Daily Peer Victimization Experiences of Adolescents with and without Chronic Pain: Associations with Mood, Sleep, Pain, and Activity Limitations

Peer victimization, defined as direct and indirect forms of intentional aggression perpetrated by peers, affects approximately one-third of children and adolescents.26 Among typically developing youth, there is a robust literature linking peer victimization status to negative health indicators, including depressed mood, sleep problems, and bodily pain.2,6,12,14,27,39,40,45,51 Despite increasing evidence linking peer victimization to physical pain and its correlates in otherwise healthy youth, we know very little about the peer victimization experiences of youth seeking treatment for chronic pain.

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ICD-10 codes for the study of chronic overlapping pain conditions in administrative databases

The significant impact of chronic pain on the American public was highlighted in the 2011 Institute of Medicine report on Relieving Pain in America.10 This report also brought focus on to some prevalent chronic pain conditions that appear to coexist in the same individuals. Further these co-existing conditions tend to be more common in females compared to males. The concept of coexisting pain conditions has been recognized by the National Institutes of Health (NIH) Pain Consortium and as an area of priority for which additional research is needed.

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Effective connectivity of beta oscillations in endometriosis-related chronic pain during rest and pain-related mental imagery

Chronic pain has been found to be associated with structural and functional changes in the regions of the brain that are involved in the cognitive and emotional modulation of pain. These neurological changes contribute to the maintenance of pain, creating a vicious self-perpetuating circle. Evidence of these neurological changes has been found in several chronic pain syndromes1,21,29,37,46,77,79; however, endometriosis-related pelvic pain was still not comprehensively studied in this context. Endometriosis is a gynecologic condition that affects up to 15% of reproductive-aged women worldwide, constituting the most common cause of chronic pelvic pain (CPP)22,33,92 in this population.

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Predicting mobility limitations in patients with total knee arthroplasty in the inpatient setting

Publication date: Available online 30 May 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Eleanor Chew Shu-Xian, Seng-Jin Yeo, Terry Haines, Julian Thumboo, Ross Allan Clark, Hwei-Chi Chong, Cheryl Lian-Li Poon, Felicia Jie-Ting Seah, Darren Tay Keng Jin, Pang Nee Hee, Celia Tan Ia Choo, Yong-Hao Pua

Abstract

Objective

To develop a prediction model for postoperative day 3 mobility limitations in patients undergoing total knee arthroplasty (TKA).

Design

Prospective cohort study

Setting

Inpatients in a tertiary care hospital.

Participants

A sample of 2300 patients who underwent primary TKA in 2016-2017.

Interventions

Not applicable

Main Outcome Measure

Candidate predictors included demographic variables and preoperative clinical and psychosocial measures. The outcome-of-interest was mobility limitations on post-TKA day 3, and this was a priori determined by an ordinal mobility outcome hierarchy based on the type of the gait aids prescribed and the level of physiotherapist assistance provided. To develop the model, we fitted a multivariable proportional odds regression model with bootstrap internal validation. We used a model approximation approach to create a simplified model that approximated predictions from the full model with 95% accuracy.

Results

On post-TKA day 3, 11% of patients required both walkers and therapist assistance to ambulate safely. Our prediction model had a concordance-index of 0.72 (95% CI, 0.68 to 0.75) when evaluating these patients. In the simplified model, predictors of greater mobility limitations included older age, greater walking aid support required preoperatively, less preoperative knee flexion range-of-movement, low-volume surgeon, contralateral knee pain, higher BMI, non-Chinese race, and greater self-reported walking limitations preoperatively.

Conclusion

We have developed a prediction model to identify patients who are at risk for mobility limitations in the inpatient setting. When used preoperatively as part of a shared-decision making process, it can potentially influence rehabilitation strategies and facilitate discharge planning.

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Effect of Pilates intervention on physical function of children and youth: A systematic review

Publication date: Available online 30 May 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elizabeth Hornsby, Leanne M. Johnston

Abstract

Objective

To conduct a systematic review to evaluate the effectiveness of Pilates intervention on physical function in children and youth.

Data Sources

Six electronic databases were searched from inception to June 2018 using the term ‘Pilates’.

Study Selection

Articles were included if they (1) reported original data for a Pilates-only intervention, (2) involved children or youth aged up to 22 years and (3) reported a musculoskeletal, pain or function study outcome. Searches identified 2565 papers and 11 studies fulfilled the inclusion criteria.

Data Extraction

The two authors independently screened and assessed all studies and any discrepancies were resolved by consensus.

Data Synthesis

Level of evidence was classified using the Oxford Centre for Evidence Based Medicine (OCEBM). Study quality was assessed using the Physiotherapy Evidence Database (PEDro) for RCTs and RoBiNT scale for SCED studies. Four studies were high quality, 3 were fair quality and four were of low quality. Findings showed that Pilates does appears to improve flexibility (n=6); muscle strength, power and movement speed (n=3); postural control, orientation and balance (n=3); metabolic cost (n=1); functional ability (n=1) and health related quality of life (n=1) and reduce pain (n=2) in children with musculoskeletal pathology, the majority with a large effect size. Pilates content varied from group-based mat classes to individualized programs using specialized equipment. Intervention dose and frequency varied widely.

Conclusions

This is the first systematic review of the effect of Pilates intervention for children and youth. Research is in the preliminary stages, however Pilates does appear to improve flexibility, strength and postural control and reduce pain in children with musculoskeletal pathology. Further research is warranted to determine the potential effectiveness of Pilates for children and youth for various population groups and to develop comprehensive treatment guidelines.

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Ultrasound-Guided Standard versus Dual-Target Subacromial Corticosteroid Injections for Shoulder Impingement Syndrome: A Randomized Controlled Trial

Publication date: Available online 29 May 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Jia-Chi Wang, Ke-Vin Chang, Wei-Ting Wu, Der-Sheng Han, Levent Özçakar

Abstract

Objective

To compare dual-target injection with standard US-guided subacromial injection in patients with SIS and possible disorders of the biceps long-head tendons.

Design

Double-blind, randomized controlled trial.

Setting

Rehabilitation outpatient clinic.

Participants

Patients with SIS (N=60).

Intervention

(1) US-guided standard subacromial bursa and (2) dual-target (subacromial bursa plus proximal biceps long-head tendon) injection, with 40-mg triamcinolone acetonide administered to patients in each group.

Main Outcome Measures

Clinical assessments were performed at baseline. The outcomes, including results from a self-administered questionnaire, the Shoulder Pain and Disability Index (SPADI), and a self-pain report, the visual analogue scale (VAS) scores for pain at rest, at night, and during overhead activities, were evaluated at baseline and at the first and third months post-intervention.

