Visual reminders of death enhance nociceptive–related cortical responses and event-related alpha desynchronisation

Rubber Hand Illusion Increases Pain Caused by Electric Stimuli.

• We tested the effect of the rubber hand illusion on pain caused by electric stimuli.• Both real hands were covered and stimulated in a double-blind procedure.• Electric stimuli was experienced as more painful on the hand under the illusion.• The pain was experienced as located between the real hand and the rubber hand.• Uncertainty about the location of pain could increase its intensity.

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Index indicates cholesterol management strategy for statin related muscle pain

US researchers have developed an index to evaluate whether muscle symptoms may be due to statin treatment, as well as a strategy to reduce cardiovascular risk in patients affected, after reviewing...

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On a mission to relieve the global epidemic of untreated pain

“The Yazidi people are considered the devil by Daesh, which wants to erase them from the Earth,” explains Richard Trèves, a rheumatologist and university professor in Limoges.The Yazidis, an ancient...

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The association between sleep quality, low back pain and disability: A prospective study in routine practice

Abstract

Background

The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice.

Methods

This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period.

Results

Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between ‘improvement in SQ’ and ‘improvement in LBP’ (4.34 [2.21; 8.51]), and ‘improvement in SQ’ and ‘improvement in disability’ (4.60 [2.29; 9.27]).

Conclusions

Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability.

Significance

In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.

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Altered pain sensitivity and axioscapular muscle activity in neck pain patients compared with healthy controls

Abstract

Background

Previous studies have indicated that neck pain patients feel increased symptoms following upper limb activities, and altered axioscapular muscle function has been proposed as a contributing factor.

Methods

Pain sensitivity and muscle activity, during arm movements, were assessed in neck pain patients and controls. Patients with ongoing insidious-onset neck pain (IONP, N = 16) and whiplash-associated disorders (WAD, N = 9) were included along with sex- and age-matched controls (N = 25). Six series of repeated arm abductions were performed during electromyographic (EMG) recordings from eight bilateral muscles. The first and last three series were separated by 8 min and 42 s, respectively. Each series consisted of three slow and three fast movements. Pressure pain thresholds (PPTs) were recorded bilaterally from neck, head and arm at baseline, after the third and sixth movement series. Pain intensity was recorded on an electronic visual analogue scale (VAS).

Results

Larger pain areas and higher VAS scores were found in patients compared with controls (p < 0.001), and in patients, the VAS scores increased in the course of movements (p < 0.02). PPTs were lower in patients compared with controls at all sites (p < 0.03), and these decreased during arm movements in the IONP group (p < 0.03), while increasing at head and neck sites in controls (p < 0.04). During the slow movements, increasing serratus anterior EMG activity was found in the series with short breaks in-between for the WAD group compared with IONP and controls (p < 0.001).

Conclusion

Axioscapular movement caused different responses in pain sensitivity and muscle activity between neck pain patient groups compared with controls.

Significance

Neck pain patients report increased symptoms following upper limb activities. This study shows that repeated arm movements caused differentiated responses in pain sensitivity and muscle activity between subgroups of neck pain patient and asymptomatic controls. Such findings may be of great clinical significance when planning rehabilitation for this patient population.

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Improvement in the Spatial Distribution of Pain, Somatic Symptoms, and Depression Following a Weight-Loss Intervention

• Obese patients with pain underwent a calorie-restriction weight loss intervention• The spatial distribution of pain, fatigue, and depressive symptoms improved• Improvement was greatest in those losing 10% or more of their body weight• The anti-inflammatory cytokine interleukin-10 increased after weight loss

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Loss of Temporal Inhibition of Nociceptive Information is Associated with Aging and Bodily Pain

• Older adults demonstrated reduced offset analgesia compared to younger adults• No sex differences in offset analgesia were evident in any age group• A reduction stimuli as small as 0.4oC resulted in significant offset analgesia• Reduced offset analgesia was associated with pain in daily life for all age groups

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Influence of neck torsion on near point convergence in subjects with idiopathic neck pain

People with neck pain (NP) experience sensorimotor and oculomotor deficits thought to be due to abnormal cervical afferent input. Convergence insufficiency (CI) measured by near point convergence (NPC) may be a feature in NP and neck torsion might help to differentiate a cervical cause.

