Symptoms of Fibromyalgia According to the 2016 Revised Fibromyalgia Criteria in Chronic Pain Patients Referred to Multidisciplinary Pain Rehabilitation: Influence on Clinical and Experimental Pain Sensitivity

• 33% of chronic pain patients were classified with fibromyalgia (FM).• FM patients showed higher levels of clinical and experimental pain sensitivity.• A higher proportion of patients classified as FM used opioids.• Specificity and sensitivity of the revised ACR-2016 FM criteria is unknown.

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Longitudinal Treatment Outcomes for an Interdisciplinary Pain Rehabilitation Program: Comparisons of Subjective and Objective Outcomes Based on Opioid Use Status

• Examination of self-report and performance based outcomes among patients receiving interdisciplinary pain rehabilitation treatment is proposed.• Patients tapered off opioids during treatment demonstrated comparable functional improvements compared to non-opioid users.• Patients can be successfully tapered off opioid pain medication and still demonstrate functional improvements

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Neuropsychological Functioning and Treatment Outcomes in Acceptance and Commitment Therapy for Chronic Pain

• Poorer neuropsychological performance related to worse baseline functioning• Relatively low neuropsychological performance not contraindicated for ACT• Executive function and processing speed most important predictors of outcomes

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Opposing Roles of Estradiol and Testosterone on Stress-Induced Visceral Hypersensitivity in Rats

• Stress induced visceral hypersensitivity in male and female Sprague-Dawley rats• The hypersensitivity persisted several weeks in females, a few days in males• Ovariectomy blocked and orchiectomy facilitated the hypersensitivity• E2 in males increased hypersensitivity, testosterone in females decreased it• E2 and testosterone altered glutamatergic receptor expression in the dorsal horn

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Within-Person Pain Variability and Mental Health in Older Adults with Osteoarthritis: an Analysis Across Six European Cohorts

• Joint pain in OA fluctuates over time and is associated with affective symptoms• Pain severity and pain variability were measured in 832 older adults with OA• The relation of these pain types with affective symptoms was investigated• More severe and stable pain was related to more affective symptoms in the older-old• Joint pain in older persons with OA should be measured at multiple time-points

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The Long-Term Footprint of Endometriosis: Population-Based Cohort Analysis Reveals Increased Pain Symptoms and Decreased Pain Tolerance at Age 46

• Endometriosis has been shown to increase pain sensitivity in fertile-aged women.• The study shows decreasd pain threshold and maximal pain tolerance in women with endometriosis at age 46• Women with endometriosis report increased pain sites and bothersome and intense pain at age 46• Delay in diagnosis of endometriosis may lead to increased pain sensitization• Endometriosis should be diagnosed and treated early on to ensure minimal comorbidity

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Randomized Controlled Trial of Online Acceptance and Commitment Therapy for Fibromyalgia

• Online acceptance and commitment therapy reduced fibromyalgia impact in this RCT• Reductions in FM impact were mediated by improvements in pain acceptance• Online ACT appears to be a feasible and efficacious treatment for FM• Use of an online delivery platform may improve access to ACT treatment for FM

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Pain after Spinal Cord Injury is Associated with Abnormal Presynaptic Inhibition in the Posterior Nucleus of Thalamus

• Electrolytic lesion of STT produces behavioral signs consistent with SCI-Pain.• Tonic activation of presynaptic GABAB autoreceptors in PO is absent in SCI-Pain.• Regulation of glutamatergic release in PO by GABABR is absent in SCI-Pain.

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Publishing the best basic and applied pain science: open science and PAIN

No abstract available

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Nerve growth factor locally sensitizes nociceptors in human skin

Nerve growth factor (NGF) injected into the human skin causes local hyperalgesia to mechanical and electrical stimuli lasting for weeks. Pig data suggested axonal sensitization of C-nociceptors as a contributing mechanism. Here, we recorded single C-nociceptors in 11 human subjects 3 weeks after intracutaneous injection of 1 μg NGF into the foot dorsum. For each identified unit, the receptive field was mapped and, whenever possible, we recorded 2 terminal branches of the same unit, 1 from the hyperalgesic NGF-site (“inside”) and the other from the nonsensitized skin (“outside”). In the saline-treated control feet, mechano-insensitive nociceptors (CMi) were more abundant than at the NGF sites (36% vs 19%). Units with axonal properties of CMi fibres but displaying positive mechanical responses (“CMi-like”) dominated at the NGF site (27% vs 6%). Moreover, axonal branches innervating the hyperalgesic skin displayed significantly lower electrical thresholds and less activity-dependent conduction velocity slowing when compared with “outside” or control skin. The “inside” branches also showed long-lasting after-discharges and less adaptation to repeated mechanical stimuli. NGF-induced long-term nociceptor hyperexcitability was maximum at the terminal branches directly treated with NGF. The sensitization included sensory and axonal components affecting both activation thresholds and supra-threshold responses. Our data suggest that a combination of sensory sensitization and axonal hyperexcitability is underlying the localized hyperalgesia by facilitating action potential generation and conduction. Axonal changes were also found in the asymptomatic skin surrounding the NGF-treatment sites, thereby possibly reflecting “nociceptive priming.”

