caused by the following: Dehydration or low ... overstretched muscle (strain) Hairline crack in the bone (stress fracture) Inflamed tendon (tendinitis) Shin splints—pain in ...
Ritter, Alexander; Franz, Marcel; Puta, Christian; Dietrich, Caroline; Miltner, Wolfgang H. R.; Weiss, Thomas
Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations induced by pain-related words in a sample of chronic back pain (CBP) patients experiencing current chronic pain compared to HC. In particular, we were interested in how current pain influences brain activations induced by pain-related adjectives. Subjects viewed pain-related, negative, positive, and neutral words; subjects were asked to generate mental images related to these words during fMRI scanning. Brain activation was compared between CBP patients and HC in response to the different word categories and examined in relation to current pain in CBP patients. Pain-related words vs. neutral words activated a network of brain regions including cingulate cortex and insula in subjects and patients. There was stronger activation in medial and dorsolateral prefrontal cortex (DLPFC) and anterior midcingulate cortex in CPB patients than in HC. The magnitude of activation for pain-related vs. negative words showed a negative linear relationship to CBP patients’ current pain. Our findings confirm earlier observations showing that pain-related words activate brain networks similar to noxious stimulation. Importantly, CBP patients show even stronger activation of these structures while merely processing pain-related words. Current pain directly influences on this activation. PMID:27517967
Choi, Jioun; Lee, Sangyong; Hwangbo, Gak
[Purpose] The purpose of this study was to identify how spinal decompression therapy and general traction therapy influence the pain, disability, and straight leg raise (SLR) ability of patients with intervertebral disc herniation. [Subjects] The subjects were 30 patients with chronic lumbar pain who were divided into a spinal decompression therapy group (SDTG, n=15), and a general traction therapy group (GTTG, n=15). [Methods] The SDTG used a spinal decompression device, and the GTTG used a ...
Full Text Available Influence of x-leg deformity in relation to fat and non-fat body composition in women was the goal of the paper. In this regards, the research included 41 female students with x-leg deformity and 41 female students without the deformity, while the total number of participants of the research was 82 aged from 18 to 19 years. 6 anthropometric variables have been used; one form measuring the body volme, three variables regarding the dimension of the sub skin fat tissue, one variable for measurement of non-fat body composition and one variable for measurement of fat body mass. Anthropometric measurements were carried out according to International Biological Program (IBP. Data collected demonstrates that x-leg deformity in women have significant influence on relation of fat and non-fat body composition. This relation is manifested as a result of decreased capacity of muscle endurance of leg muscles as main parts responsible for the physical activities, then consumption of calories and insufficient burning of fat as result of decreased capacity of movement.
Daniele, Thiago Medeiros da Costa; de Bruin, Veralice Meireles Sales; e Forte, Adriana Costa; de Oliveira, Débora Siqueira Nobre; Pompeu, Clara Mota Randal; de Bruin, Pedro Felipe Carvalhedo
To evaluate the relationship between physical activity with co morbidities and health-related quality of life in type 2 diabetic patients with and without restless legs syndrome (RLS). This is an observational study, set at tertiary care diabetic outpatient clinic, where 200 consecutive type 2 diabetic patients and 47 controls participated. Physical activity level was established by the International Physical Activity Questionnaire (IPAQ) and RLS diagnosis and RLS severity were established using the criteria defined by the International Restless Legs Syndrome Study Group; excessive daytime sleepiness was evaluated by the Epworth Sleepiness Scale, quality of sleep by the Pittsburgh Sleep Quality Index and Health-Related Quality of Life by the Short-Form Health Survey (SF-36). Depressive symptoms were investigated by Beck Depression Inventory (BDI- II). Among all diabetic patients (58 % women, mean age 52.7 ± 5.7), disease duration varied from 1 to 30 years (11.7 ± 7.5). Diabetic patients had more hypertension (76 %), peripheral neuropathy (65 %), and depressive symptoms (31 %) than controls; no gender differences were found between cases with and without depressive symptoms. RLS patients (72 % female) had worse quality of sleep. With regards to the quality of life domains, more active RLS diabetic patients had better perception of functional capacity, physical limitation, pain, and general health state (p < 0.05). RLS symptom severity did not vary according to physical activity (IPAQ level). This study shows that the physical activity is associated with a better perception of functional capacity, physical limitation, and pain in diabetic patients with RLS; thus a more active lifestyle should be encouraged.
Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg: This problem often occurs in people who play sports such as ...
Demant, Dyveke T; Lund, Karen; Finnerup, Nanna B
(-1 to 5) points more (p=0.036). For these measures, there was no significant interaction between treatment and phenotype, but there was a significant interaction for pain paroxysms (0.8, 95% CI 0.4;1.2, plidocaine 5% patch...... 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...... patients with irritable nociceptor and 25 patients with non-irritable nociceptor. In the total sample, lidocaine reduced pain by 0.3 NRS points (95% CI 0.1;0.5) and pain-related sleep disturbance by 0.6 points (95% CI 0.4;0.8) more than placebo (p=0.007 and p
Full Text Available BACKGROUND: Negative affective and pain-related cues, such as pictures or words, have been shown to act as primes and enhance the perceived intensity of subsequent painful events. For pain-related semantic primes, it remains unclear whether this effect depends on negative valence itself or, specifically, on the pain-relatedness of the words.
Morton, Darren; Callister, Robin
Exercise-related transient abdominal pain (ETAP), commonly referred to as 'stitch', is an ailment well known in many sporting activities. It is especially prevalent in activities that involve repetitive torso movement with the torso in an extended position, such as running and horse riding. Approximately 70% of runners report experiencing the pain in the past year and in a single running event approximately one in five participants can be expected to suffer the condition. ETAP is a localized pain that is most common in the lateral aspects of the mid abdomen along the costal border, although it may occur in any region of the abdomen. It may also be related to shoulder tip pain, which is the referred site from tissue innervated by the phrenic nerve. ETAP tends to be sharp or stabbing when severe, and cramping, aching, or pulling when less intense. The condition is exacerbated by the postprandial state, with hypertonic beverages being particularly provocative. ETAP is most common in the young but is unrelated to sex or body type. Well trained athletes are not immune from the condition, although they may experience it less frequently. Several theories have been presented to explain the mechanism responsible for the pain, including ischemia of the diaphragm; stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament; aggravation of the spinal nerves; and irritation of the parietal peritoneum. Of these theories, irritation of the parietal peritoneum best explains the features of ETAP; however, further investigations are required. Strategies for managing the pain are largely anecdotal, especially given that its etiology remains to be fully elucidated. Commonly purported prevention strategies include avoiding large volumes of food and beverages for at least 2 hours
Although there are numerous studies examining the relationship between spinal imaging abnormality and low back and leg pain, the majority are only concerned with the correlation between these two. If we were to attempt to use the results of these studies as the basis for a treatment plan, it would be necessary to investigate the presence (or absence) of a causal relationship between the two. However, upon examination of previous studies we consider that this causal relationship has in fact either not been proven or has been refuted. To this end, we have conducted this study based on the hypothesis that spinal imaging abnormality and low back and leg pain possess a spurious relationship wherein muscle tension is the lurking variable. Furthermore, we propose a five-phase hypothesis considering the generative sequence of and causal relationship between spinal imaging abnormality, low back and leg pain, and muscle tension. Specifically, Phase I represents the healthy condition; Phase II indicates the occurrence of muscle tension only; Phase III indicates the occurrence of pain resulting from muscle tension; Phase IV represents the occurrence of both pain and imaging abnormality as a result of muscle tension; and Phase V indicates residual imaging abnormality despite amelioration of muscle tension. We believe that this hypothesis has the potential to facilitate pathological understanding and resolve the current confusion surrounding the diagnosis and treatment of spinal disorders.
Rainville, Pierre; Bao, Quoc Viet Huynh; Chrétien, Pablo
The effect of emotions on pain perception is generally recognized but the underlying mechanisms remain unclear. Here, emotions related to pain were induced in healthy volunteers using hypnosis, during 1-min immersions of the hand in painfully hot water. In Experiment 1, hypnotic suggestions were designed to induce various positive or negative emotions. Compared to a control condition with hypnotic-relaxation, negative emotions produced robust increases in pain. In Experiment 2, induction of pain-related anger and sadness were found to increase pain. Pain increases were associated with increases in self-rated desire for relief and decreases in expectation of relief, and with increases in arousal, negative affective valence and decreases in perceived control. In Experiment 3, hypnotic suggestions specifically designed to increase and decrease the desire for relief produced increases and decreases in pain, respectively. In all three experiments, emotion-induced changes in pain were most consistently found on ratings of pain unpleasantness compared to pain intensity. Changes in pain-evoked cardiac responses (R-R interval decrease), measured in experiments 2 and 3, were consistent with changes in pain unpleasantness. Correlation and multiple regression analyses suggest that negative emotions and desire for relief influence primarily pain affect and that pain-evoked autonomic responses are strongly associated with pain affect. These results confirm the hypothesized influence of the desire for relief on pain perception, and particularly on pain affect, and support the functional relation between pain affect and autonomic nociceptive responses. This study provides further experimental confirmation that pain-related emotions influence pain perception and pain-related physiological responses.
Zakrzewska, Joanna M
The goal of a classification system of medical conditions is to facilitate accurate communication, to ensure that each condition is described uniformly and universally and that all data banks for the storage and retrieval of research and clinical data related to the conditions are consistent. Classification entails deciding which kinds of diagnostic entities should be recognized and how to order them in a meaningful way. Currently there are 3 major pain classification systems of relevance to orofacial pain: The International Association for the Study of Pain classification system, the International Headache Society classification system, and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). All use different methodologies, and only the RDC/TMD take into account social and psychologic factors in the classification of conditions. Classification systems need to be reliable, valid, comprehensive, generalizable, and flexible, and they need to be tested using consensus views of experts as well as the available literature. There is an urgent need for a robust classification system for neuropathic trigeminal pain.
Agoston, Anna Monica; Gray, Laura S; Logan, Deirdre E
Children with chronic pain frequently experience impairment in the school setting, but we do not yet understand how unique these struggles are to children with primary pain conditions compared to peers with disease-related pain or those without chronic pain symptoms. The objective of this study is to examine school functioning, defined as school attendance rates, overall quality of life in the school setting, and school nurse visits among adolescents with primary pain conditions, those with juvenile idiopathic arthritis (JIA)-related pain, and healthy peers. Two hundred and sixty adolescents participated in the study, including 129 with primary pain conditions, 61 with JIA, and 70 healthy comparison adolescents. They completed self- and parent-reported measures of school function. Findings show that as a group, youth with primary pain conditions reported more school absences, lower quality of life in the school setting, and more frequent school nurse visits compared to both adolescents with JIA-related pain and healthy peers. We conclude that compared to those who experience pain specific to a disease process, adolescents with primary pain conditions may face unique challenges in the school setting and may require more support to help them succeed in school in spite of pain.
Lousberg, Richel; Vuurman, Eric; Lamers, Theo; Breukelen, van Gerard; Jongen, Ellen; Rijnen, Heidi; Maessen, Christa; Hermens, Hermie
Objective: The purpose of the present study was to answer the ques- tion whether pain report can be increased and decreased by operant conditioning. We predicted that the conditioned pain effects would remain significant after correction for social desirability and fantasy proneness. Furthermore, we
Lousberg, Richel; Vuurman, Eric; Lamers, Theo; van Breukelen, Gerard; Jongen, Ellen; Rijnen, Heidi; Maessen, Christa; Hermens, Hermanus J.
Objective: The purpose of the present study was to answer the ques- tion whether pain report can be increased and decreased by operant conditioning. We predicted that the conditioned pain effects would remain significant after correction for social desirability and fantasy proneness. Furthermore, we
Duncan, Michael J; Al-Nakeeb, Yahya; Scurr, Joanna
This study examined the relationship between ratings of perceived exertion and muscle activity during dynamic leg extension exercise using a resistance exercise specific OMNI-RPE scale. Twenty volunteers (10 males, 10 females, age 22.2 +/- 3.1 yr) performed one set of leg extension exercise at 30%, 60%, and 90% of their one-repetition maximum (1-RM). OMNI-RPE responses were assessed for both the active muscle (OMNI-AM) and the overall body (OMNI-O) following each intensity. Electromyography (EMG) data were collected from the rectus femoris, vastus lateralis, and vastus medialis muscles. A two-factor repeated measures ANOVA showed a significant OMNI-RPE (region) X intensity interaction (p muscle groups (all p Muscle activity was significantly and positively related to OMNI-RPE in both the active muscle and overall body (all p < 0.01). The OMNI-Res RPE scale may be a promising technique for regulating resistance training intensity.
Iannitti, Tommaso; Fistetto, Gregorio; Esposito, Anna; Rottigni, Valentina; Palmieri, Beniamino
Pulsed electromagnetic field (PEMF) therapy has shown promising therapeutic effectiveness on bone- and cartilage-related pathologies, being also safe for management of knee osteoarthritis. The aim of this study was to investigate the clinical efficacy of a PEMF device for management of knee osteoarthritis in elderly patients. A total of 33 patients were screened, and 28 patients, aged between 60 and 83 and affected by bilateral knee osteoarthritis, were enrolled in this study. They received PEMF therapy on the right leg for a total of three 30-minute sessions per week for a period of 6 weeks, while the left leg did not receive any treatment and served as control. An intravenous drip containing ketoprofen, sodium clodronate, glucosamine sulfate, calcitonin, and ascorbic acid, for a total volume of 500 mL, was administered during PEMF therapy. At baseline and 3 months post-PEMF therapy, Visual Analog Scale (VAS) was used to assess knee pain and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) was used to measure knee pain, stiffness and physical function. Changes in VAS and WOMAC scores were calculated for both knees as baseline minus post-treatment. A two sample Student's t-test, comparing change in knee-related VAS pain for PEMF-treated leg (49.8 ± 2.03) vs control leg (11 ± 1.1), showed a significant difference in favor of PEMF therapy (P physical function for PEMF-treated leg (8.5 ± 0.4, 3.5 ± 0.2, 38.5 ± 2.08, respectively) vs control leg (2.6 ± 0.2; 1.6 ± 0.1; 4.5 ± 0.5 respectively), also showed a significant difference in favor of PEMF therapy (P therapy were observed. The present study shows that PEMF therapy improves pain, stiffness and physical function in elderly patients affected by knee osteoarthritis.
Agar-Wilson, M; Jackson, T
Although emotion regulation capacities have been linked to adjustment among people with chronic pain, researchers have yet to determine whether these capacities are related to functioning independent of established facets of pain coping. The present study was designed to address this gap. A sample 128 Australian adults with chronic pain (44 men, 84 women) completed self-report measures of adjustment (quality of life, negative affect, and pain-related disability), pain coping, and features of emotion regulation (emotion appraisal, perceived efficacy in emotion regulation, emotion utilization). Hierarchical multiple regression analyses indicated that efficacy in emotion regulation was related to quality of life and reduced negative affect even after statistically controlling for effects of other measures of adjustment, pain coping efficacy, and pain coping. Conversely, features of emotion regulation did not improve the prediction model for pain-related disability. Findings suggest emotion regulation capacities may have a unique role in the prediction of specific facets of adjustment among people with chronic pain.
Full Text Available Pain in carcinoma cervix is a multidimensional experience with sensory, affective and cognitive-evaluative components. Many patients do not receive adequate pain management because of a lack of proper assessment, misconceptions regarding the pharmacologic and non pharmacologic methods of pain management and failure to distinguish between different types of pain. In our audit pelvic and nodal recurrence were the commonest cause of pain presenting as as pelvic pain, [42%], lumbosacral plexopathy [40%] and abdominal pain [34%] [n = 30]. Pain on defaecation caused by rectal obstruction, and suprapubic pain due to pyometra can be relieved by colostomy and drainage. Very little literature is available on the pain syndromes associated with carcinoma cervix. The present article is a review of cancer and treatment related pains in carcinoma cervix.
Johnsen, Anna Thit; Petersen, Morten A; Snyder, Claire F
PURPOSE: To explore (1) the information obtained from related but conceptually different approaches to pain assessment and (2) the extent to which the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) can be used as a screening tool...... to predict patient-reported need for pain relief. METHODS: Cancer patients randomly sampled from 56 hospital departments were included. Questionnaire items assessed patients' (a) pain experience using the EORTC QLQ-C30 pain scale and its two pain items separately (pain intensity and pain interference) and (b...
Pratik .A. Phansopkar,
Full Text Available Background and objectives: Adequate flexibility of the Hamstring muscles and Core muscle strength is necessary for a healthy lower back. Mulligan’s techniques are fascinating Physiotherapy approach in treatment of hamstrings tightness in NS-LBP such as Mulligan’s Bent Leg Raise (BLR technique, Limited Literature is available on the efficacies of Mulligan’s Two Leg Rotation (TLR technique in Hamstrings flexibility. The objective of the present study was to determine the effectiveness of Mulligan’s TLR and BLR in treatment of acute NS-LBP. Methods: The present randomized clinical trial was conducted among 40 subjects which included both male and female symptomatic subjects between the age of 18 to 35 years with acute NS-LBP and they were randomly allocated into 2 groups namely Group A[SWD, HMP, Mulligan’s TLR, MCE] , Group B[SWD, HMP, Mulligan’s BLR, MCE]. Pre-interventional and 7th day Post-interventional outcome measurements were taken in the form of Visual Analogue Scale (VAS, Modified Oswestry Disability Questionnaire (MODQ, Active Knee Extension (AKE Measurement, Lumbar ROM and Core muscle strength. Results: Intra-group comparison for all the outcome parameters in both the groups showed statistical significance (p<0.001. Inter group comparison for all the outcome parameters had differences but showed no statistical significance. Conclusion: Mulligan’s Two Leg Rotation and Bent Leg Raise techniques are effective in increasing the hamstrings flexibility in subjects with acute non specific low back pain in terms of pain, range of motion and functional disability.
Campbell, Claudia M; Edwards, Robert R
The well-accepted biopsychosocial model proposes that the experience of pain and responses to it result from a complex interaction of biological, psychological, and social factors. However, the separation of these constructs is substantially artificial, and we presume that psychological processes have biological effects, that biological processes affect an individual's psychosocial environment, and so on. Considerable research has demonstrated that pain-coping strategies influence perceived pain intensity and physical functioning, and individual differences in styles of pain coping even shape the persistence of long-term pain complaints in some populations. A good deal of this coping research has focused on catastrophizing, which is a generally maladaptive cognitive and emotional mental set that involves feelings of helplessness when in pain, rumination about pain symptoms, and magnification of pain-related complaints. Collectively, catastrophizing has been consistently associated with heightened experiences of pain across a variety of samples. Although catastrophic thinking regarding pain-related symptoms is often classified under the "psychologic" category within the broader biopsychosocial model, we propose that catastrophizing exerts biologic effects that may account for some of its negative consequences. In general, the cognitive and affective processes captured within the construct of catastrophizing may exert effects on the neuromuscular, cardiovascular, immune, and neuroendocrine systems, and on the activity in the pain neuromatrix within the brain. The interface between pain-related neurobiology and processes such as pain-related catastrophizing represents an important avenue for future pain research.
Soraya Coelho Leal
Full Text Available Atraumatic Restorative Treatment (ART is considered to be well accepted, both by children and by adult patients. The objective of this review is to present and discuss the evidence regarding the acceptability of ART, from the patient's perspective. Aspects related to dental anxiety/fear and pain/discomfort have been highlighted, to facilitate better understanding and use of the information available in the literature. CONCLUSIONS: The ART approach has been shown to cause less discomfort than other conventional approaches and is, therefore, considered a very promising "atraumatic" management approach for cavitated carious lesions in children, anxious adults and possibly, for dental-phobic patients.
Lin, Pei-Hsin; Tsai, Yun-An; Chen, Wei-Chih; Huang, Shih-Fong
Low back pain is a common health problem among hospital nurses. However, the prevalence, characteristics, and work-related risk factors of low back pain have not been widely investigated in Taiwan. This study used a cross-sectional survey of 217 hospital nurses to gather self-reported information on the prevalence of back pain, demographic and pain characteristics, and work-related risk factors from 178 respondents who indicated a past history of back pain. The association between the characteristics of back pain and work-related risk factors was also examined. The lifetime prevalence of back pain was 82.03%, and the point prevalence of back pain was 43.78%. The mean pain score is 41.67. The number of years at work was significantly associated with the pain score for an individual's most recent episode of back pain, the extent of bothersomeness of back pain and leg pain, and the extent to which back pain interfered with normal work. Back pain is common among hospital nurses in Taiwan. Years at work are significantly associated with pain severity and disability caused by back pain.
This study investigated individual and incremental contributions of somatization and trait anxiety to pain report in children with pain-related functional gastrointestinal disorders. Eighty children (7-10 years) with pain-related functional gastrointestinal disorders completed the State-Trait Anxiet...
Full Text Available Abstract Background Traditionally, studies on the etiology of low back pain have been carried out in adult populations. However, since low back pain often appears early in life, more research on young populations is needed. This study focuses on the importance of social background factors and previous low back pain in the development of low back pain in military recruits. Methods During a three-month period, Danish military recruits with different social backgrounds live and work under the same conditions. Thus, there is an opportunity to investigate the influence of social background on the development of low back pain, when persons are removed from their usual environment and submitted to a number of new stressors. In addition, the importance of the recruits' previous low back pain history in relation to low back pain during military service was studied. This was done by means of questionnaires to 1,711 recruits before and after this three-month period. Results Sedentary occupation was negatively associated with long-lasting low back pain (>30 days during the past year at baseline with an odds ratios of 0.55 (95% CI: 0.33–0.90. This effect vanished during service. Having parents with higher education increased the risk of low back pain during service (OR: 1.9;1.2–3.0, for the highest educated group, but not of the consequences (leg pain and exemption from duty, whereas high IQ decreased the risk of these consequences (odds ratios as low as 0.2;0.1–0.8 for exemption from duty in the group with highest IQ. Long-lasting low back pain prior to service increased the risk of long-lasting low back pain (OR: 4.8;2.1–10.8, leg pain (OR: 3.3;1.3–8.3 and exemption from duty during service (OR: 5.9;2.4–14.8. Conclusion Sedentary occupation is negatively associated with low back pain at baseline. This protective effect disappears, when the person becomes physically active. For predicting trouble related to the low back during service, the
Briere, Jennifer L.; von Baeyer, Carl L.
Objective Given that forgetting negative experiences can help children cope with these experiences, we examined their ability to forget negative aspects of painful events. Methods 86 children aged 7–15 years participated in a retrieval-induced forgetting task whereby they repeatedly retrieved positive details of a physically painful experience, and an experimental pain task (cold-pressor task). Results Repeatedly retrieving positive details of a prior pain experience produced forgetting of the negative aspects of that experience. Pain-related self-efficacy predicted retrieval-induced forgetting; children with a poorer belief in their ability to cope with pain experienced less forgetting. Children who had a more difficult time forgetting prior negative experiences were more anxious about the pain task and reported higher pain thresholds. Conclusions Understanding children’s memory for painful experiences may help improve their pain management and coping ability. PMID:26666267
Bhowmik, Mrinal Kanti; Bardhan, Shawli; Das, Kakali; Bhattacharjee, Debotosh; Nath, Satyabrata
Medical Infrared Thermography (MIT) offers a potential non-invasive, non-contact and radiation free imaging modality for assessment of abnormal inflammation having pain in the human body. The assessment of inflammation mainly depends on the emission of heat from the skin surface. Arthritis is a disease of joint damage that generates inflammation in one or more anatomical joints of the body. Osteoarthritis (OA) is the most frequent appearing form of arthritis, and rheumatoid arthritis (RA) is the most threatening form of them. In this study, the inflammatory analysis has been performed on the infrared images of patients suffering from RA and OA. For the analysis, a dataset of 30 bilateral knee thermograms has been captured from the patient of RA and OA by following a thermogram acquisition standard. The thermograms are pre-processed, and areas of interest are extracted for further processing. The investigation of the spread of inflammation is performed along with the statistical analysis of the pre-processed thermograms. The objectives of the study include: i) Generation of a novel thermogram acquisition standard for inflammatory pain disease ii) Analysis of the spread of the inflammation related to RA and OA using K-means clustering. iii) First and second order statistical analysis of pre-processed thermograms. The conclusion reflects that, in most of the cases, RA oriented inflammation affects bilateral knees whereas inflammation related to OA present in the unilateral knee. Also due to the spread of inflammation in OA, contralateral asymmetries are detected through the statistical analysis.
Pacheco, Rafael A; Stock, Harlan
As summer is upon us, we thought a discussion of tennis leg would be beneficial to our fellow clinicians. Tennis leg is a relatively common clinical condition, classically manifesting as acute, sports-related pain in the mid-calf. First described in 1883, the pathogenesis has been debated--tennis leg was first attributed to rupture of the plantaris tendon, though more recent investigations have implicated rupture of the medial head of the gastrocnemius at its myotendinous junction. For simplicity, many authors use the term tennis leg to describe all such acute muscle injuries in the superficial calf.
Full Text Available OBJECTIVE: Anxiety symptoms are common in chronic pain patients. High levels of anxiety are associated with increased pain experience and disability. Proneness to anxiety has a large interindividual variation. The aim of the study was to determine whether the anxiety-related temperament trait Harm Avoidance (HA, is associated with pain-related anxiety. METHODS: One hundred chronic pain patients in a multidisciplinary pain clinic participated in the study. The patients were assessed using the HA scale of the Temperament and Character Inventory (TCI of Cloninger and Pain Anxiety Symptoms Scale-20 (PASS-20. Both the HA total score and the four subscales of HA were analyzed. Current pain intensity was measured using the Visual Analogue Scale (VAS. The Beck Depression Inventory (BDI was used to control for the influence of depression on the personality measurement. RESULTS: The HA total score was associated with PASS-20, but the association became non-significant after controlling for depression. The HA4 Fatigability subscale was associated with the PASS scales. Depression did not influence this association. Pain intensity was not correlated with HA or the PASS scales. However, the association between HA4 Fatigability and PASS was influenced by pain intensity. Higher pain intensity was associated with stronger association between the scales. CONCLUSION: Harm Avoidance, representing temperament and trait-related anxiety, has relevance in pain-related anxiety. Assessing personality and temperament may deepen the clinician's understanding of the pain experience and behavior in chronic pain patients.
Rogelio A Coronado
Full Text Available Exercise-induced injury models are advantageous for studying pain since the onset of pain is controlled and both pre-injury and post-injury factors can be utilized as explanatory variables or predictors. In these studies, rest-related pain is often considered the primary dependent variable or outcome, as opposed to a measure of activity-related pain. Additionally, few studies include pain sensitivity measures as predictors. In this study, we examined the influence of pre-injury and post-injury factors, including pain sensitivity, for induced rest and activity-related pain following exercise induced muscle injury. The overall goal of this investigation was to determine if there were convergent or divergent predictors of rest and activity-related pain. One hundred forty-three participants provided demographic, psychological, and pain sensitivity information and underwent a standard fatigue trial of resistance exercise to induce injury of the dominant shoulder. Pain at rest and during active and resisted shoulder motion were measured at 48- and 96-hours post-injury. Separate hierarchical models were generated for assessing the influence of pre-injury and post-injury factors on 48- and 96-hour rest-related and activity-related pain. Overall, we did not find a universal predictor of pain across all models. However, pre-injury and post-injury suprathreshold heat pain response (SHPR, a pain sensitivity measure, was a consistent predictor of activity-related pain, even after controlling for known psychological factors. These results suggest there is differential prediction of pain. A measure of pain sensitivity such as SHPR appears more influential for activity-related pain, but not rest-related pain, and may reflect different underlying processes involved during pain appraisal.
Marche, Tammy A; Briere, Jennifer L; von Baeyer, Carl L
.... 86 children aged 7-15 years participated in a retrieval-induced forgetting task whereby they repeatedly retrieved positive details of a physically painful experience, and an experimental pain task (cold-pressor task...
Full Text Available Learning to predict pain based on internal or external cues constitutes a fundamental and highly adaptive process aimed at self-protection. Pain-related fear is an essential component of this response, which is formed by associative and instrumental learning processes. In chronic pain, pain-related fear may become maladaptive, drive avoidance behaviors and contribute to symptom chronicity. Pavlovian fear conditioning has proven fruitful to elucidate associative learning and extinction involving aversive stimuli, including pain, but studies in chronic pain remain scarce. Stress demonstrably exerts differential effects on emotional learning and memory processes, but this has not been transferred to pain-related fear. Within this perspective, we propose that stress could contribute to impaired pain-related associative learning and extinction processes and call for interdisciplinary research. Specifically, we suggest to test the hypotheses that (1 extinction-related phenomena inducing a re-activation of maladaptive pain-related fear (e.g., reinstatement, renewal likely occur in everyday life of chronic pain patients and may alter pain processing, impair perceptual discrimination and favour overgeneralization; (2 acute stress prior to or during acquisition of pain-related fear may facilitate the formation and/or consolidation of pain-related fear memories, (3 stress during or after extinction may impair extinction efficacy resulting in greater reinstatement or context-dependent renewal of pain-related fear; and (4 these effects could be amplified by chronic stress due to early adversity and/or psychiatric comorbidity such as depression or anxiety in patients with chronic pain.
Weinstein, S M
Postamputation phenomena, including painful and nonpainful phantom sensations occur following loss of limbs and other body parts. Peripheral and central nervous system mechanisms play a role in persistent phantom pain. Understanding the pathophysiology of this syndrome has improved in recent years. Comprehensive evaluation and a multimodality treatment approach comprise the current standard of care of the patient with phantom pain.
Fejer, René; Hartvigsen, Jan
Pain and disability are interrelated, but the relationship between pain and disability is not straightforward. The objective of this study was to investigate the relationship between neck pain (NP) intensity, NP duration, and disability based on the population-based 'Funen Neck and Chest Pain......' study. Pain intensity was measured using 11-box numerical rating scales, pain duration was measured using the Standardized Nordic Questionnaire, and disability was measured by the Copenhagen Neck Functional Disability Scale. Spearman rank correlation coefficients and logistic regression analyses were...... used to measure correlations and strength of associations between pain intensity, pain duration, and disability given domain specific characteristics (socioeconomic, health and physical, comorbidity, and variables related to consequences of NP). Neck pain was very common, but mainly mild and did...
Full Text Available Restless leg syndrome (RLS or Ekbom syndrome is a sensory motor disorder with shaking legs and sometimes other parts of body. This unpleasant sensation is more common during sitting and lying particularly in the knees, ankles and depth of internal surface of legs .
Bydon, Ali; Xu, Risheng; Parker, Scott L; McGirt, Matthew J; Bydon, Mohamad; Gokaslan, Ziya L; Witham, Timothy F
With improvements in neurological imaging, there are increasing reports of symptomatic spinal synovial cysts. Surgical excision has been recognized as the definitive treatment for symptomatic juxtafacet cysts. However, the role for concomitant fusion and the incidence of recurrent back pain and recurrent cyst formation after surgery remain unclear. To determine the cumulative incidence of postoperative symptomatic relief, recurrent back and leg pain after cyst resection and decompression, and synovial cyst recurrence. Systematic review of the literature. All published studies to date reporting outcomes of synovial cyst excision with and without spinal fusion. Cyst recurrence and Kawabata, Macnab, Prolo, or Stauffer pain scales. We performed a systematic literature review of all articles published between 1970 and 2009 reporting outcomes after surgical management of spinal synovial cysts. Eighty-two published studies encompassing 966 patients were identified and reviewed. Six hundred seventy-two (69.6%) patients presented with radicular pain and 467 (48.3%) with back pain. The most commonly involved spinal level was L4-L5 (75.4%), with only 25 (2.6%) and 12 (1.2%) reported synovial cysts in the cervical or thoracic area, respectively. Eight hundred eleven (84.0%) patients were treated with decompressive surgical excision alone, whereas 155 (16.0%) received additional concomitant spinal fusion. Six hundred fifty-four (92.5%) and 880 (91.1%) patients experienced complete resolution of their back or leg pain after surgery, respectively. By a mean follow-up of 25.4 months, back and leg pain recurred in 155 (21.9%) and 123 (12.7%) patients, respectively. Sixty (6.2%) patients required reoperation, of which the majority (n=47) required fusion for correction of spinal instability and mechanical back pain. Same-level synovial cyst recurrence occurred in 17 (1.8%) patients after decompression alone but has been reported in no (0%) patients after decompression and fusion
Sung, Paul S; Leininger, Peter M
The purpose of this study was to evaluate the relationship between normalized kinematic and kinetic stability indices for spinal regions with eyes-open and eyes-closed conditions during non-dominant leg standing between subjects with recurrent low back pain and control subjects. The kinematic stability index for the spinal regions (core spine model, lumbar spine, lower and upper thorax) and the kinetic stability index from force plate were measured. All participants were asked to maintain non-dominant leg standing with the dominant hip and knee flexed approximately 90 degrees for 25 seconds. Forty-two participants enrolled in the study, including 22 subjects with low back pain (12 male, 10 female) and 20 control subjects (12 male, 8 female). For the kinematic index for stability, the visual condition (F=30.06, p=0.0001) and spinal region (F=10.82, p=0.002) were statistically significant. The post hoc test results indicated a significant difference in the lumbar spine compared with the upper and lower thorax and the core spine model. The kinetic stability (average [standard deviation]) during the eyes-closed condition significantly decreased in the low back pain group (t=-3.24, p=0.002). The subjects with recurrent low back pain demonstrated higher lumbar spine stability in eyes-open condition. This higher stability of the lumbar spine might be due to a possible pain avoiding strategy from the standing limb. The low back pain group also significantly decreased kinetic stability during the eyes-closed condition. Clinicians need to consider both kinetic and kinematic indices while considering visual condition for lumbar spine stability in subjects with recurrent low back pain. Copyright © 2015 Elsevier Ltd. All rights reserved.
Sell, L; Lund, H L; Holtermann, A
BACKGROUND: Employees with physically heavy work have an increased risk of musculoskeletal disorders leading to reduced work ability. AIMS: To investigate if a high level of musculoskeletal pain or pain-related fear of movement was associated with low productivity among employees with physically...... heavy work and differing work ability levels. METHODS: The study was conducted at a Danish production site and employees with physically heavy work in the production line were included in the study. Work ability was assessed with the Work Ability Index (WAI), pain-related fear of movement with the Tampa...... work ability, there was neither an association between pain and productivity nor between pain-related fear of movement and productivity. For employees with good work ability, higher levels of pain and higher levels of pain-related fear of movement both raised the odds of low productivity significantly...
Kadimpati, Sandeep; Zale, Emily L; Hooten, Michael W; Ditre, Joseph W; Warner, David O
Several cognitive-affective constructs, including pain catastrophizing and pain-related anxiety, have been implicated in the onset and progression of chronic pain, and both constructs have been identified as key targets for multidisciplinary pain treatment. Both neuroticism and depression have been linked to these constructs (and to each other), but how each may contribute to the pain experience is unknown. This study tested associations between neuroticism, depression, and indices of catastrophizing and pain-related anxiety among persons seeking treatment for chronic non-malignant pain. We hypothesized, as a higher-order personality trait, neuroticism would remain uniquely associated with both pain catastrophizing and pain-related anxiety, even after accounting for current symptoms of depression. A retrospective study design assessed depression (as measured by the Centers for Epidemiologic Studies-Depression scale), neuroticism (measured with the Neuroticism-Extraversion-Openness Personality Inventory), the Pain Catastrophizing Scale, and the Pain Anxiety Symptom Score in a consecutive series of patients (n=595) admitted to a 3-week outpatient pain treatment program from March 2009 through January 2011. Hierarchical regression indicated that neuroticism was independently associated with greater pain catastrophizing and pain-related anxiety, above-and-beyond the contributions of sociodemographic characteristics, pain severity, and depression. A depression by neuroticism interaction was not observed, suggesting that associations between neuroticism and cognitive-affective pain constructs remained stable across varying levels of current depression. These findings represent an early but important step towards the clarification of complex associations between trait neuroticism, current depression, and tendencies toward catastrophic and anxiety-provoking appraisals of pain among persons seeking treatment for chronic pain.
Full Text Available Several cognitive-affective constructs, including pain catastrophizing and pain-related anxiety, have been implicated in the onset and progression of chronic pain, and both constructs have been identified as key targets for multidisciplinary pain treatment. Both neuroticism and depression have been linked to these constructs (and to each other, but how each may contribute to the pain experience is unknown. This study tested associations between neuroticism, depression, and indices of catastrophizing and pain-related anxiety among persons seeking treatment for chronic non-malignant pain. We hypothesized, as a higher-order personality trait, neuroticism would remain uniquely associated with both pain catastrophizing and pain-related anxiety, even after accounting for current symptoms of depression. A retrospective study design assessed depression (as measured by the Centers for Epidemiologic Studies-Depression scale, neuroticism (measured with the Neuroticism-Extraversion-Openness Personality Inventory, the Pain Catastrophizing Scale, and the Pain Anxiety Symptom Score in a consecutive series of patients (n=595 admitted to a 3-week outpatient pain treatment program from March 2009 through January 2011. Hierarchical regression indicated that neuroticism was independently associated with greater pain catastrophizing and pain-related anxiety, above-and-beyond the contributions of sociodemographic characteristics, pain severity, and depression. A depression by neuroticism interaction was not observed, suggesting that associations between neuroticism and cognitive-affective pain constructs remained stable across varying levels of current depression. These findings represent an early but important step towards the clarification of complex associations between trait neuroticism, current depression, and tendencies toward catastrophic and anxiety-provoking appraisals of pain among persons seeking treatment for chronic pain.
M. de Groot (Mirthe)
textabstractPain in the lumbar spine and pelvic region is a frequent complication of pregnancy and delivery. The prevalence of pregnancy related low back and pelvic pain (PLBP) varies between 14.2 and 56%. In 6 to 15% the pain is so severe that it impedes daily life activities. The symptoms of PL
Full Text Available M Gabrielle Pagé,1 Jennifer Stinson,2,3 Fiona Campbell,2,4 Lisa Isaac,2,4 Joel Katz1,4,51Department of Psychology, Faculty of Health, York University, 2Department of Anesthesia and Pain Medicine, Hospital for Sick Children, 3Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 4Department of Anesthesia, Faculty of Medicine, University of Toronto, 5Department of Psychology, Hospital for Sick Children, Toronto, ON, CanadaBackground: Post-surgical pain is prevalent in children, yet is significantly understudied. The goals of this study were to examine gender differences in pain outcomes and pain-related psychological constructs postoperatively and to identify pain-related psychological correlates of acute post-surgical pain (APSP and predictors of functional disability 2 weeks after hospital discharge.Methods: Eighty-three children aged 8–18 (mean 13.8 ± 2.4 years who underwent major orthopedic or general surgery completed pain and pain-related psychological measures 48–72 hours and 2 weeks after surgery.Results: Girls reported higher levels of acute postoperative anxiety and pain unpleasantness compared with boys. In addition, pain anxiety was significantly associated with APSP intensity and functional disability 2 weeks after discharge, whereas pain catastrophizing was associated with APSP unpleasantness.Conclusion: These results highlight the important role played by pain-related psychological factors in the experience of pediatric APSP by children and adolescents.Keywords: acute post-surgical pain, children, adolescents, pain anxiety, pain catastrophizing
Bonder, Jaclyn H; Chi, Michelle; Rispoli, Leia
Myofascial pelvic pain refers to pain in the pelvic floor muscles, the pelvic floor connective tissue, and the surrounding fascia. The cause is often multifactorial and requires treatment that encompasses multiple modalities. This type of pain is often associated with other abdominopelvic disorders, so providers in these specialties need to be aware of these connections. A comprehensive musculoskeletal examination, including evaluation of the pelvic floor muscles, and history are key to diagnosing myofascial pelvic pain. Treatments include physical therapy, muscle relaxers, oral neuromodulators, cognitive-behavioral therapy, and pelvic floor muscle injections. Copyright © 2017 Elsevier Inc. All rights reserved.
Winston, Joel S; Vlaev, Ivo; Seymour, Ben; Chater, Nick; Dolan, Raymond J
The valuation of health-related states, including pain, is a critical issue in clinical practice, health economics, and pain neuroscience. Surprisingly the monetary value people associate with pain is highly context-dependent, with participants willing to pay more to avoid medium-level pain when presented in a context of low-intensity, rather than high-intensity, pain. Here, we ask whether context impacts upon the neural representation of pain itself, or alternatively the transformation of pain into valuation-driven behavior. While undergoing fMRI, human participants declared how much money they would be willing to pay to avoid repeated instances of painful cutaneous electrical stimuli delivered to the foot. We also implemented a contextual manipulation that involved presenting medium-level painful stimuli in blocks with either low- or high-level stimuli. We found no evidence of context-dependent activity within a conventional "pain matrix," where pain-evoked activity reflected absolute stimulus intensity. By contrast, in right lateral orbitofrontal cortex, a strong contextual dependency was evident, and here activity tracked the contextual rank of the pain. The findings are in keeping with an architecture where an absolute pain valuation system and a rank-dependent system interact to influence willing to pay to avoid pain, with context impacting value-based behavior high in a processing hierarchy. This segregated processing hints that distinct neural representations reflect sensory aspects of pain and components that are less directly nociceptive whose integration also guides pain-related actions. A dominance of the latter might account for puzzling phenomena seen in somatization disorders where perceived pain is a dominant driver of behavior.
Sharath, Sherene E; Kougias, Panos; Barshes, Neal R
We examined how pain beliefs are related to symptom severity, expectations of risk/benefits, and baseline physical activity among claudicants. Eligible patients at the Michael E DeBakey Veterans Affairs Medical Center were administered questionnaires that measured: fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire [FABQ]), walking impairment, baseline physical activity, claudication type, and risk/benefit attitudes. Among 20 participants, the median age was 69 years (IQR: 66-75). In our efforts to understand how fear-avoidance beliefs influenced physical activity among people with claudication, we found that 12 out of 19 participants (63%) thought that the primary etiology of their pain was walking, while 18 (out of 20) (90%) people thought that walking would exacerbate their leg symptoms - suggesting that there was some confusion regarding the effects of walking on claudication. Those who expected that walking would benefit their symptoms more than surgery reported fewer fear-avoidance beliefs ( p=0.01), but those who believed that walking would make their leg pain worse expected greater benefit from surgery ( p=0.02). As symptom severity increased, fear-avoidance beliefs also increased ( p=0.001). The association between symptom severity and fear-avoidance beliefs indicates that as pain or impairment increases, the likelihood of avoiding behaviors that are thought to cause pain might also increase. Accounting for pain-related beliefs when recommending physical activity for claudication should be considered.
Yamashita, Toshihiko; Takahashi, Kazuhisa; Yonenobu, Kazuo; Kikuchi, Shin-ichi
The incidence and characteristics of neuropathic pain associated with spinal disorders have not yet been fully clarified. The purpose of this study was to investigate the prevalence of neuropathic pain and the degree of deterioration of quality of life (QOL) in patients with chronic pain associated with spinal disorders who visited orthopedic outpatient clinics. This cross-sectional study was conducted in 1,857 patients recruited from 137 medical institutions nationwide. Participants were men and women aged 20-79 years with a history of spine-related pain for at least 3 months and a visual analog scale (VAS) score of at least 30 in the previous week. Patients were screened using a neuropathic pain screening questionnaire. The degree of QOL deterioration and its correlation with the presence of neuropathic pain were assessed using the Short Form Health Survey with 36 questions (SF-36). Overall prevalence of neuropathic pain was 53.3%. It was relatively high in patients with cervical spondylotic myelopathy (77.3%) and ligament ossification (75.7%) and relatively low in those with low back pain (29.4%) and spondylolysis (40.4%). Only 56.9% of patients with radiculopathy were diagnosed with neuropathic pain. Logistic regression analysis identified several risk factors, including advanced age, severe pain, disease duration of at least 6 months, and cervical lesions. In QOL assessment, physical functioning, role-physical, role-emotional, and social functioning were severely affected, and this trend was more pronounced in patients who were more likely to have neuropathic pain. The frequency of neuropathic pain tended to be higher in patients with diseases associated with spinal cord damage and lower in patients with diseases that primarily manifested as somatic pain. A bias toward allodynia symptoms in the screening questionnaire may have resulted in the failure to diagnose neuropathic pain in some patients with radiculopathy. Poor QOL, primarily from the aspect of
Aggradi, G.P.F.; Di Mugello, B.; Ferrante, C.M.
This patent describes a system for submarine linking between anchoring cylinders affixed to a platform leg and a related foundation pile. The anchoring cylinders are composed of two coaxial cylinders, one of which is an outer cylinder having a substantial thickness of high yield strength steel, the other of which is an inner cylinder having a thickness of low yield strength steel. The thickness is less than the thickness of the outer cylinder, wherein the outer cylinder and the inner cylinder are butt-welded to each other at their ends so as to define an annular chamber between the cylinders. The chamber being radially inwardly expansible by the application of pressure. The related foundation pile is composed of high yield strength steel in a zone where the submarine linking is to be accomplished. The zone of the pile including an outer surface with alternating slots and toothing and an inner thickened surface.
Keogh, Edmund; Cavill, Rebecca; Moore, David J; Eccleston, Christopher
Pain-related attentional interference has been found in both chronic pain and laboratory-inducted pain settings. However, few studies have examined such interference effects during common everyday painful episodes. Menstrual cycle-related pain is a common pain that affects a large number of women on a regular basis. The purpose of the current study was, therefore, to examine the effects of menstrual pain on attentional interference. Fifty-two healthy adult women were tested during 2 different phases of their menstrual cycles: once during a nonpain phase (mid follicular), and once while experiencing menstrual pain (late luteal/early follicular). On each testing session, participants received a battery of 4 attentional interference tasks that included selective attention (flanker task), attention span (n-back task), attentional switching (switching task), and divided attention (dual task). Greater attentional interference effects were found to occur during the menstrual pain phase compared to the nonpain phase. Interestingly, the nature of this effect was a general worsening in performance (e.g., slowing, less accurate), rather than a specific attentional deficit. These results add to a growing literature that generally indicates that attentional interference occurs across a range of different types of pain, including common painful episodes. However, they also highlight that the specific nature of this interference effect may depend on the type pain under consideration. Implications of these findings are also considered.
Zale, Emily L.; Ditre, Joseph W.
Chronic pain is a significant public health concern that imposes substantial burdens on individuals and healthcare systems, and factors that contribute to the development and maintenance of pain-related disability are of increasing empirical and clinical interest. Consistent with the fear-avoidance model of chronic pain, greater pain-related fear has consistently been associated with more severe disability and may predict the progression of disability over time. Recent evidence indicates that treatments designed to reduce pain-related fear are efficacious for improving disability outcomes, and several clinical trials are currently underway to test tailored intervention content and methods of dissemination. Future research in this area is needed to identify factors (e.g., substance use, comorbid psychopathology) that may influence interrelations between pain-related fear, response to treatment, and disability. PMID:25844393
Leknes, Siri; Berna, Chantal; Lee, Michael C; Snyder, Gregory D; Biele, Guido; Tracey, Irene
Context can influence the experience of any event. For instance, the thought that "it could be worse" can improve feelings towards a present misfortune. In this study we measured hedonic feelings, skin conductance, and brain activation patterns in 16 healthy volunteers who experienced moderate pain in two different contexts. In the "relative relief context," moderate pain represented the best outcome, since the alternative outcome was intense pain. However, in the control context, moderate pain represented the worst outcome and elicited negative hedonic feelings. The context manipulation resulted in a "hedonic flip," such that moderate pain elicited positive hedonics in the relative relief context. Somewhat surprisingly, moderate pain was even rated as pleasant in this context, despite being reported as painful in the control context. This "hedonic flip" was corroborated by physiological and functional neuroimaging data. When moderate pain was perceived as pleasant, skin conductance and activity in insula and dorsal anterior cingulate were significantly attenuated relative to the control moderate stimulus. "Pleasant pain" also increased activity in reward and valuation circuitry, including the medial orbitofrontal and ventromedial prefrontal cortices. Furthermore, the change in outcome hedonics correlated with activity in the periacqueductal grey (PAG) of the descending pain modulatory system (DPMS). The context manipulation also significantly increased functional connectivity between reward circuitry and the PAG, consistent with a functional change of the DPMS due to the altered motivational state. The findings of this study point to a role for brainstem and reward circuitry in a context-induced "hedonic flip" of pain.
Gordon JG Asmundson
Full Text Available Clinicians often encounter patients who present with both chronic pain and elevated levels of anxiety. In some cases, the source of the anxiety is vague and diffuse. For others, there is an identifiable precipitating object, event or situation. For example, some patients with chronic pain are able to attribute their anxiety to the possibility of not regaining lost functional abilities, financial difficulties, feelings of social inadequacy, or uncertainty about the meaning and consequences of pain. The association between chronic pain and anxiety may not be particularly surprising when one considers that, in the acute phase, both pain and target-oriented anxiety (or fear motivate actions that serve to minimize the threat and maximize the likelihood of successful escape. As well, their neurobiology, while distinct, interacts in the reticular system (1. Evaluations of the association between chronic pain and fear-relevant constructs were initiated in the 1960s and 1970s (2,3. It has only been of late, however, that theorists and researchers have begun to focus their attention on delineating the precise nature of the relationship and its specific implications for the assessment and management of pain.
de Boer, M. J.; Struys, M. M. R. F.; Versteegen, G. J.
Background Catastrophizing is a defining factor in the pain experience and strongly contributes to the prediction of various aspects of health. Catastrophizing is not just present in pain patients, but may also be present in people with non-clinical pain. The aim of the present study is to investiga
Boer, M.J. de; Struys, M.M.; Versteegen, G.J.
BACKGROUND: Catastrophizing is a defining factor in the pain experience and strongly contributes to the prediction of various aspects of health. Catastrophizing is not just present in pain patients, but may also be present in people with non-clinical pain. The aim of the present study is to investig
Negus, S Stevens
Pain is often associated with clinically relevant depression of behavior and mood, and relief of pain-related depression is a common goal of treatment in both human and veterinary medicine. In the development of pharmacological compounds to treat pain and related depression, preclinical studies may be used to evaluate the analgesic potential of new drugs. Such studies require reliable, accurate assays of pain-related behavioral depression in animals. Intracranial self-stimulation (ICSS) is a type of operant conditioning procedure that produces stable baseline behavioral response rates. The author reviews recent research on the use of ICSS to evaluate the expression and pharmacological modulation of pain-related behavioral depression in rats. Results suggest that assays of pain-depressed behavior using ICSS may serve as a useful new tool to improve the translation of preclinical findings to clinical results in analgesic drug development.
