Neural correlates differ in high and low fear-avoidant chronic low back pain patients when imagining back-straining movements

The fear-avoidance model postulates that in an initial acute phase chronic low back pain (CLBP) patients acquire a fear of movement that results in avoidance of physical activity and contributes to the pain becoming chronic. The current fMRI study investigated the neural correlates of imagining back-straining and neutral movements in CLBP patients with high (HFA) and low fear avoidance (LFA) and healthy pain-free participants. Ninety-three persons (62 CLBP patients, 31 healthy controls; age 49.7 ± 9.2 years) participated.

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

High-concentration L-menthol exhibits counter-irritancy to neurogenic inflammation, thermal and mechanical hyperalgesia caused by TRPA1-agonist trans-cinnamaldehyde

The TRPM8-agonist L-menthol has been used traditionally for its topical counter-irritant properties. While the use of topical L-menthol for pain is casuistically established, evidence regarding its efficacy is negligible. This study aimed to characterize the effect of L-menthol as a counter-irritant on cutaneous pain and hyperalgesia provoked by topical application of the TRPA1-agonist trans-cinnamaldehyde (CA). In a randomized, double-blinded study CA was applied to a 3x3cm area of the volar forearm evoking neurogenic inflammation, pain, mechanical and thermal hyperalgesia in 14 healthy volunteers.

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

Repetitive Transcranial Magnetic Stimulation for phantom limb pain in landmine victims: A double-blinded, randomized, sham-controlled trial

We evaluated the effects of repetitive Transcranial Magnetic Stimulation (rTMS) in the treatment of phantom limb pain (PLP) in landmine victims. Fifty-four patients with PLP were enrolled in a randomized, double-blinded placebo-controlled parallel group, single center trial. The intervention consisted in real or sham rTMS of M1 contralateral to the amputated leg. RTMS was given in series of 20 trains of 6s of duration (54 s inter-train, intensity 90% of Motor Threshold) at a stimulation rate of 10 Hz (1200 pulses), 20 minutes per day, during 10 days.

from The Journal of Pain http://ift.tt/1Phm8Tf
via IFTTT

The Development of a Technologically-Based Hierarchy to Assess Chronic Low Back Pain and Pain-Related Anxiety from a Fear-Avoidance Model

Previous studies have not examined the assessment of chronic low back pain (CLBP) and pain-related anxiety from a fear avoidance model through the use of motion-capture software and virtual human technologies. The aim of this study was to develop and assess the psychometric properties of an interactive, technologically based hierarchy that can be used to assess patients with pain and pain-related anxiety. We enrolled thirty licensed Physical Therapists and thirty participants with CLBP. Participants rated 21 video clips of a 3-D animated character (avatar) engaging in activities that are typically feared by patients with CLBP.

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

How should we teach lumbar manipulation? A consensus study

Spinal manipulation is an effective intervention for low back pain, yet there is little consistency in how this skill is taught.

from Manual Therapy http://ift.tt/25sT42A
via IFTTT

Table of Contents

from The Journal of Pain http://ift.tt/25roiHt
via IFTTT

Editorial Board

from The Journal of Pain http://ift.tt/1Ub4w7w
via IFTTT

Masthead

from The Journal of Pain http://ift.tt/25rohTK
via IFTTT

Erratum to (438) Efficacy of CL-108 Compared to Hydrocodone 7.5 mg/Acetaminophen 325 mg in Preventing Vomiting and the Use of Anti-Emetics, Opioid-Induced Nausea and Vomiting (OINV)

Elliot Hersh, Bernard Schachtel, William Kozarek, Emily Schachtel, and Mark Marino; University of Pennsylvania School of Dental Medicine, Philadelphia, PA.

from The Journal of Pain http://ift.tt/1Ub3RD8
via IFTTT

Erratum to (440) Opioid-Induced Nausea and Vomiting (OINV) in Post-Operative Patients: A Comparison of CL-108 to Hydrocodone 7.5 mg/Acetaminophen 325 mg

Stephen Richardson, Kyle Patrick, Stephen Daniels, Steven Royall, Emily Schachtel, Bing Zhang, Mark Marino, and Bernard Schachtel; Charleston Laboratories, Jupiter, FL.

from The Journal of Pain http://ift.tt/25roAht
via IFTTT

Erratum

Two sentences with incorrect information appeared in Thieme H, Morkisch N, Rietz C, Dohle C, Borgetto B: Management of postoperative pain: The efficacy of movement representation techniques for treatment of limb pain—a systematic review and meta-analysis. J Pain 17:167-180, 2016.

from The Journal of Pain http://ift.tt/1Ub4LPV
via IFTTT

[Policy Forum] Paying for future success in gene therapy

Imagine a young man with hemophilia A who no longer has to self-administer factor VIII replacement; an individual with sickle cell disease who is free of chronic pain and intermittent crises; a girl functionally blind since the age of 5 who can now see; or a baby rescued from a fatal, inherited neurodegenerative disease. For decades, gene therapy has tantalized us with such futuristic scenarios. However, these goals are now coming into focus, and it is the time to consider some of the consequences of success. Authors: Stuart H. Orkin, Philip Reilly

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

Exploring peer-mentoring for community dwelling older adults with chronic low back pain: a qualitative study

Location, location, location: Variation in sensitivity to pain across the body

Abstract

Background

There is evidence that sensitivity to noxious stimuli differs between the sexes and across the body, but few studies have investigated differences in the perception and experience of acute pain stimuli across the body in healthy individuals.

Methods

We recruited 52 healthy participants, aged 18–36 (50% men) and administered 39, 42 and 45 °C stimuli at four body sites bilaterally to examine differences in the experience of pain intensity and unpleasantness between body sites via an 11-point numerical rating scale.

Results

Noxious and innocuous thermal heat stimuli were perceived as significantly more intense when delivered to the wrist (M = 3.98, SD = 1.93) and back (M = 4.07, SD = 1.98) compared to the shoulder (M = 3.45, SD = 1.91) and leg (M = 3.46, SD = 1.87). Pain unpleasantness ratings yielded similar findings; stimuli were perceived as more unpleasant when administered to the wrist (M = 2.83, SD = 1.93) and lower back (M = 3.04, SD = 2.11) compared to the shoulder (M = 2.63, SD = 1.85) and leg (M = 2.26, SD = 1.82).

