Hyperpathia: “to be or not to be that is the question”

No abstract available

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Pathophysiological mechanisms of neuropathic pain: comparison of sensory phenotypes in patients and human surrogate pain models

As an indirect approach to relate previously identified sensory phenotypes of patients suffering from peripheral neuropathic pain to underlying mechanisms, we used a published sorting algorithm to estimate the prevalence of denervation, peripheral and central sensitization in 657 healthy subjects undergoing experimental models of nerve block (NB) (compression block and topical lidocaine), primary hyperalgesia (PH) (sunburn and topical capsaicin), or secondary hyperalgesia (intradermal capsaicin and electrical high-frequency stimulation), and in 902 patients suffering from neuropathic pain. Some of the data have been previously published. Randomized split-half analysis verified a good concordance with a priori mechanistic sensory profile assignment in the training (79%, Cohen κ = 0.54, n = 265) and the test set (81%, Cohen κ = 0.56, n = 279). Nerve blocks were characterized by pronounced thermal and mechanical sensory loss, but also mild pinprick hyperalgesia and paradoxical heat sensations. Primary hyperalgesia was characterized by pronounced gain for heat, pressure and pinprick pain, and mild thermal sensory loss. Secondary hyperalgesia was characterized by pronounced pinprick hyperalgesia and mild thermal sensory loss. Topical lidocaine plus topical capsaicin induced a combined phenotype of NB plus PH. Topical menthol was the only model with significant cold hyperalgesia. Sorting of the 902 patients into these mechanistic phenotypes led to a similar distribution as the original heuristic clustering (65% identity, Cohen κ = 0.44), but the denervation phenotype was more frequent than in heuristic clustering. These data suggest that sorting according to human surrogate models may be useful for mechanism-based stratification of neuropathic pain patients for future clinical trials, as encouraged by the European Medicines Agency.

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Pain after surgery

No abstract available

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[Perspectives] Osteoarthritis

Stiffness and pain in the joints was for centuries seen as a mark of mortality, one of the natural shocks of old age: just look at Leonardo da Vinci or Thomas Rowlandson's caricatures of old people, with their crooked digits and knobbly joints. Since the 16th century, anatomists have been familiar with the basic structure of joints—bones capped with cartilage, connected by ligaments, and lubricated by synovial fluid—and the name they gave to the principal disorder of these joints is a classic example of plain English put into learned Greek: arthritis, literally joint inflammation.

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The opportunity to avoid pain may paradoxically increase fear

It is commonly accepted that pain can occur in the absence of apparent tissue damage, which is often the case in chronic pain17. Furthermore, beliefs and expectations can influence the experience of pain1. The fear-avoidance model of chronic pain provides a cognitive-behavioural explanation on how acute pain may turn into chronic pain, and how pain and disability may be maintained34,35. The model emphasizes how catastrophic (mis)interpretation of pain elicits pain-related fear that in turn may spur avoidance behaviour leading to chronic pain disability.

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EXPERIMENTAL REFERRED PAIN EXTENDS TOWARDS PREVIOUSLY INJURED LOCATION – AN EXPLORATIVE STUDY

Musculoskeletal pain affects a vast majority of the population at some stage during the lifespan.4 After an initial painful musculoskeletal event, such as whiplash or an acute back sprain, recurrent episodes of pain separated by pain-free periods are common.11,18,31 Although, the mechanisms for pain recurrence are unclear unresolved tissue pathology is not considered a driving factor.24

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Ultrasound-Guided Application of Percutaneous Electrolysis as an Adjunct to Exercise and Manual Therapy for Subacromial Pain Syndrome: a Randomized Clinical Trial,

Subacromial pain syndrome, as a main cause of shoulder pain is a significant health problem and has a point prevalence ranging from 7% to 26% in the general population depending on the diagnostic criteria used in the study.23 The annual costs of shoulder pain symptoms is estimated to be 345€ million per year in primary health care.22

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Acceptance and Commitment Therapy for Prevention of Chronic Post-surgical Pain and Opioid Use in At-Risk Veterans: A Pilot Randomized Controlled Study

Chronic post-surgical pain (CPSP) is a common and debilitating problem that occurs in 5-85% of patients following a variety of surgeries.22 Orthopedic surgeries are consistently associated with high postoperative pain, with the prevalence of chronic pain at 3–24 months to be 20% or more after Total Knee Arthroplasty (TKA) and 8% or more after Total Hip Arthroplasty (THA).2,4,43,33,11 Disabling pain has a dramatic impact on functioning, quality of life, mood, sleep, cognitive functions and social life.