Full Text Available Tommaso Iannitti,1,2 Gregorio Fistetto,2 Anna Esposito,2 Valentina Rottigni,2,3 Beniamino Palmieri2,3 1Department of Physiology, University of Kentucky Medical Center, Lexington, KY, USA; 2Poliambulatorio del Secondo Parere, Modena, Italy; 3Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy Background: Pulsed electromagnetic field (PEMF therapy has shown promising therapeutic effectiveness on bone- and cartilage-related pathologies, being also safe for management of knee osteoarthritis. Aim: The aim of this study was to investigate the clinical efficacy of a PEMF device for management of knee osteoarthritis in elderly patients. Materials and methods: A total of 33 patients were screened, and 28 patients, aged between 60 and 83 and affected by bilateral knee osteoarthritis, were enrolled in this study. They received PEMF therapy on the right leg for a total of three 30-minute sessions per week for a period of 6 weeks, while the left leg did not receive any treatment and served as control. An intravenous drip containing ketoprofen, sodium clodronate, glucosamine sulfate, calcitonin, and ascorbic acid, for a total volume of 500 mL, was administered during PEMF therapy. At baseline and 3 months post-PEMF therapy, Visual Analog Scale (VAS was used to assess knee pain and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC was used to measure knee pain, stiffness and physical function. Results: Changes in VAS and WOMAC scores were calculated for both knees as baseline minus post-treatment. A two sample Student’s t-test, comparing change in knee-related VAS pain for PEMF-treated leg (49.8 ± 2.03 vs control leg (11 ± 1.1, showed a significant difference in favor of PEMF therapy (P < 0.001. A two sample Student’s t-test comparing change in knee-related WOMAC pain, stiffness, and physical function for PEMF-treated leg (8.5 ± 0.4, 3.5 ± 0.2, 38
Tzeng, Ya-Ling; Su, Tsann-Juu
A substantial proportion of women in labor suffer from low back pain, yet this issue has only been specifically evaluated in a few Western studies. The purpose of this research was to (1) describe the following characteristics of low back pain during labor: prevalence, anatomic region(s) affected, type, pattern, intensity trend, effective interventions, and exacerbating factors; (2) identify the factors relating to intrapartum low back pain in Taiwan women. A correlational design with repeated measures was used to conduct this investigation. Ninety-three low-risk women in labor were recruited from a medical center in central Taiwan. Low back pain was repeatedly measured during the latent phase (cervix dilated 2-4 cm), early active phase (cervix dilated 5-7 cm), and late active phase (cervix dilated 8-10 cm) of labor. Data were analyzed using descriptive statistics, repeated measurement ANOVA, and logistic regression. The results showed as many as 75.3% of the participants suffered episodes of low back pain during labor. The mean pain scores were 36.66-76.20 in the various stages of labor. Pain intensified as labor progressed. The location of the pain also changed with the progression of labor. The type of low back pain in 54.29% of women in labor was "muscle soreness and pain"; The pattern of pain in 45.71% women was continuous. Massage was chosen as the most effective intervention to alleviate low back pain by 65.3% of women. The women in labor who suffered from low back pain during pregnancy (OR = 3.23; p low back pain group. In conclusion, our study demonstrates low back pain intensified with the progression of labor, suggesting early prevention is necessary, especially in the case of women who had low back pain during pregnancy and heavier body weight when hospitalized.
Full Text Available Purpose: The aim of our study was to evaluate factors predisposing or related to chronic pelvic pain in women, and whether those factors allows classification using generalized cluster analysis, consistent with the presence of chronic pelvic pain. Material and method: A survey was done on 2469 women referred to Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania, between January 2006 - December 2010. Patients were stratify in regard with presence of chronic pelvic pain (GrA and assessed in regard with demographic and habitual risk factors, medical and reproductive history, lifestyle, and pain characteristics. Identified factors were used for classification using generalized cluster analysis by k-mean technique. The results were assessed in terms of correlation with the presence of chronic pelvic pain. Results: On univariate analysis, marital status and higher education were protective while complications at delivery and physical work were risk factors for chronic pelvic pain. Age at presentation and age at menarche were lower in GrA, while caffeine and alcohol consumption, number of cigarettes smoked per day, pain intensity, coexistence of pain related to periods, deep intercourse, bladder filling, and voiding have been increased in GrA. Classification of patients correlates with the presence of chronic pelvic pain (p<0.001. Conclusions: Age, marital status, level of education, type of activity, complications at delivery, caffeine and alcohol consumption are risk factors related to chronic pelvic pain in women referred for urologic conditions. Pain intensity is related to chronic pelvic pain, regardless of type and localization. Classification of patients using k-mean technique cluster analysis correlates significantly statistic with chronic pelvic pain.
Dima, A.L.; Gillanders, D.T.; Power, M.J.
Current developments in chronic pain research are changing the focus in the study of pain-emotion relations from the identification of general patterns to the study of dynamic and context-related interactions manifesting both within and between individuals. This shift towards understanding variation
Kendall, Julie C; Bird, Adam R; Azari, Michael F
Mechanical low back pain (LBP) is a very common, expensive, and significant health issue in the western world. Functional musculoskeletal conditions are widely thought to cause mechanical low back pain. The role of foot posture and leg length discrepancy in contributing to abnormal biomechanics of the lumbopelvic region and low back pain is not sufficiently investigated. This critical review examines the evidence for the association between foot function, particularly pronation, and mechanical LBP. It also explores the evidence for a role for foot orthoses in the treatment of this condition. There is a body of evidence to support the notion that foot posture, particularly hyperpronation, is associated with mechanical low back pain. Mechanisms that have been put forward to account for this finding are based on either mechanical postural changes or alterations in muscular activity in the lumbar and pelvic muscles. More research is needed to explore and quantify the effects of foot orthoses on chronic low back pain, especially their effects on lumbopelvic muscle function and posture. The clinical implications of this work are significant since foot orthoses represent a simple and potentially effective therapeutic measure for a clinical condition of high personal and social burden. Copyright © 2014 Elsevier Ltd. All rights reserved.
Choi, Jioun; Lee, Sangyong; Hwangbo, Gak
[Purpose] The purpose of this study was to identify how spinal decompression therapy and general traction therapy influence the pain, disability, and straight leg raise (SLR) ability of patients with intervertebral disc herniation. [Subjects] The subjects were 30 patients with chronic lumbar pain who were divided into a spinal decompression therapy group (SDTG, n=15), and a general traction therapy group (GTTG, n=15). [Methods] The SDTG used a spinal decompression device, and the GTTG used a lumbar traction device. Both groups received conservative physical therapy three times a week for four weeks. A visual analog scale (VAS) was used to measure the degree of pain the patients with chronic lumbar pain. The Oswestry Disability Index (ODI) was used to measure the degree of functional disability. A goniometer was used to measure the patients' SLR ability. [Results] Both SDTG and GTTG showed statistically significant decreases in VAS and ODI scores and a statistically significant increase in SLR angle. A comparison of the two groups found no statistically significant differences. [Conclusion] Spinal decompression therapy and general traction therapy are effective at improving the pain, disability, and SLR of patients with intervertebral disc herniation. Thus, selective treatment may be required.
Hemington, Kasey S; Cheng, Joshua C; Bosma, Rachael L; Rogachov, Anton; Kim, Junseok A; Davis, Karen D
Resilience, a characteristic that enhances adaptation in response to stressful events, is a positive psychological factor that can predict and modulate health outcomes. However, resilience is rarely considered in pain research. Conversely, negative psychological factors (eg, anxiety, depression) are known to be related to the affective dimension of pain. It is critical to understand all potential psychological drivers of pain affect, a prominent component of chronic pain. We tested the hypothesis that higher resilience is associated with lower pain affect, above and beyond the predictive value of negative psychological factors. Healthy adults underwent psychophysical testing to acquire ratings of heat pain intensity and unpleasantness and completed the Resilience Scale, the State-Trait Anxiety Inventory (trait form), Beck Depression Inventory, Pain Catastrophizing Scale, and the Pain Vigilance and Attention Questionnaire. Multiple regression modeling (n = 68) showed resilience to be a negatively associated with pain affect (unpleasantness). Furthermore, in individuals with higher anxiety scores, resilience was protective against higher pain affect. This highlights the importance of resilience, a positive psychological factor, in the affective dimension of pain. This study is the first to assess a positive psychological factor and experimental pain affect, and has the potential to improve prediction of and treatment strategies for clinical pain. We report that resilience, a positive psychological factor, interacts with anxiety and is associated with heat pain affect (unpleasantness) in healthy individuals. Resilience may provide predictive value of chronic pain affect and treatment outcomes, and could be a target for behavioral therapy. Copyright © 2017 American Pain Society. Published by Elsevier Inc. All rights reserved.
Lee, Hopin; McAuley, James H; Hübscher, Markus; Kamper, Steven J; Traeger, Adrian C; Moseley, G Lorimer
Evidence from randomized controlled studies shows that reconceptualizing pain improves patients' knowledge of pain biology, reduces catastrophizing thoughts, and improves pain and function. However, causal relationships between these variables remain untested. It is hypothesized that reductions in catastrophizing could mediate the relationship between improvements in pain knowledge and improvements in pain and function. To test this causal mechanism, we conducted longitudinal mediation analyses on a cohort of 799 patients who were exposed to a pain education intervention. Patients provided responses to the neurophysiology of pain questionnaire, catastrophic thoughts about pain scale, visual analogue pain scale, and the patient specific functional scale, at baseline, 1-month, 6-month, and 12-month follow-up. With adjustment for potential confounding variables, an improvement in pain biology knowledge was significantly associated with a reduction in pain intensity (total effect = -2.20, 95% confidence interval [CI] = -2.96 to -1.44). However, this effect was not mediated by a reduction in catastrophizing (indirect effect = -0.16, 95% CI = -0.36 to 0.02). This might be due to a weak, nonsignificant relationship between changes in catastrophizing and pain intensity (path b = 0.19, 95% CI = -0.03 to 0.41). Similar trends were found in models with function as the outcome. Our findings indicate that change in catastrophizing did not mediate the effect of pain knowledge acquisition on change in pain or function. The strength of this conclusion is moderated, however, if patient-clinician relational factors are conceptualized as a consequence of catastrophizing, rather than a cause.
Francisco Eudison da Silva Maia; Fabio Firmino de Albuquerque Gurgel; João Carlos Lopes Bezerra; Cleber Mahlmann Viana Bezerra
The growing incidence of low back pain is a problem of public health, causing physical, economical and psychosocial damages. Such pain is correlated with types of work and its execution, such as remaining in determinate postures for long periods and repetition of mechanically stressful movements, and its consequent metabolic damage on the composing structures of the lumbar spine. Thus, this study approaches the aetiology of the mechanical and biological factors related to low back pain, contr...
Brukner, P; Bradshaw, C; McCrory, P
Obturator neuropathy is a cause of exercise-related groin pain, particularly in those who play sports that involve much running, twisting and turning, and kicking. Symptoms include pain that begins insidiously at the adductor origin on the pubic bone and worsens with exercise. Diagnostic measures include reproduction of pain by stretching the pectineus muscle after exercise, electromyography, and a local anesthetic block of the obturator nerve. Surgery allows most patients to resume previous levels of activity.
Noh, Kyung-Hee; Kim, Ji-Won; Kim, Gyoung-Mo; Ha, Sung-Min; Oh, Jae-Seop
[Purpose] This study was performed to assess the influence of applying dual pressure biofeedback units (DPBUs) on the angle of pelvic rotation and abdominal muscle activity during the active straight leg raise (ASLR). [Subjects] Seventeen patients with low-back pain (LBP) participated in this study. [Methods] The subjects were asked to perform an active straight leg raise (ASLR) without a PBU, with a single PBU, and with DPBUs. The angles of pelvic rotation were measured using a three-dimensional motion-analysis system, and the muscle activity of the bilateral internal oblique abdominis (IO), external oblique abdominis (EO), and rectus abdominis (RA) was recorded using surface electromyography (EMG). One-way repeated-measures ANOVA was performed to determine the rotation angles and muscle activity under the three conditions. [Results] The EMG activity of the ipsilateral IO, contralateral EO, and bilateral RA was greater and pelvic rotation was lower with the DPBUs than with no PBU or a single PBU. [Conclusion] The results of this study suggest that applying DPBUs during ASLR is effective in decreasing unwanted pelvic rotation and increasing abdominal muscle activity in women with chronic low back pain.
Loss of pain perception can result from neurodevelopmental defects, degeneration of nociceptive fibers, or altered excitability of sensory neurons. Hereditary neurodegeneration leading to pain loss is classified as sensory and autonomic neuropathy (HSAN). Mutations in approximately 15 genes have been identified in the group of HSAN disorders. Hallmark of the disease is a liability to injury because of impaired acute pain as a warning system to prevent harm. The clinically overlapping "congenital insensitivity to pain (CIP)" is caused by mutations in voltage-gated sodium channels, which control the excitability of nociceptors. However, mutations in the latter genes can also result in disorders with increased pain susceptibility. This review summarizes the clinical presentation of HSAN and pain-related channelopathies and discusses the underlying disease mechanisms.
Dai, Zhaoli; Lu, Na; Niu, Jingbo; Felson, David T; Zhang, Yuqing
Dietary fiber may reduce knee pain, in part by lowering body weight and reducing inflammation. In this study, we assessed whether fiber intake was associated with patterns of knee pain development. In a prospective, multicenter cohort of 4,796 men and women ages 45-79 years with or at risk of knee osteoarthritis, participants underwent annual followups for 8 years. Dietary fiber intake was estimated using a validated food frequency questionnaire at baseline. Group-based trajectory modeling was used to identify Western Ontario and McMaster Universities Osteoarthritis Index pain trajectories, which were assessed for associations with dietary fiber intake using polytomous regression models. Of the eligible participants (4,470 persons and 8,940 knees, mean ± SD age 61.3 ± 9.1 years, 58% women), 4.9% underwent knee replacement and were censored at the time of surgery. Four distinct knee pain patterns were identified: no pain (34.5%), mild pain (38.1%), moderate pain (21.2%), and severe pain (6.2%). Dietary total fiber was inversely related to membership in the moderate or severe pain groups (P ≤ 0.006 for trend for both). Subjects in the highest versus those in the lowest quartile of total fiber intake had a lower risk of belonging to the moderate pain pattern group (odds ratio [OR] 0.76 [95% confidence interval (95% CI) 0.61-0.93]) and severe pain pattern group (OR 0.56 [95% CI 0.41-0.78]). Similar results were found with grain fiber and these 2 pain pattern groups. Our findings suggest that a high intake of dietary total or grain fiber, particularly the recommended daily fiber average intake of 25 gm per day, is associated with a lower risk of developing moderate or severe knee pain over time. © 2016, American College of Rheumatology.
Full Text Available Hypermobility is defined as an abnormally increased range of motion of a joint resulting from the excessive laxity of the soft tissues. This paper is focused on this commonly forgotten cause of several morbidities. The etiology of hypermobility is not very well known. One decade ago, joint hypermobility syndrome was considered as a benign condition, but now it is recognized as a significant contributor to chronic musculoskeletal pain, besides impacting on other organs. Patients with joint hypermobility syndrome often have diffuse, chronic complaints that are inconsistent with the musculoskeletal system. Chronic pain may cause loss of proprioception and so increased sensitivity to microtrauma, premature osteoarthritis de- velopment, soft tissue problems, psychosocial disorders, and neurophysiological deficiencies. Osteoarthritis, pes planus, mechanical low back pain, and soft tissue rheumatisms are frequent musculoskeletal findings as well as subluxations, thoracic outlet syndrome, rectal and uterine prolapses, hernias, and stress incontinence. Joint hypermobility syndrome's treatment is not easy, and nonsteroidal anti-inflammatory drugs are not usually effective or adequate. Proprioceptive and strengthening exercises have been reported to have supportive and therapeutic effects, but we have limited data on this issue. Joint hypermobility syndrome must be accepted as a multisystem connective tissue disorder rather than just joint laxities. As a result; clinicians must be aware of complexities of connective tissue disorders and comorbidities. [Arch Clin Exp Surg 2016; 5(2.000: 105-112
Day, Melissa A; Ward, L Charles; Thorn, Beverly E; Lang, Cathryne P; Newton-John, Toby R O; Ehde, Dawn M; Jensen, Mark P
Cognitive processes may be characterized as how individuals think, whereas cognitive content constitutes what individuals think. Both cognitive processes and cognitive content are theorized to play important roles in chronic pain adjustment, and treatments have been developed to target both. However, the evaluation of treatments that target cognitive processes is limited because extant measures do not satisfactorily separate cognitive process from cognitive content. The current study aimed to develop a self-report inventory of potentially adaptive and presumed maladaptive attentional processes that may occur when someone is experiencing pain. Scales were derived from a large item pool by successively applying confirmatory factor analysis to item data from two undergraduate samples (N = 393 and 233). Items, which were generated to avoid confounding of cognitive content with cognitive processes, represented nine constructs: Suppression, Distraction, Enhancement, Dissociation, Reappraisal, Absorption, Rumination, Nonjudgment, and Acceptance. The resulting nine scales formed the Pain-Related Cognitive Process Questionnaire (PCPQ), and scale correlations produced four conceptually distinct composite scales: Pain Diversion, Pain Distancing, Pain Focus, and Pain Openness. Internal consistency reliabilities of the nine scales were adequate (α ≥ 0.70) to good, and the four composite scales had α values of 0.79 or higher. Correlations with pain-related criterion variables were generally consistent with putative constructs. The developed PCPQ scales offer a comprehensive assessment of important cognitive processes specific to pain. Overall, the findings suggest that the PCPQ scales may prove useful for evaluating the role of pain-related cognitive processes in studies of chronic pain.
Fransz, Duncan P; Huurnink, Arnold; Kingma, Idsart; van Dieën, Jaap H
We aimed to verify whether the static phase after a single leg drop jump (DJ) landing on a force plate may serve as a proxy for a single leg stance (SLS) balance task, as this would increase the application possibilities of landing tasks in the evaluation of sensorimotor function in relation to injury rehabilitation or performance assessment. Twenty-five healthy participants performed two sessions of five valid trials for both tasks in a reproducibility-agreement design. Three postural stability outcome measures ('COP speed', 'COP sway' and 'Horizontal GRF') were calculated for DJ (5-20s after landing) and for SLS (15s), and were averaged per session. Paired T-tests revealed a learning effect of SLS for postural stability (4.6-6.1%; P-values 0.27). Only session 2 resulted in superior postural stability for SLS compared to DJ for 'COP speed' (5.0%; P=0.017) and 'Horizontal GRF' (8.2%; P=0.001). Bland and Altman methods demonstrated inter-session SD's of difference for DJ of 11-12% and for SLS of 10-12%, while inter-task SD's of difference ranged 10-17%. Precision ('SD within') was better for SLS concerning 'COP speed' (14-15% vs 13%) and 'Horizontal GRF' (18-20% vs 14-15%). In conclusion, postural stability during DJ and SLS cannot be considered interchangeable, due to a learning effect for SLS and inferior precision for DJ. However, a DJ task may be used as a proxy for static postural stability, although more than three trials are needed to achieve individual errors similar to SLS for 'COP speed' (4) and 'Horizontal GRF' (5).
We present the case of a 28 year old man from Mali who came to consultation for "lower limb edema and pain-ful gait".The diagnosis of dracunculiasis was established by the suggestive symptomatology and the notion of a trip back to his native country a year earlier.It was confirmed by the outing of the worm.
Fabiana Cristina Taubert de Freitas-Swerts
Full Text Available OBJECTIVES: to assess the effect of a compensatory workplace exercise program on workers with the purpose of reducing work-related stress and musculoskeletal pain.METHOD: quasi-experimental research with quantitative analysis of the data, involving 30 administrative workers from a Higher Education Public Institution. For data collection, questionnaires were used to characterize the workers, as well as the Workplace Stress Scale and the Corlett Diagram. The research took place in three stages: first: pre-test with the application of the questionnaires to the subjects; second: Workplace Exercise taking place twice a week, for 15 minutes, during a period of 10 weeks; third: post-test in which the subjects answered the questionnaires again. For data analysis, the descriptive statistics and non-parametric statistics were used through the Wilcoxon Test.RESULTS: work-related stress was present in the assessed workers, but there was no statistically significant reduction in the scores after undergoing Workplace Exercise. However, there was a statistically significant pain reduction in the neck, cervical, upper, middle and lower back, right thigh, left leg, right ankle and feet.CONCLUSION: the Workplace Exercise promoted a significant pain reduction in the spine, but did not result in a significant reduction in the levels of work-related stress.
de Freitas-Swerts, Fabiana Cristina Taubert; Robazzi, Maria Lúcia do Carmo Cruz
OBJECTIVES: to assess the effect of a compensatory workplace exercise program on workers with the purpose of reducing work-related stress and musculoskeletal pain. METHOD: quasi-experimental research with quantitative analysis of the data, involving 30 administrative workers from a Higher Education Public Institution. For data collection, questionnaires were used to characterize the workers, as well as the Workplace Stress Scale and the Corlett Diagram. The research took place in three stages: first: pre-test with the application of the questionnaires to the subjects; second: Workplace Exercise taking place twice a week, for 15 minutes, during a period of 10 weeks; third: post-test in which the subjects answered the questionnaires again. For data analysis, the descriptive statistics and non-parametric statistics were used through the Wilcoxon Test. RESULTS: work-related stress was present in the assessed workers, but there was no statistically significant reduction in the scores after undergoing Workplace Exercise. However, there was a statistically significant pain reduction in the neck, cervical, upper, middle and lower back, right thigh, left leg, right ankle and feet. CONCLUSION: the Workplace Exercise promoted a significant pain reduction in the spine, but did not result in a significant reduction in the levels of work-related stress. PMID:25296147
Mendonça, Luciana de Michelis; Ocarino, Juliana Melo; Bittencourt, Natália Franco Netto; Fernandes, Ludmila Maria Oliveira; Verhagen, Evert; Fonseca, Sérgio Teixeira
Study Design Cross-sectional clinical assessment. Background Patellar tendinopathy is not always accompanied by patellar tendon abnormalities (PTAs). Thus, clinical screening tools to help identify patients with patellar tendon pain who have PTAs could enhance clinical decision making and patient prognosis. Objectives To test the diagnostic accuracy of the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire, a single-leg decline squat (SLDS), tendon pain history, age, and years of sports participation to identify athletes with symptomatic patellar tendons who have PTAs confirmed on imaging. Methods Data provided by ultrasound examination, the VISA-P questionnaire, the SLDS, tendon pain history, age, and years of sport participation were collected in 43 athletes. A classification and regression tree (CART) model was developed to verify variables associated with PTA occurrence. Likelihood ratios (LRs) were computed for positive and negative tests. Results The SLDS, VISA-P questionnaire, and tendon pain history were associated with PTA occurrence. Athletes with negative results on all 3 tests (CART model) had a lower likelihood of having PTAs (negative LR = 0.3; 95% confidence interval [CI]: 0.2, 0.5). The isolated use of the SLDS or tendon pain history (positive LR = 4.2; 95% CI: 2.3, 7.14 and 4.5; 95% CI: 1.8, 11.1, respectively) had similar influence on probability of PTA presence compared to the CART model (positive LR = 4.1; 95% CI: 2.5, 6.3). Conclusion Although the objective was to investigate a clinical test to identify PTAs, the combined use of the tests had greater accuracy to identify individuals without PTAs. Level of Evidence Diagnosis, level 3b. J Orthop Sports Phys Ther 2016;46(8):673-680. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6192.
Leknes, Siri; Berna, Chantal; Lee, Michael C.; Snyder, Gregory D.; Biele, Guido; Tracey, Irene
Context can influence the experience of any event. For instance, the thought that “it could be worse” can improve feelings towards a present misfortune. In this study we measured hedonic feelings, skin conductance, and brain activation patterns in 16 healthy volunteers who experienced moderate pain in two different contexts. In the “relative relief context,” moderate pain represented the best outcome, since the alternative outcome was intense pain. However, in the control context, moderate pain represented the worst outcome and elicited negative hedonic feelings. The context manipulation resulted in a “hedonic flip,” such that moderate pain elicited positive hedonics in the relative relief context. Somewhat surprisingly, moderate pain was even rated as pleasant in this context, despite being reported as painful in the control context. This “hedonic flip” was corroborated by physiological and functional neuroimaging data. When moderate pain was perceived as pleasant, skin conductance and activity in insula and dorsal anterior cingulate were significantly attenuated relative to the control moderate stimulus. “Pleasant pain” also increased activity in reward and valuation circuitry, including the medial orbitofrontal and ventromedial prefrontal cortices. Furthermore, the change in outcome hedonics correlated with activity in the periacqueductal grey (PAG) of the descending pain modulatory system (DPMS). The context manipulation also significantly increased functional connectivity between reward circuitry and the PAG, consistent with a functional change of the DPMS due to the altered motivational state. The findings of this study point to a role for brainstem and reward circuitry in a context-induced “hedonic flip” of pain. PMID:23352758
Rana, Abdul Qayyum; Khan, Fatima; Mosabbir, Abdullah; Ondo, William
Leg pain and discomfort are common complaints in any primary physician's clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). NLC present as painful and sudden contractions mostly in part of the calf. Diagnosis of NLC is mainly clinical and sometimes involves investigations to rule out other mimics. RLS is a condition characterized by the discomfort or urge to move the lower limbs, which occurs at rest or in the evening/night. The similarity of RLS and leg cramps poses the issue of errors in diagnosing and differentiating the two. In this paper we review the pathopysiology of each entity and their diagnosis as well as treatment. The two conditions are then compared to appreciate the differences and similarities. Finally, suggestions are recommended for complete assessment.
Purpose: The purpose of this study is to investigate the use of Electromyography (EMG) biofeedback training in dental professionals to reduce upper trapezius muscle tension and thereby to reduce the work related neck pain. By reducing muscle activity in the neck and shoulder postural stabilizing muscles, EMG biofeedback training would be an effective mode of treatment in dental professionals for the management of work related neck pain. Subjects and Methods: This RCT included a total of 50...
Zhang, Xu; Cao, Bing; Yan, Ni; Liu, Jin; Wang, Jun; Tung, Vivian Oi Vian; Li, Ying
Within a biopsychosocial model of pain, pain is seen as a conscious experience modulated by mental, emotional and sensory mechanisms. Recently, using a rodent visceral pain assay that combines the colorectal distension (CRD) model with the conditioned place avoidance (CPA) paradigms, we measured a learned behavior that directly reflects the affective component of visceral pain, and showed that perigenual anterior cingulate cortex (pACC) activation is critical for memory processing involved in long-term visceral affective state and prediction of aversive stimuli by contextual cue. Electrical vagus nerve stimulation (VNS) has become an established therapy for treatment-resistant epilepsy. VNS has also been shown to enhance memory performance in rats and humans. High-intensity VNS (400 μA) immediately following conditional training significantly increases the CRD-induced CPA scores, and enhanced the pain affective memory retention. In contrast, VNS (400 μA) had no effect on CPA induced by non-nociceptive aversive stimulus (U69,593). Low-intensity VNS (40 μA) had no effect on CRD-induced CPA. Electrophysiological recording showed that VNS (400 μA) had no effect on basal and CRD-induced ACC neuronal firing. Further, VNS did not alter CRD-induced visceral pain responses suggesting high intensity VNS facilitates visceral pain aversive memory independent of sensory discriminative aspects of visceral pain processing. The findings that vagus nerve stimulation facilities visceral pain-related affective memory underscore the importance of memory in visceral pain perception, and support the theory that postprandial factors may act on vagal afferents to modulate ongoing nature of visceral pain-induced affective disorder observed in the clinic, such as irritable bowel syndrome. Copyright © 2012 Elsevier B.V. All rights reserved.
Schiltenwolf, M; Pogatzki-Zahn, E M
Cultural setting and sex and gender of the patient are important factors affecting the occurrence, severity, clinical course and prognosis of pain and pain-related diseases. Intercultural differences in the perception and verbal expression of symptoms and emotional function are fundamental and it is important to realize these differences in order to understand patients with a migration background. A trusting doctor-patient relationship is generally very sensitive and it is even more difficult to establish when differences in the cultural background impair mutual understanding. Regarding sex and gender there is evidence that females are more susceptible to developing chronic pain conditions, experience more severe pain and respond differently to pain therapy; however, results of recent studies indicate that females are not that different to males when comparing several modalities of experimental pain (although some differences exist). Similarly, sex and gender differences in postoperative pain seem to exist but the differences are relatively small when pain scores are compared. Other aspects, such as the response to analgesics and role of psychosocial factors should be addressed when sex and gender aspects are studied. Similarly, sex and gender differences in the prevalence of chronic pain exist but the results of some studies, e.g. those controlling for confounders, are not very clear. Research is needed to delineate the role of specific aspects affecting sex and gender differences and the underlying mechanisms (e.g. reduced inhibitory control, hormones, psychological aspects and social factors). Altogether, we need to open our minds to some intercultural and sex and gender aspects in the clinical setting. For sex and gender differences we may need a more biopsychosocial approach to understand the underlying differences and differentiate between sex and gender and sex and gender-associated aspects for acute and chronic pain.
Prenevost, Mathilde Hallingstad; Reme, Silje Endresen
Pain is not merely an isolated experience occurring within the person. It takes place in a wider social context, including the immediate social relationships that the person is a part of. The aim of this paper is to provide an overview of how intercouple interactions might influence pain coping in couples coping with chronic pain. Four different approaches to understanding the influence of intercouple interactions have been proposed in the literature. In this review, we present and discuss the empirical support for each of these models. A literature search on all studies published up until May 2017 (PubMed and PsycINFO) was performed. The search string consisted of 3 steps: Chronic pain AND couple interaction*/partner validation/marital interaction/chronic pain couple*/spouse response* AND coping/adjustment/disability/function/work participation/sick leave/sickness absence/work disability. The operant model views partner responses from the perspective of conditioned learning and focuses on how such responses might increase or decrease the occurrence of pain behaviour. The notion that partner responses can reinforce pain behaviour generally finds support in the literature. However, when it comes to negative partner responses results are mixed, and the model paints a limited picture of the range of interactions that takes place in a couple. The communal coping model focuses on one specific type of coping (i.e. catastrophizing), and emphasizes the interpersonal aspect of pain coping. There is some evidence that a tendency to catastrophize is related both to couple interactions and pain coping, but it has proved difficult to test this model empirically. The interpersonal process model of intimacy is concerned with patient disclosures of distress and subsequent validating and invalidating partner responses. There is some preliminary support that such mechanisms of validation and invalidation can be linked to pain coping. A dyadic approach focuses on processes where the
Kirkeby, Mette J; Biering, Karin; Olsen, Jørn
AIM: Menarcheal age is a predictor of several complications related to pregnancy and diseases later in life. We aimed to study if menarcheal age is a risk factor for pregnancy-related pelvic pain. MATERIAL AND METHODS: A nested case-control study was conducted within the Danish National Birth...... Cohort, a cohort of pregnant women, recruited during 1996-2002, and their children. In the second trimester of pregnancy the women provided information about age at menarche and potential confounders. Selection of cases (n = 2227) was based on self-reported pelvic pain during pregnancy from an interview...... done 6 months post-partum. The controls (n = 2588) were randomly selected among women who did not report pelvic pain. We used logistic regression analysis to calculate odds ratios (OR) for pregnancy-related pelvic pain according to age at menarche. RESULTS: In the cohort, 18.5% of all pregnant women...
This summary draws together the findings form over 80 studies published over three decades. The studies reviewed are categorized into three groups: (a) epidemiological; (b) 'testing out'; and (c) exploratory. There has been agreement on a number of points, in particular that nursing is among the high risk occupations with respect to low back problems, with a point prevalence of approximately 17%, an annual (period) prevalence of 40-50% and a lifetime prevalence of 35-80%. When considering the contributory factors there is some divergence, but one of the popular notions is generally proven, that more frequent patient handling appears to correlate with increased incidence of low back pain. However, the traditional approach of training in lifting and handling techniques alone has been shown to be of little, or no, long-term benefit and the value of ergonomics remains to be seen. Much work has also been done by taking aspects of nursing work into the laboratory, using experimental studies which have mostly focused on specific sub-tasks (of the generic task of patient handling), looking at specific transfers and procedures (e.g. bed to chair) or transfer techniques ('stoop versus squat'). Although a level of quantification can be made about the different techniques, it is questionable whether this is of any practical use, especially when considering the wide variation of loads encountered during manual handling of patients. The limitations of using quantitative methodologies is revealed in the very small number of exploratory studies. All of the studies cited in this review used methodologies based in the positivist paradigm. There does not appear to be any published work using participative or interview methods to obtain qualitative data which might identify contributory factors in the onset of occupational low back pain in nursing staff.
Crellin, Dianne J; Harrison, Denise; Santamaria, Nick; Babl, Franz E
The Face, Legs, Activity, Cry and Consolability (FLACC) scale is one of the most widely used behavioural observation pain scales. However, the psychometrics of the scale have not been adequately summarised and evaluated to provide clear recommendations regarding its use. The aim of this study was to rigorously evaluate the reliability, validity, feasibility, and utility of the scale for clinical and research purposes and provide recommendations regarding appropriate use of the scale. Databases searched were MEDLINE, CINAHL, Embase, PsycINFO (using the Ovid, PubMed, and Ebscohost platforms), The Cochrane Database of Systematic reviews and Cochrane Controlled Trials, and Google Scholar. Psychometric evaluation studies reporting feasibility, reliability, validity, or utility data for the FLACC scale applied to children (birth to 18 years) and randomised controlled trials (RCT) using the FLACC scale to measure a study outcome in infants and children. Data extraction included study design, population demographics, and psychometric data. Analysis involved in this study are quality assessment of the psychometric evaluation studies and the RCTs using the COSMIN checklist and the Jadad scale, respectively, and narrative synthesis of all results. Twenty-five psychometric evaluations studies and 52 RCTs were included. The study population, circumstances, and quality of the studies varied greatly. Sufficient data addressing postoperative pain assessment in infants and children exist. Some positive data support the psychometrics of the scale used to assess postoperative pain in children with cognitive impairment. Limited and conflicting data addressing procedural pain assessment exist. Content validity and scale feasibility have had limited psychometric evaluation. There are insufficient data to support the FLACC scale for use in all circumstances and populations to which is currently applied.
Kirwilliam, S S; Derbyshire, S W G
Emotional and attentional factors have been identified to play a significant role in modulating pain perception with negative emotions increasing pain sensitivity. Recent studies suggest that fearful images may activate the attentional components of fear driven behaviours and facilitate an attentional bias or sensitivity toward noxious stimuli. The current investigation examines whether priming of pain-related fear will affect performance by increasing sensitivity to punctuate heat stimuli. A modified version of the visual dot probe task was employed to provide priming of pain-related fear and a heat detection task was used to measure the effects of priming on sensitivity. The results indicated a significant facilitation of heat and pain perception at varying temperatures following emotional priming. In particular, there was an increase in the bias toward reporting a heat stimulus following emotional priming. The findings emphasise the efficacy of the visual dot probe task as a method of priming and provide a possible method for probing hypervigilance in chronic pain patients.
Lachlan A McWilliams
Full Text Available BACKGROUND: Behavioural conceptualizations of chronic pain posit that solicitous responses to pain behaviours are positively reinforcing and play a role in the development of chronic pain and disability. Recent research suggests that studies investigating this model were likely limited by the use of only a few narrowly defined categories of responses to pain behaviour. A measure of preferences regarding pain-related social support has the potential to improve behavioural models of chronic pain by identifying other potentially reinforcing responses to pain behaviour.
Dol, Kim Sang
[Purpose] This study was performed to assess fatigue and pain levels related to internet usage among university students. The dominant regions of fatigue and pain in the body were examined, as well as differences in fatigue and pain levels among students. [Subjects and Methods] The study used a descriptive survey and a convenience sample of 378 students from a single university. The data were collected from January 1 to June 31, 2015. Fatigue and pain levels were measured using a visual analog scale. [Results] The average reported by the participants 4.7 and 3.7 levels of fatigue and pain, respectively. The regions with the highest fatigue scores were the eyes, followed by the neck, and shoulders. The regions with the highest pain scores were the neck, followed by the shoulders, and the waist. The results show that participants' fatigue and pain levels depended on the duration of their internet use per day. [Conclusion] These findings indicate that control of internet usage time is needed to maintain the well-being of university students who use the internet.
Beck, S L
The purpose of this experimental crossover study was to evaluate to what extent the therapeutic use of music would decrease pain in patients with cancer who were receiving scheduled analgesics. Baseline data were collected for three days. Subjects then were assigned randomly to listen to their preference of seven types of relaxing music or a control (a 60-cycle hum) twice daily for three days. Then they crossed over into the alternate group for the next three days. Finally, each subject returned to a follow-up baseline period. Pain, the dependent variable, and mood, which was proposed as an intervening variable, were measured by visual analogue scales. The convenience sample included 15 outpatients with cancer, 12 female and 3 male, ages 20 through 87. Results of the McGill Pain Questionnaire (MPQ), a reliable and valid multidimensional instrument administered upon entry into the study, indicated that the study sample was comparable to other samples of patients with cancer who were in pain. There was an inconsistent relation between pain and mood. The effect of the music on pain varied by individual; 75% had at least some response and 47% had a moderate or great response. Multivariate Analysis of Variance (MANOVA) indicated a statistically significant decrease in pain from using either the music or sound, but there was no effect on mood. Although the mean percentage of change in pain for music was twice that for sound, the results did not differ statistically. The findings support the use of music as an independent nursing intervention to relieve pain.
Iodice, Pierpaolo; Cesinaro, Stefano; Romani, Gian Luca; Pezzulo, Giovanni
Athletes such as skaters or surfers maintain their balance on very unstable platforms. Remarkably, the most skilled athletes seem to execute these feats almost effortlessly. However, the dynamics that lead to the acquisition of a defined and efficient postural strategy are incompletely known. To understand the posture reorganization process due to learning and expertise, we trained twelve participants in a demanding balance/posture maintenance task for 4 months and measured their muscular activity before and after a (predictable) disturbance cued by an auditory signal. The balance training determined significant delays in the latency of participants' muscular activity: from largely anticipatory muscular activity (prior to training) to a mixed anticipatory-compensatory control strategy (after training). After training, the onset of activation was delayed for all muscles, and the sequence of activation systematically reflected the muscle position in the body from top to bottom: neck/upper body muscles were recruited first and in an anticipatory fashion, whereas leg muscles were recruited after the disturbance onset, producing compensatory adjustments. The resulting control strategy includes a mixture of anticipatory and compensatory postural adjustments, with a systematic sequence of muscular activation reflecting the different demands of neck and leg muscles. Our results suggest that subjects learned the precise timing of the disturbance onset and used this information to deploy postural adjustments just-in-time and to transfer at least part of the control of posture from anticipatory to less-demanding feedback-based strategies. In turn, this strategy shift increases the cost-efficiency of muscular activity, which is a key signature of skilled performance.
Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. ... in skin temperature, color, or texture Intense burning pain Extreme skin sensitivity Swelling and stiffness in affected ...
Lihua, Peng; Su, Min; Zejun, Zhou; Ke, Wei; Bennett, Michael I
Cancer-related pain places a heavy burden on public health with related high expenditure. Severe pain is associated with a decreased quality of life in patients with cancer. A significant proportion of patients with cancer-related pain are under-treated.There is a need for more effective control of cancer-related pain. Spinal cord stimulation (SCS) may have a role in pain management. The effectiveness and safety of SCS for patients with cancer-related pain is currently unknown. This systematic review evaluated the effectiveness of SCS for cancer-related pain compared with standard care using conventional analgesic medication. We also appraised risk and potential adverse events associated with the use of SCS. We searched the following bibliographic databases in order to identify relevant studies: the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Libary (from inception to 2012, Issue 6); MEDLINE; EMBASE; and CBM (Chinese Biomedical Database) (from inception to July, 2012). We also handsearched relevant journals. We planned to include randomised controlled trials (RCTs) that directly compared SCS with other interventions with regards to the effectiveness of pain management. We also planned to include cross-over trials that compared SCS with another treatment. We planned to identify non-randomised controlled trials but these would only be included if no RCTs could be found. The initial search strategy yielded 430 articles. By scrutinising titles and abstracts, we found 412 articles irrelevant to the analytical purpose of this systematic review due to different scopes of diseases or different methods of intervention (intrathecal infusion system; oral medication) or aims other than pain control (spinal cord function monitoring, bladder function restoration or amelioration of organ metabolism). The remaining 18 trials were reviewed as full manuscripts. No RCTs were identified. Fourteen sporadic case reports and review articles were excluded and
盛伟斌; 徐韬; 田娟; 郭海龙; 李尔旦; 普拉提; 詹玉林; 金格勒; 邓强; 郑新峰; 荀传辉
Objective To investigate whether annular tears is a cause of low back and radiating leg pain and explore the clinical characteristics and treatment for patients with this condition.Methods A total of 34 patients with low back and radiating leg pain,but without lumbar disc herniation on CT (computed tomography) or MRI (magnetic resonance imaging),were examined by electrophysiological studies and discography to identify whether there were or not annular tears and nerve root injury and decipher the relations between them.The series included 15 males and 19 females with an average age of 45.6 years old and the average duration of symptoms was 25.8 months.All patients with annular tears and positive pain provocation test were treated by local windowing decompression and debridement of nucleus pulposus after failed conservative treatment.The pre- and post-operative functions and pain were evaluated by JOA (Japanese Orthopedic Association) and VAS (visual analog scale) scores respectively.The average followup was 17.4 months.Results The clinical manifestations included low back and radiating leg pain,intermittent claudication and nerve root injury.No significant abnormalities were discovered on X-ray and CT scan.T2W images of magnetic resonance demonstrated a low intensity or black disc in all patients and highintensity zone (HIZ) (n = 21).Electromyography showed nerve root injury (n = 27).Abnormality of conduction velocities of common peroneal nerve (n = 7) and tibial nerve (n = 3) were found.Thirty-four patients with 38 discs displayed pain reproduction on contrast injection during discography and the sites of annular tears were confirmed on CT scan after discography.Pre- and post-operative average JOA scale score was 8.7 points and 13.5 points,the recovery ratio 76.2% and the excellent and good outcomes 88.2%.Pre-and post-operative average VAS score was 8.6 points and 2.8 points.And the recovery rate was 80.5%.Conclusion The annular tears result in low back and
Thoppe-Dhamodhara, Yogesh-Kumar; Asokan, Sharath; John, Baby-John; Pollachi-Ramakrishnan, GeethaPriya; Ramachandran, Punithavathy; Vilvanathan, Praburajan
Local anesthetic injection is one of the most anxiety provoking procedure in dentistry. Knowledge about change in pain related behaviour during consecutive visits helps in and scheduling of treatment procedures and management of children in dental clinic. To compare the pain perception, behavioural response and the associated change in physiological parameters while receiving local anesthesia injection with cartridge syringe and computer controlled local anesthetic delivery system (CCLAD) over two consecutive visits. In this randomized controlled cross over trial, 120 children aged 7 - 11 years were randomly divided into group A: receiving injections with CCLAD during first visit; group B: receiving injections with cartridge syringe during first visit. The physiological parameters (heart rate and blood pressure) were recorded before and during injection procedure. Objective evaluation of disruptive behaviour and subjective evaluation of pain perceived were done using Face Legs Activity Cry Consolability (FLACC) scale and modified facial image scale (FIS) respectively. No statistical difference in pain response (p= 0.164) and disruptive behaviour (p = 0.120) between cartridge syringe and CCLAD injections were seen during the first visit although the latter showed lesser scores. However, during the second visit there were significant increase in pain response (p = 0.004) and disruptive behaviour (p = 0.006) in cartridge syringe group with an associated increase in heart rate. Injections with CCLAD produced lesser pain ratings and disruptive behaviour than cartridge syringe in children irrespective of order of visit. Behaviour, cartridge syringe, CCLAD, local anesthesia.
Duffy, J R; Warburg, Finn; Koelle, S-F T
BACKGROUND: Pain and mental health concerns are prevalent among veterans. While the majority of research has focused on chronic pain as an entity, there has been little work directed towards investigating the role of neuropathic pain in relation to psychological comorbidity. As such, we hypothesi......BACKGROUND: Pain and mental health concerns are prevalent among veterans. While the majority of research has focused on chronic pain as an entity, there has been little work directed towards investigating the role of neuropathic pain in relation to psychological comorbidity. As such, we...... hypothesised that participants with signs of neuropathic pain would report higher levels of psychological distress and diminished self-rated health compared to those without a neuropathic component. METHODS: A retrospective review of standardised questionnaires (PainDETECT Questionnaire, Post-traumatic Stress...... pain correlated positively with the Post-traumatic Stress Disorder Checklist-Civilian score (rho = 0.469, P
Francisco Eudison da Silva Maia
Full Text Available The growing incidence of low back pain is a problem of public health, causing physical, economical and psychosocial damages. Such pain is correlated with types of work and its execution, such as remaining in determinate postures for long periods and repetition of mechanically stressful movements, and its consequent metabolic damage on the composing structures of the lumbar spine. Thus, this study approaches the aetiology of the mechanical and biological factors related to low back pain, contributing to the enrichment of the discussion of proposed interventionist therapies that lead to the reduction or remission of lumbar pain. For such, a literature review was performed through researching publications in the period from 2000 to 2012 in orthopedics, osteopathy, and rheumatology textbooks, as well as newspapers and databases such as Lilacs, Bireme, and Scielo, using the keywords: low back pain, physiotherapy, and health. It was observed that knowing the aetiology of low back pain is important for the formulation of a therapeutic strategy. The base for the therapeutic strategy should be composed of: the evaluation of the individual, the individual's work and the movements necessary for it, and the environment where such work is performed. The physiotherapist has a wide and effective therapeutic arsenal for the performance of his/her interventions. Treatment success depends on the selection and/or combination of the techniques that best attend the patients' needs. Thus, physiotherapy comes as an indispensable tool in the promotion of health and improvement of life quality.
Drosos, G I; Stavropoulos, N I; Katsis, A; Kesidis, K; Kazakos, K; Verettas, D-A
The aim of this study was to explore the intensity of post-arthroscopy knee pain during the first 24 hours, and to study the influence of pre-operative pain, tourniquet time and amount of surgical trauma on post-arthroscopy pain. In 78 male patients that underwent elective arthroscopic menisectomy or diagnostic arthroscopy of the knee, preoperative and post-operative pain were registered using the Visual Analogue Scale. Variance for repeated measures and for independent observations was analysed. Supplementary analgesia was required for 23% of the patients, more often in the recovery room and between 2 and 8 hours postoperatively. Of all factors analyzed, only time was statistically significant in determining the level of post-operative pain. Supplementary analgesia was required only in patients that underwent operative arthroscopy, and more often in patients with tourniquet time of more than 40 minutes. In conclusions, post-operative time is the most significant factor related to the post-arthroscopy knee pain.
Full Text Available Objectives: The aim of this study was to explore the intensity of post-arthroscopy knee pain during the first 24 hours, and to study the influence of pre-operative pain, tourniquet time and amount of surgical trauma on post-arthroscopy pain. Methods: In 78 male patients that underwent elective arthroscopic menisectomy or diagnostic arthroscopy of the knee, preoperative and post-operative pain was registered using the Visual Analogue Scale. Variance for repeated measures and for independent observations was analysed. Results: Supplementary analgesia was required for 23% of the patients, more often in the recovery room and between 2 and 8 hours postoperatively. Of all factors analyzed, only time was statistically significant in determining the level of post-operative pain. Supplementary analgesia was required only in patients that underwent operative arthroscopy, and more often in patients with tourniquet time of more than 40 minutes. Conclusion: In conclusions, post-operative time is the most significant factor related to the post-arthroscopy knee pain. [Natl J Med Res 2014; 4(1.000: 75-78
Jonsdottir, Thorbjorg; Gunnarsdottir, Sigridur; Oskarsson, Gudmundur K; Jonsdottir, Helga
Pain is a personal experience and patient-provider communication therefore an essential part of diagnosis and treatment where the patient's perspective needs to be central. The aim of this descriptive cross-sectional study was to investigate chronic-pain-related patient-provider communication in the context of sociodemographic variables, pain variables, perceived outcome of care, and satisfaction with health care providers. A postal questionnaire measuring socio-demographic variables, pain characteristics, pain-related health care utilization and patient-provider communication was sent to a sample of 4,500 individuals randomly drawn from the national population of Iceland. A subsample reporting chronic pain and having visited a health care provider for pain the previous six months (n = 401) was analyzed. Relationships between patient-provider communication and other measured variables were tested using bivariate and multivariate statistics. The more chronic pain impaired health-related quality of life, the more provider control the patients perceived in the patient-provider communication. There was also a strong negative relationship between patients' perception of providers' support and openness to discussing symptoms, and satisfaction with health care provider. Patients' perception of their own control in patient-provider communication and involvement in decisions regarding care was related to sociodemographic variables (specifically, education and residence) but not to pain related variables. This study highlights the importance of assessing chronic pain in a broad spectrum, listening, and giving patients time and support to communicate chronic pain and how it affects their life situation. The more interfering the pain is, the more important this is. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
de Jong, Jeroen R; Vlaeyen, Johan W S; van Eijsden, Marjon; Loo, Christoph; Onghena, Patrick
There is increasing evidence that pain-related fear influences the development and maintenance of pain disability, presumably mediated through the fear-related avoidance of valued activities. Individually tailored graded exposure in vivo (GEXP) has been demonstrated to reduce pain-related fear and increase functional abilities in patients with chronic low back pain, neck pain, and complex regional pain syndrome. The current study aimed to test whether these effects generalize towards patients with work-related upper extremity pain. A sequential replicated and randomized single-case experimental phase design with multiple measurements was used. Within each participant, GEXP was compared to a no-treatment baseline period and a no-treatment 6-month follow-up period. Eight patients who reported a high level of pain-related fear were included in the study. Daily changes in pain catastrophizing, pain-related fear, and pain intensity were assessed using a diary, and subjected to randomization tests. Before the start of the baseline period, just after GEXP, and at 6-month follow-up, clinically relevant changes of pain catastrophizing, pain-related fear, perceived harmfulness of physical activity, pain disability, and participation/autonomy were verified. When GEXP was introduced, levels of pain catastrophizing and pain-related fear decreased significantly. Clinically relevant improvements were observed for pain disability, perceived participation, and autonomy. These favourable changes were maintained until 6-month follow-up. The findings of the current study underscore the external validity of a cognitive-behavioural GEXP treatment for patients with chronic pain reporting increased pain-related fear.
The communication of pain has received a great deal of attention in the pain literature; however, one form of pain communication—emotional disclosure of pain-related distress (e.g., sadness, worry, anger about pain)—has not been studied extensively. The current study examined the extent to which this form of pain communication occurred during an observed conversation with one’s spouse and also investigated the correlates and consequences of disclosure. Individuals with chronic pain (ICPs) and...
