Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis

Early Incorporation of an Evidence-Based Aquatic-Assisted Approach to Arthroscopic Rotator Cuff Repair Rehabilitation: Prospective Case Study

Aligning Documentation With Congenital Muscular Torticollis Clinical Practice Guidelines: Administrative Case Report

Manipulation of neurotransmitter levels has differential effects on formalin evoked nociceptive behaviour in male and female mice

Changes in serotonin (5-hydroxytryptamine, 5-HT), noradrenaline (NA), and γ-aminobutyric acid (GABA) levels in the spinal cord are known to occur in response to nociceptive stimuli, yet little research has examined possible underlying sex differences in these changes and how they might affect nociception. We have used pharmacological approaches in a well-established model of tonic nociception, the formalin test, to explore the effects of altering neurotransmitter levels on nociceptive responses in male and female C57BL/6 mice.

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Development and Initial Validation of the Pain Resilience Scale

Over the past decade, the role of positive psychology in pain experience has gained increasing attention. One such positive factor, identified as resilience, has been defined as the ability to maintain positive emotional and physical functioning despite physical or psychological adversity. Although cross-situational measures of resilience have been shown to be related to pain, it was hypothesized that a pain-specific resilience measure would serve as a stronger predictor of acute pain experience.

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The functional value of preventive and restorative safety behaviors: A systematic review of the literature

An exploration of familial associations of two movement pattern-derived subgroups of chronic disabling low back pain; a cross-sectional cohort study

Altered movement patterns with pain have been demonstrated in children, adolescents and adults with chronic disabling low back pain (CDLBP). A previously developed classification system has identified different subgroups including active extension and multidirectional patterns in patients with CDLBP. While familial associations have been identified for certain spinal postures in standing, it is unknown whether a familial relationship might exist between movement pattern-derived subgroups in families with CDLBP.

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Turning pain into cues for goal-directed behavior: Implementation intentions reduce escape-avoidance behavior on a painful task

Pain automatically elicits escape-avoidance behavior to avert bodily harm. In patients with chronic pain long-term escape-avoidance behavior may increase the risk of chronic disability. The aim of the presents study was to examine whether implementation intentions, reduce escape-avoidance behavior during painful tasks in healthy individuals. Implementation intentions are “if-then” self-statements associating situational cues with goal-directed behaviors.Seventy healthy participants performed a painful finger pressing task, preceded by either implementation intention instructions with pain or a non-pain cue as a cue for goal directed behavior, or control instructions.

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A peripheral messenger for chronic pain

Nature Neuroscience 19, 9 (2016). doi:10.1038/nn.4217

Author: Sébastien Thuault

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Interaction between ultraviolet B-induced cutaneous hyperalgesia and nerve growth factor-induced muscle hyperalgesia

Abstract

Backgrounds and objectives

Clinical observations indicate that cutaneous hyperalgesia may arise from pain located in deep structures. The objective of this study was to investigate whether combined sensitization of deep and superficial somatic tissues facilitates skin hyperalgesia.

Methods

The interaction between muscle and cutaneous hyperalgesia was investigated in 16 healthy volunteers. Skin sensitization was induced unilaterally on the same randomly selected part of the body by ultraviolet B (UVB) irradiation above the upper trapezius and low back muscles. The next day, muscle hyperalgesia was induced bilaterally in low back muscles by injections of nerve growth factor (NGF). Thus, 1 day after irradiation there was skin sensitization, whereas after 2 days both skin and muscle sensitizations were present. Cutaneous blood flow, pin-prick thresholds, pressure pain thresholds (PPTs), temporal summation to repetitive painful pressure stimulation, and stimulus–response functions of graded pressure stimulations and pain intensity were assessed within the irradiated skin area and in the surrounding area before and 1, 2 and 3 days after irradiation.

Results

Comparing baseline with 1 day after irradiation, UVB and UVB+NGF locations demonstrated: (1) Increased superficial blood flow inside the irradiated area (p < 0.01); (2) Reduced pin-prick (p < 0.01) and PPTs (p < 0.05) within the irradiated area and in the surrounding area; (3) Left-shifted pressure stimulus–response function within the irradiated area (p < 0.01); (4) Facilitated temporal summation inside the irradiated area (p < 0.01).

Conclusions

Using skin and deep tissue pain sensitization models simultaneously, no significant synergistic effects were found within the 3-day investigation suggesting little integration between the two phenomena in this period.

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A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions?

Development and initial validation of the Activity Patterns Scale in patients with chronic pain

Several self-report measures were used to identify six activity patterns in chronic pain patients: pain avoidance, activity avoidance, task-contingent persistence, excessive persistence, pain-contingent persistence, and pacing. Instruments for assessing pacing should include three pacing behaviours (breaking tasks into smaller tasks, taking frequent short rests, slowing down), each of which relate to a single goal (increasing activity levels, conserving energy for valued activities, and reducing pain).

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Use of Opioids in Latin America: The Need of an Evidence-Based Change

Abstract

Objective

The subject of this publication has been focused on local considerations for facilitating regional best practice, including identifying and uniformly adopting the most relevant international guidelines on opioid use (OU) in chronic pain management.

Design and Setting

The Change Pain Latin America (CPLA) Advisory Panel conducted a comprehensive, robust, and critical analysis of published national and international reviews and guidelines of OU, considering those most appropriate for Latin America.

Methods

A PubMed search was conducted using the terms “opioid,” “chronic,” and “pain” and then refined using the filters “practice guidelines” and “within the last 5 years” (2007–2012). Once the publications were identified, they were selected using five key criteria: “Evidence based,” “Comprehensive,” “From a well-recognized source,” “Current publications,” and “Based on best practice” and then critically analyzed considering 10 key criteria for determining the most relevant guidelines to be applied in Latin America.

Results

The initial PubMed search identified 177 reviews and guidelines, which was reduced to 16 articles using the five preliminary criteria. After a secondary analysis according to the 10 key criteria specific to OU in Latin America, 10 publications were selected for critical review and discussion.

Conclusions

The CPLA advisory panel considered the “Safe and effective use of opioids for chronic non-cancer pain” (published in 2010 by the NOUGG of Canada) to be valid, relevant to Latin America, practical, evidence-based, concise, unambiguous, and sufficiently educational to provide clear instruction on OU and pain management and, thus, recommended for uniform adoption across the Latin America region.

