Reliability and Validity of the Measurement of Scapular Position Using the Protractor Method

Translating Genomic Advances to Physical Therapist Practice: A Closer Look at the Nature and Nurture of Common Diseases

The Human Genome Project and the International HapMap Project have yielded new understanding of the influence of the human genome on health and disease, advancing health care in significant ways. In personalized medicine, genetic factors are used to identify disease risk and tailor preventive and therapeutic regimens. Insight into the genetic bases of cellular processes is revealing the causes of disease and effects of exercise. Many diseases known to have a major lifestyle contribution are highly influenced by common genetic variants. Genetic variants are associated with increased risk for common diseases such as cardiovascular disease and osteoarthritis. Exercise response also is influenced by genetic factors. Knowledge of genetic factors can help clinicians better understand interindividual differences in disease presentation, pain experience, and exercise response. Family health history is an important genetic tool and encourages clinicians to consider the wider client-family unit. Clinicians in this new era need to be prepared to guide patients and their families on a variety of genomics-related concerns, including genetic testing and other ethical, legal, or social issues. Thus, it is essential that clinicians reconsider the role of genetics in the preservation of wellness and risk for disease to identify ways to best optimize fitness, health, or recovery. Clinicians with knowledge of the influence of genetic variants on health and disease will be uniquely positioned to institute individualized lifestyle interventions, thereby fulfilling roles in prevention and wellness. This article describes how discoveries in genomics are rapidly evolving the understanding of health and disease by highlighting 2 conditions: cardiovascular disease and osteoarthritis. Genetic factors related to exercise effects also are considered.

from Physical Therapy current issue http://ift.tt/1pPu8ir
via IFTTT

Diagnostic utility of patient history and physical examination data to detect spondylolysis and spondylolisthesis in athletes with low back pain: A systematic review

In adolescent athletes, low back pain has a 1-year prevalence of 57% and causes include spondylolysis and spondylolisthesis. An accurate diagnosis enables healing, prevention of progression and return to sport.

from Manual Therapy http://ift.tt/1ROlp9P
via IFTTT

[Perspective] A brain conditioned for social defeat

Aggression is common in the animal kingdom, even though agonistic behaviors can lead to chronic stress or pain. So how does aggression remain conserved evolutionarily? In 1859, Darwin argued in his book On the Origin of Species that the conservation of any behavioral trait is ultimately explained by its necessity for survival and reproduction. To survive with limited resources, individuals express aggressive behaviors against competitors to pass on their genes. For social animals, dominance hierarchies establish rapidly (1), avoiding the cost of recurrent fighting within the group. Hierarchy formation and maintenance rely on the effect of prior experience (2). However, the underlying mechanisms and neural circuitry remain elusive. On page 87 of issue, Chou et al. (3) identify a key role for the dorsal habenula (dHb) region of the brain in zebrafish to determine who wins and who loses in a fight. This region is highly conserved across vertebrates, raising the possibility of manipulating neuronal circuits that govern innate social behaviors. Authors: Laura Desban, Claire Wyart

from Science: Current Issue http://ift.tt/1RNpI5p
via IFTTT

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

Abstract

Background

The objective was to compare the effect of total knee replacement (TKR) followed by a 3-month non-surgical treatment with the non-surgical treatment alone in reducing pain sensitization and other pain-related measures in patients with knee osteoarthritis.

Methods

One hundred patients were randomized to (1) TKR followed by a non-surgical treatment of neuromuscular exercise, education, diet, insoles and pain medication or (2) the non-surgical treatment alone. Outcomes assessed at baseline and after 3 months were as follows: (1) pain sensitization assessed as pressure-pain thresholds (PPTs) at the knee (localized sensitization) and the lower leg (spreading sensitization), (2) peak pain intensity during the previous 24 h, (3) pain intensity after 30 min of walking, (4) pain location and pattern, (5) spreading of pain on a region-divided body chart and (6) the usage of pain medication.

Results

There was a statistical significant mean difference (95% CI) in change in PPTs from baseline to 3 months between groups in the crude analysis of 71 kPa (21–121) and of 75 kPa (33–117) when adjusting for baseline PPT, age, gender and body mass index, favouring the group having TKR. There were no significant between-group differences in change in the pain-related measures from baseline to 3 months (p = 0.15–0.27). Both groups improved in most of the pain-related measures (p < 0.05).