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Rooted in the Community: Assessing the Reintegration Impacts of Agriculture on Rural Veterans

[Editorial] Charlottesville: symptomatic of a broader pain

The appalling events in Charlottesville, Virginia, this month bring into arresting focus the devastating effects of racism and hatred. On Saturday Aug 12, a group of politically right-wing protestors, which included white supremacists, neo-Nazis, and Ku Klux Klan members, rallied against the removal of a pro-Confederate statue, and clashed with counter protestors. Heather Heyer, a civil rights activist, was run down and killed by a speeding car driven by a Nazi sympathiser; many more were injured in what is being called an act of domestic terrorism.

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Investigation of four self-report instruments (FABT, TSK-HC, Back-PAQ, HC-PAIRS) to measure healthcare practitioners' attitudes and beliefs toward low back pain: Reliability, convergent validity and survey of New Zealand osteopaths and manipulative physiotherapists

Healthcare practitioner beliefs influence advice and management provided to patients with back pain. Several instruments measuring practitioner beliefs have been developed but psychometric properties for some have not been investigated.

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The Acquisition and Extinction of Fear of Painful Touch: a Novel Tactile Fear Conditioning Paradigm

• Touch that is associated with pain in a predictable pain context induces cued fear• Touch in an unpredictable pain context induces both cued and contextual fear• Both types of fear of touch can be successfully reduced using extinction protocols• Fear of touch is a debilitating symptom in many chronic pain conditions• Tactile conditioning can be a valuable tool for studying fear of touch

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Old Friends with New Faces: are Sodium Channel Blockers the Future of Adjunct Pain Medication Management?

• Specific subtypes of voltage gated sodium channels (Nav1.1-1.9) linked to inflammatory and nociceptive pain.• Pharmacokinetic studies reveal misconceived drug interactions with oxcarbazepine• Carbamazepine and oxcarbazepine may be currently underutilized for certain pain syndromes.• There is a call for additional research for carboxamide subclass of sodium channel blockers in pain

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Validity of the Visual Trajectories Questionnaire for Pain (VTQ-Pain)

• There is growing clinical/research interest in longitudinal patient pain trajectories• We tested the validity of a self-report trajectories question in a back pain population• We compared self-report trajectories to trajectories derived using monthly measurements• We report acceptable validity of a new self-report measure of trajectories

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The Effect of Preoperative Intra-Articular Methylprednisolone on Pain after TKA: a Randomized Double-Blinded Placebo Controlled Trial in Patients with High-Pain Knee Osteoarthritis and Sensitization

• Preoperative intraarticular steroid does not reduce acute post-TKA pain.• Intraarticular steroid reduces preoperative joint IL-6.• Intraarticular steroid does not reduce postoperative sensitization.

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Within/between-session reliability and agreement of lumbopelvic kinematics in the sagittal plane during functional movement control tasks in healthy persons

A lack of adequate lumbopelvic movement control has been suggested as an underlying mechanism contributing to the development and persistence of low back pain and lower limb pathologies. The purpose of this study was to assess the within and between session reliability (i.e. the ability to discriminate between subjects), and the agreement (i.e. whether scores are identical on repeated measures) of lumbopelvic kinematics in the sagittal plane during functional movement control tasks. Kinematics were measured with a portable inertial measurement unit system.

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Beyond weakness: Characterization of pain, sensory profile and conditioned pain modulation in patients with motor neuron disease: A controlled study

Abstract

Background

Motor neuron diseases (MND) represent a group of disorders that evolve with inexorable muscle weakness and medical management is based on symptom control. However, deeper characterization of non-motor symptoms in these patients have been rarely reported.

