Musculoskeletal pain characteristics associated with lower balance confidence in community-dwelling older adults

Movement-based subgrouping in low back pain: synergy and divergence in approaches

Does adding cognitive-behavioural physiotherapy to exercise improve outcome in patients with chronic neck pain? A randomised controlled trial

Nintendo Wii Fit as an adjunct to physiotherapy following lower limb fractures: preliminary feasibility, safety and sample size considerations

A man with severe abdominal pain

A 38 year old man presented to the emergency department with a 12 hour history of central and right sided severe abdominal pain. The pain had been getting gradually worse, he had vomited, and he was...

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The Patient You Least Want to See

Signing my first orders as a medical intern was distinctly disconcerting. Wait, I can just sign this order and it will happen? Are we sure this is safe? Safe or not, new physician trainees suddenly wield the power to administer medications that can be lifesaving or life-ending. Pharmacists corrected my orders for excessive doses of insulin or potassium, while senior physicians guided my selection of vasopressor infusions and antibiotics. When it came to intravenous opioids, however, those same pharmacists never hesitated to approve my orders, and I found little structured guidance from supervising physicians. With no questions asked, I included “as needed” acetaminophen, oxycodone, and IV morphine in my standard order set for every patient I admitted. I congratulated myself on a time-saving trick to anticipate patient and nursing needs that would spare me an extra page to respond to. Instead, I unexpectedly found patients skipping the acetaminophen and getting their “as needed for severe pain” intravenous opioids around the clock for days. This often culminated in a last-minute desperate discharge plan, with many demoralizing negotiations over “just one more push of IV Dilaudid and Benadryl.” I came to appreciate a more insidious problem and, even worse, worried that I was contributing to it.

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Associations of sedentary behavior, physical activity, cardiorespiratory fitness and body fat content with pain conditions in children: the PANIC study

We investigated the cross-sectional associations of sedentary behavior, physical activity, cardiorespiratory fitness and body fat content with pain conditions in prepubertal children. The participants were a population sample of 439 children aged 6-8 years. Sedentary behavior, physical activity and pain conditions were assessed by questionnaires, cardiorespiratory fitness by maximal cycle ergometer test and body fat percentage by dual-energy X-ray absorptiometry. The associations of sedentary behavior, physical activity, cardiorespiratory fitness and body fat percentage with the risk of pain conditions were analysed using multivariate logistic regression.

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Evaluating the neck joint position sense error with a standard computer and a webcam

Joint Position Sense Error (JPSE) is a measure of cervical spine proprioception, and a simple method for measuring the JPSE could help in monitoring and evaluating the outcomes of rehabilitation of people with neck pain.In this study we demonstrate preliminary results of a method for measuring JPSE that does not require the participant to wear any equipment. Based on free publicly available head tracking software, compatible with any webcam, we developed a webpage which instructs the participant in performing a self-administered version of the test.

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Erratum to “The automatic pelvic floor muscle response to the active straight leg raise in cases with pelvic girdle pain and matched controls” [Man Ther 18 (4) (2013) 327–332]

The publisher regrets that the author Ingeborg H Brækken was listed incorrectly in the published version of the article. This has now been corrected online.

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Risk Factors Associated with Neurogenic Bowel Complications and Dysfunction in Spinal Cord Injury

Residual Limb Hyperhidrosis and RimabotulinumtoxinB: A Randomized Placebo-Controlled Study