Conclusions

These findings suggest that painful thermal stimuli delivered to the wrist and back are perceived as more intense and unpleasant compared with other body sites in healthy persons. These differences may be due to variations in receptor density, or the relative importance of these sites for daily living and survival.

Significance

Moreover, these insights are helpful for the design of studies investigating pain experience in healthy persons in experimental or clinical settings.

What does this study add?

• We tested sensitivity to acute suprathreshold thermal stimulations across a range of body sites to investigate for potential variability. We found significant differences in the perceived intensity and unpleasantness of noxious and innocuous thermal stimuli at the wrist and lower back, compared with the shoulder and leg. These results suggest that pain experience is driven by receptor density or the relative functional importance of these sites.

from European Journal of Pain http://ift.tt/20zGB6t
via IFTTT

Reductions in tonic GABAergic current in substantia gelatinosa neurons and GABAA receptor δ subunit expression after chronic constriction injury of the sciatic nerve in mice

Abstract

Background

Decreased Gamma-aminobutyric acid (GABA)-ergic phasic inhibitory transmission in the spinal cord is thought to be responsible for the development of neuropathic pain. However, the role of GABAergic tonic current in substantia gelatinosa (SG) neurons in neuropathic pain remains to be fully elucidated. In this study, we assessed GABAergic tonic currents of SG neurons in a sciatic nerve chronic constriction injury (CCI) mouse.

Method

Whole-cell patch clamp recordings form lumbar spinal cord slices was performed to evaluate GABAergic currents. We also investigated the expression changes of GABA_A receptor subunits which are considered to mediate tonic currents.

Results

The percentage of SG neurons receiving GABAergic tonic currents decreased in CCI mice compared with Naïve mice. No significant change was observed in the mean amplitude of GABAergic tonic currents. RT-PCR and Western blot revealed that the expression of GABA_A receptor δ subunits decreased following CCI.

Conclusion

A reduction in the expression the δ subunit of the GABA_A receptor and diminished GABAergic tonic current in SG neurons were observed after CCI in mice. GABAergic tonic current plays a key role in neuropathic pain. The GABA_A receptor δ subunit may be a therapeutic target in neuropathic pain.

What does this study add?

In spinal SG neurons, GABAergic inhibitory transmission operates through both phasic and tonic currents, but physiological role is largely unknown. In this study, we report dysregulation of GABA_A receptor δ subunit-mediated tonic current in SG neurons may result in spinal disinhibition resulting in neuropathic pain in CCI mice.

from European Journal of Pain http://ift.tt/1XU3G4T
via IFTTT

Effects of Leg-Press Training With Moderate Vibration on Muscle Strength, Pain, and Function After Total Knee Arthroplasty: A Randomized Controlled Trial

Additional Effects of a Physical Therapy Protocol on Headache Frequency, Pressure Pain Threshold, and Improvement Perception in Patients With Migraine and Associated Neck Pain: A Randomized Controlled Trial

Upper Limb Absence: Predictors of Work Participation and Work Productivity

Experimental manipulations of pain catastrophizing influence pain levels in patients with chronic pain and healthy volunteers

Abstract: Pain catastrophizing (PC) has been related to pain levels in both patients experiencing acute or chronic pain and in healthy volunteers exposed to experimental pain. Still, it is unclear whether high levels of pain catastrophizing lead to high levels of pain or vice versa. We therefore tested whether levels of pain catastrophizing could be increased and decreased in the same participant through hypnotic suggestions and whether the altered level of situation-specific pain catastrophizing was related to increased and decreased pain levels, respectively. Using the spontaneous pain of 22 patients with chronic tension-type headache and experimentally induced pain in 22 healthy volunteers, participants were tested in 3 randomized sessions where they received 3 types of hypnotic suggestions: Negative (based on the 13 items in the Pain Catastrophizing Scale), Positive (coping-oriented reversion of the Pain Catastrophizing Scale), and Neutral (neutral sentence) hypnotic suggestions. The hypnotic suggestions significantly increased and decreased situation-specific PC in both patients and healthy volunteers (P < 0.001). Also, the levels of pain intensity and pain unpleasantness were significantly altered in both patients and healthy volunteers (P < 0.001). Furthermore, regression analyses showed that changes in pain catastrophizing predicted changes in pain in patients (R2 = 0.204-0.304; P < 0.045) and in healthy volunteers (R2 = 0.328-0.252; P < 0.018). This is the first study to successfully manipulate PC in positive and negative directions in both patients with chronic pain and healthy volunteers and to show that these manipulations significantly influence pain levels. These findings may have important theoretical and clinical implications.

from PAIN - Featured Articles - Current Issue Highlights http://ift.tt/1VgoXVS
via IFTTT

Post-renal AKI secondary to large bladder calculus

A 40 year old woman presented with four weeks of persistent vomiting and reduced urination in the absence of abdominal pain. Examination identified no abdominal masses but a hard mass rectally. Urea...

from Latest headlines from BMJ http://ift.tt/1OIA8Qh
via IFTTT

The association between dry needling-induced twitch response and change in pain and muscle function in patients with low back pain: A quasi-experimental study

Increasing Physical Activity and Participation in People with Multiple Sclerosis: A Review

Chest and neck pain in a 22 year old woman

A 22 year old woman was referred to the emergency department by her general practitioner owing to severe chest pain that was now radiating to her neck. The pain has been worsening over the past 24...

from Latest headlines from BMJ http://ift.tt/27CVni7
via IFTTT

Pain, Fatigue, and Physical Activity in Osteoarthritis: The Moderating Effects of Pain- and Fatigue-Related Activity Interference

Intrarater Agreement of Elbow Extension Range of Motion in the Upper Limb Neurodynamic Test 1 Using a Smartphone App

Tai chi improves pain in patients with knee arthritis, trial finds

Tai chi produced beneficial effects similar to a standard course of physical therapy in the treatment of knee osteoarthritis, a randomised single blind trial has shown.1Tai chi is a traditional...

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

Culture moderates children’s responses to ostracism situations.

