Tuesday, December 27, 2016
Increasing optimism protects against pain-induced impairments in task shifting performance
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Monday, December 26, 2016
Evidenced-Based Guidelines on the Treatment of Fibromyalgia Patients- Are They Consistent and If Not, Why Not? Have effective psychological treatments been overlooked?
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Friday, December 23, 2016
Wednesday, December 21, 2016
Tuesday, December 20, 2016
The Effect of Substance P on an Intervertebral Disc Rat Organ Culture Model
Study Design. Laboratory study. Objective. Evaluate the effect of substance P (SP) on an intervertebral disc rat organ culture model. Summary of Background Data. Monolayer cell experiments have demonstrated that exposure intervertebral disc tissue cells to SP leads to upregulation in inflammatory cytokine expression; however, this has not been evaluated in a more complex organ culture model. Methods. Forty-eight intervertebral discs from eight rats were used in an organ culture model. Intervertebral discs were divided into three groups: control, SP-treated group, and a group treated with an SP antagonist followed by SP. Cytokine antibody array was used to quantify expression patterns, which were confirmed using ELISA and real-time polymerase chain reaction. Results. The cytokine array demonstrated a 3.40 ± 0.59-fold increase in interleukin 6 (IL-6) expression in the SP group (P = 0.004), and the effect of SP was mitigated by the SP antagonist (P = 0.03). These results were verified as ELISA demonstrated a significant difference in the IL-6 level between the control group and SP group (0.73 vs. 5.80 ng/mL, P < 0.001), and there was a significant difference in the IL-6 level between the SP and the SP antagonist group (5.80 vs. 4.02 ng/mL, P = 0.01). Similarly, the real-time polymerase chain reaction demonstrated that the discs treated with SP had a 4.77-fold increase in IL-6 levels (P = 0.01) compared to controls, and a significantly greater increase in IL-6 levels between the intervertebral discs in the SP group and those in the SP antagonist group versus control (4.77 vs. 1.57, P = 0.02). Conclusion. SP lead to the activation of an inflammatory pathway by increasing expression of IL-6 in an intervertebral disc organ culture model. These results provide evidence that SP may be an important factor in the link between intervertebral disc degeneration and low back pain. Level of Evidence: N/Afrom Spine - Featured Articles - Featured Articles http://ift.tt/2iaf1Nb
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Propionibacterium acnes, Coagulase-Negative Staphylococcus, and the “Biofilm-like” Intervertebral Disc
Study Design. Patients scheduled for spinal surgery were screened prospectively for a microbial presence associated with intervertebral disc specimens. Inclusion was limited to patients requiring surgery for any of five conditions: study patients with cervical spine intervertebral herniation (IVH), lumbar spine IVH, lumbar spine discogenic pain, and control patients with idiopathic scoliosis/Scheurermann's kyphosis or trauma/neuromuscular deformity. Exclusion criteria included ongoing systemic infection, abnormal pre-operative white cell counts, documented or suspected spinal infection, or previous surgery to the involved disc. Objective. The aim of this study was to test for an association between the presence of a bacterial entity in operated discs and a diagnosis of pathologic disc disease. Summary of Background Data. An association has been described between microbial colonization and progressive intervertebral disc degeneration in 36 herniation patients undergoing microdiscectomies. A total of 19 patients had positive cultures on long-term incubation, with Propionibacterium acnes present in 84% of discs. Materials and Methods. Discs were harvested during surgery, using strict sterile technique. Each disc was divided, with half the sample sealed in a sterile, commercially prepared anaerobic culture transport container, and half fixed in formalin. Live specimens were cultured for bacteria at a university-affiliated laboratory in a blinded fashion. Fixed pathologic specimens were gram-stained and read by a board-certified pathologist. Results. A total of 169 intervertebral discs from 87 patients were evaluated (46 males, 41 females). Positive cultures were noted in 76 of 169 discs (45%), with 34 discs positive for P. acnes and 30 discs positive for Staphylococcus. No pathologic evidence was seen of microorganisms, acute or chronic inflammation, or infection. Pooling the IVH and discogenic pain patients and contrasting them with control patients showed a significant association of IVH with positive bacterial cultures (χ2 = 15.37; P = 0.000088). Conclusion. Endemic bacterial biofilms are significantly associated with IVH and discogenic pain. Level of Evidence: N/Afrom Spine - Featured Articles - Featured Articles http://ift.tt/2ia051q
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540° Cervical Realignment Procedure for Extensive Cervical OPLL With Kyphotic Deformity