Publication date: May 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 5
Author(s): Paul F. Pasquina, Briana N. Perry, Aimee L. Alphonso, Sacha Finn, Kevin F. Fitzpatrick, Jack W. Tsao
ObjectiveTo investigate the use of rimabotulinumtoxinB (BoNT/B [Myobloc]) compared with placebo in treating hyperhidrosis in the residual limbs of individuals with amputation.DesignRandomized, double-blind, placebo-controlled pilot study.SettingMilitary medical center.ParticipantsMale participants (N=9) with 11 major amputations of the lower limbs and who complained of excessive sweating in their residual limbs were enrolled in the study between September 24, 2008 to October 28, 2011. Participants' lower limbs were randomly assigned to receive injections of either BoNT/B (n=7) or placebo (n=4).InterventionBoNT/B.Main Outcome MeasuresThe primary efficacy variable was a minimum of 50% reduction in sweat production 4 weeks after the injection as measured via gravimetric sweat analysis after 10 minutes of physical exertion. Secondary analyses were performed on prosthetic function and pain.ResultsAll volunteers (100%; 7) in the BoNT/B group achieved a minimum of 50% reduction in sweat production as compared with only 50% (2) in the placebo group. The percent reduction was significantly greater for the BoNT/B group than for the placebo group (−72.7%±15.7% vs −32.7%±39.2%; P<.05). Although both groups subjectively self-reported significant sweat reduction and improved prosthetic function (P<.05 for both), objective gravimetric sweat analyses significantly decreased only for the BoNT/B group (2.3±2.3g vs 0.7±1.1g; P<.05). Neither group reported a change in phantom limb pain or residual limb pain (P>.05 for both).ConclusionsBoNT/B successfully reduces sweat production in individuals with residual limb hyperhidrosis, but does not affect pain. No differences were found in perceived effect on prosthetic use between BoNT/B and placebo groups.



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Effect of Manual Lymphatic Drainage After Total Knee Arthroplasty: A Randomized Controlled Trial

Publication date: May 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 5
Author(s): Claude Pichonnaz, Jean-Philippe Bassin, Estelle Lécureux, Guillaume Christe, Damien Currat, Kamiar Aminian, Brigitte M. Jolles
ObjectiveTo evaluate the effects of manual lymphatic drainage (MLD) on knee swelling and the assumed consequences of swelling after total knee arthroplasty (TKA).DesignRandomized controlled trial.SettingPrimary care hospital.ParticipantsTwo groups of 30 patients were randomized before TKA surgery (N=60; 65% women [39]; mean age, 70.7±8.8y; weight, 77.8±11.3kg; size, 1.64±0.08m; body mass index, 29.9±4.1kg/m²).InterventionsParticipants received either 5 MLD treatments or a placebo, added to rehabilitation, in between the second day and the seventh day after surgery.Main Outcome MeasuresSwelling was measured by blinded evaluators before surgery and at second day, seventh day, and 3 months using bioimpedance spectroscopy and volume measurement. Secondary outcomes were active and passive range of motion, pain, knee function, and gait parameters.ResultsAt seventh day and 3 months, no outcome was significantly different between groups, except for the knee passive flexion contracture at 3 months, which was lower and less frequent in the MLD group (−2.6°; 95% confidence interval, −5.0° to −0.21°; P=.04; absolute risk reduction, 26.6%; 95% confidence interval, 0.9%–52.3%; number needed to treat, 4). The mean pain level decreased between 5.8 and 8.2mm on the visual analog scale immediately after MLD, which was significant after 4 of 5 MLD treatments.ConclusionsMLD treatments applied immediately after TKA surgery did not reduce swelling. It reduced pain immediately after the treatment. Further studies should investigate whether the positive effect of MLD on knee extension is replicable.



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Resilience Pain Interference and Upper Limb Loss: Testing the Mediating Effects of Positive Emotion and Activity Restriction on Distress

Publication date: May 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 5
Author(s): Michaela V. Walsh, Trey W. Armstrong, Julia Poritz, Timothy R. Elliott, Warren T. Jackson, Tiffany Ryan
ObjectiveTo test mediating effects of positive emotion and activity restriction on the associations of resilience and pain interference with distress reported by individuals with traumatic upper limb loss evaluated for prosthetics.DesignCross-sectional correlational study of several demographic and self-report measures of resilience, pain interference, activity restriction, positive emotions, and symptoms of depression and posttraumatic stress.SettingSix regional centers throughout the United States.ParticipantsA total of 263 prospective participants consented to be evaluated for eligibility and need for upper extremity prosthetics; participants (N=202; 57 women [28.2%] and 145 men [71.8%]; mean age, 41.81±14.83y; range, 18.01–72.95y) who sustained traumatic injuries were retained in this study. Most of them were identified as white (70.8%; n=143), followed by black (10.4%; n=21), Hispanic (9.9%; n=20), Asian (3.0%; n=6), other (1.5%; n=3), and missing (4.5%; n=9).InterventionsNot applicable.Main Outcome MeasuresPrimary Care Posttraumatic Stress Disorder Screen and depression screen.ResultsResilience and pain interference were significantly correlated in predicted directions with positive emotions, activity restriction, and the 2 distress variables. A path model revealed that the associations of resilience and pain interference with both distress variables were completely mediated by positive emotions and activity restriction. There were no significant direct effects of resilience or pain interference on either distress variable.ConclusionsResilience may facilitate adjustment via beneficial and predicted associations with positive emotions and active engagement with the environment. These relations are independent of the significant and inverse associations of pain interference with these same variables. Longitudinal research is needed to understand interactions between positive emotions and activity over time in promoting adjustment after traumatic limb loss. Individuals reporting depression and/or posttraumatic stress disorder symptoms may require interventions that reduce avoidance and promote activities that may increase the likelihood of experiencing positive emotions.