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Tactile acuity (dys)function in acute nociceptive low back pain: a double-blind experiment

Research shows that chronic pain is related to cortical alterations that can be reflected in reduced tactile acuity, but whether acute pain perception influences tactile acuity has not been tested. Considering the biological role of nociception, it was hypothesized that nociceptive pain will lead to a rapid improvement in tactile acuity and that this effect is correlated with pain intensity and pain distribution. In this randomised double-blind controlled experiment (trial no. NCT03021278), healthy participants were exposed to 1 of 3 experimental conditions: acute, nociceptive low back pain induced by saline injection, a sham injection (without piercing the skin) potentially inducing nocebo pain, or no intervention. Tactile acuity was measured by a battery of tests, including two-point discrimination threshold (TPD), before, during the pain experience, and after it subsided. We found that TPD did not improve but deteriorated during pain induction in the experimental group compared with the control group (P < 0.001; η2 = 0.20) and changed from 56.94 mm (95% confidence interval: 53.43-60.44) at baseline to 64.22 mm (95% confidence interval: 60.42-68.02) during the pain experience. Maximum reported pain was a significant predictor (β = 0.55, P = 0.01) and accounted for 26% of the variance in TPD (P < 0.05). Other tests, point-to-point test and two-point estimation task, changed with a similar trend but did not reach significance. We concluded that acute, nociceptive pain does not improve but deteriorates tactile acuity linearly. The biological role of the observed phenomenon is unknown, and therefore, future studies should address this question.

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Histone deacetylase 5 (HDAC5) regulates neuropathic pain through SRY-related HMG-box 10 (SOX10)-dependent mechanism in mice

A strong link between histone deacetylases (HDACs) and nociceptive hypersensitivity has been indicated in different pain models. However, the underlying molecular and cellular mechanisms remain elusive. Here, we discovered that partial sciatic nerve ligation–induced mechanical allodynia and thermal hyperalgesia in mice were associated with increased mRNA and protein expressions of HDAC5 (a member of class IIa HDACs) and SRY-related HMG-box 10 (SOX10) in the ipsilateral lumbar dorsal horn. Gene knockdown of spinal HDAC5 or SOX10 attenuated partial sciatic nerve ligation–induced nociceptive hypersensitivity, companied with decrease of spinal neuronal sensitization markers, namely phosphorylated-Erk, phosphorylated-GluN1 (ser896), and c-Fos. Conversely, overexpression of spinal HDAC5 or SOX10 by lentiviruses in naive mice not only induced pain-like behaviors but also increased the expression of these spinal neuronal sensitization markers. Of note, in contrast to its conventional deacetylation effect to silence gene expression, overexpression of HDAC5 not only enhanced SOX10 expression but also induced nociceptive hypersensitivity in naive mice, which were reversed by SOX10 gene knockdown. Chromatin-immunoprecipitation assay further confirmed a novel nonhistone modulation function of HDACs on SOX10 expression, that is, HDAC5 regulates SOX10 by binding to the promoter region of Sox10 gene. In conclusion, this study for the first time demonstrates that HDAC5 regulates spinal neuronal sensitization in neuropathic pain by upregulating modulating SOX10 expression. Thus, interventions that reduce HDAC5/SOX10 expression may represent promising avenues in the treatment of neuropathic pain.

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Induction of chronic migraine phenotypes in a rat model after environmental irritant exposure

Air pollution is linked to increased emergency department visits for headache and migraine patients frequently cite chemicals or odors as headache triggers, but the association between air pollutants and headache is not well understood. We previously reported that chronic environmental irritant exposure sensitizes the trigeminovascular system response to nasal administration of environmental irritants. Here, we examine whether chronic environmental irritant exposure induces migraine behavioral phenotypes. Male rats were exposed to acrolein, a transient receptor potential channel ankyrin-1 (TRPA1) agonist, or room air by inhalation for 4 days before meningeal blood flow measurements, periorbital cutaneous sensory testing, or other behavioral testing. Touch-induced c-Fos expression in trigeminal nucleus caudalis was compared in animals exposed to room air or acrolein. Spontaneous behavior and olfactory discrimination was examined in open-field testing. Acrolein inhalation exposure produced long-lasting potentiation of blood flow responses to a subsequent TRPA1 agonist and sensitized cutaneous responses to mechanical stimulation. C-Fos expression in response to touch was increased in trigeminal nucleus caudalis in animals exposed to acrolein compared with room air. Spontaneous activity in an open-field and scent preference behavior was different in acrolein-exposed compared with room air–exposed animals. Sumatriptan, an acute migraine treatment blocked acute blood flow changes in response to TRPA1 or transient receptor potential vanilloid receptor-1 agonists. Pretreatment with valproic acid, a prophylactic migraine treatment, attenuated the enhanced blood flow responses observed after acrolein inhalation exposures. Environmental irritant exposure yields an animal model of chronic migraine in which to study mechanisms for enhanced headache susceptibility after chemical exposure.