Across a series of studies, we investigated cultural differences in children’s responses to ostracism situations. Working with the children of farmers and herders, we focused on how painful children estimate ostracism to be. Study 1a showed that 4- to 8-year-old children from a socially interdependent farming community estimated ostracism to be less painful than did children from an independent herding community. Study 1b showed that this cultural difference was specific to social pain and did not apply to physical pain. Study 2 replicated the results of Study 1a and showed that individual differences in parents’ level of social interdependence mediated the relationship between cultural group and how painful children estimate ostracism to be. Study 3 replicated this effect again and showed that children’s tendency to recommend seeking social support following ostracism mediated the relationship between cultural group and the perceived pain of being excluded. Finally, Study 4 investigated cultural differences in moral responses to ostracism and showed that children from the farming community punished an individual who ostracized someone else less harshly than did children from the independent herding community. Thus different economic cultures are associated with striking differences in social interdependence and responses to ostracism from early in development. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

from Journal of Personality and Social Psychology - Vol 110, Iss 5 http://ift.tt/24QjNCk
via IFTTT

The Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) is not an adequate outcome measure of pressure ulcer-related neuropathic pain

Abstract

Background

Few pain assessment scales have been used in pressure ulcer (PU) research and none developed or validated for people with PUs. We examined the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale to determine its utility as an outcome measure for people with pressure area-related pain.

Methods

Leeds Assessment of Neuropathic Symptoms and Signs data from 728 participants underwent psychometric analyses: traditional tests for data quality, scaling assumptions, reliability and validity and a Rasch analysis including tests of fit, spread and targeting of item locations, response dependency, person separation index (reliability) and differential item functioning.

Results

Our findings offer support for a unidimensional scale; confirmatory factor analysis indicated a non-significant chi-square test of model fit [(df = 14) 23.48, p = 0.053]. However, some misfit was identified at the overall scale and individual item levels, and internal construct validity of the LANSS as an outcome measure for neuropathic pain in people with pressure area-related pain was not supported; low to moderate item-total correlations [Chi Square (df = 28) 55.546, p = 0.002] and inter-item correlations (mean 0.117 and range from 0.063 to 0.415); and low Cronbach's alpha (0.549) and Person Separation Index (0.334).

Conclusions

Requirements for reliable and valid measurement do not support the use of the LANSS as an outcome measure in people with PUs at the individual level or as a generalized measurement scale of neuropathic pain across ulcer severity groups. Expanding the number of items to aid differentiation between neuropathic pain levels and improving scale reliability is recommended.

What does this study add?

The Leeds Assessment of Neuropathic Symptoms and Signs scale (LANSS) is not suitable as an outcome measure of pressure ulcer-related neuropathic pain as it did not meet requirements for reliable and valid measurement in this population.

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

Patients with sciatica still experience pain and disability 5 years after surgery: A systematic review with meta-analysis of cohort studies

Abstract

Background and objective

The clinical course of patients with sciatica is believed to be favourable, but there is conflicting evidence on the postoperative course of this condition. We aimed to investigate the clinical course of sciatica following surgery.

Databases and data treatment

An electronic search was conducted on MEDLINE, EMBASE and CINAHL from inception to April 2015. We screened for prospective cohort studies investigating pain or disability outcomes for patients with sciatica treated surgically. Fractional polynomial regression analysis was used to generate pooled means and 95% confidence intervals (CI) of pain and disability up to 5 years after surgery. Estimates of pain and disability (converted to a 0–100 scale) were plotted over time, from inception to last available follow-up time.

Results

Forty records (39 cohort studies) were included with a total of 13,883 patients with sciatica. Before surgery, the pooled mean leg pain score was 75.2 (95% CI 68.1–82.4) which reduced to 15.3 (95% CI 8.5–22.1) at 3 months. Patients were never fully recovered in the long-term and pain increased to 21.0 (95% CI 12.5–29.5) at 5 years. The pooled mean disability score before surgery was 55.1 (95% CI 52.3–58.0) and this decreased to 15.5 (95% CI 13.3–17.6) at 3 months, and further reduced to 13.1 (95% CI 10.6–15.5) at 5 years.

Conclusions

Although surgery is followed by a rapid decrease in pain and disability by 3 months, patients still experience mild to moderate pain and disability 5 years after surgery.

What does this review add?

This review provides a quantitative summary of the postoperative course of patients with sciatica. Patients with sciatica experienced a rapid reduction in pain and disability in the first 3 months, but still had mild to moderate symptoms 5 years after surgery. Although no significant differences were found, microdiscectomy showed larger improvements compared to other surgical techniques.

from European Journal of Pain http://ift.tt/1YoU1S3
via IFTTT

[Feature] Museum drawers go digital

No one knows exactly how many natural history specimens exist in museums and other research institutions worldwide, but some calculate it's on the order of 3 billion. In most cases, the displays seen by visitors make up a tiny slice of this treasure; museum curators estimate that more than 99% is stored away from the public gaze. Researchers have for decades used museum specimens to answer questions about how species diverge, where they move around the globe, and how they respond to changing conditions. But they have traditionally had to travel from museum to museum in person, or else request that the specimens be mailed to them. Now, even as museums struggle with funding woes that limit their activities, many around the world are working to put specimen photographs and related data online where anyone can view them. Until recently, these efforts were slow and painstaking, barely chipping away at the staggering amount of data in collections. Now, technological advances and innovative workflows are allowing institutions to think bigger, ushering in a new age of mass digitization. A new conveyor belt system at the Smithsonian Institution's National Museum of Natural History in Washington, D.C., will allow the digitization of 650,000 specimens within the period of a year, each one costing just $1. As digitization grows faster and cheaper, more governments and institutions are investing in it. Since 2011, the U.S. National Science Foundation has devoted $10 million per year to digitization efforts in nonfederal collections across the United States. But even with these new funding opportunities, museum officials and curators stress that there is still far too little money to make all specimens digital. Author: Nala Rogers

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

Development and content of the biopsychosocial primary care intervention ‘Back on Track’ for a subgroup of people with chronic low back pain

Electrical Stimulation for hemiplegic shoulder function: A systematic review and meta-analysis of 15 randomized controlled trials

Is the brain of complex regional pain syndrome patients truly different?