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Ultrasonographic analysis of dorsal neck muscles thickness changes induced by isometric contraction of shoulder muscles: a comparison between patients with chronic neck pain and healthy controls

Altered pattern of muscle activity is commonly seen with chronic neck pain (CNP). However, limited investigations have been done on dorsal neck muscles’ activity pattern while performing upper limb tasks in patients with CNP.

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Do clinicians think that pain can be a classically conditioned response to a non-noxious stimulus?

Anecdotally, clinical presentations in which pain seems to be elicited by non-noxious stimuli are often explained using a classical conditioning framework. We were primarily interested in whether (a) clinicians think that pain can be a classically conditioned response to a non-noxious stimulus, and (b) clinicians think there is evidence to support that idea.

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Serratus Anterior or Pectoralis Minor: which muscle has the upper hand during protraction exercises?

The Serratus Anterior(SA) has a critical role in stabilizing the scapula against the thorax. Research has linked shoulder and neck disorders to impairments in the SA activation. Exercises that target the SA are included in the rehabilitation of shoulder or neck pain and mostly include a protraction component. The Pectoralis Minor(PM) functions as a synergist of the SA. From the literature it is unclear to what extent PM is activated during SA exercises.

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Role of Kv 4.3 in vibration-induced muscle pain in the rat

We hypothesized that changes in the expression of Kv4.3 contribute to the mechanical hyperalgesia induced by vibration injury, a rodent model for hand-arm vibration syndrome in humans. Here we show that the exposure of the gastrocnemius muscle to vibration injury induces muscle hyperalgesia that is accompanied by a significant down-regulation of Kv4.3 in affected sensory nerve fibers in dorsal root ganglia (DRG). We additionally demonstrate that the intrathecal administration of antisense oligonucleotides for Kv4.3 mRNA itself induces muscle hyperalgesia in the rat.

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Risk factors of prescription opioid overdose among Colorado Medicaid beneficiaries

This study aims to determine risk factors of opioid overdose among the Colorado Medicaid population. A retrospective nested case-control study was undertaken. Medicaid beneficiaries who had a medical claim(s) for an emergency department visit or a hospitalization associated with an opioid overdose from July 2009 to June 2014 were defined as cases. Controls were selected using a nearest neighbor matching without replacement. The matched controls were selected based on age, gender, and opioid prescription.

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Effect of Chest Tube Size and Analgesia on Pain During Pleurodesis

This 2×2 factorial randomized trial compares the effects of larger vs smaller chest tube size and nonsteroidal anti-inflammatory drugs vs opiates on pain and efficacy of pleurodesis in patients with malignant pleural effusion.

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Effects of static stretching of knee musculature on patellar alignment and knee functional disability in male patients diagnosed with knee extension syndrome: A single-group, pretest-posttest trial

Knee extension (Kext) syndrome is based on movement system impairments and is described as knee pain associated with quadriceps stiffness.

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A systematic review and meta-analysis of risk factors for postherpetic neuralgia

Abstract: Patients with herpes zoster can develop persistent pain after rash healing, a complication known as postherpetic neuralgia. By preventing zoster through vaccination, the risk of this common complication is reduced. We searched MEDLINE and Embase for studies assessing risk factors for postherpetic neuralgia, with a view to informing vaccination policy. Nineteen prospective studies were identified. Meta-analysis showed significant increases in the risk of postherpetic neuralgia with clinical features of acute zoster including prodromal pain (summary rate ratio 2.29, 95% confidence interval: 1.42-3.69), severe acute pain (2.23, 1.71-2.92), severe rash (2.63, 1.89-3.66), and ophthalmic involvement (2.51, 1.29-4.86). Older age was significantly associated with postherpetic neuralgia; for individual studies, relative risk estimates per 10-year increase ranged from 1.22 to 3.11. Evidence for differences by gender was conflicting, with considerable between-study heterogeneity. A proportion of studies reported an increased risk of postherpetic neuralgia with severe immunosuppression (studies, n = 3/5) and diabetes mellitus (n = 1/4). Systemic lupus erythematosus, recent trauma, and personality disorder symptoms were associated with postherpetic neuralgia in single studies. No evidence of higher postherpetic neuralgia risk was found with depression (n = 4) or cancer (n = 5). Our review confirms a number of clinical features of acute zoster are risk factors for postherpetic neuralgia. It has also identified a range of possible vaccine-targetable risk factors for postherpetic neuralgia; yet aside from age-associated risks, evidence regarding risk factors to inform zoster vaccination policy is currently limited.

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A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population

Abstract: Chronic widespread pain (CWP) is common and associated with poor general health. There has been no attempt to derive a robust prevalence estimate of CWP or assess how this is influenced by sociodemographic factors. This study therefore aimed to determine, through a systematic review and meta-analysis, the prevalence of CWP in the adult general population and explore variation in prevalence by age, sex, geographical location, and criteria used to define CWP. MEDLINE, Embase, CINAHL, and AMED were searched using a search strategy combining key words and related database-specific subject terms to identify relevant cohort or cross-sectional studies published since 1990. Included articles were assessed for risk of bias. Prevalence figures for CWP (American College of Rheumatology criteria) were stratified according to geographical location, age, and sex. Potential sources of variation were investigated using subgroup analyses and meta-regression. Twenty-five articles met the eligibility criteria. Estimates for CWP prevalence ranged from 0% to 24%, with most estimates between 10% and 15%. The random-effects pooled prevalence was 10.6% (95% confidence intervals: 8.6-12.9). When only studies at low risk of bias were considered pooled, prevalence increased to 11.8% (95% confidence intervals: 10.3-13.3), with reduced but still high heterogeneity. Prevalence was higher in women and in those aged more than 40 years. There was some limited evidence of geographic variation and cultural differences. One in 10 adults in the general population report chronic widespread pain with possible sociocultural variation. The possibility of cultural differences in pain reporting should be considered in future research and the clinical assessment of painful conditions.