Methods

This cross-sectional study aimed to describe non-motor symptoms in MND and their impact on quality of life and functional status, with a focus on pain and sensory changes. Eighty patients (31 females, 55.7 ± 12.9 years old) with MND underwent a neurological examination, pain, mood, catastrophizing and psychophysics assessments [quantitative sensory testing (QST) and conditioned pain modulation (CPM)], and were compared to sex- and age-matched healthy controls (HC).

Results

Chronic pain was present in 46% of patients (VAS =5.18 ± 2.0). Pain of musculoskeletal origin occurred in 40.5% and was mainly located in the head/neck (51%) and lower back (35%). Neuropathic pain was not present in this sample. Compared to HC, MND patients had a lower cold detection threshold (p < 0.002), and significantly lower CPM scores (4.9 ± 0.2% vs. 22.1 ± 0.2%, p = 0.012). QST/CPM results did not differ between MND patients with and without pain. Pain intensity was statistically correlated with anxiety, depression and catastrophism, and spasticity scores were inversely correlated with CPM (ρ = −0.30, p = 0.026).

Conclusions

Pain is frequently reported by patients with MNDs. Somatosensory and CPM changes exist in MNDs and may be related to the neurodegenerative nature of the disease. Further studies should investigate the most appropriate treatment strategies for these patients.

Significance

We report a comprehensive evaluation of pain and sensory abnormalities in motor neuron disease (MND) patients. We assessed the different pain syndromes present in MND with validated tools, and described the QST and conditioned pain modulation profiles in a controlled design.

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Does Postural Awareness Contribute to Exercise-Induced Improvements in Neck Pain Intensity? A Secondary Analysis of a Randomized Controlled Trial Evaluating Tai Chi and Neck Exercises

Study Design. Secondary analysis of a randomized controlled trial. Objective. This secondary analysis aims to examine associations of improvement of chronic neck pain with patients’ and intervention-related characteristics. Summary of Background Data. Previous research has found that Tai Chi and neck exercises significantly improved chronic nonspecific neck pain; however, the factors for treatment success remain unclear. Methods. Subjects with chronic nonspecific neck pain were randomly assigned to 12 weeks of group Tai Chi or conventional neck exercises, and they attended 12 weekly sessions of 60 to 90 minutes. The interventions included exercises to improve body awareness, that is, interoceptive and postural awareness. A linear forward stepwise regression analysis was conducted to examine associations with improvements in neck pain intensity. Potential predictor variables included baseline pain, age, sex, the type of intervention, attendance rate and home practice duration, and changes in psychological well-being, perceived stress, and postural and interoceptive awareness during the study. Results. Overall 75 patients were randomized into Tai Chi or conventional exercises, with the majority being women (78.7%). Participants reported an average pain intensity of 50.7 ± 20.4 mm visual analog scale at baseline, and the average reduction of pain intensity in both groups was 21.4 ± 21.3 mm visual analog scale. Regression analysis revealed that reductions in pain intensity from baseline to 12 weeks were predicted by higher pain intensity at baseline (r2 = 0.226, P < 0.001), a decrease in anxiety (r2 = 0.102, P = 0.001), and an increase in postural awareness (r2 = 0.078, P = 0.0033), explaining a total of 40.6% of variance. Conclusion. Neck pain improvement was significantly associated with changes in postural awareness in subject with chronic nonspecific neck pain independent of treatment characteristics. Training of postural awareness might be an important mechanism of action of different exercise-based interventions for chronic neck pain. Level of Evidence: N /A

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A Whole Exome Study Identifies Novel Candidate Genes for Vertebral Bone Marrow Signal Changes (Modic Changes)