Conclusions

At 3 months, TKR followed by non-surgical treatment is more effective in reducing localized and spreading pain sensitization than non-surgical treatment alone. Both treatments are equally efficacious in reducing the pain-related measures of this study.

What does this study add?

• Knee replacement followed by non-surgical treatment is more effective in reducing pain sensitization, but not other pain-related measures, as compared to non-surgical treatment alone at 3 months.

from European Journal of Pain http://ift.tt/1SopShd
via IFTTT

A randomized phase I trial evaluating the effects of inhaled 50–50% N2O–O2 on remifentanil-induced hyperalgesia and allodynia in human volunteers

Abstract

Background

Opioids are known to relieve pain, and also aggravate pre-existing hyperalgesia. In animal studies, the N-methyl-d-aspartate-receptor antagonist nitrous oxide (N₂O) was able to prevent hyperalgesia. The present study evaluated the effect of N₂O on hyperalgesia after remifentanil infusion in healthy volunteers.

Methods

Twenty-one healthy volunteers were enrolled in this placebo-controlled cross-over study. Transcutaneous electrical stimulation at high current densities induced spontaneous acute pain and stable areas of hyperalgesia. Each volunteer underwent the following four sessions: (1) 50–50% N₂–O₂ and i.v. saline; (2) 50–50% N₂–O₂ and i.v. remifentanil 0.1 μg/kg/min; (3) 50–50% N₂O–O₂ and i.v. saline; (4) 50–50% N₂O–O₂ and i.v. remifentanil 0.1 μg/kg/min. Inhaled gas mixtures lasted for 60 min, i.v. drug administration for 30 min. Visual analogue scale pain intensity, areas of pinprick hyperalgesia and touch-evoked allodynia were assessed repeatedly for 160 min.

Results

Data of 19 volunteers were analysed. There were significant time and treatment effects regarding areas of hyperalgesia and allodynia (p < 0.02). The area of hyperalgesia was significantly reduced in the N₂O + remifentanil session compared to the remifentanil session (35.88 ± 22.37 vs. 43.55 ± 18.48 cm², p = 0.004). The area of allodynia was significantly reduced in the N₂O + remifentanil session compared to the remifentanil session (29.95 ± 16.15 vs. 34.80 ± 15.35 cm², p = 0.008). The pain intensity was significantly reduced in the N₂O + remifentanil session compared to the remifentanil session (37.96 ± 12.78 vs. 42.15 ± 13.34 mm, p < 0.0001).

Conclusions

Nitrous oxide significantly reduced hyperalgesia, allodynia and pain intensity aggravated after remifentanil administration in a human volunteer model.

What does this study add?

This study brings the evidence that N₂O reduces the remifentanil aggravated secondary hyperalgesia in human volunteers exposed to a well-known model of electrical pain. N₂O was able to oppose the hyperalgesia, the allodynia and the pain intensity consecutive to remifentanil use in this specific pain model.

from European Journal of Pain http://ift.tt/1qkVjlN
via IFTTT

Effects of pregabalin on the nociceptive, emotional and cognitive manifestations of neuropathic pain in mice

Abstract

Background

Preclinical drug discovery for the treatment of chronic pain is at present challenged by the difficulty to study behaviours comparable to the complex human pain experience in animals. Several reports have demonstrated a frequent association of chronic pain in humans with affective disorders, such as anxiety and depression, and impaired cognitive functions, including memory and decision making, and motivation for goal-directed behaviours. In this study, we validated different behavioural outcomes to measure the emotional and cognitive manifestations of neuropathic pain induced in mice by partial sciatic nerve ligation.

Methods

In these mice, we evaluated at different time points the nociceptive responses, the anxiety- and depressive-like behaviours, the anhedonic state, object recognition memory and the operant responding maintained by food and the effects of the repeated administration of pregabalin on these manifestations.

Results

Our results demonstrated that the presence of allodynia and hyperalgesia in neuropathic pain mice was associated with increased anxiety- and depressive-like behaviours, reduced memory functions, development of an anhedonic state and impaired motivation to obtain food in the operant task. Chronic pregabalin treatment improved the nociceptive, anxiety-like and anhedonic responses, as well as the memory deficit, but did not modify the depressive-like alterations and the decreased motivation in these mice.