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Ultramicronized palmitoylethanolamide reduces viscerovisceral hyperalgesia in a rat model of endometriosis plus ureteral calculosis: role of mast cells

Abstract: The effects of ultramicronized palmitoylethanolamide were evaluated on pain behaviours and markers of mast cell (MC) activity in a rat model of endometriosis plus ureteral calculosis (ENDO+STONE)–induced viscerovisceral hyperalgesia (VVH). Female Sprague-Dawley rats that underwent surgical induction of endometriosis were randomly assigned to receive active (ultramicronized palmitoylethanolamide 10 mg·kg−1·d−1, orally) or placebo treatment for 25 days. At day 21, they underwent ureteral stone formation and were video-recorded till day 25 to evaluate ureteral and uterine pain behaviours. At autopsy (day 25), ureteral condition and number and diameter of endometrial cysts were evaluated. The following were then measured: number and percentage of degranulating MCs, number of vessels, chymase, nerve growth factor (NGF), vascular endothelial growth factor (VEGF), and Flk-1 (VEGF receptor) in cysts, and NGF in dorsal root ganglia (DRG). Ultramicronized palmitoylethanolamide–treated vs placebo-treated rats showed significantly lower number, duration and complexity of ureteral crises, shorter duration of uterine pain, and smaller cyst diameter (0.0001 < P < 0.004); a significantly higher percentage of expelled stones (P < 0.0001); significantly lower MC number (P < 0.01), vessel number (P < 0.01), chymase (P < 0.05), NGF (P < 0.05), VEGF (P < 0.01), and Flk-1 (P < 0.01) expression in cysts and NGF expression in DRG (P < 0.01). In all animals, the global duration of ureteral crises correlated linearly and directly with cyst diameter, MC number and chymase in cysts, and NGF in cysts and DRG (0.02 < P < 0.0002). Ultramicronized palmitoylethanolamide significantly reduces VVH from ENDO+STONE, probably by modulating MC expression/activity in cysts, thus reducing central sensitization due to noxious signals from endometriotic lesions. The results suggest potential utility of the compound for VVH in clinics.

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Research Gaps on Practice Guidelines for Acute Postoperative Pain Management in Adults: Findings from a Review of the Evidence for an American Pain Society Clinical Practice Guideline

Acute postoperative pain is a common clinical condition that when poorly controlled can result in a number of significant negative consequences. The American Pain Society (APS) commissioned an evidence-based guideline on the management of postoperative pain in in order to promote evidence-based, safe and effective perioperative pain management. An interdisciplinary panel developed 31 key questions and inclusion criteria to guide the evidence review. Investigators reviewed 6,556 abstracts from multiple electronic databases up to November 2012, an updated evidence review to October 2014 and key references suggested by expert reviewers.

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Sciatic endometriosis induces mechanical hypersensitivity, segmental nerve damage, and robust local inflammation in rats

Abstract

Background

Endometriosis is a common cause of pain including radicular pain. Ectopic endometrial tissue may directly affect peripheral nerves including the sciatic, which has not been modelled in animals.

Methods

We developed a rat model for sciatic endometriosis by grafting a piece of autologous uterine tissue around the sciatic nerve. Control animals underwent a similar surgery but received a graft of pelvic fat tissue.

Results

The uterine grafts survived and developed fluid-filled cysts; the adjacent nerve showed signs of swelling and damage. Mechanical and cold hypersensitivity and allodynia of the ipsilateral hindpaw developed gradually over the first 2 weeks after the surgery, peaked at 2–5 weeks, and was almost resolved by 7 weeks. Control animals showed only minor changes in these pain behaviours. Histological signs of inflammation in the uterine graft and in the adjacent nerve were observed at 3 weeks but were resolving by 7 weeks. In vivo fibre recording showed increased spontaneous activity, especially of C-fibres, in sciatic nerve proximal to the uterine graft. Several pro-inflammatory cytokines including interluekin-18, VEGF, fractalkine, and MIP-1α, were elevated in the uterine graft plus sciatic nerve samples, compared to samples from normal nerve or nerve plus fat graft. Growth associated protein 43 (GAP43), a marker of regenerating nerve fibres, was observed in the adjacent sciatic nerve as well as in the uterine graft.

Conclusions

This model shared many features with other rat models of endometriosis, but also had some unique features more closely related to neuropathic pain models.

What does this study/review add

Some especially painful forms of endometriosis are essentially neuropathic, because peripheral nerves are directly affected by nearby ectopic endometrial tissue. We modelled endometriosis by implanting autologous uterine tissue around rat sciatic nerve. We observed mechanical and cold pain behaviours along with signs of inflammation and nerve damage and increased pro-inflammatory cytokines at the implant site. Pain behaviours correlated with signs of nerve inflammation and damage rather than with cyst survival.

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Between the devil and the deep blue sea: avoidance-avoidance competition increases pain-related fear and slows down decision-making

Successful adjustment to dynamic environments requires the simultaneous pursuit of multiple goals. However, the pursuit of multiple goals may bring about goal conflict. Despite evidence indicating that goal conflict can have a detrimental effect on subjective well-being, little is known about the effects of goal competition in the context of pain. This experiment investigated whether different types of goal competition increase pain-related fear and slow down pain-related decision-making. Forty-six participants completed a cross-directional movement task in which they learned to associate movements in one direction (e.g.

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Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy

Sensorimotor Peripheral Nerve Function and the Longitudinal Relationship With Endurance Walking in the Health, Aging and Body Composition Study

Imaging and Clinical Characteristics Predict Near-Term Disablement From Bone Metastases: Implications for Rehabilitation

Quantification of Myofascial Taut Bands

Association of Shoulder Problems in Persons With Spinal Cord Injury at Discharge From Inpatient Rehabilitation With Activities and Participation 5 Years Later

Measuring Patients' Experience of Rehabilitation Services Across the Care Continuum. Part II: Key Dimensions

A systematic literature review of PTSD's latent structure in the diagnostic and statistical manual of mental disorders: DSM-IV to DSM-5

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Foot Care in the Management of Juvenile Idiopathic Arthritis

Experimental pain impairs recognition memory irrespective of pain predictability

Abstract

Background

Pain is hardwired to signal threat and tissue damage and therefore automatically attracts attention to initiate withdrawal or defensive behaviour. This well-known interruptive function of pain interferes with cognitive functioning and is modulated by bottom-up and top-down variables. Here, we applied predictable or unpredictable painful heat stimuli simultaneously to the presentation of neutral images to investigate (I) whether the predictability of pain modulated its effect on the encoding of images (episodic memory) and (II) whether subjects remember that certain images have been previously presented with pain (source memory).

