Acute hepatitis in a teenager

A 19 year old woman presented to the emergency department with worsening pain and distension of the right upper quadrant. She was jaundiced and had ascites. A contrast enhanced portal venous phase...

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

Arthroscopic surgery for knee pain: where is the shared decision making?

Evidence suggests significant overtreatment of knee pain with arthroscopy when less invasive, less expensive treatment options are equally effective.1 Not only is this potentially harmful for...

from Latest headlines from BMJ http://ift.tt/2bsnfy4
via IFTTT

Depression predicts functional outcome in geriatric inpatient rehabilitation

Adverse event reporting in clinical trials of intravenous and invasive pain treatments: an ACTTION systematic review

Thorough assessment and reporting of adverse events (AEs) facilitates a detailed understanding of a treatment’s risk-benefit profile. Although the Consolidated Standards of Reporting Trials (CONSORT) 2004 statement provides recommendations regarding AE reporting, adherence to these standards is often inadequate. We investigated AE reporting in clinical trials of intravenous and invasive pain treatments published in 6 major anesthesiology and pain journals between 2000-2003 and 2006-2012. We examined whether AE reporting improved following publication of the 2004 CONSORT recommendations and also comprehensively reviewed AE assessment using the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) AE reporting recommendations.

from The Journal of Pain http://ift.tt/2aP0vd5
via IFTTT

Prediction of response to tapentadol in chronic low back pain

Abstract

Background

Many chronic low back pain (cLBP) patients do not satisfactorily respond to treatment. The knowledge of responders and non-responders before initiating treatment would improve decision making and reduce health care costs. The aims of this exploratory prediction study in cLBP patients treated with tapentadol were to identify predictors of treatment outcome based on baseline characteristics, to evaluate quality-of-life and functionality as alternative outcome parameters and to develop nomograms to calculate the individual probability of response.

Methods

In a retrospective analysis of an open-label phase 3b trial, 46 baseline characteristics were included into statistical prediction modelling. One hundred and twenty-one patients were followed up during the titration and treatment period and 67 patients were analysed who discontinued the trial.

Results

Demographic data were not relevant for response prediction. Nine baseline co-variables were robust: painDETECT score, intensity of burning and painful attacks, SF36 Health Survey score (MCS, PCS), EuroQol-5, Hospital Anxiety/Depression Scale. Gender had a minor influence. Alternative outcomes (quality-of-life, functionality) were more important for response prediction than conventional pain intensity measures. Neuropathic symptoms (high painDETECT score) had a positive predictive validity. Painful attacks and classical yellow flags (depression, anxiety) negatively influenced the treatment response. High depression scores, female gender and low burning predicted discontinuation during titration.

Conclusion

In this exploratory study, predictive baseline characteristics have been identified that can be used to calculate the individual probability of tapentadol response in cLBP. The small sample size in relation to the number of initial variables is a limitation of this approach.

Significance

Predictors for treatment response of tapentadol were identified in patients with chronic low back pain based on clinical pre-treatment characteristics that can guide personalized treatment. Quality-of-life and functionality were the most relevant outcomes for response prediction.

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

Putting pain out of mind with an ‘out of body’ illusion

Abstract

Background

Chronic pain is a growing societal concern that warrants scientific investigation, especially given the ineffectiveness of many treatments. Given evidence that pain experience relies on multisensory integration, there is interest in using body ownership illusions for reducing acute pain.

Aim

In the present study, we investigate whether patients’ experience of chronic pain could be reduced by full body illusions (FBIs) that cause participants to dissociate from their own body.

Methods

Participants with chronic pain (including sciatica, osteoarthritis, fibromyalgia, muscular pain, IBS and back pain) viewed their own ‘virtual’ bodies via a video camera and head-mounted display for two minutes. In the ‘back-stroking FBI’, their backs were stroked with a stick while they viewed synchronous or asynchronous stroking on the virtual body and in the ‘front-stroking FBI’, they were stroked near their collarbone while viewing the stick approach their field of view in a synchronous or asynchronous fashion. Illusion strength and pain intensity were measured with self-report questionnaires.

Results

We found that full body illusions were experienced by patients with chronic pain and further, that pain intensity was reduced by an average of 37% after illusion (synchronous) conditions.

Conclusion

These findings add support to theories that high-level multisensory body representations can interact with homeostatic regulation and pain perception.

Significance

Pain intensity in chronic pain patients was reduced by 37% by ‘out of body’ illusions. These data demonstrate the potential of such illusions for the management of chronic pain.

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

The impact of comorbid knee and hip osteoarthritis on longitudinal clinical and health care use outcomes in older adults with new visits for back pain