Lillis, Jason; Graham Thomas, J; Seng, Elizabeth K; Lipton, Richard B; Pavlović, Jelena M; Rathier, Lucille; Roth, Julie; O'Leary, Kevin C; Bond, Dale S
Pain acceptance involves willingness to experience pain and engaging in valued activities while pain is present. Though pain acceptance could limit both headache-related disability and pain interference in individuals with migraine, few studies have addressed this issue. This study evaluated whether higher levels of total pain acceptance and its two subcomponents, pain willingness and activity engagement, were associated with lower levels of headache-related impairment in women who had both migraine and overweight/obesity. In this cross-sectional study, participants seeking weight loss and headache relief in the Women's Health and Migraine trial completed baseline measures of pain acceptance (Chronic Pain Acceptance Questionnaire [CPAQ]), headache-related disability (Headache Impact Test-6), and pain interference (Brief Pain Inventory). Migraine headache frequency and pain intensity were assessed daily via smartphone diary. Using CPAQ total and subcomponent (pain willingness and activity engagement) scores, headache frequency, pain intensity, and body mass index (BMI) as predictors in linear regression, headache-related disability, and pain interference were modeled as outcomes. On average, participants (n = 126; age = 38.5 ± 8.2 years; BMI = 35.3 ± 6.6 kg/m(2) ) reported 8.4 ± 4.7 migraine days/month and pain intensity of 6.0 ± 1.5 on a 0-10 scale on headache days. After correcting for multiple comparisons (adjusted α = .008), pain willingness was independently associated with both lower headache-related disability (P disability (P = .128; β = -0.138) and pain interference (P = .042; β = -0.154). CPAQ total score was not associated with headache-related disability (P = .439; β = 0.066) and pain interference (P = .305; β = 0.074). Pain intensity was significantly associated with outcomes in all analyses (Ps disability and general pain interference in treatment-seeking women with migraine
Tenvergert Elisabeth M
Full Text Available Abstract Objectives As impact of literature concerning this subject is scarce, the objectives of this study were to assess whether the Health Related Quality of Life (HRQoL is decreased in patients with painful temporomandibular disorders as compared to the HRQoL in the general population, and to evaluate to what extent pain duration affects HRQoL. Methods Data concerning physical and mental health were retrieved from patients with painful temporomandibular disorders. Assessment tools used were: the Mandibular Function Impairment Questionnaire (MFIQ, the Short-Form-36 (SF-36, the Hospital Anxiety and Depression Schedule (HADS, and the General Health Questionnaire (GHQ. In order to examine the influence of the duration of pain on HRQoL, the total sample was divided into three different subgroups. Subgroup 1 consisted of patients with complaints existing less than one year. Patients with complaints from 1 to 3 years were allocated to the second group. The 3rd subgroup included patients with complaints longer than 3 years. Results The total sample consisted of 95 patients (90 females and 5 males. On most physical and social functioning items, groups 2 and 3 scored significantly worse than the general population. On the other hand, none of the groups differed from the general population when comparing the mental items. Duration of pain was significantly correlated with SF-36 subscale physical functioning and the mandibular impairment. Conclusion Patients with TMD pain less than one year score better than compared to the population norm. With a longer duration of pain, mental health scores and role limitations due to emotional problems do not appear to be seriously affected by reduced physical health, while social functioning appears to be considerably affected.
Tjakkes, Geerten-Has E.; Reinders, Jan-Jaap; Tenvergert, Elisabeth M.; Stegenga, Boudewijn
Objectives: As impact of literature concerning this subject is scarce, the objectives of this study were to assess whether the Health Related Quality of Life (HRQoL) is decreased in patients with painful temporomandibular disorders as compared to the HRQoL in the general population, and to evaluate
Marc Patrick Bennett
Full Text Available Patients with chronic pain are often fearful of movements that never featured in painful episodes. This study examined whether a neutral movement’s conceptual relationship with pain-relevant stimuli could precipitate pain-related fear; a process known as symbolic generalization. As a secondary objective, we also compared experiential and verbal fear learning in the generalization of pain-related fear. We conducted an experimental study with 80 healthy participants who were recruited through an online experimental management system (Mage = 23.04 years, SD = 6.80 years. First, two artificial categories were established wherein nonsense words and joystick arm movements were equivalent. Using a between-groups design, nonsense words from one category were paired with either an electrocutaneous stimulus (pain-US or threatening information, while nonsense words from the other category were paired with no pain-US or safety information. During a final testing phase, participants were prompted to perform specific joystick arm movements that were never followed by a pain-US, although they were informed that it could occur. The results showed that movements equivalent to the pain-relevant nonsense words evoked heightened pain-related fear as measured by pain-US expectancy, fear of pain, and unpleasantness ratings. Also, experience with the pain-US evinced stronger acquisition and generalization compared to experience with threatening information. The clinical importance and theoretical implications of these findings are discussed.
Alavi, Afsaneh; Kirsner, Robert S
Major hemoglobinopathies, including sickle cell anemia, are becoming a global health issue. Leg ulcers are the most common cutaneous manifestation of sickle cell disease and an important contributor to morbidity burden in this population. Leg ulcers following sickling disorders are extremely painful, and hard to heal. The clinical evidence for the optimal management of these ulcers is limited. Treating the cause and the strategies to prevent sickling are the mainstay of treatment. The basic principles of wound bed preparation and compression therapy is beneficial in these patients.
Full Text Available Abstract. The present study explored whether pain-related psychosocial risk factors played a role in determining whether treatment gains were maintained following participation in a rehabilitation intervention for musculoskeletal injury. The study sample consisted of 310 individuals (163 women, 147 men with work-related musculoskeletal conditions who were enrolled in a physical rehabilitation program. Measures of pain severity, pain catastrophizing and pain-related fear were completed at the time of admission and at the time of discharge. Pain severity was assessed again at 1-year postdischarge. Participants were classified as “recovered” if they showed a decrease in pain of at least 2 points and rated their pain at discharge as less than 4/10. Recovered participants were considered to have failed to maintain treatment gains if their pain ratings increased by at least 2 points from discharge assessment to 1-year follow-up, and they rated their pain as 4/10 or greater at 1-year follow-up. The results of a logistic regression revealed that participants with high posttreatment scores on measures of catastrophizing and fear of pain were at increased risk of failing to maintain treatment gains. The findings suggest that unless end-of-treatment scores on catastrophizing and fear of pain fall below the risk range, treatment-related reductions in pain severity may not be maintained in the long term. The clinical and theoretical implications of the findings are discussed.
Full Text Available BACKGROUND: The piriformis syndrome, which was first described 60 years ago, is a well recognized cause of sciatica, leg pain and low back pain, due to the entrapment of the sciatic nerve in the piriformis and other rotator muscles. Very few complications relating to this syndrome have been described.
Aldrete, J A; Couto da Silva JM
Despite the increasing popularity of intrathecal infusions to treat patients with long-term non-cancer-related pain, this therapy is not without serious side-effects. Five out of 23 patients who had intrathecal infusions of opiates for longer than 24 months developed leg and feet edema. As predisposing factors, cardiovascular disease, deep venous thrombosis, peripheral vascular disease, and venous stasis of the lower extremities were considered. Every patient who developed pedal and leg edema after the implantation of an infusion pump was also found to have leg edema and venous stasis prior to the time when the pump was inserted. This complication was severe enough to limit their physical activity, and to produce lymphedema, ulcerations and hyperpigmentation of the skin. Reduction of the edema occurred when the dose of the opiate was decreased, and in two cases in which the infusion was discontinued, there was almost complete resolution of the syndrome. It appears that the pre-existence of pedal edema and of venous stasis is a relative contraindication to the long-term intrathecal infusion of opiates in patients with chronic non-cancer pain. Copyright 2000 European Federation of Chapters of the International Association for the Study of Pain.
Nelson, Erik N; Kassarjian, Ara; Palmer, William E
With increasing participation in professional and recreational athletics, activity-limiting pelvic and groin pain presents a growing challenge for patients and health care providers. The causes of musculoskeletal-related groin pain among athletes are diverse, with considerable overlap in history and physical examination findings. Pubalgia is a clinical diagnosis invoked when no more specific cause ofa patient's symptoms can be determined on history and physical examination. In many cases, dedicated MR imaging of the hip and pelvis can provide a prompt and specific diagnosis, which allows for early treatment and return to participation.
Gautschi, Oliver P; Corniola, Marco V; Smoll, Nicolas R; Joswig, Holger; Schaller, Karl; Hildebrandt, Gerhard; Stienen, Martin N
Sex differences in pain perception are known to exist; however, the exact pathomechanism remains unclear. This work aims to elucidate sex differences in subjective and objective measures of pain, functional impairment, and health-related quality of life (HRQoL) in patients with lumbar degenerative disc disease. In a prospective 2-center study, back and leg pain (visual analogue scale [VAS]), functional disability (Oswestry Disability Index and Roland-Morris Disability Index), and HRQoL (EuroQol-5D and Short Form [SF12]) were collected for consecutive patients undergoing lumbar spine surgery. Objective functional impairment (OFI) was estimated using age-adjusted and sex-adjusted cutoff values for the timed-up-and-go (TUG) test. A healthy cohort of n = 110 subjects served as the control group. Univariate and multivariate analyses were performed to test the association between sex and pain, subjective and OFIs, and HRQoL. The study comprised n = 305 patients (41.6% females). Female patients had more VAS back pain (P = 0.002) and leg pain (P = 0.014). They were more likely to report higher functional impairment in terms of Oswestry Disability Index (P = 0.005). Similarly, HRQoL measured with the EuroQol-5D index (P = 0.012) and SF12 physical composite score (P = 0.005) was lower in female patients. Female patients reported higher VAS back and leg pain, functional impairment, and reduced HRQoL than male patients. However, there were no sex differences with respect to the presence and degree of OFI measured by the TUG test using age-adjusted and sex-adjusted cutoff values. As such, the TUG may be a good test to overcome sex bias for the clinical assessment of patients with degenerative disc disease.
Britt Marie Stålnacke
Full Text Available Background. Postconcussion symptoms (PCSs—such as fatigue, headache, irritability, dizziness, and impaired memory—are commonly reported in patients who have mild traumatic brain injuries (MTBIs. Evaluation of PCS after MTBI is proposed to have a diagnostic value although it is unclear whether PCS are specific to MTBI. After whiplash injuries, patients most often complain of headaches and neck pain; the other PCS are not as closely evaluated. In patients with chronic pain because of other injuries, the presence of PCS is unclear. This study aimed to describe the frequency of PCS in patients with injury-related pain and to examine the relationships between PCS, pain, and psychological factors. Methods. This study collected data using questionnaires addressing PCS (Rivermead Postconcussion Questionnaire, RPQ, pain intensity (Visual Analogue Scale, depression, anxiety (Hospital, Anxiety, and Depression Scale, and posttraumatic stress (Impact of Event Scale. Results. Fatigue (90.7%, sleep disturbance (84.9%, headache (73.5%, poor concentration (88.2%, and poor memory (67.1% were some of the most commonly reported PCS. Significant relationships were found between PCS and posttraumatic stress, depression, and anxiety. Conclusion. To optimize treatment, it is important to assess each patient’s PCS, the mechanism of injury, and factors such as posttraumatic stress and depression.
Lindner, Dror; Agar, Gabriel; Domb, Benjamin Gilbert; Beer, Yiftah; Shub, Idit; Mann, Gideon
Cycling has become a popular recreational and competitive sport. The number of people participating in the sport is gradually increasing. Despite being a noncontact, low-impact sport, as many as 85% of athletes engaged in the sport will suffer from an overuse injury, with the lower limbs comprising the majority of these injuries. Up to 20% of all lower extremity overuse injuries in competitive cyclists are of a vascular source. A 39-year-old competitive cyclist had a 5-year history of thigh pain during cycling, preventing him from competing. The patient was eventually diagnosed with external iliac artery endofibrosis. After conservative treatment failed, the patient underwent corrective vascular surgery with complete resolution of his symptoms and return to competitive cycling by 1 year. Since its first description in 1985, there have been more than 60 articles addressing external iliac artery endofibrosis pathology.
Salarie Sker, Fatemeh; Anbarian, Mehrdad; Yazdani, Amir H; Hesari, Pouria; Babaei-Ghazani, Arash
Decreases in patellofemoral pain symptoms with bracing treatment have been established; but, the mechanisms remain unclear. The purpose of this study was to determine the immediate and long-term effects of the patellar bracing on electromyography (EMG) activity of the Vastus Medialis (VM) and Lateralis (VL), Rectus Femoris, lateral Gastrocnemius, Biceps Femoris and Semitendinosus (ST) muscles during level walking. 12 eligible women aged 20-30 years with diagnosis of patellofemoral pain participated in the before and after study. Intervention consisted of 8 weeks of patellar bracing. First, patients were tested without brace, then with a brace, and finally eight weeks later without a brace. Surface EMG activation of the selected muscles during level walking was recorded. After eight weeks of patellar bracing, EMG activity of VM muscle was significantly higher when compared to first session without brace (p=0.011) at mid-stance sub-phase. Additionally, EMG activity of ST muscle during first session with brace was significantly lower when compared to first session without brace at mid-stance sub-phase (without brace) (p=0.012). EMG activity of VM muscle after eight weeks of patellar bracing was significantly higher than the first session without brace at late stance and preswing sub-phase (p=0.013). Long-term wearing of patellar bracing increases EMG activity of VM during mid-stance and late stance and preswing sub-phases of gait and immediate effect of patellar brace is decrease of EMG activity of ST muscle during mid-stance. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available Lately, the diagnostic value of magnetic resonance imaging, Lasègue sign and classic neurological signs have been considered not accurate enough to distinguish the radicular from non-radicular low back with leg pain (LBLP and a calculation of the symptomatic side muscle volume has been indicated as a probable valuable marker. However, only the multifidus muscle volume has been calculated so far. The main objective of the study was to verify whether LBLP subjects presented symptomatic side pelvic muscle atrophy compared to healthy volunteers. The second aim was to assess the inter-rater reliability of 3-D manual method for segmenting and measuring the volume of the gluteus maximus, gluteus medius, gluteus minimus and piriformis muscles in both LBLP patients and healthy subjects.Two independent raters analyzed MR images of LBLP and healthy subjects towards muscle volume of four pelvic muscles, i.e. the piriformis, gluteus minimus, gluteus medius and gluteus maximus. For both sides, the MR images of the muscles without adipose tissue infiltration were manually segmented in 3-D medical images.Symptomatic muscle atrophy was confirmed in only over 50% of LBLP subjects (gluteus maximus (p<0.001, gluteus minimus (p<0.01 and piriformis (p<0.05. The ICC values indicated that the inter-rater reproducibility was greater than 0.90 for all measurements (LBLP and healthy subjects, except for the measurement of the right gluteus medius muscle in LBLP patients, which was equal to 0.848.More than 50% of LBLP subjects presented symptomatic gluteus maximus, gluteus minimus and piriformis muscle atrophy. 3-D manual segmentation reliably measured muscle volume in all the measured pelvic muscles in both healthy and LBLP subjects. To answer the question of what kind of muscle atrophy is indicative of radicular or non-radicular pain further studies are required.
Full Text Available Abstract Background Chronic pain patients are common in general practice. In this study "chronic pain" is defined as diffuse musculoskeletal pain not due to inflammatory diseases or cancer. Effective patient-physician relations improve treatment results. The relationship between doctors and chronic pain patients is often dysfunctional. Consultation training for physicians and medical students can improve the professional ability to build effective relations, but this demands a thorough understanding of the problems in the relation. Several studies have defined the issues that frequently cause problems, but few have described the process. The aim of this study was to understand and illustrate what GPs' experience in contact with chronic pain patients and what works and does not work in these consultations. Methods Our theoretical perspective is constructivist, based upon the relativist view that individuals construct realities to understand and navigate the world. Five Swedish General Practitioners (GPs, two male and three female, were interviewed and asked to tell a story about a difficult encounter with a chronic pain patient. Tapes of the interviews were transcribed and analysed using narrative analysis. Three GPs told narratives suited for our analytic tools and these were included in the final results. Results Each narrative highlights a certain dilemma and a strategy. The dilemmas were: power game; good intentions that fail when a patient is persuaded against her own conviction; persuasion of the unwilling; transferred tiredness; distrust and dissociation from the patient. Professional strategies of listening, encouraging and teamwork were central to handling difficult situations. Conclusions The narratives show that GP's consultations with chronic pain patients sometimes are characterized by conflicts and difficult situations. They are facilitated by methods such as active listening and teamwork, but still may remain hard to handle. This
Pinto, Rafael Zambelli; Ferreira, Paulo Henrique; Franco, Marcia Rodrigues; Ferreira, Mariana Calais; Ferreira, Manuela Loureiro; Teixeira-Salmela, Luci Fuscaldi; Oliveira, Vinicius C; Maher, Christopher
This study investigated the effect of lumbar posture on function of transversus abdominis (TrA) and obliquus internus (OI) in people with and without non-specific low back pain (LBP) during a lower limb task. Rehabilitative ultrasound was used to measure thickness change of TrA and OI during a lower limb task that challenged the stability of the spine. Measures were taken in supine in neutral and flexed lumbar postures in 30 patients and 30 healthy subjects. Data were analysed using a two-way (groups, postures) ANOVA. Our results showed that lumbar posture influenced percent thickness change of the TRA muscle but not for OI. An interaction between group and posture was found for TrA thickness change (F(1,56) = 6.818, p = 0.012). For this muscle, only healthy participants showed greater thickness change with neutral posture compared to flexed (mean difference = 6.2%; 95% CI: 3.1-9.3%; p posture can facilitate an increase in thickness of the TrA muscle while performing a leg task, however this effect was not observed for this muscle in patients with LBP. No significant difference in TrA and OI thickness change between people with and without non-specific LBP was found. Copyright © 2011 Elsevier Ltd. All rights reserved.
Elmer, Steven J; McDaniel, John; Martin, James C
One-legged cycling has served as a valuable research tool and as a training and rehabilitation modality. Biomechanics of one-legged cycling are unnatural because the individual must actively lift the leg during flexion, which can be difficult to coordinate and cause premature fatigue. We compared ankle, knee, and hip biomechanics between two-legged, one-legged, and counterweighted (11.64 kg) one-legged cycling. Ten cyclists performed two-legged (240 W), one-legged (120 W), and counterweighted one-legged (120 W) cycling (80 rpm). Pedal forces and limb kinematics were recorded to determine work during extension and flexion. During counterweighted one-legged cycling relative ankle dorsiflexion, knee flexion, and hip flexion work were less than one-legged but greater than two-legged cycling (all P cycling were greater than one-legged but less than two-legged cycling (all P cycling reduced but did not eliminate differences in joint flexion and extension actions between one- and two-legged cycling. Even with these differences, counterweighted one-legged cycling seemed to have advantages over one-legged cycling. These results, along with previous work highlighting physiological characteristics and training adaptations to counterweighted one-legged cycling, demonstrate that this exercise is a viable alternative to one-legged cycling.
Buenaver, Luis F; Edwards, Robert R; Haythornthwaite, Jennifer A
Pain-related coping, particularly catastrophizing, plays a significant role in shaping pain responses. One way catastrophizing is hypothesized to amplify pain and disability is via its effect on patients' social environments (e.g., communal coping model), though empirical support is limited. The present study tested whether the association between catastrophizing and deleterious pain-related outcomes was mediated by patients' perceptions of significant others' responses to their pain in a sample of 1356 pain patients. Regression analyses showed that perceived significant other punishing responses partially mediated catastrophizing's relationship with pain-related disability, and with depressive symptoms. Further, several variables moderated the association between catastrophizing and perceived social responses to pain. Catastrophizing was more strongly associated with greater perceived solicitous responses for patients of relatively short pain duration. Also, higher catastrophizing was more strongly associated with perceived punishing responses among patients perceiving lower social support. In addition, the mediational effects of perceived punishing responses on catastrophizing's relationship with depressive symptoms, and with pain-related disability were only found in individuals reporting low levels of perceived social support. In sum, perceived social responses were found to play a small role in mediating the relationship between catastrophizing and pain-related outcomes, and these mediational effects may be strongest in particular patient subgroups. The present data suggest that interpersonal mechanisms may not constitute a primary route by which catastrophizing exerts its maladaptive effects on pain responses. The study and further understanding of what principal factors mediate catastrophizing's deleterious effects on pain will be important in illuminating the biopsychosocial model of pain.
Full Text Available Francisco Nêuton de Oliveira Magalhães, Sandra Correia Soares, Jaqueline Melo Torres, Arthur Ungaretti, Mariana Fillipi Cacciacarro, Manoel Jacobsen Teixeira, Erich Talamoni FonoffPain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, BrazilIntroduction: In the last two decades, ozone has emerged as a treatment for low back pain, applied by means of minimally invasive techniques. Objective: The aim of this study is to assess the effect and safety of ozone therapy applied in the epidural space for chronic pain related to failed back surgery syndrome.Methods: The investigators studied 13 sequential patients of both sexes, between 18 and 70 years old, with persistent chronic pain (more than six months in the lumbar region and in the lower limbs related to failed back surgery syndrome (FBSS. Pain was classified as neuropathic and non-neuropathic regarding the topography (lumbar and lower limb, based on the DN4 questionnaire. The patients received the ozone gas in the lumbar epidural space via spinal-sacral endoscopy. Clinical evaluation was performed before, immediately after (24 hours, and 1, 3, and 6 months after intervention with visual analog scale and Oswestry Disability Index (ODI.Results: Overall, the patients had 43.7% reduction of lumbar pain, 60.9% reduction in leg pain in six months followed by 44.0% of improvement in ODI. The reduction of pain and in the disability index was markedly greater in patients with non-neuropathic predominant pain, 95.2%, 80.6%, and 75.3% improvement in lumbar, leg pain, and ODI respectively, while neuropathic predominant pain patients experienced only 12.5%, 42.4%, and 20.9% improvement, also respectively. No neurological or infectious complications were observed acutely or during the follow-up. The present data suggests that epidural ozone might be a therapeutic option for persistent low back pain, especially in non
Wilson, Anna C; Moss, Ashley; Palermo, Tonya M.; Fales, Jessica L.
Objective To examine associations between parental history of pain and catastrophizing and their adolescent’s pain, somatic symptoms, catastrophizing, and disability. Methods Participants included 178 youths aged 11–14 years recruited through public schools. Adolescents completed measures assessing pain characteristics, somatic symptoms, and pain catastrophizing. Parents reported on their own pain, and catastrophizing about their adolescent’s pain. Results About one quarter of the adolescents...
Dmitriy Valer'evich Artem'ev
Full Text Available The paper describes the epidemiology, etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, and treatment of restless legs syndrome. Recommendations are given how to choose therapeutic modalities and drugs in relation to different factors.
Full Text Available One of the main techniques for recognizing individuals in avian field research is marking birds with plastic and metal leg rings. However, in some species individuals may react negatively to rings, causing leg injuries and, in extreme cases, the loss of a foot or limb. Here, we report problems that arise from ringing and illustrate solutions based on field data from Brown Thornbills (Acanthiza pusilla (2 populations, Siberian Jays (Perisoreus infaustus and Purple-crowned Fairy-wrens (Malurus coronatus. We encountered three problems caused by plastic rings: inflammations triggered by material accumulating under the ring (Purple-crowned Fairy-wrens, contact inflammations as a consequence of plastic rings touching the foot or tibio-tarsal joint (Brown Thornbills, and toes or the foot getting trapped in partly unwrapped flat-band colour rings (Siberian Jays. Metal rings caused two problems: the edges of aluminium rings bent inwards if mounted on top of each other (Brown Thornbills, and too small a ring size led to inflammation (Purple-crowned Fairy-wrens. We overcame these problems by changing the ringing technique (using different ring types or larger rings, or using different adhesive. Additionally, we developed and tested a novel, simple technique of gluing plastic rings onto metal rings in Brown Thornbills. A review of studies reporting ring injuries (N = 23 showed that small birds (35 g tend to get rings stuck over their feet. We give methodological advice on how these problems can be avoided, and suggest a ringing hazard index to compare the impact of ringing in terms of injury on different bird species. Finally, to facilitate improvements in ringing techniques, we encourage online deposition of information regarding ringing injuries of birds at a website hosted by the European Union for Bird Ringing (EURING.
Hallegraeff, Joannes; de Greef, Mathieu; Krijnen, Wim; van der Schans, Cees
Up to 33% of the general population over 50 years of age are affected by nocturnal leg cramps. Currently there are no generally accepted clinical characteristics, which identify nocturnal leg cramps. This study aims to identify these clinical characteristics and to differentiate between them and the characteristics of restless leg syndrome and periodic limb disorder. A systematic literature study was executed from December 2015 to May 2016. This study comprised of a systematic literature review of randomized clinical trials, observational studies on nocturnal and rest cramps of legs and other muscles, and other systematic and narrative reviews. Two researchers independently extracted literature data and analyzed this using a standardized reviewing protocol. Modified versions of the Cochrane Collaboration tools assessed the risk of bias. A Delphi study was conducted to assess agreement on the characteristics of nocturnal leg cramps. After systematic and manual searches, eight randomized trials and ten observational studies were included. On the basis of these we identified seven diagnostic characteristics of nocturnal leg cramps: intense pain, period of duration from seconds to maximum 10 minutes, location in calf or foot, location seldom in thigh or hamstrings, persistent subsequent pain, sleep disruption and distress. The seven above characteristics will enhance recognition of the condition, and help clinicians make a clear distinction between NLC and other sleep-related musculoskeletal disorder among older adults.
Chang, V T
Rapidly progressive pain, or "crescendo" pain, can be a difficult management problem. A cancer patient is presented who experienced crescendo neuropathic pain due to progressive pelvic disease. This patient reported significant pain relief with the administration of intravenous phenytoin. The case illustrates the type of therapeutic approach that may be considered for crescendo pain and highlights a potential role for intravenous phenytoin in the management of patients with crescendo cancer-related neuropathic pain.
Full Text Available Ibai López-de-Uralde-Villanueva,1–4 Hector Beltran-Alacreu,1–3 Alba Paris-Alemany,1–4 Santiago Angulo-Díaz-Parreño,2,3,5 Roy La Touche1–4 1Department of Physiotherapy, Faculty of Health Science, 2Research Group on Movement and Behavioral Science and Study of Pain, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain; 3Institute of Neuroscience and Craniofacial Pain (INDCRAN, Madrid, Spain; 4Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain; 5Faculty of Medicine, Universidad San Pablo CEU, Madrid, Spain Objectives: This cross-sectional correlation study explored the relationships between craniocervical posture and pain-related disability in patients with chronic cervico-craniofacial pain (CCFP. Moreover, we investigated the test–retest intrarater reliability of two craniocervical posture measurements: head posture (HP and the sternomental distance (SMD. Methods: Fifty-three asymptomatic subjects and 60 CCFP patients were recruited. One rater measured HP and the SMD using a cervical range of motion device and a digital caliper, respectively. The Spanish versions of the neck disability index and the craniofacial pain and disability inventory were used to assess pain-related disability (neck disability and craniofacial disability, respectively. Results: We found no statistically significant correlations between craniocervical posture and pain-related disability variables (HP and neck disability [r=0.105; P>0.05]; HP and craniofacial disability [r=0.132; P>0.05]; SMD and neck disability [r=0.126; P>0.05]; SMD and craniofacial disability [r=0.195; P>0.05]. A moderate positive correlation was observed between HP and SMD for both groups (asymptomatic subjects, r=0.447; CCFP patients, r=0.52. Neck disability was strongly positively correlated with craniofacial disability (r=0.79; P>0.001. The test–retest intrarater reliability of the HP measurement was high for
von Leupoldt, Andreas; Sommer, Tobias; Kegat, Sarah; Baumann, Hans Jörg; Klose, Hans; Dahme, Bernhard; Büchel, Christian
The early detection of stimuli signalling threat to an organism is a crucial evolutionary advantage. For example, the perception of aversive bodily sensations such as dyspnea and pain strongly motivates fast adaptive behaviour to ensure survival. Their similarly threatening and motivating characters led to the speculation that both sensations are mediated by common brain areas, which has also been suggested by neuroimaging studies on either dyspnea or pain. By using functional magnetic resonance imaging (fMRI), we formally tested this hypothesis and compared the cortical processing of perceived heat pain and resistive load induced dyspnea in the same group of participants. Here we show that the perception of both aversive sensations is processed in similar brain areas including the insula, dorsal anterior cingulate cortex, amygdala and medial thalamus. These areas have a documented role in the processing of emotions such as fear and anxiety. Thus, the current study highlights the role of a common emotion-related human brain network which underlies the perception of aversive bodily sensations such as dyspnea and pain. This network seems crucial for translating the threatening character of different bodily signals into behavioural consequences that promote survival.
Full Text Available The red-legged partridge (Alectoris rufa has a great socio-economic importance as a game species and is reared by millions in farms in several European countries. The ability to respond to a wide spectrum of pathogens and environmental changes is key for farm-reared animals that, as such, face even higher pathogen exposure and specifically for those submitted to restocking programs. In this study, RNA-sequencing and de-novo assembly of genes expressed in different immune tissues were performed. The raw FASTQ files were submitted to the NCBI SRA database with accession number PRJNA289204. A total of 94.2 million reads were obtained and assembled into 51,403 contigs using OASES software. The final annotated partridge immune transcriptome comprises almost 7000 unigenes, available as FASTA in the supplementary material. A total of 12,828 microsatellites and 33,857 Single Nucleotide Polymorphisms (SNPs were identified. The candidate gene sequences and the large number of potential genetic markers from the red-legged partridge transcriptome reliably identified through the use for the first time of a high coverage 100-bp paired-end RNA-seq protocol, provide new tools for future studies in this and related species, thus contributing to the ongoing development of genomic resources in avian species. Further investigation into candidate genes and gene-associated markers will help to uncover individual variability in the resistance to infections and other external aggressions in partridges.
Muñoz-García, Daniel; Gil-Martínez, Alfonso; López-López, Almudena; Lopez-de-Uralde-Villanueva, Ibai; La Touche, Roy; Fernández-Carnero, Josué
Background. Neck pain (NP) is strongly associated with cervico-craniofacial pain (CCFP). The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI), and psychological factor of Pain Catastrophizing Scale (PCS). Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (P > 0.05). One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (P > 0.05). The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS. PMID:27119020
Full Text Available Background. Neck pain (NP is strongly associated with cervico-craniofacial pain (CCFP. The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI, and psychological factor of Pain Catastrophizing Scale (PCS. Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (P>0.05. One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (P>0.05. The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS.
Muñoz-García, Daniel; Gil-Martínez, Alfonso; López-López, Almudena; Lopez-de-Uralde-Villanueva, Ibai; La Touche, Roy; Fernández-Carnero, Josué
Background. Neck pain (NP) is strongly associated with cervico-craniofacial pain (CCFP). The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI), and psychological factor of Pain Catastrophizing Scale (PCS). Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (P > 0.05). One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (P > 0.05). The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS.
Thorborg, Kristian; Branci, Sonia; Nielsen, Peter Martin;
investigated. PURPOSE: To investigate whether isometric and eccentric hip strength are decreased in soccer players with adductor-related groin pain compared with asymptomatic soccer controls. The hypothesis was that players with adductor-related groin pain would have lower isometric and eccentric hip adduction.......5 ± 2.5 years, and the mean age of the asymptomatic controls was 22.9 ± 2.4 years. Isometric hip strength (adduction, abduction, and flexion) and eccentric hip strength (adduction) were assessed with a handheld dynamometer using reliable test procedures and a blinded assessor. RESULTS: Eccentric hip...... adduction strength was lower in soccer players with adductor-related groin pain in the dominant leg (n = 21) compared with asymptomatic controls (n = 16), namely 2.47 ± 0.49 versus 3.12 ± 0.43 N·m/kg, respectively (P
Powers, Abigail; Fani, Negar; Pallos, Andrew; Stevens, Jennifer; Ressler, Kerry J; Bradley, Bekh
Previous findings suggest a relationship between childhood abuse and pain-related conditions. It is yet to be determined whether adult posttraumatic stress disorder (PTSD) symptoms may mediate the association between the experience of childhood abuse and reported pain in adulthood. We sought to determine if emotion dysregulation may also play a role in mediating PTSD and pain levels. We examined subjects (N = 814) recruited from the primary care clinics of an urban public hospital as part of an National Institute of Mental Health-funded study of trauma-related risk and resilience. We evaluated childhood abuse with the Childhood Trauma Questionnaire, PTSD symptoms with the PTSD Symptom Severity scale, and emotional dysregulation with the Emotion Dysregulation Scale. Pain and functional limitations of pain were assessed through self-report. We found that both childhood abuse and current PTSD symptoms predicted higher levels of reported pain. Childhood abuse, PTSD symptoms, and emotion dysregulation all predicted higher levels of functional impairment related to pain. Using the Sobel method and bootstrapping techniques and controlling for current level of negative affect, we found that PTSD fully mediated the effect of childhood abuse on pain level and pain-related limitations; emotion dysregulation partially mediated the effect of PTSD symptoms in predicting higher levels of pain-related limitations. Although causality cannot be determined in the present study, these findings suggest that PTSD may serve as the pathway between exposure to childhood abuse and the development of pain-related conditions in adulthood, and that emotion dysregulation is a significant factor in understanding how PTSD relates to specific pain-related functional impairment. © 2013 Published by Academy of Psychosomatic Medicine on behalf of Academy of Psychosomatic Medicine.
... leg pain from clogged arteries Stomach/Digestive: Gallstones, intestinal obstruction, diverticulitis, ulcers, severe indigestion, severe gas pain, inflammatory bowel disease, colitis Urinary/Reproductive: Kidney stones, pelvic pain, vulvodynia, ...
Türp, Jens Christoph; Hugger, Alfons; Schindler, Hans
In this article, a practical diagnostic classification of orofacial pain for use in the general dental practice is presented. In contrast to the detailed taxonomy proposed by Okeson (1995), this classification is limited to those pain conditions dentists are confronted with most frequently. Furthermore, the fundamental differences of somatic versus neuropathic pain, localized versus widespread pain, and acute versus chronic pain are emphasized. Principles of managing the different pain entities are suggested.
Full Text Available Purpose: The purpose of this study is to investigate the use of Electromyography (EMG biofeedback training in dental professionals to reduce upper trapezius muscle tension and thereby to reduce the work related neck pain. By reducing muscle activity in the neck and shoulder postural stabilizing muscles, EMG biofeedback training would be an effective mode of treatment in dental professionals for the management of work related neck pain. Subjects and Methods: This RCT included a total of 50 dental professionals (29 males and 21 females aged between 27-44 years (mean age of 36.4.They were randomly allocated equally into either experimental group who received EMG Biofeedback or the control group who received the conventional physiotherapy management. Patients in the control group were given Hot Packs, IFT and neck care advice. In addition to conventional Physiotherapy treatments, patients in the experimental group received an EMG Biofeedback training program for the bilateral trapezius. The treatments were given for 30-45 minutes/ day / 5 days in a week for 2 weeks. The outcome tools used were; Visual Analogue Scale (VAS and Neck Disability Scale (NDI and both were measured before starting the treatment and at end of 2 weeks. Results & Conclusion: Adding EMG biofeedback training for the trapezius muscles along with conventional physiotherapy management is found to be an effective method of treatment in the management of chronic non specific neck pain patients.
Mertz, Laura; Docherty, Carrie
Ballet technique classes are designed to train dancers symmetrically, but they may actually create a lateral bias. It is unknown whether dancers in general are functionally asymmetrical, or how an individual dancer's perceived imbalance between legs might manifest itself. The purpose of this study was to examine ballet dancers' lateral preference by analyzing their postural stability and ground reaction forces in fifth position when landing from dance-specific jumps. Thirty university ballet majors volunteered to participate in this study. The subjects wore their own ballet technique shoes and performed fundamental ballet jumps out of fifth position on a force plate. The force plate recorded center of pressure (COP) and ground reaction force (GRF) data. Each subject completed a laterality questionnaire that determined his or her preferred landing leg for ballet jumps, self-identified stronger leg, and self-identified leg with better balance. All statistical comparisons were made between the leg indicated on the laterality questionnaire and the other leg (i.e., if the dancer's response to a question was "left," the comparison was made with the left leg as the "preferred" leg and the right leg as the "non-preferred leg"). No significant differences were identified between the limbs in any of the analyses conducted (all statistical comparisons produced p values > 0.05). The results of this study indicate that a dancer's preferential use of one limb over the other has no bearing on GRFs or balance ability after landing jumps in ballet. Similarly, dancers' opinions of their leg characteristics (such as one leg being stronger than the other) seem not to correlate with the dancers' actual ability to absorb GRFs or to balance when landing from ballet jumps.
Söderlund, Anne; Sandborgh, Maria; Johansson, Ann-Christin
Pain perception is influenced by several cognitive and behavioral factors of which some identified as mediators are important in pain management. We studied the mediating role of control over pain and ability to decrease pain in relation to functional self-efficacy, catastrophizing, and pain-related disability in patients with Whiplash-Associated Disorders, (WAD). Further, if the possible mediating impact differs over time from acute to three and 12 months after an accident, cross-sectional and prospective design was used, and 123 patients with WAD were included. Regression analyses were conducted to examine the mediating effect. The results showed that control over pain and ability to decrease pain were not mediators between self-efficacy, catastrophizing, and disability. Self-efficacy had a larger direct effect on pain-related disability compared to catastrophizing. Thus, healthcare staff should give priority to increase patients' self-efficacy, decrease catastrophic thinking, and have least focus on control over pain or ability to decrease pain.
Yongsong Ye; Bo Liu
Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain patients with lumbar disc herniation were treated with balanced acupuncture or body acupuncture. Central mechanisms of varied acupunctures were compared using rest-ing-state functional MRI. Patients from both groups received functional MRI before and after acu-puncture. Functional connectivity in brain regions that were strongly associated with the bilateral amygdala was analyzed utilizing AFNI software. Visual analogue scale scores were greater in the balanced acupuncture group compared with the body acupuncture group. Function of the endoge-nous pain regulation network was enhanced in patients in the balanced acupuncture group, but was not changed in the body acupuncture group. This result indicates that the analgesic effects of body acupuncture do not work through the central nervous system. These data suggest that balanced acupuncture exerts analgesic effects on low-back and leg pain patients with lumbar disc herniation by regulating the function of the endogenous pain regulation network.
Hollingshead, Nicole A; Meints, Samantha M; Miller, Megan M; Robinson, Michael E; Hirsh, Adam T
Pain judgments are the basis for pain management. The purpose of this study was to assess Black and White participants' race-related pain stereotypes. Undergraduates (n=551) rated the pain sensitivity and willingness to report pain for the typical Black person, White person, and themselves. Participants, regardless of race, rated the typical White person as being more pain sensitive and more willing to report pain than the typical Black person. White participants rated themselves as less sensitive and less willing to report pain than same-race peers; however, Black participants rated themselves as more pain sensitive and more willing to report pain than same-race peers. These findings highlight similarities and differences in racial stereotypic pain beliefs held by Black and White individuals.
Kappesser, Judith; de C Williams, Amanda C
Observer underestimation of others' pain was studied using a concept from evolutionary psychology: a cheater detection mechanism from social contract theory, applied to relatives and friends of chronic pain patients. 127 participants estimated characters' pain intensity and fairness of behaviour after reading four vignettes describing characters suffering from pain. Four cues were systematically varied: the character continuing or stopping liked tasks; continuing or stopping disliked tasks; availability of medical evidence; and pain intensity as rated by characters. Results revealed that pain intensity and the two behavioural variables had an effect on pain estimates: high pain self-reports and stopping all tasks led to high pain estimates; pain was estimated to be lowest when characters stopped disliked but continued with liked tasks. This combination was also rated least fair. Results support the use of social contract theory as a theoretical framework to explore pain judgements.
... bones from physical activities, such as: Running Ballet dancing Basketball Marching Contact sports, such as hockey and ... pain, your doctor might prescribe stronger pain medications. Therapy After your cast or splint is removed, you' ...
Ringsted, Thomas K; Wildgaard, Kim; Kreiner, Svend
OBJECTIVE:: Persistent postoperative pain is an acknowledged entity that reduces daily activities. Evaluation of the post-thoracotomy pain syndrome (PTPS) is often measured using traditional pain scales without in-depth questions on pain impairment. Thus, the purpose was to create a procedure...
Hussein, Tarek; Yiou, Eric; Larue, Jacques
Although the effect of temporal pressure on spatio-temporal aspects of motor coordination and posture is well established in young adults, there is a clear lack of data on elderly subjects. This work examined the aging-related effects of temporal pressure on movement synchronization and dynamic stability. Sixteen young and eleven elderly subjects performed series of simultaneous rapid leg flexions in an erect posture paired with ipsilateral index-finger extensions, minimizing the difference between heel and finger movement onsets. This task was repeated ten times under two temporal conditions (self-initiated [SI] vs. reaction-time [RT]). Results showed that, first, temporal pressure modified movement synchronization; the finger extension preceded swing heel-off in RT, and inversely in SI. Synchronization error and associated standard deviation were significantly greater in elderly than in young adults in SI only, i.e. in the condition where proprioception is thought to be crucial for temporal coordination. Secondly, both groups developed a significantly shorter mediolateral (ML) anticipatory postural adjustment duration in RT (high temporal pressure) than in SI. In both groups, this shortening was compensated by an increase in the anticipatory peak of centre-of-gravity (CoG) acceleration towards the stance-leg so that ML dynamic stability at foot-off, quantified with the "extrapolated centre-of-mass", remained unchanged across temporal conditions. This increased CoG acceleration was associated with an increased anticipatory peak of ML centre-of-pressure shift towards the swing-leg in young adults only. This suggested that the ability to accelerate the CoG with the centre-of-pressure shift was degraded in elderly, probably due to weakness in the lower limb muscles. Dynamic stability at foot-off was also degraded in elderly, with a consequent increased risk of ML imbalance and falling. The present study provides new insights into the ability of elderly adults to deal
Full Text Available Although the effect of temporal pressure on spatio-temporal aspects of motor coordination and posture is well established in young adults, there is a clear lack of data on elderly subjects. This work examined the aging-related effects of temporal pressure on movement synchronization and dynamic stability. Sixteen young and eleven elderly subjects performed series of simultaneous rapid leg flexions in an erect posture paired with ipsilateral index-finger extensions, minimizing the difference between heel and finger movement onsets. This task was repeated ten times under two temporal conditions (self-initiated [SI] vs. reaction-time [RT]. Results showed that, first, temporal pressure modified movement synchronization; the finger extension preceded swing heel-off in RT, and inversely in SI. Synchronization error and associated standard deviation were significantly greater in elderly than in young adults in SI only, i.e. in the condition where proprioception is thought to be crucial for temporal coordination. Secondly, both groups developed a significantly shorter mediolateral (ML anticipatory postural adjustment duration in RT (high temporal pressure than in SI. In both groups, this shortening was compensated by an increase in the anticipatory peak of centre-of-gravity (CoG acceleration towards the stance-leg so that ML dynamic stability at foot-off, quantified with the "extrapolated centre-of-mass", remained unchanged across temporal conditions. This increased CoG acceleration was associated with an increased anticipatory peak of ML centre-of-pressure shift towards the swing-leg in young adults only. This suggested that the ability to accelerate the CoG with the centre-of-pressure shift was degraded in elderly, probably due to weakness in the lower limb muscles. Dynamic stability at foot-off was also degraded in elderly, with a consequent increased risk of ML imbalance and falling. The present study provides new insights into the ability of
Caes, L; Fisher, E; Clinch, J; Tobias, J H; Eccleston, C
Anxiety, in particular pain-related anxiety, plays an important role in explaining the severity of pain complaints and pain-related disability in both adults and children with chronic pain. The fear-avoidance model (FAM) describes how pain-related anxiety plays a critical role in the maintenance of pain-avoidance behaviour, which in turn influences pain-related disability. However, the FAM does not take into account broader aspects of adolescence, such as social functioning, which could be negatively impacted by anxiety. In addition, most studies examining the role of anxiety in pain have used small convenience or clinical samples. By using a large UK epidemiological database, this study investigated the associations between pain-related anxiety, disability and judgements of social impairment. Participants (n = 856) with recurrent pain were selected from a larger epidemiological study (Avon Longitudinal Study of Parents and Children) of adolescents attending a research clinic at the age of 17 (n = 5170). Adolescents completed a self-report questionnaire on pain-related anxiety, disability and perceived social impairment. High levels of pain-related anxiety were associated with more disability. In girls, higher levels of pain-related anxiety were also related to the self-perception of greater impairment in social functioning compared with their peers. Pain-related anxiety was associated with greater pain-related disability and impaired social functioning. Social functioning should be explored as an integral part of fear-avoidance models of adolescent chronic pain. © 2014 European Pain Federation - EFIC®
Price, Patricia; Fogh, Karsten; Glynn, Chris;
document persistent wound pain and not to develop a treatment and monitoring strategy to improve the lives of persons with chronic wounds. Unless wound pain is optimally managed, patient suffering and costs to health care systems will increase. Udgivelsesdato: 2007-Apr......Chronic wound pain is not well understood and the literature is limited. Six of 10 patients venous leg ulcer experience pain with their ulcer, and similar trends are observed for other chronic wounds. Chronic wound pain can lead to depression and the feeling of constant tiredness. Pain related...... to the wound should be handled as one of the main priorities in chronic wound management together with addressing the cause. Management of pain in chronic wounds depends on proper assessment, reporting and documenting patient experiences of pain. Assessment should be based on six critical dimensions...
Sharma, Saurab; Shrestha, Nischal; Jensen, Mark P
Chronic low back pain is known to contribute to lost work days (LWDs) in nurses. However, there is a limited understanding of the factors that moderate the impact of low back pain (LBP) on LWDs - in particular factors that are modifiable and that could therefore be the treatment targets of interventions designed to help nurses more effectively manage LBP. This study aims to identify pain-related factors that are associated with LWDs in nurses with LBP, in order to inform the development of interventions that could reduce LBP-related work dysfunction and improve patient care. A cross sectional study was conducted on 111 female nurses who were asked to answer questions regarding demographic information, work history, presence or absence of LBP, number of LWDs due to illness, and a number of factors that could potentially be related to LWDs including: (1) average and worst pain intensity; (2) the temporal pattern of LBP (constant versus intermittent); (3) pain aggravating factors (lifting, bending, walking, and standing); and (4) pain alleviating factors (medications, rest, exercise). Sixty-five percent (n=72) of the sample reported LBP. Constancy of pain and having a LBP problem that was alleviated by rest were significantly associated with the number of LWDs, while maximum and average LBP intensity were only weakly associated. The findings provide important new information regarding what is (and of equal importance) what is not associated with LWDs in nurses with LBP. To effectively reduce LBP-related work disability, interventions may need to teach nurses how to better manage constant pain and remain active despite pain, rather than focus on pain reduction. Research to examine the potential efficacy of such treatment approaches for nurses with LBP is warranted. Copyright © 2015 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Jensen, J. C.; Haahr, J. P.; Frost, P.
. Repetitive work and psychosocial factors did not have any statistically significant impact on care-seeking for neither back pain nor upper extremity pain. CONCLUSION: Work-related factors such as heavy lifting do, to some extent, contribute to care-seeking with MP. We suggest that asking the patient about...
Aung, Min S.H.; Kaltwang, Sebastian; Romera-Paredes, Bernardino; Martinez, Brais; Singh, Aneesha; Cella, Matteo; Valstar, Michel; Meng, Hongying; Kemp, Andrew; Shafizadeh, Moshen; Elkins, Aaron C.; Kanakam, Natalie; Rothschild, de Amschel; Tyler, Nick; Watson, Paul J.; C. Williams, de Amanda C.; Pantic, Maja; Bianchi-Berthouze, Nadia
Pain-related emotions are a major barrier to effective self rehabilitation in chronic pain. Automated coaching systems capable of detecting these emotions are a potential solution. This paper lays the foundation for the development of such systems by making three contributions. First, through litera
José Vinícius Martins da Silva
Full Text Available Objective The study aims to investigate the presence of pain amongst multiple sclerosis (MS patients. Method One hundred MS patients responded to questionnaires evaluating neuropathic and nociceptive pain, depression and anxiety. Statistical analysis was performed using the Mann–Whitney U, Chi-Square and two-tailed Fisher’s exact tests and multivariate logistic regression. Results Women had a statistically higher prevalence of pain (p = 0.037, and chances of having pain after the age of 50 reduced. Women with pain had a statistically significant lower number of relapses (p = 0.003, restricting analysis to those patients with more than one relapse. After the second relapse, each relapse reduced the chance of having pain by 46%. Presence of pain was independent of Expanded Disability Status Scale (EDSS anxiety, and depression. Conclusion Our findings suggest a strong inverse association between relapses and pain indicating a possible protective role of focal inflammation in the control of pain.
Sullivan, M J L; Martel, M O; Tripp, D; Savard, A; Crombez, G
The Communal Coping Model of pain catastrophizing proposes that pain catastrophizers enact pain behaviors in order to solicit support or empathy from their social environment. By this account, pain catastrophizers might be expected to engage in behavior aimed at maximizing the probability that their pain will be perceived by others in their social environment. To test this prediction, 40 undergraduates were videotaped during a cold pressor procedure. A separate sample of 20 (10 men, 10 women) undergraduates were asked to view the video sequences and infer the pain ratings of the cold pressor participants. Correlational analyses revealed that higher levels of pain catastrophizing of the cold pressor participants were associated with observer inferences of more intense pain, r=.39, ppain catastrophizing and observer inferences of pain intensity was mediated by the cold pressor participants' pain behavior. Although pain catastrophizing was associated with observers' inferences of more intense pain, cold pressor participants' level of pain catastrophizing was not associated with observers' accuracy in inferring self-reported pain. Implications of the findings for theory and clinical practice are addressed.
Relation of the International Restless Legs Syndrome Study Group rating scale with the Clinical Global Impression severity scale, the restless legs syndrome 6-item questionnaire, and the restless legs syndrome-quality of life questionnaire.
Allen, Richard; Oertel, Wolfgang; Walters, Arthur; Benes, Heike; Schollmayer, Erwin; Grieger, Frank; Moran, Kimberly; Kohnen, Ralf
The SP790 study (ClinicalTrials.gov, NCT00136045) showed benefits of rotigotine over placebo in improving symptom severity of restless legs syndrome (RLS), also known as Willis-Ekbom disease, on the International Restless Legs Syndrome Study Group rating scale (IRLS), Clinical Global Impression item 1 (CGI-1), RLS 6-item questionnaire (RLS-6), and the RLS-quality of life questionnaire (RLS-QoL) in patients with moderate to severe idiopathic RLS. To provide clinical context for the IRLS and to guide the choice of assessment scales for RLS studies, our post hoc analysis of SP790 data evaluated associations between the IRLS and the CGI-1, IRLS and RLS-6, and the IRLS and RLS-QoL. Scale associations were analyzed at baseline and at the end of maintenance (EoM) using data from the safety set (rotigotine and placebo groups combined [n=458]). Changes from baseline to EoM in IRLS score vs comparator scale scores also were analyzed. There was a trend towards increasing IRLS severity category with increasing CGI-1, RLS-6, and RLS-QoL score. Pearson product moment correlation coefficients showed correlations between IRLS and comparator scale scores at baseline and EoM as well as correlations for change from baseline to EoM. Correlations between the IRLS and comparator scales were substantial. These data indicate that the IRLS is clinically meaningful. The IRLS and CGI-1 are generally sufficient to evaluate the overall severity and impact of RLS symptoms in clinical trials. Copyright © 2013 Elsevier B.V. All rights reserved.