Study Design. A family-based study. Objective. The aim of this study was to identify rare genetic factors predisposing to Modic changes (MCs). Summary of Background Data. Lumbar disc degeneration (LDD) is one of the contributing factors behind low back pain (LBP). Lumbar MC visualized as bone marrow signal intensity changes on magnetic resonance imaging (MRI) represent a specific phenotype of LDD, which has a stronger association with LBP than LDD without MC. Methods. The study set consisted of two Finnish families: Family I included seven affected and four unaffected individuals and Family II eight affected and seven unaffected individuals. MCs were evaluated in 26 individuals using MRI. Whole exome sequencing was used to identify alleles cosegregating with MC. Annotate variation was used to carry out functional annotation of alleles and their frequencies were evaluated using 1000Genomes, Sequencing Initiative Suomi (SISu), and the Exome Aggregation Consortium (ExAC) databases. Results. We identified predisposing genetic alleles for MC in two Finnish families. In each family, only single allele cosegregated with MC. In Family I, the observed allele was an insertion and deletion in the HSPG2 gene, resulting in a premature termination codon. In Family II, a single nucleotide polymorphism (rs61753465) in the MAML1 gene was identified in all affected family members. Conclusion. We have identified two novel candidate genes, MAML1 and HSPG2, associating with MC. These genes are important in cartilage structure and joint cartilage maintenance. Our findings are novel among lumbar spine degenerative phenotypes. Level of Evidence: N/A

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Dose-dependent Nerve Inflammatory Response to rhBMP-2 in a Rodent Spinal Nerve Model

Study Design. We developed a spinal nerve root wrapping rodent model to evaluate the relationship between recombinant human bone morphogenetic protein 2 (rhBMP-2) dosage and the degree of inflammation. Objective. To investigate the direct effects of recombinant human bone morphogenetic protein 2 (rhBMP-2) dosage and the degree of inflammation in rodent spinal nerve roots. Summary of Background Data. rhBMP-2 is commonly used in clinical practice to augment spinal fusion. However, complications such as postoperative leg pain, and a higher rate of postoperative neurologic deficits have been reported. These may be attributable to the exposure of adjacent nerve roots to high doses of rhBMP-2. Methods. Eighteen rats were randomized into three groups as follows: Group 1: absorbable collagen sponge (ACS) + 10 μg rhBMP-2, Group 2: ACS + 1 μg rhBMP-2, and Group 3 ACS with 20 μL saline. The ACS containing rhBMP-2 or saline were then wrapped around the L5 nerve root and secured loosely with nonabsorbable sutures. At 1-week postoperation, the rats were sacrificed, and the L5 nerve root and dorsal root ganglion harvested for reverse transcription polymerase chain reaction (RT-PCR), histology and immunohistochemical staining. Results. In our study, 10 μg rhBMP-2 induced a 10-fold increase in seroma compared with 1 μg group. Using RT-PCR, macrophage markers MIP3-α, and CD-68 were upregulated by 8- and 2-fold respectively in comparison with the saline group. Haematoxylin and eosin (H&E) images demonstrated disruption of nerve structures in the high dose 10 μg rhBMP-2, but not at 1 μg rhBMP-2 and with saline. Conclusion. High doses of rhBMP-2 induced neuroinflammation in a dose dependent manner, resulting in higher seroma volume, macrophage marker gene expressions, and higher proportions of immunohistochemically stained TNF-alpha and more macrophage infiltration. Level of Evidence: 2

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Surgery for Refractory Coccygodynia: Operative Versus Nonoperative Treatment

Study Design. This is a retrospective cohort study. Objective. To evaluate the long-term outcomes for patients with refractory coccygodynia treated with coccygectomy compared to a nonsurgical regimen of sitting aids, physical therapy, medications, and injections. Summary of Background Data. The surgical treatment of coccygodynia remains controversial. To date, there has only been one small comparative study of surgical versus nonsurgical treatment. Methods. From 2004 to 2014, 109 patients presenting with coccygodynia were treated with either total coccygectomy or a nonsurgical course of sitting aids, physical therapy, anti-inflammatory medications, and injections. All had at least 2 years of symptoms before surgery. The patient principally made the treatment decision, counseled by the treating physician. Before surgery, all subjects underwent at least 2 years of conservative treatment and three-dimensional imaging (computed tomography and/or magnetic resonance imaging). Subjects completed visual analog pain scales, EuroQol five-dimension, components of the PROMIS measure, and a novel Coccygodynia Disability Index evaluation. Work status, complications, and satisfaction were recorded. Results. A total of 61 patients received nonsurgical care; eight declined participation and five could not be located. Forty-eight patients underwent total coccygectomy; three declined participation and five could not be located. At an average 4.8 years of follow-up (range: 2–9), the nonsurgical visual analog pain scales was 5 and the surgical 2 (P = 0.001); 79% of surgically treated patients were improved at 2 years versus 43% for the nonsurgical group. EuroQol five-dimension (P = 0.002), Coccygodynia Disability Index (0.01), and PROMIS Pain interference scores (0.02) were also significantly improved in the surgical group. Eleven surgical patients (26%) had complications, all wound related with successful resolution; seven treated with dressing changes and four with surgical debridement. Conclusion. Total coccygectomy is a safe and effective surgical treatment of coccygodynia refractory to nonoperative care. Patient-reported outcome measures were improved after surgery compared with nonsurgical management. Postoperative wound care remains a concern. Level of Evidence: 4

