Chronic Pain in Irish Prison Officers: Profile and Predictors of Pain-Related Disability and Depression

Abstract

Objective

International research has consistently found increased risk for physical health and psychological difficulties among prison officers including elevated risk of assault resulting in acute pain. This study represented an exploratory examination of the experience of chronic pain conditions among Irish prison officers with particular reference to the psychosocial predictors of pain severity, pain interference, and depression.

Design

A questionnaire battery was completed by 152 Irish prison officers. The questionnaires measured pain severity and interference, anxiety, depression, social support, coping strategies, and resilience.

Results

Results showed that 48% of participants reported chronic pain based on the International Association for the Study of Pain definition. Psychological distress was high among respondents reporting chronic pain, with 38% of participants meeting the criteria for “probable depression” while 51% met the criteria for “probable anxiety disorder.” In regression analyses, depression emerged as a significant predictor of both pain severity and pain interference while anxiety and pain interference emerged as significant predictors of depression.

Conclusion

Chronic pain appears to be prevalent in prison officers and is associated with both physical and psychological impairment. Health care staff in correctional facilities should be aware that these health difficulties are prevalent in the prison work environment.

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Reported Pain and Fatigue Behaviors Mediate the Relationship Between Catastrophizing and Perceptions of Solicitousness in Patients with Chronic Fatigue

Catastrophizing is associated with negative outcomes in chronic pain and illness. The Communal Coping Model (CCM) and cognitive-behavioral (CB) formulations provide differing accounts of the function of catastrophizing in these contexts. The present study examined predictions from CCM and CB theoretical models in a sample of 116 patients with chronic fatigue to test: (1) whether patient-reported solicitous responses from significant others mediate the relationship of catastrophizing with patient-reported pain and fatigue behaviors, as predicted by the CCM, and (2) whether pain and fatigue behaviors mediate the relationship of catastrophizing with solicitous responses, consistent with a CB model.

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Efficacy of Posterior Segmental Decompression Surgery for Pincer Mechanism in Cervical Spondylotic Myelopathy: A Retrospective Case-controlled Study Using Propensity Score Matching

Study Design. Retrospective case-controlled study using propensity score matching. Objective. We aimed to evaluate the efficacy of cervical microendoscopic laminoplasty (CMEL) of the articular segment in patients with cervical spondylotic myelopathy (CSM) by comparing the clinical results of CMEL with conventional expansive laminoplasty (ELAP) for CSM. Summary of Background Data. A total of 259 patients undergoing CMEL or ELAP surgery for CSM at authors’ institute were reviewed. Methods. The patients were matched according to calculated propensity scores in a logistic regression model adjusted for age, sex, and preoperative severity of disorders and divided into the CMEL and ELAP groups. All patients were followed postoperatively for more than 2 years. The preoperative and 2-year follow-up evaluations included neurological assessment (Japanese Orthopaedic Association [JOA] score), recovery rates, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), axial pain (visual analog scale), and the Short Form 36 questionnaire (SF-36). Results. There were 71 patients in each group (47 males and 24 females each). The mean ages of the CMEL and ELAP groups were 63.8 and 62.8 years, respectively. There was no significant difference in the preoperative JOA score between groups. The mean numbers of surgically affected levels in the ELAP and CMEL groups were 3.2 and 1.8 discs, respectively (P ≤ 0.05). The groups exhibited similar recoveries of JOA, JOACMEQ, and SF-36 scores postoperatively. Sagittal alignment was maintained in both groups. However, postoperative neck axial complaints were significantly reduced in the CMEL group. Conclusion. CMEL may be a useful and effective surgical procedure for CSM, providing similar results as ELAP. CMEL for CSM is indicated for posterior decompression of the articular segment along with a pincer mechanism. This minimally invasive technique may have potential advantages compared with conventional ELAP, and may provide an alternative surgical option. Level of Evidence: 4

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An Updated Meta-Analysis Comparing Artificial Cervical Disc Arthroplasty (CDA) Versus Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Cervical Degenerative Disc Disease (CDDD)

Study Design. A meta-analysis of published randomized controlled Trials (RCTs). Objective. The aim of this study was to compare the efficacy and safety of cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion (ACDF) for the treatment of one-level cervical degenerative disc disease (CDDD). Summary of Background Data. ACDF has been widely performed for the treatment of CDDD. However, the loss of motion at the operated level has been hypothesized to accelerated adjacent-level disc degeneration. CDA is designed to avoid the side effect of fusion. However, it is still uncertain whether CDA is more effective and safer than ACDF. Methods. We performed a meta-analysis of published RCTs to examine whether there was a superior clinical effects of CDA than ACDF. A PubMed database search through October 2014 was performed for relevant studies. We included RCTs that reported relevant data in the treatment of one-level CDDD, which were suitable for detailed extraction of data. Results. We identified 18 RCTs eligible for analysis. The results of the meta-analysis indicated longer operative times, more blood loss, lower neck and arm pain scores reported on a visual analog scale (VAS), better neurological success, greater motion at the operated level, fewer secondary surgical procedures in the CDA group than in the ACDF group (P < 0.05). The 2 groups had similar lengths of hospital stay, Neck Disability Index scores, and rates of adverse events (P > 0.05). Conclusions. Findings of the present meta-analysis indicated that CDA was an effective and safe surgical procedure for the treatment of one-level CDDD, and CDA was found to be more superior than ACDF in terms of VAS neck and arm pain, neurological success, range of motion at the operated level, and secondary surgical procedures. Level of Evidence: 1

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“Lovely Pie in the Sky Plans”: A Qualitative Study of Clinicians’ Perspectives on Guidelines for Managing Low Back Pain in Primary Care in England

Study Design. A qualitative study in south-west England primary care. Objective. To clarify the decision-making processes that result in the delivery of particular treatments to patients with low back pain (LBP) in primary care and to examine clinicians’ perspectives on the English National Institute for Health and Care Excellence (NICE) clinical guidelines for managing LBP in primary care. Summary of Background Data. Merely publishing clinical guidelines is known to be insufficient to ensure their implementation. Gaining an in-depth understanding of clinicians’ perspectives on specific clinical guidelines can suggest ways to improve the relevance of guidelines for clinical practice. Methods. We conducted semi-structured interviews with 53 purposively sampled clinicians. Participants were 16 general practitioners (GPs), 10 chiropractors, 8 acupuncturists, 8 physiotherapists, 7 osteopaths, and 4 nurses, from the public sector (20), private sector (21), or both (12). We used thematic analysis. Results. Official guidelines comprised just 1 of many inputs to clinical decision-making. Clinicians drew on personal experience and inter-professional networks and were constrained by organizational factors when deciding which treatment to prescribe, refer for, or deliver to an individual patient with LBP. Some found the guideline terminology—“non-specific LBP”—unfamiliar and of limited relevance to practice. They were frustrated by disparities between recommendations in the guidelines and the real-world situation of short consultation times, difficult-to-access specialist services, and sparse commissioning of guideline-recommended treatments. Conclusion. The NICE guidelines for managing LBP in primary care are one, relatively peripheral, influence on clinical decision-making among GPs, chiropractors, acupuncturists, physiotherapists, osteopaths, and nurses. When revised, these guidelines could be made more clinically relevant by: ensuring that guideline terminology reflects clinical practice terminology; dispelling the image of guidelines as rigid and prohibiting patient-centered care; providing opportunities for clinicians to engage in experiential learning about guideline-recommended complementary therapies; and commissioning guideline-recommended treatments for public sector patients. Level of Evidence: N/A.