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Parent responses to child pain during Intensive Interdisciplinary Pain Treatment and 1 Year Follow-up,,✯✯✯

Impairment in youth with chronic pain is impacted by observable and unobservable (e.g. emotional and cognitive) behaviors of those around them 11,26, particularly their caregivers. Parents and other caregivers are integral to the social context of all youth, including those with chronic pain 48. Unfortunately, parents of youth with chronic pain often experience increased levels of emotional distress, interpersonal difficulties, and financial hardships 14,17,31, which may impair their ability to respond effectively to their child's pain.

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Footballer’s knee . . . and other stories

Occupational hazards of professional footballersThe prevalence of knee pain and radiographic evidence of osteoarthritis is two to three times higher among retired professional footballers than in the...

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Orofacial pain

What you need to knowOrofacial pain is not a hallmark feature of rhinosinusitis and affects only 10% of patients with rhinosinusitisConsider alternative diagnoses such as migraine, midfacial segment...

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Pain management after bone reconstruction surgery using an analgesic bone cement: a functional non-invasive in vivo study using gait analysis

Postoperative pain following bone reconstruction is one of the most frequent undesirable complications, especially in bone iliac crest graft procedures 15,24,28,36,42,54. This pain significantly disrupts patient recovery by reducing their mobility, delaying their functional recovery, increasing their hospital stay and decreasing their quality of life and autonomy 37,53. Furthermore, recent data suggest that chronic pain could induce changes at the immune system level, by modifying immune cell gene expression 29.

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Pathobiology of Christianson Syndrome: Linking Disrupted Endosomal-Lysosomal Function with Intellectual Disability and Sensory Impairments

Flesh-eating bacteria thrive on pain

Flesh-eating bacteria thrive on pain

Flesh-eating bacteria thrive on pain, Published online: 10 May 2018; doi:10.1038/d41586-018-05137-6

Microbes weaken host’s immune response by triggering pain neurons.

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Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively

Study Design. A prospective cohort study of consecutive patients. Objective. Determination of the quality of life (QoL) and prevalence of slip progression in patients with degenerative lumbar spondylolisthesis managed nonoperatively. Summary of Background Data. Lumbar spinal stenosis secondary to degenerative lumbar spondylolisthesis is a common radiographic diagnosis associated with chronic back pain and radicular symptoms. There is limited evidence as to the clinical course in terms of validated QoL measures, and the extent of slip progression in patients with this condition treated nonoperatively. Methods. Validated disease-specific and generic QoL metrics including SF12 physical and mental scores [SF12-physical component summary (PCS) and SF12-mental component summary (MCS)], Oswestry Disability Index (ODI), and numeric scales for back and leg pain as well as radiographic assessment of slip extent were evaluated at initial consultation (baseline) and at a minimum of 5 years after the baseline assessment. Slip progression was defined by a >5% increase in slip percentage. Results. Thirty-nine of 160 (24.4%) patients elected to switch to operative management, despite no slip progression on preoperative radiographs. Seventy spondylolisthetic levels in 66 participants were assessed after a minimum of 5 years of nonoperative management. Twenty-one participants (31.8%) had slip progression. SF12-PCS, ODI, and leg pain improved similarly in both groups (P < 0.05). SF12-MCS did not change significantly in either group. Back pain improved only in the nonprogressing group. Conclusion. The majority of cases of low-grade spondylolisthesis do not progress over 5 years with nonoperative management. Regardless of whether there was progression or not, the mean PCS, ODI, and leg pain improved from baseline, although symptoms remained and a significant number elected to switch to surgical management before 5 years. Back pain improved with nonoperative treatment only in those without progression. Level of Evidence: 2

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Cartilage Endplate Thickness Variation Measured by Ultrashort Echo-Time MRI Is Associated With Adjacent Disc Degeneration