Results

No significant difference was observed in baseline evaluations between groups (n = 30 in each treatment arm) prior to injections. Both groups exhibited significant SPADI and VAS-score improvements after the first month. The dual-target injection group had less rebounding pain at the 3-month follow-up. The standard injection group had more patients reporting worsening pain within 1 day post-injection.

Conclusion

US-guided dual-target corticosteroid injection showed similar short-term efficacy to standard subacromial injections, but with an extended duration of symptom relief. Therefore, dual-target corticosteroid injections may be useful for shoulder-pain treatment in patients with SIS.

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Instrumental control enhances placebo analgesia

Placebo analgesia occurs when the treatment context elicits expectancies that drive pain relief and is readily established both in experimental and clinical settings.16 Pharmacological and neuroimaging studies have begun to uncover the biological mechanisms of placebo analgesia, including the central role of µ-opioids.11,27,29 An important remaining question concerns if and how we can tailor the treatment context to capitalise on the placebo effect and improve pain outcomes.

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The Role of Fatigue in Functional Outcomes for Youth with Chronic Pain

Abstract

Background

As a complex multidimensional construct, fatigue may play an important role in the physical and psychosocial functioning of youth with chronic pain. Based on a model previously tested in adults, the current study similarly utilized Patient‐Reported Outcomes Measurement System (PROMIS) to examine how fatigue contributes to functional outcomes for youth with chronic pain. The model tested self‐reported ratings of pain intensity, depressive symptoms, and sleep disturbance as predictors of outcomes (mobility, pain‐related interference, and school functioning) as mediated by ratings of fatigue.

Methods

285 youth with chronic pain ages 8–17 years and their caregivers, completed surveys as part of their initial clinical evaluation at a tertiary pediatric pain clinic. Study measures included: pediatric PROMIS domains (mobility, pain interference, sleep disturbance, fatigue, and depressive symptoms), Pediatric Quality of Life (PedsQL) school functioning, and pain intensity. All mediated effects were calculated via a 1000‐draw bootstrap‐estimation method in Mplus.

Results

Fatigue was found to be a statistically significant mediator of the effects of pain intensity, sleep disturbance, and depressive symptoms on outcomes of pain interference, mobility, and school functioning. While pain intensity was found to independently contribute to mobility and pain interference, depressive symptoms did not show significant effects on any outcome beyond its association with fatigue. Sleep disturbance predicted pain interference while fatigue predicted school functioning.

Conclusions

Findings suggest that fatigue is an important intervening factor for functional outcomes among youth with chronic pain. Targeting fatigue may be effective in optimizing school functioning and reducing the deleterious effects of depressive symptoms.

This article is protected by copyright. All rights reserved.

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A diagnosis of rheumatoid arthritis, endometriosis or IBD is associated with later onset of fibromyalgia and chronic widespread pain

Abstract

Background

Widespread pain is a common comorbidity in several chronic diseases and is suspected to be caused by the underlying disease that has provoked a state of central sensitization. However, this argument is currently limited by evidence that has not sufficiently captured the temporal nature of the relationship between diagnosis of the underlying disease and onset of widespread pain. The aim of this study was to investigate whether patients with rheumatoid arthritis (RA), endometriosis or inflammatory bowel disease (IBD) have a higher risk of developing widespread pain (fibromyalgia or chronic widespread pain [CWP]).

Methods

Using the Swedish Skåne Healthcare Register of healthcare consultation, a cohort of 889,938 adult patients were followed from 2007‐2016, and incident cases of RA, endometriosis or IBD and of fibromyalgia and CWP were identified by registered diagnoses. Using Poisson regression, we calculated incidence rate ratios (IRR) adjusted for sex, age, education, and propensity to seek health care.

Results

For patients with RA, the IRR for later fibromyalgia was 3.64 (95% CI: 2.75‐4.81) compared to patients without RA, and for CWP the figure was 2.96 (95% CI: 1.81‐4.86). For endometriosis patients, the IRR for fibromyalgia was 2.83 (95% CI: 1.96‐4.08) and for CWP 5.02 (95% CI: 3.10‐8.13). IRR for IBD patients was 2.32 (95% CI: 1.58‐3.42) for fibromyalgia and 1.42 (95% CI: 0.93‐2.17) for CWP.

Conclusions

This study shows that RA, endometriosis and IBD are all risk factors for later fibromyalgia and chronic widespread pain, consistent with a hypothesis of central sensitization as an effect of a painful underlying condition.

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Don’t you want me, baby? Cardiac and Electrocortical Concomitants of Romantic Interest and Rejection: Running Title: Romantic Interest and Rejection

Publication date: Available online 25 May 2019

Source: Biological Psychology

Author(s): F.M. van der Veen, A. Burdzina, S.J.E. Langeslag

Abstract

Online dating has become a very popular way to find a romantic partner. In the present study, we examined whether romantic interest and rejection in such a setting would evoke differential electrocortical and cardiac responses. For this purpose a database was created, similar to a dating website, where the participants’ personal information and photos were placed. Heterosexual, single participants (N = 61) evaluated the profiles of opposite-sex potential romantic partners and decided whether they would like to date this person or not. Subsequently, participants passively viewed (34 analyzable volunteers participated in the EEG session; 10 male; mean age = 20) the pictures of the potential partners together with their own judgment about the “dateability” of the potential partner, and the potential partner’s judgment of the “dateability” of the participant. After viewing the pictures participants received the email addresses to contact their matches. Electrocortical and cardiac responses to these “match” or “non-match” judgments were measured. A significantly larger P3 response was found when participants received a positive evaluation as compared to negative evaluations. This is in line with an explanation in terms of reward. A significantly larger cardiac deceleration was found when participants received a negative evaluation as compared to positive evaluations, which is in line with an explanation in terms of social pain. Findings are discussed in terms of activation of different parts of the anterior cingulate cortex.

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Sessions of prolonged continuous theta burst stimulation or high-frequency 10 Hz stimulation to left dorsolateral prefrontal cortex for three days decreased pain sensitivity by modulation of the efficacy of conditioned pain modulation

Non-invasive brain stimulation has received a lot of attention as a potential pain therapy.25,35 For instance, 10Hz repetitive transcranial magnetic stimulation (rTMS) applied to the left dorsolateral prefrontal cortex (L-DLPFC) decreased pain sensitivity in healthy subjects13,62 and reduced experimental,56,61,62 post-operative,9,10,14 and chronic pain.12,45,57 Although several studies demonstrated pain relief effects of daily 10Hz L-DLPFC rTMS sessions in chronic12,45,57 and in experimental pain,56 no studies have proven whether the decreased pain sensitivity in healthy subjects could be maintained for several hours by repetitive sessions of rTMS, which may have a clinical relevance if one considers rTMS to be potentially useful before painful procedures.