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A smaller magnitude of exercise-induced hypoalgesia in African Americans compared to non-Hispanic Whites: A potential influence of physical activity

Quality of life in children: A critical examination of concepts, approaches, issues, and future directions

The Efficacy of Motivational Interviewing in adults with Chronic Pain: A Meta-Analysis and Systematic Review

Motivational interviewing (MI) has become a popular approach for increasing adherence. This study investigates whether MI is effective in improving adherence, pain and physical function for patients with chronic pain. A literature search of randomized controlled trials identified 7 eligible studies with 962 participants with chronic pain. There was a small to moderate overall effect of MI on increased adherence to treatment from baseline to post intervention, but not from baseline to follow-up. Although significant short-term effects of MI were also observed for pain intensity, analyses revealed that this finding may be due to publication bias.

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[In Depth] An obscure mosquito-borne disease goes global

A little-known virus called Zika has caused outbreaks in Pacific Ocean islands the past few years and has arrived in South America this year. Scientists predict it will spread far and wide in the Western Hemisphere, and perhaps in southern Europe as well, because the Aedes mosquitoes that transmit the virus are so widespread. Scientifically speaking, Zika virus is still largely terra incognita. Its symptoms, including rash, fatigue, headaches, muscle pains, and swollen and painful joints, appear to be generally mild, but during an outbreak in French Polynesia that started in 2013, some patients developed a serious neurological condition named Guillain-Barré syndrome. Although it is primarily spread by mosquitoes, some evidence suggests sexual transmission is possible as well. Author: Martin Enserink

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Internet-based interventions for posttraumatic stress: A meta-analysis of randomized controlled trials

Threat and the Body: How the Heart Supports Fear Processing

Corrigendum: The dorsal posterior insula subserves a fundamental role in human pain

Nature Neuroscience 18, 1861 (2015). doi:10.1038/nn1215-1861d

Author: Andrew R Segerdahl, Melvin Mezue, Thomas W Okell, John T Farrar & Irene Tracey

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The patient experience of osteopathic healthcare

Osteopathy in Australia is a primary care limited scope practice. Practitioner surveys suggest that patients present with chronic pain and receive manual therapies, exercise and lifestyle advice. Further research is required to deepen the understanding of this intervention from the perspective of patients.

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The impact of military deployment on children: Placing developmental risk in context

Novel Measure of Opioid Dose and Costs of Care for Diabetes Mellitus

Diabetes mellitus (DM) has well-known costly complications but we hypothesized that costs of care for chronic pain treated with opioid analgesics (OA) would also be substantial. In a statewide, privately insured cohort of 29,033 adults aged 18-64 with DM and non-cancer pain who filled OA prescription(s) from 2008 -2012, our outcomes were costs for specific health care services and total costs per 6-month interval after first filled OA prescription. Average daily OA dose (4 categories) and total dose (quartiles) in morphine equivalent mgs were calculated per 6-month interval after first OA prescription and combined into a novel OA dose measure.

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Adverse Event Rates Associated with Transforaminal and Interlaminar Epidural Steroid Injections: A Multi-Institutional Study

Abstract

Background

Transforaminal epidural steroid injections (TFESI) have demonstrated efficacy and effectiveness in treatment of radicular pain. Despite little evidence of efficacy/effectiveness, interlaminar epidural steroid injections (ILESI) are advocated by some as primary therapy for radicular pain due to purported greater safety.

Objective

To assess immediate and delayed adverse event rates of TFESI and ILESI injections at three academic medical centers utilizing International Spine Intervention Society practice guidelines.

Methods

Quality assurance databases from a Radiology and two physical medicine and rehabilitation (PM&R) practices were interrogated. Medical records were reviewed, verifying immediate and delayed adverse events.

Results

There were no immediate major adverse events of neurologic injury or hemorrhage in 16,638 consecutive procedures in all spine segments (14,956 TFESI; 1,682 ILESI). Vasovagal reactions occurred in 1.2% of procedures, more frequently (P = 0.004) in TFESI (1.3%) than ILESI (0.5%). Dural punctures occurred in 0.06% of procedures, more commonly after ILESI (0.2% vs 0.04%, P = 0.006). Delayed follow up on PM&R patients (92.5% and 78.5, next business day) and radiology patients (63.1%, 2 weeks) identified no major adverse events of neurologic injury, hemorrhage, or infection. There were no significant differences in delayed minor adverse event rates. Central steroid response (sleeplessness, flushing, nonpositional headache) was seen in 2.6% of both TFESI and ILESI patients. 2.1% of TFESI and 1.8% of ILESI patients reported increased pain. No long-term sequelae were seen from any immediate or delayed minor adverse event.

Conclusions

Both transforaminal and ILESI are safely performed with low immediate and delayed adverse event rates when informed by evidence-based procedural guidelines. By demonstrating comparable safety, this study suggests that the choice between ILESI and TFESIs can be based on documented efficacy and effectiveness and not driven by safety concerns.

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Ultrasound-Guided Hyaluronic Acid Injections for Trigger Finger: A Double-Blinded, Randomized Controlled Trial

Effectiveness of Botulinum Toxin for Shoulder Pain Treatment: A Systematic Review and Meta-Analysis

Pilates Method for Women's Health: Systematic Review of Randomized Controlled Trials

Neuropathic ocular pain due to dry eye is associated with multiple comorbid chronic pain syndromes

Recent data demonstrate that dry eye (DE) susceptibility and other chronic pain syndromes (CPS) such as chronic widespread pain, irritable bowel syndrome and pelvic pain, may share common heritable factors. Previously, we showed that DE patients describing more severe symptoms tended to report features of neuropathic ocular pain (NOP). We hypothesize that patients with a greater number of CPS would have a different DE phenotype compared to those with fewer CPS. We recruited a cohort of 154 DE patients from the Miami Veterans Affairs Hospital and defined high and low CPS groups by cluster analysis.