Study Design. A retrospective study. Objective. The aim of this study was to present a novel, two-stage [posterior and anterior-posterior (P-AP) 540°] procedure for extensive cervical ossification of the longitudinal ligament (OPLL) with kyphotic deformity. Summary of Background Data. The optimal surgical strategy for extensive cervical OPLL remains a controversial issue. Neurological injury and dural defect are complications of anterior surgery, while a posterior surgery can lead to poor clinical outcomes related to incomplete decompression. Methods. We analyzed consecutive cases of patients who underwent procedure described herein, which consists of two stages: the first (P: laminectomy and facet release with segmental screw fixations without rod assembly) and the second 1 week later (AP: multilevel anterior cervical discectomy with fusions (ACDFs) at the apex of the deformity without decompression, placement of lordotic grafts, and posterior fusion). To assess the radiographic parameters, extent of OPLL, maximal canal occupying ratio (%), the distances from the maximal compression to the K-line, and C2–7 angle were analyzed. Clinically, we analyzed visual analog scale of neck and arm pain, neck disability index (NDI), Japanese Orthopedic Association (JOA) score, and complications. Results. A total of 18 patients were enrolled (M:F = 15:3, mean age 64.5 yrs, mean follow-up was 30 months). The mean extent of the OPLL was 3.8 vertebral body levels. Posterior fusion was performed on a mean 4.5 segments and anterior fusion was on a mean 2.4 segments. The mean C2–7 Cobb angle was improved from 10.5° to -12.2° at follow-up. The K-line distance to the maximal compression and canal occupying ratio were improved from −3.3 mm, 73.5% to 3.8 mm, 38.4%, respectively. Preoperative NDI and JOA scores were significantly improved (18.5 to 9.4 and 8.2 to 14.8) at the last follow-up. Conclusion. The 540° P-AP procedure could provide safe decompression, cervical realignment, and favorable outcomes without the disadvantages of the conventional anterior and/or posterior surgery for extensive cervical OPLL with kyphotic deformity. Level of Evidence: 4from Spine - Featured Articles - Featured Articles http://ift.tt/2iabRcj
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Can C3 Laminectomy Reduce Interlaminar Bony Fusion and Preserve the Range of Motion After Cervical Laminoplasty?
Study Design. Retrospective comparative study. Objective. To investigate whether the resection of C3 lamina during cervical laminoplasty can prevent C2-C4 interlaminar bony fusion and preserve the range of motion (ROM) postoperatively. Summary of Background Data. Interlaminar bony fusion is a common complication after cervical laminoplasty, especially in the C2-C4. Laminectomy, rather than laminoplasty, of C3 has been recently introduced. Its advantages include minimizing muscle detachment at C2 and reducing postoperative neck pain. Methods. A total of 59 patients with cervical spondylotic myelopathy that involved three or more levels, including C3, were consecutively treated with laminoplasty and followed up for more than 3 years after surgery. The first 45 patients underwent open-door laminoplasty at C3 (Lp group) and the subsequent 14 patients underwent laminectomy at C3 rather than laminoplasty (Ln group). The Lp group was further divided into two subgroups based on the development of interlaminar bony fusion at C2-C3 and/or C3-C4: Lp-NF (nonfusion) and Lp-F (fusion) groups. Clinical outcomes and radiographic parameters were assessed pre- and postoperatively. Results. Nineteen out of 45 patients who underwent laminoplasty demonstrated fusion at 3-year follow up. Fusion developed more commonly in those patients who had a smaller preoperative ROM at C2-C4 segments (Lp-F 14.3° ± 6.9° vs. Lp-NF 21.4° ± 5.3°, P = 0.013). The neck disability index (range, 13.4 ± 7.3 to 6.3 ± 5.2, P < 0.001), visual analog scale for neck pain (range, 2.5 ± 1.7 to 0.9 ± 1.3, P = 0.027), Japanese Orthopedic Association (JOA) score (range, 14.3 ± 1.9 to 16.0 ± 2.4, P < 0.001), and JOA recovery rate (63.4 ± 19.8%) in the Ln group improved postoperatively; however, there was no significant difference in the improvement of these clinical outcomes among all three groups. Postoperative cervical ROM was significantly reduced in all groups; however, the extent of reduction was significantly smaller in the Ln group (10.5°; range, 44.2° ± 9.1° to 33.7 ± 6.0°) than in the Lp-NF (15.1°; range, 45.4° ± 8.5° to 30.3° ± 7.4°) or Lp-F (18.2°; range, 39.6° ± 9.3° to 21.4° ± 10.3°) groups (P < 0.05). Conclusion. C3 laminectomy with laminoplasty can prevent interlaminar bony fusion at C2-C4 and, ultimately, result in better preservation of cervical ROM than C3 laminoplasty. Furthermore, it yields similar clinical outcomes when compared with C3 laminoplasty. Level of Evidence: 3from Spine - Featured Articles - Featured Articles http://ift.tt/2iadx5o
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Clinical and Radiological Study Focused on Relief of Low Back Pain After Decompression Surgery in Selected Patients With Lumbar Spinal Stenosis Associated With Grade I Degenerative Spondylolisthesis