Methods

Twenty-four healthy subjects performed a categorization task in which 80 images had to be categorized into living or non-living objects. We compared the processing and encoding of these images during cued and non-cued pain trials as well as cued and non-cued pain-free trials. Effects on recognition performance and source memory for pain were immediately tested using a surprise recognition task.

Results

Painful thermal stimulation impaired recognition accuracy (d′, recollection, familiarity). This negative effect of pain was positively correlated with the individual expectation of pain interference and the attentional avoidance of pain-related words. However, the interruptive effect of pain was not modulated by the predictability of pain. Source memory for painful stimulation was at chance level, indicating that subjects did not explicitly remember that images had been paired with pain.

Conclusions

Targeting negative expectations and a maladaptive attentional bias for pain-related material might help reducing frequently reported pain-induced cognitive impairments.

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Combined non-pharmacological interventions for newborn pain relief in two degrees of pain procedures: A randomized clinical trial

Abstract

Background

Non-pharmacological interventions are effective neonatal pain reduction strategies. We aimed to study the effects of non-nutritive sucking (NNS) and swaddling on infants' behavioural and physiological parameters during shallow or deep heel stick procedures.

Method

In this prospective, multi-centred, randomized controlled clinical trial, we enrolled 671 newborns. The infants undergoing shallow or deep heel stick procedures were randomized into four groups: oral sucrose (routine care, group S), oral sucrose combined with NNS (group NS), oral sucrose combined with swaddling (group SS) and oral sucrose combined with NNS and swaddling (group NSS). The behavioural responses were evaluated by the Revised Neonatal Facial Coding System and the physiological signals were monitored by electrocardiogram monitors.

Results

A significant synergistic analgesic effect was observed between the NS and SS groups in both the shallow (F = 5.952, p = 0.015) and deep heel stick (F = 7.452, p = 0.007) procedure. NSS group exhibited the lowest pain score. For the deep heel stick procedure, the NS group had a significantly lower increase in heart rate (HR)% and decrease in SPO₂% than the S group (F = 17.540, p = 0.000, F = 10.472, p = 0.001), while this difference was not observed in the shallow heel stick procedure. No difference was found between the S and SS groups, in terms of different physiological parameters.

Conclusion

Non-nutritive sucking and swaddling had synergistic effects on pain relief when used with oral sucrose. For the deep heel stick procedure, oral sucrose combined with NNS and swaddling provided the best pain relief effect. For the shallow heel stick procedure, addition of NNS and swaddling did not improve the effects.

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Dynamic weight bearing as a non-reflexive method for the measurement of abdominal pain in mice

Abstract

Background

Chronic pelvic pain (CPP) is a high burden for patients and society. It affects 15–24% of women in reproductive age and is an area of high unmet medical need. CPP can be caused by a wide range of visceral diseases such as abdominal infections, gastrointestinal or gynaecological diseases like endometriosis. Despite the high medical need for this condition, pharmacological approaches are hampered by the limited number of available methods for the behavioural evaluation of pain in inflammation-driven animal models of pelvic pain.

Methods

The dynamic weight bearing (DWB) system was used for the evaluation of spontaneous behaviour changes in the zymosan-induced peritonitis mouse model. Inflammatory mediator levels were evaluated in peritoneal lavage and their correlation with the behavioural endpoints was assessed. We evaluated the effect on behavioural endpoints of the selective cyclooxygenase-2 (COX-2) inhibitor celecoxib and the Na_v1.8 blocker A-803467.

Results

The presence of a relief posture, characterized by a significantly increased weight distribution towards the front paws, was observed following intraperitoneal injection of zymosan. A positive correlation was detected between PGE2 levels in the peritoneal lavage and DWB endpoints. In addition, zymosan-induced weight bearing changes were reverted by celecoxib and A-803467.

Conclusions

This study described for the first time the use of DWB as a non-subjective and non-reflexive method for the evaluation of inflammatory-driven abdominal pain in a mouse model.

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The in vitro mechanisms and in vivo efficacy of intravenous lidocaine on the neuroinflammatory response in acute and chronic pain

Abstract

Introduction

The neuroinflammatory response plays a key role in several pain syndromes. Intravenous (iv) lidocaine is beneficial in acute and chronic pain. This review delineates the current literature concerning in vitro mechanisms and in vivo efficacy of iv lidocaine on the neuroinflammatory response in acute and chronic pain.

Databases and data treatment

We searched PUBMED and the Cochrane Library for in vitro and in vivo studies from July 1975 to August 2014. In vitro articles providing an explanation for the mechanisms of action of lidocaine on the neuroinflammatory response in pain were included. Animal or clinical studies were included concerning iv lidocaine for acute or chronic pain or during inflammation.

Results

Eighty-eight articles regarding iv lidocaine were included: 36 in vitro studies evaluating the effect on ion channels and receptors; 31 animal studies concerning acute and chronic pain and inflammatory models; 21 clinical studies concerning acute and chronic pain.

Low-dose lidocaine inhibits in vitro voltage-gated sodium channels, the glycinergic system, some potassium channels and Gαq-coupled protein receptors. Higher lidocaine concentrations block potassium and calcium channels, and NMDA receptors. Animal studies demonstrate lidocaine to have analgesic effects in acute and neuropathic pain syndromes and anti-inflammatory effects early in the inflammatory response. Clinical studies demonstrate lidocaine to have advantage in abdominal surgery and in some neuropathic pain syndromes.

Conclusions

Intravenous lidocaine has analgesic, anti-inflammatory and antihyperalgesic properties mediated by an inhibitory effect on ion channels and receptors. It attenuates the neuroinflammatory response in perioperative pain and chronic neuropathic pain.

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Processes of change in Acceptance and Commitment Therapy and Applied Relaxation for long-standing pain

Abstract

Background

The utility of cognitive behavioural (CB) interventions for chronic pain has been supported in numerous studies. This includes Acceptance and Commitment Therapy (ACT), which has gained increased empirical support. Previous research suggests that improvements in pain catastrophizing and psychological inflexibility are related to improvements in treatment outcome in this type of treatment. Although a few studies have evaluated processes of change in CB-interventions, there is a particular need for mediation analyses that use multiple assessments to model change in mediators and outcome over time, and that incorporate the specified timeline between mediator and outcome in the data analytic model.