Abstract

Background

In recent years, changes in brain structure and function have been studied extensively in patients with complex regional pain syndrome (CRPS) following clinical observations of altered central processing of sensory stimuli and motor control. However, concerning MRI data, the evidence is complex to interpret due to heterogeneity in statistical methods and results.

Method

The aim of this study was to determine if CRPS patients exhibit specific, clinically relevant changes in brain structure and function in rest. We do this by presenting MRI data on brain structure and function in 19 chronic, female CRPS patients and age- and sex-matched healthy controls (HCs). In addition, we analyse and report the data in multiple ways to make comparison with previous studies possible and to demonstrate the effect of different statistical methods, in particular, concerning the correction for multiple testing.

Results

Using family-wise error (FWE) correction for multiple testing, in our group of CRPS patients, we find no specific difference in brain structure or function in rest in comparison to HCs. In addition, we argue that previously found MRI results in the literature are inconsistent in terms of localization, quantity and directionality of the reported changes in brain structure and function.

Conclusion

Previously published MRI-based evidence for altered brain structure and function in rest in CRPS patients is not consistent and our data suggests that no such phenomenon exists.

What does this study add?

This article does not replicate the previous found results. The reported evidence in MRI literature of aberrant neuroplasticity in CRPS patients is inconsistent in terms of localization, quantity and directionality of changes in brain structure and function.

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

Habituation deficit of auditory N100m in patients with fibromyalgia

Abstract

Background

Habituation refers to the brain's inhibitory mechanism against sensory overload and its brain correlate has been investigated in the form of a well-defined event-related potential, N100 (N1). Fibromyalgia is an extensively described chronic pain syndrome with concurrent manifestations of reduced tolerance and enhanced sensation of painful and non-painful stimulation, suggesting an association with central amplification of all sensory domains. Among diverse sensory modalities, we utilized repetitive auditory stimulation to explore the anomalous sensory information processing in fibromyalgia as evidenced by N1 habituation.

Methods

Auditory N1 was assessed in 19 fibromyalgia patients and age-, education- and gender-matched 21 healthy control subjects under the duration-deviant passive oddball paradigm and magnetoencephalography recording. The brain signal of the first standard stimulus (following each deviant) and last standard stimulus (preceding each deviant) were analysed to identify N1 responses. N1 amplitude difference and adjusted amplitude ratio were computed as habituation indices.

Results

Fibromyalgia patients showed lower N1 amplitude difference (left hemisphere: p = 0.004; right hemisphere: p = 0.034) and adjusted N1 amplitude ratio (left hemisphere: p = 0.001; right hemisphere: p = 0.052) than healthy control subjects, indicating deficient auditory habituation. Further, augmented N1 amplitude pattern (p = 0.029) during the stimulus repetition was observed in fibromyalgia patients.

Conclusions

Fibromyalgia patients failed to demonstrate auditory N1 habituation to repetitively presenting stimuli, which indicates their compromised early auditory information processing. Our findings provide neurophysiological evidence of inhibitory failure and cortical augmentation in fibromyalgia.

What's already known about this topic?

• Fibromyalgia has been associated with altered filtering of irrelevant somatosensory input. However, whether this abnormality can extend to the auditory sensory system remains controversial.
• N!00, an event-related potential, has been widely utilized to assess the brain's habituation capacity against sensory overload.

What does this study add?

• Fibromyalgia patients showed defect in N100 habituation to repetitive auditory stimuli, indicating compromised early auditory functioning.
• This study identified deficient inhibitory control over irrelevant auditory stimuli in fibromyalgia.

from European Journal of Pain http://ift.tt/279USM8
via IFTTT

A meta-analytic review of brief guided self-help education for chronic pain

Abstract

Up to 30% of the population in Western countries suffer from chronic pain. The treatment of chronic pain causes medical and socioeconomic problems. Guided self-help (GSH) might be an effective supplementary treatment, however, the size of this effect is unclear. This meta-analysis quantifies the effect of GSH on chronic pain. A systematic literature search was conducted using PubMed, Cochrane, Psyndex, Psycinfo and Scopus. Studies that investigated GSH in chronic pain conditions (children and adults) were included. Disability, quality of life and pain severity were defined as main outcomes. We conducted random effects models to calculate standardized mean differences (SMDs). By applying mixed models and subgroup analyses, we examined the moderating effects of sample characteristics (age; pain region), GSH format (online; face-to-face contact) and study characteristics (study quality; control condition). We identified 16 eligible studies, including 739 subjects. Between-group analyses resulted in a medium, but heterogeneous effect size for pain severity (SMD = 0.51; CI₉₅: 0.21, 0.81). After excluding two samples suggesting small study bias, the effect on pain severity was small but homogeneous (SMD = 0.34; CI₉₅: 0.13, 0.54). We found a small effect size for disability (SMD = 0.30; CI₉₅: 0.10, 0.50). The pooled effect size for quality of life did not reach significance (SMD = 0.24; CI₉₅: −0.07, 0.54). We conclude that GSH has a small but robust effect on pain severity and disability in chronic pain patients. This applies to various GSH formats and patient populations. It seems reasonable to integrate GSH into clinical practice as a supplemental treatment option.

What does this review add?

The present meta-analytic review found small but robust effects of guided self-help interventions for the treatment of chronic pain.

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

The clinimetric properties of the COMFORT scale: A systematic review

Abstract

The COMFORT scale is a measurement tool to assess distress, sedation and pain in nonverbal paediatric patients. Several studies have described the COMFORT scale, but no formal assessment of the methodological quality has been undertaken. Therefore, we performed a systematic review to study the clinimetric properties of the (modified) COMFORT scale in children up to 18 years. We searched Central, CINAHL, Embase, Medline, PsycInfo and Web of Science until December 2014. The selection, data extraction and quality assessment were performed independently by two reviewers. Quality of the included studies was appraised using the COSMIN checklist. We found 30 studies that met the inclusion criteria. Most participants were ventilated children up to 4 years without neurological disorders. The results on internal consistency and interrater reliability showed values of >0.70 in most studies, indicating an adequate reliability. Construct validity resulted in correlations between 0.68 and 0.84 for distress, between 0.42 and 0.94 for sedation and between 0.31 and 0.96 for pain. The responsiveness of the (modified) COMFORT scale seems to be adequate. The quality of the included studies ranged from poor to excellent. The COMFORT scale shows overall an adequate reliability in providing information on distress, sedation and pain. Construct validity varies from good to excellent for distress, from moderate to excellent for sedation, and from poor to excellent for pain. The included studies were clinically and methodologically heterogeneous, hampering firm conclusions.