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Associations Between Low Back Pain and Muscle-strengthening Activity in U.S. Adults

Study Design. This was a cross-sectional study. Objective. The primary aim of the study was to examine the association between low back pain (LBP) and muscle-strengthening activity (MSA) among U.S. adults using gender-stratified analyses. Summary of Background Data. LBP is a common medical condition that impacts quality of life and professional productivity and increases the financial burden on the health care system by augmenting medical treatment costs. Previous studies analyzing gender-dependent relationships between MSA and LBP have produced mixed results. Methods. Our sample included 12,721 participants from the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES). Participants were categorized into one of three levels of self-reported MSA: no MSA, insufficient MSA (1 day/wk), or meeting the 2008 Department of Health and Human Services (DHHS) recommendation for MSA (≥2 days/wk). Results. Gender-stratified analyses revealed significantly lower odds of reporting LBP among women [odds ratio (OR) 0.82, 95% confidence interval (CI) 0.70–0.96, P = 0.03] and men (OR 0.86; 95% CI 0.70–0.96, P = 0.01) who reported amounts of MSA that met the DHHS recommendation compared with those reporting no MSA. Following adjustment for smoking status, the odds remained significant among women (P = 0.03) but not among men (P = 0.21). Conclusion. These findings indicate that engaging in MSA at least 2 days/wk is associated with lower odds of LBP and that smoking may be an important mediating factor that should be considered in future LBP research. Level of Evidence: 4

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Clinical and Radiographical Differences Between Thoracic Idiopathic Spinal Cord Herniation and Spinal Arachnoid Cyst

Study Design. A retrospective, multicenter, case-controlled study. Objective. The aim of this study was to investigate the clinical and radiographical differences between thoracic idiopathic spinal cord herniation (ISCH) and spinal arachnoid cyst (SAC). Summary of Background Data. ISCH and SAC are relatively rare diseases. Preoperative misdiagnose was frequently reported in both; however, these clinical and radiographical differences remain unclear. Methods. Of 30,469 patients who underwent spinal surgery, 18 (0.059%) and 22 (0.072%) patients were diagnosed as ISCH or SAC at nine hospitals, respectively, and their clinical and radiographical data were retrospectively evaluated. The spinal cord kink angle was measured on magnetic resonance or computed tomography myelography sagittal images; the kink angle was the exterior angle formed between the two tangents to the dorsal-side inflection points at the maximally affected level. Results. There were no significant differences in age, gender, and duration of symptoms. Preoperative motor deficit was significantly higher (94.4%) and severer (manual muscle testing: 3.1 ± 1.1) in ISCH. Brown-Séquard syndrome was observed in 38.9% of ISCH, while no patients in SAC. In addition, leg sensory disorder and bladder rectal disorder were significantly more common in ISCH, while back pain was significantly frequent in SAC. With respect to radiographical findings, the length of disease (5.1 ± 2.7 levels) and altered cerebrospinal flow (CSF) (81.8%) in the lesion was significantly longer and more common in SAC. On the contrary, the kink angle was significantly greater in ISCH (54.0 ± 23.1°) than in SAC (14.1 ± 12.0°) (P < 0.001). The cut-off value of the kink angle to distinguish ISCH and SAC was 32.8°. Conclusion. Patients with ISCH commonly had severe preoperative neurological deficit, Brown-Séquard syndrome, and higher kink angle, while patients with SAC had back pain, longer length of disease, and altered CSF in the lesion. Level of Evidence: 4