Methods

This study used session-to-session assessments to evaluate if psychological inflexibility, catastrophizing, and pain intensity mediated the effects of treatment on pain interference. Analyses were based on data from a previously conducted randomized controlled trial (n = 60) evaluating the efficacy of ACT and Applied Relaxation (AR). A moderated mediation model based on linear mixed models was used to analyse the data.

Results

Neither catastrophizing nor pain intensity mediated changes in pain interference for any of the treatments. In contrast, psychological inflexibility mediated effects on outcome in ACT but not in AR.

Conclusions

Results add to previous findings illustrating the role of psychological inflexibility as a mediator in ACT.

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Effectiveness of ultrasound-guided vs fluoroscopy (FS) or computed tomography (CT) scanning guidance lumbar facet joint injections in adults with facet joint syndrome – A meta-analysis of controlled trails

Efficacy of the Opioid Compliance Checklist to Monitor Chronic Pain Patients on Opioid Therapy in Primary Care

The Opioid Compliance Checklist (OCC) is a self-report measure for chronic pain patients prescribed long-term opioid therapy. The original measure includes yes/no items that reflect the content of a typical opioid therapy agreement. The aim of the study was to assess the efficacy of the OCC for monitoring opioid adherence among chronic noncancer pain patients within primary care. One hundred seventy seven (N=177) chronic pain patients were recruited as part of a larger study from 8 primary care centers.

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A Correlative Relationship between Chronic Pain and Insulin Resistance in Zucker Fatty Rats: Role of Downregulation of Insulin Receptors

Epidemiological studies and meta-analyses report a strong relationship between chronic pain and abnormalities in glucose metabolism, but the exact relationship between chronic pain and insulin resistance in type-2-diabetes (T2D) remains unknown. Using a model of neuropathic thermal and tactile hypersensitivity induced by chronic constriction sciatic nerve injury (CCI) in Zucker diabetic fatty (ZDF) and Zucker lean (ZL) littermates, we compared the recovery period of hypersensitivity and the progression of T2D and studied the possible involvement of insulin receptors (IR) in the comorbidity of these two conditions.

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The role of prefrontal inhibition in regulating facial expressions of pain: a rTMS study

Although research on facial expressions of pain has a long history, little is known about the cerebral mechanisms regulating these expressions. It has been suggested that the medial prefrontal cortex (mPFC) might be involved in regulating/inhibiting the degree to which pain is facially displayed. To test whether such a prefrontal regulation does indeed take place, we reduced medial prefrontal excitability via repetitive transcranial magnetic stimulation (rTMS) and assessed its effect on facial expressions.

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Australian court orders Nurofen’s specific pain range off the shelves

Reckitt Benckiser (RB), the health and hygiene multinational, has been ordered to recall from Australian stockists a suite of ibuprofen products that claim to relieve specific types of pain after a...

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School-based programs to reduce and prevent substance use in different age groups: What works for whom? Systematic review and meta-regression analysis.

Comparison of the Effectiveness of Suprascapular Nerve Block with Physical Therapy, Placebo, and Intra-articular Injection in Management of Chronic Shoulder Pain- a Meta-analysis of Randomized Controlled Trials

Central sensitization and neuropathic features of ongoing pain in a rat model of advanced osteoarthritis

Osteoarthritis (OA) pain is most commonly characterized by movement-triggered joint pain. However, in advanced disease, OA pain becomes persistent, ongoing and resistant to treatment with NSAIDs. The mechanisms underlying ongoing pain in advanced OA are poorly understood. We recently showed that intra-articular (i.a.) injection of monosodium iodoacetate (MIA) into the rat knee joint produces concentration-dependent outcomes. Thus, a low dose of i.a. MIA produces NSAID-sensitive weight asymmetry without evidence of ongoing pain while a high i.a.

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Lumbar Total Disc Replacement for Discogenic Low Back Pain: Two-year Outcomes of the activL Multicenter Randomized Controlled IDE Clinical Trial

Study Design. A prospective, multicenter, randomized, controlled, investigational device exemption (IDE) noninferiority trial. Objective. The aim of this study was to evaluate the comparative safety and effectiveness of lumbar total disc replacement (TDR) in the treatment of patients with symptomatic degenerative disc disease (DDD) who are unresponsive to nonsurgical therapy. Summary of Background Data. Lumbar TDR has been used to alleviate discogenic pain and dysfunction while preserving segmental range of motion and restoring stability. There is a paucity of data available regarding the comparative performance of lumbar TDR. Methods. Patients presenting with symptomatic single-level lumbar DDD who failed at least 6 months of nonsurgical management were randomly allocated (2:1) to treatment with an investigational TDR device (activL®, n = 218) or FDA-approved control TDR devices (ProDisc-L or Charité, n = 106). The hypothesis of this study was that a composite effectiveness outcome at 2 years in patients treated with activL would be noninferior (15% delta) to that in controls. Results. The primary composite endpoint of this study was met, which demonstrated that the activL TDR was noninferior to control TDR (P < 0.001). A protocol-defined analysis of the primary composite endpoint also confirmed that activL was superior to controls (P = 0.02). Radiographic success was higher with activL versus controls (59% vs. 43%; P < 0.01). Mean back pain severity improved by 74% with activL and 68% with controls. Oswestry Disability Index scores decreased by 67% and 61% with activL and controls, respectively. Patient satisfaction with treatment was over 90% in both groups at 2 years. Return to work was approximately 1 month shorter (P = 0.08) with activL versus controls. The rate of device-related serious adverse events was lower in patients treated with activL versus controls (12% vs. 19%; P = 0.13). Surgical reintervention rates at the index level were comparable (activL 2.3%, control 1.9%). Conclusion. The single-level activL TDR is safe and effective for the treatment of symptomatic lumbar DDD through 2 years. Level of Evidence: 2

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Sympathectomy and Sympathetic Blockade Reduce Pain Behavior Via Alpha-2 Adrenoceptor of the Dorsal Root Ganglion Neurons in a Lumbar Radiculopathy Model