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Concurrent Assessment of the Antinociceptive and Behaviorally Disruptive Effects of Opioids in Squirrel Monkeys

• Opioid antinociceptive and behaviorally disruptive effects are measured concurrently.• The ratio of ED50 values for both measures are calculated, and differ among opioids.• These ratios indicate the behavioral selectivity of opioid antinociception.• ED50 ratios serve as preclinical estimates of therapeutic index.• Opioids with differing ED50 ratios may have differing scopes of clinical utility.

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Motor-Evoked Pain Increases Force Variability in Chronic Jaw Pain

• Chronic jaw pain is characterized by increased force variability.• The accuracy of force production was not compromised in the presence of motor-evoked pain.• Predictors of force variability shift from trait to state measure of pain as force level increases.

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Degenerative cervical myelopathy

What you need to knowConsider degenerative cervical myelopathy in patients over 50 with progressive neurological symptoms, such as pain and stiffness in the neck or limbs, imbalance, numbness, loss...

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Assessing Complex Movement Behaviors in Rodent Models of Neurological Disorders

What Is the Longitudinal Profile of Impairments and Can We Predict Difficulty Caring for the Profoundly Affected Arm in the First Year Poststroke?

Viscosupplementation for Hip Osteoarthritis: A Systematic Review and Meta-Analysis of the Efficacy on Pain and Disability, and the Occurrence of Adverse Events

Abdominal migraine

What you need to knowAbdominal migraine is episodic central abdominal pain occurring with other features of migraine and associated with other episodic syndromes (particularly cyclical vomiting and...

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Authors’ reply to the comment by Kendall et al

Abstract

We would like to thank for the opportunity to reply to the important questions raised by Kendall et al. and also would like to thank the authors of that letter for their kind words. Our results indeed seem contrary to previous results about opioid-induced hyperalgesia (OIH), but on a detailed look there is not necessarily a contradiction. Until now no direct link between the short-lasting OIH and long-term pain has been shown in humans.

This article is protected by copyright. All rights reserved.

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Defective Endogenous Pain Modulation in Fibromyalgia: a Meta-Analysis of Temporal Summation and Conditioned Pain Modulation Paradigms

• We review temporal summation and conditioned pain modulation in fibromyalgia (FM).• Results revealed pain sensitization and defective endogenous pain modulation in FM• Sensitivity analysis uncovered multiple modifying covariates• Lack of blinding is a critical issue in most of the studies reviewed• The paradigms studied may serve future diagnosis, treatment and research on FM.

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The Psychometric Properties of the MBPS Scale Used to Assess Procedural Pain.

• The MBPS is reliable and sensitive to procedural pain in infants and young children• It is unlikely that the MBPS is specific for procedural pain• There are concerns about the feasibility of the MBPS for procedural pain assessment.• There are design limitations making the MBPS unsuitable for procedural use.

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Effects of Higher Versus Lower Threat Contexts on Pain-Related Visual Attention Biases: an Eye-Tracking Study of Chronic Pain

• Effects of threat on attention biases were assessed in people with chronic pain• Gaze responses were assessed in modified dot-probe and impending pain paradigms• Orienting and maintenance of gaze towards pain images emerged across threat contexts• State fear and disengagement difficulty were pronounced in the higher threat context

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Opioid prescriptions rise in England despite poor efficacy and harms, finds study

The number of opioid drugs prescribed in England is steadily rising despite a lack of effectiveness for treating chronic pain and their potentially serious side effects, a study has...

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Catastrophizing, pain and traumatic stress symptoms following burns: A prospective study

Abstract

Background

Pain and PTSD symptoms are significant problems in the aftermath of a burn injury and they often co-occur. Catastrophizing has been linked to both phenomena. The aim of this study was to investigate the underlying role of catastrophizing in PTSD symptoms and pain following burns.

Methods

This prospective study included 216 patients with burns. PTSD symptoms and pain were measured during hospitalization (T1) and 6 (T2) and 12 months (T3) postburn. The Impact of Event Scale-Revised (IES-R) indexed PTSD symptoms. Acute pain (T1) was the mean pain during the first two weeks of hospitalization measured using an 11-point graphic numeric rating scale. Chronic pain was indexed using the single item ‘average’ pain from the Brief Pain Inventory (BPI). Catastrophizing was measured at T1 and T2 using the Cognitive Emotion Regulation Questionnaire (CERQ). Data were analyzed using structural equation modeling (SEM).