What does this review add?

1. An in-depth assessment of the clinimetric properties of the COMFORT scale.

• The COMFORT scale shows overall an adequate reliability in providing information on distress, sedation and pain. Construct validity varies from good to excellent for distress, from moderate to excellent for sedation, and from poor to excellent for pain.

from European Journal of Pain http://ift.tt/279URb4
via IFTTT

Motor/Prefrontal Transcranial Direct Current Stimulation (tDCS) Following Lumbar Surgery Reduces Postoperative Analgesia Use

Study Design. Randomized, controlled pilot trial. Objective. The present study is the first randomized, double-blind, sham-controlled pilot clinical trial of transcranial direct current stimulation (tDCS) for pain and patient-controlled analgesia (PCA) opioid usage among patients receiving spine surgery. Summary of Background Data. Lumbar spinal surgeries are common, and while pain is often a complaint that precedes surgical intervention, the procedures themselves are associated with considerable postoperative pain lasting days to weeks. Adequate postoperative pain control is an important factor in determining recovery and new analgesic strategies are needed that can be used adjunctively to existing strategies potentially to reduce reliance on opioid analgesia. Several novel brain stimulation technologies including tDCS are beginning to demonstrate promise as treatments for a variety of pain conditions. Methods. Twenty-seven patients undergoing lumbar spine procedures at Medical University of South Carolina were randomly assigned to receive four 20-minute sessions of real or sham tDCS during their postsurgical hospital stay. Patient-administered hydromorphone usage was tracked along with numeric rating scale pain ratings. Results. The effect of tDCS on the slope of the cumulative PCA curve was significant (P < 0.001) and tDCS was associated with a 23% reduction in PCA usage. In the real tDCS group a 31% reduction was observed in pain-at-its-least ratings from admission to discharge (P = 0.027), but no other changes in numeric rating scale pain ratings were significant in either group. Conclusion. The present pilot trial is the first study to demonstrate an opioid sparing effect of tDCS after spine surgical procedures. Although this was a small pilot trial in a heterogeneous sample of spinal surgery patients, a moderate effect-size was observed for tDCS, suggesting that future work in this area is warranted. Level of Evidence: 2

from Spine - Featured Articles - Featured Articles http://ift.tt/1TP7AJ6
via IFTTT

Targeted Therapy for Low Back Pain in Elderly Degenerative Lumbar Scoliosis: A Cohort Study

Study Design. Prospective cohort study. Objective. To compare the novel treatment procedure with nonoperative treatment for low back pain (LBP) in elderly patients with degenerative lumbar scoliosis (DLS). Summary of Background Data. Treatment of LBP associated with elderly DLS is controversial. We developed a novel treatment procedure, termed percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI). Methods. We included patients with de novo DLS aged ≥65 years who had LBP with a visual analogue scale (VAS) score of >50 for ≥6 months with intervertebral vacuum and vertebral bone marrow edema (BME) defined on fat-saturated T2-weighted or gadolinium-enhanced T1-weighted magnetic resonance imaging. The primary outcomes were evaluated using the VAS score and modified Oswestry Disability Index (ODI). As an objective measurement, we scored BME on magnetic resonance imaging. Results. Between August 2004 and July 2011, 109 patients underwent PIPI and 53 received nonoperative treatment. At 1 month, mean improvements in VAS scores were −55.3 (95% CI, −60.5 to −50.1) and −1.9 (CI, −7.7 to 3.8) and mean improvements in ODI were −22.7 (CI, −27.3 to −18.2) and −0.6 (CI, −6.6 to 5.4) for the PIPI and nonoperative groups, respectively. At 2 years, mean improvements in VAS scores were −52.2 (CI, −59.9 to −44.4) and −4.0 (CI, −10.9 to 3.0) and mean improvements in ODI were −20.7 (CI, −27.3 to −14.5) and −1.0 (CI, −7.7 to 5.7) for the PIPI and nonoperative groups, respectively. BME substantially decreased in the PIPI group compared with the nonoperative group (P <0.001) and correlated with VAS score and ODI improvements (VAS score: r = 0.502, P <0.001; ODI: r = 0.372, P <0.001). Conclusion. PIPI improved treatment for LBP, with a sustained clinical benefit for at least 2 years. Level of Evidence: 3

from Spine - Featured Articles - Featured Articles http://ift.tt/1TP7AZH
via IFTTT

Bone Marrow Edema and Low Back Pain in Elderly Degenerative Lumbar Scoliosis: A Cross-Sectional Study

Study Design. Cross-sectional study. Objective. To examine whether bone marrow edema is associated with low back pain in elderly patients with degenerative lumbar scoliosis. Summary of Background Data. The cause of low back pain in degenerative lumbar scoliosis is unclear. Methods. A total of 120 degenerative lumbar scoliosis patients 65 years of age or older were evaluated. Radiography, computed tomography (CT), magnetic resonance imaging (MRI), and tender point examination in the lumbar spine were performed. On MRI, coronal gadolinium-contrasted T1- or T2-weighed fat-saturated images were used to score the size of bone marrow edema. The prevalence of bone marrow edema in patients with and without low back pain was compared; in patients with low back pain, we tested whether the locations of lumbar tender point were consistent with that of bone marrow edema. Results. Bone marrow edema was found in 62 of 64 (96.9%) patients with low back pain compared with 21 of 56 (37.5%) patients without it (P < 0.001). Bone marrow edema located more frequently on the concave side than on the convex side of scoliosis (P < 0.001). Among patients with low back pain, bone marrow edema score was associated with low back pain severity (r = 0.724; P < 0.001), and the location of lumbar tender point were consistent with that of bone marrow edema (κ value = 0.745; P < 0.001). Conclusion. Bone marrow edema on MRI was closely associated with the presence of low back pain in elderly degenerative lumbar scoliosis. Level of Evidence: 4

from Spine - Featured Articles - Featured Articles http://ift.tt/1TP7Ckf
via IFTTT