Conclusions

These results indicate that some emotional manifestations of chronic pain do not necessarily resolve when pain is relieved and underline the relevance to evaluate multiple behavioural responses associated with chronic pain, including the affective-motivational and cognitive behaviours, to increase the predictive value of preclinical drug discovery.

What does this study add?

• In this study, we have validated different behavioural outcomes allowing a reliable measurement of the emotional and cognitive manifestations of neuropathic pain induced in mice by partial sciatic nerve ligation.
• These results underline the relevance to evaluate these multiple pain-related alterations to improve the predictive value of preclinical drug discovery.

from European Journal of Pain http://ift.tt/1UVLpnp
via IFTTT

Expectations of recovery: A prognostic factor in patients with neck pain undergoing manual therapy treatment

Abstract

Background

Expectations have been investigated in populations seeking care for neck pain, however not considering potential confounding factors. The aim of this study was to investigate if pretreatment expectations of recovery is a prognostic factor for recovery from neck pain at 7 weeks follow-up in patients seeking manual therapy treatment.

Method

The study was based on the Stockholm Manual Intervention Trial, a randomized controlled trial investigating efficiency of three combinations of manual therapy. The patients with neck pain were included in this study (n = 716).

Expectations of recovery was measured at baseline; ‘How likely is it, according to your judgment, that you are completely recovered from your neck/back problems in 7 weeks’. Patients answered on a 11-point scale, further categorized into low, moderate and high expectations. The outcome was measured at 7 weeks follow-up by a modified version of the Global Perceived Recovery Question. Potential effect measure modifiers and confounders were measured at baseline. Multivariable log binomial regression models were used to analyse the association between expectations and recovery, presented as relative risks and 95% confidence intervals (CI).

Results

High expectations of recovery yielded a 47% increased probability of being recovered at 7 weeks follow-up. High expectations of recovery yielded improved recovery in both men and women separately, but moderate expectations yielded improved recovery only among men.

Conclusion

Our results suggest that expectations of recovery is a prognostic factor for recovery in patients with neck pain seeking manual therapy treatment.

What does this study add?

We found that high expectations of recovery yielded a higher probability of recovery compared to having low expectations, also when considering potential confounding factors. Expectations seemed to have a more distinct influence on recovery among men.

from European Journal of Pain http://ift.tt/1Son2Zn
via IFTTT

Involvement of transient receptor potential A1 channel in algesic and analgesic actions of the organic compound limonene

Abstract

Background

TRPA1 is a Ca-permeable nonselective cation channel expressed in sensory neurons and acts as a nocisensor. Recent reports show that some monoterpenes, a group of naturally occurring organic compounds, modulate TRP channel activity. Here, we report that limonene, being contained in citrus fruits and mushrooms, shows a unique bimodal action on TRPA1 channel.

Methods

We examine the effects of limonene on sensory neurons from wild-type, TRPV1- and TRPA1-gene-deficient mice and on heterologously expressed channels in vitro. Molecular determinants were identified with using mutated channels. Cellular excitability is monitored with ratiometric Ca imaging. Nociceptive and analgesic actions of limonene are also examined in vivo.

Results

In wild-type mouse sensory neurons, limonene increased the intracellular Ca²⁺ concentration ([Ca²⁺]_i), which was inhibited by selective inhibitors of TRPA1 but not TRPV1. Limonene-responsive neurons highly corresponded to TRPA1 agonist-sensitive ones. Limonene failed to stimulate sensory neurons from the TRPA1 (−/−) mouse. Heterologously expressed mouse TRPA1 was activated by limonene. Intraplantar injection of limonene elicited acute pain, which was significantly less in TRPA1 (−/−) mice. Systemic administration of limonene reduced nociceptive behaviours evoked by H₂O₂. In both heterologously and endogenously expressed TRPA1, a low concentration of limonene significantly inhibited H₂O₂-induced TRPA1 activation. TRPA1 activation by limonene was abolished in H₂O₂-insensitive cysteine-mutated channels.

Conclusions

Topically applied limonene stimulates TRPA1, resulting in elicitation of acute pain, but its systemic application inhibits nociception induced by oxidative stress. Because limonene is a safe compound, it may be utilized for pain control due to its inhibition of TRPA1 channels.