Study Design. Animal experimental study with intervention. Objective. We investigated whether sympathectomy and pharmacological sympathetic blockade reduced pain behavior and reversed adrenoceptor mRNA expression of the dorsal root ganglion (DRG) in a lumbar radiculopathy model. Summary of Background Data. The abnormal sympathetic-somatosensory interaction may underlie some forms of neuropathic pain. There are several reports that sympathectomy and pharmacological sympathetic blockades are often effective to treat neuropathic pain. However, its pathophysiological mechanisms remain obscure. Methods. We used 91 male Sprague-Dawley rats. Just after root constriction (RC), the rats underwent sympathectomy or received 3 local injections of subtype-specific α-adrenergic receptor antagonists around the DRG. We evaluated the analgesic effects of sympathectomy and sympathetic blockade using behaviors indicative mechanical allodynia and thermal hyperalgesia. We estimated the mRNA expression levels of the DRG adrenoceptor subtypes using real time reverse transcription polymerase chain reaction. Results. Sympathectomy and α2-antagonist significantly reduced the mechanical allodynia and thermal hyperalgesia after RC. Real time reverse transcription polymerase chain reaction analysis indicated that sympathectomy possibly reversed α2A- and α2B-adrenoceptors mRNA overexpression in the DRG after RC. Conclusion. We considered that pain behaviors of neuropathic pain are due, at least in part, to enhanced sympathetic noradrenergic transmission within the DRG. Suppression of sympathetic activity by reducing adrenergic release, α2-adrenoceptor stimulation, and/or α2-adrenoceptor upregulation in the DRG may relieve neuropathic pain. Level of Evidence: 3

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Impact of Axial Neck Pain on Quality of Life After Laminoplasty

Study Design. A prospective study. Objective. The aim of this study was to elucidate the impact of axial pain following cervical laminoplasty on health-related quality of life (HRQOL). Summary of Background Data. Axial neck pain is a frequently encountered complication after laminoplasty. However, limited information is available regarding the time-dependent changes in axial pain and the impact of this pain on clinical outcomes, including HRQOL. Methods. One hundred sixty-two consecutive patients with cervical myelopathy underwent double-door laminoplasty using hydroxyapatite spacers from 2008 to 2012. The outcome measures included the Japanese Orthopaedic Association score (JOA score), the EuroQol 5 Dimension Questionnaire (EQ-5D), and the Short Form-36 survey (SF-36). The intensity of axial pain was assessed using an 11-point numerical rating scale (NRS). These assessments were conducted preoperatively and at 6-month, 1-year, and 2-year follow-ups. Patient satisfaction with outcome was graded using a 7-point NRS at the 2-year follow-up. Result. One hundred twenty-one patients completed the 2-year follow-up. The mean axial pain intensity decreased slightly over time; however, the decrease was not significant. The JOA score, EQ-5D score, and all SF-36 domains, excluding general health perceptions, improved significantly compared with baseline levels at the 6-month follow-up or later. Baseline axial pain intensity showed a significant negative correlation with baseline HRQOL only in the SF-36 bodily pain domain. In contrast, axial pain intensity showed significant negative correlations with all HRQOL measures at the 6-month follow-up. At the 2-year follow-up, patients with an axial pain intensity ≥3 showed significantly worse outcomes than did patients with a pain intensity <3 in the EQ-5D score, SF-36 score, and patient satisfaction grades, but not in the JOA score. Conclusion. Axial neck pain has a significant negative impact on clinical outcomes, including a wide range of HRQOL measures and patient satisfaction with outcome, in patients undergoing conventional double-door laminoplasty. Level of Evidence: 3

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Postoperative Perfection: Ceiling Effects and Lack of Discrimination With Both SRS-22 and -24 Outcomes Instruments in Patients With Adolescent Idiopathic Scoliosis

Study Design. Review of a prospective database registry. Objective. To compare the Scoliosis Research Society (SRS)-22 and SRS-24 outcomes instruments in terms of scores, rate of ceiling effects, and discriminant ability in patients with pre- and postoperative adolescent idiopathic scoliosis. Summary of Background Data. Despite improvements noted with the SRS-22, the SRS-24 is still occasionally used prospectively and for comparisons with previous studies reporting SRS-24 scores. Previous work has demonstrated that postoperative scores from the 2 versions are not interchangeable. Methods. A multicenter prospective registry of patients who underwent surgical correction of adolescent idiopathic scoliosis was queried for preoperative and 2-year postoperative SRS-22 and SRS-24 scores. Scores were compared between versions and ceiling effects were identified. Groups of deformity severity were created to evaluate discriminant ability. Results. 829 patients were identified. The SRS-22 scores for pain and general function were significantly greater than SRS-24 scores (P < 0.001), whereas the SRS-22 scores were significantly lower than the SRS-24 for self-image (P < 0.001). Preoperative ceiling effect was only noted in 1 domain each. Both versions were able to discriminate between large (80°+) and small (<45°) preoperative curves in all domains and total scores (P < 0.05). Postoperatively, the SRS-22 scores for all shared domains and total score were significantly greater than SRS-24 scores (P < 0.001). Ceiling effects in 5 of 5 domain scores were noted postoperatively for SRS-22 and in 4 of 7 for SRS-24. With a smaller range of deformity postoperatively, only the SRS-22 self-image domain was able to discriminate between large (29°+) and small (≤11°) residual curves (P < 0.05). Conclusion. Scores obtained by the SRS-22 and the SRS-24 are not translatable despite shared domains. Whereas both versions demonstrated preoperative discriminant ability, postoperative discrimination of residual deformity is lacking in both. Patient-reported outcomes of treatment are crucial in advancing treatment, and improvement in the ability to assess subjective outcomes is essential. Level of Evidence: 3

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Physical Activity Might Be of Greater Importance for Good Spinal Control Than If You Have Had Pain or Not: A Longitudinal Study