Study Design. A retrospective study. Objective. The aim of the present study was to identify the clinical and radiological features of low back pain (LBP) that was relieved after decompression alone of lumbar spinal stenosis (LSS) associated with grade I lumbar degenerative spondylolisthesis (LDS). Summary of Background Data. Although decompression and fusion are generally the recommended surgical treatments of LDS, several authors have reported that some patients with LDS could obtain good clinical results including relief from LBP by decompression alone. The pathogenesis of relief from LBP after decompression is, however, not known. Methods. Forty patients with LSS associated with grade I LDS, who underwent a minimally invasive surgical-decompression were enrolled in the present study. All patients complained preoperatively of predominantly leg-related symptoms and LBP (≥ 4 points on Numeric Rating Scale). Clinical and radiological assessments were performed 1 year after surgery (a relief of LBP: Numeric Rating Scale reduction ≥3 points and valuation ≤3 points) and at the last follow-up. We conducted a comparative study between patient groups with and without the relief from LBP (groups R and N, respectively). Results. Twenty-nine patients were distributed to group R and the remaining 11 patients to group N. Preoperatively, there was a significant difference between the two groups for age and radiographic flexibility for lumbar extension. Postoperatively, there was a positive correlation between improvement in both LBP and leg symptoms. The clinical outcomes of group R were significantly better than those of group N throughout follow-up period (mean 37 mo). In group R, sagittal lumbopelvic radiographic parameters improved significantly after surgery. Conclusion. Although the causes of LBP are varied in each patients, our results show that concomitant LSS itself might cause LBP in some patients with grade I LDS, because it involves impingement of the neural tissue and discordant sagittal lumbopelvic alignment. Level of Evidence: 3from Spine - Featured Articles - Featured Articles http://ift.tt/2ia8K4h
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Results of Revision Surgery for Proximal Junctional Kyphosis Following Posterior Segmental Instrumentation: Minimum 2-Year Postrevision Follow-Up
Study Design. A retrospective cohort study. Objectives. The aim of this study was to evaluate radiographic and patient-reported outcomes at minimum 2 years after revision surgery for proximal junctional kyphosis (PJK), correlating these results with PJK etiology. Summary of Background Data. There are no studies detailing the results of revision surgery for PJK following posterior segmental instrumentation. Methods. Thirty-two consecutive patients treated with revision surgery after PJK above posterior fusions (25 women/7 men, average age at surgery 60.6 yrs) were reviewed for radiographic and patient-reported outcomes (mean follow-up, 4.5 yrs; range, 2–10 yrs). Patients were subdivided into fracture (F) and nonfracture (NF) groups on the basis of PJK etiology. Results. Radiographic severity of PJK improved significantly with revision surgery and was maintained at ultimate follow-up (P < 0.001). However, initial sagittal vertical axis (SVA) correction was not maintained through ultimate follow-up (P = 0.04). There were significant postrevision improvements in mean Oswestry scores (P < 0.001) and SRS total scores (P < 0.001) in all patients. In patients with pelvic incidence-lumbar lordosis (PI-LL) mismatch < 11°, final PJK measurement was smaller than in patients with mismatch ≥11° (9.4° vs. 19.8°, P = 0.009). Six patients (19%) developed new postrevision PJK, with two (6%) requiring additional surgery. Patients who sustained PJK through a fracture had greater improvements in Oswestry (P = 0.004), total SRS (P = 0.04), pain (P < 0.001), and satisfaction (P = 0.05) scores, although the fracture patients had less maintained SVA correction (P = 0.002). Conclusion. Revision surgery for PJK following posterior instrumentation achieved acceptable radiographic and clinical outcomes at minimum 2-year follow-up. Patients with PI-LL mismatch <11° experienced more ultimate PJK correction than patients with mismatch ≥11°. Although the NF group experienced more sustained correction of sagittal balance, the F group reported greater improvements in patient-reported outcomes. Ultimate clinical outcomes after revision surgery for PJK were similar between patients with and without compression fractures. Level of Evidence: 3from Spine - Featured Articles - Featured Articles http://ift.tt/2iaf37L
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A Systematic Review of Cross-cultural Adaptation of the Oswestry Disability Index