Cameron L. Randall
Full Text Available Background. Acute and chronic orofacial pain can significantly impact overall health and functioning. Associations between fear of pain and the experience of orofacial pain are well-documented, and environmental, behavioral, and cognitive components of fear of pain have been elucidated. Little is known, however, regarding the specific genes contributing to fear of pain. Methods. A genome-wide association study (GWAS; N=990 was performed to identify plausible genes that may predispose individuals to various levels of fear of pain. The total score and three subscales (fear of minor, severe, and medical/dental pain of the Fear of Pain Questionnaire-9 (FPQ-9 were modeled in a variance components modeling framework to test for genetic association with 8.5 M genetic variants across the genome, while adjusting for sex, age, education, and income. Results. Three genetic loci were significantly associated with fear of minor pain (8q24.13, 8p21.2, and 6q26; p<5×10-8 for all near the genes TMEM65, NEFM, NEFL, AGPAT4, and PARK2. Other suggestive loci were found for the fear of pain total score and each of the FPQ-9 subscales. Conclusions. Multiple genes were identified as possible candidates contributing to fear of pain. The findings may have implications for understanding and treating chronic orofacial pain.
Rogers, Simon N; Cleator, Alexander J; Lowe, Derek; Ghazali, Naseem
To describe clinical characteristics of head and neck cancer (HNC) patients with pain and those wishing to discuss pain concerns during consultation. Cross-sectional, questionnaire study using University of Washington Quality of Life, version 4 (UW-QOL) and the Patients Concerns Inventory (PCI) in disease-free, post-treatment HNC cohort. Significant pain on UW-QOL and indicating "Pain in head and neck" and "Pain elsewhere" on PCI. One hundred and seventy-seven patients completed UW-QOL and PCI. The prevalence of self-reported pain issues was 38% (67/177) comprising 25% (44/177) with significant problems despite medications and 13% (23/177) with lesser or no problems but wishing to discuss pain. Patients aged under 65 years and patients having treatment involving radiotherapy were more likely to have pain issues. Just over half, 55% (24/44) of patients with significant pain did not express a need to discuss this. Those with significant pain or others wanting to discuss pain in clinic had greater problems in physical and social-emotional functioning, reported suboptimal QOL, and also had more additional PCI items to discuss in clinic compared to those without significant pain and not wishing to discuss pain. Significant HNC-related pain is prevalent in the disease-free, posttreatment cohort. Onward referral to a specialist pain team may be beneficial. The UW-QOL and PCI package is a valuable tool that may routinely screen for significant pain in outpatient clinics.
Klingelhoefer, Lisa; Bhattacharya, Kalyan; Reichmann, Heinz
Restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED), is a common movement disorder characterised by an uncontrollable urge to move because of uncomfortable, sometimes painful sensations in the legs with a diurnal variation and a release with movement. The pathophysiology is only partially known and a genetic component together with dopaminergic and brain iron dysregulation plays an important role. Secondary causes for RLS need to be excluded. Treatment depends on the severity and frequency of RLS symptoms, comprises non-pharmacological (eg lifestyle changes) and pharmacological interventions (eg dopaminergic medication, alpha-2-delta calcium channel ligands, opioids) and relieves symptoms only. Augmentation is the main complication of long-term dopaminergic treatment of RLS. This article will provide a clinically useful overview of RLS with provision of diagnostic criteria, differential diagnoses, possible investigations and different treatment strategies with their associated complications. © 2016 Royal College of Physicians.
Full Text Available Abstract Background Leg weakness issues are a great concern for the pig breeding industry, especially with regard to animal welfare. Traits associated with leg weakness are partly influenced by the genetic background of the animals but the genetic basis of these traits is not yet fully understood. The aim of this study was to identify quantitative trait loci (QTL affecting leg weakness in pigs. Methods Three hundred and ten F2 pigs from a Duroc × Pietrain resource population were genotyped using 82 genetic markers. Front and rear legs and feet scores were based on the standard scoring system. Osteochondrosis lesions were examined histologically at the head and the condylus medialis of the left femur and humerus. Bone mineral density, bone mineral content and bone mineral area were measured in the whole ulna and radius bones using dual energy X-ray absorptiometry. A line-cross model was applied to determine QTL regions associated with leg weakness using the QTL Express software. Results Eleven QTL affecting leg weakness were identified on eight autosomes. All QTL reached the 5% chromosome-wide significance level. Three QTL were associated with osteochondrosis on the humerus end, two with the fore feet score and two with the rear leg score. QTL on SSC2 and SSC3 influencing bone mineral content and bone mineral density, respectively, reached the 5% genome-wide significance level. Conclusions Our results confirm previous studies and provide information on new QTL associated with leg weakness in pigs. These results contribute towards a better understanding of the genetic background of leg weakness in pigs.
Tan, Gabriel; Teo, Irene; Anderson, Karen O; Jensen, Mark P
Coping and beliefs are cornerstones to our understanding of adjustment to chronic pain. This study sought to test the hypothesis that maladaptive pain-related coping and beliefs are more strongly related to measures of patient adjustment than are adaptive coping and beliefs. A sample of 106 veterans with mixed chronic pain diagnoses in a multidisciplinary pain treatment program were administered measures of pain beliefs and pain coping, and composite scores were computed to reflect adaptive and maladaptive responses. Correlations between the composite scores and outcomes (pain intensity, pain interference, depression) were examined. Hierarchical multiple regressions were also conducted to estimate the independent contributions of adaptive and maladaptive responses. The maladaptive response composite score was found to be significantly related to pain interference and depression, whereas both adaptive and maladaptive response composite scores were found to be significantly related to pain intensity. The maladaptive response composite showed stronger independent associations with pain interference and depression after controlling for demographic variables, pain intensity, and adaptive responses. Contrary to expectations, only the adaptive response composite showed an independent association with pain intensity. The findings suggest that the relative importance of adaptive versus maladaptive beliefs and coping may differ as a function of the outcome domain in question. The findings support current cognitive-behavioral interventions that focus on reducing the frequency of maladaptive coping responses and beliefs as a way to improve patient functioning.
Letzen, Janelle E; Boissoneault, Jeff; Sevel, Landrew S; Robinson, Michael E
Test-retest reliability, or reproducibility of results over time, is poorly established for functional brain connectivity (fcMRI) during painful stimulation. As reliability informs the validity of research findings, it is imperative to examine, especially given recent emphasis on using functional neuroimaging as a tool for biomarker development. Although proposed pain neural signatures have been derived using complex, multivariate algorithms, even the reliability of less complex fcMRI findings has yet to be reported. This study examined the test-retest reliability for fcMRI of pain-related brain regions, and self-reported pain (through visual analogue scales [VASs]). Thirty-two healthy individuals completed 3 consecutive fMRI runs of a thermal pain task. Functional connectivity analyses were completed on pain-related brain regions. Intraclass correlations were conducted on fcMRI values and VAS scores across the fMRI runs. Intraclass correlations coefficients for fcMRI values varied widely (range = -.174-.766), with fcMRI between right nucleus accumbens and medial prefrontal cortex showing the highest reliability (range = .649-.766). Intraclass correlations coefficients for VAS scores ranged from .906 to .947. Overall, self-reported pain was more reliable than fcMRI data. These results highlight that fMRI findings might be less reliable than inherently assumed and have implications for future studies proposing pain markers.
Bharat Sutariya; Amit Patel; Ankit Desai; Sadik Shaikh
Objectives: The aim of this study was to explore the intensity of post-arthroscopy knee pain during the first 24 hours, and to study the influence of pre-operative pain, tourniquet time and amount of surgical trauma on post-arthroscopy pain. Methods: In 78 male patients that underwent elective arthroscopic menisectomy or diagnostic arthroscopy of the knee, preoperative and post-operative pain was registered using the Visual Analogue Scale. Variance for repeated measures and for independen...
Drosos, G. I.; Stavropoulos, N.I; Katsis, A; Kesidis, K; Kazakos, K.; Verettas, D.-A
The aim of this study was to explore the intensity of post-arthroscopy knee pain during the first 24 hours, and to study the influence of pre-operative pain, tourniquet time and amount of surgical trauma on post-arthroscopy pain. In 78 male patients that underwent elective arthroscopic menisectomy or diagnostic arthroscopy of the knee, preoperative and post-operative pain were registered using the Visual Analogue Scale. Variance for repeated measures and for independent observations was analy...
Brown, Christopher A; El-Deredy, Wael; Jones, Anthony K P
Supraspinal processes in humans can have a top-down enhancing effect on nociceptive processing in the brain and spinal cord. Studies have begun to suggest that such influences occur in conditions such as fibromyalgia (FM), but it is not clear whether this is unique to FM pain or common to other forms of chronic pain, such as that associated with osteoarthritis (OA). We assessed top-down processes by measuring anticipation-evoked potentials and their estimated sources, just prior (pain stimulation, in 16 patients with FM, 16 patients with OA and 15 healthy participants, by using whole-brain statistical parametric mapping. Clinical pain and psychological coping factors (pain catastrophizing, anxiety, and depression) were well matched between the patient groups, such that these did not confound our comparisons between FM and OA patients. For the same level of heat pain, insula activity was significantly higher in FM patients than in the other two groups during anticipation, and correlated with the intensity and extent of reported clinical pain. However, the same anticipatory insula activity also correlated with OA pain, and with the number of tender points across the two patient groups, suggesting common central mechanisms of tenderness. Activation in the dorsolateral prefrontal cortex was reduced during anticipation in both patient groups, and was related to less effective psychological coping. Our findings suggest common neural correlates of pain and tenderness in FM and OA that are enhanced in FM but not unique to this condition.
van den Oord, M.H.A.H.
Military pilots and rear aircrew members are occupations with several occupational exposures that might cause neck pain. In addition to the negative impact of neck pain on health, safety is one of the main concerns for the military aviation, because neck pain may interfere with flying performance. I
van den Oord, M.H.A.H.
Military pilots and rear aircrew members are occupations with several occupational exposures that might cause neck pain. In addition to the negative impact of neck pain on health, safety is one of the main concerns for the military aviation, because neck pain may interfere with flying performance.
textabstractMore than half of all pregnant women experience low back and/or pelvic pain of whom one-third has severe complaints. In most cases the pelvic pain disappears within a few months after delivery, either spontaneously or after conservative treatment. In a minority of patients the pain
textabstractMore than half of all pregnant women experience low back and/or pelvic pain of whom one-third has severe complaints. In most cases the pelvic pain disappears within a few months after delivery, either spontaneously or after conservative treatment. In a minority of patients the pain per
Orita, Sumihisa; Yamashita, Toshihiko; Ohtori, Seiji; Yonenobu, Kazuo; Kawakami, Mamoru; Taguchi, Toshihiko; Kikuchi, Shin-Ichi; Ushida, Takahiro; Konno, Shin-Ichi; Nakamura, Masaya; Fujino, Keiji; Matsuda, Shuichi; Yone, Kazunori; Takahashi, Kazuhisa
A cross-sectional study of 1804 consecutive patients. The aim of this study was to investigate the prevalence of pathological pain and its distribution features in patients with chronic lumbar spinal disorders. Clinical spinal disorders can involve pathological neuropathic pain (NeP) as well as physiological nociceptive pain (NocP), as they have varied pathology, including spinal cord injury, stenosis, and compression. A study conducted by the Japanese Society for Spine Surgery and Related Research (JSSR) has determined a prevalence of 29.4% for NeP in patients with lumbar spinal disorder. However, the data did not include information on pain location. Patients aged 20 to 79 years with chronic lower back pain (≥3 months, visual analog scale score ≥30) were recruited from 137 JSSR-related institutions. Patient data included an NeP screening questionnaire score and pain location (lower back, buttock, and legs). The association between the pain pathology and its location was analyzed statistically using the unpaired t test and Chi-square test followed by Fisher test. P < 0.05 was considered significant. Low back pain subjects showed 31.9% of NeP prevalence, and the pain distribution showed [NocP(%)/NeP(%)] low back pain only cases: 44/22, while low back pain with leg pain cases showed a prevalence of 56/78. This indicates that low back pain alone can significantly induce NocP rather than NeP (P < 0.01). Buttock pain was revealed to significantly induce both lower back pain and leg pain with NeP properties (P < 0.01). Leg pain was revealed to be predominantly neuropathic, especially when it included peripheral pain (P < 0.01). Low back pain with no buttock pain induces NocP rather than NeP. Buttock pain is significantly associated with NeP prevalence whether or not leg pain exists. Leg pain can increase the prevalence of NeP, especially when it contains a peripheral element. 3.
Fagherazzi, Guy; Vilier, Alice; Boutron-Ruault, Marie-Christine; Clavel-Chapelon, Françoise; Mesrine, Sylvie
If height is a well-established risk factor for breast cancer, leg length and sitting height are usually considered as better candidate biomarkers of growth hormone exposure than height, respectively...
Park, Young-Min; Shin, Hyun-Woo
Zolpidem-induced sleep-related complex behaviors (SRCB) with anterograde amnesia have been reported. We describe herein a case in which the development of zolpidem-induced sleep-related eating disorder (SRED) and SRCB was strongly suspected. A 71-year-old Korean male was admitted to the Department of Psychiatry due to his repetitive SRED and SRCB with anterograde amnesia, which he reported as having occurred since taking zolpidem. The patient also had restless legs syndrome (RLS) and obstructive sleep apnea (OSA). His baseline serum iron level was low at admission. Zolpidem discontinuation resulted in the immediate disappearance of his SRED, but did not affect his RLS symptoms. These symptoms rapidly improved after adding a single i.v. iron injection once daily, and so he was discharged to day-clinic treatment. These findings indicate that zolpidem can induce SRCB. Although the pathophysiology of zolpidem-induced SRED and other SRCB remains unclear, clinicians should carefully monitor for the potential induction of complex behaviors associated with zolpidem in patients with comorbid RLS or OSA. PMID:27489385
Park, Young-Min; Shin, Hyun-Woo
Zolpidem-induced sleep-related complex behaviors (SRCB) with anterograde amnesia have been reported. We describe herein a case in which the development of zolpidem-induced sleep-related eating disorder (SRED) and SRCB was strongly suspected. A 71-year-old Korean male was admitted to the Department of Psychiatry due to his repetitive SRED and SRCB with anterograde amnesia, which he reported as having occurred since taking zolpidem. The patient also had restless legs syndrome (RLS) and obstructive sleep apnea (OSA). His baseline serum iron level was low at admission. Zolpidem discontinuation resulted in the immediate disappearance of his SRED, but did not affect his RLS symptoms. These symptoms rapidly improved after adding a single i.v. iron injection once daily, and so he was discharged to day-clinic treatment. These findings indicate that zolpidem can induce SRCB. Although the pathophysiology of zolpidem-induced SRED and other SRCB remains unclear, clinicians should carefully monitor for the potential induction of complex behaviors associated with zolpidem in patients with comorbid RLS or OSA.
Matthew K. Seeley
Full Text Available The causes of able-bodied gait asymmetries are unclear. Mild ( 1 cm; n = 7. Statistically significant relationships were observed between LLI and the symmetry coefficient for knee joint moment (r = -0.48 and power (r = -0.51, and ankle joint moment (r = -0.41 and power (r = -0.42. Similarly, subjects with relatively large LLI exhibited significantly lower symmetry coefficients for knee joint moment (p = 0.40 and power (p = 0.35, and ankle joint moment (p = 0.40 and power (p = 0.22 than subjects with relatively small LLI. Degree of bilateral symmetry for knee and ankle joint kinetics appears to be related to LLI in able- bodied gait. This finding supports the idea that LLI is one cause of able-bodied gait asymmetries. Other factors, however, are also likely to contribute to these gait asymmetries; these may include other morphological asymmetries as well as asymmetrical neuromuscular input to the lower limb muscles
Malfliet, Anneleen; Leysen, Laurence; Pas, Roselien; Kuppens, Kevin; Nijs, Jo; Van Wilgen, Paul; Huysmans, Eva; Goudman, Lisa; Ickmans, Kelly
In the last decade, evidence regarding chronic pain has developed exponentially. Numerous studies show that many chronic pain populations show specific neuroplastic changes in the peripheral and central nervous system. These changes are reflected in clinical manifestations, like a generalized hypersensitivity of the somatosensory system. Besides a hypersensitivity of bottom-up nociceptive transmission, there is also evidence for top-down facilitation of pain due to malfunctioning of the endogenous descending nociceptive modulatory systems. These and other aspects of modern pain neuroscience are starting to be applied within daily clinical practice. However, currently the application of this knowledge is mostly limited to the general adult population with musculoskeletal problems, while evidence is getting stronger that also in other chronic pain populations these neuroplastic processes may contribute to the occurrence and persistence of the pain problem. Therefore, this masterclass article aims at giving an overview of the current modern pain neuroscience knowledge and its potential application in post-cancer, paediatric and sports-related pain problems. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.
Brandt, Charles P; Zvolensky, Michael J; Daumas, Stephanie D; Grover, Kristin W; Gonzalez, Adam
Persons living with HIV/AIDS (PLHA) experience clinically significant pain as a result of HIV and such pain is often related to increased levels of anxiety/depression. Pain-related anxiety has been identified as a mechanism in the onset and progression of pain experience and associated affective distress. However, there has not been empirical study of pain-related anxiety in relation to affective processes among PLHA. To address this gap, hierarchical multiple regressions were conducted using SPSS v.21 to examine pain-related anxiety (as measured using the Pain Anxiety Symptoms Scale) in relation to anxiety and depressive symptoms (as measured using the Mood and Anxiety Symptoms Questionnaire) among 93 PLHA (10.8% female; Mean age = 49.63, SD = 8.89). Pain-related anxiety was significantly related to anxious arousal symptoms (β = .43) and anhedonic depressive symptoms (β = .25); effects were evident beyond the variance accounted for by CD4 count, race, sex, income level, and current level of bodily pain. The present results suggest that pain-related anxiety may play a role in the experience of anxiety and depressive symptoms among PLHA.
-third of patients who reported pain relief with analgesics had these prescribed on their drug lists. Sleep was characterized by frequent awakenings. Urinary urgency and restless legs were frequently reported as troublesome. Patients rated HRQoL as significantly worse in all items compared with a healthy reference population matched for age and sex.Conclusions: Experiences of chronic PD-related pain are complex; there is substantial sleep fragmentation and negative impact on HRQoL.Keywords: data reporting, pain, Parkinson disease, sleep fragmentation
Pool-Goudzwaard, A.; Slieker ten Hove, M.C.; Vierhout, M.E.; Mulder, P.H.M. de; Pool, J.; Snijders, C.J.; Stoeckart, R.
To assess the occurrence of pelvic floor dysfunction (PFD) in pregnancy- related low back and pelvic pain (PLBP) patients, a cross-sectional study was performed, comprising 77 subjects. Each subject underwent physical assessment, and filled in the Urogenital Distress Inventory completed with gynaeco
Hiraoka, Regina; Crouch, Julie L; Reo, Gim; Wagner, Michael; Milner, Joel S; Skowronski, John J
This study examined whether parents with varying degrees of child physical abuse (CPA) risk differed in pain tolerance, pain sensitivity, and accessibility of aggression-related schemata. Participants included 91 (51 low CPA risk and 40 high CPA risk) general population parents. Participants were randomly assigned to complete either an easy or a difficult anagram task. Pain tolerance and pain sensitivity were assessed using a cold pressor task. Accessibility of aggression-related schemata was assessed at the outset of the data collection session and at the end of the session using a word completion task. Parents' self-reported negative affect was assessed three times over the course of the study: baseline, after the anagram task, and after the cold pressor task. As expected, high-risk (compared to low-risk) parents reported higher levels of negative affect at each time point. Moreover, after completing the difficult anagram task, high-risk (compared to low-risk) parents exhibited higher pain sensitivity during the cold pressor task. Following completion of the cold pressor task, high-risk (compared to low-risk) parents exhibited greater accessibility of aggression-related schemata. Collectively, these findings indicate that under certain conditions, high-risk parents experience a confluence of aggression-related risk factors (i.e., negative affect, pain sensitivity, and aggression-related information processes) that may predispose them to aggressive behavior.
Nelson, E Andrea
Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide
Albert, Hanne Birgit; Kjær, Per; Jensen, Tue Secher
, and type 3 is sclerotic bone. The temporal evolution of MC is uncertain, but the time span is years. Subchondral bone marrow signal changes associated with pain can be observed in different specific infectious, degenerative and immunological diseases such as osseous infections, osteoarthritis, ankylosing...... spondylitis and spondylarthritis. In the vertebrae, MC is seen in relation to vertebral fractures, spondylodiscitis, disc herniation, severe disc degeneration, injections with chymopapain, and acute Schmorl's impressions. The aim of this paper is to propose two possible pathogenetic mechanisms causing Modic......-50% of patients with LBP and enable in the development of efficient treatments which might be antibiotics, special rehabilitation programmes, rest, stabilizing exercise, or surgical fixation, depending on the underlying cause for the MC....
Lee, Jennifer E.; Watson, David; Frey Law, Laura A.
Pain is a debilitating condition affecting millions each year, yet what predisposes certain individuals to be more sensitive to pain remains relatively unknown. Several psychological factors have been associated with pain perception, but the structural relations between multiple higher- and lower-order constructs and pain are not well understood. Thus, we aimed to examine the associations between pain perception using the cold pressor task (CPT), higher-order personality traits (neuroticism, ...
The pain experience includes a sensory-discriminative and an emotional-affective components. The affective dimension refers to the unpleasantness or aversion of sensation. The great progress at the genetic, molecular, cellular, and systemic levels on the study of the sensory dimension of pain has been made over past four decades. However, "to consider only the sensory features of pain, and ignore its motivational and affective properties, is to look at only part of the problem and not even the most important part of that". A line of clinic observations indicate that the patients with chronic pain suffer from much more affective disturbance than pain itself. Obviously,physiological arousal and hypervigilance to pain cause negative affect, such as anxiety, anger, worry, aversion, even tendency of suicide,these negative affective states in turn enhance pain sensation. Today, more and more attention has been paid to the study on mechanisms underlying affective dimension of pain. In order to deepen and expand our understanding of the nature of pain, this review summarizes the main progress and recent findings from our laboratory regarding affective component of pain in neuroanatomy, neurophysiology, and cell biochemistry.
Minár, M; Petrleničová, D; Valkovič, P
Multiple sclerosis (MS) is connected with higher prevalence of secondary restless legs syndrome/Willis-Ekbom disease (RLS/WED). Aim of this study was to determine risk factor for developing symptoms of RLS in MS patients. In cross-sectional study we examined 200 random MS patients. After obtaining informed consents, patients undervent a structured interview based on RLS and MS symptoms and characteristics, demographic, and health-related data. Than we collected results of brain/spinal cord magnetic resonance imaging (MRI). Blood samples were examined for blood count and biochemistry. From all 200 subjects, 26% were RLS-positives (95% CI: 20-32%). From positive patients, 44% had negative family history for RLS, and developed secondary RLS after onset of MS. Compared to RLS-negatives, the positives had significantly higher prevalence of spinal cord lesions (p=0.01). Presence of spinal pathology was connected with higher risk of RLS development (OR=3.846, 95%CI:1.304-11.346). There were no statistically significant differences in the levels of red blood cells, iron metabolism parameters, or levels of B or D vitamins. Risk of RLS/WED in MS increases with presence of lesions in spinal cord. The role of decreased dopamine delivery to lower spinal regions as the pathological background must be proved by more detailed research. Copyright © 2017 Elsevier B.V. All rights reserved.
The aim of this thesis is to determine which work related physical and psychosocial risk factors exist which cause neck pain and absenteeism because of neck pain. There is some evidence for a positive relationship between he duration of sedentary posture at work and neck pain, and between twisting o
Ebbehøj, N; Borly, L; Bülow, J
The relation between pancreatic tissue fluid pressure and pain, morphology, and function was studied in a cross-sectional investigation. Pressure measurements were performed by percutaneous fine-needle puncture. Thirty-nine patients with chronic pancreatitis were included, 25 with pain and 14...... calcifications. In conclusion, pancreatic tissue fluid pressure is a valuable indicator of pain in chronic pancreatitis....
Fall-Dickson, Jane M; Mock, Victoria; Berk, Ronald A; Grimm, Patricia M; Davidson, Nancy; Gaston-Johansson, Fannie
The purpose of this cross-sectional, correlational study was to describe stomatitis-related pain in women with breast cancer undergoing autologous hematopoietic stem cell transplant. The hypotheses that significant, positive relationships would exist between oral pain and stomatitis, state anxiety, depression, and alteration in swallowing were tested. Stomatitis, sensory dimension of oral pain, and state anxiety were hypothesized to most accurately predict oral pain overall intensity. Thirty-two women were recruited at 2 East Coast comprehensive cancer centers. Data were collected on bone marrow transplantation day +7 +/- 24 hours using Painometer, Oral Mucositis Index-20, Oral Assessment Guide, State-Trait Anxiety Inventory, and Beck Depression Inventory. Data analysis included descriptive statistics, correlations, and stepwise multiple regression. All participants had stomatitis; 47% had oral pain, with a subset reporting continuous moderate to severe oral pain despite pain management algorithms. Significant, positive associations were seen between oral pain, stomatitis, and alteration in swallowing and between oral pain with swallowing and alteration in swallowing. Oral pain was not significantly correlated with state anxiety and depression. Oral sensory and affective pain intensity most accurately predicted oral pain overall intensity. Future research needs to explore factors that affect perception and response to stomatitis-related oropharyngeal pain and individual patient response to opioid treatment.
Schoth, Daniel E; Ma, Yizhu; Liossi, Christina
Attentional biases for pain-related words and images have commonly been reported in individuals with chronic pain. In former studies, however, pain-related stimuli have been presented without context, for example, facial expressions of pain with no accompanying information regarding the location, severity, or cause of pain or injury. The present study investigated attentional biases for pain-related information using complex, real-world scenes in an ecologically valid experimental paradigm. Participants with chronic musculoskeletal pain (n=20) and healthy, pain-free controls (n=23) completed a version of the change detection paradigm, the flicker task, which requires participants to detect a single difference between 2 otherwise identical versions of the same scene. These change-scenes were presented in a continuous cycle for approximately 3 minutes, with an unrelated distractor-scene interspersed between. Both pain-related and neutral scenes were used in 4 experimental conditions: change-pain/distractor-pain, change-pain/distractor-neutral, change-neutral/distractor-pain, and change-neutral/distractor-neutral. Individuals with chronic musculoskeletal pain, relative to healthy control participants, took significantly longer to detect changes when the change-scene was pain-related. Within-group analysis showed healthy control participants to take significantly longer to detect changes in neutral change-scenes compared with pain-related change-scenes. This study is the first to show individuals with chronic pain possess attentional biases for pain-related information presented as part of complex, real-world scenes. Possible future research includes the use of real-world scenes in visual-search paradigms modifying attentional biases, and exploration into the relations and effects of combined cognitive biases (eg, attention, memory, and interpretation) in chronic pain.
马明; 周卫; 张世民; 李星; 章永东; 黎作旭; 吴冠男; 张兆杰
目的:初步研制腰腿痛患者报告结局量表.方法:通过对前期量表修订、典型病例访谈、核心小组讨论、专家咨询、借鉴国内外相关量表等方法,形成初步量表.于2010年6月-2011年2月间,纳入住院患者100例:男性44例,女性56例;年龄22～65岁,平均51.8岁;腰椎间盘突出症66例,腰椎管狭窄症34例.应用该量表对患者进行测评,并对其进行认知性、信度和效度分析.结果:形成一个由3个域16个条目组成的腰腿痛患者报告结局量表.32例病情无变化患者两次评分比较差异无统计学意义(P＞0.05),且有显著相关性(r＞0.9);该量表总体克朗巴赫a系数为0.936;每个条目得分与其所在域得分的相关系数均大于0.5;该量表同Oswestry功能障碍指数问卷表对患者的评分结果具有显著相关性(r＞0.9).结论:该量表有较好的认知性、信度和效度,可尝试作为腰腿痛患者临床疗效的评价工具,但仍需进一步的评价和修订.%Objective:To develop a patient reported outcome instrument for low back and leg pain preliminarily. Methods: The primary instrument was formed by revising early scale, interviewing typical cases, focus group discussion, expert consulting, referring to related instrument,and etc. 100 inpatients(44 males and 56 females)were analyzed from June 2010 to February 2011. They aged from 22 to 65 years old(mean, 51. 8 years), including 66 lumbar disc herniation and 34 lumber spinal stenosis. They were tested by the instrument, and then analyzed the cognition, reliability and validity of the scale. Results: A 3-domain,16-item instrument was developed. For 32 patients with no changes in illness, there was no statistical significant difference between two scores(P>0. 05)and it showed significant correlation r>0. 9). The total Cronbach's Alpha of the instrument was 0. 936. The correlation coefficients of the score of each item and its corresponding domain were more than 0. 5. Measurement
Reis-Pina, Paulo; Lawlor, Peter G; Barbosa, António
Background Several guidelines have advocated the need for adequate cancer-related pain (CRP) management. The pain management index (PMI) has been proposed as an auditable measure of the appropriateness for analgesic therapy. Objectives To determine the adequacy of CRP management based on the PMI status and its patient-related predictors at the point of referral to a pain clinic (PC). Methods Consecutive patients referred to a PC had standardized initial assessments and status documentation on the Brief Pain Inventory (BPI) ratings; pain mechanism, using a neuropathic pain diagnostic questionnaire (the Douleur Neuropathique 4 tool); episodic pain; oral morphine equivalent daily dose; the Hospital Anxiety Depression Scale and the Emotion Thermometer scores; and cancer diagnosis, metastases, treatment, and pain duration. Predictors of “negative PMI status” [PMI(−)] were examined in logistic regression models. Variables with pPMI(−), suggesting undertreatment of CRP. Both female sex and higher scores on the BPI’s “interference with general activity” more strongly predicted PMI(−). Patients who received either radiotherapy or one or more adjuvant analgesics prior to the initial consultation at the PC, those who had neuropathic pain, those who had a greater need for emotional help, and those with higher BPI’s “relief ” scores were all less likely to be PMI(−). Conclusion The potential burden of patient and family distress associated with suboptimal CRP management in one in four patients should generate major public health concern and prompt appropriate educational and health policy measures to address the deficit.
Claes, Nathalie; Vlaeyen, Johan W S; Crombez, Geert
Previous research shows that goal-directed behavior might be modulated by cues that predict (dis)similar outcomes. However, the literature investigating this modulation with pain outcomes is scarce. Therefore, this experiment investigated whether environmental cues predicting pain or reward modulate
van Harten, Barbera; Weinstein, Henry C.; Scheltens, Philip; Scherder, Erik J. A.; Oosterman, J
Since aging is a risk factor for both dementia and the occurrence of painful conditions, with the number of aged people increasing in the next decades, an increase in the number of elderly people suffering from both conditions can be anticipated. Reliable pain assessment in this population is restri
Scherder, E; Wolters, E; Polman, C; Sergeant, J; Swaab, D
Although pain is one of the major clinical symptoms of Parkinson's disease (PD) and multiple sclerosis (MS), it is often neglected and therefore undertreated. The question why the perception of pain in stages without cognitive impairment is not affected by the neuropathology has not been addressed s
Tamburin, Stefano; Idone, Domenico; Zanette, Giampietro
We report on a patient with segmental rhythmic myoclonus resembling belly dance. This patient developed the myoclonus in temporal and anatomical association with chronic abdominal pain. No structural or metabolic abnormalities were found. EMG recordings suggested the presence of a spinal cord central pattern generator (CPG). We hypothesize that pain-related spinal plasticity might have contributed to the hyperactivity of a spinal CPG, thus leading to the myoclonic jerks in our patient.
Chronic muscle pain is a common complaint among patients who seek care for musculoskeletal disorders. A spectrum of clinical presentations exists, ranging from focal or regional complaints that usually represent myofascial pain syndromes to more wide spread pain that may meet criteria for a diagnosis of fibromyalgia. This article addresses the epidemiology, pathophysiology, and clinical management of myofascial pain syndrome and fibromyalgia. These conditions are challenging to treat and require physiatrists to be aware of the wide range of pharmacologic, rehabilitative,and psychosocial interventions that can be helpful.
Flaten, Magne Arve
Individuals undergoing treatment for a symptom like pain expect that the treatment will reduce the pain. Many studies show that healthy volunteers or patients in pain report less pain after inactive treatment, if they believe that active medication has been administrated. The reduction of pain can be partly blocked by systemic administration of naloxone, an opioid antagonist. There is reduced central nervous system activation to painful stimuli in individuals who have been given a placebo and told it is a painkiller. These findings suggest that the expectation of pain relief generates central nervous system opioid activity that inhibits pain transmission to the cerebral cortex. Expectations may thus lead to changes in central nervous system activity that reduces pain. It is proposed that expectations activate a homeostatic system that corrects perturbations to the system via negative feedback. The nocebo effect is the opposite of the placebo effect, and is due to induction of negative emotions. Part of the treatment of many symptoms and diseases is due to autonomic adjustments controlled by the central nervous system. The involvement of emotional processes in placebo effects could have important consequences for interpretation of data from randomized controlled trials.
Aredo, Jacqueline V; Heyrana, Katrina J; Karp, Barbara I; Shah, Jay P; Stratton, Pamela
Chronic pelvic pain is a frustrating symptom for patients with endometriosis and is frequently refractory to hormonal and surgical management. While these therapies target ectopic endometrial lesions, they do not directly address pain due to central sensitization of the nervous system and myofascial dysfunction, which can continue to generate pain from myofascial trigger points even after traditional treatments are optimized. This article provides a background for understanding how endometriosis facilitates remodeling of neural networks, contributing to sensitization and generation of myofascial trigger points. A framework for evaluating such sensitization and myofascial trigger points in a clinical setting is presented. Treatments that specifically address myofascial pain secondary to spontaneously painful myofascial trigger points and their putative mechanisms of action are also reviewed, including physical therapy, dry needling, anesthetic injections, and botulinum toxin injections.
Aredo, Jacqueline V.; Heyrana, Katrina J.; Karp, Barbara I.; Shah, Jay P.; Stratton, Pamela
Chronic pelvic pain is a frustrating symptom for patients with endometriosis and is frequently refractory to hormonal and surgical management. While these therapies target ectopic endometrial lesions, they do not directly address pain due to central sensitization of the nervous system and myofascial dysfunction, which can continue to generate pain from myofascial trigger points even after traditional treatments are optimized. This article provides a background for understanding how endometriosis facilitates remodeling of neural networks, contributing to sensitization and generation of myofascial trigger points. A framework for evaluating such sensitization and myofascial trigger points in a clinical setting is presented. Treatments that specifically address myofascial pain secondary to spontaneously painful myofascial trigger points and their putative mechanisms of action are also reviewed, including physical therapy, dry needling, anesthetic injections, and botulinum toxin injections. PMID:28049214
Rømsing, Janne; Larsen, Camilla; Friis, Susanne Molin
BACKGROUND: Children being cared for in hospital often undergo multiple diagnostic and therapeutic procedures. Procedure-related pain, anxiety, and distress may consequently place a significant burden on the children. Although standards for pain management exist, procedure-related pain remains...... inadequately treated. OBJECTIVE: To determine the frequency and pain intensity of procedures in children, as well as the associated pharmacologic interventions to manage the pain in a Danish University Hospital. METHODS: During a 3-month period in 2013, a structured questionnaire was used to prospectively...
Omori, Shigeki; Isose, Sagiri; Misawa, Sonoko; Watanabe, Keisuke; Sekiguchi, Yukari; Shibuya, Kazumoto; Beppu, Minako; Amino, Hiroshi; Kuwabara, Satoshi
Neuropathic pain can result from neuronal hyperexcitability and complex interactions of the nociceptive pathways. Intraepidermal electrical stimulation (IES) is a novel technique that can selectively activate Aδ and C fibers. To investigate patterns of changes in Aδ- and C-mediated brain responses in patients with neuropathic pain using IES, we recorded pain-related evoked potential (PREP) after IES of Aδ and C fibers in 20 patients with neuropathic pain and 15 age-matched healthy volunteers. We evaluated PREP latencies, amplitudes, and amplitude ratios of PREPs after C/Aδ-fiber stimulation. PREP amplitudes after Aδ-fiber stimulation tended to be smaller in the patient group, whereas there were no significant differences in amplitudes after C-fiber stimulation between the patient and normal control groups. PREP amplitude ratios after C/Aδ-fiber stimulation were significantly greater in the patient group than in the control group, and the higher ratio tended to be associated with a greater visual analog scale score. Patients with neuropathic pain had a tendency towards decreased Aδ amplitudes and significantly increased C/Aδ PREP amplitude ratios and this ratio appeared to be associated with the intensity of pain. Our findings suggest that decreased inhibition of the Aδ to C nociceptive systems is associated with generation of neuropathic pain. Copyright © 2017 Elsevier Ireland Ltd and Japan Neuroscience Society. All rights reserved.
Richter, Maria; Eck, Judith; Straube, Thomas; Miltner, Wolfgang H R; Weiss, Thomas
Previous studies suggested that areas of the pain matrix of the human brain are recruited by the processing of pain-related environmental cues such as pain-related pictures or descriptors of pain. However, it is still sketchy whether those activations are specific to the pain-relevance of the stimuli or simply reflect a general effect of negative valence or increased arousal. The present study investigates the neural mechanisms underlying the processing of pain-related, negative, positive, and neutral words. Pain-related words were matched to negative words regarding valence and arousal, and to positive words regarding arousal. Sixteen healthy subjects were scanned during two tasks, imagination and distraction, using functional MRI. When subjects were instructed to image a situation associated with the word presented (imagination task), we found increased activation within dorsolateral prefrontal cortex (DLPFC), inferior patietal gyri (IPG), and precuneus when processing pain-related words compared to other words. However, when attention was focused on a foreground task and words were presented in the background (distraction task), we found a decrease in activation within dorsal anterior cingulum (dACC) and a relative increase in activation within the subgenual ventral anterior cingulum (sACC) when processing pain related words compared to other words. Thus, activations to pain-related words are strongly modulated by the attention demands of the task. Most remarkably, the differences in processing pain-related words compared to non-pain-related words are specific to the pain-relevance of the words and cannot simply be explained by their valence or arousal.
Hartvigsen, Lisbeth; Hestbæk, Lise; Leboeuf-Yde, Charlotte
Background Low back pain (LBP) patients with related leg pain and signs of nerve root involvement (NRI) are considered to have a worse prognosis than patients with LBP alone. However, knowledge is limited about the importance of distinguishing between leg pain above or below the knee and leg pain...... whether this relationship is similar chiropractic practice (CP) and general practice (GP). Method This is a prospective observational cohort study of adult patients seeking care for LBP in CP or GP. Patients completed an extensive baseline questionnaire and were classified into the four QTF categories...... between distinctly different patient subgroups. Local LBP was on all parameters the least severe condition. Although less clear-cut, distribution of leg pain and clinical signs of NRI differentiated between patient groups with different clinical presentation and course; generally with increasing severity...
Are reductions in pain intensity and pain-related distress necessary? An analysis of within-treatment change trajectories in relation to improved functioning following interdisciplinary acceptance and commitment therapy for adults with chronic pain.
Vowles, Kevin E; Witkiewitz, Katie; Levell, Jayne; Sowden, Gail; Ashworth, Julie
A key issue in chronic pain treatment concerns the changes necessary for improved physical and emotional functioning. Traditionally, reducing pain intensity and pain-related distress have been viewed as a prerequisite for these improvements. Alternatively, acceptance and commitment therapy, a behavior change approach, theorizes that pain and distress reduction are not necessary for improvement, rather responses must change, such that functioning improves in clearly specified areas (e.g., engagement in valued activities, decreased disability in social activity) even when pain and distress persist. This study sought to directly examine aspects of change in pain and distress over the course of an interdisciplinary program of acceptance and commitment therapy in relation to functioning at treatment's conclusion and a 3-month follow-up in 174 treated patients. Latent change trajectories of pain intensity and pain-related distress were assessed weekly over 4 weeks of treatment and analyzed via latent growth curve and growth mixture modeling. A single latent trajectory with a decreasing quadratic slope was indicated for pain, while 2 separate trajectories were identified for pain-related distress 1 of linear decrease and the other an early increase followed by a decrease to initial level. Overall, and with only 3 exceptions across multiple tests, results indicated that trajectories of pain and distress during treatment were not significantly associated with improvements in functioning at treatment's conclusion and follow-up. This pattern of findings suggests that significant improvements in functioning may not require decreases in pain intensity and pain-related distress during treatment for chronic pain. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Vægter, Henrik Bjarke; Handberg, G.; Graven-Nielsen, Thomas
BACKGROUND: Aerobic and isometric exercises are known to decrease pain sensitivity. The effect of different types of exercise on central mechanisms such as temporal summation of pain (TSP) is less clear. This study hypothesized that both aerobic and isometric exercises would increase pressure pain...... and a non-exercise condition (experiment 1), and after low- and high-intensity bicycling and low- and high-intensity isometric arm and leg exercises with the dominant arm/leg (experiment 2). PTT and TSP were assessed before and after each exercise condition on the non-dominant arm and leg by computer......-controlled cuff algometry. TSP was assessed by visual analogue scale (VAS) scores of the pain intensity during sequential cuff-pressure stimulation at the pain tolerance intensity related to that specific time point. RESULTS: In experiment 1, bicycling, but not the non-exercise condition, slightly increased PTT...
Miller, I M; Nielsen, J S; Lophaven, S
between pain-reducing intervention and diagnosis, pre-treatment, gender or age was found. CONCLUSIONS: Pain-reducing intervention was required in 44% of the PDT treatments. Intervention was particularly required when treating lesions in areas suited for PDT therapy for cosmetic reasons such as the scalp...
Klepstad, P; Kurita, G P; Mercadante, S
The European Association for Palliative Care has initiated a comprehensive program to achieve an over-all review of the evidence of multiple cancer pain management strategies in order to extend the current guideline for treatment of cancer pain. The present systematic review analyzed the existing...
Fabiana Maria Rodrigues Lopes de Oliveira
Full Text Available Objective: to investigate the association between foot pain and functional disability in the elderly. Methods: descriptive study conducted among the elderly attended in a geriatric outpatient clinic of a university hospital. The sample consisted of 114 elderly who reported foot pain. Data was collected through subsidized interview, using structured instrument, covering demographic variables and the Manchester Foot Pain and Disability Index in Elderly and the Mini Mental State Examination. Results: there was a high incidence of foot pain among women and young elderly as well as significant inability to perform certain daily activities. Conclusion: it is identified the need for special attention to the health of elderly reporting foot pain, since this tends to restrict daily activities, causing decreased quality of life, immobilization and possible episodes of falls.
Full Text Available Britt-Marie Stålnacke, Anna ÖstmanDepartment of Community Medicine and Rehabilitation, Umeå University, SwedenAim: To investigate post-traumatic stress, pain intensity, depression, and anxiety in patients with injury-related chronic pain before and after participating in multimodal pain rehabilitation.Methods: Twenty-eight patients, 21 women and seven men, who participated in the multimodal rehabilitation programs (special whiplash program for whiplash injuries within 1.5 years after the trauma or ordinary program answered a set of questionnaires to assess post-traumatic stress (Impact of Event Scale [IES], pain intensity [Visual Analogue Scale (VAS], depression, and anxiety (Hospital Anxiety and Depression Scale [HAD] before and after the programs.Results: Both pain intensity and post-traumatic stress decreased significantly after the rehabilitation programs in comparison with before (VAS: 57.8 ± 21.6 vs. 67.5 ± 21.9; P = 0.009, IES total score 21.8 ± 13.2 vs. 29.5 ± 12.9; P < 0.001. Patients younger than 40 years reported a statistically higher level of post-traumatic stress compared with patients older than 40 years both before (P = 0.037 and after rehabilitation (P = 0.023. No statistically significant differences were found on the HAD scores.Conclusion: The multimodal rehabilitation programs were effective in reducing both pain intensity and post-traumatic stress. The experience of higher levels of post-traumatic stress in younger persons has to be taken into account when managing patients with injury-related chronic pain.Keywords: post-traumatic, stress disorder, chronic pain, whiplash injuries
Martel, Marc O; Finan, Patrick H; Dolman, Andrew J; Subramanian, Subu; Edwards, Robert R; Wasan, Ajay D; Jamison, Robert N
The primary purpose of this study was to examine the association between self-reports of medication side effects and pain-related activity interference in patients with chronic pain. The potential moderators of the association between reports of side effects and pain-related activity interference were also examined. A total of 111 patients with chronic musculoskeletal pain were asked to provide, once a month for a period of 6 months, self-reports of medication use and the presence of any perceived side effects (eg, nausea, dizziness, headaches) associated with their medications. At each of these time points, patients were also asked to provide self-reports of pain intensity, negative affect, and pain-related activity interference. Multilevel modeling analyses revealed that month-to-month increases in perceived medication side effects were associated with heightened pain-related activity interference (P effects were associated with heightened pain-related activity interference even after controlling for the influence of patient demographics, pain intensity, and negative affect. This study provides preliminary evidence that reports of medication side effects are associated with heightened pain-related activity interference in patients with chronic pain beyond the influence of other pain-relevant variables. The implications of our findings for clinical practice and the management of patients with chronic pain conditions are discussed.
Cano, Annmarie; Leong, Laura E M; Williams, Amy M; May, Dana K K; Lutz, Jillian R
The communication of pain has received a great deal of attention in the pain literature; however, one form of pain communication--emotional disclosure of pain-related distress (e.g., sadness, worry, anger about pain)--has not been studied extensively. This study examined the extent to which this form of pain communication occurred during an observed conversation with one's spouse and also investigated the correlates and consequences of disclosure. Individuals with chronic pain (ICP) and their spouses (N=95 couples) completed several questionnaires regarding pain, psychological distress, and relationship distress as well as video recorded interactions about the impact of pain on their lives. Approximately two-thirds of ICPs (n=65) disclosed their pain-related distress to their spouses. ICPs who reported greater pain severity, ruminative catastrophizing and affective distress about pain, and depressive and anxiety symptoms were more likely to disclose their distress to their spouses. Spouses of ICPs who disclosed only once or twice were significantly less likely to invalidate their partners whereas spouses of ICPs who disclosed at a higher rate were significantly more likely to validate their partners. Furthermore, spouses were more likely to engage in invalidation after attempting more neutral or validating responses, suggesting an erosion of support when ICPs engaged in high rates of disclosure. Correlates of spousal invalidation included both spouses' helplessness catastrophizing, ICPs' affective distress about pain, and spouses' anxiety, suggesting that both partners' distress are implicated in maladaptive disclosure-response patterns. Findings are discussed in light of pain communication and empathy models of pain.
Larsson, Caroline; Ekvall Hansson, Eva; Sundquist, Kristina; Jakobsson, Ulf
The contribution of kinesiophobia (fear of movement) to the pain experience among older adults has been poorly evaluated. The aim of this study was to study prevalence at baseline, development over a 12-month period and cognitive-affective variables of kinesiophobia in a population-based sample of older adults with chronic pain. The study included 433 older adults (+65 years) with chronic pain (mean age 74.8 years) randomly selected using a Swedish register of inhabitants. Kinesiophobia was measured at baseline and 12-month follow-up with the 11-item version of the Tampa Scale of Kinesiophobia (TSK-11). Associations of demographic-, cognitive affective - and pain-related variables to kinesiophobia were analysed with linear regression analyses. The mean level of kinesiophobia was low. Worsening and recovering from kinesiophobia occurred over time, but the mean level of kinesiophobia remained unchanged (p = 0.972). High levels of kinesiophobia (TSK ≥35) were found among frailer and older adults predominately living in care homes, but not dependent on sex. Poor self-perceived health (OR = 8.84) and high pain intensity (OR = 1.22) were significantly associated with kinesiophobia. Results indicate that potential interventions regarding kinesiophobia among older adults should aim to decrease pain intensity and strengthen health beliefs.
Background: Pain management is a frequent problem in the neonatal intensive care unit (NICU). Few studies examining effects of integrative care therapies on pain-related outcomes in neonates have included physiological outcomes or investigated the use of such therapies in a practice-based setting. Objective: The purpose of this practice-based retrospective study was to examine the associations between integrative care therapies, particularly massage and healing touch, and pain-related outcome...
International cricket studies mostly concentrate on young fast- bowlers and their ... no studies have investigated injuries and pain among schoolboy cricket players in .... the hips after the ball has been released, causing the abdominal and.
A Cancer Currents blog post about a clinical trial demonstrating that duloxetine (Cymbalta®) may reduce joint pain caused by aromatase inhibitors in women being treated for early-stage breast cancer.
Gottrup, F.; Jorgensen, B.; Karlsmark, T.
Six out of 10 patients with chronic wounds suffer from persistent wound pain. A multinational and multicenter randomized double-blind clinical investigation of 122 patients compared two moist wound healing dressings: a nonadhesive foam dressing with ibuprofen (62 patients randomized to Biatain Ibu...... Nonadhesive Coloplast A/S) and a nonadhesive foam without ibuprofen (60 patients to Biatain Non-Adhesive-comparator). Patients were recruited from September 2005 to April 2006. The ibuprofen foam was considered successful if the pain relief on a five-point Verbal Rating Scale was higher than the comparator...... without compromising safety including appropriate healing rate. Additional endpoints were change in persistent wound pain between dressing changes and pain at dressing change on days 1-5 (double blind) and days 43-47 (single blind). The primary response variable, persistent pain relief, was significantly...
