Clinical prediction rules for prognosis and treatment prescription in neck pain: A systematic review

Clinical prediction rules (CPRs) developed to identify sub-groups of people with neck pain for different prognoses (i.e. prognostic) or response to treatments (i.e. prescriptive) have been recommended as a research priority to improve health outcomes for these conditions. A systematic review was undertaken to identify prognostic and prescriptive CPRs relevant to the conservative management of adults with neck pain and to appraise stage of development, quality and readiness for clinical application.

from Manual Therapy http://ift.tt/2et5ZJJ
via IFTTT

Are physiotherapists adhering to quality indicators for the management of knee osteoarthritis? An observational study

Osteoarthritis (OA) is a common musculoskeletal condition that often leads to pain, stiffness and disability. Physiotherapy plays an important role in the management of knee OA, however we hypothesize discordance between physiotherapists' practice and existing guideline recommendations.

from Manual Therapy http://ift.tt/2eJwXgW
via IFTTT

Neuropsychology: Pain passed on by smell

Neuropsychology: Pain passed on by smell

Nature 538, 7626 (2016). doi:10.1038/538430c

Mice housed in the same room as one another can pass certain types of pain to each other through smell.Exposure to inflammatory molecules or withdrawal from drugs or alcohol can cause hyperalgesia, a painful hypersensitivity to touch, heat or chemical irritants. Andrey Ryabinin and

from Nature - Issue - nature.com science feeds http://ift.tt/2eGLo5f
via IFTTT

An incidental finding

A 68 year old man presented with abdominal pain and underwent abdominal radiography. What finding is present on the radiograph (fig 1)?bmj;355/oct26_2/i5419/F1F1f1Fig 1 Anteroposterior abdominal...

from Latest headlines from BMJ http://ift.tt/2euvPzM
via IFTTT

An unusual cause of a mass in the groin

A healthy 61 year old man presented with left groin and thigh pain on exercise. Examination showed a deep rounded mass in the left femoral triangle that exhibited arterial pulsation. Ultrasound...

from Latest headlines from BMJ http://ift.tt/2eQqYWF
via IFTTT

Updating the definition of pain

No abstract available

from PAIN - Featured Articles - Current Issue Highlights http://ift.tt/2e67EVl
via IFTTT

Spotlight on pain: optogenetic approaches for interrogating somatosensory circuits

No abstract available

from PAIN - Featured Articles - Current Issue Highlights http://ift.tt/2e69G7O
via IFTTT

Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial

Abstract: Cognitive behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit patients with chronic pain by increasing mindfulness and pain acceptance. However, little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR vs CBT. In a randomized controlled trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with chronic low back pain (N = 342), we examined (1) baseline relationships among measures of catastrophizing, self-efficacy, acceptance, and mindfulness and (2) changes on these measures in the 3 treatment groups. At baseline, catastrophizing was associated negatively with self-efficacy, acceptance, and 3 aspects of mindfulness (nonreactivity, nonjudging, and acting with awareness; all P values <0.01). Acceptance was associated positively with self-efficacy (P < 0.01) and mindfulness (P values <0.05) measures. Catastrophizing decreased slightly more posttreatment with MBSR than with CBT or UC (omnibus P = 0.002). Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks (omnibus P = 0.001). In both the entire randomized sample and the subsample of participants who attended ≥6 of the 8 MBSR or CBT sessions, differences between MBSR and CBT at up to 52 weeks were few, small in size, and of questionable clinical meaningfulness. The results indicate overlap across measures of catastrophizing, self-efficacy, acceptance, and mindfulness and similar effects of MBSR and CBT on these measures among individuals with chronic low back pain.

from PAIN - Featured Articles - Current Issue Highlights http://ift.tt/2e64alX
via IFTTT

Opioid prescribing for patients with cancer in the last year of life: a longitudinal population cohort study

Abstract: We linked UK cancer registry data with the corresponding electronic primary care medical records of 6080 patients who died of cancer over a 7-year period in a large United Kingdom city. We extracted all prescriptions for analgesics issued to each patient in the linked cohort during the 12 months before death and analysed the extent and duration of strong opioid treatment with clinical and patient characteristics. Strong opioids were prescribed for 48% of patients in the last year of life. Median interval between first prescription of a strong opioid and death was 9 weeks (interquartile range 3-23). Strong opioid prescribing was not influenced by cancer type, duration of illness, or gender but was adversely influenced by older age. Compared with patients who died in a hospice, those who died in a hospital were 60% less likely to receive a strong opioid in primary care before admission (relative risk ratio 0.4, CI 0.3-0.5, P < 0.01). The study provides the first detailed analysis of the relatively late onset and short duration of strong opioid treatment in patients with cancer before death in a representative UK cohort. This pattern of prescribing does not match epidemiological data which point to earlier onset of pain. Although persistent undertreatment of cancer pain is well documented, this study suggests that strategies for earlier pain assessment and initiation of strong opioid treatment in community-based patients with cancer could help to improve pain outcomes.

from PAIN - Featured Articles - Current Issue Highlights http://ift.tt/2e64alI
via IFTTT

Does degree of vulvar sensitivity predict vulvodynia characteristics and prognosis?