Study Design. Longitudinal design. A cohort followed in 3 waves of data collection. Objective. The aim of the study was to describe the relationships between the performance of 2 tests of spinal control at the age of 52 years and low back pain, physical activity level, and fitness earlier in life, as well as to describe the cross-sectional relationships between these measures. Summary of Background Data. Altered spinal control has been linked to pain; however, other stimuli may also lead to inability to control the movements of the spine. Methods. Participants answered questions about physical activity and low back pain, and performed physical fitness tests at the age of 16, 34, and 52 years. The fitness test battery included tests of endurance in the back and abdominal muscles, a submaximal bicycle ergometer test to estimate maximal oxygen uptake, and measurements of hip flexion, thoracic spine flexibility, and anthropometrics. Two tests were aggregated to a physical fitness index. At the age of 52, also 2 tests of spinal control, the standing Waiter's bow (WB) and the supine double leg lower (LL) were performed. Results. Logistic regression analyses showed that higher back muscle endurance at the age of 34 years could positively predict WB performance at 52 years and higher physical fitness at the age of 34 could positively predict LL performance at 52 years. Regarding cross-sectional relationships, an inability to perform the WB correctly was associated with lower physical fitness, flexibility and physical activity, and larger waist circumference. An inability to correctly perform the LL was associated with lower physical fitness. One-year prevalence of pain was not significantly associated with WB or LL test performance. Conclusion. An active life resulting in higher physical fitness is related to better spinal control in middle-aged men and women. This further strengthens the importance of physical activity throughout the life span. Level of Evidence: 3

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Do Patient Demographics and Patient-Reported Outcomes Predict 12-Month Loss to Follow-Up After Spine Surgery?

Study Design. Analysis of patients in a prospective registry. Objective. To determine the association between patient demographics, outcomes, and loss to follow-up 12 months after spine surgery. Summary of Background Data. Obtaining outcomes 12 months after spine surgery remains a challenge. Loss to follow-up is believed to introduce biases and portend poor outcomes. Associations between follow-up, patient demographics, and outcomes in the degenerative spine population have not been studied. Methods. Patients undergoing surgery for degenerative spine disease at a single institution over a 2-year period were enrolled in a prospective registry. Patient demographics, comorbidities, treatment variables, readmissions/reoperations, and all 90-day surgical morbidity were collected. Patient-reported outcomes were recorded at baseline, 3-months, and 12-months after surgery. Multivariate logistic regression analysis was done to identify predictors of loss to follow-up. Results. A total of 1484 patients with baseline and 3-month outcomes were included. Two hundred thirty-three (15.7%) patients were lost to follow-up at 12 months. There was no difference in the baseline demographics (Sex: P = 0.46) and comorbidities (American Society of Anesthesiologists Grade: P = 0.06) of patients who had follow-up at 12-months versus those who did not, except age and employment status. Patients lost to follow-up at 12 months were younger (51.0 vs. 57.1 years; P < 0.001) and a higher proportion were employed preoperatively (45.9% vs. 41.7%, P = 0.24). Preoperative pain, disability, and quality of life was similar between the two groups (P > 0.05). There was no difference in 90-day morbidity (17.2% vs. 16.2%; P = 0.70) and 3-month pain, disability, quality of life, and patient satisfaction (85.0% vs. 88.3%; P = 0.63) (P > 0.05). In multivariate model, only younger age (P < 0.001) was an independent predictor of loss to follow-up at 12 months. Conclusion. In our prospective spine registry the 12-month loss to follow-up rate is approximately 15%. The only independent predictor of loss to follow-up is younger age and preoperative employment. Level of Evidence: 3

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Sequestrectomy Versus Conventional Microdiscectomy for the Treatment of a Lumbar Disc Herniation: A Systematic Review

Study Design. A systematic review. Objective. The aim of this study was to compare the effects of sequestrectomy versus conventional microdiscectomy for lumbar disc herniation (LDH). Summary of Background Data. Open surgery for LDH can be performed by sequestrectomy (removal of disc fragments) or conventional discectomy (removal of disc fragments and disc). Sequestrectomy might be associated with a higher risk of recurrence but less low back pain (LBP) after surgery. Methods. We searched MEDLINE and EMBASE from 1980 to November 2014. We selected randomized controlled trials (RCTs) and nonrandomized prospective studies of conventional discectomy versus sequestrectomy for adult patients with LDH that evaluated the following primary outcomes: radicular pain or LBP as measured by a visual analog scale, or neurological deficits of the lower extremity. We also evaluated the following secondary outcomes: complications of surgery, reherniation rate, duration of hospital stay, postoperative analgesic use, and health-related quality-of-life measures. Two authors independently reviewed citations and articles for inclusion. We assessed the risk of bias, synthesized data, and the level evidence using standard methodological procedures as recommended by the Cochrane Back Review Group. Results. We identified 5 studies (746 participants) of sequestrectomy versus microdiscectomy. One study was RCT and the other 4 were nonrandomized prospective comparisons; all studies were assessed as being at a high risk of bias. There were no significant differences for leg pain, LBP, functional outcomes, complications, and hospital stay or recurrence rate for 2 years (level of evidence: Low). Sequestrectomy was associated with less analgesic consumption versus discectomy (level of evidence: Very low). Conclusion. Sequestrectomy and standard microdiscectomy were associated with similar effects on pain after surgery, recurrence rate, functional outcome, and complications; more evidence is needed to determine whether sequestrectomy is associated with less postoperative analgesic consumption. Level of Evidence: 2

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Electrochemotherapy to Metastatic Spinal Melanoma: A Novel Treatment of Spinal Metastasis?

Study Design. Preliminary report of new antitumor treatment. Objective. To evaluate the effectiveness of electrochemotherapy as a novel treatment of spinal metastasis. Summary of Background Data. Electrochemotherapy is a new antitumor treatment that combines systemic bleomycin with electric pulses delivered locally at the tumor site. These electric pulses permeabilize cell membranes in the tissue, allow bleomycin delivery diffusion inside the cells, and increase bleomycin cytotoxicity. Previous clinical studies have demonstrated the effectiveness of electrochemotherapy in the treatment of several primary and metastatic solid tumors. Methods. Treatment planning for electrode positioning and electrical pulse parameters was prepared for 4 needle electrodes. Mini-open surgery with a left L5 laminectomy was performed to introduce the eletrodes. The patient was treated according to the established Electrochemotherapy Protocol with Bleomycin. Clinical efficacy of electrochemotherapy was evaluated according to a visual analog scale of pain, Oswestry Disability Index 2.0, the Karnofsky Performance Scale, and Response Evaluation Criteria in Solid Tumors. Results. The assessed follow-up period was 48 months after the electrochemotherapy procedure. Neither serious electrochemotherapy-related adverse events, nor bleomycin toxicity were reported. Overall improvement in pain according to Oswestry Disability Index 2.0 and Karnofsky Performance Scale outcomes was better. Conclusion. Our case represents, to our knowledge, the first one to test the potential role of electrochemotherapy as treatment of spinal metastasis. Electrochemotherapy allowed a successful treatment of metastatic spinal melanoma. However, we believe that there is a strong scientific rationale to support the potential utility of electrochemotherapy as a novel treatment of spinal metastasis, regardless of the histological types. Level of Evidence: 5

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A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics

Does muscle morphology change in chronic neck pain patients? – A systematic review

Neck pain is a common disabling worldwide health problem with a high socio-economic burden. Changes underlying the transition to, or the maintenance of a chronic state are still barely understood. Increasing evidence suggests that morphological muscle changes, including changes in cross-sectional area (CSA) or fatty infiltration, play a role in chronic neck pain. However, a structured overview of the current evidence of morphological changes is lacking.