The Impact of Small Spinal Curves in Adolescents Who Have Not Presented to Secondary Care: A Population-Based Cohort Study

Study Design. A prospective, population-based, birth cohort study. Objective. The aim of this study was to identify whether there is any hidden burden of disease associated with smaller spinal curves. Summary of Background Data. Adolescent idiopathic scoliosis is present in 3% to 5% of the general population. Large curves are associated with increased pain and reduced quality of life. However, no information is available on the impact of smaller curves, many of which do not reach secondary care. Methods. The Avon Longitudinal Study of Parents and Children (ALSPAC) recruited over 14,000 pregnant women from the Bristol area of South-West England between 1991 and 1992 and has followed up their offspring regularly. At age 15, presence or absence of spinal curvature ≥6 degrees in the offspring was identified using the validated dual-energy X-ray absorptiometry Scoliosis Measure on 5299 participants. At age 18, a structured pain questionnaire was administered to 4083 participants. Logistic regression was used to investigate any association between presence of a spinal curve at age 15 and self-reported outcomes at age 18 years. Results. Full data were available for 3184 participants. Two hundred two (6.3%) had a spinal curve ≥6 degrees and 125 (3.9%) had a curve ≥10 degrees (median curve size of 11 degrees). About 46.3% reported aches and pains that lasted for a day or longer in the previous month. About 16.3% reported back pain. Those with spinal curves were 42% more likely to report back pain than those without (odds ratio 1.42, 95% confidence interval 1.00–2.02, P = 0.047). Those with spinal curves had more days off school and were more likely to avoid activities that caused their pain. Conclusion. Our results highlight that small scoliotic curves may be less benign than previously thought. Teenagers with small curves may not present to secondary care, but are nonetheless reporting increased pain, more days off school, and avoidance of activities. These data suggest that we should reconsider current scoliosis screening and treatment practices. Level of Evidence: 2

from Spine - Featured Articles - Featured Articles http://ift.tt/1TP7CAJ
via IFTTT

Effect of body mass index on knee function outcomes following continuous passive motion in patients with osteoarthritis after total knee replacement

Reliability of lumbar movement dysfunction tests for chronic low back pain patients; Methodological concerns to avoid misinterpretation

I was interested to read the paper by Bauer CM and colleagues published in the Mar 2016 issue of Man Ther. They aimed to evaluate the reliability of three movement dysfunction tests named trunk range of motion (ROM), movement or control impairment (MCI), and reposition error (RE) when measured with a novel Inertial measurement unit (IMU)-systems. (1) The authors used generalizability-theory and minimal detectable change, measuring 21 chronic low back pain patients in seven trials on two days. They reported that on average, ROM test were more reliable, compared to MCI and RE tests.

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

Towards Identifying Moderators of Associations Between Pre-Surgery Emotional Distress and Post-Operative Pain Outcomes: A Meta-Analysis of Longitudinal Studies

Pre-surgery emotional distress has had variable associations with outcomes of surgery in past narrative reviews. This meta-analysis was designed to evaluate overall strengths of relation between pre-surgical emotional distress and key post-surgical pain outcomes (i.e., pain intensity, analgesic use, functional impairment) and to identify moderators that might explain effect size heterogeneity between studies. PubMed, Web of Science, PsychINFO, Google Scholar, and Science Direct databases were searched to identify studies subjected to meta-analysis.

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

Effects of the carrier frequency of interferential current on pain modulation and central hypersensitivity in people with chronic nonspecific low back pain: A randomized placebo-controlled trial

Abstract

Background

Interferential current (IFC) is commonly used for pain relief, but the effects of carrier frequency of the current and its action on pain mechanisms remain unclear. This randomized placebo-controlled trial tested the effects of IFC in people with chronic nonspecific low back pain.

Methods

One hundred and fifty participants were randomly allocated into three groups: 1 kHz, 4 kHz and placebo. The primary outcomes were pain intensity at rest in the first session (immediate effect of the IFC), after 12 sessions, 4 months after randomization (follow-up) and during movement (first and last session). The secondary outcomes were disability, global perceived effect, functional performance, discomfort caused by the IFC, use of analgesics and physiological measures of pain.

Results

Only during the first session, there was a significant decrease in pain intensity in the active groups. However, there were no differences in the improvement of pain at rest or during movement in the active groups compared to the placebo group in the remaining sessions. The frequency use of analgesics was significantly decreased in the active groups. For pain physiology measures, there was a significant increase in pressure pain thresholds in both active groups compared to the placebo group and a reduction in the temporal summation in the 1 kHz group compared to the other groups.

Conclusions

These results suggest that although the IFC has changed some physiological mechanisms of pain and showed decrease frequency use of pain medication, there was no change in the primary aim, pain intensity.

What does this study add?

• The interferential current (IFC) presented advantages in the physiological measures of pain and showed decrease frequency use of pain medication.
• Future studies should investigate analgesic intake with IFC treatment.

from European Journal of Pain http://ift.tt/1SRcM04
via IFTTT

Repeated exposure to others’ pain reduces vicarious pain intensity estimation

Abstract

Background

Pain perception in others can be influenced by different contextual factors. In clinical settings, the repeated exposure to others’ pain has been proposed as a factor that could explain underestimation of patients’ pain by health care providers. Previous research supported this idea by showing that repeated exposure to persons in pain biases the subsequent willingness to impute pain in others. However, it remains unclear if the effect of repeated exposure on the detection of pain extends to deliberate pain estimation of stimuli presented for a longer period.

Method

Therefore, in a first experiment, healthy participants were either exposed to clips of facial expressions of intense pain or neutral expressions before estimating the intensity of other individuals’ pain expressions. To test the specificity of this effect with regard to the pain content, a second study was conducted with healthy adults, which compared the effect of exposure to fear, pain and neutral videos on subsequent pain assessment in others.