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Cannabis use preferences and decision making among a cross-sectional cohort of medical cannabis patients with chronic pain

Since 1996, the legality of cannabis in the United States has changed dramatically. While it remains a Schedule I substance (i.e., no accepted medical use, high risk of abuse) under the Controlled Substances Act, cannabis is now legal in 33 states and Washington DC for medical purposes, as well as in 10 states and Washington DC for recreational use.39 According to estimates from state medical cannabis registry data, there are now >2.1 million legal medical cannabis patients nationwide,40 and we recently reported that 67% of qualifying conditions in medical cannabis state registries are for chronic pain.

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When Environment Meets Genetics: A Clinical Review of the Epigenetics of Pain, Psychological Factors, and Physical Activity

Publication date: June 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 6

Author(s): Andrea Polli, Kelly Ickmans, Lode Godderis, Jo Nijs

Abstract

Epigenetic mechanisms represent a link between the environment and gene function. Recent research shows how early life stress, inflammation, and physical activity can influence gene expression through epigenetic mechanisms. Epigenetic changes—such as DNA methylation and microRNA interference—can be measured in humans and might soon become important biological markers. Epigenetic marks can accompany clinical assessment to measure the effectiveness of various interventions, such as exercise therapy. In addition, epigenetics is improving the understanding of important underlying mechanisms related to the central nervous system, the opioidergic system, and stress responses. Epigenetics is closing a gap in our explanatory abilities and should be implemented to broaden the field of rehabilitation sciences, promote a mechanism-based clinical reasoning, and develop new treatments. In the present review, we focused on epigenetic mechanisms related to pain, psychological factors (such as fear and anxiety), and physical activity, translating relevant findings from these 3 different, yet related, areas of cardinal importance for clinicians.

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Exercise Therapy in Addition to an Orthosis Reduces Pain More Than an Orthosis Alone in Patients With Thumb Base Osteoarthritis: A Propensity Score Matching Study

Publication date: June 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 6

Author(s): Robbert M. Wouters, Jonathan Tsehaie, Harm P. Slijper, Steven E.R. Hovius, Reinier Feitz, Arjen Blomme, Berbel Sluijter, Corinne Schouten, Dirk-Jan van der Avoort, Erik Walbeehm, Gijs van Couwelaar, Guus Vermeulen, Hans Schipper, Hans Temming, Jeroen van Uchelen, Luitzen de Boer, Nicoline de Haas, Oliver Zöphel, Reinier Feitz, Sebastiaan Souer

Abstract

Objective

To compare the effect of exercises and orthotics with orthotics alone on pain and hand function in patients with first carpometacarpal joint (CMC-1) osteoarthritis (OA) and to predict outcomes on pain and hand function of exercises and orthotics.

Design

Prospective cohort study with propensity score matching.

Setting

Data collection took place in 13 outpatient clinics for hand surgery and hand therapy in The Netherlands.

Participants

A consecutive, population-based sample of patients with CMC-1 OA (N=173) was included in this study, of which 84 were matched on baseline demographics and baseline primary outcomes.

Interventions

Exercises and orthotics versus orthotics alone.

Main Outcome Measures

Primary outcomes included pain and hand function at 3 months, measured using visual analog scale (VAS, 0-100) and the Michigan Hand Outcomes Questionnaire (MHQ, 0-100).

Results

A larger decrease in VAS pain at rest (11.1 points difference; 95% confidence interval, 1.9-20.3; P=.002) and during physical load (22.7 points difference; 95% confidence interval, 13.6-31.0; P<.001) was found in the exercise + orthotic group compared to the orthotic group. In addition, larger improvement was found for the MHQ subscales pain, work performance, aesthetics, and satisfaction in the exercise + orthotic group. No differences were found on other outcomes. Baseline scores of metacarpophalangeal flexion, presence of scaphotrapeziotrapezoid OA, VAS pain at rest, heavy physical labor, and MHQ total predicted primary outcomes for the total exercise + orthotic group (N=131).

Conclusions

Non-surgical treatment of patients with CMC-1 OA should include exercises, since there is a relatively large treatment effect compared to using an orthosis alone. Future research should study exercises and predictors in a more standardized setting to confirm this finding.

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Inpatient Rehabilitation Quality of Care From the Patient’s Perspective: Effect of Data Collection Timing and Patient Characteristics

Publication date: June 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 6

Author(s): Anne Deutsch, Allen W. Heinemann, Karon F. Cook, Linda Foster, Ana Miskovic, Arielle Goldsmith, David Cella

Abstract

Objective

To compare, by collection time and patient characteristics, inpatient rehabilitation quality measure scores calculated using patient-reported data.

Design

Cohort study of rehabilitation inpatients with neurologic conditions who reported their experience of care and pain status at discharge and 1month after discharge.

Setting

Two inpatient rehabilitation facilities (IRFs).

Participants

Patients with neurologic conditions (N=391).

Interventions

Not applicable.

Main Outcome Measures

We calculated 18 quality measure scores using participants’ responses to 55 experience of care and health status questions addressing communication, support and encouragement, care coordination, discharge information, goals, new medications, responsiveness of staff, cleanliness, quietness, pain management, care transitions, overall hospital rating, willingness to recommend, and pain.

Results

Of the 391 participants reporting at discharge, 277 (71%) also reported postdischarge after multiple attempts by e-mail, mail, and telephone. Discharge experience of care quality scores ranged from 25% (responsiveness of hospital staff) to 75% (willingness to recommend hospital); corresponding postdischarge scores were 32% to 87%, respectively. Five of the 16 experience of care quality scores increased significantly between discharge and postdischarge. The percentage of participants reporting high pain levels at discharge did not change across time periods. Patients with less education, older age, higher motor and cognitive function, and those who were not Hispanic or black had more favorable quality measure scores.

Conclusion

Patients’ experience of care responses tended to be more favorable after discharge compared to discharge, suggesting that survey timing is important. Responses were more favorable for patients with selected characteristics, suggesting the possible need for risk adjustment if patient-reported quality measure scores are compared across IRFs.

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Robotic-Assisted Shoulder Rehabilitation Therapy Effectively Improved Poststroke Hemiplegic Shoulder Pain: A Randomized Controlled Trial

Publication date: June 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 6

Author(s): Min-Su Kim, Sung Hoon Kim, Se-Eung Noh, Heui Je Bang, Kyoung-Moo Lee

Abstract

Objective

The purpose of this study was to investigate the therapeutic effects of a newly developed shoulder robot on poststroke hemiplegic shoulder pain.

Design

Prospective, single-blind randomized controlled trial.

Setting

Inpatient department of a tertiary university hospital.