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Efficacy of Different Types of Mobilization Techniques in Patients With Primary Adhesive Capsulitis of the Shoulder: A Systematic Review

Publication date: May 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 5
Author(s): Suzie Noten, Mira Meeus, Gaetane Stassijns, Francis Van Glabbeek, Olivier Verborgt, Filip Struyf
ObjectiveTo systematically review the literature for efficacy of isolated articular mobilization techniques in patients with primary adhesive capsulitis (AC) of the shoulder.Data SourcesPubMed and Web of Science were searched for relevant studies published before November 2014. Additional references were identified by manual screening of the reference lists.Study SelectionAll English language randomized controlled trials evaluating the efficacy of mobilization techniques on range of motion (ROM) and pain in adult patients with primary AC of the shoulder were included in this systematic review. Twelve randomized controlled trials involving 810 patients were included.Data ExtractionTwo reviewers independently screened the articles, scored methodologic quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database Scale for randomized controlled trials.Data SynthesisThe efficacy of 7 different types of mobilization techniques was evaluated. Angular mobilization (n=2), Cyriax approach (n=1), and Maitland technique (n=6) showed improvement in pain score and ROM. With respect to translational mobilizations (n=1), posterior glides are preferred to restore external rotation. Spine mobilizations combined with glenohumeral stretching and both angular and translational mobilization (n=1) had a superior effect on active ROM compared with sham ultrasound. High-intensity mobilization (n=1) showed less improvement in the Constant Murley Score than a neglect group. Finally, positive long-term effects of the Mulligan technique (n=1) were found on both pain and ROM.ConclusionsOverall, mobilization techniques have beneficial effects in patients with primary AC of the shoulder. Because of preliminary evidence for many mobilization techniques, the Maitland technique and combined mobilizations seem recommended at the moment.



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[Correspondence] Partial breast irradiation and the GEC-ESTRO trial

The results of the GEC-ESTRO phase 3 trial1 add to the growing body of level I evidence supporting accelerated partial breast irradiation (APBI), as an equal alternative to whole breast irradiation (WBI) in selected patients with early stage breast cancer treated with breast-conserving therapy.2–4 With a median follow-up of 6·6 years, the 5-year actuarial rates of local recurrence, disease-free survival, and cause-specific survival were not significantly different.1 Just as important, all measures of acute and chronic toxic effects showed no differences between approaches, with only a slight advantage noted with APBI for breast pain and skin side-effects of grade 2–3.

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A systematic review of the predictions of the Interpersonal-Psychological Theory of Suicidal Behaviour

Publication date: Available online 20 April 2016
Source:Clinical Psychology Review
Author(s): Jennifer Ma, Philip J. Batterham, Alison L. Calear, Jin Han
ContextSince the development of the Interpersonal Psychological Theory (IPTS; Joiner, 2005), a growing body of literature has emerged testing different aspects of the theory across a range of populations.ObjectiveThe aim of this review was to identify support for the IPTS, and critical gaps in the evidence base, by systematically reviewing current evidence testing the effects of thwarted belongingness, perceived burdensomeness, and acquired capability on suicide ideation and attempt.MethodsPsycInfo and PubMed databases were electronically searched for articles published between January 2005 and July 2015. Articles were included if they directly assessed the IPTS constructs as predictors of suicidal ideation or suicide attempt.ResultsFifty-eight articles reporting on 66 studies were identified. Contrary to expectations, the studies provided mixed evidence across the theory's main predictions. The effect of perceived burdensomeness on suicide ideation was the most tested and supported relationship. The theory's other predictions, particularly in terms of critical interaction effects, were less strongly supported.ConclusionsFuture research focused on expanding the availability of valid measurement approaches for the interpersonal risk factors, and further elaborating upon their mixed relationships with suicide ideation and attempt across multiple populations is important to advance theoretical and clinical progress in the field.