Study Design. A magnetic resonance imaging study of human cadaver spines. Objective. To investigate associations between cartilage endplate (CEP) thickness and disc degeneration. Summary of Background Data. Damage to the CEP is associated with spinal injury and back pain. However, CEP morphology and its association with disc degeneration have not been well characterized. Methods. Ten lumbar motion segments with varying degrees of disc degeneration were harvested from six cadaveric spines and scanned with magnetic resonance imaging in the sagittal plane using a T2-weighted two-dimensional (2D) sequence, a three-dimensional (3D) ultrashort echo-time (UTE) imaging sequence, and a 3D T1ρ mapping sequence. CEP thicknesses were calculated from 3D UTE image data using a custom, automated algorithm, and these values were validated against histology measurements. Pfirrmann grades and T1ρ values in the disc were assessed and correlated with CEP thickness. Results. The mean CEP thickness calculated from UTE images was 0.74 ± 0.04 mm. Statistical comparisons between histology and UTE-derived measurements of CEP thickness showed significant agreement, with the mean difference not significantly different from zero (P = 0.32). Within-disc variation of T1ρ (standard deviation) was significantly lower for Pfirrmann grade 4 than Pfirrmann grade 3 (P < 0.05). Within-disc variation of T1ρ and adjacent CEP thickness heterogeneity (coefficient of variation) had a significant negative correlation (r = −0.65, P = 0.04). The standard deviation of T1ρand the mean CEP thickness showed a moderate positive correlation (r = 0.40, P = 0.26). Conclusion. This study demonstrates that quantitative measurements of CEP thickness measured from UTE magnetic resonance imaging are associated with disc degeneration. Our results suggest that variability in CEP thickness and T1ρ, rather than their mean values, may serve as valuable diagnostic markers for disc degeneration. Level of Evidence: N/A

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Spinal Surgeons’ Opinions on Pre- and Postoperative Rehabilitation in Patients Undergoing Lumbar Spinal Fusion Surgery: A Survey-Based Study in the Netherlands and Sweden

Study Design. A cross-sectional survey in the Netherlands and Sweden. Objective. To investigate Dutch and Swedish spinal surgeons’ opinions on spinal fusion pre- and postoperative rehabilitation. Summary of Background Data. Lumbar spinal fusion surgery is increasingly provided in patients with chronic low back pain. No guidelines however exist for pre- and postoperative rehabilitation and it is unknown what opinions spinal surgeons currently have about pre- and postoperative rehabilitation. Methods. A survey was circulated to Dutch and Swedish spinal surgeons. Reminders were sent after 4 and 8/9 weeks. Data of completed questionnaires of orthopedic- and neurosurgeons currently performing lumbar spinal fusion were included for analysis. Analysis comprised a range of descriptive summaries (numerical, graphical, and tabular). Results. Surveys of 34 Dutch and 48 Swedish surgeons were analyzed. Surgeons provided preoperative information on postoperative mobilization. Spinal fusion techniques varied, but technique did not influence postoperative treatment. Swedish surgeons recommended slightly faster mobilization than Dutch (direct vs. 1-day postoperative), and more activities the first day (sitting, standing, walking). Stair climbing was the most reported discharge criterion; however, time point to start varied. More Swedish surgeons referred to postoperative physiotherapy than Dutch (88% vs. 44%). Time-point to start home activities varied from 1 week to more than 6 months. Pain increase was allowed for less than 24 hours (The Netherlands 81%, Sweden 92%). Conclusion. Findings reflect variability in lumbar spinal fusion rehabilitation in two European countries, especially in postoperative phase. The study proposes many new research topics and acts as starting point for future research valuable for the spinal community. Level of Evidence: 3

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When you live with a degenerative illness, no symptoms are mild

I was first given a diagnosis of relapsing remitting multiple sclerosis in my 20s. Four years later, a string of relapses triggered involuntary movements in my arms and legs, and I had pain, visual...

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How to tell how much wasp stings will hurt

How to tell how much wasp stings will hurt

How to tell how much wasp stings will hurt, Published online: 08 May 2018; doi:10.1038/d41586-018-05126-9

Short stinging organs tend to carry more-toxic venom — but inflict less pain — than long ones.

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Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial

AbstractObjectiveTo compare the effects of a programme of load management education plus exercise, corticosteroid injection use, and no treatment on pain and global improvement in individuals with...

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A man with chest pain and a broad QRS complex tachycardia

A 50 year old man with “heavy” chest pain was referred urgently from a local district hospital to the cardiothoracic centre because a broad QRS complex tachycardia had been noticed on...

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