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Providing services for acute low-back pain: a survey of Australian physiotherapists

To determine whether physiotherapists avoid lumbar x-rays for acute non-specific low back pain and advise people to stay active.

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Pioglitazone inhibits the development of hyperalgesia and sensitization of spinal nociresponsive neurons in type 2 diabetes

Thiazolidinedione drugs (TZDs) such as pioglitazone are FDA-approved for the treatment of insulin resistance in type 2 diabetes. However, whether TZDs reduce painful diabetic neuropathy (PDN) remains unknown. Therefore we tested the hypothesis that chronic administration of pioglitazone would reduce PDN in Zucker Diabetic Fatty (ZDFfa/fa) rats. Compared to Zucker Lean (ZLfa/+) controls, ZDF developed: (1) elevated blood glucose, HbA1c, methylglyoxal and insulin; (2) mechanical and thermal hyperalgesia at the hindpaw; (3) increased avoidance of noxious mechanical probes in a mechanical conflict avoidance behavioral assay, the first report of a measure of affective-motivational pain-like behavior in ZDF; and (4) exaggerated lumbar dorsal horn immunohistochemical expression of pressure-evoked phosphorylated extracellular signal-regulated kinase (pERK).

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The Aetiological and Psychopathological Validity of Borderline Personality Disorder in Youth: A Systematic Review and Meta-analysis

Altered nociception and morphine tolerance in neuropeptide FF receptor type 2 over-expressing mice

Abstract

Background

The neuropeptide FF system is thought to act as an anti-opioid modulator and plays a role in nociception, morphine antinociception and dependence. Two receptor subtypes, NPFFR1 and NPFFR2, have been identified, but their respective roles in these processes remain uncertain.

Methods

In the present study, the role of NPFFR2 was investigated using transgenic mice over-expressing NPFFR2 in addition to a NPFFR2 agonist AC-263093.

Results

NPFFR2 Tg mice exhibited increased sensitivity to both mechanical and thermal noxious stimuli compared to the WT mice, while the antinociceptive effects of morphine at three different doses (6.25, 12.5 and 25 mg/kg, s.c.) were similar in both strains. The development of tolerance to morphine antinociception after chronic morphine treatment (12.5 mg/kg, s.c.; twice daily × 5 days) was attenuated in NPFFR2 Tg mice when compared to WT mice. Similarly, WT mice receiving AC-263093 pretreatment (2.5 mg/kg, i.p.) showed attenuated morphine tolerance compared to vehicle controls. Most naloxone-precipitated morphine withdrawal symptoms were not attenuated in NPFFR2 Tg mice, with the exception of wet dog shake that was significantly reduced. Both NPFFR2 Tg and WT mice displayed similar degree of morphine rewarding.

Conclusions

Our results suggest that neuropeptide FF R2 is mainly involved in the modulation of nociception and tolerance to morphine antinociception.

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Some words hurt more than others: Semantic activation of pain concepts in memory and subsequent experiences of pain

Consistent with current theories of memory and pain, we found that high, relative to low activation of pain concepts in memory increased both psychological and physiological responses to laser-induced pain. The effect remained regardless of whether participants demonstrated conscious awareness of activation. Theoretical and clinical implications are discussed.

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Withdrawal symptoms in internet gaming disorder: A systematic review

Neuropsychological deficits in BPD patients and the moderator effects of co-occurring mental disorders: A meta-analysis

A man with a murmur and missing heart

An 81 year old man presented with increased lethargy over several months and progressive dyspnoea on exertion. He had no orthopnoea, paroxysmal nocturnal dyspnoea, chest pain, palpitations, or...

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The role of family interventions in bipolar disorder: a systematic review

[In Depth] DNA helps build molecular libraries for drug testing

In the painstaking work of synthesizing vast numbers of compounds and identifying those that are the best candidate drugs, researchers have cultivated a capable new lab assistant: DNA. At a meeting last month just outside Boston, chemists and biologists discussed the promise of DNA-encoded chemical libraries (DELs), which rely on the unique talents of DNA to track, select, and even synthesize compounds that bind to enzymes, receptors, and other biological targets. The technology is allowing basic scientists and small companies to generate impressive libraries of molecules, on a scale once reserved for big pharma, and select from them the most useful compounds. Faster, cheaper, and more versatile than traditional screening methods, DELs are a potential game-changer for academics who want to probe the workings of biological molecules, and they have already yielded drug candidates entering clinical trials. Author: Trisha Gura

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Hip pain and radiographic signs of osteoarthritis

Hip pain is common, particularly among adults older than 50 years, and intuitively linked to osteoarthritis. Osteoarthritis refers to a heterogeneous group of joint disorders characterised by...

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Size and viewpoint of an embodied virtual body impact the processing of painful stimuli

Looking at one’s own body may induce visual analgesia. However, the cognitive and physiological mechanisms underlying such visual analgesia are unknown. As body and pain representations in the brain are multisensory, and have been reported to be partially overlapping, we here investigated whether experimentally-induced changes in bodily self-consciousness (BSC) modulate pain. We measured physiological responses to pain (Skin Conductance Response – SCR) and the subjective experience of pain, under conditions of manipulated BSC.

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Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review

Attention-deficit/hyperactivity disorder (ADHD) and overweight/obesity: New data and meta-analysis

Editorial Board

Long-term effects of prevention and treatment on youth antisocial behavior: A meta-analysis

Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study

Study question Is there concordance between hip pain and radiographic hip osteoarthritis?Methods In this diagnostic test study, pelvic radiographs were assessed for hip osteoarthritis in two cohorts:...

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