Participants

Hemiplegic shoulder pain patients (N=38) were consecutively recruited and randomly assigned to an intervention or control group.

Interventions

A newly developed robot was designed to perform joint mobilization and stretching exercises with patients lying in the supine position. Conventional physical therapy directed at both improving upper extremity mechanics and reducing neurologic injury was performed twice per day in both groups. In the intervention group, additional robotic-assisted shoulder rehabilitation therapy was administered for 30 minutes per day, 5 times per week for 4 weeks.

Main Outcome Measures

The visual analog scale was the primary outcome, and the pain-free passive range of motion of the shoulder joint, the Korean version of the Shoulder Disability Questionnaire, and ultrasonographic grades were the secondary outcomes. The outcomes were evaluated at baseline (T0), postintervention (T1), and a 4-week follow-up (T2).

Results

Significant time and group interaction effects were found on the visual analog scale, in the abduction passive range of motion, and on the Shoulder Disability Questionnaire (F_2,33=16.384, P=.002; F_2,33=10.609, P=.012; F_2,33=32.650, P=.008, respectively). Significantly higher improvements in these outcome measures were observed in the intervention group than in the control group at T1 after post hoc analysis (P<0.05, all). These improvements were sustained at T2 when the intervention group was compared with the control group (P<.05, all).

Conclusions

A prototype shoulder rehabilitation robot as an adjuvant therapy improves hemiplegic shoulder pain and self-reported shoulder-related disability.

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Systematic review and meta-analysis of genetic risk of developing chronic postsurgical pain

Chronic post-surgical pain (CPSP) is an important clinical problem of considerable magnitude, that negatively affects recovery after surgery. The initial criteria proposed by Macrae and Davies55 in 1999, and modified by Werner and Kongsgaard89 define CPSP as 1) pain that develops after a surgical procedure or increases in intensity after the surgical procedure, 2) pain of at least 3–6 months’ duration and significantly affects quality of life, 3) pain that is a continuation of acute post-surgery pain or develops after an asymptomatic period, 4) pain localized to the surgical field, projected to the innervation territory of a nerve situated in the surgical field, or referred to a dermatome, and 5) other causes of the pain should be excluded.

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Development and Assessment of a Crosswalk Between ICD-9-CM and ICD-10-CM to Identify Patients with Common Pain Conditions

Pain is a significant public health problem affecting approximately 20% of adults in the United States (US).4,11,14 However, specific data are lacking on the incidence, prevalence, and outcomes of most common pain conditions. Health services research on chronic pain has typically focused on single pain conditions, such as low back pain or headache, despite an increasing recognition of multiple chronic overlapping pain conditions.13 Focusing on single pain conditions can limit understanding of the effects of chronic pain, as those who are most disabled by chronic pain and use the most health care services typically suffer from multiple pain conditions.

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Effect of local infiltration with oxytocin on hemodynamic response to surgical incision and postoperative pain in patients having open laparoscopic surgery under general anesthesia

Abstract

Background

Preemptive analgesia encompasses different perioperative interventions that have the final aim of decreasing postoperative pain and improving recovery. Recently, peripheral analgesic effects of oxytocinergic modulation have been suggested. In this regard, we tested the potential analgesic effects of subcutaneous oxytocin (OT) infiltration in patients submitted to laparoscopic cholecystectomy.

Methods

Thirty patients with similar general characteristics and medical physical conditions were evaluated. The patients were assigned by simple random selection to one of three groups: (i) OT group (n=10), which received preincisional subcutaneous OT (4 μg/4 ml saline) in the surgical sites for trocar placements; (ii) Lidocaine group (n=10), which received subcutaneous lidocaine 1% (4 ml) in the surgical sites; and (iii) Control group (n=10), which did not receive any treatment. Then we measured the effect of those treatments on the hemodynamic variations produced as responses to the surgical incisions and trocar insertions (open port placements using the Hasson technique). Moreover, we assessed the intensity of postoperative pain with the visual analogue scale during recovery and 24 hours after surgery.

Results

Hemodynamic parameters were stable in both intervention groups (subcutaneous OT and lidocaine) during the surgical incisions and trocar placements, whereas a most likely sympathetic activation due to trocar insertions (open port placements) was not blunted in the placebo group. Furthermore, postoperative pain was diminished in both OT and lidocaine groups when compared to the control group.

Conclusions

Preincisional subcutaneous OT administration reduced the hemodynamic response produced by the latter. Furthermore, OT also diminished postoperative pain.

This article is protected by copyright. All rights reserved.

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The serum protease network—one key to understand complex regional pain syndrome pathophysiology

Complex regional pain syndrome (CRPS) develops after fracture. The acute CRPS phenotype resembles exaggerated inflammation, which is explained by local and systemic activation of a proinflammatory network including peptides and cytokines. Epidemiologic data suggest that inactivation of the peptidase angiotensin-converting enzyme in patients treated for hypertension increases the odds to develop CRPS. This hint leads us to investigate the serum protease network activity in patients with CRPS vs respective controls. For this purpose, we developed a dabsyl-bradykinin (DBK)-based assay and used it to investigate patients with CRPS, as well as healthy and pain (painful diabetic neuropathy [dPNP]) controls. The major result is that the degradation of DBK to fragments 1-8 and 1-5 in healthy control and dPNP is shifted to higher values for DBK1-8 and lower values for DBK1-5 at 1 hour of incubation in patients with CRPS. Using this novel reporter peptide assay, we have been able to show that the resolving protease network for mediators such as BK might be different in patients with CRPS; having a look at the clinical signs, which resemble inflammation, this resolving protease network is probably less effective in CRPS.

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Pain coping skills training for African Americans with osteoarthritis: results of a randomized controlled trial

African Americans bear a disproportionate burden of osteoarthritis (OA), but they have been underrepresented in trials of behavioral interventions for pain. This trial examined a culturally tailored pain coping skills training (CST) program, compared to a wait list control group, among 248 African Americans with knee or hip OA. The pain CST program involved 11 telephone-based sessions over 3 months. Outcomes were assessed at baseline, 3 months (primary), and 9 months, and included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (primary outcome), WOMAC total score and function subscale, PROMIS Pain Interference, Short-Form 12 Mental and Physical Composite Subscales, Coping Strategies Questionnaire—Total Coping Attempts, Pain Catastrophizing Scale, Patient Health Questionnaire-8, Arthritis Self-Efficacy Scale, and Patient Global Impression of Arthritis Symptom Change. Linear mixed models were fit for all outcomes. There were no significant between-group differences in WOMAC pain score at 3 months (−0.63 [95% confidence interval −1.45, 0.18]; P = 0.128) or 9 months (−0.84 [95% confidence interval −1.73, 0.06]; P = 0.068). Among secondary outcomes, at 3 months, there were significant differences, in favor of the CST group, for Coping Strategies Questionnaire Total Coping Attempts, Pain Catastrophizing Scale, Arthritis Self-Efficacy, and Patient Global Impression of Arthritis Symptom Change (P < 0.01). Coping Strategies Questionnaire Total Coping Attempts, Arthritis Self-Efficacy, and Patient Global Assessment Change were also significantly improved at 9 months in the CST group, compared with wait list (P < 0.01). The culturally tailored pain CST program did not significantly reduce pain severity but did improve key measures of pain coping and perceived ability to manage pain among African Americans with OA.