Results

Results from the first experiment indicated that repeated exposure to others’ pain diminished the subsequent estimation of the intensity of pain in others. Results from the second experiment suggested that exposure to fear could bias pain estimation in a similar manner. However, the absence of difference in ratings between the exposure to fear and neutral groups warrants caution in the interpretation of these findings.

Conclusion

By demonstrating that repeated exposure to others’ pain diminished subsequent pain estimation in others, this study adds relevant information on the factors that could contribute to pain underestimation in health care professionals.

What does this study add?

• Repeated exposure to facial expressions of intense pain not only biases pain detection, but also pain estimation in others.
• Prior exposure to facial expressions of pain compared to exposure to neutral ones leads to a reduced estimation of others’ pain. This effect is not specific to pain as exposure to another negative emotion (fear) also biases subsequent pain estimation.
• These results support the interpretation that the underestimation of patients’ pain by health care professionals could be related to repeated exposure to other's pain.

from European Journal of Pain http://ift.tt/1Wc0Wjn
via IFTTT

Perceived pain extent is associated with disability, depression and self-efficacy in individuals with whiplash-associated disorders

Abstract

Background

Completion of a pain drawing is a familiar task in those presenting with whiplash-associated disorders (WAD). Some people report pain almost over their entire body. Yet the reasons for larger pain extent have not been fully explored.

Methods

A novel method was applied to quantify pain extent from the pain drawings of 205 individuals with chronic WAD. Pain extent was evaluated in relation to sex, age, educational level, insurance status and financial status. Multiple linear regression analysis was used to verify whether pain extent was associated with other health indicators including perceived pain and disability, health-related quality of life, pain catastrophizing, anxiety, depression and self-efficacy.

Results

Pain extent was influenced by sex (χ²:10.392, p < 0.001) with larger pain extent in women compared to men (7.88 ± 7.66% vs. 5.40 ± 6.44%). People with unsettled insurance claims (χ²: 7.500, p < 0.05) and those with a worse financial situation (χ²:12.223, p < 0.01) also had larger pain extent. Multiple linear regression models revealed that, when accounting for age, sex, education, insurance status, financial status and neck pain intensity, pain extent remained associated with perceived disability (p < 0.01), depression (p < 0.05) and self-efficacy (p < 0.001).

Conclusion

By utilizing a novel method for pain extent quantification, this study shows that widespread pain is associated with a number of factors including perceived disability, depression and self-efficacy in individuals with chronic WAD. Widespread pain should alert the clinician to consider more specific psychological screening, particularly for depression and self-efficacy, in patients with WAD.

What does this study add?

Women with chronic WAD, those with unsettled insurance claims and those with poorer financial status perceive more widespread pain.

When controlling for these factors, larger pain areas remain associated with perceived pain and disability, depression and self-efficacy.

The pain drawing is useful to support psychological screening in people with chronic WAD.

from European Journal of Pain http://ift.tt/1STbaQ4
via IFTTT

Discrepancies between cortical and behavioural long-term readouts of hyperalgesia in awake freely moving rats

Abstract

Background

It is still unclear to what extent the most common animal models of pain and analgesia, based on indirect measures such as nocifensive behaviours, provide valid measures of pain perception.

Methods

To address this issue, we developed a novel animal model comprising a more direct readout via chronically (>1 month) implanted multichannel electrodes (MCE) in rat primary somatosensory cortex (S1; known to be involved in pain perception in humans) and compared this readout to commonly used behavioural pain-related measures during development of hyperalgesia. A translational method to induce hyperalgesia, UVB irradiation of the skin, was used. Localized CO₂ laser stimulation was made of twenty skin sites (20 stimulations/site/observation day) on the plantar hind paw, before and during the time period when enhanced pain perception is reported in humans after UVB irradiation.

Results

We demonstrate a 2–10 fold significant enhancement of cortical activity evoked from both irradiated and adjacent skin and a time course that corresponds to previously reported enhancement of pain magnitude during development of primary and secondary hyperalgesia in humans. In contrast, withdrawal reflexes were only significantly potentiated from the irradiated skin area and this potentiation was significantly delayed as compared to activity in S1.

Conclusions

The present findings provide direct evidence that chronic recordings in S1 in awake animals can offer a powerful, and much sought for, translational model of the perception of pain magnitude during hyperalgesia.

What does this study add?

In a novel animal model, chronic recordings of nociceptive activity in primary somatosensory cortex (S1) in awake freely moving rats are compared to behavioural readouts during UVB-induced hyperalgesia. Evoked activity in rat S1 replicates altered pain perception in humans during development of hyperalgesia, but withdrawal reflexes do not.

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

Incidence and prognosis of mid-back pain in the general population: A systematic review

Abstract

Background and objective

Despite being common early in life and affecting individuals' quality of life to the same degree as neck and low back pain, research into epidemiological aspects of mid-back pain (MBP) has been scarce. The purpose of our systematic review was therefore to describe the incidence and prognosis of MBP in the general population. The PRISMA Statement guided the study process.

Databases

A systematic search was conducted in CINAHL, PEDro, PsycINFO and Scopus.

Results

Of 3194 unique records identified, seven were included in our qualitative synthesis. The 3-month and 2-year incidence proportions of MBP in children and adolescents were approximately 4% and 50%, respectively. In adults, the 1-month incidence proportion was less than 1%. The persistence or recurrence of MBP over a 1- to 4-year period was between 13% and 45% in children and adolescents; a change in spinal pain location over time was common. Individuals reporting MBP have an increased risk of future care seeking compared with people without musculoskeletal complaints. No studies assessing adult MBP recovery trajectories or prognostic factors were identified.

Conclusions

Knowledge about the incidence and prognosis of MBP in the general population is limited. The incidence of MBP in children and adolescents seems to be similar to the incidence of neck and low back pain; in adults, it is lower than that of neck and low back pain. Studies investigating recovery trajectories of MBP in adults and prognostic factors for MBP are lacking.

What does this study add?