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Consensus Recommendations on Initiating Prescription Therapies for Opioid-Induced Constipation

Abstract

Objective

Aims of this consensus panel were to determine (1) an optimal symptom-based method for assessing opioid-induced constipation in clinical practice and (2) a threshold of symptom severity to prompt consideration of prescription therapy.

Methods

A multidisciplinary panel of 10 experts with extensive knowledge/experience with opioid-associated adverse events convened to discuss the literature on assessment methods used for opioid-induced constipation and reach consensus on each objective using the nominal group technique.

Results

Five validated assessment tools were evaluated: the Patient Assessment of Constipation–Symptoms (PAC-SYM), Patient Assessment of Constipation–Quality of Life (PAC-QOL), Stool Symptom Screener (SSS), Bowel Function Index (BFI), and Bowel Function Diary (BF-Diary). The 3-item BFI and 4-item SSS, both clinician administered, are the shortest tools. In published trials, the BFI and 12-item PAC-SYM are most commonly used. The 11-item BF-Diary is highly relevant in opioid-induced constipation and was developed and validated in accordance with US Food and Drug Administration guidelines. However, the panel believes that the complex scoring for this tool and the SSS, PAC-SYM, and 28-item PAC-QOL may be unfeasible for clinical practice. The BFI is psychometrically validated and responsive to changes in symptom severity; scores range from 0 to 100, with higher scores indicating greater severity and scores >28.8 points indicating constipation.

Conclusions

The BFI is a simple assessment tool with a validated threshold of clinically significant constipation. Prescription treatments for opioid-induced constipation should be considered for patients who have a BFI score of ≥30 points and an inadequate response to first-line interventions.

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Capsaicin 8% patch versus oral pregabalin in patients with peripheral neuropathic pain

Abstract

Background

Clinical trials have not yet compared the efficacy of capsaicin 8% patch with current standard therapy in peripheral neuropathic pain (PNP).

Objectives

Head-to-head efficacy and safety trial comparing the capsaicin patch with pregabalin in PNP.

Methods

Open-label, randomized, multicentre, non-inferiority trial. Patients with PNP, aged 18–80 years, were randomly assigned to either the capsaicin 8% patch (n = 282) or an optimised dose of oral pregabalin (n = 277), and assessed for a ≥30% mean decrease in Numeric Pain Rating Scale (NPRS) score from baseline to Week 8. Secondary endpoints included optimal therapeutic effect (OTE), time-to-onset of pain relief and treatment satisfaction.

Results

The capsaicin 8% patch was non-inferior to pregabalin in achievement of a ≥30% mean decrease in NPRS score from baseline to Week 8 (55.7% vs. 54.5%, respectively; Odds ratio: 1.03 [95% CI: 0.72, 1.50]). The proportion of patients achieving OTE at Week 8 was 52.1% for the capsaicin 8% patch versus 44.8% for pregabalin (difference: 7.3%; 95% CI: −0.9%, 15.6%). The median time-to-onset of pain relief was significantly shorter for capsaicin 8% patch versus pregabalin (7.5 vs. 36.0 days; Hazard ratio: 1.68 [95% CI: 1.35, 2.08]; p < 0.0001). Treatment satisfaction was also significantly greater with the capsaicin 8% patch versus pregabalin. TEAEs were mild-to-moderate in severity, and resulted in treatment discontinuation only with pregabalin (n = 24). Systemic adverse drug reactions ranged from 0 to 1.1% with capsaicin 8% patch and 2.5 to 18.4% with pregabalin.

Conclusions

The capsaicin 8% patch provided non-inferior pain relief to an optimized dose of pregabalin in PNP, with a faster onset of action, fewer systemic side effects and greater treatment satisfaction.

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Repetitive acupoint treatment with diluted bee venom relieves mechanical allodynia and restores intraepidermal nerve fiber loss in oxaliplatin-induced neuropathic mice

We demonstrate that repetitive acupoint stimulation with DBV gradually and significantly reduces oxaliplatin-induced mechanical allodynia and restores the loss of IENFs in neuropathic mice via an alpha-2 adrenoceptor mechanism. Collectively this study suggests that repetitive acupoint treatment with DBV can be a potential strategy for the management of chemotherapy-induced neuropathy.

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Placebo use in pain management: a mechanism-based educational intervention enhances placebo treatment acceptability

Healthcare providers use treatments whose effectiveness’s derive partially or completely from ‘non-specific’ factors, frequently referred to as placebo effects. While the ethics of interventional placebo use continues to be debated, evidence suggests that placebos can produce clinically meaningful analgesic effects. Burgeoning evidence suggest that patients with chronic pain may be open to placebos treatments under certain contexts despite limited knowledge of their well-established psycho-neurobiological underpinnings.

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Validation of a Modified German Version of the Brief Pain Inventory For Use in Nursing Home Residents with Chronic Pain

The Brief Pain Inventory (BPI) has been psychometrically evaluated worldwide in adult patients with cancer-related and chronic pain in several languages, but never in nursing home residents with chronic pain. To address this gap, we evaluated the validity of a modified version of the BPI (BPI-NHR) in individuals residing in German nursing homes. One analytic sample comprised 137 nursing home residents (mean age, 83.3 years; SD, 8.0 years) without any missing values. An extended sample included also individuals with previous missing values that were substituted with the personal mean (n=163; mean age, 83.3 years; SD, 8.3 years).

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Pain and pain tolerance in whiplash-associated disorders: A population-based study

Abstract

Background

Pain is a cardinal symptom in individuals with whiplash-associated disorders (WAD). We aimed to compare pain characteristics between individuals with WAD and individuals reporting chronic pain from other causes, and to determine whether potential differences were accounted for by experimental pain tolerance.

Methods

Data from the 6th Tromsø Study (2007–2008, n = 12,981) were analysed. The number of painful locations was compared between individuals with WAD and individuals reporting chronic pain from other causes using negative binomial regression, pain frequency using multinomial logistic regression and pain intensity using multiple linear regression. Differences in experimental pain tolerance (cold pressor test) were tested using Cox regression; one model compared individuals with WAD to those with chronic pain from other causes, one compared the two groups with chronic pain to individuals without chronic pain. Subsequently, regression models investigating clinical pain characteristics were adjusted for pain tolerance.

Results

Of individuals with WAD, 96% also reported other causes for pain. Individuals with WAD reported a higher number of painful locations [median (inter-quartile range): 5 (3.5–7) vs. 3 (2–5), p < 0.001] and higher pain intensity (crude mean difference = 0.78, p < 0.001) than individuals with chronic pain from other causes. Pain tolerance did not differ between these two groups. Compared to individuals without chronic pain, individuals with WAD and individuals with chronic pain from other causes had reduced pain tolerance.

Conclusions

Individuals with WAD report more additional causes of pain, more painful locations and higher pain intensity than individuals with chronic pain from other causes. The increased pain reporting was not accounted for by pain tolerance.