What does this study add: Limonene, a monoterpene in essential oils of various plants, has been known for its antitumor and anti-inflammatory properties. However, molecular basis of their actions has not been identified. This study shows that limonene activates nociceptive TRPA1 and elicits acute pain, when it is topically applied. In addition, systemic application of limonene exerts inhibitory effects on nociception induced by an oxidative stress-induced TRPA1 activation.

from European Journal of Pain http://ift.tt/1UVLpnj
via IFTTT

Enhanced c-Fos expression in the central amygdala correlates with increased thigmotaxis in rats with peripheral nerve injury

Abstract

Background

Pain is associated with affective, cognitive and sensory dysfunction. Animal models can be used to observe ethologically relevant behaviours such as thigmotaxis, giving insight into how ongoing sensory abnormalities influence natural rodent behaviours. The amygdala is a complex group of nuclei implicated in the integration and generation of emotional behavioural responses, including those associated with pain, and a region known as the central amygdala is particularly associated with generation of behavioural responses, due to its links to the descending pain modulation pathways; as such, study of amygdalar c-Fos immunoreactivity can help identify the neuronal circuits involved.

Method

This study investigated changes in both nociceptive evoked responses and open field behaviour following spinal nerve transection (SNT) in male Wistar rats, and attempted to correlate these with changes in central amygdala c-Fos immunoreactivity.

Results

Fourteen days after SNT, mechanical hypersensitivity was present in the hind paw ipsilateral to site of injury. Thigmotactic behaviour was significantly increased in both SNT and sham surgery animals, with c-Fos immunoreactivity in the central amygdala significantly greater in SNT animals compared to both sham and naive groups. Activation was greatest in the capsular and lateral subnuclei of the central amygdala, and in the caudal-most regions. There was a strong correlation between thigmotactic behaviour and central amygdala activation following SNT surgery not seen in sham animals suggesting a role for the amygdala in behavioural responses to peripheral nerve injury.

Conclusions

This study provides evidence to support the role of the amygdala in thigmotactic open field behaviour following SNT.

What does this study add?

Thigmotaxis and amygdala activation are positively correlated in rats following spinal nerve transection.

Behavioural changes seen in sham animals did not correlate with amygdala activation, suggesting amygdala activation is related to nociceptive input.

Evoked measures, such as hindpaw withdrawal, are not correlated with either thigmotaxis or amygdala activation, emphasizing the importance of complex behaviours when studying pain.

from European Journal of Pain http://ift.tt/1Son3N7
via IFTTT

Corrigendum to ‘Implementation fidelity of physiotherapist-delivered group education and exercise interventions to promote self-management in people with osteoarthritis and chronic low back pain: A rapid review Part II*’ [Manual Therapy 20/2 (2014) 1–8]

The authors regret that during a recent review of this work, an erroneous calculation of a percentage fidelity score for one study only (Johnson et al., 2007) was uncovered. This had been accidentally calculated as 81% instead of 58%. Although it does not change the overall conclusions or discussion of the paper, there was a small amount of text within the paper that needed to be amended accordingly. These points were as follows:

from Manual Therapy http://ift.tt/1qkxtqz
via IFTTT

Dosing of opioids and other stories . . .

Incalculable opioidsEvery palliative care formulary contains equivalence charts for commonly used opioids such as morphine, oxycodone, buprenorphine, and fentanyl, the bedrock of pain control in...

from Latest headlines from BMJ http://ift.tt/1ZKqnrj
via IFTTT

Qigong or Yoga versus no intervention in older adults with chronic low back pain – a randomized controlled trial

The aim of this study was to assess the effectiveness of the reduction of chronic lower back pain in older adults using either yoga classes or qigong classes compared with no intervention. Older adults (≥ 65 years of age) with chronic low back pain were enrolled in and randomly allocated to 1) yoga (24 classes, 45 minutes each, during 3 months), 2) qigong (12 classes, 90 min each, during 3 months) or 3) a control group who received no additional intervention. The pain-intensity item of the Functional Rating Index after 3 months was used as primary outcome parameter.

from The Journal of Pain http://ift.tt/1pZDAke
via IFTTT

Pain at the back of the heel

What you need to knowAchilles tendinopathy is the most common cause of chronic posterior heel painAchilles tendinopathy is a clinical diagnosis and imaging is not needed unless there is diagnostic...