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A Systematic Review of the Use of Acceptance and Commitment Therapy (ACT) in Chronic Disease and Long-Term Conditions

Publication date: Available online 20 April 2016
Source:Clinical Psychology Review
Author(s): Christopher D. Graham, Joanna Gouick, Charlotte Krahé, David Gillanders
Many have proposed that Acceptance and Commitment Therapy (ACT) may be particularly effective for improving outcomes in chronic disease/long-term conditions, and ACT techniques are now being used clinically. However, reviews of ACT in this context are lacking, and the state of evidence is unclear. This systematic review aimed to: collate all ACT interventions with chronic disease/long-term conditions, evaluate their quality, and comment on efficacy. Ovid MEDLINE, EMBASE and Psych Info were searched. Studies with solely mental health or chronic pain populations were excluded. Study quality was then rated, with a proportion re-rated by a second researcher. Eighteen studies were included: eight were randomised controlled trials (RCTs), four used pre-post designs, and six were case studies. A broad range of applications were observed (e.g. improving quality of life and symptom control, reducing distress) across many diseases/conditions (e.g. HIV, cancer, epilepsy). However, study quality was generally low, and many interventions were of low intensity. The small number of RCTs per application and lower study quality emphasise that ACT is not yet a well-established intervention for chronic disease/long-term conditions. However, there was some promising data supporting certain applications: parenting of children with long-term conditions, seizure-control in epilepsy, psychological flexibility, and possibly disease self-management.



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Exercises for mechanical neck disorders: A Cochrane Review Update

Neck pain (NP) is disabling and costly.

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Medialized Muscle-Splitting Approach for Posterior Lumbar Interbody Fusion: Technique and Multicenter Perioperative Results

Study Design. Retrospective, multicenter study of perioperative results Objective. The purpose of this study was to describe the surgical technique for medialized posterior lumbar fusion as well as present preliminary complication and treatment results from a multicenter retrospective study. Summary of Background Data. Posterior exposures remain the most commonly performed approaches for spinal fusion. Conventional open posterior exposures, however, have relatively high exposure-related morbidity and postoperative infection rates. Less invasive exposures for transforaminal and anterior (lateral) interbody fusion have been widely used over the past decade, but the need for bilateral posterior exposure has challenged the development of less invasive exposures for direct posterior approaches for lumbar fusion. Methods. Consecutive patients treated with minimally invasive spine (MIS) posterior lumbar interbody fusion with medialized cortical bone trajectory pedicle screw and rod fixation were identified from four sites in the United States. Of the 138 patients identified, 61% of patients were treated for degenerative spondylolisthesis at 167 levels, most commonly at L4–5 (62%). Perioperative treatment, complication, and reoperation data were collected to describe early feasibility of the approach. Results. Mean total operative time was 135 minutes with an average of 236 mL of blood loss. Mean total postoperative length of hospital stay was 2.6 days, with 25% of patients discharged on the same day or within 23 hours of surgery. Total perioperative complication rate in 138 patients was 10.1% (14/138) with three related reoperations. Intraoperative complications included five (3.6%) instances of incidental durotomy, without any progression to persistent cerebrospinal fluid leaks. Nine (6.5%) postoperative complications occurred, including one L5 vertebral body fracture, two pulmonary embolisms, one deep vein thrombosis, one urinary tract infection one instance of urinary retention, two superficial surgical site infections, and one patient with persistent pain at 6 months postoperative. Three (2.2%) reoperations were performed, one for revision of the L5 vertebral body fracture, and two for wound debridement. No instances of postoperative radiculitis or neurological injury were observed. Conclusion. Medialized, muscle-sparing posterior exposures with specialized instrumentation can be performed in patients with degenerative lumbar pathology with low surgical morbidity and blood loss and a short length of postoperative hospital stay. Level of Evidence: 4

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Distraction Laminoplasty With Interlaminar Lumbar Instrumented Fusion (ILIF) for Lumbar Stenosis With or Without Grade 1 Spondylolisthesis: Technique and 2-Year Outcomes