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Topical prazosin attenuates sensitivity to tactile stimuli in patients with complex regional pain syndrome

Abstract

Background

The sympathetic nervous system may play an important role in certain forms of chronic pain. The main aim of this study was to determine whether functional blockade of α₁-adrenoceptors would alter sensitivity to cutaneous stimulation in patients with complex regional pain syndrome (CRPS).

Methods and Results

In an initial study, high-performance liquid chromatography-mass spectrometry of intradermal interstitial fluid collected from the forearms of three healthy individuals established that the α₁-adrenoceptor antagonist prazosin penetrated the skin barrier when mixed in Lipoderm^® cream base. Next, we found that application of this cream to the forearm of 10 healthy participants attenuated axon reflex vasodilatation to the iontophoresis of phenylephrine, demonstrating functional blockade of α₁-adrenoceptors. Subsequently, effects of the cream on sensitivity to mechanical and thermal stimulation were investigated in 14 healthy participants and 19 patients with CRPS (eight with an apparent adrenergic component of pain). Both in patients and controls, topical application of the prazosin cream increased sensitivity to skin cooling but reduced sensations evoked by gentle brushing. In addition, hyperalgesia to sharp stimulation was lower at the prazosin- than vehicle-treated site in the CRPS-affected limb, and allodynia to brushing was lower at the prazosin-treated than vehicle-treated site in patients with an adrenergic component of pain.

Conclusions

Prazosin cream inhibited adrenergic axon reflex vasodilatation in healthy volunteers, and also inhibited dynamic allodynia and punctate hyperalgesia in the CRPS-affected limb of some patients. Further studies are required to assess the potential benefits of topically applied prazosin for CRPS.

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Does Lumbosacral Transitional Vertebra Have Any Influence on Sacral Tilt?

Study design. Retrospective case-control study. Objective. To compare the sacral tilt (ST) angle between patients with and without lumbosacral transitional vertebra (LSTV). Summary of Background Data. Although LSTV is a common malformation of the lumbosacral region, data regarding the effect of LSTV on the tilt of sacrum is limited. Methods. Anterioposterior and lateral lumbar radiographs of patients with low back pain performed between March 2013 and September 2013 were extracted from the medical electronic database. Among these radiographs, those belonging to patients with Castellvi types II, III, and IV LSTV were identified. The angle of ST was measured on lateral lumbar radiographs and compared with that of age- and sex-matched controls without LSTV. Results. Of the 1588 radiographs extracted from the database, 96 (6.1%) were positive in terms of Castellvi types II, III and IV LSTV. 85 of them were found to be eligible for analysis. Patients with LSTV had significantly smaller ST angle than those without LSTV (p = 0.000). However, this angle did not differ among types (II, III and IV) of LSTV (p = 0.788). Conclusion. Results of this study revealed that patients with LSTV had less ST—that is to say more vertical sacrum—than those without this malformation. Level of Evidence: 4

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Responsiveness and Interpretability of the Portuguese Version of the Neck Disability Index in Patients With Chronic Neck Pain Undergoing Physiotherapy

Study Design. A prospective cohort study with a 7-week follow-up of 113 patients with chronic neck pain undergoing physiotherapy. Objective. To examine the responsiveness of the Portuguese Version of the Neck Disability Index (NDI-PT), and to determine the minimal clinically important difference (MCID), minimal detectable change (MDC), and floor/ceiling effects. Summary of Background Data. Studies that determine MDC and MCID are needed to provide more accurate outcome evaluation and critically assess potential relevant sources for differences in the minimal important change values for the NDI. Methods. The NDI-PT was administered twice: at the baseline and after 7 weeks of physiotherapy treatment. A Global Transition Scale was used as an external criterion measure to distinguish between improved and nonimproved patients’ scores between baseline and follow-up. The responsiveness of the NDI-PT was assessed through anchor-based methods (correlation coefficient and receiver operating characteristics curves—ROC curves). The MCID was estimated by the ROC curve method, and the MDC through the standard Error of Measurement (SEM). Results. The NDI-PT revealed moderate responsiveness when applied to patients with chronic neck pain undergoing physiotherapy (ρ = 0.328 and area under the curve of 0.595, 95% confidence interval: 0.484–0.706). The MDC achieved 12 points, whereas the MCID was found to be 5.5 points. A complementary ROC analysis based on percentage differences in NDI-PT scores from baseline revealed an optimal cutoff point of 27%. The optimal cutoff point was found to be dependent of disability baseline scores. Conclusion. The NDI-PT demonstrated moderate levels of responsiveness. The amount of change in questionnaire scores perceived by the patient to be meaningful is smaller than the amount of change required to be statistically 95% confident that score change is not just measurement error. Level of Evidence: N/A

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Chronic Opioid Therapy After Lumbar Fusion Surgery for Degenerative Disc Disease in a Workers’ Compensation Setting

Study Design. Retrospective cohort study. Objective. To evaluate prescription opioid use after lumbar fusion for degenerative disc disease in a workers’ compensation (WC) setting. Summary of Background Data. Use of opioids for treating chronic low back pain has increased greatly. Few studies have evaluated risk factors for chronic opioid therapy (COT) among the clinically-distinct WC population. Methods. We used “Current Procedural Terminology” and “International Classification of Diseases, Ninth Revision” codes to identify 1002 Ohio WC subjects who underwent lumbar fusion for degenerative disc disease from 1993 to 2013. Postoperative COT was defined as being supplied with opioid analgesics for greater than 1 year after the 6-week acute period after fusion. 575 subjects fit these criteria, forming the COT group. The remaining 427 subjects formed a temporary opioid group. To identify prognostic factors associated with COT after fusion, we used a multivariate logistic regression analysis. Results. Returning to work was negatively associated with COT (P < 0.001; odds ratio [OR] 0.38). COT before fusion (P < 0.001; OR 6.15), failed back syndrome (P < 0.001; OR 3.40), additional surgery (P < 0.001; OR 2.84), clinically diagnosed depression (P < 0.001; OR 2.34), and extended work loss before fusion (P = 0.038; OR 1.61) were positively associated with COT. The rates of postoperative COT associated with these factors were 27.8%, 79.6%, 85.0%, 76.4%, 77.1%, and 61.3%, respectively. Higher preoperative opioid load (P < 0.001) and duration of use (P < 0.001) were positively associated with higher postoperative rates of COT. Within 3 years after fusion, the COT group was supplied with an average of 1083.4 days of opioids and 49.0 opioid prescriptions, 86.2% of which were Schedule II. The COT group had an 11.0% return to work rate, $27,952 higher medical costs per subject, 43.5% rate of psychiatric comorbidity, 16.7% rate of failed back syndrome, and 27.7% rate of additional lumbar surgery. Conclusion. The majority of the study population was on COT after fusion. COT was associated with considerably worse outcomes. The poor outcomes of this study could suggest a more limited role for discogenic fusion among WC patients. Level of Evidence: 3