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A man with severe leg pain

A 23 year old man presented to the emergency department after being trapped between two cars and suffering a crush injury to his right leg. Radiography revealed no underlying fractures. One hour...

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The Relation of Self‐Compassion to Functioning among Adults with Chronic Pain

Abstract

Previous research has shown that self‐compassion is associated with improved functioning and health outcomes among multiple chronic illnesses. However, the role of self‐compassion in chronic pain‐related functioning is understudied. The present study sought to understand the association between self‐compassion and important measures of functioning within a sample of patients with chronic pain. Treatment‐seeking individuals (N= 343 with chronic pain) that were mostly White (97.9%) and female (71%) completed a battery of assessments that included the Self‐Compassion Scale (SCS), as well as measures of pain‐related fear, depression, disability, pain acceptance, success in valued activity, and use of pain coping strategies. Cross‐sectional multiple regression analyses that controlled for age, sex, pain intensity, and pain duration, revealed that self‐compassion accounted for a significant and unique amount of variance in all measures of functioning (r ² range: .07 – .32, all p < .001). Beta weights indicated that higher self‐compassion was associated with lower pain‐related fear, depression, and disability, as well as greater pain acceptance, success in valued activities, and utilization of pain coping strategies. These findings suggest that self‐compassion may be a relevant adaptive process in those with chronic pain. Targeted interventions to improve self‐compassion in those with chronic pain may be useful.

Significance

Self‐compassion is associated with better functioning across multiple general and pain‐specific outcomes, with the strongest associations among measures related to psychological functioning and valued living. These findings indicate that self‐compassion may be an adaptive process that could minimize the negative impact of chronic pain on important areas of life.

This article is protected by copyright. All rights reserved.

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Predictors of treatment outcome in children with medically unexplained pain seeking primary care: A prospective cohort study

Abstract

Background

Medically unexplained pain in children and adolescents is a common and increasing health care problem. Primary care is usually the first point of contact for these patients. It is the overall objective of this study to investigate treatment outcome of medically unexplained pain in pediatric primary care and to identify predictors of treatment failure.

Method

In a prospective observational cohort study with three assessments over six months, N=266 children (6 to 17 years) presenting to pediatric primary care due to medically unexplained pain were included. The primary outcome is treatment failure after 6 months defined as disabling chronic pain. Risk factors for treatment failure were identified by means of logistic regression analyses.

Results

At the 6‐months follow‐up, treatment proved unsuccessful in 22.6% of patients. In patients with headaches, high functional impairment and strong emotional pain burden at study inclusion, the risk for treatment failure was increased. However, when also including data on the initial treatment response, pain location and functional impairment were no longer significant. Patients who did not respond to treatment within the first three months were more likely to experience treatment failure (OR=104.3; p<.001) at 6 months, as were children with a higher emotional pain burden at study inclusion (OR=1.2; p=.007; R²=.755).

Conclusions

This study indicates that pediatric primary care is not sufficient for nearly one quarter of children with medically unexplained pain. Individuals without a positive treatment response after three months are at increased risk for treatment failure.

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Visual Attention to Pain Cues for Impending Touch Versus Impending Pain: An Eye‐Tracking Study

Abstract

Background

In this eye‐tracking study, we evaluated pain‐related biases in orienting and maintenance of gaze within impending touch versus impending pain tasks and examined features of pain resilience as individual difference influences on potential biases.

Methods

Gaze preferences of healthy adults (25 women, 39 men) were assessed during standardized pain‐neutral (P‐N) image pair presentations (2000ms) of an impending touch task versus an impending pain task whereby image pair offsets were followed by potential non‐painful touch and potential pain stimulation, respectively.

Results

Within each task, participants were significantly more likely to fixate first upon pain images in P‐N pairs and maintain gaze on these images for longer overall durations during trials. Between task comparisons indicated pain‐related biases in orienting and maintenance were significantly stronger when image pairs signaled potential pain rather than impending touch. Finally, within the impending pain task, higher scores on the behavior perseverance dimension of pain resilience were related to shorter first fixation durations and overall gaze durations toward pain images.

Conclusions

Supporting specific threat interpretation model premises, comparatively more threatening external pain cues for impending pain were characterized by gaze biases reflecting pronounced early attentional capture and subsequent prolonged vigilance. However, elevations in self‐reported behavioral perseverance in spite of pain corresponded to an increased capacity to disengage from pain images that signaled potential pain.

This article is protected by copyright. All rights reserved.

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Pain and Posttraumatic Stress Disorder in refugees who survived torture: The role of pain catastrophizing and trauma‐related beliefs

Abstract

Background

Traumatized refugees with comorbid pain report more severe posttraumatic stress disorder (PTSD), respond less well to PTSD‐focused treatments, and exhibit greater disability. A mutually maintaining relationship may exist between pain and PTSD, that may be partly accounted for by depression, but no prior studies have tested this assumption in traumatized refugees.

Method

Self‐report measures of pain, PTSD, depression, disability, pain catastrophizing (PC), and trauma‐related beliefs (TRBs) were administered to 197 refugees referred to the Danish Institute Against Torture (DIGNITY) prior to treatment. The contribution of pain, depression, PC, and TRBs to the overall variance in PTSD severity was examined. We also examined whether the relationship between pain and PTSD was mediated by PC and TRBs, after controlling for depression.

Results

Depression, pain severity, PC, and TRBs together accounted for 66% of the overall variance in PTSD, with depression being the primary contributor (57%). In univariate tests, both PC and TRBs significantly mediated the relationship between pain interference/severity and PTSD. However, after controlling for depression only PC mediated this relationship.

Conclusions

Negative beliefs about pain and the trauma made small, but additive contributions to the relationship between pain and PTSD severity, after controlling for depression. Longitudinal studies with refugees, involving tests of more complex mutual maintenance models, are warranted.

This article is protected by copyright. All rights reserved.

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Postoperative gas gangrene

A 13 year old girl presented with two days of pyrexia, left groin and leg pain, crepitus in the left groin and abdominal wall, and a feathery pattern of extensive gas formation (fig 1, red arrows) on...