Although women with vulvodynia typically have increased vulvar sensitivity, data on characteristics associated with the degree of vulvar sensitivity are lacking. We measured vulvar sensitivity by cotton swab test and vulvodolorimeter among a subset of 335 women, ages <70 years, in the longitudinal Woman to Woman Health Study. Comparing the vulvodynia screening results from their online/paper survey to that at the time of the examination, 42 cases had ongoing vulvodynia, 66 cases had a recent remission, 22 controls now had a recent onset of vulvodynia, and 205 controls remained asymptomatic.

from The Journal of Pain http://ift.tt/2eDdIai
via IFTTT

National Trends in Direct Healthcare Expenditures Among Us Adults With Migraine: 2004-2013

Migraine is a common neurological disorder with significant economic burden in the United States. However, changes in the economic burden of migraine in the past decade have not been examined given therapeutic advances at the national level. Therefore, we estimated cross-sectional trends in the incremental total and types of direct healthcare expenditures among individuals with migraine using a nationally representative data, the Medical Expenditures Panel Survey. The analytic sample comprised of a weighted population of 228,010,000 adults aged 18 years and older from 2004 to 2013.

from The Journal of Pain http://ift.tt/2f1QPjA
via IFTTT

Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial

Objective To evaluate whether invasive coronary angiography or computed tomography (CT) should be performed in patients clinically referred for coronary angiography with an intermediate probability...

from Latest headlines from BMJ http://ift.tt/2exliEp
via IFTTT

Threat and fear of pain induces attentional bias to pain words: An eye-tracking study

Abstract

Background

This study aimed to investigate the effects of fear of pain (FOP) and threat on attentional biases, using eye-tracking methods.

Method

One hundred and seven undergraduate students were randomized to receive threatening or reassuring information about the cold pressor task; and divided into high and low FOP groups. Participants completed the dot-probe task, while their eye movements were tracked.

Results

Results showed that those who received threatening information were less likely to have their first fixation on pain words, particularly affective pain words. Furthermore, under conditions of high threat, the high FOP group who did fixate on affective pain words, fixated more quickly than for sensory pain words, whereas the opposite was the case under low threat. In regression analyses, initial vigilance towards affective pain words was a significant predictor of reporting pain more quickly on the cold pressor.

Conclusions

Taken together, these results suggest that initial vigilance of affective pain stimuli predicts actual hypervigilance to an acute experimental pain task. However, under conditions of high threat, participants show evidence of avoidance of affective pain words, even though when they do fixate on these stimuli, the high FOP group does so more quickly. These results confirm that attentional processes, characterized by vigilance avoidance, appear important.

Significance

Interventions that change attention towards pain to reduce vigilance and subsequent avoidance may be indicated to improve pain outcomes.

from European Journal of Pain http://ift.tt/2eJnypG
via IFTTT

Extinction of fear generalization: a comparison between fibromyalgia patients and healthy controls

Fear learning deficiencies might contribute to the development and maintenance of chronic pain disability. Fear is often not restricted to movements (conditioned stimulus=CS+) originally associated with pain (unconditioned stimulus=US), but expands to similar movements (generalization stimuli=GSs). This spreading of fear becomes dysfunctional when overgeneralization to safe stimuli occurs. More importantly, persistence of pain-related fear to GSs despite corrective feedback might even be more debilitating and maintain long-term chronic pain disability.

from The Journal of Pain http://ift.tt/2exPn4C
via IFTTT

Functional characterization of at-level hypersensitivity in patients with spinal cord injury

At-level and above-level hypersensitivity was assessed in patients with chronic complete thoracic spinal cord injury (SCI). Patients were classified by somatosensory mapping (brush, cold, pinprick) and assigned into two groups, i.e. patients i) with at-level hypersensitivity (SCIHs, n=8) and ii) without at-level hypersensitivity (SCINHs, n=7). Gender and age-matched healthy subjects served as controls. Quantitative sensory testing (QST), electrically- and histamine-induced pain and itch, laser Doppler imaging and laser-evoked potentials (LEP) were recorded at-level and above-level in SCI-patients.

from The Journal of Pain http://ift.tt/2f3xNIw
via IFTTT

Matching Task Difficulty to Patient Ability During Task Practice Improves Upper Extremity Motor Skill After Stroke

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

Predictors of Exercise Adherence in Patients With Meniscal Tear and Osteoarthritis

Exploration of conditioned pain modulation effect on long-term potentiation-like pain amplification in humans

Abstract

Background

This study aimed to explore conditioned pain modulation (CPM) effect on long-term potentiation (LTP)-like pain amplification induced by cutaneous 10-Hz conditioning electrical stimulation (CES).