Full Text Available Corey B Simon¹, Sandra E Stryker², Steven Z George³1Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA; 2Life’s Work Physical Therapy, Portland, Oregon, USA; 3Department of Physical Therapy and Center for Pain Research and Behavioral Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USABackground: The influence of work-related fear-avoidance on pain and function has been consistently reported for patients with musculoskeletal low back pain. Emerging evidence suggests similar influences exist for other anatomical locations of musculoskeletal pain, such as the cervical spine and extremities. However, research is limited in comparing work-related fear-avoidance and associations with clinical outcomes across different anatomical locations. The purpose of this study was to examine the associations between work-related fear-avoidance, gender, and clinical outcomes across four different musculoskeletal pain locations for patients being treated in an outpatient physical therapy setting.Methods: This study was a secondary analysis of data obtained prospectively from a cohort of 313 participants receiving physical therapy from an outpatient clinic.Results: No interaction was found between gender and anatomical location of musculoskeletal pain on work-related fear-avoidance scores. Work-related fear-avoidance scores were higher in the cervical group versus the lower extremity group; however, there were no other differences across anatomical locations. Work-related fear-avoidance influenced intake pain intensity in patients with spine pain but not extremity pain. Conversely, work-related fear-avoidance influenced intake function for participants with extremity pain but not spine pain. Similar results were observed for change scores, with higher work-related fear-avoidance being associated with more, not less, change in pain
Bianchini, Kevin J; Aguerrevere, Luis E; Guise, Brian J; Ord, Jonathan S; Etherton, Joseph L; Meyers, John E; Soignier, R Denis; Greve, Kevin W; Curtis, Kelly L; Bui, Joy
The Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI) are both popular clinical screening instruments in general orthopedic, rheumatologic, and neurosurgical clinics and are useful for identifying pain patients whose physical symptom presentations and disability may be non-organic. Previous studies found both to accurately detect malingered pain presentations; however, the generalizability of these results is not clear. This study used a criterion groups validation design (retrospective cohort of patients with chronic pain, n = 328) with a simulator group (college students, n = 98) to determine the accuracy of the MSPQ and PDI in detecting Malingered Pain Related Disability. Patients were grouped based on independent psychometric evidence of MPRD. Results showed that MSPQ and PDI scores were not associated with objective medical pathology. However, they accurately differentiated Not-MPRD from MPRD cases. Diagnostic statistics associated with a range of scores are presented for application to individual cases. Data from this study can inform the clinical management of chronic pain patients by screening for psychological overlay and malingering, thus alerting clinicians to the possible presence of psychosocial obstacles to effective treatment and triggering further psychological assessment and/or treatment.
Name, Name; Mohamadian, Robab; Rahmani, Azad; Fizollah-Zadeh, Hussein; Jabarzadeh, Franak; Azadi, Arman; Rostami, Hussein
Many cancer patients still experience pain worldwide. There are many barriers for effective control of cancer pain and many of these are related to health care providers. There is a need for further investigation of these barriers. The aim of this study was to investigate nurse-related barriers to control of cancer pain among Iranian nurses. In this descriptive study 49 nurses from two hospitals affiliated to Tabriz and Ardebil Universities of Medical Sciences participated using a census sampling method. A demographic and profession related checklist and Barriers Questionnaire II (BQ-II) were used for data collection. The results showed negative attitudes of participants regarding control of cancer pain. Participants believed that cancer pain medications do not manage cancer pain at acceptable levels; patients may become addicted by using these drugs; cancer pain medications have many uncontrollable effects; and controlling cancer pain may distract the physicians from treating disease. Iranian nurses have negative attitudes toward pain control in cancer patients especially about effectiveness of pain medication and their side effects. Educational intervention to reduce these misconceptions is needed.
Chan, Keith K. W.; Sit, Regina W. S.; Wu, Ricky W. K.; Ngai, Allen H. Y.
Background Pain is the predominant symptom of knee osteoarthritis (OA) and the main reason of disability. Ultrasound is now one of the new imaging modality in Musculoskeletal medicine and its role in assessing the pain severity in the knee osteoarthritis is evaluated in this study. Objectives (1) To study the correlation between ultrasonographic (US) findings and pain score and (2) whether ultrasonographic findings show a better association of pain level than conventional X-rays in patients suffering from primary knee osteoarthritis. Methods In this multi-center study, 193 patients with primary knee OA were asked to score their average knee pain using the Western Ontario and McMaster Universities Arthritis (WOMAC) questionnaire;patients would then go for a radiological and an US evaluation of their painful knee. Findings from both imaging modalities will be studied with the associated pain score. Results Ultrasound showed that knee effusion has positive correlation with pain score upon walking (r = 0.217) and stair climbing (r = 0.194). Presence of suprapatellar synovitis had higher pain score on sitting (Spearman's Rank correlation = 0.355). The medial(r = 0.170) and lateral meniscus protrusion (r = 0.201) were associated with pain score upon stair climbing. Conclusions Our study found that both imaging modalities shown some significant association with the aspect of pain; neither one is clearly better but rather complementary to each other. A trend is found in both modalities: walking pain is related to pathologies of the either the lateral or medial tibiofemoral joint(TFJ)while stair climbing pain is related to both tibiofemoral joint pathologies and also to the patellofemoral joint (PFJ) pathology. This suggested that biomechanical derangement is an important aspect in OA knee pain. PMID:24675807
Keith K W Chan
Full Text Available Pain is the predominant symptom of knee osteoarthritis (OA and the main reason of disability. Ultrasound is now one of the new imaging modality in Musculoskeletal medicine and its role in assessing the pain severity in the knee osteoarthritis is evaluated in this study.(1 To study the correlation between ultrasonographic (US findings and pain score and (2 whether ultrasonographic findings show a better association of pain level than conventional X-rays in patients suffering from primary knee osteoarthritis.In this multi-center study, 193 patients with primary knee OA were asked to score their average knee pain using the Western Ontario and McMaster Universities Arthritis (WOMAC questionnaire;patients would then go for a radiological and an US evaluation of their painful knee. Findings from both imaging modalities will be studied with the associated pain score.Ultrasound showed that knee effusion has positive correlation with pain score upon walking (r = 0.217 and stair climbing (r = 0.194. Presence of suprapatellar synovitis had higher pain score on sitting (Spearman's Rank correlation = 0.355. The medial(r = 0.170 and lateral meniscus protrusion (r = 0.201 were associated with pain score upon stair climbing.Our study found that both imaging modalities shown some significant association with the aspect of pain; neither one is clearly better but rather complementary to each other. A trend is found in both modalities: walking pain is related to pathologies of the either the lateral or medial tibiofemoral joint(TFJwhile stair climbing pain is related to both tibiofemoral joint pathologies and also to the patellofemoral joint (PFJ pathology. This suggested that biomechanical derangement is an important aspect in OA knee pain.
Groenewald, Cornelius B; Wright, Davene R; Palermo, Tonya M
The primary objective of this study was to assess the impact of pediatric pain-related conditions on health care expenditures. We analyzed data from a nationally representative sample of 6- to 17-year-old children captured in the 2007 National Health Interview Survey and 2008 Medical Expenditure Panel Survey. Health care expenditures of children with pain-related conditions were compared with those of children without pain-related conditions. Pain-related conditions were associated with incremental health care expenditures of $1339 (95% confidence interval [CI], $248-$2447) per capita. Extrapolated to the nation, pediatric pain-related conditions were associated with $11.8 billion (95% CI, $2.18-$21.5 billion) in total incremental health care expenditures. The incremental health care expenditures associated with pediatric pain-related conditions were similar to those of attention deficit and hyperactivity disorder ($9.23 billion; 95% CI, $1.89-$18.1 billion), but more than those associated with asthma ($5.35 billion; 95% CI, $0-$12.3 billion) and obesity ($0.73 billion; 95% CI, $6.28-$8.81 billion). Health care expenditures for pediatric pain-related conditions exert a considerable economic burden on society. Efforts to prevent and treat pediatric pain-related conditions are urgently needed.
Sells, James N.; Beckenbach, John; Patrick, Shawn
The article presents an integrated theoretical perspective on the origin, maintenance and alteration of relational conflict. It suggests that relational conflict and reconciliation can be understood as two behavioral alternatives that couples respond with during the experience of pain or other negative emotion. The presence of pain elicits a…
Bergström, Cecilia; Persson, Margareta; Mogren, Ingrid
Pelvic girdle pain (PGP) in pregnancy is distinct from pregnancy-related low back pain (PLBP). However, women with combined PLBP and PGP report more serious consequences in terms of health and function. PGP has been estimated to affect about half of pregnant women, where 25% experience serious pain and 8% experience severe disability. To date there are relatively few studies regarding persistent PLBP/PGP postpartum of more than 3 months, thus the main objective was to identify the prevalence of persistent PLBP and PGP as well as the differences over time in regard to pain status, self-rated health (SRH) and family situation at 12 months postpartum. The study is a 12 month follow-up of a cohort of pregnant women developing PLBP and PGP during pregnancy, and who experienced persistent pain at 6 month follow-up after pregnancy. Women reporting PLBP/PGP (n = 639) during pregnancy were followed up with a second questionnaire at approximately six month after delivery. Women reporting recurrent or persistent LBP/PGP at the second questionnaire (n = 200) were sent a third questionnaire at 12 month postpartum. A total of 176 women responded to the questionnaire. Thirty-four women (19.3%) reported remission of LBP/PGP, whereas 65.3% (n = 115) and 15.3% (n = 27), reported recurrent LBP/PGP or continuous LBP/PGP, respectively. The time between base line and the 12 months follow-up was in actuality 14 months. Women with previous LBP before pregnancy had an increased odds ratio (OR) of reporting 'recurrent pain' (OR = 2.47) or 'continuous pain' (OR = 3.35) postpartum compared to women who reported 'no pain' at the follow-up. Women with 'continuous pain' reported statistically significant higher level of pain at all measure points (0, 6 and 12 months postpartum). Non-responders were found to report a statistically significant less positive scoring regarding relationship satisfaction compared to responders. The results from this study demonstrate that persistent PLBP/PGP is a
Miyamoto, Masayuki; Miyamoto, Tomoyuki; Hirata, Koichi
Sleep disturbances are important nonmotor symptoms in Parkinson's disease (PD) that are associated with a negative impact on quality of life. Restless legs syndrome (RLS), which is characterized by an urge to move the legs accompanied by abnormal leg sensations, can coexist with PD, although the pathophysiology of these disorders appears to be different. RLS and PD both respond favorably to dopaminergic treatment, and several investigators have reported a significant relationship between RLS and PD. Sensory symptoms, pain, motor restlessness, akathisia, and the wearing-off phenomenon observed in PD should be differentiated from RLS. RLS in PD may be confounded by chronic dopaminergic treatment; thus, more studies are needed to investigate RLS in drug-naïve patients with PD. Recently, leg motor restlessness (LMR), which is characterized by an urge to move the legs that does not fulfill the diagnostic criteria for RLS, has been reported to be observed more frequently in de novo patients with PD than in age-matched healthy controls, suggesting that LMR may be a part of sensorimotor symptoms intrinsic to PD. In this paper, we provide an overview of RLS, LMR, and PD and of the relationships among these disorders. PMID:26504610
Al-Rawi, Natheer H; Khatib, Hiba El; Rajoub, Lin; El-Sayed, Mariem; Naji, Rawand; Youssef, Reem; Kawas, Sausan Al
Dentists are at a very high risk of developing work-related musculoskeletal pain. The present study aimed at studying the prevalence of musculoskeletal pain among different dental specialists in the United Arab Emirates (UAE), and correlating the region of pain with the type of clinical work done by the specialists. A sample of more than 100 dentists was chosen randomly from different emirates in UAE. An interview questionnaire was administered regarding the number of years of experience and the presence, region, duration, and type of musculoskeletal pain they experienced. Musculoskeletal pain is experienced by 83.3% of periodontists, 80% of conservative dentists, 77.8% of endodon-tists, 72.7% of orthodontists, 70% of oral surgeons, 63.6% of prosthodontists, 63% of general dental practitioners, and 50% of pedodontists. The results have also indicated that the region of experienced musculoskeletal pain does vary according to the specialty. From those dentists who experience work-related musculoskeletal pain, 80% of conservative dentists experience pain in neck and shoulders, 66.7% of periodontists, and 54.5% of orthodontists experience pain in the lower back region. More than 50% of endodontists experience pain in the neck and shoulders regions, and 39% of general dental practitioners who experience pain in the neck region. Preventive measures need to be taken to decrease the risk of dentists and dental specialists developing work-related musculoskeletal pain. The prevalence and distribution of musculoskeletal disorders (MSDs) among registered general dental practitioners and dental specialists in UAE was not clearly documented. The study results indicated that the region that experienced musculoskeletal pain does vary according to the specialty.
Vaegter, Henrik Bjarke; Palsson, Thorvaldur Skuli; Graven-Nielsen, Thomas
pressure pain threshold (cPPT), tolerance (cPTT), temporal summation of pain (TSP: increase in pain scores to ten repeated stimulations at cPTT intensity), and conditioning pain modulation (CPM: increase in cPPT during cuff pain conditioning on the contralateral leg). Heat detection (HDT) and heat pain...
Genik, Lara M; McMurtry, C Meghan; Breau, Lynn M
Some children with intellectual disabilities (ID): experience pain more frequently than children without ID, express their pain differently, and are incapable of providing self-reports. No research has examined disability and pain-related beliefs of respite workers (RW) and their relations to pain assessment and management decisions for children with ID.
Sell, Lea; Lund, Henrik Lambrecht; Holtermann, Andreas
Scale for Kinesiophobia and productivity and musculoskeletal pain by self-reported measures. Sickness absence records for construction of WAI were obtained from the workplace. RESULTS: There was a 77% response rate with 350 employees included in the final analysis. Among employees with only moderate...
Lim, Crystal S.; Mayer-Brown, Sarah J.; Clifford, Lisa M.; Janicke, David M.
This study examined associations between pain, physical activity, physical fitness, and health-related quality of life (HRQOL) in overweight and obese children. Participants were 270 overweight and obese children 8–12 years of age and their parents. Children were separated into No Pain Frequency, Low Pain Frequency, and High Pain Frequency groups. Children in the Low Pain Frequency group spent less time in moderately intense physical activities compared to the No Pain Frequency group. Childre...
Kanakaris, Nikolaos K; Roberts, Craig S; Giannoudis, Peter V
A large number of scientists from a wide range of medical and surgical disciplines have reported on the existence and characteristics of the clinical syndrome of pelvic girdle pain during or after pregnancy. This syndrome refers to a musculoskeletal type of persistent pain localised at the anterior and/or posterior aspect of the pelvic ring. The pain may radiate across the hip joint and the thigh bones. The symptoms may begin either during the first trimester of pregnancy, at labour or even during the postpartum period. The physiological processes characterising this clinical entity remain obscure. In this review, the definition and epidemiology, as well as a proposed diagnostic algorithm and treatment options, are presented. Ongoing research is desirable to establish clear management strategies that are based on the pathophysiologic mechanisms responsible for the escalation of the syndrome's symptoms to a fraction of the population of pregnant women.
肜祎; 宋箱; 陶江涛
目的:分析中医针灸联合中药热敷治疗颈肩腰腿疼痛的短期疗效.方法:选择2013年1月-12月间于我院接受治疗的198例颈肩腰腿疼痛患者为研究对象,行随机数字表法分组.观察组99例行中医针灸结合中药热敷治疗;对照组99例行常规超短波治疗.所有患者持续治疗14d,并于治疗前后以视觉模拟评分(VAS)评价疗效,并进一步对观察组患者按疾病分组,评价中医针灸结合中药热敷对不同原发疾病疼痛的疗效.结果:两组治疗前VAS评分接近,差异无统计学意义;治疗后均有显著下降,较治疗前差异有统计学意义(P<0.05).且观察组评分[(2.28±1.03)分比(3.26±1.68)分,t=-4.948,P<0.05]显著低于对照组.观察组颈椎病疼痛、肩周炎、腰肌劳损、关节炎疼痛治疗均较佳,且关节炎疼痛治疗显效率高达100.0%.结论:中医针灸结合中药热敷治疗颈肩腰腿疼痛,具有极佳的短期疗效,可能具有推广价值.%Objective: Acupuncture plus TCM heat for neck and leg pain were investigated. Methods: 198 neck and leg pain patients were included. 99 patients in the observation group received TCM acupuncture treatment; In the control group, 99 recieved ultrshoart wave therapy. Results: Before treatment VAS score was similiar, the difference was not statistically significant; decreased significantly after treatment, compared with before treatment, difference was statistically significant (P<0.05). And scores [(2.28 ± 1.03) points vs (3.26 ± 1.68) points,t =-4.948,P<0.05] in the observation group were significantly lower than that in the control group. In the observation group cervical spondylosis pain, frozen shoulder, lumbar muscle strain, arthritis pain treatment are preferred, and efficiency for arthritis pain therapy goes up to 100.0%. Conclusion: Acupuncture plus TCM heat in treating neck and leg pain could have excellent short-term effects.
Jordan, Melissa; Richardson, Elizabeth J
Previous studies have shown that virtual walking to treat spinal cord injury-related neuropathic pain (SCI-NP) can be beneficial, although the type of SCI-NP that may benefit the most is unclear. This study's aims were to (1) determine the effect of location of SCI-NP on pain outcomes after virtual walking treatment and (2) examine the potential relationship between neuronal hyperexcitability, as measured by quantitative sensory testing, and pain reduction after virtual walking treatment. Participants were recruited from a larger ongoing trial examining the benefits of virtual walking in SCI-NP. Neuropathic pain was classified according to location of pain (at- or below-level). In addition, quantitative sensory testing was performed on a subset of individuals at a nonpainful area corresponding to the level of their injury before virtual walking treatment and was used to characterize treatment response. These pilot results suggest that when considered as a group, SCI-NP was responsive to treatment irrespective of the location of pain (F1, 44 = 4.82, P = 0.03), with a trend for the greatest reduction occurring in at-level SCI-NP (F1, 44 = 3.18, P = 0.08). These pilot results also potentially implicate cold, innocuous cool, and pressure hypersensitivity at the level of injury in attenuating the benefits of virtual walking to below-level pain, suggesting certain SCI-NP sensory profiles may be less responsive to virtual walking.
Tse, Mimi M Y; Wan, Vanessa T C; Vong, Sinfia K S
The purpose of this exploratory cross-sectional study was to explore the health-related profile and quality of life among older persons living with and without pain in nursing homes. Ten nursing homes were approached, and 535 older persons were invited to join the study from 2009 to 2011. The nursing home residents' demographic information and information regarding their pain situation and the use of oral analgesic drug and nondrug therapy among the older residents with chronic pain were also collected. Residents' physical health (using the Barthel Activities of Daily Living (ADL) and Elderly Mobility Scores); psychologic health, including happiness, life satisfaction, depression, and loneliness (using the Happiness Scale, the Life Satisfaction Scale, the Geriatric Depression Scale, and the UCLA Loneliness Scale); and quality of life were investigated. Among the 535 nursing home residents, 396 (74%) of them suffered from pain, with mean pain scores of 4.09 ± 2.19, indicating medium pain intensity a remaining 139 (26%) reported no pain. The location of pain was mainly in the knees, back and shoulders. Our results demonstrated that, with the exception of the no-pain group (p nursing home residents' pain affected both their psychologic health, including happiness, life satisfaction, and depression, and their physical quality of life. Nevertheless, only one-half of the older persons with pain used oral analgesic drug or nondrug therapy to relieve their pain. Pain had a significant impact on their mobility and ADL, was positively correlated with happiness and life satisfaction, and was negatively correlated with loneliness and depression. Pain management is a high priority in elderly care; as such, innovative and interdisciplinary strategies are necessary to enhance quality of life particularly for older persons living in nursing homes.
Anja; Schirbel; Anne; Reichert; Stephanie; Roll; Daniel; C; Baumgart; Carsten; Büning; Bianca; Wittig; Bertram; Wiedenmann; Axel; Dignass; Andreas; Sturm
AIM: To evaluate intensity, localization and cofactors of pain in Crohn’s disease and ulcerative colitis patients in connection with health-related quality of life (HRQOL) and disease activity. METHODS: We reviewed and analyzed the responses of 334 patients to a specifically designed questionnairebased on the short inflammatory bowel disease questionnaire (SIBDQ) and the German pain questionnaire. Pain intensity, HRQOL, Crohn’s disease activity index (CDAI) and colitis activity index (CAI) were correlated a...
Sawazaki, Kenta; Mukaino, Yoshito; Kinoshita, Fujihisa; Honda, Tatsuro; Mohara, Osamu; Sakuraba, Hinata; Togo, Toshihiro; Yokoyama, Kazuhito
To investigate the effects of acupuncture on perceived pain, mood disturbances and medical expenses related to low back pain (LBP), an intervention study was performed among 72 employees of a steel company, 70 males and 2 females, aged 53.1+/-7.1 (mean+/-SD) yr, with LBP. They received acupuncture treatment once a week for 8 wk (from October to December 1998) by licensed acupuncturists, adopting a new hypothesis of the Meridian test. Perceived pain scale, and Profile of Mood States (POMS) were administered. Past and present histories of employees' visits to hospitals and their medical expenses for LBP were surveyed from receipts obtained from the subjects' branch factory and from receipts from another nearby branch factory (control) during the period from April 1998 to March 1999. After 8 wk of treatment, patients with LBP reported diminished pain (pacupuncture intervention (November 1998 to March 1999) were significantly decreased as compared with those before intervention (April 1998 to October 1998). In contrast, such decreases were not observed in employees from the control branch factory. It is suggested that acupuncture can reduce medical expenses for LBP through improvement in mood and pain.
Vergani, Francesco; Boukas, Alexandros; Mukerji, Nitin; Nanavati, Nishma; Nicholson, Claire; Jenkins, Alistair
To report our experience related to the use of spinal cord stimulation (SCS) for relief of chronic pancreatitis-related neuropathic visceral pain. Two patients, 50 years old and 39 years old, presented with intractable visceral pain related to chronic pancreatitis. A quadripolar electrode for SCS was inserted at the T8-10 level using a percutaneous technique. After a successful trial, a permanent stimulator was inserted. At a mean follow-up of 7 years, both patients showed a marked improvement, with 80% and 90% decrease of pain, respectively, as assessed by Visual Analogue Scale. Pain medications were discontinued in both cases. SCS appears to be an effective long-term treatment for neuropathic visceral pain related to chronic pancreatitis. Copyright © 2014 Elsevier Inc. All rights reserved.
Objective:To explore the clinical effect of "Shaoshi therapy" treatment of low back and leg pain due to rear of the gluteal muscle injury. Methods:80 cases were given"Shaoshi therapy"(crossed hip partition to determine the treatment site,manual therapy pa-tients,in conjunction with traction,physiotherapy treatment). Compared VAS score and the clinical curative effect of the two groups after treatment. Results:After treatment,VAS score was decreased compared with before treatment,and the cure rate was 87. 5% . Conclu-sion:"Shaoshi therapy" treatment of low back and leg pain due to rear of the gluteal muscle injury has significant effect.%目的：探讨“邵氏诊疗法”治疗臀中肌后部损伤所致腰腿痛的临床疗效。方法：对所有80例患者采用“邵氏诊疗法”（按对臀部的划线、分区，确定治疗部位，对治疗部位进行手法治疗，同时配合牵引、中药透敷）进行治疗。治疗后进行 VAS 评分并比较临床疗效。结果：治疗后 VAS 评分较治疗前明显下降；治愈率为87.5%。结论：“邵氏诊疗法”治疗臀中肌后部损伤所致腰腿痛疗效显著。
Full Text Available Dominik Michalski1,*, Stefanie Liebig1,*, Eva Thomae1,2, Andreas Hinz3, Florian Then Bergh1,21Department of Neurology, 2Translational Centre for Regenerative Medicine (TRM, 3Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany *These authors contributed equallyBackground: Pain of various causes is a common phenomenon in patients with Multiple Sclerosis (MS. A biopsychosocial perspective has proven a useful theoretical construct in other chronic pain conditions and was also started in MS. To support such an approach, we aimed to investigate pain in MS with special emphasis on separating quantitative and qualitative aspects, and its interrelation to behavioral and physical aspects.Materials and methods: Pain intensity (NRS and quality (SES were measured in 38 consecutive outpatients with MS (mean age, 42.0 ± 11.5 years, 82% women. Pain-related behavior (FSR, health care utilization, bodily complaints (GBB-24 and fatigue (WEIMuS were assessed by questionnaires, and MS-related neurological impairment by a standardized neurological examination (EDSS.Results: Mean pain intensity was 4.0 (range, 0–10 and mean EDSS 3.7 (range, 0–8 in the overall sample. Currently present pain was reported by 81.6% of all patients. Disease duration and EDSS did not differ between patients with and without pain and were not correlated to quality or intensity of pain. Patients with pain had significantly higher scores of musculoskeletal complaints, but equal scores of exhaustion, gastrointestinal and cardiovascular complaints. Pain intensity correlated only with physical aspects, whereas quality of pain was additionally associated with increased avoidance, resignation and cognitive fatigue.Conclusion: As in other conditions, pain in MS must be assessed in a multidimensional way. Further research should be devoted to adapt existing models to a MS-specific model of pain.Keywords: pain intensity, quality of pain, pain-related
Ekberg, O. [Dept. of Diagnostic Radiology, Malmoe General Hospital (Sweden); Sjoeberg, S. [Dept. of Diagnostic Radiology, Malmoe General Hospital (Sweden); Westlin, N. [Dept. of Orthopedic Surgery, Malmoe General Hospital (Sweden)
Our purpose was to assess the role of MRI in evaluating the musculoskeletal system in athletes with chronic pain laterally in the groin of unknown etiology. Magnetic resonance imaging (MRI) of the public ring was performed in 11 young athletes (soccer players) with long-standing groin pain. MR findings were compared with plain films and isotope examination (bone scan Tc99M). Abnormal MRI findings included a broadened and irregular symphysis with a characteristic pattern of low signal intensity on T1W and high signal intensity on T2W images localized in the superior public ramus at a distance from the symphysis. Positive findings were also observed on plaon films and on nuclear medicine studies. However, the imaging findings in the superior pubic ramus of the symphysis was located considerably more laterally on MRI. MRI is a valuable method for evaluating discrete and ambiguous pelvic pain in athletes, particularly for identifying concomitant changes in the superior ramus, which may give rise to long-standing pain localized laterally in the groin. (orig.)
Full Text Available Objective. To investigate the prevalence and nature of lumbo-pelvic pain (LPP, that is experienced by women in the lumbar and/or sacro-iliac area and/or symphysis pubis during pregnancy. Design. Cross-sectional, descriptive study. Setting. An Australian public hospital antenatal clinic. Sample population: Women in their third trimester of pregnancy. Method. Women were recruited to the study as they presented for their antenatal appointment. A survey collected demographic data and was used to self report LPP. A pain diagram differentiated low back, pelvic girdle or combined pain. Closed and open ended questions explored the experiences of the women. Main Outcome Measures. The Visual Analogue Scale and the Oswestry Disability Index (Version 2.1a. Results. There was a high prevalence of self reported LPP during the pregnancy (71%. An association was found between the reporting of LPP, multiparity, and a previous history of LPP. The mean intensity score for usual pain was 6/10 and four out of five women reported disability associated with the condition. Most women (71% had reported their symptoms to their maternity carer however only a small proportion of these women received intervention. Conclusion. LPP is a potentially significant health issue during pregnancy.
Højsted, Jette; Ekholm, Kim Ola Michael; Kurita, Geana Paula
,281 individuals were analyzed through multiple logistic regression analyses to assess the association between chronic pain (lasting ⩾6 months), opioid use, health behavior, and body mass index. Six potential addictive behaviors were identified: daily smoking; high alcohol intake; illicit drug use in the past year...
Full Text Available Background/Aims: Increasingly, an inflammatory modulating effect of adipokines within synovial joints is being recognized. To date, there has been no work examining a potential association between the presence of adipokines in the shoulder and patient-reported outcomes. This study undertakes an investigation assessing these potential links. Methods: 50 osteoarthritis patients scheduled for shoulder surgery completed a pre-surgery questionnaire capturing demographic information including validated, patient-reported function (Disabilities of the Arm, Shoulder, and Hand questionnaire and pain (Short Form McGill Pain Questionnaire measures. Synovial fluid (SF samples were analyzed for leptin, adiponectin, and resistin levels using Milliplex MAP assays. Linear regression modeling was used to assess the association between adipokine levels and patient-reported outcomes, adjusted for age, sex, BMI, and disease severity. Results: 54% of the cohort was female (n = 27. The mean age (SD of the sample was 62.9 (9.9 years and the mean BMI (SD was 28.1 (5.4 kg/m2. From regression analyses, greater SF leptin and adiponectin levels, but not regarding resistin, were found to be associated with greater pain (p Conclusions: The identified association between shoulder-derived SF leptin and adiponectin and shoulder pain is likely explained by the pro-inflammatory characteristics of the adipokines and represents potentially important therapeutic targets.
Firmin, Michael W.; Burger, Amanda J.; Sherman, Amanda L.; Grigsby, Megan E.; Croft, Jennifer N.
This phenomenological, qualitative research study involved in-depth interviews with 22 participants enrolled in a private Midwestern university. Each participant reported living with a respective chronic pain syndrome while also being a full-time student. Our semi-structured, interviews centered around the constructs of physical, social,…
Dr. B.Arun, MPT, PhD
Low back pain was experienced by 50% of older adults that has threatened to quality of life. The economic cost of low back pain is more in older adults. Various literatures found that there is strong relationships exist between the low back pain and the psychosocial factors like sleep disturbances, depression, mood sway and chronic illness. Studies has found that depression is one of the commonest psychological problem faced by older adults which relates to other factors like pain, sleep dist...
Jacobs, Jesse V; Lyman, Courtney A; Hitt, Juvena R; Henry, Sharon M
People with low back pain exhibit altered postural coordination that has been suggested as a target for treatment, but heterogeneous presentation has rendered it difficult to identify appropriate candidates and protocols for such treatments. This study evaluated the associations of task-related and person-related factors with the effect of low back pain on anticipatory postural adjustments. Thirteen subjects with and 13 without low back pain performed seated, rapid arm flexion in self-initiated and cued conditions. Mixed-model ANOVA were used to evaluate group and condition effects on APA onset latencies of trunk muscles, arm-raise velocity, and pre-movement cortical potentials. These measures were evaluated for correlation with pain ratings, Fear Avoidance Beliefs Questionnaire scores, and Modified Oswestry Questionnaire scores. Delayed postural adjustments of subjects with low back pain were greater in the cued condition than in the self-initiated condition. The group with low back pain exhibited larger-amplitude cortical potentials than the group without pain, but also significantly slower arm-raise velocities. With arm-raise velocity as a covariate, the effect of low back pain remained significant for the latencies of postural adjustments but not for cortical potentials. Latencies of the postural adjustments significantly correlated with Oswestry and Fear Avoidance Beliefs scores. Delayed postural adjustments with low back pain appear to be influenced by cueing of movement, pain-related disability and fear of activity. These results highlight the importance of subject characteristics, task condition, and task performance when comparing across studies or when developing treatment of people with low back pain. Copyright © 2017 Elsevier B.V. All rights reserved.
Chng, Hui Yi; He, Hong-Gu; Chan, Sally Wai-Chi; Liam, Joanne Li Wee; Zhu, Lixia; Cheng, Karis Kin Fong
To examine parents' knowledge about and attitudes towards pain management, use of pain relief strategies and satisfaction with their children's postoperative pain management, as well as the relationships among these variables. Children's postoperative pain is inadequately managed worldwide. Despite increasing emphasis on parental involvement in children's postoperative pain management, few studies have examined parents' management of their child's postoperative pain in Singapore. A descriptive correlational study. A convenience sample of 60 parents having 6- to 14-year-old children undergoing inpatient elective surgery in a public hospital in Singapore was recruited. Data were collected one day after each child's surgery using the Pain Management Knowledge and Attitudes questionnaire and the Parents' Use of Pain Relief Strategies questionnaire. Descriptive statistics, Mann-Whitney U tests, Kruskal-Wallis tests and Spearman's rank correlation coefficient were used for data analyses. Parents displayed moderate levels of knowledge, attitudes and use of pain relief methods in relation to their children's postoperative pain and pain management. They were generally satisfied with the management of their child's postoperative pain. There was significant difference in Parents' Use of Pain Relief Strategies scores between parents with and without previous experience of caring for their hospitalised child. Statistically significant positive correlations were found between parents' knowledge and attitude, knowledge and satisfaction, attitude and satisfaction, knowledge and pain relief strategies, as well as attitude and pain relief strategies. This study indicates the need to provide parents with more information regarding their children's postoperative pain management. Future studies are needed to develop educational interventions for parents to improve their knowledge and attitudes, which will eventually improve their use of pain relief strategies for their children. Health
Reis-Pina, Paulo; Lawlor, Peter G; Barbosa, António
Pain relief is vital to the treatment of cancer. Despite the widespread use and recognition of clinical recommendations for the management of cancer-related pain, avoidable suffering is still prevalent in patients with malignant disease. A gap exists between what is known about pain medical management and actual practices of patients, caregivers, healthcare professionals and institutions. Opioids are the pillar of the medical management of moderate to severe pain. The prescription of opioid analgesics - by a registered medical practitioner for absolute pain control - is a legitimate practice. In this article we look at patients' fears and physicians' general hesitations towards morphine and alike. We examine misconceptions that yield fallacies on the therapeutically use of opioids and, therefore, sustain inadequate pain management.
Full Text Available Abstract Background There is a large increase in back pain reporting in the early teens. In no previous study has the prevalence of low back pain been investigated in relation to the onset of puberty. The objective of this study was to establish whether the onset of puberty is associated with back pain reporting in young girls. Methods A subsample of 254 girls aged 8–10 years and 165 girls aged 14–16 years from a cross-sectional survey of 481 children aged 8–10 years and 325 adolescents aged 14–16 years of both sexes. Main outcome measures were back pain defined as low back pain, mid back pain, and/or neck pain in the past month. Other variables of interest were Puberty (five different stages, age, body mass index, and smoking. Independent information on onset of puberty was obtained through a physical examination and on back pain through an individual structured interview. The association was studied between onset of puberty and the outcome variable (the one month period prevalence of back pain, controlling for overweight, and smoking. Odds ratios with 95% confidence intervals were used to describe bivariate associations, logistic regression with robust standard errors was used for multivariate analyses. Results There is a highly significant trend for increased back pain reporting with increasing level of puberty until maturity is reached. The biggest leap appears between the second level (beginning of puberty and the third level (mid puberty and the findings remain after controlling for the covariates. These results emanate from the low back, whereas pain in the mid back and neck do not seem to be linked with pubertal stage. Conclusion In girls, the reporting of low back pain increases in frequency during puberty until maturity, regardless of age. Why some girls are susceptible to back pain in the early stage of puberty is unknown.
Full Text Available ABSTRACTBACKGROUND AND OBJECTIVES: Injection pain after propofol administration is common and maydisturb patients' comfort. The aim of this study was to compare effectiveness of intravenous(iv nitroglycerin, lidocaine and metoprolol applied through the veins on the dorsum of hand orantecubital vein on eliminating propofol injection pain.METHOD: There were 147 patients and they were grouped according to the analgesic adminis-tered. Metoprolol (n = 31, Group M, lidocaine (n = 32, Group L and nitroglycerin (n = 29, GroupN were applied through iv catheter at dorsum hand vein or antecubital vein. Pain was evalu-ated by 4 point scale (0 - no pain, 1 --- light pain, 2 --- mild pain, 3 --- severe pain in 5, 10, 15and 20th seconds. ASA, BMI, patient demographics, education level and the effect of pathwaysfor injection and location of operations were analyzed for their effect on total pain score.RESULTS: There were no differences between the groups in terms of total pain score (p = 0.981.There were no differences in terms of total pain score depending on ASA, education level,location of operation. However, lidocaine was more effective when compared with metoprolol(p = 0.015 and nitroglycerin (p = 0.001 among groups. Although neither lidocaine nor metopro-lol had any difference on pain management when applied from antecubital or dorsal hand vein(p > 0.05, nitroglycerin injection from antecubital vein had demonstrated statistically lowerpain scores (p = 0.001.CONCLUSION: We found lidocaine to be the most effective analgesic in decreasing propofolrelated pain. We therefore suggest iv lidocaine for alleviating propofol related pain at operations.
Niederstrasser, N G; Meulders, A; Meulders, M; Struyf, D; Vlaeyen, J W
Generalization of fear of movement-related pain across novel but similar movements can lead to fear responses to movements that are actually not associated with pain. The peak-shift effect describes a phenomenon whereby particular novel movements elicit even greater fear responses than the original pain-provoking movement (CS+), because they represent a more extreme version of the CS+. There is great variance in the propensity to generalize as well as the speed of extinction learning when these novel movements are not followed by pain. It can be argued that this variance may be associated with executive function capacity, as individuals may be unable to intentionally inhibit fear responses. This study examined whether executive function capacity contributes to generalization and extinction of generalization as well as peak-shift of conditioned fear of movement-related pain and expectancy. Healthy participants performed a proprioceptive fear conditioning task. Executive function tests assessing updating, switching, and inhibition were used to predict changes in (extinction of) fear of movement-related pain and pain expectancy generalization. Low inhibitory capacity was associated with slower extinction of generalized fear of movement-related pain and pain expectancy. Evidence was found in favor of an area-shift, rather than a peak-shift effect, which implies that the peak conditioned fear response extended to, but did not shift to a novel stimulus. Participants with low inhibitory capacity may have difficulties withholding fear responses, leading to a slower decrease of generalized fear over time. The findings may be relevant to inform treatments. Low inhibitory capacity is not associated with slower generalization, but extinction of fear generalization. Fear elicited by a novel safe movement, situated outside the CS+/- continuum on the CS+ side, can be as strong as to the original stimulus predicting the pain-onset. © 2017 European Pain Federation - EFIC®.
Johnson, Ensa; Bornman, Juan; Tönsing, Kerstin M
Children with significant communication difficulties who experience pain need appropriate means to communicate their pain in order to receive appropriate treatment. Augmentative and alternative communication (AAC) strategies could be used to enable children to self-report pain. The aim of this research study was to identify the common vocabulary children with typical development use to describe physical pain experiences and develop and socially validate an appropriate pain-related vocabulary list for children who use or could benefit from using AAC. A sequential, exploratory, mixed-method design was employed. This paper focuses on the quantitative phase. A set of scenarios was developed to gather pain-related vocabulary appropriate for children aged 6;0-7;11 (years;months) and children aged 8;0-9;11, from 74 children, 61 parents, and 56 teachers. Some 629 pain-related words or phrases were suggested and then classified into seven categories. A composite list of the 84 most frequently occurring pain-related vocabulary items was compiled and socially validated by three adults who used AAC. They emphasized the need to individualize vocabulary and provided suggestions for vocabulary organization for display on any type of AAC system. Despite similarities in the categories of words offered by the various respondent groups, the differences underscore the importance of more than one perspective (particularly that of children and adults) in generating a comprehensive vocabulary list.
Woldendorp, Kees H.; van de Werk, Pieter; Boonstra, Anne M.; Stewart, Roy E.; Otten, Egbert
Objective: To explore the muscle activation patterns in relation to pain complaints in bassists studied during a musical task. This study was based on the assumption that pain complaints are caused by increased muscle activation during playing or relaxation and/or faster onset of fatigue of muscles.
Heuvel, S.G. van den; Ariëns, G.A.M.; Boshuizen, H.C.; Hoogendoorn, W.E.; Bongers, P.M.
This study aimed at determining the prognostic factors related to the recurrence of low-back pain and future sickness absence due to low-back pain. Data were used from a prospective cohort study in a working population with a three year follow-up period. They were collected with annual
Woldendorp, Kees H.; van de Werk, Pieter; Boonstra, Anne M.; Stewart, Roy E.; Otten, Egbert
Objective: To explore the muscle activation patterns in relation to pain complaints in bassists studied during a musical task. This study was based on the assumption that pain complaints are caused by increased muscle activation during playing or relaxation and/or faster onset of fatigue of muscles.
Meulders, A.; Karsdorp, P.A.; Claes, N.; Vlaeyen, J.W.S.
Cognitive-behavioral treatments for chronic pain typically target pain-related fear; exposure in vivo is a common treatment focusing on disconfirming harm expectancy of feared movements. Exposure therapy is tailored on Pavlovian extinction; an alternative fear reduction technique that also alters st
Reiman, Michael P; Thorborg, Kristian
UNLABELLED: Evidence-based clinical examination and assessment of the athlete with hip joint related pain is complex. It requires a systematic approach to properly differentially diagnose competing potential causes of athletic pain generation. An approach with an initial broad focus (and hence use...
Heuvel, S.G. van den; Ariëns, G.A.M.; Boshuizen, H.C.; Hoogendoorn, W.E.; Bongers, P.M.
This study aimed at determining the prognostic factors related to the recurrence of low-back pain and future sickness absence due to low-back pain. Data were used from a prospective cohort study in a working population with a three year follow-up period. They were collected with annual questionnaire
Futro, Agnieszka; Masłowska, Katarzyna; Dwyer, Cathy M.
Although neonatal farm animals are frequently subjected to painful management procedures, the role of maternal behaviour in pain coping, has not been much studied. We investigated whether ewes were able to distinguish between lambs in pain and those that were not, and whether their behaviour altered depending on the severity of lamb pain. Eighty male lambs were allocated to one of 4 pain treatments within 24 hours of birth. Lambs were either handled only (C), bilaterally castrated with tight rubber rings (RR), as for RR but with the application of a Burdizzo clamp immediately proximal to the ring (Combined) or subjected to short scrotum castration (SSC) where the testicles were retained within the abdomen and only the scrotum removed. The behaviour of the ewe, treated lamb and untreated sibling where present (n = 54) were recorded for 30 minutes after treatment. Castration treatment increased the expression of abnormal standing and lying postures, specific pain-related behaviours (head-turning, stamping/kicking, easing quarters, tail wagging) and composite pain scores (P<0.001 for all). The greatest expression of pain-related behaviours was shown by lambs in the RR group, which were the only group to show rolling responses indicative of severe pain, followed by the SSC group. Ewes expressed more licking/sniffing responses to the RR and SSC lambs than towards the Combined and C lambs (P<0.05), and oriented most to RR lambs and least to C lambs (P<0.001). Ewes with two lambs also directed more attention towards the treated than the untreated lamb (P<0.001). The quantity of maternal care directed towards the lamb was positively correlated with the expression of active pain behaviours. The data demonstrate that ewes are able to discriminate between lambs in pain and those that are not, and that their response is increased with a greater severity of pain. PMID:26217942
Full Text Available Although neonatal farm animals are frequently subjected to painful management procedures, the role of maternal behaviour in pain coping, has not been much studied. We investigated whether ewes were able to distinguish between lambs in pain and those that were not, and whether their behaviour altered depending on the severity of lamb pain. Eighty male lambs were allocated to one of 4 pain treatments within 24 hours of birth. Lambs were either handled only (C, bilaterally castrated with tight rubber rings (RR, as for RR but with the application of a Burdizzo clamp immediately proximal to the ring (Combined or subjected to short scrotum castration (SSC where the testicles were retained within the abdomen and only the scrotum removed. The behaviour of the ewe, treated lamb and untreated sibling where present (n = 54 were recorded for 30 minutes after treatment. Castration treatment increased the expression of abnormal standing and lying postures, specific pain-related behaviours (head-turning, stamping/kicking, easing quarters, tail wagging and composite pain scores (P<0.001 for all. The greatest expression of pain-related behaviours was shown by lambs in the RR group, which were the only group to show rolling responses indicative of severe pain, followed by the SSC group. Ewes expressed more licking/sniffing responses to the RR and SSC lambs than towards the Combined and C lambs (P<0.05, and oriented most to RR lambs and least to C lambs (P<0.001. Ewes with two lambs also directed more attention towards the treated than the untreated lamb (P<0.001. The quantity of maternal care directed towards the lamb was positively correlated with the expression of active pain behaviours. The data demonstrate that ewes are able to discriminate between lambs in pain and those that are not, and that their response is increased with a greater severity of pain.
Schulz, Sven; Brenk-Franz, Katja; Kratz, Anne; Petersen, Juliana J; Riedel-Heller, Steffi G; Schäfer, Ingmar; Weyerer, Siegfried; Wiese, Birgitt; Fuchs, Angela; Maier, Wolfgang; Bickel, Horst; König, Hans-Helmut; Scherer, Martin; van den Bussche, Hendrik; Gensichen, Jochen
The impact of self-efficacy on pain-related disability in multimorbid elderly patients in primary care is not known. The aim of our study was to analyze the influence of self-efficacy on the relation between pain intensity and pain-related disability, controlled for age and disease count, in aged multimorbid primary care patients with osteoarthritis and chronic pain. Patients were recruited in the German MultiCare study (trial registration: ISRCTN89818205). Pain was assessed using the Graded Chronic Pain Scale, and self-efficacy using the General Self-Efficacy Scale. We employed SPSS for statistical analysis. One thousand eighteen primary care patients were included in the study. Correlation analyses showed significant correlations between pain intensity and pain-related disability (r = 0.591, p self-efficacy (r = 0.078, p self-efficacy and pain-related disability (r = 0.153, p self-efficacy partially mediates the relation between pain intensity and pain-related disability. In our results, we found little evidence that self-efficacy partially mediates the relation between pain intensity and pain-related disability in aged multimorbid primary care patients with osteoarthritis and chronic pain. Further research is necessary to prove the effect.
Full Text Available Background Pain complaints are common among musicians, whose occupation is highly demanding on both a physical and a psychological level. The purpose of the present study was to better understand the severity of musculoskeletal pain in orchestra musicians by measuring the potential contributions of biological (medical diagnosis, psychosocial (age, gender, instrument, practice and exercising history, and occupational satisfaction, and psychological (pain-related anxiety, performance anxiety, and affect variables. Participants and procedure Data were collected from 59 music students playing in a symphonic orchestra. Univariate analyses were performed to assess differences in biological, psychosocial, and psychological predictors, using the presence or absence of pain as the dependent variable. Regression analyses were performed to develop a model of variance to explain the severity of pain. Results The results revealed lower occupational satisfaction to be associated with the presence of pain. However, a greater proportion of variance (31% in pain severity was explained by pain-related anxiety combined with performance anxiety. Thus, the model that would best explain playing-related pain in musicians would need to focus mainly on psychological variables, namely pain-related and performance anxiety. Conclusions Further investigation is needed to determine how treatment of musculoskeletal pain in musicians should address these psychological variables.
Karroum, E; Konofal, E; Arnulf, I
Restless-legs syndrome (RLS) is a sensorimotor disorder, characterized by an irresistible urge to move the legs usually accompanied or caused by uncomfortable and unpleasant sensations. It begins or worsens during periods of rest or inactivity, is partially or totally relieved by movements and is exacerbated or occurs at night and in the evening. RLS sufferers represent 2 to 3% of the general population in Western countries. Supportive criteria include a family history, the presence of periodic-leg movements (PLM) when awake or asleep and a positive response to dopaminergic treatment. The RLS phenotypes include an early onset form, usually idiopathic with a familial history and a late onset form, usually secondary to peripheral neuropathy. Recently, an atypical RLS phenotype without PLM and l-DOPA resistant has been characterized. RLS can occur in childhood and should be distinguished from attention deficit/hyperactivity disorder, growing pains and sleep complaints in childhood. RLS should be included in the diagnosis of all patients consulting for sleep complaints or discomfort in the lower limbs. It should be differentiated from akathisia, that is, an urge to move the whole body without uncomfortable sensations. Polysomnographic studies and the suggested immobilization test can detect PLM. Furthermore, an l-DOPA challenge has recently been validated to support the diagnosis of RLS. RLS may cause severe-sleep disturbances, poor quality of life, depressive and anxious symptoms and may be a risk factor for cardiovascular disease. In most cases, RLS is idiopathic. It may also be secondary to iron deficiency, end-stage renal disease, pregnancy, peripheral neuropathy and drugs, such as antipsychotics and antidepressants. The small-fiber neuropathy can mimic RLS or even trigger it. RLS is associated with many neurological and sleep disorders including Parkinson's disease, but does not predispose to these diseases. The pathophysiology of RLS includes an altered brain
Bruehl, Stephen; Denton, Jerod S; Lonergan, Daniel; Koran, Mary Ellen; Chont, Melissa; Sobey, Christopher; Fernando, Shanik; Bush, William S; Mishra, Puneet; Thornton-Wells, Tricia A
G-protein coupled inwardly rectifying potassium (GIRK) channels are effectors determining degree of analgesia experienced upon opioid receptor activation by endogenous and exogenous opioids. The impact of GIRK-related genetic variation on human pain responses has received little research attention. We used a tag single nucleotide polymorphism (SNP) approach to comprehensively examine pain-related effects of KCNJ3 (GIRK1) and KCNJ6 (GIRK2) gene variation. Forty-one KCNJ3 and 69 KCNJ6 tag SNPs were selected, capturing the known variability in each gene. The primary sample included 311 white patients undergoing total knee arthroplasty in whom postsurgical oral opioid analgesic medication order data were available. Primary sample findings were then replicated in an independent white sample of 63 healthy pain-free individuals and 75 individuals with chronic low back pain (CLBP) who provided data regarding laboratory acute pain responsiveness (ischemic task) and chronic pain intensity and unpleasantness (CLBP only). Univariate quantitative trait analyses in the primary sample revealed that 8 KCNJ6 SNPs were significantly associated with the medication order phenotype (P KCNJ6 gene (gene set-based analysis) just failed to reach significance (P = .054). No significant KCNJ3 effects were observed. A continuous GIRK Related Risk Score (GRRS) was derived in the primary sample to summarize each individual's number of KCNJ6 "pain risk" alleles. This GRRS was applied to the replication sample, which revealed significant associations (P KCNJ6 genetic variation on pain outcomes is warranted.
McWilliams, Lachlan A; Asmundson, Gordon J G
Despite the prominence of fear-avoidance models of chronic pain, there is a paucity of research regarding the origins of pain-related fear. Based on the premise that insecure attachment could be a developmentally based origin of elevated fear of pain, associations between adult attachment dimensions and constructs included in fear-avoidance models of chronic pain were investigated. Consistent with Bartholomew and Horowitz's [Bartholomew K, Horowitz LM. Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol 1991;61:226-44.] model, attachment was conceptualized as being comprised of a model of self dimension (i.e., degree of anxiety regarding rejection based on beliefs of personal unworthiness) and a model of others dimension (i.e., degree of interpersonal mistrust and discomfort with interpersonal closeness). A large university student sample free of chronic pain (N=278) completed a measure of adult romantic attachment (i.e., Experiences in Close Relationships Questionnaire; [Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult attachment: an integrative overview. In: Simpson JA, Rholes WS, editors. Attachment theory and close relationships. New York: The Guilford Press, 1998. p. 46-76.]), the Fear of Pain Questionnaire-III [McNeil DW, Rainwater AJ. Development of the fear of pain questionnaire - III. J Behav Med 1998;21:389-410.], the Pain Vigilance and Awareness Questionnaire [McCracken LM. Attention to pain in persons with chronic pain: a behavioural approach. Behav Ther 1997;28:271-84.], and the Pain Catastrophizing Scale [Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995;7:24-532.]. It was hypothesized that insecure attachment would be positively associated with reports of pain-related fear, hypervigilance, and catastrophizing and that the model of self dimension would be the attachment variable most strongly associated with these variables
Wewer, Anne Vibeke; Andersen, L P; Pærregaard, Anders;
The aim of the study was to assess and compare the IgG seroprevalence of H. pylori in children with recurrent abdominal pain with healthy children and to investigate the related symptoms. IgG antibodies against low-molecular weight H. pylori antigens were assessed in 438 children with recurrent...... of the abdominal pain, presence of pyrosis, nocturnal pain, relation of pain to meals and bowel irregularities. The seroprevalence was 21% (95% CI: 17-25%) in the children with recurrent abdominal pain and 10% (95% CI: 5-18%) in the healthy controls (p = 0.30). In seropositive children with RAP H. pylori was found...... in 46/66 by culture and histology. The presence of H. pylori was significantly associated with active or inactive chronic gastritis. The presence of H. pylori was associated with both parents being born in a country with a high prevalence and a low social class. Helicobacter pylori-positive children had...