Study Design. Prospective, nonrandomized cohort. Objective. Describe the surgical technique and clinical outcome of distraction lumbar laminoplasty with allograft bone block augmentation and interlaminar lumbar instrumented fusion (ILIF) Summary of Background Data. ILIF is a recently described technique that may offer a less invasive alternative to traditional posterior pedicle screw fixation for stabilization during posterior or posterolateral lumbar fusion after decompression for lumbar spinal stenosis. Methods. Data from two sites of a prospective, multicenter clinical study is described in this report and includes 37 patients over age 40 with single-level degenerative disc disease between L1-2 and L4-5 with neurogenic claudication. Subjects were treated with lumbar decompression using a distraction laminoplasty procedure followed by insertion of a preshaped allograft bone block and interspinous stabilization with a fixation device. BMP-2 was not used. Follow-up clinical evaluation was performed at baseline and at 6 weeks, 3, 6, 12, and 24 months, including perioperative complications, visual analog pain score, Oswestry Disability Index, Zurich Claudication Questionnaire scores and return to activity and work. Radiographic evaluation of fusion and segmental and regional lumbar lordosis were performed to 2 years. Results. Thirty-three patients (89%) of mean age 71 years (17% woman) met all follow-up criteria at 2 years. Levels treated were L4-5 (78.4%), L3-4 (16.2%), or L2-3 (5.4%). Thirty-two of 37 (86%) of patients had a grade-1 spondylolisthesis. Mean hospital length of stay (LOS) was 2 days. Complications included one dural tear, one new neuro deficit that resolved by 6 weeks, one implant failure, one seroma, and one case of cancer diagnosis. At 2 years, 67% had >2 cm improvement on visual analog pain score and 73% had >12.4% Oswestry Disability Index improvement. Symptom severity and physical function subset scores of Zurich Claudication Questionnaire improved by >0.5 cm in 76 and 73% of patients, respectively. At 2 years 94% of patients were off all narcotics and NSAIDS and 94% reported satisfaction with the procedure. Mean lumbar lordosis at baseline and 2 years was 53 ± 14° and 53 ± 13°, respectively. Seventy-two percent of subjects met strict fusion criterion of <3° motion on flexion/extension XRAY and bridging bone; 97% met criteria for stability by independent surgeon evaluation. Conclusion. Distraction laminoplasty with allograft bone block augmentation and ILIF may provide a less-invasive alternative to traditional pedicle screw fixation after decompression and posterolateral fusion. The present study describes this technique, and demonstrates excellent clinical outcomes and an acceptable rate of radiographic fusion success. Level of Evidence: NA

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Two-year Comparative Outcomes of MIS Lateral and MIS Transforaminal Interbody Fusion in the Treatment of Degenerative Spondylolisthesis: Part I: Clinical Findings

Study Design. A prospective, multicenter, institutional review board (IRB) approved study with randomized and observational study arms. Objective. The purpose of this study was to compare clinical outcomes between minimally invasive transforaminal (MIS TLIF) and MIS lateral interbody fusion (XLIF) in the treatment of patients with low-grade degenerative spondylolisthesis with stenosis through two years postoperative. Summary of Background Data. Few reports exist comparing different MIS approaches directly in the treatment of similar pathology, as most studies report differences between MIS and open procedures. Methods. A total of 55 patients undergoing surgical treatment for degenerative spondylolisthesis with spinal stenosis at one or two contiguous levels between L1 and L5 were enrolled. Twenty-nine patients were treated with XLIF and 26 patients were treated with MIS TLIF. Results. Operative time and length of stay were similar between the XLIF and MIS TLIF groups (171 vs 186 minutes; two days for each group). Blood loss was significantly lower in the XLIF group, with 79% of XLIF cases and 27% of MIS TLIF cases resulting in <100 mL of blood loss, P < 0.001. Hip flexion weakness was more common in the XLIF group (31%) than in the MIS TLIF group (0%). One patient in the XLIF group had a new distal motor weakness and three patients in the XLIF group and two patients in the MIS TLIF group had new sensory changes postoperatively, all of which resolved by 12 months postoperative. Back and leg pain for both XLIF and MIS TLIF groups improved significantly from baseline to 24 months postoperative, with 73% improvement in the XLIF and 64% in the MIS TLIF group. Worst leg pain showed similar improvements through two years postoperative, with a 79% decrease seen in the XLIF group and 74% in the MIS TLIF group. Disability (ODI) improved 53% in the XLIF group and 57% in the MIS TLIF group. Conclusion. Despite different mechanisms of action (indirect vs direct decompression), mid-term clinical outcomes between XLIF and MIS TLIF were similar. These two-year results suggest that both XLIF and MIS TLIF are reasonable MIS approaches for the treatment of lumbar degenerative pathology. Level of Evidence: 2

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Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up prospective randomized controlled clinical trial

It is unknown if low back pain (LBP) outcomes are enhanced by classification-specific treatment based on the Movement System Impairment classification system. The moderating effect of adherence to treatment also is unknown.