Results

The results showed that T2 catastrophizing mediated between acute and chronic PTSD symptoms, and T3 pain. Furthermore, the study revealed significant associations between catastrophizing, PTSD symptoms and pain at the respective measurements, and significant longitudinal associations between the constructs.

Conclusion

A negative cognitive-affective response to a burn event, such as catastrophizing, mediated the relationship acute and chronic PTSD symptoms and later chronic pain. Screening for catastrophizing and acute PTSD symptoms is recommended to identify persons at risk for chronic PTSD symptoms and pain.

This article is protected by copyright. All rights reserved.

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Anterior insular volume decrease is associated with dysfunction of the reward system in patients with chronic pain

Abstract

Background

Chronification of pain is associated with both anatomical and functional alterations of the brain. Alteration in regional gray matter volume might potentially be associated with modified activity of specific brain networks. In this cross-sectional, observational study, we sought to identify brain regions with gray matter volume changes in patients with chronic pain and to reveal its significance by analysing alteration in functional connectivity from those regions. We further explored relevance of such alterations with psychometrics of chronic pain.

Methods

We recruited 23 patients with chronic pain and 17 age-, gender-matched healthy control subjects. After completing multiple psychophysical questionnaires, each subject underwent resting-state functional magnetic resonance imaging and 3-dimensional anatomical imaging on a 3 Tesla magnetic resonance imaging scanner.

Results

Patients with chronic pain showed significant volume decrease at the right anterior insular cortex (p<0.001) and the left middle cingulate cortex (p<0.001) compared with healthy controls. They also showed decreased connectivity between the right anterior insular cortex and the left nucleus accumbens in negative association with the Pain Catastrophizing Scale (R²=0.20, p=0.046) and the Beck's Depression Inventory scores (R²=0.24, p=0.017).

Conclusions

Decreased gray matter volumes of those core regions for affective processing of pain might be a common cerebral feature shared by, at least some of, different aetiologies of chronic pain. Dysfunctional network between the anterior insular cortex and the nucleus accumbens might reflect affective and motivational disability involved in chronic pain. Such anatomical and functional profiles could potentially be part of a cerebral signature for chronification of pain.

This article is protected by copyright. All rights reserved.

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Effects of a Standard American Diet and an Anti-inflammatory Diet in Male and Female Mice

Abstract

Significance

Obesity may increase susceptibility to chronic pain often due to poor diet. Diet has potential to be used as treatment for pain. The current study investigates the use of a novel translatable diet to act as a preventative (i.e., prior to surgery) or an intervention (i.e., following an injury).

Background

Obesity and chronic pain are prevalent concerns. Pain is frequently experienced in weight bearing joints, but is common in other areas of the body as well, suggesting other factors. Poor diet often contributes to obesity and can directly influence the immune system. We have shown that poor diet prolongs recovery from inflammatory injury. Therefore, our goal was to determine if poor-quality diet-induced consequences could be prevented or reversed by an anti-inflammatory diet.

Methods

A Standard American Diet (SAD) was developed to investigate the effects of poor diet on pain. The SAD includes amounts of refined sugar, carbohydrates and fats that better model the typical American diet, as compared to high-fat diets. We developed an Anti-inflammatory Diet (AID) to explore whether the effects of the SAD could reversed or whether the AID would enhance recovery prophylactically. The AID was developed using ingredients (EGCG, sulforaphane, resveratrol, curcumin, and ginseng) with known anti-inflammatory properties. Following 15 weeks of diet (SAD, AID or regular (REG)) exposure, male and female mice underwent inflammatory injury, at which point some animals had their diets switched for the remainder of the study.

Results

Animals who consumed the SAD showed longer recovery compared to the AID and REG-fed animals. Animals switched off the SAD had faster recovery times, with AID-fed animals recovering as fast as REG-fed animals.

Conclusions

Poor diet prolonged recovery from inflammatory injury. Substitution of SAD with AID or REG promoted faster recovery. These findings suggest diet can be used as a non-pharmacological intervention following injury.

This article is protected by copyright. All rights reserved.

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Randomized double-blind controlled study of bedtime low dose amitriptyline in chronic neck pain

Abstract

Background

Amitriptyline has well-established efficacy in several chronic pain conditions. While optimal treatment for chronic neck pain (CNP) remains controversial, amitriptyline was not tested for CNP. We evaluated the effect of bedtime amitriptyline in the management of CNP.

Methods

220 patients suffering from idiopathic CNP were randomized to receive either placebo pill (n = 108) or 5 mg of amitriptyline (n = 112) at bedtime for two months. Primary outcome measure was visual analog scale (VAS) for pain. Secondary outcome measures were Neck pain Disability Index (NPDI), Bergen Insomnia Score (BIS), and Hospital Anxiety and Depression Scale (HAD), measured before and at the end of two months of treatment, with the percentage of patient satisfaction measured at the end of follow-up only.