Objective:To analyze the effect of lycopene on the expression of pain-related molecules in spinal cord of model rats with neuropathic pain.Methods:A total of 30 healthy female SD rats were collected to establish neuropathic pain models according to the literatures, including 10 in sham operation group, 10 in model control group and 10 in model treatment group. Rats were executed to obtain L2-L6 segment of spinal cord, and then serum levels of pain-related indicators as well as gene and protein expression in it were detected.Results:Serum IL-17, HMGB-1, Aβ, Tau and C3 levels of sham operation group were lower than those of model control group and model treatment group while CGRP level was higher than that of model control group and model treatment group, and serum IL-17, HMGB-1, Aβ, Tau and C3 levels of model treatment group were lower than those of model control group while CGRP level was higher than that of model control group; ERK, CREB, BDNF, NMDA, AMPA and c-fos mRNA expression levels of sham operation group were lower than those of model control group and model treatment group, and ERK, CREB, BDNF, NMDA, AMPA and c-fos mRNA expression levels of model treatment group were lower than those of model control group; TRPV1, NF-κB, NOS, GFAP, ERK and CREB protein expression levels of sham operation group were lower than those of model control group and model treatment group while Reg expression level was higher than that of model control group and model treatment group, and TRPV1, NF-κB, NOS, GFAP, ERK and CREB protein expression levels of model treatment group were lower than those of model control group while Reg expression level was higher than that of model control group.Conclusion: Lycopene can effectively decrease the expression of pain-promoting genes in model rats with neuropathic pain, and is expected to become new treatment means of neuropathic pain in the future.
Högl, Birgit; Stefani, Ambra
Restless legs syndrome is a frequent neurological disorder with potentially serious and highly distressing treatment complications. The role and potential implications of periodic leg movements during sleep range from being a genetic risk marker for restless legs syndrome to being a cardiovascular risk factor. The diagnosis of restless legs syndrome in patients with daytime movement disorders is challenging and restless legs syndrome needs to be differentiated from other sleep-related movement disorders. This article provides an update on the diagnosis of restless legs syndrome as an independent disorder and the role of periodic leg movements and reviews the association of restless legs syndrome with Parkinson's disease and other movement disorders. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.
Dr. B.Arun, MPT, PhD
Full Text Available Low back pain was experienced by 50% of older adults that has threatened to quality of life. The economic cost of low back pain is more in older adults. Various literatures found that there is strong relationships exist between the low back pain and the psychosocial factors like sleep disturbances, depression, mood sway and chronic illness. Studies has found that depression is one of the commonest psychological problem faced by older adults which relates to other factors like pain, sleep disturbances ect.. Physiotherapy has been shown very effective in the management of chronic low back pain. Various approaches in physiotherapy play a major role in rehabilitation of patients with chronic low back pain. This study estimates to find out the effect of myofascial release therapy on pain related disability, quality of sleep and depression in older adults with chronic low back pain. Study is a single group pre test and post test design. 37 Patients with chronic low back pain were selected from a community setup. Selected subjects were undergone 6 weeks of myofascial release therapy along with moist heat therapy. At the end the outcome measured are pain related disability using pain disability index, Quality of sleep using Insomnia severity index and depression using beck depression inventory. The paired ‘t’ test was used to find out the differences between variables. The result showed that there was a significant improvement in the pre test and post test variables. The beck depression inventory was 21.3 (p<0.05%, and the pain disability index was 24.9 (p<0.05%. The study concludes that the myofascial release therapy is very effective in reducing the pain related disability, quality of sleep and depression on older adults with chronic low back pain.
Persons with chronic wounds may experience wound-related itch (pruritus) and pain. A cross-sectional study was conducted to examine the occurrence of itch and pain in chronic wounds and the relationship of the intensity between these factors. Patients in an outpatient wound care center, 18 years and older with an open wound, were recruited consecutively over a 5-month period. The 199 participants (112 [56%] men) had a mean age of 67 years (range 21-98 years); one wound per person was addressed and included venous (31), arterial (23), neuropathic (31), pressure-related (33), traumatic (37), and "other" (41) wounds. Wound-related pain and itch data were obtained using a modified Paul-Pieper Itching Questionnaire and Characteristics of Itch Questionnaire. Responses were hand-recorded and coded without personal identifiers and analyzed using descriptive statistics, and associations among data were assessed using Pearson chi-square, Mantel-Haenszel chi-square, and Cochran-Armitage trend tests. Wound-related itch was significantly associated with participant age (P = 0.011) and employment status (P = 0.003). Wound-related pain was significantly associated only with education level (P = 0.048). Persons with venous wounds had both the largest proportion with wound-related itch (45.2%) and the largest proportion with wound-related pain (61.2%) out of all of the wound types. Persons with diabetic neuropathy had both the smallest proportion with wound-related itch (16.1%) and the smallest proportion with wound-related pain (35.4%) among all of the wound types. Associations between wound type and wound-related itch or pain were not significant. When venous wounds were compared to all other wound types combined, wound-related itch was significantly associated (P = 0.021) with wound type - ie, venous wound type and itch was statistically significant when venous wounds were compared to a combination of all other wound types. Wound-related pain and itch occurred together in 35
Full Text Available Despite the limitations set by FINA regulations, execution technique in breaststroke swimming is being improved thanks to more and more advanced analyses of the efficiency of the swimmer’s movements. The aim of this study was to detect the parameters of the time structure of the cycle correlated with the maximal swimming speed at the of 50 meters distance, in order to focus to specific technical aspects in the breaststroke training. In the group of 23 participants, between the age of 15.0 ± 1.17, the breaststroke cycle movement of the arms and legs was divided into two phases: propulsive or non-propulsive. In addition, indices characterizing the temporal coordination of movements of the upper limbs in relation to the lower limbs were distinguished: 1 Arm-Leg Lag - determines the interval between the phases of propulsion generated by upper and lower limbs; 2 Glide or Overlap - the inter-cyclic glide or overlap of the propulsive movement of the upper on lower limbs. Significant dependence was noted between the swim speed (V50surface breast and the percentage of time of the arm propulsive in-sweep phase 0.64, p < 0.01. A significant correlation was observed between the V50surface breast with the percentage of partially surfaced hand phase of arm recovery 0.54, p < 0.01. Correlation between total leg propulsion and non-propulsion phases with V50surface breast was 0.49 and -0.49 respectively, both p < 0.01. The Glide or Overlap index was significantly related to the swimming speed V50surface breast 0.48, p < 0.05. This type of analysis suggests how to refine the swimming technique, with the goal to improve the current speed capabilities; furthermore the results also indicate the direction of its development in the future swimmers of the group studied.
van Dijk, Jacqueline F M; van Wijck, Albert J M; Kappen, Teus H; Peelen, Linda M; Kalkman, Cor J; Schuurmans, Marieke J
Guidelines for postoperative pain treatment are based on patients' pain scores. Patients with an intermediate Numeric Rating Scale (NRS) score of 5 or 6 may consider their pain as either bearable or unbearable, which makes it difficult to decide on pain treatment because guidelines advise professionals to treat pain at NRS > 4. Educating patients in using an NRS score for pain might improve adequate pain treatment. A quasi-randomized controlled trial was conducted in which 194 preoperative patients watched the educational film and 183 the control film. Pain scores were considered discordant when patients reported an NRS ≤ 4 and wanted additional opioids or when patients reported an NRS > 4 and did not want additional opioids. Beliefs, fear, and knowledge of pain; pain assessment; and pain treatment were measured by questionnaires. No significant differences in discordant pain scores between the groups were found: relative risk (RR) 0.73, confidence interval (CI) 0.47-1.15 at rest and RR 0.96, CI 0.72-1.28 at movement. Patients in the intervention group had lower NRS pain scores than patients in the control group. In the intervention group, patients had significantly more knowledge and lower barriers to pain management compared with the control group. We did not find a statistically significant reduction in discordant pain scores when comparing the intervention group with the control group. However, patients in the intervention group had significantly lower pain scores, lower barriers, and more knowledge of pain treatment than patients in the control group.
Rachel Cherian Koshy
Full Text Available Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being.
岳剑宁; 王琦; 倪家骧
A series of systemic symptoms such as nerve - psychiatric symptom, damages of oral mucosa and skin, kidney lesions, peripheral nerve lesions may occur in mercury poisoning patients.Drug mercury displacement treatment, the preferred choice for patients with a definite history, has a good effect.In this paper, both of the patients were caused by mercury in cosmetics with skin damages.The symptom manifested as pains in lumbosacral region and extremities, but their histories were occult , thus leading to misdiagnosis at early stage as lumbago - leg pain or unexplained nerve damages, then to misuse of other treatments and to delays of mercury displacement treatment.Most patients with chronic mercury poisoning caused pains as main symptoms are caused by whitemng cosmetics containing mercury.So young females with unexplained lumbosacral pains, especially those with pains symmetrically distributing in limbs accompanied by skin damages, should be asked the causative factors such as cosmetics, latrogenic factors probably leading to mercury exposure, which is conducive to early diagnosis to avoid misdiagnosis and mistreatment.%汞中毒患者可以出现神经-精神症状及口腔黏膜、皮肤、肾脏、周围神经损害等全身性症状.病史明确的患者早期进行药物驱汞治疗是首选治疗方法,且疗效较好.本文2例汞中毒患者均因化妆品含汞导致,均有皮肤损害,症状均表现为腰骶区及四肢肌肉痛,但是汞中毒病史隐匿,导致前期误诊为腰腿痛及不明原因神经损伤,误行其他治疗,延误了驱汞治疗,造成了患者经济损失及身体的损伤.慢性汞中毒导致疼痛为主要症状的患者中,很大一部分是美白化妆品含汞导致.故年轻女性出现不明原因的腰骶痛,尤其是四肢对称性分布的疼痛伴有皮肤损害,医生应详细追问化妆品、医源性等可能导致汞接触的致病因素,有利于早期明确诊断,避免误诊误治.
Grant, Joshua A; Courtemanche, Jérôme; Rainville, Pierre
Concepts originating from ancient Eastern texts are now being explored scientifically, leading to new insights into mind/brain function. Meditative practice, often viewed as an emotion regulation strategy, has been associated with pain reduction, low pain sensitivity, chronic pain improvement, and thickness of pain-related cortices. Zen meditation is unlike previously studied emotion regulation techniques; more akin to 'no appraisal' than 'reappraisal'. This implies the cognitive evaluation of pain may be involved in the pain-related effects observed in meditators. Using functional magnetic resonance imaging and a thermal pain paradigm we show that practitioners of Zen, compared to controls, reduce activity in executive, evaluative and emotion areas during pain (prefrontal cortex, amygdala, hippocampus). Meditators with the most experience showed the largest activation reductions. Simultaneously, meditators more robustly activated primary pain processing regions (anterior cingulate cortex, thalamus, insula). Importantly, the lower pain sensitivity in meditators was strongly predicted by reductions in functional connectivity between executive and pain-related cortices. Results suggest a functional decoupling of the cognitive-evaluative and sensory-discriminative dimensions of pain, possibly allowing practitioners to view painful stimuli more neutrally. The activation pattern is remarkably consistent with the mindset described in Zen and the notion of mindfulness. Our findings contrast and challenge current concepts of pain and emotion regulation and cognitive control; commonly thought to manifest through increased activation of frontal executive areas. We suggest it is possible to self-regulate in a more 'passive' manner, by reducing higher-order evaluative processes, as demonstrated here by the disengagement of anterior brain systems in meditators.
Sznajder, Kristin K; Harlow, Siobán D; Burgard, Sarah A; Wang, Yanrang; Han, Cheng; Liu, Jing
Background: Dysmenorrhea, dyspareunia, and non-cyclic pelvic pain are health concerns for factory workers in China and may be increased by occupational stress. Objectives: To estimate the prevalence and demographic and occupational factors associated with three types of gynecologic pain among female factory workers in Tianjin. Methods: The study included 651 female workers from three factories in Tianjin, China. Logistic regression models were estimated to determine associations between occupational stress and gynecologic pain. Results: Occupational stress including high job strain, exhaustion, and stress related to working conditions was a risk factor for gynecologic pain. High job strain and poor job security were associated with an increased risk for dysmenorrhea. Compulsory overtime and exhaustion were associated with increased non-cyclic pelvic pain. Working overtime and exhaustion were associated with increased dyspareunia. Conclusions: As China’s population of female factory workers grows, research on the reproductive health of this population is essential. PMID:24804338
Goossens, Mariëlle E; Kindermans, Hanne P; Morley, Stephen J; Roelofs, Jeffrey; Verbunt, Jeanine; Vlaeyen, Johan W
Recurrent pain not only has an impact on disability, but on the long term it may become a threat to one's sense of self. This paper presents a cross-sectional study of patients with work-related upper extremity pain and focuses on: (1) the role of self-discrepancies in this group, (2) the associations between self-discrepancies, pain, emotions and (3) the interaction between self-discrepancies and flexible-goal adjustment. Eighty-nine participants completed standardized self-report measures of pain intensity, pain duration, anxiety, depression and flexible-goal adjustment. A Selves Questionnaire was used to generate self-discrepancies. A series of hierarchical regression analyses showed relationships between actual-ought other, actual-ought self, actual-feared self-discrepancies and depression as well as a significant association between actual-ought other self-discrepancy and anxiety. Furthermore, significant interactions were found between actual-ought other self-discrepancies and flexibility, indicating that less flexible participants with large self-discrepancies score higher on depression. This study showed that self-discrepancies are related to negative emotions and that flexible-goal adjustment served as a moderator in this relationship. The view of self in pain and flexible-goal adjustment should be considered as important variables in the process of chronic pain.
Noormohammadpour, Pardis; Mansournia, Mohammad Ali; Koohpayehzadeh, Jalil; Asgari, Fereshteh; Rostami, Mohsen; Rafei, Ali; Kordi, Ramin
Chronic musculoskeletal pain (CMP) is increasing in prevalence rapidly. Over the past 2 decades low back pain has been ranked globally as the primary cause of years lived with disability. The primary objective of this study was to investigate the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and chronic knee pain (CKP) and their related risk factors in the national Iranian population. We analyzed data obtained through a cross-sectional, population-based survey of 7889 Iranians who were aged between 30 and 70 years. The prevalence of CNP, CLBP, and CKP was 15.34%, 27.18%, and 29.97%, respectively. Female sex, aging, body mass index≥25, Lur or Arab ethnicity, illiteracy, passive smoking, positive osteoporosis history, and low or high physical activity levels were risk factors for CLBP, CNP, and CKP after adjustment for potential confounders. For example, in participants with a body mass index≥30, odds ratios for CNP, CLBP, and CKP adjusted for age, sex, ethnicity, living area, education, employment status, smoking, and physical activity levels were 1.26 (95% confidence interval [CI], 1.04-1.52), 1.37 (95% CI, 1.17-1.59), and 1.64 (95% CI, 1.41-1.91), respectively. This is the first study investigating the prevalence of CNP, CLBP, and CKP in the national population of Iran. It shows some modifiable risk factors for CMP, and suggests that affordable planning for these risk factors can be valuable in preventing CMP globally. However, this is a cross-sectional study and future longitudinal studies in this field are necessary.
June, Kyung Ja; Cho, Sung-Hyun
To examine the relationship of low back pain prevalence and treatment to personal and work-related characteristics among intensive care unit nurses. Back pain is the most common work-related health problem among nurses. A cross-sectional study including a survey conducted in 2007. The study sample included 1345 nurses in 65 intensive care units in 22 South Korean hospitals. Back pain prevalence was measured by the frequency of back pain (always, once a week, once a month or once in two or more months) during the past year. Multilevel logistic regression analyses were conducted to examine the relationship between back pain and personal and work-related characteristics. The mean age of nurses was 27.2 years. Overall, 90.3% of nurses had back pain at least once a month (21.9% always, 40.7% once a week and 27.7% once a month). Only 18.3% had received medical treatment for their back pain. Compared with neonatal intensive care unit nurses, who had the lowest prevalence, nurses in other specialties, excluding paediatric intensive care units, had a greater likelihood of back pain. Specialty medical (e.g. cardiology, neurology) intensive care unit nurses had the greatest probability of back pain and treatment. Perceiving staffing as inadequate and working 6 or more night shifts per month were related to a 64% increase (OR = 1.64; 95% CI =1.16-2.33) and 48% increase (OR =1.48; 95% CI = 1.10-1.99) in back pain, respectively. Nurses with 2-4 years of working experience in intensive care units had the greatest probability of back pain and treatment. A high prevalence of back pain was found in intensive care unit nurses, even though they comprise a very young workforce in Korea. Improving nurse staffing, reducing the frequency of night shifts and assessing risk factors in specific intensive care unit specialties are suggested to decrease back pain prevalence. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.
Full Text Available There is a general agreement that physical pain serves as an alarm signal for the prevention of and reaction to physical harm. It has recently been hypothesized that "social pain," as induced by social rejection or abandonment, may rely on comparable, phylogenetically old brain structures. As plausible as this theory may sound, scientific evidence for this idea is sparse. This study therefore attempts to link both types of pain directly. We studied patients with borderline personality disorder (BPD because BPD is characterized by opposing alterations in physical and social pain; hyposensitivity to physical pain is associated with hypersensitivity to social pain, as indicated by an enhanced rejection sensitivity.Twenty unmedicated female BPD patients and 20 healthy participants (HC, matched for age and education played a virtual ball-tossing game (cyberball, with the conditions for exclusion, inclusion, and a control condition with predefined game rules. Each cyberball block was followed by a temperature stimulus (with a subjective pain intensity of 60% in half the cases. The cerebral responses were measured by functional magnetic resonance imaging. The Adult Rejection Sensitivity Questionnaire was used to assess rejection sensitivity.Higher temperature heat stimuli had to be applied to BPD patients relative to HCs to reach a comparable subjective experience of painfulness in both groups, which suggested a general hyposensitivity to pain in BPD patients. Social exclusion led to a subjectively reported hypersensitivity to physical pain in both groups that was accompanied by an enhanced activation in the anterior insula and the thalamus. In BPD, physical pain processing after exclusion was additionally linked to enhanced posterior insula activation. After inclusion, BPD patients showed reduced amygdala activation during pain in comparison with HC. In BPD patients, higher rejection sensitivity was associated with lower activation differences during
Bungert, Melanie; Koppe, Georgia; Niedtfeld, Inga; Vollstädt-Klein, Sabine; Schmahl, Christian
Objective There is a general agreement that physical pain serves as an alarm signal for the prevention of and reaction to physical harm. It has recently been hypothesized that “social pain,” as induced by social rejection or abandonment, may rely on comparable, phylogenetically old brain structures. As plausible as this theory may sound, scientific evidence for this idea is sparse. This study therefore attempts to link both types of pain directly. We studied patients with borderline personality disorder (BPD) because BPD is characterized by opposing alterations in physical and social pain; hyposensitivity to physical pain is associated with hypersensitivity to social pain, as indicated by an enhanced rejection sensitivity. Method Twenty unmedicated female BPD patients and 20 healthy participants (HC, matched for age and education) played a virtual ball-tossing game (cyberball), with the conditions for exclusion, inclusion, and a control condition with predefined game rules. Each cyberball block was followed by a temperature stimulus (with a subjective pain intensity of 60% in half the cases). The cerebral responses were measured by functional magnetic resonance imaging. The Adult Rejection Sensitivity Questionnaire was used to assess rejection sensitivity. Results Higher temperature heat stimuli had to be applied to BPD patients relative to HCs to reach a comparable subjective experience of painfulness in both groups, which suggested a general hyposensitivity to pain in BPD patients. Social exclusion led to a subjectively reported hypersensitivity to physical pain in both groups that was accompanied by an enhanced activation in the anterior insula and the thalamus. In BPD, physical pain processing after exclusion was additionally linked to enhanced posterior insula activation. After inclusion, BPD patients showed reduced amygdala activation during pain in comparison with HC. In BPD patients, higher rejection sensitivity was associated with lower activation
Full Text Available Abstract Introduction Deep vein thrombosis (DVT is a serious health problem that affects more than 2 million people annually in the United States. Many of these patients develop asymptomatic DVT, but months to years later may experience symptomatic post-thrombotic syndrome (PTS. It is not known how many cases of PTS can be traced to "asymptomatic" DVT because venography is no longer routinely done and ultrasonography (US may miss some asymptomatic clots. As a result, a clinical tool in addition to US to detect symptom emergence or exacerbation in patients after DVT would be of value. Methods Seventy-seven patients hospitalized with an acute DVT interviewed by telephone at 3–7 days, 30–40 days, and 12-months following discharge were included in this report. All were treated with a standard anticoagulation "Clinical Pathway Protocol" between April 1999 and January 2000. Using a 14-item Deep Vein Thrombosis Leg Symptom Index (DVT-LSI, patients were queried regarding leg pain, swelling, skin discoloration, cosmetic appearance, activity tolerance, emotional distress, and leg-related sleep problems. Results The DVT-LSI for each leg was reliable at all assessments, with instrument reliability (alpha coefficients greater than 0.70 at all time points (range 0.71–0.87. DVT-LSI scores, and the percentage of patients exhibiting symptoms, were higher in the DVT-affected leg at all time points. Among patients with unilateral disease, symptom severity ratings were significantly worse for patients in the affected leg compared to the normal leg at all time points, with the exception of those with a right-leg DVT at 12 months. Patients with bilateral thrombi did not have different scores on one leg compared to the other. Conclusion The DVT-LSI is useful in assessing symptomatic clinical outcomes in patients after diagnosis of DVT, and may represent a surrogate marker for DVT otherwise presumed to be asymptomatic.
Full Text Available Abstract Background Low back pain with onset during pregnancy is common and approximately one out of three women have disabling pain. The pathogenesis of the pain condition is uncertain and there is no information on the role of physical fitness. Whether poorer physical conditioning is a cause or effect of back pain is also disputed and information from prospective studies needed. Methods A cohort of pregnant women, recruited from maternal health care centers in central Sweden, were examined regarding estimated peak oxygen uptake by cycle ergometer test in early pregnancy, reported physical activity prior to pregnancy, basic characteristics, back pain during pregnancy and back pain postpartum. Results Back pain during the current pregnancy was reported by nearly 80% of the women. At the postpartum appointment this prevalence was 40%. No association was displayed between estimated peak oxygen uptake and incidence of back pain during and after pregnancy, adjusted for physical activity, back pain before present pregnancy, previous deliveries, age and weight. A significant inverse association was found between estimated peak oxygen uptake and back pain intensity during pregnancy and a direct association post partum, in a fully adjusted multiple linear regression analysis. Conclusions Estimated peak oxygen uptake and reported physical activity in early pregnancy displayed no influence on the onset of subsequent back pain during or after pregnancy, where the time sequence support the hypothesis that poorer physical deconditioning is not a cause but a consequence of the back pain condition. The mechanism for the attenuating effect of increased oxygen uptake on back pain intensity is uncertain.
Full Text Available Host selection by female moths is fundamental to the survival of their larvae. Detecting and perceiving the non-volatile chemicals of the plant surface involved in gustatory detection determine the host preference. In many lepidopteran species, tarsal chemosensilla are sensitive to non-volatile chemicals and responsible for taste detection. The tea geometrid Ectropis obliqua is one devastating chewing pest selectively feeding on limited plants, requiring the specialized sensors to forage certain host for oviposition. In present study, we revealed the distribution of chemosensilla in the ventral side of female fifth tarsomere in E. obliqua. To investigate its molecular mechanism of gustatory perception, we performed HiSeq 2500 sequencing of the male- and female- legs transcriptome and identified 24 candidate odorant binding proteins (OBPs, 21 chemosensory proteins (CSPs, 2 sensory neuron membrane proteins (SNMPs, 3 gustatory receptors (GRs and 4 odorant receptors (ORs. Several leg-specific or enriched chemosensory genes were screened by tissue expression analysis, and clustered with functionally validated genes from other moths, suggesting the potential involvement in taste sensation or other physiological processes. The RPKM value analysis revealed that 9 EoblOBPs showed sex discrepancy in the leg expression, 8 being up-regulated in female and only 1 being over expressed in male. These female-biased EoblOBPs indicated an ecological adaption related with host-seeking and oviposition behaviors. Our work will provide basic knowledge for further studies on the molecular mechanism of gustatory perception, and enlighten a host-selection-based control strategy of insect pests.
Giummarra, Melita J; Bradshaw, John L
Chronic pain conditions often "mimic" the symptoms of restless legs syndrome (RLS) with worse pain in the evening and upon rest, associated with an urge to move and relief upon movement. We propose that too little has been made of these parallels, with pain conditions resembling RLS being dismissed as mimics. We found, in a large questionnaire study (n=283) on phantom limb perception, a pattern of phantom pain that resembled RLS: amputees with nocturnal phantom pain were more likely to report worse pain upon rest and/or lying down, with an urge to move the phantom and/or walk to relieve their pain, and to experience spontaneous limb movements akin to periodic leg movements of RLS. We present the hypothesis that a model of restless legs syndrome may provide new insights into the mechanisms underlying phantom pain, and lead to new mechanism-based phantom pain treatment. In particular, central changes associated with sensory and motor symptoms of RLS, neuropathy, and dopamine may also be involved in those predisposed to experience phantom pain that mimics the symptoms of RLS. Ultimately, restless legs syndrome may indeed be a pain syndrome, and warrants further investigation in chronic pain populations. .
Fung, James Kiujing; Yeung, Victor Hip Wo; Chu, Sau Kwan; Man, Chi Wan
KILT syndrome is a rare condition composing the triad of kidney and inferior vena cava anomaly and extensive venous thrombosis. We present a case of newly diagnosed KILT syndrome in a 41-years-old gentleman presenting with loin pain and fever. Reviewing previous case reports, KILT syndrome is usually an incidental finding on imaging studies and there is a wide scope of initial clinical presentations. However, recent evidence suggests IVC anomaly may have caused subsequent renal hypoplasia. Identification of the underlying etiology may be helpful in planning early vascular intervention to treat the condition.
Zambelis, Th; Wolgamuth, B R; Papoutsi, S N; Economou, N T
Α case of a chronic idiopathic form of a severe type of Restless Legs Syndrome (RLS), which developed during pregnancy and persisted after this, misdiagnosed for 34 years as radiculopathy S1, is reported. In spite of the thorough clinical and laboratory investigation, in addition to constant changes of the therapeutic approach, the diagnosis of S1 radiculopathy could not be confirmed, resulting in a chronic clinical course; the latter was characterized by relapses and remissions not attributed or linked in any way to the treatment (various types of). In fact, it was due to a routine workup in a sleep clinic, where the patient was referred because of a coincident chronic insomnia (Restless Legs Syndrome is a known and important cause of insomnia/chronic insomnia), which resulted in a proper diagnosis and treatment of this case. With the use of Restless Legs Syndrome appropriate treatment (Pramipexole 0.18 mg taken at bedtime, a dopaminergic agent and Level A recommended drug for Restless Legs Syndrome) an excellent response and immediate elimination of symptoms was achieved. Restless Legs Syndrome may present with a variety of symptoms (with the most prominent shortly being reported with the acronym URGE: Urge to move the legs usually associated with unpleasant leg sensations, Rest induces symptoms, Getting active brings relief, Evening and night deteriorate symptoms); given the fact that Restless Legs Syndrome presents with a great variety and heterogeneity of symptoms (mostly pain, dysesthesia and paresthesia), which may occur in several other diseases (the so called "RLS mimics"), proper diagnosis of Restless Legs Syndrome usually fails. Restless Legs Syndrome misinterpreted as S1 radiculopathy, to the best of our knowledge, has not been reported yet in the literature. Here, case history, clinical course and common RLS mimics are presented. Different forms of Restless Legs Syndrome manifestations, which are commonly -as in this case- misinterpreted due to their
Behr, James; Friedly, Janna; Molton, Ivan; Morgenroth, David; Jensen, Mark P; Smith, Douglas G
Pain and pain-related interference with physical function have not been thoroughly studied in individuals who have undergone knee-disarticulation amputations. The principal aim of this study was to determine whether individuals with knee-disarticulation amputations have worse pain and pain-related interference with physical function than do individuals with transtibial or transfemoral amputations. We analyzed cross-sectional survey data provided by 42 adults with lower-limb amputations. These individuals consisted of 14 adults reporting knee-disarticulation amputation in one limb and best-matched cases (14 reporting transfemoral amputation and 14 reporting transtibial amputation) from a larger cross-sectional sample of 472 individuals. Participants were rigorously matched based on time since amputation, reason for amputation, age, sex, diabetes diagnosis, and pain before amputation. Continuous outcome variables were analyzed by one-way analysis of variance. Categorical outcomes were analyzed by Pearson chi-square statistic. Given the relatively small sample size and power concerns, mean differences were also described by estimated effect size (Cohen's d). Of the 42 participants, 83% were male. They ranged in age from 36 to 85 (median = 55.1, standard deviation = 11.0). Most amputations were of traumatic origin (74%), and participants were on average 12.4 years from their amputations at the time of the survey. Individuals with transtibial amputation reported significantly more prosthesis use than did individuals with knee-disarticulation amputation. Amputation levels did not significantly differ in phantom limb pain, residual limb pain, back pain, and pain-related interference with physical function. Estimates of effect size, however, indicated that participants with knee-disarticulation amputation reported less phantom limb pain, phantom limb pain-related interference with physical function, residual limb pain, residual limb pain-related interference with physical
Sarah K. Galloway
Full Text Available Breast cancer is a leading cancer diagnosis among women worldwide, with more than 210,000 new cases and 40,000 deaths per year in the United States. Pain, anxiety, and depression can be significant factors during the course of breast cancer. Pain is a complex experience with sensory, affective, and cognitive dimensions. While depression and anxiety symptoms are relatively common among breast cancer patients, little is known about the relation between these psychiatric factors and distinct components of the pain experience. In the present study 60 females presenting to an NCI-designated Cancer Center with newly diagnosed breast cancer completed the Center for Epidemiological Studies 10-item Depression Scale, the State Instrument of the Spielberger State-Trait Anxiety Inventory, and the McGill Pain Questionnaire. Findings indicate that anxiety and depression are common among newly diagnosed breast cancer patients; furthermore, patients experience an appreciable amount of pain even before oncologic treatment starts. State anxiety serves as a predictor of the sensory dimension of the pain experience, whereas depression serves as a predictor of the affective dimension of the pain experience.
Gross, Douglas P; Field, Jasmine; Shanski, Kurt; Ferrari, Robert
Review of newspaper articles. To assess the content of newspaper articles in 2 provinces in Canada to determine if rest or avoidance of activity is being recommended for back pain. Inaccurate back pain beliefs in the general public may arise due to messages in the mass media. One persisting belief in Canada is that rest or activity avoidance is needed until back pain resolves. We searched newspapers in 2 Canadian provinces via an electronic database for articles discussing back pain. Two trained raters used an article review template to indicate whether the article's main recommendation was to stay active, rest, was neutral (indicating a balance between rest and activity), or did not provide advice on level of activity during an episode of back pain. One hundred 29 articles were identified. The primary advice provided related to level of activity during an episode of back pain was stay active in 24% of articles, whereas no articles primarily recommended rest or avoidance of activity. Sixteen percent of articles were rated as neutral, indicating the authors suggested a balance between rest and activity. Back-pain-related newspaper articles do not carry messages that advocate rest or avoidance of activity, but rather highlight the importance of staying active during an episode or participating in exercise.
Negus, S Stevens; Neddenriep, Bradley; Altarifi, Ahmad A; Carroll, F Ivy; Leitl, Michael D; Miller, Laurence L
Pain-related functional impairment and behavioral depression are diagnostic indicators of pain and targets for its treatment. Nesting is an innate behavior in mice that may be sensitive to pain manipulations and responsive to analgesics. The goal of this study was to develop and validate a procedure for evaluation of pain-related depression of nesting in mice. Male ICR mice were individually housed and tested in their home cages. On test days, a 5- × 5-cm Nestlet was subdivided into 6 pieces, the pieces were evenly distributed on the cage floor, and Nestlet consolidation was quantified during 100-minute sessions. Baseline nesting was stable within and between subjects, and nesting was depressed by 2 commonly used inflammatory pain stimuli (intraperitoneal injection of dilute acid; intraplantar injection of complete Freund adjuvant). Pain-related depression of nesting was alleviated by drugs from 2 classes of clinically effective analgesics (the nonsteroidal anti-inflammatory drug ketoprofen and the μ-opioid receptor agonist morphine) but not by a drug from a class that has failed to yield effective analgesics (the centrally acting kappa opioid agonist U69,593). Neither ketoprofen nor morphine alleviated depression of nesting by U69,593, which suggests that ketoprofen and morphine effects were selective for pain-related depression of nesting. In contrast to ketoprofen and morphine, the kappa opioid receptor antagonist JDTic blocked depression of nesting by U69,593 but not by acid or complete Freund adjuvant. These results support utility of this procedure to assess expression and treatment of pain-related depression in mice.
Paananen, Markus V; Taimela, Simo P; Tammelin, Tuija H; Kantomaa, Marko T; Ebeling, Hanna E; Taanila, Anja M; Zitting, Paavo J; Karppinen, Jaro I
Musculoskeletal pain is common among adolescents, but little is known about the factors that affect seeking health care for the problem. We examined the care-seeking pattern among adolescents reporting musculoskeletal pain. The study consisted of adolescents aged 16 years from the 1986 Northern Finland Birth Cohort who responded to a mailed questionnaire in 2001 and reported musculoskeletal pain over the preceding 6 months (n=5052). Logistic regression analyses were performed to assess whether enabling resources, need factors, personal health habits, and psychological problems were associated with seeking health care for musculoskeletal pain. Musculoskeletal pain during the preceding 6 months was reported by 68% of boys and 83% of girls in the study population. Only 16% of boys and 20% of girls reporting pain had sought medical care. Among both boys and girls, care-seeking was associated with being a member of a sports club (boys, odds ratio [OR] 2.1; girls, OR 1.5) and having one (boys, OR 2.1; girls, OR 1.8) or at least 2 (boys, OR 2.2; girls, OR 2.1) other health disorders. In addition, it was associated with a high physical activity level (OR 1.5) and low self-rated (OR 1.5) health among girls. Reporting pain in other anatomical areas decreased the likelihood of seeking care for pain among both genders. In conclusion, relatively few adolescents with musculoskeletal pain had consulted a health professional for the problem. Being physically active (trauma), participating in organized sport (accessibility of care), and having other health problems may explain why an adolescent seeks care for musculoskeletal pain.
... Into Relieved Are you experiencing symptoms linked to restless legs syndrome (RLS)? Find tools and support to help get ... I couldn’t sleep. Fortunately, I found the Restless Legs Syndrome Foundation and learned what type of doctor to ...
... and Teens, Men, WomenTags: neurological disorders, restless legs syndrome, RLS, sitting, sleep disorders, sleeping, uncomfortable feeling in legs at rest Family Health, Kids and Teens, Men, Women November ...
Full Text Available AJ Haugen,1 L Grøvle,1 JI Brox,2 B Natvig,3 M Grotle4 1Department of Rheumatology, Østfold Hospital Trust, Grålum, 2Department of Physical Medicine and Rehabilitation, Division for Neuroscience, Oslo University Hospital, 3Department of General Practice, Institute of Health and Society, University of Oslo, 4FORMI (Communication Unit for Musculoskeletal Disorders, Division of Neuroscience, Oslo University Hospital, Oslo, Norway Objectives: The purpose of this study was to explore the associations between pain-related fear, pain disability, and self-perceived recovery among patients with sciatica and disk herniation followed up for 2 years.Patients and methods: Pain-related fear was measured by the Tampa Scale for Kinesiophobia (TSK and the Fear-Avoidance Beliefs Questionnaire-Physical Activity (FABQ-PA subscale. Disability was measured by the Maine–Seattle Back Questionnaire. At 2 years, patients reported their sciatica/back problem on a global change scale ranging from completely gone to much worse. No specific interventions regarding pain-related fear were provided.Results: Complete data were obtained for 372 patients. During follow-up, most patients improved. In those who at 2 years were fully recovered (n=66, pain-related fear decreased substantially. In those who did not improve (n=50, pain-related fear remained high. Baseline levels of pain-related fear did not differ significantly between those who were fully recovered and the rest of the cohort. In the total cohort, the correlation coefficients between the 0–2-year change in disability and the changes in the TSK and the FABQ-PA were 0.33 and 0.38, respectively. In the adjusted regression models, the 0–2-year change in pain-related disability explained 15% of the variance in the change in both questionnaires.Conclusion: Pain-related fear decreased substantially in patients who recovered from sciatica and remained high in those who did not improve. Generally, the TSK and the FABQ
Jacobsen, Ramune; Sjøgren, Per; Møldrup, Claus
OBJECTIVE: The purpose of this review is to summarize the results of studies on physician-related barriers to cancer pain management with opioid analgesics. METHODS: A literature search was conducted in PUBMED, using a combined text word and MeSH heading search strategy. Those articles whose full...... of drug prescribing documents. The results of the articles found were analyzed with respect to (a) knowledge, beliefs, concerns, problems endorsed or acknowledged by physicians treating cancer pain, (b) physicians' skills in pain assessment, and (c) adequacy of opioid prescription. CONCLUSIONS......: This review revealed mostly general and common physician-related barriers to cancer pain management: concerns about side effects to opioids, prescription of not efficient doses of opioids, and very poor prescription for the treatment of side effects from opioids. In the future, the evaluation of the influence...
Falk, S.; Ipsen, D. H.; Appel, C. K.
, and the effect of morphine was investigated. Randall Selitto measures of cancer-induced bone pain were supplemented by von Frey testing, weight-bearing and limb use test. Contribution of cutaneous nociception to Randall Selitto measures were examined by local anaesthesia. Results: Randall Selitto pressure...... and pathological bone pain and compared the outcome with more traditional pain-related behaviour measures. Methods: Randall Selitto pressure algometry was performed over the anteromedial part of the tibia in naïve rats, sham-operated rats, and rats inoculated with MRMT-1 carcinoma cells in the left tibia...... algometry over the tibia resulted in reproducible withdrawal thresholds, which were dose-dependently increased by morphine. Cutaneous nociception did not contribute to Randall Selitto measures. In cancer-bearing animals, compared with sham, significant differences in pain-related behaviours were...
Nambi, Gopal S; Dipika Inbasekaran; Ratan Khuman; Surbala Devi; Shanmugananth; Jagannathan, K.
Background: Nonspecific chronic low back (nCLBP) pain is prevalent among adult population and often leads to functional limitations, psychological symptoms, lower quality of life (QOL), and higher healthcare costs. The purpose of this study was to determine the efficacy of Iyengar yoga therapy on pain intensity and health related quality of life (HRQOL) with nCLBP. Aim of the Study: To compare the effect of Iyengar yoga therapy and conventional exercise therapy on pain intensity and HRQOL...
Full Text Available Sleep-related eating disorder (SRED is characterized by recurrent episodes of involuntary eating during sleep period and is often associated with restless legs syndrome (RLS. Although pharmacotherapy is recommended for SRED patients, no drug have shown promising effects so far. The patient, a 48-year-old Japanese housewife, first visited our clinic and complained about nighttime eating. She had a history of hypertension, diabetes mellitus, sleep apnea syndrome, and depression. Insomnia appeared 10 years before the first visit and she often received hypnosedatives; at the same time, she developed nocturnal eating episodes. She had amnesia for these episodes, and she felt urge to move her legs while sleeping. The patient was diagnosed with SRED and RLS. Reduction in the doses of triazolam decreased her nighttime eating frequency, and her complete amnesia changed to vague recall of eating during night. Clonazepam 1.0 mg at bedtime decreased nocturnal eating frequency from 1 to 2 times per month, though sleepwalking remained. Administration of pramipexole 0.125 mg relieved all symptoms including SRED, RLS, and sleepwalking. This is the first paper to report that the combination of clonazepam and pramipexole therapy-reduced SRED episodes and RLS symptoms.
Kobayashi, Nobuyuki; Yoshimura, Ryohei; Takano, Masahiro
Sleep-related eating disorder (SRED) is characterized by recurrent episodes of involuntary eating during sleep period and is often associated with restless legs syndrome (RLS). Although pharmacotherapy is recommended for SRED patients, no drug have shown promising effects so far. The patient, a 48-year-old Japanese housewife, first visited our clinic and complained about nighttime eating. She had a history of hypertension, diabetes mellitus, sleep apnea syndrome, and depression. Insomnia appeared 10 years before the first visit and she often received hypnosedatives; at the same time, she developed nocturnal eating episodes. She had amnesia for these episodes, and she felt urge to move her legs while sleeping. The patient was diagnosed with SRED and RLS. Reduction in the doses of triazolam decreased her nighttime eating frequency, and her complete amnesia changed to vague recall of eating during night. Clonazepam 1.0 mg at bedtime decreased nocturnal eating frequency from 1 to 2 times per month, though sleepwalking remained. Administration of pramipexole 0.125 mg relieved all symptoms including SRED, RLS, and sleepwalking. This is the first paper to report that the combination of clonazepam and pramipexole therapy-reduced SRED episodes and RLS symptoms.
Abstract Background There is a high prevalence of mental health problems amongst adolescents. In addition there is a high prevalence of spinal pain in this population. Evidence suggests that these conditions are related. This study sought to extend earlier findings by examining the relationship between mental health problems as measured by the Child Behaviour Check List (CBCL) and the experience of back and neck pain in adolescents. Methods One thousand five hundred and eighty participants (m...
O'Sullivan Peter B
Full Text Available Abstract Background There is a high prevalence of mental health problems amongst adolescents. In addition there is a high prevalence of spinal pain in this population. Evidence suggests that these conditions are related. This study sought to extend earlier findings by examining the relationship between mental health problems as measured by the Child Behaviour Check List (CBCL and the experience of back and neck pain in adolescents. Methods One thousand five hundred and eighty participants (mean age 14.1 years from the Western Australian Pregnancy (Raine Study provided cross-sectional spinal pain and CBCL data. Results As predicted, there was a high prevalence of back and neck pain in this cohort. On the whole, females reported more mental health difficulties than males. There were strong relationships between the majority of symptom scales of the CBCL and back and neck pain. Scores on the CBCL were associated with higher odds of comorbid back and neck pain. Conclusions These findings strongly support the need to consider both psychological and pain symptoms when providing assessments and treatment for adolescents. Further research is required to inform causal models.
Jensen, Mark P; Hu, Xiaojun; Potts, Susan L; Gould, Errol M
Assay sensitivity remains a significant issue in pain clinical trials. One possible method for increasing assay sensitivity for detecting changes in pain intensity is to increase the reliability of pain intensity assessment by increasing the number of intensity ratings obtained, and combining these ratings into composite scores. The current study performed secondary analyses from a published clinical trial to test this possibility. The reliability and assay sensitivity pain intensity scores made up of 1 to 9 24-hour pain intensity recall ratings were compared. Although the reliability of the outcome measures improved as the number of items increased, this increase in reliability was not associated with an increase in assay sensitivity. A single 24-hour recall rating was about as valid (sensitive) for detecting treatment effects as composite scores made up of 2 to 9 different ratings. If this finding replicates in other pain populations, it has significant implications for the design and conduct of pain clinical trials. Specifically, it suggests the possibility that assessment burden (and associated costs and problems related to missing data) might be greatly reduced by specifying a single recall rating as the primary outcome variable. Research is needed to explore this possibility further.
Kjaer, Monica L; Mainz, Jan; Soernsen, Lars T
In the clinical setting, diagnosis and treatment of venous leg ulcers can vary considerably from patient to patient. The first step to reducing this variation is to document venous leg ulcer care through use of quantitative scientific documentation principles. This requires the development of valid...... and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel......; an independent medical doctor tested the feasibility and reliability of these clinical indicators, assessing the quality of medical technical care on 100 consecutive venous leg ulcer patients. Main outcome measures were healing, recurrence, pain, venous disease diagnosis, differential diagnosis and treatment...
Ruppert Katherine A
Full Text Available Abstract Corticotropin-releasing factor receptor CRF1 has been implicated in the neurobiological mechanisms of anxiety and depression. The amygdala plays an important role in affective states and disorders such as anxiety and depression. The amygdala is also emerging as a neural substrate of pain affect. However, the involvement of the amygdala in the interaction of pain and anxiety remains to be determined. This study tested the hypothesis that CRF1 receptors in the amygdala are critically involved in pain-related anxiety. Anxiety-like behavior was determined in adult male rats using the elevated plus maze (EPM test. The open-arm preference (ratio of open arm entries to the total number of entries was measured. Nocifensive behavior was assessed by measuring hindlimb withdrawal thresholds for noxious mechanical stimulation of the knee. Measurements were made in normal rats and in rats with arthritis induced in one knee by intraarticular injections of kaolin/carrageenan. A selective CRF1 receptor antagonist (NBI27914 or vehicle was administered systemically (i.p. or into the central nucleus of the amygdala (CeA, by microdialysis. The arthritis group showed a decreased preference for the open arms in the EPM and decreased hindlimb withdrawal thresholds. Systemic or intraamygdalar (into the CeA administration of NBI27914, but not vehicle, inhibited anxiety-like behavior and nocifensive pain responses, nearly reversing the arthritis pain-related changes. This study shows for the first time that CRF1 receptors in the amygdala contribute critically to pain-related anxiety-like behavior and nocifensive responses in a model of arthritic pain. The results are a direct demonstration that the clinically well-documented relationship between pain and anxiety involves the amygdala.
Price, Patricia E; Fagervik-Morton, Hilde; Mudge, Elizabeth J; Beele, Hilde; Ruiz, Jose Contreras; Nystrøm, Theis Huldt; Lindholm, Christina; Maume, Sylvie; Melby-Østergaard, Britta; Peter, Yolanda; Romanelli, Marco; Seppänen, Salla; Serena, Thomas E; Sibbald, Gary; Soriano, Jose Verdú; White, Wendy; Wollina, Uwe; Woo, Kevin Y; Wyndham-White, Carolyn; Harding, Keith G
This cross-sectional international survey assessed patients' perceptions of their wound pain. A total of 2018 patients (57% female) from 15 different countries with a mean age of 68.6 years (SD = 15.4) participated. The wounds were categorised into ten different types with a mean wound duration of 19.6 months (SD = 51.8). For 2018 patients, 3361 dressings/compression systems were being used, with antimicrobials being reported most frequently (n= 605). Frequency of wound-related pain was reported as 32.2%, 'never' or 'rarely', 31.1%, 'quite often' and 36.6%, 'most' or 'all of the time', with venous and arterial ulcers associated with more frequent pain (P= 0.002). All patients reported that 'the wound itself' was the most painful location (n= 1840). When asked if they experienced dressing-related pain, 286 (14.7%) replied 'most of the time' and 334 (17.2%) reported pain 'all of the time'; venous, mixed and arterial ulcers were associated with more frequent pain at dressing change (P dressing change, for 449 (22.2%) it took 1-2 hours, for 192 (9.5%) it took 3-5 hours and for 154 (7.6%) patients it took more than 5 hours. Pain intensity was measured using a visual analogue scale (VAS) (0-100) giving a mean score of 44.5 (SD = 30.5, n= 1981). Of the 1141 who reported that they generally took pain relief, 21% indicated that they did not feel it was effective. Patients were asked to rate six symptoms associated with living with a chronic wound; 'pain' was given the highest mean score of 3.1 (n= 1898). In terms of different types of daily activities, 'overdoing things' was associated with the highest mean score (mean = 2.6, n= 1916). During the stages of the dressing change procedure; 'touching/handling the wound' was given the highest mean score of 2.9, followed by cleansing and dressing removal (n= 1944). One thousand four hundred and eighty-five (80.15%) patients responded that they liked to be actively involved in their dressing changes, 1141 (58.15%) responded that
Jensen, Hanne Irene; Plesner, Karin; Kvorning, Nina
OBJECTIVE: To describe the associations between demographics and health-related quality of life for chronic non-malignant pain patients. DESIGN: A cohort study. SETTING: A multidisciplinary Danish pain centre. STUDY PARTICIPANTS: All patients treated at the centre between 2007 and 2013. MAIN.......7 ± 14.4 (range 18-89), and 21% were able to work full or part time. On a Numeric Rating Scale from 0 to 10, median pain-intensity was 8 (interquartile range 7-8) and pain-discomfort 8 (interquartile range 7-9) at time of referral. More than half of the patients had symptoms of anxiety and depression...
Hestbæk, L.; Larsen, K.; Weidich, F.
BACKGROUND: Traditionally, studies on the etiology of low back pain have been carried out in adult populations. However, since low back pain often appears early in life, more research on young populations is needed. This study focuses on the importance of social background factors and previous low...... on the development of low back pain, when persons are removed from their usual environment and submitted to a number of new stressors. In addition, the importance of the recruits' previous low back pain history in relation to low back pain during military service was studied. This was done by means of questionnaires...... to 1,711 recruits before and after this three-month period. RESULTS: Sedentary occupation was negatively associated with long-lasting low back pain (>30 days during the past year) at baseline with an odds ratios of 0.55 (95% CI: 0.33-0.90). This effect vanished during service. Having parents...
Biering, Karin; Nøhr, Ellen Aagaard; Olsen, Jørn
Objective. To investigate the association between pre-pregnancy overweight/obesity and pregnancy-related pelvic pain. Design: Nested case-control study. Setting and population. The Danish National Birth Cohort, a cohort of pregnant women and their children recruited 1996–2002. Methods. The women...... had not given birth before. Conclusion. The risk of pregnancy-related pelvic pain increasedwith pre-pregnancy BMI in an exposure–response relation and potentially adds another maternal complication to obesity....... were interviewed twice during pregnancy and twice after childbirth. The first pregnancy interview provided information on self-reported pre-pregnancy body mass index (BMI) and possible confounders, while data on pregnancy-related pelvic pain came from an interview sixmonths postpartum. Cases (n=2 271...
Khawaja, S.N.; McCall, W.; Dunford, R.; Nickel, J.C.; Iwasaki, L.R.; Crow, H.C.; Gonzalez, Y.