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Longer Preoperative Duration of Symptoms Negatively Affects Health-related Quality of Life After Surgery for Cervical Radiculopathy

Study Design. Retrospective cohort. Objective. Determine the effect of duration of symptoms (DOS) on health-related quality of life (HRQOL) outcomes for patients with cervical radiculopathy. Summary of Background Data. The effect of DOS has not been extensively evaluated for cervical radiculopathy. Methods. A retrospective analysis of patients who underwent an anterior cervical decompression and fusion for radiculopathy was performed. Patients were grouped based on DOS of less than 6 months, 6 months to 2 years, and more than 2 years and HRQOL outcomes were evaluated. Results. A total of 216 patients were included with a mean follow-up of 16.0 months. There were 86, 61, and 69 patients with symptoms for less than 6 months, 6 months to 2 years, and more than 2 years, respectively. No difference in the absolute postoperative score of the patient reported outcomes was identified between the cohorts. However, in the multivariate analysis, radiculopathy for more than 2 years predicted lower postoperative Short Form-12 Physical Component Score (P = 0.037) and Short Form-12 Mental Component Score (P = 0.029), and higher postoperative Neck Disability Index (P = 0.003), neck pain (P = 0.001), and arm pain (P = 0.004) than radiculopathy for less than 6 months. Furthermore, the recovery ratios for patients with symptoms for less than 6 months demonstrated a greater improvement in NDI, neck pain, and arm pain than for 6 months to 2 years (P = 0.041; 0.005; 0.044) and more than 2 years (P = 0.016; 0.014; 0.002), respectively. Conclusion. Patients benefit from spine surgery for cervical radiculopathy at all time points, and the absolute postoperative score for the patient reported outcomes did not vary based on the duration of symptoms; however, the regression analysis clearly identified symptoms for more than 2 years as a predictor of worse outcomes, and the recovery ratio was statistically significantly improved in patients who underwent surgery within 6 months of the onset of symptoms. Level of Evidence: 3

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Predictors of Extended Length of Hospital Stay in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Segmental Instrumented Fusion: An Analysis of 407 Surgeries Performed at a Large Academic Center

Study Design. Retrospective cohort study. Objective. The aims of this study were to (1) compare patient and procedure-specific characteristics among those who had short versus long hospital stays and (2) identify independent risk factors that may correlate with extended length of hospital stay (LOS) in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior segmental instrumented fusion (PSIF). Summary of Background Data. Reducing the LOS and identifying risk factors associated with extended admission have become increasingly relevant to healthcare policy makers. There is currently limited research identifying risk factors that correlate with extended stay in patients undergoing PSIF for AIS. Methods. A single-institution, longitudinally maintained database was queried to identify 407 patients who met specific inclusion and exclusion criteria. Based on the distribution and median LOS in the cohort (4 days), patients were divided into those who had long versus short LOS. In both groups, patient demographics, comorbidities, preoperative scoliosis curve measurements, surgery-related characteristics, and complications were analyzed. A univariate and multivariate regression analysis was then conducted to identify independent risk factors associated with extended LOS. Results. Patients who had extended LOS tended to be women (84.6% vs. 75%, P = 0.01), had more levels fused (9 ± 2 vs. 7 ± 2 levels, P < 0.001), had more major postoperative complications (0.8% vs. 7.4%, P = 0.002), had more blood loss during surgery (723 ± 548 vs. 488 ± 341 cm3, P < 0.001), and received less epidural analgesia for pain control (69% vs. 89%, P < 0.001). Except for higher thoracic kyphosis, long LOS patients did not have worse preoperative radiographic curve parameters. Multivariate logistic analysis identified female sex, having ≥9 ± 2 levels of fusion, operative blood loss, major postoperative complications, lack of epidural analgesia, and higher thoracic kyphosis as independent risk factors correlating for extended LOS. Conclusion. Independent risk factors identified by this study may be used to recognize patients with AIS at risk of prolonged hospital stay. Level of Evidence: 3

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Discrepancies Between Patient and Surgeon Expectations of Surgery for Sciatica: A Challenge for Informed Decision Making?

Study Design. Qualitative study. Objective. The objective of this study was to compare the perceptions of patients and surgeons regarding the risks and benefits of lumbar decompressive surgery for sciatica following a consultation meeting. Summary of Background Data. Evidence regarding pain improvement in patients following lumbar decompressive surgery for sciatica is inconsistent. Given this inconsistency, patients choosing to undergo lumbar decompressive surgery must accept the risks associated with the surgery despite uncertainty regarding benefits. This raises questions as to the nature of informed decision-making for patients choosing to undergo surgery for sciatica. Methods. We undertook a qualitative descriptive study with 12 adult lumbar decompressive surgery candidates and six of their spine surgeons and analyzed data using inductive content analysis. Results. Our analysis revealed that most patients were satisfied with the consultation despite limited understanding of lumbar decompressive surgery. We found discrepancies between patients’ preoperative expectations and understanding of information provided by surgeons and what surgeons believed they had conveyed. Surgeons and patients disagreed on how much information is needed about postsurgical activity modifications and long-term outcomes to make a decision about whether or not to undergo surgery, with patients desiring more information. As a result, for most patients, the decision-making process extended beyond the information provided by surgeons and incorporated information from family members, friends, family doctors, and the internet. Conclusion. Our results highlight misunderstandings between patients and surgeons, particularly in regard to prognosis and activity modifications. Since this information is important for patients choosing whether to undergo a surgical intervention, our study provides guidance to improve informed decisions about sciatica and, potentially, other elective surgeries. Level of Evidence: 4

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An Evaluation of PROMIS in Patients With Primary or Metastatic Spine Tumors

Study Design. Retrospective evaluation of prospectively collected data. Objective. In spine tumor patients: i) to assess the correlation of Patient-reported Outcomes Measurement Information System (PROMIS) physical function (PF), pain interference (PI), and Depression scores with Oswestry Disability Index (ODI) and Neck Disability Index (NDI) scores; and ii) to assess ceiling and floor effects of PROMIS PF, PI, and Depression domains and the ODI/NDI. Summary of Background Data. There remains no widely used patient-reported outcome (PRO) instrument for spine tumor patients. PROMIS, a universal PRO tool, may add notable value to patient care. A paucity of work exists comparing PROMIS to legacy PRO tools in primary and metastatic spine tumor patients. Methods. Patients confirmed to have a primary or metastatic spine tumor were asked to complete PROMIS PF, PI, and Depression domains and either an ODI or NDI questionnaire between May 2015 and December 2017. Pearson correlation coefficients (r) were calculated. Ceiling and floor effects were determined. P < 0.05 was significant. Results. Eighty unique visits from 51 patients with spine tumors (44 metastatic/67 visits; 7 primary/13 visits) met our inclusion criteria. A strong correlation existed between PROMIS PI and the ODI/NDI in both primary and metastatic tumor patient subgroups (range, r = 0.75–0.86, P < 0.05). PROMIS PF and the ODI/NDI demonstrated a strong correlation among all patients (r = –0.75, P < 0.05) and in the metastatic disease subgroup (r = –0.78, P < 0.05). A strong correlation existed between PROMIS Depression and the ODI/NDI in the primary tumor subgroup (r = 0.79, P < 0.05). PROMIS Depression demonstrated the largest floor effect (13.6%); there were similar ceiling effects. Conclusion. PROMIS PF and PI domains correlate well with the ODI/NDI in spine tumor patients and have a similar ceiling effect but decreased floor effect. PROMIS Depression was not as well captured, except in the primary tumor subgroup. Level of Evidence: 2