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Treating Huge Tear-Drop Fracture of Axis With Trapezoidal Bone: A Case Report and Literature Review

Study Design. Case report and review of relevant literature. Objective. To discuss the surgical strategies and clinical outcome of managing huge tear drop fracture of axis. Summary of Background Data. Teardrop fracture of axis is rarely seen, especially the huge type. The surgical technique is demanding because of the special anatomical structure and difficulty with bone grafting. Moreover, the surgical approach is controversial in the literature. Methods. A 51-year-old male patient suffered from neck pain after falling from the bicycle, neck movement was limited with no neurological compromise. X-ray suggested huge tear-drop fracture of anterior-inferior corner of axis, narrowing of C2/3 intervertebral disc. Fusion with self-designed tricortical trapezoidal iliac bone was performed. Results. Treating huge teardrop fracture of axis by anterior bone grafting with self-designed tricortical trapezoidal iliac bone is effective and stable. A 3-month follow-up showed fusion was achieved, upper cervical curvature was restored, and neck pain disappeared. Conclusion. Self-designed tricortical trapezoidal iliac bone provided adequate fusion area of bone grafting, restoring the normal intervertebral height and cervical alignment, and the midterm outcome is satisfactory. Level of Evidence: 5

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Response of Aneurysmal Bone Cyst to Denosumab

Study Design. Case report and literature review. Objective. To describe a unique case of large sacral aneurysmal bone cysts (ABCs) treated with denosumab and review the literature on this rare entity. Summary and Background Data. ABCs are expansile osteolytic lesions that typically contain blood-filled spaces separated by fibrous septa. Standard treatment includes surgical resection or curettage and packing; however, for some spinal lesions, the standard approach is not optimal. One therapeutic strategy is to treat spinal ABC with an agent that targets a pathway that is dysregulated in a disease with similar pathophysiology. The bone destruction in both giant cell tumors of bone and ABCs is mediated by RANK ligand (RANKL) produced by the tumor cells. Denosumab, a human monoclonal antibody to RANKL, is effective in the treatment of giant cell tumors of bone. Methods. We report a case of a large sacral ABC that responded to denosumab. A 27-year-old male developed increasing back pain. Imaging revealed a lytic lesion in the sacrum with no clear solid component and regions where the cortex was difficult to identify. ABC was diagnosed on biopsy. Surgery or radiation treatment was expected to be associated with serious morbidity; therefore, denosumab was given using the regimen for giant cell tumors of bone (120 mg monthly with a loading dose). Results. The patient's pain gradually resolved after 2 months of treatment. New bone formation with a more clearly defined cortex was evident on computed tomographic scan at 16 weeks and continued to show evidence of improvement at 7 and 12 months. Biopsy at 12 months revealed a hypocellular fibrous stroma with new bone formation and no giant cells. Conclusion. We conclude that denosumab can result in symptomatic and radiological improvement in ABC and may be useful in select cases. Level of Evidence: 5

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[In Depth] Baby's leukemia recedes after novel cell therapy

A London baby with end-stage leukemia has received a remarkable new cancer treatment: off-the shelf T cells with several gene modifications. Doctors say it's too early to know whether she's cured, but the announcement advances a frontier in cancer immunotherapy, in which the body's immune system tackles the disease. For the past several years, researchers have been modifying T cells so they can attack leukemia, but the cells must be painstakingly isolated from the patients themselves and grown in a lab. Drug companies and many doctors dream of using off-the-shelf cells to make the therapy more like a regular drug. Now, by harnessing advances in genome editing to slice and dice genes in donor T cells, researchers have created a new type of cancer immunotherapy. Author: Jennifer Couzin-Frankel

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Pelvic pain

What you need to knowRefer immediately to gynaecology all patients with a pelvic mass, abnormal cervix, or persistent bleedingConsider endometriosis and therefore referral in patients presenting with...

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Choice-impulsivity in children and adolescents with attention-deficit/hyperactivity disorder (ADHD): A meta-analytic review

Advancing Cardiovascular Science

As scientists, clinicians, students, residents, and fellows gather to attend the 2015 American Heart Association (AHA) Annual Scientific Sessions, JAMA is pleased to publish this theme issue on cardiovascular disease (CVD). This issue includes 3 research articles that provide new data on timely topics in CVD as well as 5 scholarly Viewpoints that address important topics in cardiovascular medicine and 2 other articles specifically on chest pain. In addition, 5 additional innovative research reports are being released online simultaneously with their scientific presentation during the AHA meeting.

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Does This Patient With Chest Pain Have Acute Coronary Syndrome?

This Rational Clinical Examination examines the accuracy of initial history, physical examination, electrocardiogram, and risk scores combined with the first cardiac-specific troponin for diagnosing acute coronary syndrome in the emergency department.

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Exercise Treadmill Testing

A 53-year-old man with chest pain and treated hypertension undergoes an exercise treadmill test, which demonstrates 1.5-mm ST-segment depression in inferolateral leads during recovery. How do you interpret the test result?

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The role of physical activity and psychological coping strategies in the management of painful diabetic neuropathy – A systematic review of the literature

Physiotherapy after subacromial decompression surgery: development of a standardised exercise intervention

Agreement between physiotherapists rating scapular posture in multiple planes in patients with neck pain: Reliability study

The efficacy of movement representation techniques for treating limb pain – a systematic review and metaanalysis

Relatively new evidence suggests that movement representation techniques, i.e. therapies that use the observation and/or imagination of normal pain-free movements, such as Mirror Therapy, Motor Imagery or Movement/ Action Observation may be effective in reducing some types of limb pain. To summarize the evidence regarding the efficacy of those techniques, a systematic review with metaanalysis was performed. We searched CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, PsychINFO, PEDro and OT-seeker up to August 2014 and handsearched further relevant resources for randomised controlled trials that studied the efficacy of movement representation techniques in reducing limb pain.

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A novel orally administered trimebutine compound (GIC-1001) is anti-nociceptive and features peripheral opioid agonistic activity and Hydrogen Sulphide-releasing capacity in mice

Abstract

Background

Trimebutine maleate, a noncompetitive spasmolytic agent with some affinity for peripheral μ- and κ-opioid receptors has been evaluated as a treatment in a limited number of patients undergoing sedation-free full colonoscopy. The efficiency of such treatment was comparable to sedation-based colonoscopies to relieve from pain and discomfort.

Methods

A new and improved trimebutine salt capable of releasing in vivo hydrogen sulphide (H₂S), a gaseous mediator known to reduce nociception, has been developed. This drug salt (GIC-1001) is composed of trimebutine bearing a H₂S-releasing counterion (3-thiocarbamoylbenzoate, 3TCB), the latter having the ability to release H₂S. GIC-1001 has been tested here in a mouse model of colorectal distension.