Objectives Pain-related Temporomandibular disorders (TMD) are the most prevalent conditions among TMDs. There is contrasting evidence available for association of pain-related TMD and masticatory muscle activity (MMA). The present investigation assesses the associations between MMA levels of masseter and temporalis muscles during awake and sleep among pain-related TMD diagnostic groups. Setting and Sample Population The department of Oral Diagnostic Sciences, University at Buffalo. Twenty females and 6 males participated in this study. Material & Methods Using the Diagnostic Criteria for Temporomandibular Disorders (DC-TMD), participants were diagnostically categorized. Subjects used a custom monitoring system, which recorded in–field muscle activities. A factorial model tested for association between independent variable (muscle, time period, MMA level, diagnostic group) effects and the logarithm of MMA. Greenhouse–Geisser test was used to determine any statistically significant associations (p ≤ 0.003). Results No statistically significant association was found among four-way, three-way, and two-way analyses. However, among the main effects, range of magnitudes was the only variable to be statistically significant. Although the data suggest a trend of increased masseter MMA in the pain-related TMD diagnoses group both during awake and sleep time periods, such observation is not maintained for the temporalis muscle. In addition, temporalis MMA was found to be higher in the pain-related TMD diagnoses group only at extreme activity levels (TMD conditions. PMID:25865542
Palermo, Tonya M; Law, Emily F; Zhou, Chuan; Holley, Amy Lewandowski; Logan, Deirdre; Tai, Gabrielle
Although pain and function improve at immediate posttreatment for youth receiving cognitive behavioral therapy for chronic pain, limited data are available to understand changes that youth make during psychological treatment. We sought to characterize distinct trajectory patterns of change in pain and function to understand the temporal association of these changes during internet-delivered cognitive behavioral therapy (CBT). Weekly repeated assessments of pain and function were conducted during 8 weeks of treatment among 135 adolescents, aged 11 to 17 years, with chronic pain who were randomized to the cognitive behavioral intervention arm of an ongoing trial of internet-delivered CBT (Web-based management of adolescent pain; Web-MAP2). Using random-effects growth mixture models, we characterized pain and functional disability trajectories finding distinct trajectory groups indicating patterns of both linear and quadratic effects. Trajectories of change showed that some patients' pain and functional disability were improving, others worsened or changed minimally. Paired t tests compared the within-subject relative change rate in pain and function demonstrating similar change range for pain and function during the treatment period. There was no support for improvements in either pain or function to precede changes in the other domain. Findings may be useful in informing future studies of psychosocial treatments for pediatric chronic pain to consider how to target treatment strategies to distinct patient response profiles. This may lead to the development of intervention strategies that can both more effectively target children's pain and function during treatment and lead to sustained changes after treatment.
Mista, Christian A; Christensen, Steffan W; Graven-Nielsen, Thomas
Experimental muscle pain typically reorganizes the motor control. The pain effects may decrease when the three-dimensional force components are voluntarily adjusted, but it is not known if this could have negative consequences on other structures of the motor system. The present study assessed the effects of acute pain on the force variability during sustained elbow flexion when controlling task-related (one-dimensional) and all (three-dimensional) contraction force components via visual feedback. Experimental muscle pain was induced by bolus injection of hypertonic saline into m. biceps brachii, and isotonic saline was used as control. Twelve subjects performed sustained elbow flexion at different levels of the maximal voluntary contraction (5-30% MVC) before, during, and after the injections. Three-dimensional force components were measured simultaneously with surface electromyography (EMG) from elbow flexors and auxiliary muscles. Results showed that force variability was increased during pain compared to baseline for contractions using one-dimensional feedback (PEMG activity from m. trapezius was increased during contractions using both one-dimensional and three-dimensional feedback (PEMG from m. triceps brachii and m. deltoid was higher for the three-dimensional feedback (P<.05). In conclusion, the three-dimensional feedback reduced the pain-related functional distortion at the cost of a more complex control of synergistic muscles.
Macaré van Maurik, J. F M; Oomen, R. T W; van Hal, M.; Kon, M.; Peters, E J G
Aims: The aim of this study was to assess whether surgical decompression of nerves in the lower extremity in people with painful diabetic polyneuropathy would have an effect on health-related quality of life and to determine minimal clinically important differences in pain and quality of life scores
Full Text Available Abstract Background Skeletal metastases are often accompanied by bone pain. To investigate the clinical meaning of bone pain associated with skeletal metastasis in breast cancer patients after surgery, we explored whether the presence of bone pain was due to skeletal-related events (SREs or survival (cause specific death, CSD, retrospectively. Methods Consecutive breast cancer patients undergoing surgery between 1988 and 1998 were examined for signs of skeletal metastasis until December 2006. Patients who were diagnosed as having skeletal metastasis were the subjects of this study. Bone scans were performed annually for 5, 7 or 10 years; they were also conducted if skeletal metastasis was suspected. Data concerning bone pain and tumor markers at the time of skeletal metastasis diagnosis, and data relating to various factors including tumors, lymph nodes and hormone receptors at the time of surgery, were investigated. The relationships between factors such as bone pain, SRE and CSD were analyzed using the Kaplan-Meier method and Cox's analysis. Results Skeletal metastasis occurred in 668 patients but the pain status of two patients was unknown, therefore 666 patients were included in the study. At the time of skeletal metastasis diagnosis 270 patients complained of pain; however, 396 patients did not. Analysis of data using Cox's and Kaplan-Meier methods demonstrated that patients without pain had fewer SREs and better survival rates than those with pain. Hazard ratios regarding SRE (base = patients without pain were 2.331 in univariate analysis and 2.243 in multivariate analysis. Hazard ratios regarding CSD (base = patients without pain were 1.441 in univariate analysis and 1.535 in multivariate analysis. Similar results were obtained when analyses were carried out using the date of surgery as the starting point. Conclusion Bone pain at diagnosis of skeletal metastasis was an indicator of increased SRE and CSD. However, these data did not
Ruggiero, Antonio; Coccia, Paola; Arena, Roberta; Maurizi, Palma; Battista, Andrea; Ridola, Vita; Attinà, Giorgio; Riccardi, Riccardo
The current study investigated the efficacy, safety, tolerability, and compliance of a transdermal buprenorphine delivery system for the management of chronic cancer pain in the pediatric population. Sixteen pediatric patients with moderate to severe cancer-related pain not satisfactorily controlled with previous non-opioid therapies were enrolled. Transdermal buprenorphine was administered following a 72 hour schedule and rescue medication (tramadol) was allowed for breakthrough pain. Pain intensity was assessed using the Wong-Baker faces pain rating scale (WBS) and other parameters related to the global quality of life were evaluated. Children's evaluations of efficacy, compliance, and tolerability were recorded using numerical scales. Adverse events were monitored during the study and the medications needed to control opioid-related nausea and constipation were recorded. Eleven patients (68.75%) responded to transdermal buprenorphine after 2 weeks of treatment. Pain intensity measured with WBS decreased from 6.25 at baseline to 1.38 at Day +60 (P alimentation, play and activity, speech, and crying) significantly improved over the 60-day study period. Children's evaluations of compliance and tolerability of the drug were always positive over the entire period of treatment. No severe adverse events were recorded. Opioid-related nausea was well controlled with medication on request, and the need for laxative therapy was greater at the end of the second month of treatment. Transdermal buprenorphine was found to represent an efficient, safe and well tolerated approach to the management of children's chronic cancer pain. Copyright © 2012 Wiley Periodicals, Inc.
Claassen, J; Labrenz, F; Ernst, T M; Icenhour, A; Langhorst, J; Forsting, M; Timmann, D; Elsenbruch, S
There is evidence to support a role of the cerebellum in emotional learning processes, which are demonstrably altered in patients with chronic pain. We tested if cerebellar activation is altered during visceral pain-related fear conditioning and extinction in irritable bowel syndrome (IBS). Cerebellar blood oxygenation level-dependent (BOLD) data from N = 17 IBS patients and N = 21 healthy controls, collected as part of a previous fMRI study, was reanalyzed utilizing an advanced normalizing method of the cerebellum. The differential fear conditioning paradigm consisted of acquisition, extinction, and reinstatement phases. During acquisition, two visual conditioned stimuli (CS) were presented either paired (CS+) or unpaired (CS-) with painful rectal distension as unconditioned stimulus (US). In the extinction phase, the CS+ and CS- were presented without US. For reinstatement, unpaired US presentations were followed by unpaired CS+ and CS- presentations. Group differences in cerebellar activation were analyzed for the contrasts CS+ > CS- and CS- > CS+. During acquisition, IBS patients revealed significantly enhanced cerebellar BOLD responses to pain-predictive (CS+) and safety (CS-) cues compared to controls (p CS- and CS- > CS+. Group differences were most prominent in the contrast CS- > CS+. During extinction and reinstatement, no significant group differences were found. During visceral pain-related fear conditioning, IBS patients showed increased activations in circumscribed areas of the medial, intermediate, and lateral cerebellum. These areas are involved in autonomic, somatosensory, and cognitive functions and likely contribute to the different aspects of pain-related fear. The cerebellum contributes to altered pain-related fear learning in IBS.
Menz, Hylton B; Fotoohabadi, Mohammad R; Munteanu, Shannon E; Zammit, Gerard V; Gilheany, Mark F
Forefoot pain is a common problem in older people. We determined whether plantar pressures during gait and the relative lengths of the lesser metatarsals differ between older people with and without plantar forefoot pain. Dynamic plantar pressure assessment during walking was undertaken using the Tekscan MatScan® system in 118 community-dwelling older people (44 males and 74 females), mean age 74 (standard deviation=5.9) years, 43 (36%) of whom reported current or previous plantar forefoot pain. The relative lengths of metatarsals 1-5 were determined from weightbearing X-rays. Participants with current or previous plantar forefoot pain exhibited significantly (p=0.032) greater peak plantar pressure under metatarsal heads 3-5 (1.93 ± 0.41 kg/cm(2) vs. 1.74 ± 0.48 kg/cm(2) ). However, no differences were found in relative metatarsal lengths between the groups. These findings indicate that older people with forefoot pain generate higher peak plantar pressures under the lateral metatarsal heads when walking, but do not exhibit relatively longer lesser metatarsals. Other factors may be responsible for the observed pressure increase, such as reduced range of motion of the metatarsophalangeal joints and increased stiffness of plantar soft tissues. Copyright © 2012 Orthopaedic Research Society.
Neupane, Subas; Nygård, Clas-Håkan; Oakman, Jodi
Work-related musculoskeletal pain is a major occupational problem. Those with pain in multiple sites usually report worse health outcomes than those with pain in one site. This study explored prevalence and associated predictors of multi-site pain in health care sector employees. Survey responses from 1348 health care sector employees across three organisations (37% response rate) collected data on job satisfaction, work life balance, psychosocial and physical hazards, general health and work ability. Musculoskeletal discomfort was measured across 5 body regions with pain in ≥ 2 sites defined as multi-site pain. Generalized linear models were used to identify relationships between work-related factors and multi-site pain. Over 52% of the employees reported pain in multiple body sites and 19% reported pain in one site. Poor work life balance (PRR = 2.33, 95% CI = 1.06-5.14). physical (PRR = 7.58, 95% CI = 4.89-11.77) and psychosocial (PRR = 1.59, 95% CI = 1.00-2.57) hazard variables were related to multi-site pain (after controlling for age, gender, health and work ability. Older employees and females were more likely to report multi-site pain. Effective risk management of work related multi-site pain must include identification and control of psychosocial and physical hazards.
Wu, Wen Hua; Meijer, Onno G.; Bruijn, Sjoerd M.; Hu, Hai; Van Dieën, Jaap H.; Lamoth, Claudine J. C.; Van Royen, Barend J.; Beek, Peter J.
Walking is impaired in Pregnancy-related Pelvic girdle Pain (PPP). Walking velocity is reduced, and in postpartum PPP relative phase between horizontal pelvis and thorax rotations was found to be lower at higher velocities, and rotational amplitudes tended to be larger. While attempting to confirm t
Damen, L.; Buyruk, H.M.; Guler-Uysal, F.; Lotgering, F.K.; Snijders, C.J.; Stam, H.J.
STUDY DESIGN: Prospective cohort study. OBJECTIVE: To determine the prognostic value of asymmetric laxity of the sacroiliac joints during pregnancy on pregnancy-related pelvic pain postpartum. SUMMARY OF BACKGROUND DATA: In a previous study, we observed a significant relation between asymmetric laxi
Hwang, Michael Huynh; Khesbak, Ziyad; Liu, Yiju Teresa
A 51-year-old male presented to the ED with a rash to his left thigh (figure 1) with erythema, swelling and pain. He endorsed paraesthesias, pruritus, fevers, vomiting and diarrhoea. Initial vitals were unremarkable. He was well appearing with an 8×8 cm violaceous patch on his left medial thigh with vesicles, surrounding erythema and induration with a second, smaller lesion on the right thigh. Both rashes were extremely tender.emermed;34/10/686/F1F1F1Figure 1Erythematosus and vesicular rash in bilateral legs.A bedside ultrasound image of the rash was obtained (figure 2).emermed;34/10/686/F2F2F2Figure 2Bedside ultrasound of rash. What is the most likely cause of the patient's rash?A. Herpes zosterB. CellulitisC. Necrotising fasciitisD. Bullous pemphigoid. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Hathaway, Elizabeth E.; Luberto, Christina M.; Bogenschutz, Lois H.; Geiss, Sue; Wasson, Rachel S.
Background: Pain management is a frequent problem in the neonatal intensive care unit (NICU). Few studies examining effects of integrative care therapies on pain-related outcomes in neonates have included physiological outcomes or investigated the use of such therapies in a practice-based setting. Objective: The purpose of this practice-based retrospective study was to examine the associations between integrative care therapies, particularly massage and healing touch, and pain-related outcomes among hospitalized infants. Methods: We conducted a retrospective review of a clinical database from a level III NICU regularly delivering integrative care therapies. Paired-samples t-tests were used to examine associations between integrative care therapies and 4 pre-post outcome measures: therapist-rated pain and presentation (ranging from asleep to agitated) and neonates' heart rate and oxygen saturation. Results: Of 186 patients (Mage=68 days), 58% were male and 67% were Caucasian. Sixty-two percent received both massage and healing touch; the remainder received a single therapy. From pre-post therapy, statistically significant changes were observed in infants' heart rate (Mpre=156 vs Mpost=140 per minute; P<.001), oxygen saturation (Mpre=95.0% vs.Mpost=97.4%; P<.001), and therapist-reported pain (Mpre=2.8 vs Mpost=0.2; P<.001) and presentation (Mpre=3.2 vs. Mpost=1.0; P<.001). Conclusion: Observed improvements in pain-related outcomes suggest that massage and healing touch may be useful integrative therapies to consider as pain management options in the NICU. PMID:26331102
J.A.C.G. Jansen (Jaap)
textabstractAlthough participation in sports is considered important by the Dutch government, it does increase the risk for musculoskeletal injury. Every year, about 3,500,000 sports injuries occur in the Netherlands (Schmikli et al., 2004). In this thesis, emphasis is placed on sports-related groin
AM Girbik; PA Dilorenzo
The Naval Reactors Prime Contractor Team (NRPCT) recommended the development of a gas cooled reactor directly coupled to a Brayton energy conversion system as the Space Nuclear Power Plant (SNPP) for NASA's Project Prometheus. The section of piping between the reactor outlet and turbine inlet, designated as the hot leg piping, required unique design features to allow the use of a nickel superalloy rather than a refractory metal as the pressure boundary. The NRPCT evaluated a variety of hot leg piping concepts for performance relative to SNPP system parameters, manufacturability, material considerations, and comparison to past high temperature gas reactor (HTGR) practice. Manufacturability challenges and the impact of pressure drop and turbine entrance temperature reduction on cycle efficiency were discriminators between the piping concepts. This paper summarizes the NRPCT hot leg piping evaluation, presents the concept recommended, and summarizes developmental issues for the recommended concept.
Chabowski, Mariusz; Junke, Michał; Juzwiszyn, Jan; Milan, Magdalena; Malinowski, Maciej; Janczak, Dariusz
Background Pain is one of the factors that decrease quality of life. Undergoing surgery is inevitably associated with the sensation of pain, which can affect a patient’s level of acceptance of an illness. The aim of the study was to evaluate the level of acceptance of illness in patients undergoing surgical treatment with relation to the pain perceived by them during surgical treatment and to determine other factors that affect adaptation to illness among patients subjected to invasive treatment. Material and methods The study was conducted on a group of 100 patients with mean age of 51.27 (SD=18.98) hospitalized in surgery departments in the Provincial Specialist Hospital in Wrocław, Poland, in April 2016. The Acceptance of Illness Scale (AIS) and the Visual Analog Scale (VAS) for pain were used. Results The mean score of VAS was 3.86 (SD =2.02). The mean score of AIS was 24.42 (SD =7.35). The level of acceptance of illness was significantly negatively correlated with the intensity of pain (p<0.001; r=−0.498), the number of coexisting diseases (p=0.002; r=−0.31), age (p<0.001; r=−0.391), and the period of time since the operation (p=0.007; r=−0.266). Patients taking analgesics showed a significantly lower acceptance of illness than those who did not (p=0.009). A patient’s place of living, education, and sex had no significant impact on their acceptance of illness. Conclusion A higher level of pain translates into a lower adaptation to illness despite the use of analgesics, which may indicate that inadequate pain control leads to a decrease in the acceptance of illness. Further research on monitoring postoperative pain, as well as the development of postoperative prevention programs, is required. PMID:28721086
Vartiainen, Pekka; Heiskanen, Tarja; Sintonen, Harri; Roine, Risto P; Kalso, Eija
Health-related quality of life (HRQoL) measurement aims to capture the complete, subjective health state of the patients and to comprehensively evaluate treatment outcomes. The aim of this study was to assess, using the 15D HRQoL instrument, HRQoL in a sample of 1528 chronic pain patients, referred to the multidisciplinary pain clinic of the Helsinki University Hospital during 2004 to 2012. The 15D results of the chronic pain patients were compared with those of a matched general population. To analyse the properties of the 15D, the results were compared with the preadmission questionnaire of the pain clinic, containing questions about background factors, aspects of the pain, and its impact on life. The mean 15D score of the chronic pain patients was one of the lowest reported using 15D; 0.710 vs 0.922 in the general population. It equalled the score of advanced cancer patients in palliative care. The 15D scores were normally distributed, and 15D showed both statistically and clinically significant discriminative power in pain-related background factors. Visual analogue scale on pain intensity, visual analogue scale on pain-related distress, and the impact of pain on daily life correlated well with the 15D score. Pain intensity did not have independent predictive value on the score. The results indicate heavy perceived burden of illness in chronic pain patients. In light of the questions analysed, 15D appears sensitive and discriminative in chronic pain patients in tertiary care. Instead of pain intensity, the impaired HRQoL in chronic pain was mainly because of the psychosocial aspects of pain.
Li, Chun-Mei; Zhang, Da-Ming; Yang, Chun-Xiao; Ma, Xu; Gao, He-Ren; Zhang, Duo; Xu, Man-Ying
The caudate putamen (CPu) has been suggested to be involved in nociceptive modulation. Some neurotransmitters, including acetylcholine (ACh), participate in pain modulation in the central nervous system. However, the active mechanism of ACh on the pain-related neurons in the CPu remains unclear. This study aimed to investigate the effects of the cholinergic agonists ACh and pilocarpine and the muscarinic ACh receptor antagonist atropine on the pain-induced response of pain-related neurons in the CPu of Wistar rats. Trains of electrical impulses applied to the sciatic nerve of rat were used as the noxious stimulus. The electrical activities of pain-excited neurons (PENs) or pain-inhibited neurons (PINs) in the CPu were recorded by a glass microelectrode. Our results showed that an intra-CPu injection of 4 μg/2 μl ACh or pilocarpine decreased and increased the pain-induced discharge frequency in the PENs and PINs, respectively. Intra-CPu administration of 1 μg/2 μl atropine produced the opposite effect on these neurons. These findings indicate that ACh may play an analgesic role by affecting the electric activities of PENs and PINs, and the muscarinic pathway may be involved in the modulation of pain perception in the CPu.
Elander, J; Richardson, C; Morris, J; Robinson, G; Schofield, M B
Motivational and behavioural models of adjustment to chronic pain make different predictions about change processes, which can be tested in longitudinal analyses. We examined changes in motivation, coping and acceptance among 78 men with chronic haemophilia-related joint pain. Using cross-lagged regression analyses of changes from baseline to 6 months as predictors of changes from 6 to 12 months, with supplementary structural equation modelling, we tested two models in which motivational changes influence behavioural changes, and one in which behavioural changes influence motivational changes. Changes in motivation to self-manage pain influenced later changes in pain coping, consistent with the motivational model of pain self-management, and also influenced later changes in activity engagement, the behavioural component of pain acceptance. Changes in activity engagement influenced later changes in pain willingness, consistent with the behavioural model of pain acceptance. Based on the findings, a combined model of changes in pain self-management and acceptance is proposed, which could guide combined interventions based on theories of motivation, coping and acceptance in chronic pain. This study adds longitudinal evidence about sequential change processes; a test of the motivational model of pain self-management; and tests of behavioural versus motivational models of pain acceptance. © 2017 European Pain Federation - EFIC®.
[Quality assurance in therapy of chronic pain. Results obtained by a taskforce of the German Section of the Association for the Study of Pain on psychological assessment of chronic pain. V. Instruments for the assessment of pain-related cognitions and coping with pain.].
Denecke, H; Klinger, R; Kröner-Herwig, B; Nilges, P; Redegeld, M; Weiß, L; Glier, B
The present paper is one of a series of publications, reviewing German instruments for psychological assessment of pain. Their main focus is on the results of a task force on quality testing for each subject. This paper describes and comments on methods regarding self-reporting of pain cognitions and both cognitive and behavioral strategies for coping with pain. Concerning pain cognitions one focus is on patients' attributions of causes of pain and the modes of controlling pain (subjective pain model). The other focus is on instruments recording "pain beliefs" in the sense of dysfunctional congitions associated with the experience of pain. Each instrument was examined with reference to approved psychometric criteria, empirical foundation and clinical relevance. It was noted that several instruments are deficient in their psychometric criteria and their empirical foundations. We used these data as a basis to elaborate a specific and differential recommendation. A similar procedure was followed with instruments for the assessment of pain-related coping strategies. According to our research there are two subgroups of coping instruments, one more specifically for cognitive coping with pain, and the other combined with behavioral coping strategies. Once again, we elaborated a specific and differential recommendation, giving priority to instruments taking account of both cognitive and behavioral dimensions of coping with pain.
Ozturk, Erhan Arif; Gundogdu, Ibrahim; Kocer, Bilge; Comoglu, Selcuk; Cakci, Aytul
Although there are studies evaluating pain in Parkinson's disease (PD), to our knowledge, there is no study evaluating the following topics in a cohort of PD patients; (1) frequency of chronic pain, (2) characteristics of chronic pain, (3) severity of chronic pain, (4) types of chronic pain, (5) independent predictors of chronic pain, (6) impact of chronic pain on health-related quality of life (HRQoL), and (7) the role of chronic pain among the independent predictors of HRQoL. The purpose of this study was to evaluate the frequency, characteristics, severity, types, and independent factors of chronic pain, as well as the relationship of chronic pain with HRQoL in a cohort of PD patients. One-hundred and thirteen individuals with a confirmed diagnosis of PD who were consecutively referred to the Ministry of Health Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Movement Disorders Outpatient Clinic were included in the study. Demographic variables, disease characteristics, disease-related motor symptoms and motor complications, comorbid conditions, and health-related quality of life were evaluated and recorded. Pain lasting longer than three months was defined as `chronic pain' and participants were questioned relating to the characteristics of the chronic pain. The Visual Analogue Scale was used for assessment of pain. Seventy-three patients (64.6%) suffered from chronic pain. Of these, 12 (16.4%) had previous pain at the time of diagnosis of PD. The sources of pain experienced by patients were 89.0% musculoskeletal, 31.5% radicular/peripheral neuropathic, 15.1% dystonic, and 4.1% central parkinsonian, respectively. Twenty-six patients (35.6%) had different types of pain simultaneously. The pain type with the highest severity was a central parkinsonian pain.The independent predictors of chronic pain included gender (female), Unified Parkinson's Disease Rating Scale (UPDRS) part II (activities of daily living), UPDRS part III (motor symptoms
Springer, Kristen S; George, Steven Z; Robinson, Michael E
Previous studies have not examined the assessment of chronic low back pain (CLBP) and pain-related anxiety from a fear avoidance model through the use of motion-capture software and virtual human technologies. The aim of this study was to develop and assess the psychometric properties of an interactive, technologically based hierarchy that can be used to assess patients with pain and pain-related anxiety. We enrolled 30 licensed physical therapists and 30 participants with CLBP. Participants rated 21 video clips of a 3-D animated character (avatar) engaging in activities that are typically feared by patients with CLBP. The results of the study indicate that physical therapists found the virtual hierarchy clips acceptable and depicted realistic patient experiences. Most participants with CLBP reported at least 1 video clip as being sufficiently anxiety-provoking for use clinically. Therefore, this study suggests a hierarchy of fears can be created out of 21 virtual patient video clips paving the way for future clinical use in patients with CLBP. This report describes the development of a computer-based virtual patient system for the assessment of back pain-related fear and anxiety. Results show that people with back pain as well as physical therapists found the avatar to be realistic, and the depictions of behavior anxiety- and fear-provoking. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.
Hechler, Tanja; Kosfelder, Joachim; Vocks, Silja; Mönninger, Theresa; Blankenburg, Markus; Dobe, Michael; Gerlach, Alexander L; Denecke, Heide; Zernikow, Boris
While sex differences in pain-related coping have been widely reported, little is known on sex differences in changes in coping following multimodal pain treatment and how these changes relate to treatment outcome. The present prospective study therefore aimed to investigate sex differences in coping strategies between boys and girls with chronic pain prior to multimodal inpatient treatment and at 3-month follow-up. Sixty-four boys and 103 girls with various pain disorders were evaluated. Core outcomes (pain intensity and pain-related disability) and coping were assessed via validated questionnaires. At admission, boys and girls used similar coping strategies. Three months following treatment, boys and girls decreased passive pain coping and seeking social support while they maintained the degree of positive self-instruction. Girls displayed higher seeking social support than boys and of importance, only for girls, a reduction in seeking social support was related to decreases in pain intensity. In both groups, the changes in coping were related to positive treatment outcome. Results suggest that both groups may benefit from reductions in passive pain coping and seeking social support. The causal quality of this relationship remains to be determined in future studies. Gender-role expectations and family interactions may account for the sex differences demonstrated for seeking social support. Boys and girls with chronic pain show profound similarities in pain-related coping strategies prior and after multimodal pain treatment. The changes in coping are related to positive treatment outcomes. Sex-specific treatment strategies for changing seeking social support may need to be developed and tested for their differential efficacy in boys and girls. Copyright 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.
Ji, Guangchen; Li, Zhen; Neugebauer, Volker
Accumulating evidence suggests an important contribution of reactive oxygen species (ROS) to pain and neuropsychiatric disorders, but their role in pain-related plasticity in the brain is largely unknown. Neuroplasticity in the central nucleus of the amygdala (CeA) correlates positively with pain behaviors in different models. Little is known, however, about mechanisms of visceral pain-related amygdala changes. The electrophysiological and behavioral studies reported here addressed the role of ROS in the CeA in a visceral pain model induced by intracolonic zymosan. Vocalizations to colorectal distension and anxiety-like behavior increased after intracolonic zymosan and were inhibited by intra-CeA application of a ROS scavenger (tempol, a superoxide dismutase mimetic). Tempol also induced a place preference in zymosan-treated rats but not in controls. Single-unit recordings of CeA neurons in anesthetized rats showed increases of background activity and responses to visceral stimuli after intracolonic zymosan. Intra-CeA application of tempol inhibited the increased activity but had no effect under normal conditions. Whole-cell patch-clamp recordings of CeA neurons in brain slices from zymosan-treated rats showed that tempol decreased neuronal excitability and excitatory synaptic transmission of presumed nociceptive inputs from the brainstem (parabrachial area) through a combination of presynaptic and postsynaptic actions. Tempol had no effect in brain slices from sham controls. The results suggest that ROS contribute to visceral pain-related hyperactivity of amygdala neurons and amygdala-dependent behaviors through a mechanism that involves increased excitatory transmission and excitability of CeA neurons.
Lasheen, Wael; Walsh, Declan; Mahmoud, Fade; Sarhill, Nabeel; Rivera, Nilo; Davis, Mellar; Lagman, Ruth; Legrand, Susan
Morphine (M) is the opioid analgesic of choice for severe cancer pain. The IV to PO M equipotent switch ratio (CR) is controversial. We designed this prospective observational cohort to confirm the efficacy and safety of M IV to PO CR of 1:3. Consecutive cancer patients admitted to an inpatient palliative medicine unit were screened for inclusion. Pain was managed by palliative medicine specialists. They were blinded to the patient data collected, and the calculated CR. The switch was considered successful if the following criteria were met: (1) Pain adequately controlled: pain rated as none or mild (2) Number of RD less than 4 (for non incident pain) per 24 hours (3) No limiting side effects. We used Day 3 ATC M dose for CR calculations. The major outcome measures were the IV : PO CR ratio, morphine doses (mg/day), pain severity, number of PRN doses, and day 1 and day 3side effects. Descriptive statistics were used to report mean, median, standard deviation and range of different variables. Two hundred and fifty six consecutive admissions were screened, and 106 were eligible for the study. Sixty two underwent a successful M route switch and were included in this analysis. A ratio of 1:3 was safely implemented over a wide M dose range. About 80% were successfully switched with a calculated CR of 1:3. 20% required an oral M dose adjustment after route switch either to better pain control or reduce side effects with a resultant higher (e.g. 1:4) or lower (e.g. 1:2) calculated potency ratios respectively. A potency ratio of 1:3 was safe as evaluated by common M side-effects, the dose also easy to calculate. The 1: 3 M IV to PO relative milligram potency ratio appears correct and practical for most patients over a wide M dose range.
Full Text Available Objective To observe the effects of peripheraltissueinjury in the developmental stage of newborn rats on pain-related behaviors in adult rats. Methods SD rats 1,4,7,14,21 and 28days after birth were selected in thepresent study(4litters at each time point and 10 rats per litter.Each litter of rats was randomly divided intoinjury group(receiving subcutaneous injection of 20μl bee venomand control group(receiving subcutaneous injection of 20μl normal saline, with20 in each group, and then raised for 2 months to adulthood. The baseline pain threshold was observed by measuring spontaneous paw flinching reflex,paw withdrawal thermal latency(PWTLand paw withdrawal mechanical threshold(PWMT, then 50μl 0.4% bee venom was subcutaneously injected to each rat, and the changesinpa in reaction and pain threshold were determined. Results The baseline thermal pain threshold in adult rats receiving bee venom or normal saline at different time points after birth was similar,but baseline mechanical pain threshold in adult rats receiving bee venom at1,4,7and14 days after birth was decreased significantly compared with the adult rats receiving normal saline at corresponding time points(P0.05.Mechanical hyperalgesia was not induced in rats injected with bee venom but induced in adult ratsinjected with normal saline4-21days after birth.Injection of bee venom 21 and 28 days after birth could obviously enhance the bee venom-induced hyperalgesiain adult rats compared with control group(P<0.01. Conclusions Bee venom stimuli at different time points after birth could affect the baseline PWMT and mechanical pain hypersensitivityin adult rats but not the baseline PWTL and thermal pain hypersensitivity. The 21st day maybe a key time point of nervous system development in rats.
Martin, Caren McHenry
Restless legs syndrome (RLS) is a sensorimotor disorder characterized by the uncontrollable urge to move the legs. This urge can often be accompanied by pain or other unpleasant sensations, and it either occurs or worsens with rest. Affecting an estimated 6% to 15% of the adult population, RLS compromises the patient's ability to sleep and can significantly decrease quality of life. Because diagnosis currently relies solely on patient (or caregiver) interview, recognizing the symptoms of RLS and knowing what medications treat this condition--as well as the many that exacerbate it--is important for all health care practitioners.
Lichtner, Valentina; Dowding, Dawn; Closs, S José
Assessment and management of pain in patients with dementia is known to be challenging, due to patients' cognitive and/or communication difficulties. In the UK, pain in hospital is managed through regular assessments, with the use of pain intensity scores as triggers for action. The aim of this study was to understand current pain assessment practices, in order to later inform the development of a decision support tool designed to improve the management of pain for people with dementia in hospital. An exploratory study was conducted in four hospitals in the UK (11 wards), with observations of patients with dementia (n = 31), interviews of staff (n = 52) and patients' family members (n = 4) and documentary analysis. A thematic analysis was carried out, structured along dimensions of decision making. This paper focuses on the emergent themes related to the use of assessment tools and pain intensity scores. A variety of tools were used to record pain intensity, usually with numerical scales. None of the tools in actual use had been specifically designed for patients with cognitive impairment. With patients with more severe dementia, the patient's body language and other cues were studied to infer pain intensity and then a score entered on behalf of the patient. Information regarding the temporality of pain and changes in pain experience (rather than a score at a single point in time) seemed to be most useful to the assessment of pain. Given the inherent uncertainty of the meaning of pain scores for patients with dementia, numerical scales were used with caution. Numerical scores triggered action but their meaning was relative - to the patient, to the clinician, to the time of recording and to the purpose of documenting. There are implications for use of data and computerized decision support systems design. Decision support interventions should include personalized alerting cut-off scores for individual patients, display pain scores over time and integrate
L. Damen (Léonie)
textabstractThe review of the origin, the diagnosis and treatment of pregnancy-related pelvic pain led to the conclusion that laxity of the S!Js may play a central role in the understanding of this syndrome. The department of Biomedical Physics and Technology and the department of Rehabilitation hav
Zwienen, C.M. van; Bosch, E.W. van den; Snijders, C.J.; Vugt, A.B. van
STUDY DESIGN: Single-group prospective follow-up study. OBJECTIVES: To assess the functional outcome of internal fixation of the pelvic ring in patients with severe pregnancy-related low back and pelvic pain (PLBP) in whom all other treatments failed. BACKGROUND DATA: More than half of all pregnant
Branci, Sonia; Thorborg, Kristian; Nielsen, Michael Bachmann;
Long-standing symphyseal and adductor-related groin pain is a common problem for many athletes, and requires a multidisciplinary approach. Radiological evaluation of symptomatic individuals is a cornerstone in the diagnostic workup, and should be based on precise and reliable diagnostic terms and...
van Wijk, A.J.; de Jongh, A.; Lindeboom, J.A.
PURPOSE: Anxiety sensitivity (AS) refers to the fear of anxiety-related symptoms resulting from beliefs that such sensations have negative somatic, social, or psychological consequences. The aim of the present study was to investigate whether AS can predict both anticipated and experienced pain and
Zwienen, C.M. van; Bosch, E.W. van den; Snijders, C.J.; Vugt, A.B. van
STUDY DESIGN: Single-group prospective follow-up study. OBJECTIVES: To assess the functional outcome of internal fixation of the pelvic ring in patients with severe pregnancy-related low back and pelvic pain (PLBP) in whom all other treatments failed. BACKGROUND DATA: More than half of all pregnant
Jacobsen, Ramune; Møldrup, Claus; Christrup, Lona Louring;
, carried out in Cochrane Library, Medline (through PubMed), Web of Science and EMBASE databases for the period 1994-2005. Thirty-seven studies, dealing with cognitive, sensory and affective patient-related barriers, as well as studies, describing patients' pain communication and their adherence...
Hamberg - Reenen, H.H. van; Ariëns, G.A.M.; Blatter, B.M.; Twisk, J.W.R.; Mechelen, W. van; Bongers, P.M.
Aims: To investigate the longitudinal relation between physical capacity (isokinetic lifting strength, static endurance of the back, neck, and shoulder muscles, and mobility of the spine) and low back, neck, and shoulder pain. Methods: In this prospective cohort study, 1789 Dutch workers
The work contained within this thesis presents new insights into the diagnostics and treatment of long-standing adductor-related groin pain (LSARGP) in athletes. In the Netherlands a novel treatment programme using heat, manual therapy according to Van den Akker, stretching and a return to running p
Hamberg - Reenen, H.H. van; Ariëns, G.A.M.; Blatter, B.M.; Twisk, J.W.R.; Mechelen, W. van; Bongers, P.M.
Aims: To investigate the longitudinal relation between physical capacity (isokinetic lifting strength, static endurance of the back, neck, and shoulder muscles, and mobility of the spine) and low back, neck, and shoulder pain. Methods: In this prospective cohort study, 1789 Dutch workers participate
van der Heijden Geert JMG
Full Text Available Abstract Background Shoulder pain is common in primary care, and has an unfavourable outcome in many patients. Information about predictors of shoulder pain related sick leave in workers is scarce and inconsistent. The objective was to develop a clinical prediction rule for calculating the risk of shoulder pain related sick leave for individual workers, during the 6 months following first consultation in general practice. Methods A prospective cohort study with 6 months follow-up was conducted among 350 workers with a new episode of shoulder pain. Potential predictors included the results of a physical examination, sociodemographic variables, disease characteristics (duration of symptoms, sick leave in the 2 months prior to consultation, pain intensity, disability, comorbidity, physical activity, physical work load, psychological factors, and the psychosocial work environment. The main outcome measure was sick leave during 6 months following first consultation in general practice. Results Response rate to the follow-up questionnaire at 6 months was 85%. During the 6 months after first consultation 30% (89/298 of the workers reported sick leave. 16% (47 reported 10 days sick leave or more. Sick leave during this period was predicted in a multivariable model by a longer duration of sick leave prior to consultation, more shoulder pain, a perceived cause of strain or overuse during regular activities, and co-existing psychological complaints. The discriminative ability of the prediction model was satisfactory with an area under the curve of 0.70 (95% CI 0.64–0.76. Conclusion Although 30% of all workers with shoulder pain reported sick leave during follow-up, the duration of sick leave was limited to a few days in most workers. We developed a prediction rule and a score chart that can be used by general practitioners and occupational health care providers to calculate the absolute risk of sick leave in individual workers with shoulder pain, which
Munts, Alexander G; van Rijn, Monique A; Geraedts, Erica J; van Hilten, Jacobus J; van Dijk, J Gert; Marinus, Johan
The quantitative thermal test showed cold and warmth hypesthesia without increased heat pain sensitivity in the affected limbs of complex regional pain syndrome (CRPS) patients with tonic dystonia (n = 44) in comparison with healthy controls with a similar age and sex distribution (n = 35). The degrees of cold and warmth hypesthesia were strongly correlated. We conclude that dysfunction in small nerve fiber (i.e., C and Aδ) processing is present in patients with CRPS-related dystonia.
Kurita, G P; Benthien, K S; Nordly, M;
clinical and methodological diversity that precluded a meta-analysis. They also presented several limitations, which reduced study internal validity. However, they demonstrated better pain control for all interventions analysed. Side effects were described, but there were few significant differences...... related to cancer, pain, neuraxial route, analgesic and side effects. The search was performed in PubMed, EMBASE, and Cochrane for the period until February 2014. Studies were analysed according to methods, results, quality of evidence, and strength of recommendation. RESULTS: The number of abstracts...
Gentle, M J; Hunter, L N; Waddington, D
The number of pecks delivered by birds to an attractive visual stimulus was measured before and again 6, 26 and 32 h after partial beak amputation. There was a significant reduction in the number of pecks by birds 26 h after amputation but not at 6 h after. This reduction was considered to be a quantitative measure of pain related guarding behaviour. The results indicated the presence of a pain-free period immediately following amputation which may last in some birds for as long as 26 h.
Karmakar, Manoj Kumar; Samy, Winnie; Li, Jia W; Lee, Anna; Chan, Wing Cheong; Chen, Phoon P; Ho, Anthony M-H
Patients undergoing breast cancer surgery frequently experience chronic postoperative pain. The primary objective of this randomized study was to determine if thoracic paravertebral block (TPVB) reduced the incidence of chronic pain after a modified radical mastectomy (MRM) when compared with general anesthesia (GA). One hundred eighty women undergoing MRM were randomized to 1 of 3 study groups: group 1: standardized GA, group 2: GA with a single-injection TPVB and placebo paravertebral infusion, and group 3: GA with a continuous TPVB. Outcomes assessed postoperatively included acute postoperative pain and analgesic consumption and, at 3 and 6 months, the incidence and severity of chronic pain and physical and mental health-related quality of life (HRQOL). There was no significant difference in the incidence of chronic pain at 3 months (P = 0.13) and 6 months (P = 0.79) after the MRM between the study groups. The relative risk of developing chronic pain (P = 0.25) was also similar between the groups. There was no difference in acute pain (P = 0.22) or postoperative analgesic consumption (P = 0.67) between the groups. Nevertheless, differences were observed in chronic pain-related secondary outcome variables. The TPVB groups reported lower chronic pain scores (P < 0.05), exhibited fewer symptoms and signs of chronic pain (P ≤ 0.01), and also experienced better physical and mental HRQOL than did the GA group. Chronic pain scores also decreased with time in all study groups (P < 0.05). There is no significant difference in the incidence or relative risk of chronic pain at 3 and 6 months after an MRM when TPVB is used in conjunction with GA. Nevertheless, patients who receive a TPVB report less severe chronic pain, exhibit fewer symptoms and signs of chronic pain, and also experience better physical and mental HRQOL.
马明; 周卫; 张世民; 李星; 章永东; 黎作旭; 吴冠男; 刘昱彰; 张兆杰
目的:检验腰腿痛患者报告结局量表的信度、效度及反应度.方法:2010年8月至2012年1月,纳入住院腰椎间盘突出症及腰椎管狭窄症患者患者200例,男93例,女107例；年龄22～65岁,平均50.3岁；腰椎间盘突出症144例,腰椎管狭窄症56例 应用腰腿痛患者报告结局量表对患者进行测评,并对量表进行信度、效度、反应度分析.结果:39例病情无变化患者两次评分无显著性差异(P＞0.05),且有显著相关性(r＞0.9)；该量表同Oswestry功能障碍指数问卷(ODI)对患者评分结果具有显著相关性(r＞0.8)；该量表总体克朗巴赫α系数为0.931,总体Guttman折半系数为0.912;该量表KMO统计量为0.919,Bartlett球形检验卡方值l 882.975(P＜0.01),因子分析方法提取特征根值＞1的3个公因子,累计贡献率为64.364％;43例病情有好转患者两次评分结果分别为34.80±9.00和28.77±8.73,两者差异有统计学意义(P＜0.01).结论:腰腿痛患者报告结局量表有较好的信度、效度及反应度,可作为腰腿痛患者临床疗效的评价工具.%Objective:To explore the reliability,validity and reaction degree of patient reported outcome scale for low back and leg pain. Methods:Two hundreds inpatients were analyzed between August 2010 and January 2012,including 93 males and 107 females with an average age of 50.3 years old ranging from 22 to 65 years. There were 144 cases of lumbar disc herniation and 56 of lumber spinal stenosis. All patients were tested by the patient reported outcome scale for low back and leg pain,and then analyzed the reliability,validity and reaction degree of the scale. Results:There was no statistical significence difference (P>0.05) and significant correlation (r>0.9) in scores of two times in patients with no change in illness. Measurement result of the scale had significant correlation (r>0.9) with Oswestry disability index (ODI). The total Cronbach's Alpha of the instrument was 0.931, the
Enzi, Björn; Amirie, Scharbanu; Brüne, Martin
Empathy, i.e., the ability to perceive and share another person's affective state, is associated with activity in a complex neural network, including the anterior insula, the anterior and mid-cingulate cortex, and the lateral prefrontal cortex. Here, we were interested in the question how facial emotions influence the activation of the 'pain network'. In the present study, we used functional magnetic resonance imaging to investigate the neuronal correlates of empathy for pain and its interaction with emotional face recognition in 20 healthy subjects. We identified various brain regions commonly associated with empathy for pain, including the right mid-cingulate cortex, the left anterior insula (AI), and the left dorsolateral prefrontal cortex (dlPFC), with an increased neuronal response in the left dlPFC after the presentation of angry faces. Furthermore, a negative correlation between psychological measures of alexithymia and empathy for pain-related brain activity was observed in the left AI. The dlPFC is an important brain region involved in cognitive reappraisal or in 'top-down' control of the limbic system. Our findings could therefore reflect a regulatory response associated with distancing from negatively valenced stimuli. Moreover, our results underline the involvement of the AI in empathy for pain responses and their relationship to alexithymia.
Walsh, David A; Mapp, Paul I; Kelly, Sara
Arthritis is the commonest cause of disabling chronic pain, and both osteoarthritis (OA) and rheumatoid arthritis (RA) remain major burdens on both individuals and society. Peripheral release of calcitonin gene-related peptide (CGRP) contributes to the vasodilation of acute neurogenic inflammation. Contributions of CGRP to the pain and inflammation of chronic arthritis, however, are only recently being elucidated. Animal models of arthritis are revealing the molecular and pathophysiological events that accompany and lead to progression of both arthritis and pain. Peripheral actions of CGRP in the joint might contribute to both inflammation and joint afferent sensitization. CGRP and its specific receptors are expressed in joint afferents and up-regulated following arthritis induction. Peripheral CGRP release results in activation of synovial vascular cells, through which acute vasodilatation is followed by endothelial cell proliferation and angiogenesis, key features of chronic inflammation. Local administration of CGRP to the knee also increases mechanosensitivity of joint afferents, mimicking peripheral sensitization seen in arthritic joints. Increased mechanosensitivity in OA knees and pain behaviour can be reduced by peripherally acting CGRP receptor antagonists. Effects of CGRP pathway blockade on arthritic joint afferents, but not in normal joints, suggest contributions to sensitization rather than normal joint nociception. CGRP therefore might make key contributions to the transition from normal to persistent synovitis, and the progression from nociception to sensitization. Targeting CGRP or its receptors within joint tissues to prevent these undesirable transitions during early arthritis, or suppress them in established disease, might prevent persistent inflammation and relieve arthritis pain.
Full Text Available Affective and cognitive empathy are traditionally differentiated, the affective component being concerned with resonating with another’s emotional state, whereas the cognitive component reflects regulation of the resulting distress and understanding of another’s mental states (see Decety and Jackson, 2004 for a review. Adolescence is a critical period for the development of cognitive control processes necessary to regulate affective processes: it is only in young adulthood that these control processes achieve maturity (Steinberg, 2005. Thus, one should expect adolescents to show greater automatic empathy than young adults. The present study aimed at exploring the neural correlates of affective (automatic and cognitive empathy for pain from adolescence to young adulthood. With this aim, Event Related Potentials (ERPs were recorded in 32 participants (aged 11 to 39 in a task designed to dissociate these components. ERPs results showed an early automatic frontocentral response to pain (that was not modulated by task demand and a late parietal response to painful stimuli modulated by attention to pain cues. Adolescents exhibited earlier automatic responses to painful situations than young adults did and showed greater activity in the late cognitive component even when viewing neutral stimuli. Results are discussed in the context of the development of regulatory abilities during adolescence.
Öte Karaca, Şeyda; Demirsoy, Nesrin; Günendi, Zafer
We aimed to investigate the effects of aerobic exercise on pain perception, sensitivity, and health-related quality of life; to assess its effect on parasympathetic tonus by analysis of heart rate recovery; and to examine the effects of parasympathetic tone on pain sensitivity in patients with chronic musculoskeletal pain. Fifty patients with chronic musculoskeletal pain were randomized into two groups: control group (C group) and aerobic exercise group (AE group). Both groups received conventional physical therapy for 2 weeks; the AE group performed submaximal aerobic exercise on a treadmill for 30 min additionally. Exercise test, pressure-pain threshold measurement, short form-36, and visual analog scale were administered initially and finally for evaluation. Visual analog scale scores in both groups decreased significantly after treatment (Pexercise test duration was significant in the AE group compared with the C group (P=0.0002). Heart rate recovery did not change with therapy in the groups. For short form-36, the AE group showed alterations in role limitations because of physical problems and general health perceptions; both groups showed a significant improvement in the physical function and bodily pain subscales, but mental health significantly improved only in C group. Short-term aerobic exercise along with conventional physical therapy decreased pain sensitivity and increased aerobic capacity, with significant improvements in health-related quality of life.