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Zero Pain Is Not the Goal

What should health care be trying to accomplish? This question becomes increasingly important as research advances, the population ages, and financial pressures intensify. Simple measures for which 100% is the target cannot define performance for the complex work of health care. Quality does not mean the elimination of death or perfect compliance with guidelines. Efficiency does not mean the elimination of all spending or even 100% elimination of all wasteful spending. And compassion for patients does not mean the elimination of all pain.

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CDC Guideline for Prescribing Opioids for Chronic Pain 2016

This guideline from the Centers for Disease Control and Prevention makes 12 recommendations to improve communication about opioids for chronic pain, to improve the safety and effectiveness of pain treatment, and to reduce risks associated with long-term opioid therapy.

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US Opioid Prescriptions After Low-Risk Surgical Procedures 2004-2012

This study assesses trends in the amount of hydrocodone/acetaminophen and oxycodone/acetaminophen prescribed for postoperative pain management.

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Incorrect Number of Patients in a Figure

In the Original Contribution entitled “Effect of Opioids vs NSAIDs and Larger vs Smaller Chest Tube Size on Pain Control and Pleurodesis Efficacy Among Patients With Malignant Pleural Effusion,” published in the December 22/29, 2015, issue of JAMA, an incorrect number of patients was given in Figure 2. In the table section of the figure, in the analgesia group, per-protocol row, NSAIDs column, the number of patients should have been 137, not 170. This article has been corrected online.

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The effect of threat on cognitive biases and pain outcomes: An eye-tracking study

Abstract

Background

Theoretical accounts of attentional and interpretation biases in pain suggest that these biases are interrelated and are both influenced by perceived threat. A laboratory-based study was conducted to test whether these biases are influenced by threat and their interrelationship and whether attention or interpretation biases predict pain outcomes.

Methods

Healthy participants (n = 87) received either threatening or reassuring pain information and then completed questionnaires, interpretation and attentional bias tasks (with eye-tracking) and a pain task (the cold pressor).

Results

There was an interaction effect for threat group and stimuli type on mean dwell time for face stimuli, such that there was an attentional bias towards happy faces in the low- but not high-threat group. Further, high threat was also associated with shorter pain tolerance, increased pain and distress. In correlational analyses, avoidance of affective pain words was associated with increased pain. However, no relationship was found between attention and interpretation biases, and interpretation biases were not influenced by threat or associated with pain.

Conclusions

These findings provide partial support for the threat interpretation model and the importance of threat and affective pain biases, yet no relationship between cognitive processing biases was found, which may only occur in clinical pain samples.

What does this study add?

1. In healthy participants, no relationship between attention and interpretation biases was found.
2. Eye tracking revealed an association between later attentional processes and pain.
3. Threat influenced attentional biases and pain outcomes, partially supporting theoretical accounts.

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Systematic review of childhood and adolescent risk and prognostic factors for recurrent headaches

Little is known about childhood and adolescent risk and prognostic factors for recurrent headaches. This systematic review: (1) Examined longitudinal evidence about factors associated with onset and course of recurrent headaches in childhood or adolescence, using meta-analysis where possible; and (2) Evaluated the quality of this evidence using a modified GRADE framework. Through searching electronic databases, reference lists of included studies, and an electronic mail list we identified and included 23 articles reporting 19 cohorts.

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Using structural and functional brain imaging to investigate responses to acute thermal pain

Despite a fundamental interest in the relationship between structure and function, the relationships between measures of white matter microstructural coherence and functional brain responses to pain are poorly understood. We investigate whether fractional anisotropy (FA) in two white matter regions in pathways associated with pain is related to the fMRI Blood oxygen level dependent (BOLD) response to thermal stimulation. BOLD fMRI was measured from 16 healthy male subjects during painful thermal stimulation of the right arm.