Results

8/112 patients (7.14%) in the amitriptyline group withdrew from the study because of intolerance. Amitriptyline group showed significantly lower VAS scores than placebo group (3.34 ± 1.45 versus 6.12 ± 0.92; p < 0.0001), which corresponds to a 53.06 ± 20.29% of improvement from baseline pain as compared to 14.41 ± 11.05%, respectively (p < 0.0001). Similar significant improvements were observed with lesser extents for secondary outcome measures: NPDI, BIS, HAD-A, HAD-D and percentage of patient satisfaction.

Conclusion

Low-dose amitriptyline is effective for the management of idiopathic CNP with few side effects and high patients’ satisfaction.

This article is protected by copyright. All rights reserved.

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Assessing neuropathic pain in patients with low back-related leg pain: Comparing the painDETECT Questionnaire with the 2016 NeuPSIG grading system

Abstract

Background

Low back-related leg pain with nerve root involvement is conceptually regarded as a neuropathic condition. However, it is uncertain to what extent patients with this condition can be formally classified with neuropathic pain.

Method

First, we used the 2016 revision of the IASP Special Interest Group on Neuropathic Pain (NeuPSIG) grading system for neuropathic pain to grade patients suffering from low back-related leg pain and a corresponding disc herniation with either unlikely, possible, probable or definite neuropathic pain. Examination included bedside quantitative sensory testing. Next, we used the clinical classification based on the 2016 NeuPSIG grading system as a reference standard to assess the ability of the painDETECT Questionnaire to identify patients with neuropathic pain.

Results

Of the 50 included patients, 6 (12%) fulfilled the clinical classification criteria for probable and 44 (88%) for definite neuropathic pain, while none were graded unlikely or possible. According to painDETECT, 23 patients (46%) was classified with unlikely neuropathic pain, 18 patients (36%) had an uncertain condition, and in 9 patients (18%) neuropathic pain was likely. Among the 44 patients graded as having definite neuropathic pain by the clinical classification, 8 were classified as likely neuropathic pain by painDETECT, resulting in an agreement of 18%. Of these 44 patients graded with definite neuropathic pain, painDETECT classified 21 patients (48%) as unlikely and 15 (34%) as uncertain.

Conclusion

Our results do not support the use of painDETECT as a screening tool to classify or grade neuropathic components in patients with low back-related leg pain.

This article is protected by copyright. All rights reserved.

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The impact of a short educational movie on promoting chronic pain health literacy in school: a feasibility study

Abstract

Background

School-based health education programs on chronic pain providing information about the proper management of recurrent and chronic pain may increase health literacy in terms of pain knowledge and may thereby prevent dysfunctional coping and may decrease the risk of pain chronification. The aim of the present feasibility study was to evaluate the effectiveness of an educational movie on recurrent and chronic pain in increasing pain knowledge among students.

Methods

N=95 adolescent students provided demographic and pain-related information and completed a pain knowledge questionnaire before and after viewing an educational movie on recurrent and chronic pain. Participants were classified as experiencing frequent pain if they reported pain at least once a week in the last three months.

Results

One-third of the participants experienced frequent pain. There was a significant increase in pain knowledge for all participants (η_p ²=0.544). Students with frequent pain had a stronger knowledge increase regarding the management of chronic and recurrent pain than those without frequent pain (η_p ²=0.087). Sex did not moderate the gain in pain knowledge.

Conclusions

This feasibility study provides first evidence that a short educational movie on recurrent and chronic pain may increase chronic pain health literacy in students. Future studies should investigate the long-term retention of pain knowledge and any associated effects on behavior change. Due to barriers to implementation of interventional studies in the school setting, these studies should use a waitlist control group design and online data collection.

This article is protected by copyright. All rights reserved.

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Cumulative effects of multiple pains sites in youth with chronic pain

Abstract

Background

The experience of persistent pain in multiple locations is common in youth. Based on current literature, youth with multiple pain sites (MPS) are at risk of experiencing poorer emotional outcomes and a spread of symptoms into late adolescence and adulthood. Little is known regarding the association between MPS with physical and school functioning domains, particularly after initiation of multidisciplinary pain treatment. Therefore, the objective of this study was to examine the association of MPS with disability and school functioning among youth with chronic pain.

Methods

A total of 195 patients with chronic pain, aged 8-17, and their parents completed measures assessing patient distress and functioning at a multidisciplinary pain clinic evaluation and at 4-month follow-up.

Results

At evaluation, 63% of patients presented with MPS; 25% reporting MPS endorsed pain in five or more locations. When controlling for relevant demographic and emotional distress factors, MPS was associated with lower school functioning at evaluation with a persistent trend at follow-up. Although MPS was not a significant predictor of pain-related disability at evaluation, it emerged as significant at follow-up.

Conclusions

Potentially due to the MPS load and the inverse effects that such a pain state has on function, such patients may be at-risk for poorer health and school-related outcomes. The mechanisms influencing these relationships appear to extend beyond psychological/emotional factors and warrant further investigation in order to aid in our understanding of youth with MPS.