Study Design. Systematic review of cross-cultural adaptation of the Oswestry Disability Index (ODI). Objective. The aim of this study was to evaluate the translation procedures for and measurement properties of cross-cultural adaptations of the ODI. Summary of Background Data. The ODI is the most commonly used questionnaire to determine the outcome of low back pain, and has been translated into many other languages, such as Danish, Greek, and Korean, and adapted for use in different countries. Methods. PubMed, the Cochrane Library, Medline, and EMBASE were searched from the time they were established to January 2015. Studies related to cross-cultural adaptation of the ODI in a specific language/culture were included. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and Quality Criteria for Psychometric Properties of Health Status Questionnaire were used for assessment. Results. This study included 27 versions of ODI adaptations in 24 different languages/cultures. Only the Danish-Danish adaptation employed all six of the cross-cultural adaptation processes. Expert committee review (three of 27), back translation (eight of 27), and pretesting (nine of 27) were conducted in very few studies. The Polish-Polish (two) adaptation reported all (nine of nine) the measurement properties, whereas the Traditional Chinese-Taiwan and Hungarian-Hungarian adaptations reported six of them. Content validity (16/27), construct validity (17/27), and reliability (22/27) were determined in a relatively high number of studies, whereas agreement (three of 27), responsiveness (12/27), floor and ceiling effects (six of 27), and interpretability (one of 27) were only determined in some studies. Conclusion. We recommend the Traditional Chinese-Taiwan, Simplified Chinese-Mandarin Chinese, Danish-Danish, German-Swiss, Hungarian-Hungarian, Italian-Italian, and Polish-Polish (two) versions for application, but Traditional Chinese-Hong Kong, French-Swiss, Japanese-Japanese (two), Polish-Polish (two), Tamil-Indian, and Thai-Thai versions may need more research. Furthermore, supplementary tests for the adaptations are necessary, especially for assessing agreement, responsiveness, and interpretability. Level of Evidence: 1from Spine - Featured Articles - Featured Articles http://ift.tt/2iabQVN
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Lumbar Spine Paraspinal Muscle and Intervertebral Disc Height Changes in Astronauts After Long-Duration Spaceflight on the International Space Station
Study Design. Prospective case series. Objective. Evaluate lumbar paraspinal muscle (PSM) cross-sectional area and intervertebral disc (IVD) height changes induced by a 6-month space mission on the International Space Station. The long-term objective of this project is to promote spine health and prevent spinal injury during space missions and here on Earth. Summary of Background Data. National Aeronautics and Space Administration (NASA) crewmembers have a 4.3 times higher risk of herniated IVDs, compared with the general and military aviator populations. The highest risk occurs during the first year after a mission. Microgravity exposure during long-duration spaceflights results in approximately 5 cm lengthening of body height, spinal pain, and skeletal deconditioning. How the PSMs and IVDs respond during spaceflight is not well described. Methods. Six NASA crewmembers were imaged supine with a 3 Tesla magnetic resonance imaging. Imaging was conducted preflight, immediately postflight, and then 33 to 67 days after landing. Functional cross-sectional area (FCSA) measurements of the PSMs were performed at the L3-4 level. FCSA was measured by grayscale thresholding within the posterior lumbar extensors to isolate lean muscle on T2-weighted scans. IVD heights were measured at the anterior, middle, and posterior sections of all lumbar levels. Repeated measures analysis of variance was used to determine significance at P < 0.05, followed by post-hoc testing. Results. Paraspinal lean muscle mass, as indicated by the FCSA, decreased from 86% of the total PSM cross-sectional area down to 72%, immediately after the mission. Recovery of 68% of the postflight loss occurred during the next 6 weeks, still leaving a significantly lower lean muscle fractional content compared with preflight values. In contrast, lumbar IVD heights were not appreciably different at any time point. Conclusion. The data reveal lumbar spine PSM atrophy after long-duration spaceflight. Some FCSA recovery was seen with 46 days postflight in a terrestrial environment, but it remained incomplete compared with preflight levels. Level of Evidence: 4from Spine - Featured Articles - Featured Articles http://ift.tt/2ia0Esb
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Surgical Resection of Intradural Extramedullary Spinal Tumors: Patient Reported Outcomes and Minimum Clinically Important Difference
Study Design. Analysis of prospectively collected longitudinal web-based registry data. Objective. To determine relative validity, responsiveness, and minimum clinically important difference (MCID) thresholds in patients undergoing surgery for intradural extramedullary (IDEM) spinal tumors. Summary of Background Data. Patient-reported outcomes (PROs) are vital in establishing the value of care in spinal pathology. There is limited availability of prospective, quality studies reporting PROs for IDEM spine tumors. Methods. . A total of 40 patients were analyzed. Baseline, postoperative 3-month, and 12-month PROs were recorded: Oswestry Disability Index or Neck disability Index (ODI/NDI), Quality of life EuroQol-5D (EQ-5D), Short Form-12 (SF-12), Numeric Rating Scale (NRS)-pain