from Latest headlines from BMJ http://ift.tt/1RHyoXW
via IFTTT

Changes over time of prescription and non-prescription analgesics for headache with or without other somatic pain Effects of prescription regulatory changes

The aim of this study was to examine the association and changes over time between headaches with or without somatic pain and the self-reported use of pain medication. The study further examined whether the law amendment in 2003 in Norway releasing the sale of non-prescription drugs to shops has changed these relationships.The study is based on repeated self-report cross sectional studies from 1998 to 2012 in Norway. A total of 27,247 adults were included. As expected, there was a strong association between headache, especially headache with co-morbid somatic pain and consumption of prescription vs.

from The Journal of Pain http://ift.tt/1MHDu4Z
via IFTTT

Association between the 10 item Örebro musculoskeletal pain screening questionnaire and physiotherapists’ perception of the contribution of biopsychosocial factors in patients with musculoskeletal pain

Contrasting evidence exists on the ability of clinicians to identify biopsychosocial factors in patients with musculoskeletal pain compared to questionnaires.

from Manual Therapy http://ift.tt/1LNNIpR
via IFTTT

Rotator cuff related shoulder pain: Assessment, management and uncertainties

Rotator cuff related shoulder pain (RCRSP) is an over-arching term that encompasses a spectrum of shoulder conditions including; subacromial pain (impingement) syndrome, rotator cuff tendinopathy, and symptomatic partial and full thickness rotator cuff tears. For those diagnosed with RCRSP one aim of treatment is to achieve symptom free shoulder movement and function. Findings from published high quality research investigations suggest that a graduated and well-constructed exercise approach confers at least equivalent benefit as that derived from surgery for; subacromial pain (impingement) syndrome, rotator cuff tendinopathy, partial thickness RC tears and atraumatic full thickness rotator cuff tears.

from Manual Therapy http://ift.tt/22LA7U5
via IFTTT

Response to Letter to the Editor Re: “Effect of education on non-specific neck and low back pain: a meta-analysis of randomized controlled trials”

To the Editor: The recent article by Ainpradub et al. (2015) includes two types of data extraction errors that can have a marked influence on the pooled results of a systematic review. We would like to alert readers to the problem and also point to some easy methods to recognise, and so avoid, such errors when conducting systematic reviews.

from Manual Therapy http://ift.tt/1LNNG11
via IFTTT

Association of levels of opioid use with pain and activity interference among patients initiating chronic opioid therapy: a longitudinal study

Abstract: Little is known about long-term pain and function outcomes among patients with chronic noncancer pain initiating chronic opioid therapy (COT). In the Middle-Aged/Seniors Chronic Opioid Therapy study of patients identified through electronic pharmacy records as initiating COT for chronic noncancer pain, we examined the relationships between level of opioid use (over the 120 days before outcome assessment) and pain and activity interference outcomes at 4- and 12-month follow-ups. Patients aged 45+ years (N = 1477) completed a baseline interview; 1311 and 1157 of these comprised the 4- and 12-month analysis samples, respectively. Opioid use was classified based on self-report and electronic pharmacy records for the 120 days before the 4- and 12-month outcome assessments. Controlling for patient characteristics that predict sustained COT and pain outcomes, patients who had used opioids minimally or not at all, compared with those with intermittent/lower-dose and regular/higher-dose opioid use, had better pain intensity and activity interference outcomes. Adjusted mean (95% confidence interval) pain intensity (0-10 scale) at 12 months was 4.91 (4.68-5.13) for the minimal/no use group and 5.71 (5.50-5.92) and 5.72 (5.51-5.93) for the intermittent/lower-dose and regular/higher-dose groups, respectively. A similar pattern was observed for pain intensity at 4 months and for activity interference at both time points. Better outcomes in the minimal/no use group could reflect pain improvement leading to opioid discontinuation. The similarity in outcomes of regular/higher-dose and intermittent/lower-dose opioid users suggests that intermittent and/or lower-dose use vs higher-dose use may confer risk reduction without reducing benefits.

from PAIN - Featured Articles - Current Issue Highlights http://ift.tt/21K0Az5
via IFTTT

Differences in demographic, clinical, and symptom characteristics and quality of life outcomes among oncology patients with different types of pain