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Relationship Between Proprioception and Pain and Disability in People With Non-Specific Low Back Pain: A Systematic Review With Meta-Analysis

Study Design. Systematic review with meta-analysis. Objective. To examine the association between proprioception and pain and disability in people with non-specific low back pain (NSLBP) and the impact of potential moderators on the strength of the association. Summary of Background Data. NSLBP is a common musculoskeletal disorder and a leading cause of disability. Proprioception deficit has been associated with low back pain and correlated with pain and disability; however, the correlation coefficients presented are conflicting. Methods. Systematic literature search was performed in eight databases and Google scholar. Two independent reviewers assessed the literature and extracted data. Data of interest included participant characteristics of NSLBP group, pain and disability, proprioception test protocol, and the correlation coefficient between proprioception and pain/disability. Meta-analysis of data from homogeneous studies was performed according to proprioception test methods. Subgroup of movement directions was analyzed. The methodological quality of studies was assessed. Results. The literature search identified 3067 records of which 14 studies were included for meta-analysis. Proprioception was measured by active joint repositioning sense (AJRS), passive joint repositioning sense (PJRS), and threshold to detect passive motion (TTDPM). Meta-analysis revealed no significant correlation coefficient between any proprioception measures and pain or disability (P > 0.05). The subgroup analysis showed little correlation between absolute error (AE) of passive lumbar flexion and pain (r = 0.225, 95% CI 0.040–0.395), and between AE of passive lumbar extension and disability (r = 0.196, 95%CI 0.010–0.369). Conclusion. AJRS and TTDPM are not correlated with pain and disability in people with NSLBP. The AE of passive lumbar movement is correlated to a small degree with pain and disability. However, the degree of correlation is small and should be interpreted with caution. Therefore, the differences in proprioception observed between people with pain and people without pain seem to be independent of the symptoms. Level of Evidence: 1

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Transient effects of sleep on next-day pain and fatigue in older adults with symptomatic osteoarthritis

Poor sleep quality, pain and fatigue are commonly experienced by older adults with osteoarthritis (OA).1,40,48,65,66 Cross-sectional studies have demonstrated significant associations between poor sleep quality and higher OA-related pain intensity and/or fatigue24,46 and sleep improvements following Cognitive Behavioral Therapy for Insomnia (CBT-I) have been associated with downstream and sustained reductions in pain and fatigue.61,62 In older age adults with hip or knee OA, weekly fluctuations in sleep interference and OA-related pain have been shown to track with each other.

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Suppression of WNK1-SPAK/OSR1 attenuates bone cancer pain by regulating NKCC1 and KCC2

Bone cancer pain (BCP), the most common symptom of the patients with primary or metastatic bone cancer, affects approximately one third of cancer patients.6,9 This type of pain is often severe and substantially hampers patients’ quality of life.11,30,34 Unfortunately, treatment for BCP still remains a major challenge due to the lack of understanding of underlying mechanisms.

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Unveiling the Relationship Between Central Parkinsonian Pain and Motor Symptoms in Parkinson's Disease

Abstract

Background

Pain in Parkinson's disease (PD) is a common and heterogeneous non‐motor symptom. Though the characteristics and predictors of pain in general and of central pain in particular are still largely unknown.

Methods

A semi‐structured interview, the Brief Pain Inventory, and the Pain Disability Index were used to identify and characterize pain in a consecutive series of 292 PD patients. Unified Parkinson's Disease Rating Scale‐III, Hoehn & Yahr, Schwab and England Independence Scale, and Freezing of Gait Questionnaire were applied to assess motor symptoms and functional independence in off and on conditions. Hospital Anxiety and Depression Scale and Questionnaire of Impulsive‐Compulsive Control Disorders were used to screen for anxiety, depression and impulse control disorders.

Results

Two hundred and twelve patients (73%) reported pain, which was classified as: musculoskeletal (63%), dystonia‐related (27%), central parkinsonian (22%), and/or radicular or neuropathic (9%). Patients with pain had more comorbidities and more severe motor symptoms. Patients with central parkinsonian pain were significantly younger, had earlier disease onset, fewer comorbidities, greater non‐axial motor symptom severity in on, more pain‐related disability, and more relief of pain with antiparkinsonian medication than patients with non‐central parkinsonian pain.

Conclusions

PD patients with central parkinsonian pain have some distinctive demographic and clinical features, including lower levodopa responsiveness of motor appendicular/limb symptoms to levodopa, associated with greater responsiveness of pain symptoms to these same medications. These findings suggest the need for a more integrated approach to motor and non‐motor symptoms in these patients’ clinical care.

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Associations of Co‐occurring Psychosocial and Lifestyle Factors with Multisite Musculoskeletal Pain during Late Adolescence – A birth Cohort Study

Abstract

Background

Musculoskeletal (MS) pain is common. It often exists in several sites and is recurrent. Psychosocial difficulties and unhealthy behaviours have been related to multisite MS pain, but no literature has assessed the impact of accumulated psychosocial and lifestyle factors on recurrent multiple MS pain.

Methods

Our data was gathered from two questionnaires of the well‐known Northern Finland Birth Cohort 1986 (NFBC1986), sent to members when they were aged 16 and 18. A total of 1625 adolescents (712 boys and 913 girls) answered questions on smoking, physical activity, sedentary behaviour, sleeping, and emotional and behavioural problems at 16 years and on musculoskeletal pain at 16 and 18 years. Weight and height measurements were taken at a health examination at baseline. A latent class analysis (LCA) and multinomial regression analysis were conducted.

Results

We identified four clusters among both sexes. “Externalizing behavior” among both genders (OR 2.98, CI 1.73–5.13 among boys; OR 2.38, CI 1.38–4.11 among girls), “Multiple risk behaviors” among girls (OR 2.73, CI 1.30–5.71) and a “Sedentary” cluster among boys (OR 1.85, CI 1.21–2.82) were associated to recurrent multisite MS pain. ‘Obese’ clusters had no significant associations with recurrent multiple MS pain.