Baron, Ralf; Maier, Christoph; Attal, Nadine; Binder, Andreas; Bouhassira, Didier; Cruccu, Giorgio; Finnerup, Nanna B.; Haanpää, Maija; Hansson, Per; Hüllemann, Philipp; Jensen, Troels S.; Freynhagen, Rainer; Kennedy, Jeffrey D.; Magerl, Walter; Mainka, Tina; Reimer, Maren; Rice, Andrew S.C.; Segerdahl, Märta; Serra, Jordi; Sindrup, Sören; Sommer, Claudia; Tölle, Thomas; Vollert, Jan; Treede, Rolf-Detlef
Abstract Patients with neuropathic pain are heterogeneous in etiology, pathophysiology, and clinical appearance. They exhibit a variety of pain-related sensory symptoms and signs (sensory profile). Different sensory profiles might indicate different classes of neurobiological mechanisms, and hence subgroups with different sensory profiles might respond differently to treatment. The aim of the investigation was to identify subgroups in a large sample of patients with neuropathic pain using hypothesis-free statistical methods on the database of 3 large multinational research networks (German Research Network on Neuropathic Pain (DFNS), IMI-Europain, and Neuropain). Standardized quantitative sensory testing was used in 902 (test cohort) and 233 (validation cohort) patients with peripheral neuropathic pain of different etiologies. For subgrouping, we performed a cluster analysis using 13 quantitative sensory testing parameters. Three distinct subgroups with characteristic sensory profiles were identified and replicated. Cluster 1 (sensory loss, 42%) showed a loss of small and large fiber function in combination with paradoxical heat sensations. Cluster 2 (thermal hyperalgesia, 33%) was characterized by preserved sensory functions in combination with heat and cold hyperalgesia and mild dynamic mechanical allodynia. Cluster 3 (mechanical hyperalgesia, 24%) was characterized by a loss of small fiber function in combination with pinprick hyperalgesia and dynamic mechanical allodynia. All clusters occurred across etiologies but frequencies differed. We present a new approach of subgrouping patients with peripheral neuropathic pain of different etiologies according to intrinsic sensory profiles. These 3 profiles may be related to pathophysiological mechanisms and may be useful in clinical trial design to enrich the study population for treatment responders. PMID:27893485
Venturini Pier L
Full Text Available Abstract This systematic review aims to assess the efficacy of aromatase inhibitors (AIs in treating pain symptoms caused by endometriosis. A comprehensive literature search was conducted to identify all the published studies evaluating the efficacy of type II nonsteroidal aromatase inhibitors (anastrozole and letrozole in treating endometriosis-related pain symptoms. The MEDLINE, EMBASE, PubMed, and SCOPUS databases and the Cochrane System Reviews were searched up to October 2010. This review comprises of the results of 10 publications fitting the inclusion criteria; these studies included a total of 251 women. Five studies were prospective non-comparative, four were randomized controlled trials (RCTs and one was a prospective patient preference trial. Seven studies examined the efficacy of AIs in improving endometriosis-related pain symptoms, whilst three RCTs investigated the use of AIs as post-operative therapy in preventing the recurrence of pain symptoms after surgery for endometriosis. All the observational studies demonstrated that AIs combined with either progestogens or oral contraceptive pill reduce the severity of pain symptoms and improve quality of life. One patient preference study demonstrated that letrozole combined with norethisterone acetate is more effective in reducing pain and deep dyspareunia than norethisterone acetate alone. However, letrozole causes a higher incidence of adverse effects and does not improve patients' satisfaction or influence recurrence of symptoms after discontinuation of treatment. A RCT showed that combining letrozole with norethisterone acetate causes a lower incidence of adverse effects and lower discontinuation rate than combining letrozole with triptorelin. Two RCTs demonstrated that, after surgical treatment of endometriosis, the administration of AIs combined with gonadotropin releasing hormone analogue for 6 months reduces the risk of endometriosis recurrence when compared with gonadotropin
Cagnie, B; Danneels, L; Van Tiggelen, D; De Loose, V; Cambier, D
Work related neck disorders are common problems in office workers, especially among those who are intensive computer users. It is generally agreed that the etiology of work related neck disorders is multidimensional which is associated with, and influenced by, a complex array of individual, physical and psychosocial factors. The aim of the current study was to estimate the one-year prevalence of neck pain among office workers and to determine which physical, psychological and individual factors are associated with these prevalences. Five hundred and twelve office workers were studied. Information was collected by an online questionnaire. Self-reported neck pain during the preceding 12 months was regarded as a dependent variable, whereas different individual, work-related physical and psychosocial factors were studied as independent variables. The 12 month prevalences of neck pain in office workers was 45.5%. Multivariate analysis revealed that women had an almost two-fold risk compared with men (OR = 1.95, 95% CI 1.22-3.13). The odds ratio for age indicates that persons older than 30 years have 2.61 times more chance of having neck pain than younger individuals (OR = 2.61, 95% CI 1.32-3.47). Being physically active decreases the likelihood of having neck pain (OR = 1.85, 95% CI 1.14-2.99). Significant associations were found between neck pain and often holding the neck in a forward bent posture for a prolonged time (OR = 2.01, 95% CI 1.20-3.38), often sitting for a prolonged time (OR = 2.06, 95% CI 1.17-3.62) and often making the same movements per minute (OR = 1.63, 95% CI 1.02-2.60). Mental tiredness at the end of the workday (OR = 2.05, 95% CI 1.29-3.26) and shortage of personnel (OR = 1.71, 95% CI 1.06-2.76) are significantly associated with neck pain. The results of this study indicate that physical and psychosocial work factors, as well as individual variables, are associated with the frequency of neck pain. These association patterns suggest also
Obilor, Helen N; Adejumo, Prisca O; Ilesanmi, Rose E
This study was necessitated by the international recognition of wound-related pain (WRP) as a must-address issue and patient-centred concerns. The aim of this study was to assess patients' WRP experiences at rest and in relation to dressing change. This descriptive study utilised a WRP questionnaire which incorporated a visual analogue scale of 0-10 for data collection. A total of 109 patients participated in this study; 95·4% of the participants experienced wound pain at rest and during performance of activities of daily living, which were moderate (47·1%) and severe (30·8%) in intensity. Also, 91·7% of the participants experienced wound dressing change-related pain, mostly as moderate (47·0%) and severe (28·0%) pain. The major factors that worsened WRP experiences were touch/handling, change in position/movement, wound cleansing, removal of dressings and usage of honey as a dressing agent, while the use of analgesic and brief rest between dressing change were considered the major strategies that can relieve WRP. WRP experiences have been reported by patients at rest, during performance of activities of daily living and at wound dressing change. A need to incorporate WRP assessment has been observed, which is vital in improving wound care outcome.
Yozgatian, Joseph H; Zeredo, Jorge L; Hotokezaka, Hitoshi; Koga, Yoshiyuki; Toda, Kazuo; Yoshida, Noriaki
To investigate by behavioral methods the relationship between emotional stress and pain during experimental tooth movement in rats. Sixteen male Sprague-Dawley rats (210 to 250 g) were divided into two groups. The experimental group was treated with an active Ti-Ni appliance, and the control group received a passive appliance. A force of 20 gf was delivered by the active appliance between the maxillary first and second molars for 3 days. During this period the rat's behavior was evaluated eight times by means of open-field test and resistance-to-capture test. The specific parameters of animal activity were facial grooming, rearing, and locomotor activity, movement into the center of the open field, and response to capture. Parameters related to stress and pain were higher in the group carrying active appliance, compared to the group with a passive appliance. Statistically significant differences in stress-related behavior between control and experimental groups were found 8 hours after placing the appliance and were most evident on the second day. Pain-related behavior was significantly greater in the experimental group than in the control group at 24 hours. The increase in emotional stress evoked by orthodontic tooth movement may precede the appearance of periodontal pain.
Meulders, Ann; Franssen, Mathijs; Fonteyne, Riet; Vlaeyen, Johan W S
Ample empirical evidence endorses the role of associative learning in pain-related fear acquisition. Nevertheless, research typically focused on self-reported and psychophysiological measures of fear. Avoidance, which is overt behavior preventing the occurrence of an aversive (painful) stimulus, has been largely neglected so far. Therefore, we aimed to fill this gap and developed an operant conditioning procedure for pain-related avoidance behavior. Participants moved their arm to a target location using the HapticMaster (FCS Robotics; Moog Inc, East Aurora, New York), a 3 degrees-of-freedom, force-controlled robotic arm. Three movement trajectories led to the target location. If participants in the Experimental Group took the shortest/easiest trajectory, they always received a painful stimulus (T1 = 100% reinforcement; no resistance). If they deviated from this trajectory, the painful stimulus could be partly or totally prevented (T2 = 50% reinforcement; T3 = 0% reinforcement), but more effort was needed (T2 = moderate resistance and deviation; T3 = strongest resistance and largest deviation). The Yoked Group received the same reinforcement schedule irrespective of their own behavior. During the subsequent extinction phase, no painful stimuli were delivered. Self-reported pain-expectancy and pain-related fear were assessed, and avoidance behavior was operationalized as the maximal distance from the shortest trajectory. During acquisition, the Experimental Group reported more pain-related fear and pain-expectancy to T1 vs T2 vs T3 and deviated more from the shortest trajectory than the Yoked Group. During subsequent extinction, avoidance behavior, self-reported fear, and pain-expectancy decreased significantly, but conditioned differences persisted despite the absence of painful stimuli. To conclude, this operant learning task might provide a valid paradigm to study pain-related avoidance behavior in future studies.
Full Text Available Individuals with pain-related concerns are likely to interpret ambiguous pain-related information in a threatening manner. It is unknown whether this interpretation bias also occurs for ambiguous pain-related facial expressions. This study examined whether individuals who habitually attach a catastrophic meaning to pain are characterized by negative interpretation bias for ambiguous pain-related facial expressions. Sixty-four female undergraduates completed an incidental learning task during which pictures of faces were presented, each followed by a visual target at one of two locations. Participants indicated target location by pressing one of two response keys. During the learning phase, happy and painful facial expressions predicted target location. During two test phases, morphed facial expressions of pain and happiness were added, equally often followed by a target at either location. Faster responses following morphs to targets at the location predicted by painful expressions compared to targets at the location predicted by happy expressions were taken to reflect pain-related interpretation bias. During one test phase, faces were preceded by either a safe or threatening context cue. High, but not low, pain-catastrophizers responded faster following morphs to targets at the location predicted by painful expressions than to targets at the other location (when participants were aware of the contingency between expression type and target location. When context cues were presented, there was no indication of interpretation bias. Participants were also asked to directly classify the facial expressions that were presented during the incidental learning task. Participants classified morphs more often as happy than as painful, independent of their level of pain catastrophizing. This observation is discussed in terms of differences between indirect and direct measures of interpretation bias.
Tan, Boon-Kiang; Smith, Anne; O'Sullivan, Peter; Chen, Gang; Burnett, Angus
Beliefs held about low back pain (LBP) can influence treatment outcomes and the development of LBP-related disability. Beliefs are shaped by cultural norms but few cross-cultural studies have been done. This cross-sectional study investigated the back pain beliefs and their associations with disability in 109 Chinese nurses and 165 Australian Caucasian nurses. Chinese nurses held more pessimistic views about the consequences of LBP than the Australian and those with LBP held higher level of fear avoidance beliefs and had higher disability than the Australian nurses with LBP. In both groups, more negativeback pain beliefs were significantly associated with higher disability.
Full Text Available Abstract Background Pain contains both sensory and affective dimensions. Using a rodent visceral pain assay that combines the colorectal distension (CRD model with the conditioned place avoidance (CPA paradigms, we measured a learned behavior that directly reflects the affective component of visceral pain, and showed that perigenual anterior cingulate cortex (pACC activation is critical for memory processing involved in long-term visceral affective state and prediction of aversive stimuli by contextual cue. Progress has been made and suggested that activation of vagal afferents plays a role in the behavioral control nociception and memory storage processes. In human patients, electrical vagus nerve stimulation enhanced retention of verbal learning performance. Cholecystokinin-octapeptide (CCK, which is a gastrointestinal hormone released during feeding, has been shown to enhance memory retention. Mice access to food immediately after training session enhanced memory retention. It has been well demonstrated that CCK acting on vagal afferent fibers mediates various physiological functions. We hypothesize that CCK activation of vagal afferent enhances visceral pain-related affective memory. Results In the presented study, infusion of CCK-8 at physiological concentration combining with conditional training significantly increased the CRD-induced CPA scores, and enhanced the pain affective memory retention. In contrast, CCK had no effect on CPA induced by non-nociceptive aversive stimulus (U69,593. The physiological implications were further strengthened by the similar effects observed in the rats with duodenal infusion of 5% peptone, which has been shown to induce increases in plasma CCK levels. CCK-8 receptor antagonist CR-1409 or perivagal application of capsaicin abolished the effect of CCK on aversive visceral pain memory, which was consistent with the notion that vagal afferent modulates affective aspects of visceral pain. CCK does not change
Miletić, Vladimir; Relja, Maja
Being of the most frequent causes of insomnia, which in the end leads to chronic fatigue, inadequate performance of daily activities, and serious disruption of quality of living, restless legs syndrome (RLS) is nowadays not only a serious medical problem but a socio-economical one as well. Prevalence of the disorder in general population is estimated at 5 to 15%. Family history is positive in over 50% of idiopathic RLS patients which points to genetic basis of the disorder. The characteristics of the secondary or acquired form of RLS are symptoms that start later in life as well as a rapid progression of the disease. On the other hand, idiopathic RLS more often starts at a younger age and the prognoses are better. Over twenty disorders and conditions are brought in connection with secondary RLS. Although the cause of primary RLS is still unknown, there is a strong connection between central metabolism of iron as well as dopamine levels and RLS manifestation. A differential diagnosis of RLS includes a wide specter of motor and sensory disorders. Diagnosis is based on clinical features and the history of disease. To correctly diagnose idiopathic RLS one must first eliminate secondary causes of RLS and then also exclude any disorders with clinical features that mimic those of RLS. It has been estimated that some 20 to 25% of patients need pharmacological therapy. Best initial therapy is the application of nonergot dopamine agonists. Anticonvulsants, benzodiazepines and opioides can be given to patients who are refractory to dopaminergic therapy, those suffering from RLS with emphasized painful sensory component and those with RLS connected with insomnia.
Full Text Available Pain is the most important and current nursing diagnosis at I.C.U of heart surgery. So it must be relive for its acute complication. The purpose of this study was to compare nurses and patients perception of pain and its relation to analgesics in patients undergone coronary bypass surgery in one of the selected hospital in Iran medical university in 2000 and to give some suggestions according to results of this study. This research was a descriptive study. In this study 30 patients with30 nurses caring of them in cardiac surgery I.C.U in one of the hospital of Iran medical university were participated .The materials in this study included question forms, scale of intensity of pain and analgesic dose check list. The first part included questions related to personal specifications of nurses and patients participating in study. The second part included 25 sentences about patients and nurses understanding of pain. For evaluating the degree of pain and severity of its perception in patients the statistical method was used. According to its"10" scores column the "o" was for no pain perception and "10" was for the most possible sense pain. The result of this study was summarized in 6 figures. The " T " statistical analysis showed that the patients average of pain perception was more than pain perception of nurses (P=0.001. The "pair t-test" detected significant differences between degree of perception of pain in patients before and after injection of analgesics and also perception of patients pain in their nurses (P=0.001. In addition according to "t-test" there was significant differences between the degree of pain in patients and degree of perception of this pain in nurses before and after the injection of analgesics (P=0.001. But, there was no relation between dose of analgesics with the patients’ and nurses’ perception of pain, and also the degree of patients pain before and after the injection of analgesics and degree of nurses perception of
Molnar, Miklos Zsolt; Fornadi, Katalin; Shapiro, Colin M
In this paper we discuss therapy with ropinirole (known as adartrel in the United Kingdom) in patients with restless legs syndrome. Restless legs syndrome is characterized by an urge to move the legs, uncomfortable sensations in the legs and worsening of these symptoms during rest with at least temporary relief brought on by activity. Current recommendations suggest dopaminergic therapy (levodopa or dopamine receptor agonists like ropinirole) as the first-line treatment for restless legs syndrome. Based on the results of randomized, placebo-controlled, double-blind trials, we conclude that ropinirole is effective in reducing symptoms of restless legs syndrome in the general population. Ropinirole has no serious or common side effects that would limit its use significantly. Rebound and augmentation problems are relatively rarely seen with ropinirole, although properly designed comparative trials are still needed to address this question. It must be noted, however, that most published studies with ropinirole compare this drug with placebo. Very few studies have compared ropinirole with other drugs (L-dopa, gabapentin, opioids, benzodiazepines, other dopaminergic agents and selegiline hydrochloride). No cost-effectiveness trial has been published yet. Treatment of restless legs syndrome with ropinirole shows it to be effective, well-tolerated and safe and it can be used in restless legs syndrome in general.
Præsentation af seniorforsker-projekt Lyden-af-Leg i et traderingsperspektiv og med indledende fokus på YouTube som traderings-platform.......Præsentation af seniorforsker-projekt Lyden-af-Leg i et traderingsperspektiv og med indledende fokus på YouTube som traderings-platform....
A. el Barzouhi (Abdelilah); C.L.A.M. Vleggeert-Lankamp (Carmen); G.J.L.A. Nijeholt (Geert J. Lycklama A); B.F.W. van der Kallen (Bas); W.B. van den Hout (Wilbert); B.W. Koes (Bart); W.C. Peul (Wilco)
textabstractBackground: Patients with sciatica frequently complain about associated back pain. It is not known whether there are prognostic relevant differences in Magnetic Resonance Imaging (MRI) findings between sciatica patients with and without disabling back pain. Methods: The study population
Background: Ninety percent of all people sometimes during their lives experience low back pain, and 30-40% develops radicular leg pain with the sciatica characteristics. Although for clinical diagnosis of lumbar disc herniation (LDH) straight leg raising (SLR) test in 85-90% of cases indicates LDH, but in our practice with LDH patients this test is frequently negative despite radicular leg pain due to LDH. Hence, we decided to evaluate this test in LDH in different age groups. Materials and M...
Hall, Helen; Cramer, Holger; Sundberg, Tobias; Ward, Lesley; Adams, Jon; Moore, Craig; Sibbritt, David; Lauche, Romy
Abstract Background: Low back pain and pelvic girth pain are common in pregnancy and women commonly utilize complementary manual therapies such as massage, spinal manipulation, chiropractic, and osteopathy to manage their symptoms. Objective: The aim of this systematically review was to critically appraise and synthesize the best available evidence regarding the effectiveness of manual therapies for managing pregnancy-related low back and pelvic pain. Methods: Seven databases were searched from their inception until April 2015 for randomized controlled trials. Studies investigating the effectiveness of massage and chiropractic and osteopathic therapies were included. The study population was pregnant women of any age and at any time during the antenatal period. Study selection, data extraction, and assessment of risk of bias were conducted by 2 reviewers independently, using the Cochrane tool. Separate meta-analyses were conducted to compare manual therapies to different control interventions. Results: Out of 348 nonduplicate records, 11 articles reporting on 10 studies on a total of 1198 pregnant women were included in this meta-analysis. The therapeutic interventions predominantly involved massage and osteopathic manipulative therapy. Meta-analyses found positive effects for manual therapy on pain intensity when compared to usual care and relaxation but not when compared to sham interventions. Acceptability did not differ between manual therapy and usual care or sham interventions. Conclusions: There is currently limited evidence to support the use of complementary manual therapies as an option for managing low back and pelvic pain during pregnancy. Considering the lack of effect compared to sham interventions, further high-quality research is needed to determine causal effects, the influence of the therapist on the perceived effectiveness of treatments, and adequate dose–response of complementary manual therapies on low back and pelvic pain outcomes during
Yasuda, Seiko; Yoshida, Mitsuhiro; Yamagata, Hirotaka; Iwanaga, Yasutake; Suenaga, Hiromi; Ishikawa, Kozo; Nakano, Masako; Okuyama, Satoshi; Furukawa, Yoshiko; Furukawa, Shoei; Ishikawa, Toshizo
Depression-like behavior is often complicated by chronic pain. Antidepressants including imipramine (IMI) are widely used to treat chronic pain, but the mechanisms are not fully understood. Brain-derived neurotrophic factor (BDNF) is a neuromodulator that reduces depression by regulating synaptic transmission. We aimed to characterize the antidepressant effects of IMI without analgesia based on BDNF (trkB)-mediated signaling and gene expression in chronic pain. A chronic constriction injury (CCI) model was constructed in Sprague-Dawley (SD) rats. IMI (5 mg/kg, i.p.) was administered from day 10 after CCI. The pain response was assessed using the paw withdrawal latency (PWL) and depression was judged from the immobility time in a forced swim test. Anti-BDNF antibody, K252a, or 5,7-dihydroxytryptamine (5,7-DHT) were used to examine the antidepressant effects of imipramine. Changes in pERK1/2 (immunohistochemistry), 5-HT and BDNF (ELISA), and BDNF mRNA (RT-PCR) were measured in the anterior cingulate cortex (ACC), rostral ventromedial medulla (RVM), and spinal cord. After CCI, rats showed decreased PWL and increased immobility time. A low dose of IMI reduced the immobility time without having analgesic effects. This antidepressant effect was reversed by anti-BDNF antibody, K252a, and 5,7-DHT. IMI reduced excessive activation of pERK1/2 associated with decreased pCREB and BDNF mRNA, and these changes were reversed by 5,7-DHT. These results show that IMI reduces pain-related negative emotion without influencing pain and that this effect is diminished by denervation of 5-HT neurons and by anti-BDNF treatment. IMI also normalizes derangement of ERK/CREB coupling, which leads to induction of BDNF. This suggests a possible interaction between 5-HT and BDNF.
Full Text Available Gait change in the elderly may be a strategy to maintain postural stability while walking. However, gait laterality is accompanied by back pain or an increased risk of a fall. This study aimed to examine group-related differences and gait laterality in elderly females with mild or severe unilateral knee pain. Seventy-five elderly females (66–87 years old were included, which comprised the following groups: 47 with mild unilateral knee pain and 28 with severe unilateral knee pain. They completed a 12 m walk test with maximum effort. Stance time, swing time, and step length were selected as evaluation parameters. A two-way ANOVA (group × leg was used for analysis. No significant differences were found in interaction or in either main factor of the group and leg. In conclusion, elderly females do not show group-related differences or gait laterality regardless of the degree (mild or severe of unilateral knee pain.
Kristiansen, Jesper; Ektor-Andersen, John; Bondesson, Elisabeth;
To examine the association between autonomic regulation and length of pain-related sick leave in subjects receiving a cognitive behavioural therapy-based return to work intervention.......To examine the association between autonomic regulation and length of pain-related sick leave in subjects receiving a cognitive behavioural therapy-based return to work intervention....
Kunz, Miriam; Mylius, Veit; Schepelmann, Karsten; Lautenbacher, Stefan
There is ample evidence that dementia changes the processing of pain. However, it is not known whether this change in pain processing is related to the general decline in cognitive functioning or whether it may be related to specific domains of cognitive functioning. With the present study we tried
Iyengar, Smriti; Ossipov, Michael H; Johnson, Kirk W
Calcitonin gene-related peptide (CGRP) is a 37-amino acid peptide found primarily in the C and Aδ sensory fibers arising from the dorsal root and trigeminal ganglia, as well as the central nervous system. Calcitonin gene-related peptide was found to play important roles in cardiovascular, digestive, and sensory functions. Although the vasodilatory properties of CGRP are well documented, its somatosensory function regarding modulation of neuronal sensitization and of enhanced pain has received considerable attention recently. Growing evidence indicates that CGRP plays a key role in the development of peripheral sensitization and the associated enhanced pain. Calcitonin gene-related peptide is implicated in the development of neurogenic inflammation and it is upregulated in conditions of inflammatory and neuropathic pain. It is most likely that CGRP facilitates nociceptive transmission and contributes to the development and maintenance of a sensitized, hyperresponsive state not only of the primary afferent sensory neurons but also of the second-order pain transmission neurons within the central nervous system, thus contributing to central sensitization as well. The maintenance of a sensitized neuronal condition is believed to be an important factor underlying migraine. Recent successful clinical studies have shown that blocking the function of CGRP can alleviate migraine. However, the mechanisms through which CGRP may contribute to migraine are still not fully understood. We reviewed the role of CGRP in primary afferents, the dorsal root ganglion, and in the trigeminal system as well as its role in peripheral and central sensitization and its potential contribution to pain processing and to migraine.
Iyengar, Smriti; Ossipov, Michael H.; Johnson, Kirk W.
Abstract Calcitonin gene–related peptide (CGRP) is a 37-amino acid peptide found primarily in the C and Aδ sensory fibers arising from the dorsal root and trigeminal ganglia, as well as the central nervous system. Calcitonin gene–related peptide was found to play important roles in cardiovascular, digestive, and sensory functions. Although the vasodilatory properties of CGRP are well documented, its somatosensory function regarding modulation of neuronal sensitization and of enhanced pain has received considerable attention recently. Growing evidence indicates that CGRP plays a key role in the development of peripheral sensitization and the associated enhanced pain. Calcitonin gene–related peptide is implicated in the development of neurogenic inflammation and it is upregulated in conditions of inflammatory and neuropathic pain. It is most likely that CGRP facilitates nociceptive transmission and contributes to the development and maintenance of a sensitized, hyperresponsive state not only of the primary afferent sensory neurons but also of the second-order pain transmission neurons within the central nervous system, thus contributing to central sensitization as well. The maintenance of a sensitized neuronal condition is believed to be an important factor underlying migraine. Recent successful clinical studies have shown that blocking the function of CGRP can alleviate migraine. However, the mechanisms through which CGRP may contribute to migraine are still not fully understood. We reviewed the role of CGRP in primary afferents, the dorsal root ganglion, and in the trigeminal system as well as its role in peripheral and central sensitization and its potential contribution to pain processing and to migraine. PMID:28301400
Icenhour, A; Labrenz, F; Ritter, C; Theysohn, N; Forsting, M; Bingel, U; Elsenbruch, S
Studies investigating mechanisms underlying nocebo responses in pain have mainly focused on negative expectations induced by verbal suggestions. Herein, we addressed neural and behavioral correlates of nocebo responses induced by classical conditioning in a visceral pain model. In two independent studies, a total of 40 healthy volunteers underwent classical conditioning, consisting of repeated pairings of one visual cue (CS(High) ) with rectal distensions of high intensity, while a second cue (CS(Low) ) was always followed by low-intensity distensions. During subsequent test, only low-intensity distensions were delivered, preceded by either CS(High) or CS(Low) . Distension intensity ratings were assessed in both samples and functional magnetic resonance imaging data were available from one study (N=16). As a consequence of conditioning, we hypothesized CS(High) -cued distensions to be perceived as more intense and expected enhanced cue- and distension-related neural responses in regions encoding sensory and affective dimensions of pain and in structures associated with pain-related fear memory. During test, distension intensity ratings did not differ depending on preceding cue. Greater distension-induced neural activation was observed in somatosensory, prefrontal, and cingulate cortices and caudate when preceded by CS(High) . Analysis of cue-related responses revealed strikingly similar activation patterns. We report changes in neural activation patterns during anticipation and visceral stimulation induced by prior conditioning. In the absence of behavioral effects, markedly altered neural responses may indicate conditioning with visceral signals to induce hypervigilance rather than hyperalgesia, involving altered attention, reappraisal, and perceptual acuity as processes contributing to the pathophysiology of visceral pain. © 2017 John Wiley & Sons Ltd.
Full Text Available Pain-related massage, important in traditional Eastern medicine, is increasingly used in the Western world. So the widening acceptance demands continual safety assessment. This review is an evaluation of the frequency and severity of adverse events (AEs reported mainly for pain-related massage between 2003 and 2013. Relevant all-languages reports in 6 databases were identified and assessed by two coauthors. During the 11-year period, 40 reports of 138 AEs were associated with massage. Author, year of publication, country of occurrence, participant related (age, sex or number of patients affected, the details of manual therapy, and clinician type were extracted. Disc herniation, soft tissue trauma, neurologic compromise, spinal cord injury, dissection of the vertebral arteries, and others were the main complications of massage. Spinal manipulation in massage has repeatedly been associated with serious AEs especially. Clearly, massage therapies are not totally devoid of risks. But the incidence of such events is low.
Hemmer, Judith M.; Heesewijk, Hans P.M. van [St. Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Kelder, Johannes C. [St. Antonius Hospital, Department of Statistics, Nieuwegein (Netherlands)
The purpose of this study was to determine the significance of variables such as duration of the procedure, type of breast tissue, number of passes, depth of the biopsies, underlying pathology, the operator performing the procedure, and their effect on women's perception of pain and discomfort during stereotactic large-core needle breast biopsy. One hundred and fifty consecutive patients with a non-palpable suspicious mammographic lesions were included. Between three and nine 14-gauge breast passes were taken using a prone stereotactic table. Following the biopsy procedure, patients were asked to complete a questionnaire. There was no discomfort in lying on the prone table. There is no relation between type of breast lesion and pain, underlying pathology and pain and performing operator and pain. The type of breast tissue is correlated with pain experienced from biopsy (P = 0.0001). We found out that patients with dense breast tissue complain of more pain from biopsy than patients with more involution of breast tissue. The depth of the biopsy correlates with pain from biopsy (P = 0.0028). Deep lesions are more painful than superficial ones. There is a correlation between the number of passes and pain in the neck (P = 0.0188) and shoulder (P = 0.0366). The duration of the procedure is correlated with pain experienced in the neck (P = 0.0116) but not with pain experienced from biopsy. (orig.)
Kristensen, Morten Tange
OBJECTIVE: To examine whether functional performance upon hospital discharge is influenced by pain in the region of the hip fracture or related to the fracture type. DESIGN: Prospective observational study. SETTING: A 20-bed orthopedic hip fracture unit. PATIENTS: Fifty-five cognitively intact...... testing (P fracture type, day of TUG performance, and pain intensity....... Multivariate linear regression analyses (fracture type not included) showed that only greater age (B = 0.34), low prefracture function (B = 7.9), and experiencing moderate to severe pain (B = 8.7) were independently associated with having a poorer TUG score. CONCLUSIONS: Hip fracture-related pain primarily...
Kroese Mariëlle EAL
Full Text Available Abstract Background Absence of knowledge of pregnancy-related pelvic girdle pain (PPGP has prompted the start of a large cohort study in the Netherlands. The objective of this study was to investigate the prevalence and incidence of PPGP, to identify risk factors involved in the onset and to determine the prognosis of pregnancy-related pelvic girdle pain. Methods/design 7,526 pregnant women of the southeast of the Netherlands participated in a prospective cohort study. During a 2-year period, they were recruited by midwives and gynecologists at 14 weeks of pregnancy. Participants completed a questionnaire at baseline, at 30 weeks of pregnancy, at 2 weeks after delivery, at 6 months after delivery and at 1 year after delivery. The study uses extensive questionnaires with questions ranging from physical complaints, limitations in activities, restriction in participation, work situation, demographics, lifestyle, pregnancy-related factors and psychosocial factors. Discussion This large-scale prospective cohort study will provide reliable insights in incidence, prevalence and factors related to etiology and prognosis of pregnancy-related pelvic girdle pain.
Menstruation - painful; Dysmenorrhea; Periods - painful; Cramps - menstrual; Menstrual cramps ... related activities for a few days during each menstrual cycle. Painful menstruation is the leading cause of ...
Guddal, Maren Hjelle; Stensland, Synne Øien; Småstuen, Milada Cvancarova; Johnsen, Marianne Bakke; Zwart, John-Anker; Storheim, Kjersti
sports was associated with increased odds of low back pain, whereas team sports were associated with increased odds of lower extremity pain. Strength and extreme sports were related to pain in all regions. Conclusion: We found that a moderate physical activity level was associated with less neck and shoulder pain and low back pain, and that participation in endurance sports may be particularly beneficial. Our findings highlight the need for health care professionals to consider the types of sports adolescents participate in when evaluating their musculoskeletal pain. PMID:28203603
Purpose: This study of relatives to patients with head and neck cancer (HNC) treated with radiotherapy describes how the relatives experienced the patients situation, especially with respect to pain, and how the relatives themselves experienced the situation. Methods: Semi-structured interviews of 21 relatives to HNC patients who suffered from pain were conducted, and a qualitative content analysis was performed. Results: The relatives experienced that the patients suffered from physical, psy...
Dysvik, Elin; Kvaløy, Jan Terje; Stokkeland, Ragnhild; Natvig, Gerd Karin
Cognitive behavioural therapy (CBT) has been useful in the treatment of chronic pain conditions for many years. Given the increasing number of persons with chronic pain and associated psychosocial problems, the development and implementation of effective interventions based on CBT is warranted. The aim of this study is to evaluate the effects of a multidisciplinary pain management programme on health-related quality of life (HRQL), as measured by the Short Form Health Survey (SF-36), pain perception as measured by the Brief Pain Inventory (BPI), and readiness-to-change as measured by the Pain Stages of Change Questionnaire (PSOCQ). A pretest-post-test quasi-experimental design, with waiting list controls and baseline and post-test measures, was used. The study was conducted in the rehabilitation unit of a university hospital. Of 117 people suffering from chronic pain, 113 completed the 8-week multidisciplinary pain management programme. The patients were consecutive referrals. Inclusion criteria were: adults (18-67 years), pain lasting over 6 months, motivation and no ongoing litigation. Exclusion criteria were affected by major mental disorders or major medical conditions requiring treatment. The intervention was based on a cognitive behavioural approach. Therapeutic dialogues and training, combined with physical activity, were provided to a fixed plan, including homework. The programme has several features that directly address psychosocial aspects of chronic pain. Statistical and clinical significance are considered. The findings suggest that this programme has the potential to improve HRQL, reduce pain intensity and interference, and contribute to improvement in readiness-to-change. Statistically significant results are supplemented by results showing their clinical significance. Improvements in HRQL, pain-related disability, and readiness-to-change suggest that the vicious cycle of chronic pain may be alleviated by our programme. As we see it, effective
Otto, Marit; Bach, Flemming W; Jensen, Troels S
Painful polyneuropathy is a common neuropathic pain condition. The present study describes health-related quality of life (HRQL) in a sample of patients with painful polyneuropathy of different origin and the possible predictive role of HRQL for analgesic effect. Ninety-three patients with a diag......Painful polyneuropathy is a common neuropathic pain condition. The present study describes health-related quality of life (HRQL) in a sample of patients with painful polyneuropathy of different origin and the possible predictive role of HRQL for analgesic effect. Ninety-three patients...... questionnaire (SF-36) after a drug-free baseline period and at the end of each treatment period. At baseline, all eight SF-36 scores were lower than in the normal population. No significant differences were found between SF-36 scales during placebo and treatment with valproic acid and St. John's wort. Those two...
José Lourenço Kallás
Full Text Available OBJECTIVES: To make a retrospective analysis and evaluate a clinical response to the control of disc degeneration related pain of 396 patients submitted to percutaneous lumbar nucleoplasty; and to make a record of visual analogical scale (VAS up to a three-year follow-up after the surgical procedure. METHODS: Analysis of VAS score in 396 patients with lumbar disc degeneration related pain, according to anamnesis, clinical examination and magnetic resonance imaging (MRI, without improvement of previous clinical treatment, submitted to percutaneous nucleoplasty. RESULTS: A total of 26% of the patients presented 100% remission of pain or paresthesia, of whom 75% showed at least 50% of pain improvement. The median VAS pain improvement was about 67%. CONCLUSIONS: The median VAS improvement in inferior disc levels was higher than four points. The VAS showed improvement of the pain and paresthesia up to a three-year follow up after the surgical procedure.
Emad T. Ahmed
Full Text Available Background: Physical therapy often is used in the management of work-related low back pain (LBP. Little information, however, is known about work related low back pain that may occur in physical therapy experts themselves. Work related low back agony speaks to one of the real wellbeing issues that happen in well-beings experts. The point of this study is to examine the pervasiveness of work related low back pain in physical therapy experts, and its connection to the way of work. Methods: One hundred and seven physical therapy experts working at general hospitals at Taif, KSA took part in this study, their age ranged from 25 to 60 years, and they were complaining from low back pain for more than 3 months and their current pain for at least three or more weeks. Every subject was requested to finish the Oswestry Low Back Pain Disability Index Questionnaires that comprised of 15 close-ended inquiries. Results: We analyzed Data by utilizing descriptive statistics to gauge the predominance of low back pain in physical therapy experts and to explore connection between back pain and hospital facility work. Out of two hundred thirty physical therapist advisor, one hundred and ten (47.8% physical specialists finished/gave back the surveys. three polls were rejected from investigation since members had missed a few things in filling the survey. In this manner, just information from 107 members was utilized to figure the predominance rates. It was found that the commonness of work related low back pain in physical therapy expert is equivalent 72%. It was found that a connection between the works related low back pain and age, proficient rank, and specialty. Conclusion: There is a higher occurrence of work related back pain among physiotherapist expert and this may be impacted by age, proficient rank and specialty.
Full Text Available Female birds transfer antibodies to their offspring via the egg yolk, thus possibly providing passive immunity against infectious diseases to which hatchlings may be exposed, thereby affecting their fitness. It is nonetheless unclear whether the amount of maternal antibodies transmitted into egg yolks varies with female quality and egg laying order. In this paper, we investigated the transfer of maternal antibodies against type A influenza viruses (anti-AIV antibodies by a long-lived colonial seabird, the yellow-legged gull (Larus michahellis, in relation to fluctuating asymmetry in females, i.e. the random deviation from perfect symmetry in bilaterally symmetric morphological and anatomical traits. In particular, we tested whether females with greater asymmetry transmitted fewer antibodies to their eggs, and whether within-clutch variation in yolk antibodies varied according to the maternal level of fluctuating asymmetry. We found that asymmetric females were in worse physical condition, produced fewer antibodies, and transmitted lower amounts of antibodies to their eggs. We also found that, within a given clutch, yolk antibody level decreased with egg laying order, but this laying order effect was more pronounced in clutches laid by the more asymmetric females. Overall, our results support the hypothesis that maternal quality interacts with egg laying order in determining the amount of maternal antibodies transmitted to the yolks. They also highlight the usefulness of fluctuating asymmetry as a sensitive indicator of female quality and immunocompetence in birds.
Hammouda, Abdessalem; Selmi, Slaheddine; Pearce-Duvet, Jessica; Chokri, Mohamed Ali; Arnal, Audrey; Gauthier-Clerc, Michel; Boulinier, Thierry
Female birds transfer antibodies to their offspring via the egg yolk, thus possibly providing passive immunity against infectious diseases to which hatchlings may be exposed, thereby affecting their fitness. It is nonetheless unclear whether the amount of maternal antibodies transmitted into egg yolks varies with female quality and egg laying order. In this paper, we investigated the transfer of maternal antibodies against type A influenza viruses (anti-AIV antibodies) by a long-lived colonial seabird, the yellow-legged gull (Larus michahellis), in relation to fluctuating asymmetry in females, i.e. the random deviation from perfect symmetry in bilaterally symmetric morphological and anatomical traits. In particular, we tested whether females with greater asymmetry transmitted fewer antibodies to their eggs, and whether within-clutch variation in yolk antibodies varied according to the maternal level of fluctuating asymmetry. We found that asymmetric females were in worse physical condition, produced fewer antibodies, and transmitted lower amounts of antibodies to their eggs. We also found that, within a given clutch, yolk antibody level decreased with egg laying order, but this laying order effect was more pronounced in clutches laid by the more asymmetric females. Overall, our results support the hypothesis that maternal quality interacts with egg laying order in determining the amount of maternal antibodies transmitted to the yolks. They also highlight the usefulness of fluctuating asymmetry as a sensitive indicator of female quality and immunocompetence in birds. PMID:22590497
RéVillon, Sidonie; Teagle, Damon A. H.; Boulvais, Philippe; Shafer, John; Neal, Clive R.
Hole 1205A was drilled on Nintoku Seamount, which lies in the midportion of the Emperor Seamount Chain. This seamount was emergent ˜56 Myr ago but was submerged by 54 Ma, so the lavas have endured weathering in both subaerial and submarine environments. We have studied the petrology, mineralogy, and geochemistry of intercalated altered basalts, breccias, and soil samples recovered at Hole 1205A to quantify the chemical exchanges between the seamount and seawater and/or meteoric fluids. The secondary mineralogy is relatively uniform throughout the section and comprises smectite, Fe-oxyhydroxides, iddingsite, and Ca-carbonates. Soils are composed of variably altered basaltic clasts in a matrix of kaolinite, smectite, and vermiculite with minor goethite, hematite, and magnetite. Throughout the basement section, altered basalts, breccias, and soils are depleted in Si, Mg, Ca, Na, Sr, Rb, and Ba and enriched in Fe. Fe3+/FeT (up to ˜1), δ18O (up to ˜+20‰), and 87Sr/86Sr ratios are strongly elevated relative to primary igneous values. Differences in the 87Sr/86Sr ratios define an Upper Alteration Zone with 87Sr/86Sr close to 56 Ma seawater (˜0.7077) from a Lower Alteration Zone where 87Sr/86Sr are less elevated (˜0.704). The Lower Alteration Zone likely reflects interaction with a subaerial oxidizing fluid at low temperature. This zone probably retained most of the original subaerial weathering signature. The Upper Alteration Zone was altered through circulation of large quantities of cold oxidizing seawater that partially overprinted the subaerial weathering chemical characteristics. Altered samples were compared to estimated protolith compositions to calculate chemical gains and losses. Global chemical fluxes are calculated for the entire basement section using different lithological proportions models and different rates of oceanic island emplacement. Although the global construction rate of ocean islands is small compared to igneous accretion at mid
Vinall, Jillian; Miller, Steven P; Chau, Vann; Brummelte, Susanne; Synnes, Anne R; Grunau, Ruth E
Procedural pain is associated with poorer neurodevelopment in infants born very preterm (≤ 32 weeks gestational age), however, the etiology is unclear. Animal studies have demonstrated that early environmental stress leads to slower postnatal growth; however, it is unknown whether neonatal pain-related stress affects postnatal growth in infants born very preterm. The aim of this study was to examine whether greater neonatal pain (number of skin-breaking procedures adjusted for medical confounders) is related to decreased postnatal growth (weight and head circumference [HC] percentiles) early in life and at term-equivalent age in infants born very preterm. Participants were n=78 preterm infants born ≤ 32 weeks gestational age, followed prospectively since birth. Infants were weighed and HC measured at birth, early in life (median: 32 weeks [interquartile range 30.7-33.6]) and at term-equivalent age (40 weeks [interquartile range 38.6-42.6]). Weight and HC percentiles were computed from sex-specific British Columbia population-based data. Greater neonatal pain predicted lower body weight (Wald χ(2)=7.36, P=0.01) and HC (Wald χ(2)=4.36, P=0.04) percentiles at 32 weeks postconceptional age, after adjusting for birth weight percentile and postnatal risk factors of illness severity, duration of mechanical ventilation, infection, and morphine and corticosteroid exposure. However, later neonatal infection predicted lower weight percentile at term (Wald χ(2)=5.09, P=0.02). Infants born very preterm undergo repetitive procedural pain during a period of physiological immaturity that appears to impact postnatal growth, and may activate a downstream cascade of stress signaling that affects later growth in the neonatal intensive care unit.
González de la Torre, Héctor; Quintana-Lorenzo, María L; Perdomo-Pérez, Estrella; Verdú, José
This study aims to determine health-related quality of life (HRQoL) in patients suffering with venous ulceration and to correlate wound's severity status with HRQoL loss as well as identify the aspects of HRQoL most negatively affected by the presence of venous ulcers. In this observational, cross-sectional, descriptive, analytical multi-centre study, data was compiled over a period of 3·5 months. Thrity-four patients with venous ulceration were recruited. The RESVECH 2·0 scale was used to monitor wounds. The MAID scale was used to measure wound's severity. The Charing Cross Venous Ulcer Questionnaire (CCVUQe) (Spanish version) was used to evaluate quality of life. The mean CCVUQe score was 60·58 ± 16·04. The HRQoL dimension most affected was 'Emotional state' (mean score = 77. 67 ± 17·34). The average RESVECH 2.0 score for the wounds was 13·15 ± 5·07. A statistically significant association between total CCVUQ-e score and total RESVECH 2.0 score was detected [Pearson correlation coefficient r = 0·546 (P ≤ 0·001)]. Venous ulcers affect patients' HRQoL, particularly their emotional status. There is a relationship between the severity of the wound and loss of HRQoL. The presence of non-viable tissue, poor exudate control and infection all determine loss of HRQoL. New studies are needed to confirm these findings.
... of the back. Some causes and treatment of back pain are described in this chart.Our trusted Symptom ... Problems Hip Problems Knee Problems Leg Problems Lower Back Pain Menstrual Cycle Problems Mouth Problems Mouth Problems in ...
Kevin E. Kip
Full Text Available Background: As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA system may have posttraumatic stress disorder (PTSD, and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART, a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD. Methods: A randomized controlled trial of ART versus an attention control (AC regimen was conducted among 45 US service members/veterans with symptoms of combat-related PTSD. Participants received a mean of 3.7 sessions of ART. Results: Mean age was 41.0 + 12.4 years and 20% were female. Most veterans (93% reported pain. The majority (78% used descriptive terms indicative of neuropathic pain, with 29% reporting symptoms of a concussion or feeling dazed. Mean pre-/post-change on the Pain Outcomes Questionnaire (POQ was −16.9±16.6 in the ART group versus −0.7±14.2 in the AC group (p=0.0006. Among POQ subscales, treatment effects with ART were reported for pain intensity (effect size = 1.81, p=0.006, pain-related impairment in mobility (effect size = 0.69, p=0.01, and negative affect (effect size = 1.01, p=0.001. Conclusions: Veterans with symptoms of combat-related PTSD have a high prevalence of significant pain, including neuropathic pain. Brief treatment of symptoms of combat-related PTSD among veterans by use of ART appears to acutely reduce concomitant pain.
Villarreal Santiago, María; Tumilty, Steve; Mącznik, Aleksandra; Mani, Ramakrishnan
Acupuncture has been studied for several decades to establish evidence-based clinical practice. This systematic review aims to evaluate evidence for the effectiveness of acupuncture in influencing the functional connectivity of the central nervous system in patients with musculoskeletal pain. A systematic search of the literature was conducted to identify studies in which the central response of acupuncture in patients with musculoskeletal pain was evaluated by neuroimaging techniques. Databases searched were AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, PEDro, Pubmed, SCOPUS, SPORTDiscuss, and Web of Science. Included studies were assessed by two independent reviewers for their methodological quality by using the Downs and Black questionnaire and for their levels of completeness and transparency in reporting acupuncture interventions by using Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) criteria. Seven studies met the inclusion criteria. Three studies were randomized controlled trials (RCTs) and four studies were nonrandomized controlled trials (NRCTs). The neuroimaging techniques used were functional magnetic resonance imaging (fMRI) and positron emission tomography (PET). Positive effects on the functional connectivity of the central nervous system more consistently occurred during long-term acupuncture treatment. The results were heterogeneous from a descriptive perspective; however, the key findings support acupuncture's ability to alter pain-related functional connectivity in the central nervous system in patients with musculoskeletal pain.
Younse, Paulo; Aghazarian, Hrand
The figure depicts selected aspects of a six-legged robot that moves by hopping and that can be steered in the sense that it can be launched into a hop in a controllable direction. This is a prototype of hopping robots being developed for use in scientific exploration of rough terrain on remote planets that have surface gravitation less than that of Earth. Hopping robots could also be used on Earth, albeit at diminished hopping distances associated with the greater Earth gravitation. The upper end of each leg is connected through two universal joints to an upper and a lower hexagonal frame, such that the tilt of the leg depends on the relative position of the two frames. Two non-back-driveable worm-gear motor drives are used to control the relative position of the two frames along two axes 120 apart, thereby controlling the common tilt of all six legs and thereby, further, controlling the direction of hopping. Each leg includes an upper and a lower aluminum frame segment with a joint between them. A fiberglass spring, connected via hinges to both segments, is used to store hopping energy prior to launch into a hop and to cushion the landing at the end of the hop. A cable for loading the spring is run into each leg through the center of the universal joints and then down along the center lines of the segments to the lower end of the leg. A central spool actuated by a motor with a harmonic drive and an electromagnetic clutch winds in all six cables to compress all six springs (thereby also flexing all six legs) simultaneously. To ensure that all the legs push off and land in the same direction, timing- belt pulley drives are attached to the leg segments, restricting the flexing and extension of all six legs to a common linear motion. In preparation for a hop, the spool can be driven to load the spring legs by an amount corresponding to a desired hop distance within range. The amount of compression can be computed from the reading of a shaft-angle encoder that
Juul, Rasmus V; Foster, David J R; Upton, Richard N
The purpose of the study was to investigate placebo and buprenorphine effects on event-related potentials (ERPs) in experimental pain and the potential benefit of population pharmacodynamic modelling in data analysis. Nineteen healthy volunteers received transdermal placebo and buprenorphine...... in a cross-over study. Drug plasma concentrations and ERPs after electrical stimulation at the median nerve with intensity adjusted to pain detection threshold were recorded until 144 hrs after administration. Placebo and concentration-effect models were fitted to data using non-linear mixed......-effects modelling implemented in NONMEM (V7.2.0.). Pharmacodynamic models were developed to adequately describe both placebo and buprenorphine ERP data. Models predicted significant placebo effects, but did not predict significant effects related to buprenorphine concentration. Models revealed that ERPs varied both...
"Let's talk about OA pain": a qualitative analysis of the perceptions of people suffering from OA. Towards the development of a specific pain OA-Related questionnaire, the Osteoarthritis Symptom Inventory Scale (OASIS.
Full Text Available INTRODUCTION: Pain is the primary outcome measurement in osteoarthritis, and its assessment is mostly based on its intensity. The management of this difficult chronic condition could be improved by using pain descriptors to improve analyses of painful sensations. This should help to define subgroups of patients based on pain phenotype, for more adapted treatment. This study draws upon patients' descriptions of their pain, to identify and understand their perception of osteoarthritis pain and to categorize pain dimensions. METHODS: This qualitative study was conducted with representative types of patients suffering from osteoarthritis. Two focus groups were conducted with a sample of 14 participants, with either recent or chronic OA, at one or multiple sites. Focus groups were semi-structured and used open-ended questions addressing personal experiences to explore the experiences of patients with OA pain and the meanings they attributed to these pains. RESULTS: TWO MAIN POINTS EMERGED FROM CONTENT ANALYSES: -A major difficulty in getting patients to describe their osteoarthritis pain: perception that nobody wants to hear about it; necessity to preserve one's self and social image; notion of self-imposed stoicism; and perception of osteoarthritis as a complex, changing, illogical disease associated with aging. -Osteoarthritis pains were numerous and differed in intensity, duration, depth, type of occurrence, impact and rhythm, but also in painful sensations and associated symptoms. Based on analyses of the verbatim interviews, seven dimensions of OA pain emerged: pain sensory description, OA-related symptoms, pain variability profile, pain-triggering factors, pain and physical activity, mood and image, general physical symptoms. SUMMARY: In osteoarthritis, pain analysis should not be restricted to intensity. Our qualitative study identified pain descriptors and defined seven dimensions of osteoarthritis pain. Based on these dimensions, we aim to
Larsson, Caroline; Ekvall Hansson, Eva; Sundquist, Kristina; Jakobsson, Ulf
.... The aim of this study was to study prevalence at baseline, development over a 12-month period and cognitive-affective variables of kinesiophobia in a population-based sample of older adults with chronic pain...
Kunz, Miriam; Mylius, Veit; Schepelmann, Karsten; Lautenbacher, Stefan
There is ample evidence that dementia changes the processing of pain. However, it is not known whether this change in pain processing is related to the general decline in cognitive functioning or whether it may be related to specific domains of cognitive functioning. With the present study we tried to answer this question. We assessed different cognitive domains (orientation, memory, abstract thinking/executive function, aphasia and apraxia, and information processing speed) in 70 older patients with cognitive impairment (mild cognitive impairment up to moderate degrees of dementia). Pain responsiveness was assessed by measuring the nociceptive flexion reflex (NFR) threshold and facial responses to noxious electrical stimulation. Using regression analyses, we assessed which domain of cognitive functioning best predicted variance in pain responsiveness. Variance in pain responsiveness (NFR and facial expressions) was best explained by those items assessing executive functioning even when controlling for overall cognitive performance and memory functioning. The close association between executive functioning and pain responsiveness suggests that dementia-related neurodegeneration in prefrontal areas might result not only in reduced executive functioning but also in a loss of pain inhibitory potency, rendering the patient more vulnerable to pain. Our findings also suggest that pain assessment in dementia should be regularly completed by tests of cognitive functions.
Full Text Available There is ample evidence that dementia changes the processing of pain. However, it is not known whether this change in pain processing is related to the general decline in cognitive functioning or whether it may be related to specific domains of cognitive functioning. With the present study we tried to answer this question. We assessed different cognitive domains (orientation, memory, abstract thinking/executive function, aphasia and apraxia, and information processing speed in 70 older patients with cognitive impairment (mild cognitive impairment up to moderate degrees of dementia. Pain responsiveness was assessed by measuring the nociceptive flexion reflex (NFR threshold and facial responses to noxious electrical st