Abstract: The purposes of this study, in oncology outpatients receiving chemotherapy (n = 926), were to: describe the occurrence of different types of pain (ie, no pain, only noncancer pain [NCP], only cancer pain [CP], or both CP and NCP) and evaluate for differences in demographic, clinical, and symptom characteristics, and quality of life (QOL) among the 4 groups. Patients completed self-report questionnaires on demographic and symptom characteristics and QOL. Patients who had pain were asked to indicate if it was or was not related to their cancer or its treatment. Medical records were reviewed for information on cancer and its treatments. In this study, 72.5% of the patients reported pain. Of the 671 who reported pain, 21.5% reported only NCP, 37.0% only CP, and 41.5% both CP and NCP. Across the 3 pain groups, worst pain scores were in the moderate to severe range. Compared with the no pain group, patients with both CP and NCP were significantly younger, more likely to be female, have a higher level of comorbidity, and a poorer functional status. In addition, these patients reported: higher levels of depression, anxiety, fatigue, and sleep disturbance; lower levels of energy and attentional function; and poorer QOL. Patients with only NCP were significantly older than the other 3 groups. The most common comorbidities in the NCP group were back pain, hypertension, osteoarthritis, and depression. Unrelieved CP and NCP continue to be significant problems. Oncology outpatients need to be assessed for both CP and NCP conditions.

from PAIN - Featured Articles - Current Issue Highlights http://ift.tt/21K0Az0
via IFTTT

Upregulation of the sodium channel NaVβ4 subunit and its contributions to mechanical hypersensitivity and neuronal hyperexcitability in a rat model of radicular pain induced by local dorsal root ganglion inflammation

Abstract: High-frequency spontaneous firing in myelinated sensory neurons plays a key role in initiating pain behaviors in several different models, including the radicular pain model in which the rat lumbar dorsal root ganglia (DRG) are locally inflamed. The sodium channel isoform NaV1.6 contributes to pain behaviors and spontaneous activity in this model. Among all isoforms in adult DRG, NaV1.6 is the main carrier of tetrodotoxin-sensitive resurgent Na currents that allow high-frequency firing. Resurgent currents flow after a depolarization or action potential, as a blocking particle exits the pore. In most neurons, the regulatory β4 subunit is potentially the endogenous blocker. We used in vivo siRNA-mediated knockdown of NaVβ4 to examine its role in the DRG inflammation model. NaVβ4 but not control siRNA almost completely blocked mechanical hypersensitivity induced by DRG inflammation. Microelectrode recordings in isolated whole DRG showed that NaVβ4 siRNA blocked the inflammation-induced increase in spontaneous activity of Aβ neurons and reduced repetitive firing and other measures of excitability. NaVβ4 was preferentially expressed in larger diameter cells; DRG inflammation increased its expression, and this was reversed by NaVβ4 siRNA, based on immunohistochemistry and Western blotting. NaVβ4 siRNA also reduced immunohistochemical NaV1.6 expression. Patch-clamp recordings of tetrodotoxin-sensitive Na currents in acutely cultured medium diameter DRG neurons showed that DRG inflammation increased transient and especially resurgent current, effects blocked by NaVβ4 siRNA. NaVβ4 may represent a more specific target for pain conditions that depend on myelinated neurons expressing NaV1.6.

from PAIN - Featured Articles - Current Issue Highlights http://ift.tt/21K0AyV
via IFTTT

Sleep problems and pain: a longitudinal cohort study in emerging adults

Abstract: Sleep and pain are thought to be bidirectional related on a daily basis in adolescents with chronic pain complaints. In addition, sleep problems have been shown to predict the long-term onset of musculoskeletal pain in middle-aged adults. Yet, the long-term effects of sleep problems on pain duration and different types of pain severity in emerging adults (age: 18-25) are unknown. This study investigated the cross-sectional and longitudinal relationship between sleep problems and chronic pain, and musculoskeletal pain, headache, and abdominal pain severity in a general population of emerging adults. We studied whether these relationships were moderated by sex and whether symptoms of anxiety and depression, fatigue, or physical inactivity mediated these effects. Data of participants from the longitudinal Dutch TRacking Adolescents' Individual Lives Survey were used. Follow-up data were collected in 1753 participants who participated in the fourth (N = 1668, mean age: 19.0 years [SD = 0.6]) and/or fifth (N = 1501, mean age: 22.3 years [SD = 0.6]) assessment wave. Autoregressive cross-lagged models were used for analyses. Sleep problems were associated with chronic pain, musculoskeletal pain, headache and abdominal pain severity, and predicted chronic pain and an increase in musculoskeletal pain severity at 3 years of follow-up. This prospective effect was stronger in females than in males and was mediated by fatigue but not by symptoms of anxiety and depression or physical inactivity. Only abdominal pain had a small long-term effect on sleep problems. Our results suggest that sleep problems may be an additional target for treatment in female emerging adults with musculoskeletal pain complaints.