scores. Responders were defined as those who achieved a level of improvement one or two, after surgery, on health transition index (HTI) of SF-36. Receiver-operating characteristic curves were generated to assess the validity of PROs, and the difference between standardized response means (SRMs) in responders versus nonresponders was utilized to determine the relative responsiveness of each PRO measure. MCID thresholds were derived using previously reported minimal detectable change approach. Results. A significant improvement across all PROs at 3-months and 12-months follow up was noted. The derived MCID thresholds were 13.9 points: ODI/NDI, 0.14 quality adjusted life years: EQ-5D, 2.8 points: SF-12PCS and 10.7 points: SF-12MCS, 1.9 points: NRS-back/neck pain, and 1.8 points: NRS-leg/arm pain. SF-12PCS was most accurate discriminator of meaningful improvement (area under the curve, AUC-0.83) and most responsive (SRM-1.36) to postoperative improvement. EQ-5D, ODI/NDI, NRS-pain scores were all accurate discriminator (AUC-0.7–0.8) and responsive measures (0.97–0.67) of meaningful postoperative improvement. SF-12MCS was neither a valid discriminator (AUC-0.48) nor a responsive measure (SRM: -1.5) of outcome. Conclusion. Surgical resection of IDEM spinal tumors provides significant and sustained improvement in quality of life, general health, disability, and pain at 12-month after surgery. The surgically resected IDEM-specific clinically meaningful thresholds are reported. All the PROs reported in this study can accurately discriminate responders and nonresponder based on SF-36 HTI index except for SF-12 MCS. Level of Evidence: 3from Spine - Featured Articles - Featured Articles http://ift.tt/2ia1IMG
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Monday, December 19, 2016
The effectiveness of treatments for patients with medication overuse headache; a systematic review and meta-analysis
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Sunday, December 18, 2016
Saturday, December 17, 2016
Higher Prescription Opioid Dose is associated with Worse Patient-Reported Pain Outcomes and More Health Care Utilization
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Causal Mediation in the Development of Painful Temporomandibular Disorder
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Friday, December 16, 2016
Thursday, December 15, 2016
Role of transient receptor potential ankyrin 1 receptors in rodent models of meningeal nociception – Experiments in vitro
Abstract
Background
The TRP channel ankyrin type 1 (TRPA1) is a nonselective cation channel known to be activated by environmental irritants, cold and endogenous mediators of inflammation. Activation of TRPA1 in trigeminal afferents innervating meningeal structures has recently been suggested to be involved in the generation of headaches.
Methods
Two in vitro models of meningeal nociception were employed using the hemisected rodent head preparation, (1) recording of single meningeal afferents and (2) release of calcitonin gene-related peptide (CGRP) from the cranial dura mater. The role of TRPA1 was examined using the TRPA1 agonists acrolein and mustard oil (MO). BCTC, an inhibitor of TRP vanilloid type 1 receptor channels (TRPV1), and the TRPA1 inhibitor HC030031 as well as mice with genetically deleted TRPA1 and TRPV1 proteins, were used to differentiate between effects.
Results
Acrolein did not cause discharge activity in meningeal Aδ- or C-fibres but increased the electrical activation threshold. Acrolein was also effective in releasing CGRP from the dura of TRPV1−/− but not of TRPA1−/− mice. MO increased the discharge activity of afferent fibres from rat as well as C57 wild-type and TRPA1−/− but not TRPV1−/− mice. The effect was higher in C57 compared to TRPA1−/− mice.
Conclusion
Sole TRPA1 receptor channel activation releases CGRP and increases the activation threshold of meningeal afferents but does not generate propagated activity, and so would be capable of causing local effects like vasodilatation but not pain generation. In contrast, combined TRPA1 and TRPV1 activation may be rather pronociceptive supporting headache generation.
Significance
Sole activation of TRPA1 receptor channels increases the activation threshold but does not cause propagated action potentials in meningeal afferents. TRPA1 agonists cause CGRP release from rodent dura mater. Peripheral TRPA1 receptors may have a pronociceptive function in trigeminal nociception only in combination with TRPV1.
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Biological mechanism of post-herpetic neuralgia: Evidence from multiple patho-psychophysiological measures
Abstract
Background
Post-herpetic neuralgia (PHN), which develops after the resolution of a herpes zoster eruption, is an exceptionally drug-resistant neuropathic pain. The unsatisfactory management of PHN partly results from the difficulty in dissecting out its contributing factors due to the complexity of PHN mechanism.
Methods
Here, to elaborate our understanding of the PHN mechanism and to establish a basis for effective therapeutic strategies, we comprehensively investigated the contributions of multiple factors to PHN severity.