Methods

Conditioned pain modulation was induced by cold pressor conditioning stimulus (CPCS) (4 °C) which was applied immediately before CES in the active session. In the control session, water with a temperature of 32 °C was used. Twenty subjects participated in two sessions in a randomized crossover design with at least 1-week interval. Perceptual intensity ratings to single electrical stimulation (SES) at the conditioned skin site and to pinprick and light-stroking stimuli in the immediate vicinity of the CES electrodes were measured . Superficial blood flow (SBF), skin temperature (ST) and heat pain threshold (HPT) were measured covering both homotopic and heterotopic skin. The pain intensities during CES process were measured and short-form McGill Pain Questionnaire (SF-MPQ) was used for assessing CES pain experience.

Results

Cold pressor conditioning stimulus reduced pain perception increments to weak pinprick and light-stroking stimuli after 10-Hz CES compared with the control session. Moreover, CPCS resulted in lower pain intensity ratings during CES process but without affecting the SF-MPQ scores between two sessions. The SBF and ST increased after CES and then gradually declined but without differences between CPCS and control sessions. CPM did not affect HPT and pain intensity increments to SES.

Conclusions

The CPCS inhibited heterotopic perception amplification to weak mechanical stimuli after CES. The results indicate that endogenous descending inhibitory systems might play a role against development of non-nociceptive perception amplificatory states (e.g. allodynia).

Significance

Conditioned pain modulation (CPM) may play a role in inhibiting the pain amplificatory process at the central nervous system and prompting central desensitization. CPM has a special inhibition effect for the development of perception amplification to non-painful mechanical stimuli.

from European Journal of Pain http://ift.tt/2dTludD
via IFTTT

Is interferential current prior to Pilates exercises more effective than placebo in patients with chronic non-specific low back pain? A randomized controlled trial

Sensorimotor control in individuals with idiopathic neck pain and healthy individuals: A systematic review and meta-analysis

When Less Is More: The indications for MIS Techniques and Separation Surgery in Metastatic Spine Disease

Study Design. Systematic review. Objective. The aim of this study was to review the techniques, indications, and outcomes of minimally invasive surgery (MIS) and separation surgery with subsequent radiosurgery in the treatment of patients with metastatic spine disease. Summary of Background Data. The utilization of MIS techniques in patients with spine metastases is a growing area within spinal oncology. Separation surgery represents a novel paradigm where radiosurgery provides long-term control after tumor is surgically separated from the neural elements. Methods. PubMed, Embase, and CINAHL databases were systematically queried for literature reporting MIS techniques or separation surgery in patients with metastatic spine disease. PRISMA guidelines were followed. Results. Of the initial 983 articles found, 29 met inclusion criteria. Twenty-five articles discussed MIS techniques and were grouped according to the primary objective: percutaneous stabilization (8), tubular retractors (4), mini-open approach (8), and thoracoscopy/endoscopy (5). The remaining 4 studies reported separation surgery. Indications were similar across all studies and included patients with instability, refractory pain, or neurologic compromise. Intraoperative variables, outcomes, and complications were similar in MIS studies compared to traditional approaches, and some MIS studies showed a statistically significant improvement in outcomes. Studies of mini-open techniques had the strongest evidence for superiority. Conclusions. Low-quality evidence currently exists for MIS techniques and separation surgery in the treatment of metastatic spine disease. Given the early promising results, the next iteration of research should include higher-quality studies with sufficient power, and will be able to provide higher-level evidence on the outcomes of MIS approaches and separation surgery. Level of Evidence: N/A

from Spine - Featured Articles - Featured Articles http://ift.tt/2ejfgY2
via IFTTT

Cognitive Interventions and Nutritional Supplements (The CINS Trial): A Randomized Controlled, Multicenter Trial Comparing a Brief Intervention With Additional Cognitive Behavioral Therapy, Seal Oil, and Soy Oil for Sick-Listed Low Back Pain Patients