from PAIN - Featured Articles - Current Issue Highlights http://ift.tt/21K0APz
via IFTTT

[Correspondence] Inappropriate use of antibiotics in children in China

Despite WHO's years of advocating appropriate use of antibiotics in children,1 the situation in China remains difficult. In April, 2015, a boy aged 3 years visited a hospital for abdominal pain that was then diagnosed as colitis. 3 weeks later, he died from organ failure induced by Klebsiella pneumoniae—a superbug resistant to most or all forms of available antibiotics.2

from The Lancet http://ift.tt/1UPkkRw
via IFTTT

The Behavioral Activation and Inhibition Systems: Implications for Understanding and Treating Chronic Pain

Evidence from a number of sources supports the existence of 2 relatively independent neurophysiological systems that underlie avoidance- and approach-related emotions, cognitions, and behavior. There is considerable overlap between 1) the emotions, cognitions, and behaviors controlled by these 2 systems, and 2) the known effects of chronic pain. Here we propose a 2-factor model of chronic pain on the basis of these well established 2-factor models, and discuss the implications of the model for understanding the effects of pain and mechanisms of psychological pain treatments.

from The Journal of Pain http://ift.tt/1LKLCXH
via IFTTT

The Role of Expectancy and Proactive Control in Stress Regulation: A Neurocognitive Framework for Regulation Expectation

The Relative Importance of Baseline Pain, Fatigue, Sleep and Physical Activity: Predicting Change in Depression in Adults with Multiple Sclerosis

Letter to the Editor: ‘Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials’

To the Editor: The recent article by Ainpradub et al. (2015) includes two types of data extraction errors that can have a marked influence on the pooled results of a systematic review. We would like to alert readers to the problem and also point to some easy methods to recognise, and so avoid, such errors when conducting systematic reviews.

from Manual Therapy http://ift.tt/1WJX4DA
via IFTTT

A systematic review and meta-analysis of low intensity CBT for psychosis

Parent-based interventions for preventing or reducing adolescent substance use – a systematic literature review

Rheumatoid arthritis

What you need to knowConsider rheumatoid arthritis in any patient presenting with joint pain, swelling, and morning stiffness of over 30 minutesRefer within two weeks if symptoms affect small joints...

from Latest headlines from BMJ http://ift.tt/1UFDv1h
via IFTTT

Effects of Mirror Therapy in Stroke Patients With Complex Regional Pain Syndrome Type 1: A Randomized Controlled Study

Mind-Body Approaches for Chronic Low Back Pain

The substantial increase in clinical trials of mindfulness meditation over the past 2 decades reflects an increasing interest in using mindfulness approaches to treat various symptoms and disorders. For example, mindfulness-based stress reduction (MBSR), a semistandardized 8-week program created in 1979, has been used for many of these trials and is based on meditation techniques. These meditation techniques were not intended to cure any specific health problems. Rather, they were intended as a way to deal with stress and address adverse life experiences by increasing awareness of breathing, thoughts, and bodily sensations and learning to observe them from a detached perspective. Not reacting to these phenomena, but simply observing them, can lead to greater objectivity about how an individual thinks and feels toward them. This objectivity could lead to a different experience of the phenomena altogether and may lead to a deeper understanding of how the mind and body interact to create life experiences. Thus, this awareness of what causes life experiences could lead to reduced pain and stress through avoidance of mental and physical behaviors that promote adverse outcomes.

from JAMA Current Issue http://ift.tt/25j4fIt
via IFTTT

Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy

This randomized trial compares the effects of mindfulness-based stress reduction vs cognitive behavioral therapy vs usual treatment for improving symptoms and physical function among adult patients with chronic lower back pain.

from JAMA Current Issue http://ift.tt/1pxb20x
via IFTTT

A woman with abdominal distension and pain

A 40 year old woman presented to the surgical assessment unit with a 12 hour history of abdominal distension and tenderness. She had not opened her bowels or passed wind since her symptoms started....

from Latest headlines from BMJ http://ift.tt/25j12sE
via IFTTT

Obesity in early adulthood predicts knee pain and walking difficulties among men: A life course study

Abstract

Background

Few studies have addressed the role of obesity in young adulthood in knee problems later in life. We assessed the associations of overweight/obesity with knee pain and functional limitations of the knee across the life course.