Results

In mice, while orally given trimebutine (the maleate salt, non-H₂S-releaser) only slightly reduced the nociceptive response to increasing pressures of colorectal distension, oral administration of GIC-1001 (the H₂S-releaser) was able to significantly reduce nociceptive response to all noxious stimuli, in a dose-dependent manner. This effect of GIC-1001 was significantly better than the effects of its parent compound trimebutine administered at equimolar doses.

Conclusions

Taken together, these results demonstrated increased antinociceptive properties for GIC-1001 compared to trimebutine, suggesting that this compound would be a better option to relieve from visceral pain and discomfort induced by lumenal distension.

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The influence of chronic pain on post-operative pain and function after hip surgery: a prospective observational cohort study

Pre-existing or chronic pain is an established risk factor for severe post-operative pain. In this prospective observational cohort-study, we investigate whether a history of chronic pain, beyond the presence of hip-related pain, affects other post-operative factors including early mobilization, function, and psychological distress following hip surgery.Patients undergoing total hip replacement surgery were observed from the pre-operative day until the seventh post-operative day. Prior to surgery, they were characterized by their pain history, pain intensity, function and psychological characteristics.

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Reorganized Trunk Muscle Activity During Multi-Directional Floor Perturbations After Experimental Low Back Pain: A Comparison Of Bilateral Versus Unilateral Pain

This study provides novel observations of differential trunk muscle activity in response to perturbations dependent on pain intensity and/or pain distribution. Due to complex and variable changes the relevance of clinical examination of muscle activity during postural tasks is challenged.

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Ginsenoside Rb1 Attenuates Acute Inflammatory Nociception by Inhibiting Neuronal ERK Phosphorylation by Regulating the Nrf2 and NF-κB Pathways

Ginsenoside-Rb1 (Rb1) has anti-inflammatory effects. However, the potential anti-nociceptive value of Rb1 for the treatment of acute inflammatory nociception is still unknown. Here, we examined whether Rb1 has any anti-nociceptive effects on acute inflammatory nociception in Sprague Dawley rats given intrathecal (i.t.) introduction of Rb1 (2, 10, and 50 μg) 20 minutes before injection of formalin (5%, 50 μl) into the plantar surface of the hind paws. I.t. introduction with Rb1 significantly decreased nociceptive behavior during phase II (16-60 minutes), but not phase I (0-10 minutes), after formalin stimulation, corresponding to the reduced activation of c-Fos in the L4-L5 spinal dorsal horn after formalin stimulation.

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[Correspondence] Ureteric colic and clinical evidence – Authors' reply

We thank Luca Villa and colleagues for their interest in our Article on the SUSPEND trial.1 They raise concerns with respect to confounding by the possible presence of a dilated urinary collecting system above the stone, and the appropriateness of our primary outcome measure. Dilatation of the collecting system is widespread in patients presenting with a ureteric stone. In the few patients who also have uncontrolled pain, sepsis, or impaired renal function, urgent intervention is indicated and this factor was an exclusion criterion for our study.

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Conceptual Conditioning: Mechanisms Mediating Conditioning Effects on Pain

Classical conditioning can profoundly modify subsequent pain responses, but the mechanisms that drive this effect are unresolved. In pain-conditioning studies, cues are typically conditioned to primary aversive reinforcers; hence, subsequent pain modulation could reflect learned precognitive associations (i.e., those involving neural plasticity independent of expectations and other forms of conceptual thought) or conceptual expectancies. We isolated conceptual contributions using a thermal pain-conditioning procedure in which different conditioned stimulus (CS) cues were repeatedly paired with symbolic representations of high and low noxious heat. In a subsequent test phase, identical noxious stimuli evoked larger skin conductance responses (SCRs) and pain ratings when preceded by CS cues associated with high temperature than by those associated with low temperature. These effects were mediated by participants’ self-reported expectancies. CS cues associated with high temperature also evoked larger anticipatory SCRs than did CS cues associated with low temperature, but larger anticipatory SCRs predicted smaller subsequent heat-evoked SCRs. These results provide novel evidence that conditioned modulation of pain physiology can be acquired through purely conceptual processes, and that self-reported expectancies and physiological threat responses have opposing effects on pain.

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Outcome of Cervical Radiculopathy Treated with Periradicular/Epidural Corticosteroid Injections

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Deconstructing Chronic Low Back Pain in the Older Adult: Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part IV: Depression

Abstract

Objective

To present the fourth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on depression.

Methods

The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a three-member content expert panel, and a nine-member primary care panel were involved in the iterative development of these materials. The algorithm was developed keeping in mind medications and other resources available within Veterans Health Administration (VHA) facilities. As panelists were not exclusive to the VHA, the materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor's clinical practice.

Results

We present an algorithm and supportive materials to help guide the care of older adults with depression, an important contributor to CLBP. The case illustrates an example of a complex clinical presentation in which depression was an important contributor to symptoms and disability in an older adult with CLBP.

Conclusions

Depression is common and should be evaluated routinely in the older adult with CLBP so that appropriately targeted treatments can be planned and implemented.

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Patellofemoral pain

The bottom linePatellofemoral pain commonly presents as gradual onset of knee pain (behind or around the patella) associated with patellofemoral loaded activities (squatting, climbing stairs, hiking,...

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Factors associated with cervical kinematic impairments in patients with neck pain

Cervical kinematics have functional relevance and are important for assessment and management in patients with neck disorders. A better understanding of factors that might influence cervical kinematics is required. The aim of this study was to determine any relationships between altered kinematics to the symptoms and signs of sensorimotor impairments, neck pain and disability and fear of neck motion in people with neck pain.

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Increased Sliding of Transverse Abdominis during Contraction after Myofascial Release in Patients with Chronic Low Back Pain

Recent evidence suggested the significance of integrity of the tension balance of the muscle-fascia corset system in spinal stability, particularly the posterior musculofascial junction which is adjacent to dorsal located paraspinal muscles joining each other at lateral raphe (LR). The purpose of this study was to compare the contraction of the transversus abdominis (TrA) at both anterior and posterior musculofascial muscle-fascia junctions in patients with low back pain (LBP) and asymptomatic participants before and immediately after a sustained manual pressure to LR.

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Disrupting spinal noradrenergic activation delays recovery of acute incision induced hypersensitivity and increases spinal glial activation in the rat

Clinical studies suggest that descending inhibitory controls from the brainstem are important for speeding recovery from pain following surgery. We examined the effects of destroying spinally projecting noradrenergic neurons via intrathecally administered antibody to dopamine β-hydroxylase conjugated to saporin (DβH-saporin) on recovery in an acute incisional pain model. Mechanical and thermal paw withdrawal thresholds and non-evoked spontaneous guarding scores were tested for several weeks postoperatively and analyzed using mixed effects growth curve modeling.