• The incidence of mid-back pain (MBP) in young individuals is similar to that of neck and low back pain, and ≤50% report persistent pain; however, the evidence base is limited.
• Knowledge about adult trajectories and prognostic factors for MBP is lacking.

from European Journal of Pain http://ift.tt/1NYgR29
via IFTTT

A meta-analysis on pain sensitivity in self-injury

Review Articles
J. Koenig, J. F. Thayer, M. Kaess,
Psychological Medicine, Volume 46 Issue 08, pp 1597-1612

Abstract


from Psychological Medicine - Current Issue http://ift.tt/24xo91j
via IFTTT

Treatment of Patients With Stable Ischemic Heart Disease

To the Editor In a recent issue of JAMA, 2 articles differed on the correct treatment of patients with stable ischemic heart disease. In a Viewpoint on evidence-based management of stable ischemic heart disease, Dr Bangalore and colleagues reviewed evidence showing that coronary revascularization was not associated with a reduction in death, myocardial infarction, unplanned revascularization, or angina compared with medical therapy alone and recommended that revascularization should not be performed as first-line treatment in most stable patients. However, Drs Polonsky and Blankstein, in a JAMA Diagnostic Test Interpretation, presented a case of a 53-year-old man with mild angina after running more than 2 miles, with no other symptoms. He underwent an exercise treadmill test (ETT), which showed excellent functional capacity, absence of chest pain, and a Duke Treadmill Score of 5.5 (low risk [ie, <1% mortality/year]). Despite stable disease, mild symptoms, excellent exercise capacity, and low risk, the patient underwent a coronary angiogram and subsequent coronary artery bypass graft (CABG) surgery. Hence, his treatment appears to contradict that recommended by Bangalore et al. Inappropriate coronary revascularization is a problem worldwide, and although recent years have seen improvement, it still represents a high percentage of all revascularization procedures. Contradictory messages may contribute to this important problem.

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

Treatment of Patients With Stable Ischemic Heart Disease

To the Editor Drs Polonsky and Blankstein presented an informative discussion of a patient with chest pain, but their description of the diagnostic characteristics of the ETT merits closer attention—particularly because the case was published in the JAMA Diagnostic Test Interpretation section. Although they reported that the sensitivity of ETT for obstructive coronary artery disease (CAD) is “approximately 68% in men and 61% in women” and the specificity “is approximately 77% in men and 70% in women,” these estimates may significantly misrepresent the test’s true performance. Because of referral bias (also known as verification bias) in studies that have evaluated ETT, high-risk patients are generally more likely to be referred to cardiac catheterization than low-risk patients. Although clinically appropriate, this referral pattern results in an observed sensitivity that overestimates the test’s true sensitivity and an observed specificity that underestimates the test’s true specificity. Studies and meta-analyses of ETT performance rarely account for this bias, and those that do account for it report, for example, stress test sensitivity rates as low as 32% in women and 42% in men and test specificity rates that exceed 80% in both sexes.

from JAMA Current Issue http://ift.tt/1W6DsNp
via IFTTT

Adjunctive cognitive behavioural treatment for chronic pain couples improves marital satisfaction but not pain management outcomes

Abstract

Background

Data have consistently shown that patient coping with chronic pain can be affected by various factors associated with the primary relationship, and hence efforts to include the patient's partner in the treatment process have merit. This study evaluated the benefit of adding an adjunctive, couples-based, cognitive behavioural treatment (CBT) for chronic pain to a standard cognitive behavioural pain management programme.

Methods

Forty-five couples were randomly assigned to either an adjunctive couples intervention (n = 19) or the pain programme only (n = 26). All patient participants completed a 3-week multi-disciplinary pain management programme, to which their partners were invited to attend one full day. In addition, partners in the adjunctive condition received four, one hour treatment sessions focusing on pain education, patient–partner communication, operant behavioural principles and relapse prevention strategies. Partner sessions for the adjunctive intervention were provided over the telephone.

Results

By the completion of the pain programme the adjunctive couples intervention demonstrated significant improvements in marital satisfaction for the spouses over and above attendance at the pain management programme alone (p = 0.003). However, spouse involvement did not facilitate any additional response to treatment for pain patients on marital satisfaction, pain, disability or any indices of distress. All treatment gains were maintained at 1 month follow-up.

Conclusions

These data demonstrate that a brief CBT intervention can significantly improve marital satisfaction for spouses of chronic pain patients, but the treatment does not translate to improvements in function on any outcomes, including marital satisfaction, for patients of chronic pain.

What does this study add?

• A brief, telephone-based intervention for couples living with chronic pain is an acceptable format for intervention.
• This intervention can significantly improve marital satisfaction for partners of chronic pain patients.
• Patients who are already participating in a multidisciplinary pain programme will not obtain further benefit.

from European Journal of Pain http://ift.tt/1W1HaHm
via IFTTT

Psychological correlates of acute postsurgical pain: A systematic review and meta-analysis

Abstract

Due to the frequency of surgeries, acute postsurgical pain (APSP) is a common problem. However, the role of psychological factors in the experience of this kind of pain has not been well established. In this review, we focused on presurgical psychological factors associated with the experience of APSP. A systematic search of articles was performed using PsycARTICLES, PsycINFO, PubMed, MEDLINE, Scopus, Cochrane and DARE. For each study, we assessed the risk of bias, the level of evidence, the corresponding score points and the degree of association with APSP. Separate meta-analyses were performed for the selected variables. Fifty-three relevant publications were selected. Pain catastrophizing, optimism, expectation of pain, neuroticism, anxiety (state and trait), negative affect and depression were classified as likely associated with APSP. Only one of the analysed psychological variables – locus of control – was recognized as shown unlikely association with APSP. Results of meta-analyses suggested that pain catastrophizing was most strongly linked with APSP. Results of the studies reviewed suggest that patients who do not exaggerate the negative aspects of the situation and who have positive expectation of the future before undergoing surgery report lower levels of APSP than patients who catastrophize pain and expect negative events in the future. An increasing interest in preoperative positive psychological variables has been observed over the last few years in studies of surgical patients.

What does this review add?

• Pain catastrophizing, optimism, expectation of pain, neuroticism, anxiety (state and trait), negative affect and depression were classified as likely associated with acute postsurgical pain, and locus of control was classified as unlikely associated with acute postsurgical pain.
• Anxiety was the psychological variable most frequently measured before surgery.
• Pain catastrophizing was most strongly linked with acute postsurgical pain.

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