Methods

Military health records from 1967 to 2000 (baseline) were searched for 18- to 50-year-old Finnish men (n = 1913) who participated in the Health 2000 Study (follow-up). Visits to health care were followed during service. Height and weight were measured at baseline and follow-up and waist circumference at follow-up. Weight was inquired at follow-up for ages of 20, 30, 40 and 50 years, if applicable. Life course body mass index (BMI) was calculated. One-month knee pain and functional limitations (walking difficulties and limping) due to knee problems were enquired with interview at follow-up. Cox regression model, logistic regression and trajectory analysis were applied.

Results

Body mass index at the age of 20 increased the risk of unilateral knee pain by 38% and functional limitations by 27% for one standard deviation increment of BMI, respectively. One-unit increment of Z-score of life course BMI increased knee pain by 32%. Development of severe obesity during the follow-up increased the risk of knee pain by 80% and functional limitations by 93%. The effect of obesity on functional limitations was partly mediated by traumatic knee problems during military service.

Conclusions

Reducing overweight already in adolescence and avoiding further weight gain during life course may prevent knee pain and associated disability.

What does this study add?

BMI at the age of 20 increases the likelihood of knee pain and functional limitations of the knee later in life.

Development of severe obesity in adulthood increases the risk of knee pain by 80% and functional limitations by more than 90%.

Both general and abdominal obesity are associated with knee pain, associations being stronger for general obesity.

from European Journal of Pain http://ift.tt/1pEIToR
via IFTTT

Sensorimotor dysfunction after limb fracture – An exploratory study

Abstract

Background

Chronic pain is often associated with sensorimotor dysfunction but little is known about the early impact of limb fracture on sensory and motor performance. This exploratory study sought to assess these changes in patients with recent wrist and ankle fractures. A secondary aim was to determine the incidence of Complex Regional Pain Syndrome (CRPS) and its clinical features.

Methods

Fifty-three patients at a UK fracture centre underwent Quantitative Sensory Testing (QST), Motor Imagery (MI) and Body Perception Disturbance (BPD) assessments ≤5 weeks post-fracture (Time 1). Subjective evaluation of recovery and clinical examination for CRPS was conducted 5 weeks later (Time 2, 50 patients). Patient-reported outcomes of pain, psychological distress and limb function were collected at Times 1 and 2, and 6 months after T1 (Time 3, 36 patients, postal questionnaire).

Results

Quantitative sensory testing at Time 1 demonstrated cold and pressure-pain hyperalgesia in the fractured limb compared to the non-fractured side (p < 0.05). Imagined movements were reported as significantly more difficult to perform on the fractured side (p < 0.001). There was evidence of BPD in the fractured limb, similar to that found in CRPS. The incidence of CRPS was 9.4%; however, individual signs and symptoms of the condition were commonly present (70% reported ≥ one symptom). Only 33% of patients reported to being ‘back to normal’ 6 months after fracture with 34% reporting ongoing pain.

Conclusions

Limb fracture is associated with changes in pain perceptions, motor planning, and disruption to body perception. Signs and symptoms of CRPS, ongoing pain and delayed recovery post-fracture are common.

What does this study add?

In the immediate post-fracture period: Body perception disturbance is reported in the fractured limb. Imagined movements of the fractured limb are less vivid and associated with pain

This study contributes to the incidence literature on CRPS.

from European Journal of Pain http://ift.tt/1pEyZDK
via IFTTT

Medical cannabis associated with decreased opiate medication use in retrospective cross-sectional survey of chronic pain patients

Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015.

from The Journal of Pain http://ift.tt/1RVd7KM
via IFTTT

Doctors are urged to limit opioid prescribing

Doctors should use non-steroidal anti-inflammatory drugs and physical therapy instead of opioids when treating patients with chronic, non-cancer pain, the US Centers for Disease Control and...

from Latest headlines from BMJ http://ift.tt/1WvZZ2A
via IFTTT