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Individuals’ experiences and opinions of psychological therapies for psychosis: A narrative synthesis

The initial effects of a sustained glenohumeral postero-lateral glide during elevation on shoulder muscle activity: A repeated measures study on asymptomatic shoulders

Manual therapy enhances pain-free range of motion and reduces pain levels, but its effect on shoulder muscle activity is unclear. This study aimed to assess the effects of a sustained glenohumeral postero-lateral glide during elevation on shoulder muscle activity.

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Neck motion, motor control, pain and disability: A longitudinal study of associations in neck pain patients in physiotherapy treatment

Neck pain is associated with several alterations in neck motion and motor control, but most of the findings are based on cross-sectional studies.

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Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials

Neck and low back pain are significant health problems due to their high prevalence among the general population. Educational intervention commonly aims to reduce the symptoms and risk for additional problems by increasing the participant’s knowledge, which in turn will alter the person’s behavior. The primary aim of this study was to review randomize controlled trials (RCTs) to gain insights into the effectiveness of education for the prevention and treatment of non-specific neck and low back pain.

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Biomechanical measures in participants with shoulder pain: intra-rater reliability

Biomechanical measures are used to characterize the mechanisms of treatment for shoulder pain. The objective was to characterize test-retest reliability and measurement error of shoulder surface electromyographic(sEMG) and kinematic measures. Individuals(n=12) with subacromial pain syndrome were tested at 2 visits. Five repetitions of shoulder scapular plane elevation were performed while collecting sEMG of the upper trapezius(UT), middle trapezius(MT), lower trapezius(LT), serratus anterior(SA) middle-deltoid, and infraspinatus muscles during ascending and descending phases.

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Beneficial Effects of Improvement in Depression, Pain Catastrophizing, and Anxiety on Pain Outcomes: A 12-Month Longitudinal Analysis

Depression, pain catastrophizing, and anxiety commonly co-occur with chronic pain. However, the degree to which improvement in these psychological comorbidities predicts subsequent pain outcomes and, in particular, the relative effects of these 3 psychological factors with respect to one another is only partially known. Longitudinal analysis of 250 primary care patients with chronic musculoskeletal pain enrolled in the Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial was examined, using data gathered at baseline, 3 and 12 months.

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Psychological Treatments for Adults with Posttraumatic Stress Disorder: A Systematic Review and Meta-analysis

Extent of recovery in the first 12 months of complex regional pain syndrome type-1: A prospective study

Abstract

Background

The literature concerning the outcomes of complex regional pain syndrome (CRPS) is contradictory, with some studies suggesting high rates of symptom resolution, whilst others demonstrate that CRPS symptoms can persist and lead to significant disability. The aim of the present study was to carefully document the extent of recovery from each of the signs and symptoms of CRPS.

Methods

A sample of 59 patients with recently onset (<12 weeks) CRPS-1 were followed prospectively for 1 year, during which time they received treatment-as-usual. At baseline, 6 and 12 months, the following were measured: CRPS severity scores (symptoms and signs of CRPS), pain, disability, work status and psychological functioning.

Results

Analyses showed that rates of almost all signs and symptoms of CRPS reduced significantly over 1 year. Reductions in symptom severity were clinically relevant and were greatest in the first 6 months and plateaued thereafter. However, at 1 year, nearly 2/3 of patients continued to meet the IASP-Orlando criteria for CRPS and 1/4 met the Budapest research criteria for CRPS. Only 5.4% of patients were symptom-free at 12 months.

Conclusions

Overall the results were less optimistic than several previously conducted prospective studies and suggest that few cases of CRPS resolve completely within 12 months of onset. Improvements were generally greater in the first 6 months, and suggest that it may be worth exploring early interventions to prevent long-term disability in CRPS.

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2015 Updated Method Guideline for Systematic Reviews in the Cochrane Back and Neck Group

Study Design. Method guideline for systematic reviews of trials of interventions for neck and back pain, and related spinal disorders. Objective. To help authors design, conduct, and report systematic reviews of trials in this field. Summary of Background Data. In 1997, the Cochrane Back Review Group editorial board published the Method Guideline for Systematic Reviews, which was updated in 2003 and in 2009. Since then, new methodological evidence has emerged and standards have changed, therefore it was clear that revisions were needed to the 2009 guideline. In May 2015 the group changed its name to Cochrane Back and Neck. Methods. The editorial board met in September 2014 to review the relevant new methodological evidence and determine how it should be incorporated. Members of the advisory board were consulted. Based on the feedback received, an updated method guideline was prepared and approved by the editorial board. Results. We have updated recommendations in 7 categories: objectives, literature search, selection criteria, risk of bias assessment, data extraction, data analysis, and reporting of results and conclusions. Each category is classified into minimum criteria (mandatory) and further guidance (optional). This update also includes some new guidance for preparation of summary of finding tables and for conducting nonintervention reviews. Conclusion. Citations of previous versions of the method guideline in published scientific articles (1193 in total) suggest that others may find this guideline useful to plan, conduct, or evaluate systematic reviews in the field of back and neck pain, and spinal disorders. Level of Evidence: N/A

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Effect of Lumbar Disc Degeneration and Low-Back Pain on the Lumbar Lordosis in Supine and Standing: A Cross-Sectional MRI Study

Study Design. Cross-sectional study. Objective. To examine the influence of low-back pain (LBP) and lumbar disc degeneration (LDD) on the lumbar lordosis in weight-bearing positional magnetic resonance imaging (pMRI). Summary of Background Data. The lumbar lordosis increases with a change of position from supine to standing and is known as an essential contributor to dynamic changes. However, the lordosis may be affected by disc degeneration and pain. Methods. Patients with LBP >40 on a 0 to 100 mm Visual Analog Scale (VAS) both during activity and rest and a sex and age-decade matching control group without LBP were scanned in the supine and standing position in a 0.25-T open MRI unit. LDD was graded using Pfirrmann's grading-scale. Subsequently, the L2-to-S1 lumbar lordosis angle (LA) was measured. Results. Thirty-eight patients with an average VAS of 58 (±13.8) mm during rest and 75 (±5.0) mm during activities, and 38 healthy controls were included. MRI findings were common in both groups, whereas, the summation of the Pfirrmann's grades (LDD-score) was significantly higher in the patients [(MD 1.44; 95% confidence intervals (CI) 0.80 to 2.10; P < 0.001]. The patients were less lordotic than the controls in both the supine (MD −6.4°; 95% CI −11.4 to −1.3), and standing position (MD −5.6°; 95% CI −10.7 to −0.7); however, the changes between the positions (ΔLA) were the same (MD 0.8°; 95% CI −1.8 to 3.3). Using generalized linear model the LDD-score was associated with age (P < 0.001) for both groups. The LDD-score and ΔLA were negatively associated in the control group (P < 0.001), also after adjustments for gender and age (β-coefficient: −2.66; 95% CI −4.3 to −1.0; P = 0.002). Conclusion. Patients may be less lordotic in both the supine and standing position, whereas, change in the lordosis between the positions may be independent of pain. Decreasing lordosis change seems to be associated with age-related increasing disc degeneration in healthy individuals. Level of Evidence: 2