Significance

Youth with MPS may be at risk for experiencing poorer physical and school functioning in comparison to single-site peers, despite treatment initiation. Further research is warranted in order to inform assessment and treatment approaches for this subgroup of patients.

This article is protected by copyright. All rights reserved.

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Vastus lateralis motor unit firing rate is higher in females with patellofemoral pain

Neonatal Handling Produces Sex Hormone-Dependent Resilience to Stress-Induced Muscle Hyperalgesia in Rats

• Neonatal handling (NH) markedly reduces stress-induced muscle pain in adult male rats• NH has minimal effect on stress-induced muscle pain in adult females• Gonadectomy blocks the NH effect on stress-induced pain in males• Knockdown of the androgen receptor attenuates NH protection in gonad intact males• Resilience to stress-induced muscle pain by NH is androgen-dependent

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Early Impact of Postoperative Bracing on Pain and Quality of Life After Posterior Instrumented Fusion for Lumbar Degenerative Conditions: A Randomized Trial

Study Design. A randomized controlled trial. Objective. To investigate whether bracing after posterior spinal instrumented fusion (PSIF) can improve pain relief and quality of life (QoL) 6 weeks and 3 months postoperatively. Summary of Background Data. Braces are commonly prescribed after PSIF in patients with lumbar degenerative conditions with the aim of improving pain relief and QoL. However, there is a lack of evidence on the indication for postoperative bracing, as surgeons use braces mainly based on their experience and training. Methods. A randomized blinded and controlled trial of 43 patients with PSIF for lumbar degenerative conditions were recruited. The caregivers were blinded but not the orthotist in the present study. There were 25 patients in the brace group and 18 patients in the control group with similar baseline characteristics. All patients completed the Oswestry Disability Index (ODI), the short form (SF)-12v2 General Health Survey and Visual Analog Scale (VAS) for back pain preoperatively, at 6 weeks and 3 months follow-up. Wilcoxon-Mann-Whitney test and a level of significance of 0.05 were used for statistical analyses. Results. Both groups had comparable demographic characteristics, and preoperative SF-12v2, ODI, and VAS scores. The ODI, SF-12v2, and VAS for back pain were improved in comparison to preoperative scores. The improvement was significant at 3 months follow-up regarding ODI and VAS for both groups and significant only for the control group regarding SF-12v2 scores. The improvement in ODI, SF-12v2, and VAS was significantly greater for control group at 3 months postoperatively. Moreover, larger proportion of patients in the control group reached minimum clinically important difference as compared to brace group at 6 weeks and 3 months. Conclusion. Postoperative bracing did not result in better improvement in QoL or pain relief up to 3 months after PSIF in patients with lumbar degenerative conditions. Level of Evidence: 1

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A Microstructural Investigation of Disc Disruption Induced by Low Frequency Cyclic Loading

Study Design. Microstructural investigation of low frequency cyclic loading and flexing of the lumbar disc. Objective. To explore micro-level structural damage in motion segments subjected to low frequency repetitive loading and flexing at sub-acute loads. Summary of Background Data. Cumulative exposure to mechanical load has been implicated in low back pain and injury. The mechanical pathways by which cyclic loading physically affects spine tissues remain unclear, in part due to the absence of high quality microstructural evidence. Methods. The study utilized seven intact ovine lumbar spines and from each spine one motion segment was used as a control, two others were cyclically loaded. Ten motion segments were subjected to 5000 cycles at 0.5 Hz with a peak load corresponding to ∼30% of that required to achieve failure. An additional small group of segments subjected to 10,000 or 30,000 cycles was similarly analyzed. Following chemical fixation and decalcification samples were cryosectioned along one of the oblique fiber angles and imaged in their fully hydrated state using differential interference contrast optical microscopy. Structural damage obtained from the images was organized into an algebraic shell for analysis. Results. At 5000 cycles the disc damage was limited to inner wall distortions, evidence of stress concentrations at bridging-lamellae attachments, and small delaminations. The high-cycle discs tested exhibited significant mid-wall damage. There was no evidence of nuclear material being displaced. Conclusion. At this low frequency and without the application of sustained loading or a more severe loading regime, or maintaining a constant flexion with repetitive loading, it seems unlikely that actual nuclear migration occurs. It is possible that the inner-annular damage shown in the low dose group could disrupt pathways for nutrient diffusion leading to earlier cell death and matrix degradation, thus contributing to a cascade of degeneration. Level of Evidence: N/A

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Progressive Bone Formation After Cervical Disc Replacement: Minimum of 5-Year Follow-up