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Leisure-time physical activity and sciatica: A systematic review and meta-analysis

Abstract

Background and objective

The role of leisure-time physical activity in sciatica is uncertain. This study aimed to assess the association of leisure-time physical activity with lumbar radicular pain and sciatica.

Databases and data treatment

Literature searches were conducted in PubMed, Embase, Web of Science, Scopus, Google Scholar and ResearchGate databases from 1964 through August 2015. A random-effects meta-analysis was performed, and heterogeneity and small-study bias were assessed.

Results

Ten cohort (N = 82,024 participants), four case–control (N = 9350) and four cross-sectional (N = 10,046) studies qualified for meta-analysis. In comparison with no regular physical activity, high level of physical activity (≥4 times/week) was inversely associated with new onset of lumbar radicular pain or sciatica in a meta-analysis of prospective cohort studies [risk ratio (RR) = 0.88, 95% CI 0.78–0.99, I² = 0%, 7 studies, N = 78,065]. The association for moderate level of physical activity (1–3 times/week) was weaker (RR = 0.93, CI 0.82–1.05, I² = 0%, 6 studies, N = 69,049), and there was no association with physical activity for at least once/week (RR = 0.99, CI 0.86–1.13, 9 studies, N = 73,008). In contrast, a meta-analysis of cross-sectional studies showed a higher prevalence of lumbar radicular pain or sciatica in participants who exercised at least once/week [prevalence ratio (PR) = 1.29, CI 1.09–1.53, I² = 0%, 4 studies, N = 10,046], or 1–3 times/week (PR = 1.34, CI 1.02–1.77, I² = 0%, N = 7631) than among inactive participants. There was no evidence of small-study bias.

Conclusions

This meta-analysis suggests that moderate to high level of leisure physical activity may have a moderate protective effect against development of lumbar radicular pain. However, a large reduction in risk (>30%) seems unlikely.

What does this review add

Leisure-time physical activity may reduce the risk of developing lumbar radicular pain.

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Increased pain and muscle glutamate concentration after single ingestion of monosodium glutamate by myofascial temporomandibular disorders patients

Abstract

Background

A randomized, double-blinded, placebo-controlled study was conducted to investigate if single monosodium glutamate (MSG) administration would elevate muscle/serum glutamate concentrations and affect muscle pain sensitivity in myofascial temporomandibular disorders (TMD) patients more than in healthy individuals.

Methods

Twelve myofascial TMD patients and 12 sex- and age-matched healthy controls participated in two sessions. Participants drank MSG (150 mg/kg) or NaCl (24 mg/kg; control) diluted in 400 mL of soda. The concentration of glutamate in the masseter muscle, blood plasma and saliva was determined before and after the ingestion of MSG or control. At baseline and every 15 min after the ingestion, pain intensity was scored on a 0–10 numeric rating scale. Pressure pain threshold, pressure pain tolerance (PPTol) and autonomic parameters were measured. All participants were asked to report adverse effects after the ingestion.

Results

In TMD, interstitial glutamate concentration was significantly greater after the MSG ingestion when compared with healthy controls. TMD reported a mean pain intensity of 2.8/10 at baseline, which significantly increased by 40% 30 min post MSG ingestion. At baseline, TMD showed lower PPTols in the masseter and trapezius, and higher diastolic blood pressure and heart rate than healthy controls. The MSG ingestion resulted in reports of headache by half of the TMD and healthy controls, respectively.

Conclusion

These findings suggest that myofascial TMD patients may be particularly sensitive to the effects of ingested MSG.

What does this study add?’

1. Elevation of interstitial glutamate concentration in the masseter muscle caused by monosodium glutamate (MSG) ingestion was significantly greater in myofascial myofascial temporomandibular disorders (TMD) patients than healthy individuals.
2. This elevation of interstitial glutamate concentration in the masseter muscle significantly increased the intensity of spontaneous pain in myofascial TMD patients.

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Thalamic Functional Connectivity in Mild Traumatic Brain Injury: Longitudinal Associations with Patient-Reported Outcomes and Neuropsychological Tests

The Immediate Biomechanical Implications of Transfer Component Skills Training on Independent Wheelchair Transfers

Fusion adds little value to decompression for lumbar spinal stenosis, studies show

Fusion of affected vertebrae in treating lumbar spinal stenosis achieves no improvement in clinical outcomes, including disability due to low back pain, when compared with decompression surgery, the...