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SRS-22r Scores in Nonoperated Adolescent Idiopathic Scoliosis Patients With Curves Greater Than Forty Degrees

Study Design. Case control comparative series. Objective. Describe surgical range adolescent idiopathic scoliosis (AIS) patients electing to forgo surgery and compare health-related quality-of-life outcomes to a similar cohort of operated AIS patients by the same single surgeon. Summary of Background Data. No data have been published either documenting SRS-22r scores of nonoperated patients with curves ≥40° or comparing these scores to a demographically similar operated cohort. Methods. Individuals with curves ≥40°, age ≥18 years, and electing to forgo surgery were identified. All patients completed an SRS-22r questionnaire. This nonoperated cohort's SRS-22r scores were compared to those of a large demographically similar cohort operated by the same surgeon. Group differences between the SRS-22r scores were evaluated by comparing these to published Minimal Clinically Important Differences (MCID) for the SRS-22r. Results. One hundred ninety subjects with nonoperated curves were compared to 166 individuals who underwent surgery. The nonoperated cohort averaged 23.5 years of age, averaged 7.7 years since curve reached 40°, and had an average 50° Cobb angle at last follow-up. No statistical significant differences were found between the groups on the Pain, Function, or Mental Health domains of the SRS-22r. Statistically significant differences in favor of the operative cohort were found for self-image, satisfaction, and total score. The observed group differences did not meet the established thresholds for minimal clinically important differences in any of the domain scores, the average total score, or raw scores. Conclusion. There are no meaningful clinically significant differences in SRS-22r scores at average 8-year follow-up between AIS patients with curves ≥40° treated with or without surgery. These data in conjunction with an absence of long-term evidence of serious medical consequences with nonsurgical management of curves ≥40° should encourage surgeons to reevaluate the benefits of routine surgical care. Level of Evidence: 3

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Psychosocial Stress After a Disaster and Low Back Pain-Related Interference With Daily Living Among College Students: A Cohort Study in Fukushima

Study Design. A cohort study. Objective. To investigate the association between psychosocial stress and low back pain (LBP)-related interference with daily living among college students. Summary of Background Data. Few longitudinal studies have examined the likelihood of developing LBP in the presence of a designated psychosocial stressor. All participants in the present study were suddenly affected by the Great East Japan disaster after enrolment in our cohort study. Methods. The present study was initiated among 95 students at Fukushima Medical University in January 2011. We assessed psychosocial stress in students using the Japanese version of the Perceived Stress Scale (JPSS). Follow-up surveys were conducted in July 2011 and May 2013, analyzing 94 students. Students were then divided into three groups (improved, −19 to −4; Maintained, −3 to +4; Aggravated, +5 to +22) based on the tertile points of JPSS change from baseline to 4 months after the disaster. LBP-related interference with daily living was assessed using the Brief Pain Inventory (BPI) questionnaire. Linear regression modeling was performed with BPI at 4 months after the disaster as the outcome, and JPSS change, sex, history of LBP, baseline physical activity, and baseline BPI as explanatory variables. Results. We found a significant increase in BPI score for the aggravated stress group (β coefficient, +0.79; 95% confidence interval, +0.06–+1.53), compared with the improved stress group. History of LBP and higher physical activity were also significantly associated with BPI. Conclusion. The present study suggests that perceived psychosocial stress induced by the disaster may be associated with LBP-related interference with daily living among college students in Fukushima. Level of Evidence: 3

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Of 20,376 Lumbar Discectomies, 2.6% of Patients Readmitted Within 30 Days: Surgical Site Infection, Pain, and Thromboembolic Events Are the Most Common Reasons for Readmission