Study Design. Retrospective review. Objective. Our objective was to examine the prevalence, clinical significance, ramifications, and possible etiology of postoperative bone formation at the index level after cervical disc replacement (CDR) with a minimum of 5 years of follow-up. Summary of Background Data. CDR can be complicated by postoperative ossification and unwanted ankylosis at the index level, which some authors have termed “heterotopic ossification.” This terminology may be inaccurate as it assumes the postoperative bone formation is unnatural and a consequence of the CDR surgery. We advocate that this phenomenon has more to do with individual patient factors rather than the surgery. Methods. Patients who underwent Bryan CDR for cervical myelopathy or radiculopathy between 12/2003 and 8/2008 with a minimum of 5-years follow-up were analyzed. They were divided into two groups, those with and without postoperative bone formation. Patient-reported outcomes (Japanese Orthopaedic Association score, Neck Disability Index, Visual Analogue Scale for neck and arm pain) and radiographic parameters were collected pre- and postoperatively and compared between groups. Results. Sixty-one patients (76 levels) were identified (mean follow-up 94.2 mo). The overall incidence of postoperative ossification was 50%. Both groups had sustained significant improvements across all patient-reported outcome measures at final follow-up. Notably, patients with more severe preoperative cervical spondylosis had higher rates of postoperative ossification (P = 0.036) and adjacent segment degeneration (P = 0.010). Conclusion. Although the long-term incidence of postoperative bone formation after CDR was relatively high, this did not adversely affect patient outcomes. Patients with more severe preoperative spondylosis had higher rates of postoperative ossification, suggesting that postoperative ossification at the CDR segment is likely one of progressive bone formation in individuals already predisposed to forming bone rather than one of alleged heterotopic ossification as a consequence of the surgery. Level of Evidence: 3

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Do Former Smokers Exhibit a Distinct Profile Before and After Lumbar Spine Surgery?

Study Design. Retrospective longitudinal cohort. Objectives. To determine if former smokers undergoing lumbar spine surgery have distinct baseline and postoperative patient-reported outcomes (PROs) compared with never smokers and current smokers. Summary of Background Data. Smoking has known deleterious effects on patients undergoing lumbar spine surgery. However, former smokers have not been extensively evaluated. There are few studies regarding the relationship between pack-years or duration of smoking cessation, and subsequent clinical outcome. Methods. Patients undergoing lumbar spine surgery at three Quality Outcomes Database participating sites were identified. Demographic, surgical and PRO data including pre-op and 12-month post-op back and leg pain scores, Oswestry Disability Index (ODI) and EuroQOL-5D were collected. Smoking status was assessed from individual medical records. Three cohorts, never smokers, former smokers and current smokers, were compared. Association between PROs and quantitative smoking history and duration of pre-op smoking cessation were evaluated in the former smokers. Results. Of 1187 eligible cases, 843 (71%) had complete data, with 477 never, 250 former, and 116 current smokers. Among patients who had a fusion, baseline and 12-month post-op PROs were significantly different between cohorts, with former smokers having intermediate scores between current and never smokers. In the decompression only group, 12-month ODI was worse in the Current smokers, but overall the effects were much less pronounced. There was a significant negative correlation between smoke-free days before surgery and baseline back pain, ODI, 12-month leg pain and ODI and improvement in ODI. However, the correlation coefficients were small. Conclusion. Former smokers have distinct baseline and 12-month post-op PROs that are intermediate between those of never smokers and current smokers. Smoking cessation does not entirely mitigate the negative effects of smoking on baseline and postoperative PROs for patients undergoing lumbar fusion surgery. This effect is less pronounced in patients undergoing decompression alone. Level of Evidence: 2

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Anterior Cervical Discectomy and Fusion Outcomes over 10 Years: A Prospective Study

Study Design. Prospective cohort study with >10-year follow-up. Objective. To assess the long-term, >10-year clinical outcomes of anterior cervical discectomy and fusion (ACDF) and to compare outcomes based on primary diagnosis of disc herniation, stenosis or advanced degenerative disc disease (DDD), number of levels treated, and preexisting adjacent level degeneration. Summary of Background Data. ACDF is a proven treatment for patients with stenosis and disc herniation and results in significantly improved short- and intermediate-term outcomes. Motion preservation treatments may result in improved long-term outcomes but need to be compared to long-term ACDF outcomes reference. Methods. Patients who had disc herniation, stenosis, and DDD and underwent ACDF with or without decompression were prospectively enrolled and followed for a minimum of 10 years with outcome assessment at various intervals. All 159 consecutive patients had autogenous tricortical iliac crest bone graft and plate instrumentation used. Outcomes included visual analog scale for neck and arm pain. pain drawing, Oswestry Disability Index, and self-assessment of procedure success. Preoperative adjacent-level disc degeneration, pseudarthrosis, and secondary operations were analyzed. Results. For all diagnostic groups, significant outcomes improvement was seen at all follow-up periods for all scales relative to preoperative scores. Outcomes were not related to age, gender, number of levels treated, and minimally to preexisting degeneration at the adjacent level. The use of narcotic pain medication decreased substantially. Neurological deficits almost all resolved. Patient self-reported success ranged from 85% to 95%. Over the long term, additional surgery for pseudarthrosis (10%) occurred in the early follow-up period, and for adjacent segment degeneration (21%), which occurred linearly during the >10-year follow-up period. Conclusion. ACDF leads to significantly improved outcomes for all primary diagnoses and was sustained for >10 years’ follow-up. Secondary surgeries were performed for pseudarthrosis repair and for symptomatic adjacent-level degeneration. Level of Evidence: 2

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Is Traditional Closed Thoracic Drainage Necessary to Treat Pleural Tears After Posterior Approach Thoracic Spine Surgery?