Results
Based on the comparison of somatosensory detection thresholds (C, Aδ and Aβ fibre thresholds) between affected and unaffected sides, 16 PHN patients with significant sensory deficits and 13 PHN patients without significant sensory deficits were identified and assigned to different groups. The different extents of lesions in the nociceptive system between patients with and without sensory deficits were confirmed using laser-evoked brain responses. Moreover, patients with sensory deficits had more severe pain and psychological disorders, e.g. anxiety and depression. Importantly, chronic pain severity was significantly influenced by various psychophysiological factors (sleep disturbances, psychological disorders and hypothalamic-pituitary-adrenal axis dysfunction) for patients with sensory deficits.
Conclusions
Our findings demonstrated the contribution of multiple patho-psychophysiological factors to PHN severity, which could help establish a basis for the development of a rational, patient-centred therapeutic strategy.
Significance
This study revealed the contribution of multiple patho-psychophysiological factors to PHN severity, which expanded our understanding of the underlying PHN mechanism, and helped develop a rational, patient-centred therapeutic strategy targeting towards the corresponding etiology and psychophysiological disorders for individual patient.
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Mechanical pinprick pain in patients with unilateral spatial neglect: The influence of space representation on the perception of nociceptive stimuli
Abstract
Background
Crossing the hands over the midline can reduce the perceived intensity of nociceptive stimuli applied onto the hands. It remains unclear to what extent intact representation of peripersonal space influences this effect. Here we used the crossed-hands paradigm in patients with unilateral spatial neglect, a neuropsychological condition characterized by the inability to detect, attend and respond to contralesional (most often left) stimuli, and spared ability to process stimuli in the non-affected space.
Methods
Sixteen post-stroke patients without unilateral neglect and 11 patients with unilateral spatial neglect received punctate mechanical pinprick stimuli onto their crossed or uncrossed hands. We tested: (i) whether deficits in space representation reduce the possibility of observing ‘crossed-hands analgesia’, and; (ii) whether placing the contralesional hand, normally lying in the affected space in the healthy space would increase the number of detected stimuli.
Results
Our results showed that neglect patients did not exhibit ‘crossed-hands’ analgesia, but did not provide strong evidence for an improvement in the number of detected stimuli when the contralesional hand was in the healthy space.
Conclusion
These findings uphold the notion that the perception of nociceptive stimuli is modulated by the relative position of the hands in space, but raise questions about the conditions under which these effects may arise.
Significance
We show that deficits in space representation can influence the processing of mechanical pinprick stimuli. Our results raise several questions on the mechanisms underlying these effects, which are relevant for the clinical practice.
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Preoperative sleep quality predicts postoperative pain after planned caesarean delivery
Abstract
Background
Severe post-caesarean pain remains an important issue associated with persistent pain and postpartum depression. Women's sleep quality prior to caesarean delivery and its influence on postoperative pain and analgesic intake have not been evaluated yet.
Methods
Women undergoing caesarean delivery with spinal anaesthesia (bupivacaine 12 mg, fentanyl 20 μg, morphine 100 μg) were evaluated preoperatively for sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire (PSQI 0–5 indicating good sleep quality, PSQI 6–21 poor sleep quality). Peak and average postoperative pain scores at rest, movement and uterine cramping were evaluated during 24 h using a verbal numerical pain score (VNPS; 0 indicating no pain and 100 indicating worst pain imaginable), and analgesic intake was recorded. Primary outcome was peak pain upon movement during the first 24 h.
Results
Seventy-eight of 245 women reported good sleep quality (31.2%; average PSQI 3.5 ± 1.2) and 167 poor sleep quality (68.2%; average PSQI 16.0 ± 3.4; p < 0.001). Women with poor sleep quality had significantly higher peak pain scores upon movement (46.7 ± 28.8 vs. 36.2 ± 25.6, respectively; p = 0.006). With multivariable logistic regression analysis, poor sleep quality significantly increased the risk for severe peak pain upon movement (VNPS ≥70; OR 2.64; 95% CI 1.2–6.0; p = 0.02).
Discussion
A significant proportion of women scheduled for caesarean delivery were identified preoperatively as having poor sleep quality, which was associated with more severe pain and increased analgesic intake after delivery. The PSQI score may therefore be a useful tool to predict increased risk for acute post-caesarean pain and higher analgesic requirements, and help tailor anaesthetic management.
Significance
Multiple studies have evaluated predictors for severe acute pain after caesarean delivery that may be performed in a clinical setting, however, sleep quality prior to delivery has not been included in predictive models for post-caesarean pain. The PSQI questionnaire, a simple test to administer preoperatively, identified that up to 70% of women report poor sleep quality before delivery, and poor sleep quality was associated with increased post-caesarean pain scores and analgesic intake, indicating that PSQI could help identify preoperatively women at risk for severe pain after caesarean delivery.