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Geographic Variation in Early MRI for Acute Work-Related Low Back Pain and Associated Factors

Study design. Retrospective cohort study using medical claims data. Objective. To document the extent of geographic variation in utilization of magnetic resonance imaging (MRI) for working-age patients early in the course of acute, disabling low back pain (LBP); to identify potential factors associated with the most extreme variations. Summary of Background Data. Although guidelines discourage MRI in acute uncomplicated LBP, this practice is highly prevalent. Geographic variation in radiologic testing is common, and may indicate problems with access or quality of care, yet this has not been studied in working-age patients with LBP (a frequent cause for acute care visits). Methods. All cases of acute, disabling LBP with onset between 1/1/2002 and 12/31/2007 were selected from a large workers’ compensation data source. Detailed information from medical bills was used to identify persons who received early MRI (within 30 days of onset), classify cases by LBP severity, and exclude those with concurrent injuries or diseases, and/or prior LBP disability. Individual predictors included age, gender, job tenure, and industry. State-level predictors included economic, physician supply and practice variables, workers compensation system features, and MRI testing location. Generalized linear mixed models were constructed to evaluate within- and between-state variability, selecting the six highest and six lowest MRI utilization states. Results. State rates of early MRI scanning varied from 6.0% to 58.4%. In the 12 selected most extreme states, non-hospital MRI sites and lower state median income were associated with higher rates of early MRIs, explaining 84% of between-state variation, and 12.5% of all observed variability. Inter-state differences in MRI rates were greatest for lower-severity cases. Higher severity diagnoses were more common in high utilization states. Conclusions. Between-state inappropriate early MRI variability is largely explained by rate of non-hospital MRI sites and state median income. Potential solutions include efforts to address inappropriate referral patterns based on private MRI facility ownership, and to improve quality of communication with low-income patients. Level of Evidence: 4

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Rationale for the Surgical Treatment of Lumbar Degenerative Spondylolisthesis

Study Design. A questionnaire survey. Objective. The aim of this study was to determine the effect of patient age, dynamic instability, and/or low back pain on the treatment of patients with a degenerative spondylolisthesis, and if the operative approach is affected by surgeon specialty, location, or practice model. Summary of Background Data. The classic treatment for patients with symptomatic degenerative spondylolisthesis is decompression and fusion; however in a select group of patients, an isolated decompression may be reasonable. Methods. A survey was sent to surgeon members of the Lumbar Spine Research Society and AOSpine requesting information regarding their preferred treatment of degenerative spondylolisthesis for a number of different clinical scenarios. Determinants included patient age, the presence of instability, symptoms of low back pain, surgeon's location, surgeon's specialty, and practice model. Results. A total of 223 spine surgeons completed the survey. Age of the patient, the presence of instability, and low back pain all significantly (P < 0.0001) affected the recommended treatment, which were independent of surgeon factors. Older patients were significantly less likely to be offered an interbody fusion and more likely to be recommended for an isolated decompression (P < 0.0001), and the presence of dynamic instability made an interbody fusion more likely than an isolated decompression (P < 0.0001). Of those who responded, 53.2% of surgeons reported they would recommend an isolated decompression for a properly selected patient with a degenerative spondylolisthesis. Conclusion. The most common operative treatment for a degenerative spondylolisthesis is a decompression and fusion; however, the results of this survey demonstrate that surgeons consider degenerative spondylolisthesis a heterogeneous condition that requires an individualized surgical plan. Future studies are needed to evaluate the effect of variables such as age, the presence of low back pain, and the presence of dynamic instability on patient reported outcomes from various surgical options. Level of Evidence: N/A.

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A Cross-Sectional Examination of the Associations Between Symptoms, Community Integration, and Mental Health in Multiple Sclerosis

Reducing sitting time after stroke. A Phase II safety and feasibility randomised controlled trial

Effectiveness of Soft Tissue Massage for Nonspecific Shoulder Pain: Randomized Controlled Trial

Cognitive Functional Therapy for Disabling Nonspecific Chronic Low Back Pain: Multiple Case-Cohort Study

Direct and Indirect Benefits Reported by Users of Transcutaneous Electrical Nerve Stimulation for Chronic Musculoskeletal Pain: Qualitative Exploration Using Patient Interviews

Diagnostic Value of Clinical Cervical Spine Tests in Patients With Cervicogenic Somatic Tinnitus

Clinical Ratings of Pain Sensitivity Correlate With Quantitative Measures in People With Chronic Neck Pain and Healthy Controls: Cross-Sectional Study

Addressing Neuroplastic Changes in Distributed Areas of the Nervous System Associated With Chronic Musculoskeletal Disorders

Present interventions utilized in musculoskeletal rehabilitation are guided, in large part, by a biomedical model where peripheral structural injury is believed to be the sole driver of the disorder. There are, however, neurophysiological changes across different areas of the peripheral and central nervous systems, including peripheral receptors, dorsal horn of the spinal cord, brain stem, sensorimotor cortical areas, and the mesolimbic and prefrontal areas associated with chronic musculoskeletal disorders, including chronic low back pain, osteoarthritis, and tendon injuries. These neurophysiological changes appear not only to be a consequence of peripheral structural injury but also to play a part in the pathophysiology of chronic musculoskeletal disorders. Neurophysiological changes are consistent with a biopsychosocial formulation reflecting the underlying mechanisms associated with sensory and motor findings, psychological traits, and perceptual changes associated with chronic musculoskeletal conditions. These changes, therefore, have important implications in the clinical manifestation, pathophysiology, and treatment of chronic musculoskeletal disorders. Musculoskeletal rehabilitation professionals have at their disposal tools to address these neuroplastic changes, including top-down cognitive-based interventions (eg, education, cognitive-behavioral therapy, mindfulness meditation, motor imagery) and bottom-up physical interventions (eg, motor learning, peripheral sensory stimulation, manual therapy) that induce neuroplastic changes across distributed areas of the nervous system and affect outcomes in patients with chronic musculoskeletal disorders. Furthermore, novel approaches such as the use of transcranial direct current stimulation and repetitive transcranial magnetic stimulation may be utilized to help renormalize neurological function. Comprehensive treatment addressing peripheral structural injury as well as neurophysiological changes occurring across distributed areas of the nervous system may help to improve outcomes in patients with chronic musculoskeletal disorders.

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