Study Design. A prospective study. Objective. The aim of this study was to evaluate the outcomes and efficacy of using a 10Fr elastic tube with a regular negative pressure ball to treat the operative pleural tear in the complicated single-stage posterior approach thoracic spine surgeries. Summary of Background Data. In some complicated single-stage posterior approach thoracic spine surgeries, such as total en bloc spondylectomy, pleural tear is quite inevitable. Traditional chest tube with a water-sealed bottle has many shortcomings, as pain, inconvenience, and other complications. In many thoracic surgeries, a smaller-caliber elastic tube has been used to avoid such complications and achieve quick recovery. However, there are concerns about the efficacy and safety of the smaller-caliber elastic tube. Methods. A prospective trial was performed in 72 patients between April 2008 and March 2012. Pleural tear occurred in 19 patients, among whom 10 patients were inserted a 10Fr elastic tube with a regular negative pressure ball (Group I), and nine were inserted a 28Fr chest tube with a water-sealed bottle (Group II). Comparative evaluation of the clinical and radiographic data was carried out. Results. The basic condition of two groups did not differ significantly. The oxygen saturation monitor, hospital length of stay, average volume, and failure rate of drainage between two groups were not statistically significant. The difference of the visual analog score was significant (1.10 ± 0.35 vs. 3.89 ± 0.59, P < 0.001). Conclusion. Patients who received a 10Fr elastic tube with a regular negative pressure ball experienced less pain and a tendency of quicker recovery than those who received a 28Fr chest tube with a water-sealed bottle. The complication rate in Group I was not higher than Group II, indicating an equally good drainage efficacy. Level of Evidence: 2

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“It Encourages Them to Complain”: A Qualitative Study of the Unintended Consequences of Assessing Patient-Reported Pain.

• Routine pain screening helps identify patients who might otherwise be overlooked.• It may also increase “false positives” and prompt treatment where not a priority.• It may hinder patients from implementing alternative and coping strategies.• Targeting screening to certain populations may be more effective and appropriate.

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Cognitive Biases in Children and Adolescents with Chronic Pain: a Review of Findings and a Call for Developmental Research

Cognitive biases that emphasise bodily harm, injury, and illness could play a role in the maintenance of chronic pain, by facilitating fear and avoidance. Whereas extensive research has established attention, interpretation, and memory biases in adults with chronic pain, far less is known about these same biases in children and adolescents with pain. Studying cognitive biases in attention, interpretation, and memory in relation to pain occurring in youth is important because youth is a time when pain can first become chronic, and when relationships between cognitive biases and pain outcomes emerge and stabilise.

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Disease-Related Microstructural Differences in the Brain in Females with Provoked Vestibulodynia

• In PVD microstructural alterations were observed in fibers associated with sensorimotor integration and pain processing.• Alterations were associated with increased vulvar pain and muscle tenderness in PVD.• Differences between chronic overlapping pain syndromes may be related to sensorimotor-thalamic-brainstem thalamic connectivity.

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Research Design Characteristics of Published Pharmacologic Randomized Clinical Trials for Irritable Bowel Syndrome and Chronic Pelvic Pain Conditions: an Acttion Systemic Review.

• Clinical trial design for abdominal and pelvic pain conditions is challenging• Review of RCT entry criteria and endpoints in representative conditions is provided• Encouraged future research areas to inform trial design are discussed

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Signs and Symptoms in 1043 Patients with Complex Regional Pain Syndrome (CRPS)

• CRPS was caused by just 11 distinct etiological triggers in 99.5% of our patients.• Some diagnostic signs were found only in about 50% of patients.• A weighted screening score aids in distinguishing CRPS from other pain disorders.• Descriptions of pain quality in CRPS might be quite characteristic.

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Supported Employment for Veterans With Traumatic Brain Injury: Patient Perspectives

Work Productivity Loss After Mild Traumatic Brain Injury

Student Veterans Reintegrating From the Military to the University With Traumatic Injuries: How Does Service Use Relate to Health Status?

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

The effectiveness of botulinum toxin A for persistent upper limb pain after breast cancer treatment: a double-blinded randomized controlled trial

A keen eye for risk

A 56 year old woman was referred to the rapid access chest pain clinic with stable angina pectoris. Her only cardiovascular risk factor was a family history of atherosclerosis, with her mother...

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