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Is hyperactivity ubiquitous in ADHD or dependent on environmental demands? Evidence from meta-analysis

Children’s Exposure to Intimate Partner Violence: A Meta-Analysis of Longitudinal Associations with Child Adjustment Problems

Eating Disorders and Personality, 2004-2016: A Systematic Review and Meta-analysis

Economic Insecurity Increases Physical Pain

The past decade has seen a rise in both economic insecurity and frequency of physical pain. The current research reveals a causal connection between these two growing and consequential social trends. In five studies, we found that economic insecurity produced physical pain and reduced pain tolerance. In a sixth study, with data from 33,720 geographically diverse households across the United States, economic insecurity predicted consumption of over-the-counter painkillers. The link between economic insecurity and physical pain emerged when people experienced the insecurity personally (unemployment), when they were in an insecure context (they were informed that their state had a relatively high level of unemployment), and when they contemplated past and future economic insecurity. Using both experimental-causal-chain and measurement-of-mediation approaches, we also established that the psychological experience of lacking control helped generate the causal link from economic insecurity to physical pain. Meta-analyses including all of our studies testing the link from economic insecurity to physical pain revealed that this link is reliable. Overall, the findings show that it physically hurts to be economically insecure.

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Ignoring adverse experiences of people taking statins

In primary prevention trials statins slightly reduce atherosclerotic events but not total serious adverse events.1 Another paradox is that many patients have muscle pain, fatigue, or weakness that...

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Short message service prompts for skills practice in Internet-delivered cognitive behaviour therapy for chronic pain – are they feasible and effective?

Abstract

Background

Patients face numerous challenges adopting skills taught within pain self-management programmes. The present study reports the acceptability and preliminary outcomes of supplementing an Internet-delivered cognitive behavioural therapy (iCBT) course for chronic pain, the Pain Course, with brief automated short message service (SMS) prompts that encourage skills practice.

Methods

Participants were recruited from the Waitlist Control Group of a large randomized controlled trial and provided access to the Pain Course over 8 weeks, with the addition of SMS prompts. Fifteen SMS prompts were created to encourage the use of self-management skills during the course. Participants were sent one random SMS prompt each business day. The acceptability of the SMS was assessed and clinical outcomes of participants who received prompts (n = 56) compared with a historical group who previously received the course without prompts (n = 139).

Results

SMS prompts were rated highly with 85% reporting them to be very helpful or helpful and that they would recommend them to others. Clinical improvements for those receiving SMS, at post-treatment and 3-month follow-up (disability, d = 0.44; 0.58; anxiety d = 0.50; 0.51; depression, d = 0.78; 0.79 and average pain d = 0.49; 0.54), were consistent with participant who had received the course previously without SMS (ps >0.05).

Conclusions

Brief automated SMS prompts were an acceptable adjunct to iCBT for chronic pain but did not result in any additional clinical benefit. Further research is needed to systematically evaluate the potential of SMS prompts to increase skills practice and facilitate treatment outcomes.

What does this study add?

• Automated short message service (SMS) messages are an acceptable means of prompting skills practice during iCBT for chronic pain.
• SMS prompts did not improve clinical outcomes of an established clinician-supported iCBT programme.

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Cognitive biases to appearance-related stimuli in body dissatisfaction: A systematic review

Analgesics or pain, who is the real enemy? Suggestions from the CDC guidelines

Responsible use of analgesic drugs is crucial to the management of pain. Proper diagnosis and classification of pain, measurement of its intensity with a validated scale, determination of the type of...

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A systematic review of depression psychotherapies among Latinos

The Effect of Base Rate on the Predictive Value of Brain Biomarkers

The use of biomarkers as an objective measure of pain has received substantial attention in the recent literature, with proponents arguing that brain-derived markers in particular may some day surpass, or even replace, self-report in the characterization of pain.1 Several empirical studies regarding the use of pain biomarkers for diagnosis and classification have been published in recent years.3,7,14,22 However, to our knowledge, no such studies have considered the critical effect of previous probabilities on the diagnostic utility of biomarkers for pain.

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An often forgotten cause of chest pain

A 66 year old white woman presented to the emergency department of a district general hospital with shortness of breath and chest pain, which radiated to her back. She had previously received...

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