Study Design. A retrospective cohort study of prospectively collected data. Objective. As an initial effort to address readmissions after lumbar discectomy, reasons for hospital readmission are identified and discussed. Summary of Background Data. Lumbar discectomy is a commonly performed procedure. The Affordable Care Act codifies penalties for hospital readmissions. New quality-based reimbursements tied to readmissions call for a better understanding of the causes of readmission after procedures such as lumbar discectomy. Methods. Lumbar discectomies performed in 2012 to 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patient demographics, surgical variables, and reasons for readmissions within 30 days were recorded. Pearson chi square was used to compare rates of demographics and surgical variables between readmitted and nonreadmitted patients. Multivariate regression was used to identify risk factors for readmission. Results. Of 20,376 lumbar discectomies, 533 patients (2.62%) were readmitted within 30 days of surgery. The most common reasons for readmission were surgical site infections (n = 130, 0.64% of all discectomies, 24.4% of all readmissions), followed by pain issues (n = 89, 0.44%, 16.7%), and thromboembolic events (43, 0.21%, 8.1%). Overall time to readmission was 13.0 ± 8.0 days (mean ± standard deviation). Factors most associated with readmission after lumbar discectomy were higher American Society of Anesthesiologists class (relative risk = 1.49, P < 0.001) and prolonged operative time (relative risk = 1.41, P = 0.002). Conclusion. Surgical site infection, postoperative pain, and thromboembolic events were the most common reasons for readmission after lumbar discectomy. These findings identify potential areas for quality improvement initiatives. Level of Evidence: 3

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Pregnant and nil by mouth

A 36 year old woman who was 29 weeks pregnant (gravida 5 para 4) presented with pain in her abdomen and right flank. She denied any dysuria or urinary frequency, but complained of several episodes of...

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An unusual cause of chest pain

A 65 year old man with a 40 pack year smoking history described a one month history of worsening breathlessness and chest discomfort on walking. He presented to hospital following a collapse after...

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Chronic widespread pain prevalence in the general population: A systematic review

Abstract

Chronic widespread pain (CWP) is a significant burden in communities. Understanding the impact of population-dependent (e.g., age, gender) and contextual-dependent (e.g. survey method, region, inequality level) factors have on CWP prevalence may provide a foundation for population-based strategies to address CWP. Therefore, the purpose of this study was to estimate the global prevalence of CWP and evaluate the population and contextual factors associated with CWP. A systematic review of CWP prevalence studies (1990–2017) in the general population was undertaken. Meta-analyses were conducted to determine CWP prevalence, and study population data and contextual factors were evaluated using a meta-regression. Thirty-nine manuscripts met the inclusion criteria. Study CWP prevalence ranged from 1.4% to 24.0%, with CWP prevalence in men ranging from 0.8% to 15.3% and 1.7% to 22.1% in women. Estimated overall CWP prevalence was 9.6% (8.0–11.2%). Meta-regression analyses showed gender, United Nations country development status, and human development index (HDI) influenced CWP prevalence, while survey method, region, methodological and reporting quality, and inequality showed no significant effect on the CWP estimate. Globally CWP affects one in ten individuals within the general population, with women more likely to experience CWP than men. HDI was noted to be the socioeconomic factor related to CWP prevalence, with those in more developed countries having a lower CWP prevalence than those in less developed countries. Most CWP estimates were from developed countries, and CWP estimates from countries with a lower socioeconomic position is needed to further refine the global estimate of CWP.

Significance

This systematic review and meta-analysis updates the current global CWP prevalence by examining the population-level (e.g. age, gender) and contextual (e.g. country development status; survey style; reporting and methodologic quality) factors associated with CWP prevalence. This analyses provides evidence to support higher levels of CWP in countries with a lower socioeconomic position relative to countries with a higher socioeconomic position.

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Gabapentinoids should not be used for chronic low back pain, meta-analysis concludes

Gabapentinoids, including pregabalin and gabapentin, are increasingly being used off label to treat chronic low back pain, but a systematic review and meta-analysis in PLoS Medicine has concluded...

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