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Development of a repository of individual participant data from randomized controlled trials of therapists delivered interventions for low back pain
Abstract
Background
Individual patient data (IPD) meta-analysis of existing randomized controlled trials (RCTs) is a promising approach to achieving sufficient statistical power to identify sub-groups. We created a repository of IPD from multiple low back pain (LBP) RCTs to facilitate a study of treatment moderators. Due to sparse heterogeneous data, the repository needed to be robust and flexible to accommodate millions of data points prior to any subsequent analysis.
Methods
We systematically identified RCTs of therapist delivered intervention for inclusion to the repository. Some were obtained through project publicity. We requested both individual items and aggregate scores of all baseline characteristics and outcomes for all available time points. The repository is made up of a hybrid database: entity-attribute-value and relational database which is capable of storing sparse heterogeneous datasets. We developed a bespoke software program to extract, transform and upload the shared data.
Results
There were 20 datasets with more than 3 million data points from 9328 participants. All trials collected covariates and outcomes data at baseline and follow-ups. The bespoke standardized repository is flexible to accommodate millions of data points without compromising data integrity. Data are easily retrieved for analysis using standard statistical programs.
Conclusions
The bespoke hybrid repository is complex to implement and to query but its flexibility in supporting datasets with varying sets of responses and outcomes with different data types is a worthy trade off. The large standardized LBP dataset is also an important resource useable by other LBP researchers.
Significance
A flexible adaptive database for pain studies that can easily be expanded for future researchers to map, transform and upload their data in a safe and secure environment. The data are standardized and harmonized which will facilitate future requests from other researchers for secondary analyses.
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Tuesday, December 13, 2016
Spinal D-serine increases PKC-dependent GluN1 phosphorylation contributing to the sigma-1 receptor-induced development of mechanical allodynia in a mouse model of neuropathic pain
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Monday, December 12, 2016
A trial based economic evaluation comparing spinal cord stimulation with best medical treatment in painful diabetic peripheral neuropathy
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Friday, December 9, 2016
Diagnosis and Treatment of C4 Radiculopathy
Study Design. Clinical case series. Objective. This study sought to clarify symptoms, diagnostic criteria, and treatment of C4 radiculopathy, and the role of diagnostic C4 root block in this entity. Summary of Background Data. Although well understood cervical dermatomal/myotomal syndromes have been described for symptoms originating from impingement on the C2, C3, C5, C6, C7, and C8 roots, less has been written about the syndrome(s) associated with the C4 root. Methods. The senior author reviewed surgical records and describes his personal experience with the diagnosis and treatment of C4 radiculopathy. Results. A total of 712 procedures for cervical radiculopathy without myelopathy were reviewed. Among that cohort, 13 procedures involved the C4 root only and five procedures involved two level procedures including the C4 root. Patients described pain as involving the axial cervical region, paraspinal muscles, trapezius muscle, and interscapular region. No patient described pain over the anterior chest wall or radiating distal to the shoulder, one described pain over the medial clavicle. All patients who were offered surgery had a positive response to a diagnostic C4 transforaminal single nerve root block. Thirteen patients underwent posterior foraminotomy (five at two levels) and five patients underwent an anterior discectomy and fusion at C3-4. Mean Oswestry Disability Index score significantly declined; preoperative score 24.3 (range 14–29), postoperative score 9.7 (range 2–18; P = 0.003) at ≥3 months. Mean Short Form-36v2 score significantly increased; preoperative score 34.2 (range 20–40.2), postoperative score 73.7 (range 40.5–88.3, P = 0.001) at ≥3 months. Conclusion. C4 root symptoms overlap those of the C3 and C5 roots and are very similar to facet mediated pain. Asymptomatic C4 foraminal stenosis may be a common imaging finding, it can be difficult to diagnose C4 radiculopathy clinically. Diagnostic C4 root block can make an accurate diagnosis and lead to successful surgical outcomes. Level of Evidence: 4from Spine - Featured Articles - Featured Articles http://ift.tt/2h3MFqG
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Clinical Outcome of Cervical Laminoplasty and Postoperative Radiological Change for Cervical Myelopathy With Degenerative Spondylolisthesis