Study Design. A randomized controlled trial. Objective. The aim of this study was to evaluate whether a tailored and manualized cognitive behavior therapy (CBT) or nutritional supplements of seal oil and soy oil had any additional benefits over a brief cognitive intervention (BI) on return to work (RTW). Summary of Background Data. Brief intervention programs are clinically beneficial and cost-effective for patients with low back pain (LBP). CBT is recommended for LBP, but evidence on RTW is lacking. Seal oil has previously been shown to have a possible effect on muscle pain, but no randomized controlled trials have so far been carried out in LBP patients. Methods. Four hundred thirteen adults aged 18 to 60 years were included. Participants were sick-listed 2 to 10 months due to LBP. Main outcome was objectively ascertained work participation at 12-month follow-up. Participants were randomly assigned to BI (n = 100), BI and CBT (n = 103), BI and seal oil (n = 105), or BI and soy oil (n = 105). BI is a two-session cognitive, clinical examination program followed by two booster sessions, while the CBT program is a tailored, individual, seven-session manual-based treatment. Results. At 12-month follow-up, 60% of the participants in the BI group, 50% in the BI and CBT group, 51% in the BI and seal oil group, and 53% in the BI and soy oil group showed reduced sick leave from baseline, and had either partly or fully RTW. The differences between the groups were not statistically significant (χ2 = 2.54, P = 0.47). There were no significant differences between the treatment groups at any of the other follow-up assessments either, except for a significantly lower sick leave rate in the BI group than the other groups during the first 3 months of follow-up (χ2 = 9.50, P = 0.02). Conclusion. CBT and seal oil had no additional benefits over a brief cognitive intervention on sick leave. The brief cognitive intervention alone was superior in facilitating a fast RTW. Level of Evidence: 2

from Spine - Featured Articles - Featured Articles http://ift.tt/2ejjBuf
via IFTTT

Can Patients With Low Back Pain Be Satisfied With Less Than Expected?

Study Design. A prospective cohort study within care as usual. Objective. (1) To explore the psychometric properties of a baseline disability questionnaire designed to collect patients’ expectation. (2) To analyze relations between satisfaction with care and treatment success in patients with chronic low back pain (CLBP). (3) To determine the chances of being satisfied with the received care in absence of treatment success. Summary of Background Data. There is a lack of evidence on determinants of treatment satisfaction in patients with CLBP, specifically the role of patient's expectation of disability reduction after treatment. Methods. Treatment expectation was measured with questions inspired by the Pain Disability Index (PDI) at baseline. Treatment success was considered if disability at the end of therapy was lower than, or equal to pretreatment expectation. An exploratory factor analysis was performed on the new questionnaire. Binary logistic regression models were used to analyze how much variance of satisfaction with care was explained by treatment success, pain disability at baseline, sex, age, duration of complaints, and pain intensity. The odds ratio of being satisfied when treatment was successful was calculated. Results. Six hundred nine patients were included. The factor structure of the PDI-expectancy had optimal fit with a one factor structure. There were low correlations between the expected and baseline disability, pain intensity, and duration of pain. Correlation between treatment success and satisfaction with care was low (χ2 = 0.13; P < 0.01). Treatment success had a low contribution to satisfaction with care. Of all participating patients, 51.4% were satisfied with care even when treatment was not successful. The odds ratio for being satisfied was 2.42 when treatment was successful compared to when treatment was not successful. Conclusion. The PDI-expectancy is internally consistent. Pretreatment expectation contributes uniquely but slightly to satisfaction with care; patients whose treatment was considered successful have 1.38 to 4.24 times higher chance of being satisfied at the end of treatment. Even when treatment was not successful, 51.4% of the patients with CLBP are satisfied with care. Level of Evidence: 2

from Spine - Featured Articles - Featured Articles http://ift.tt/2ejgx1h
via IFTTT

Neuroscience: Why mole rats don't feel the heat

Neuroscience: Why mole rats don't feel the heat

Nature 538, 7625 (2016). doi:10.1038/538293c

A gene variant could explain why naked mole rats are impervious to certain types of pain that most mammals experience when exposed to heat.In the nervous system, a peptide called nerve growth factor (NGF) mediates hypersensitivity to pain caused by heat. Gary Lewin at

from Nature - Issue - nature.com science feeds http://ift.tt/2dqKZ4U
via IFTTT

A mass on the spine indicating Pott’s disease

A 24 year old student was admitted with a three month history of right sided back pain radiating to the right iliac fossa. He had ongoing weight loss of 15 kg during this period, and had experienced...

from Latest headlines from BMJ http://ift.tt/2e0Ja1B
via IFTTT

Quiet dissent: The attitudes, beliefs and behaviours of UK osteopaths who reject low back pain guidance – A qualitative study

Our central theme was a ‘Precedence of Osteopathy’ over medicine and other manual therapies. Three subthemes were: 1) beliefs about self; 2) perceptions of others; 3) attitudes to guidelines and research.

from Manual Therapy http://ift.tt/2eqwTRZ
via IFTTT

Authors’ reply to Hawkins

Impacted ear wax is an important and common presentation in primary care and may be associated with pain, as Hawkins has pointed out.1 2 Wax is apparent on examination and should be removed not only...

from Latest headlines from BMJ http://ift.tt/2dlgbrf
via IFTTT