Study Design. A retrospective cohort study with prospectively collected data. Objective. The aim of this study was to investigate the clinical and radiological outcome of cervical laminoplasty for cervical myelopathy with degenerative spondylolisthesis. Summary of Background Data. The presence of spondylolisthesis is thought to represent segmental instability in spine. Cervical laminoplasty is a common decompression surgery for cervical myelopathy, but its clinical result for cervical spondylolisthesis has not been well studied. Methods. One hundred seventeen patients who underwent cervical laminoplasty for degenerative cervical myelopathy were included. Japanese Orthopaedic Association score (JOA score) and visual analog scale of neck pain, upper arm pain and numbness were evaluated before surgery, and at scheduled time points after surgery. Spondylolisthesis was defined as more than 2 mm slip on plain radiograph, and the clinical results were compared between the patients with spondylolisthesis (group S) and without spondylolisthesis (group C). In the patients with spondylolisthesis, the slip distance and translational motion between flexion and extension was examined on plain lateral radiograph before surgery and 2 years after surgery. Results. Degenerative cervical spondylolisthesis was found in 49 levels of 33 patients (28.2%), and the average age of group S was significantly higher than group C. JOA score and each VAS score was significantly improved after surgery in both groups. Average JOA score of group S was significantly lower than group C at every time points, but the recovery rate was similar between the two groups. In the level of spondylolisthesis, average slip distance did not changed, but average translational motion was significantly decreased in 2years after surgery. Conclusion. Cervical spondylolisthesis was common in elderly patients. The clinical outcome in group S was comparable with group C, and the level with spondylolisthesis has been stabilized after surgery. Thus, laminoplasty can be a treatment option even for cervical myelopathy with degenerative spondylolisthesis. Level of Evidence: 3from Spine - Featured Articles - Featured Articles http://ift.tt/2h3IfjC
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Braces for Idiopathic Scoliosis in Adolescents
Study Design. A Cochrane systematic review. Objective. To evaluate the efficacy of bracing for adolescents with AIS versus no treatment or other treatments, on quality of life, disability, pulmonary disorders, progression of the curve, psychological, and cosmetic issues. Summary of Background Data. Idiopathic scoliosis is a three-dimensional deformity of the spine. The most common form is diagnosed in adolescence. Although adolescent idiopathic scoliosis (AIS) can progress during growth and cause a surface deformity, it is usually not symptomatic. Methods. We searched CENTRAL, MEDLINE, EMBASE, five other databases, and two trials registers up to February 2015. We also checked reference lists and hand searched grey literature. Randomized controlled trials (RCTs) and prospective controlled cohort studies comparing braces with no treatment, other treatment, surgery, and different types of braces for adolescent with AIS. We used standard methodological procedures expected by the Cochrane Collaboration. Results. We included seven studies. Five were planned as RCTs, two as prospective controlled clinical trials. One RCT failed completely, another was continued as an observational study. There was very low quality evidence from one small RCT that quality of life (QoL) during treatment did not differ significantly between rigid bracing and observation. Conclusion. Two studies showed that bracing did not change QoL during treatment, and QoL, back pain psychological and cosmetic issues in the long term (16 years.) All articles showed that bracing prevented curve progression. The high rate of failure of RCTs demonstrates the huge difficulties in performing RCTs in a field where parents reject randomization of their children. Level of Evidence: 1from Spine - Featured Articles - Featured Articles http://ift.tt/2h3Hl6L
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New Minimally Invasive Technique for Direct Pars Interarticularis Osteosynthesis Using Cortical Screws and Spinous-Process Modular Link
Study Design. Case report. Objective. To report a case of direct pars osteosynthesis using computed topography (CT) navigation, image guided cortically placed screws with curvilinear subspinous modular link. Summary of Background Data. Spondylolysis fracture is commonly encountered in athletes who subject their spines to repetitive hyperextension stress. Initial treatment is nonoperative, consisting of rest, activity modification, physical therapy, and/or bracing. When nonoperative treatment is deemed unsuccessful, surgery may be recommended. Methods. A 17-year-old male, competitive rower, presented with 3 months of a traumatic low-back pain without radicular symptoms. After a 9-month period of nonoperative management, the patient was submitted to surgery. Using navigation, cortical screws were placed in the standard inferomedial to superolateral trajectory crossing the fracture lines. A rod was contoured in a curvilinear fashion and passed through the L4-5 interspinous ligament and connected to the screw tulip heads. Results. Patient did well postoperatively and remained neurologically intact throughout his course. CT performed at 1 year demonstrated healed fracture sites without signs of fixation loosening or failure. Patient underwent removal of retained fixation approximately 16 months after surgery. Patient has returned to rowing and all sports activities with no restrictions and no reported lower back pain. Conclusion. This technique offers a novel solution for the treatment of pars fractures through a minimally invasive, relative muscle-sparing approach by not compromising healing potential and preserving the native facet joint. Level of Evidence: 4from Spine - Featured Articles - Featured Articles http://ift.tt/2h3H1EV
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Thursday, December 8, 2016
[World Report] Doctors lobby for better chronic pain management
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Wednesday, December 7, 2016
What it feels like to be an interesting teaching opportunity
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An adolescent with disabling abdominal pain
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Assessment of shoulder pain for non-specialists
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Tuesday, December 6, 2016
Monday, December 5, 2016
Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial
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