Conclusions

Adolescents with psychosocial difficulties and/or several adverse health behaviours were at an increased risk of recurrent multisite MS pain, which emphasizes the importance of simultaneously studying multiple rather than single factors. The identification of risk groups may help more accurately target preventive interventions.

Significance

This study found subgroups of adolescents at risk of recurrent multisite musculoskeletal pain during late adolescence. The accumulation of multiple adverse behaviours is likely to provide new perspectives for understanding the multidimensional nature of multiple MS pains.

This article is protected by copyright. All rights reserved.

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[Editorial] Malaysia's Pain Free programme

At the Annual Scientific Meeting of the Australia and New Zealand College of Anaesthetists in Kuala Lumpur (Malaysia) last week, Dr Mary Suma Cardosa, pain specialist at Hospital Selayang and President of the Malaysian Association for the Study of Pain, presented over a decade of work in Malaysia addressing pain. Cardosa described how adoption of “pain as the fifth vital sign” in 2008 improved awareness of pain in hospitals but did not lead to significant practice change. The Pain Free Hospital campaign was subsequently initiated in Malaysia's public health system in 2011, and extended to include primary care and dental services in 2017.

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[Perspectives] Body of thought

“It happened quickly, an inverse magician's trick: now you don't see it, now you do.” This is how Sinéad Gleeson's body announced itself to her when she was 13 years old, as she describes in Blue Hills and Chalk Bones, the opening essay in her debut collection of prose and poetry Constellations: Reflections from Life. Her previously normal, active life was consumed by pain emanating from her left hip. The eventual diagnosis was monoarticular arthritis, but getting to that point took some time, and finding actual relief from the condition even longer.

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[Department of Error] Department of Error

van Dijk AH, Wennmacker SZ, de Reuver PR, et al. Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial. Lancet 2019; published online April 26. http://dx.doi.org/10.1016/S0140-6736(19)30941-9—In this Article, the name of the co-author “Klass H in het Hof” should be “Klaas in ‘t Hof”. This correction has been made to the online version as of May 9, 2019.

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Psychometric properties of the Dutch-Flemish PROMIS Pain Behavior item bank in patients with musculoskeletal complaints

Pain behaviors are external manifestations of experiencing pain, such as sighing or crying, verbal reports of pain, and also include pain severity behaviors such as resting, guarding, facial expressions, and asking for help. Pain behaviors have been associated with pain intensity17, disability17,18, depression16, and with the development of chronic pain18. Interest in how to measure pain behaviors in patients with pain has been growing in order to identify subgroups of patients that might benefit from tailored interventions15,28, or as a possible target for treatment in itself11.

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Discharged and dismissed: A qualitative study with back pain patients discharged without treatment from orthopaedic consultations

Abstract

Background

Consultation‐based reassurance for patients with low back pain (LBP) in primary care has been shown to be associated with patients’ outcomes. Little is known about the role of reassurance in people with LBP consulting with orthopaedic spinal care teams. Reassurance may be important, especially in cases where surgery is not indicated and patients are discharged without treatment.

Methods

Semi‐structured interviews were conducted with thirty patients with chronic disabling musculoskeletal LBP who had recently consulted with spinal orthopaedic care teams. Interviews were audio recorded, transcribed, coded, and analysed.

Results

Most patients reported feeling dismissed and discouraged. Patients perceived that they needed specific behaviours from practitioners in order to feel sufficiently reassured to commit to self‐management. These behaviours group into four domains: ‘Knowing my whole story’ (evidence that practitioners read the case notes; were familiar with the patients’ previous health care history; carried out tests and a physical examination and gathered information about the patients’ lifestyle), ‘Seeing the right person’ (showing empathy; listening; building rapport, demonstrating they are qualified and experienced), ‘Nothing to worry about’ (reducing generic reassuring statements but increasing validating statements recognising suffering), and ‘Getting to grips with my problem’ (providing explanations and a clear management plan). In the absence of these behaviours, patients rejected advice to self‐manage, reported distress, anger, and intention to re‐consult.

Conclusion

Effective communication with patients attending spinal orthopaedic care settings is important, especially when no active treatment is being offered.

This article is protected by copyright. All rights reserved.

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PAIN-INDUCED REDUCTION IN CORTICOMOTOR EXCITABILITY IS COUNTERACTED BY COMBINED ACTION-OBSERVATION AND MOTOR IMAGERY

Pain education and exercise are interventions known to assist recovery of function in patients with musculoskeletal pain.6,37 However, it still remains unknown how to target the well-established sensorimotor changes occurring in response to acute or chronic muscle pain.45 Acute experimental muscle pain reduces corticomotor excitability35,46,59 and a body of evidence suggest that patients with chronic musculoskeletal pain show a reduction in corticomotor representation of the muscles in pain.57,67 Indeed, persistent pain can alter our movement patterns and may serve to protect the painful limb against further harm31 and as result lead to long-standing, possibly maladaptive, changes in cortical motor excitability.

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The Effect of Induced and Chronic Pain on Attention

Pain is adaptive, interrupting current concerns to warn of potential danger facilitating survival in threatening environments.14 However, this interruption can become disabling. Indeed, chronic pain patients report cognitive problems, adding to difficulties with activities of daily living. This may be particularly true for patients with fibromyalgia, which affects 2% of the population.21 Current diagnostic criteria for fibromyalgia include pain, stiffness, fatigue, and headaches.4,24,41 However, cognitive difficulties have emerged as a symptom cluster and are recommended for inclusion in diagnostic criteria.

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A child with a painful limp

A 10 year old boy presented to the paediatric emergency department with a one week history of a limp and increasing pain in his left thigh. He first noticed this while running at school. Over the...

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Pharmacological Inhibition of Porcupine, Disheveled and β-catenin in Wnt Signaling Pathway Ameliorates Diabetic Peripheral Neuropathy in Rats

Type 1 diabetes is often associated with many co-morbid complications, out of which, diabetic peripheral neuropathy (DPN), stands out to be one of the most common one, across the globe, affecting almost 50-60% of diabetic patients worldwide.8,53 DPN manifests as sensory symptoms in a distal ‘glove-and-stocking’ distribution, thereby causing a debilitating pain in the form of parasthesias, hyperalgesia and allodynia.15,45 Hyperglycemia, the characteristic feature of Type 1 diabetes long been thought to instigate DPN pathology, either through direct neurotoxicity, or from the activation of secondary pathways.

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Patient willingness to pay (WTP) for reductions in chronic low back pain and chronic neck pain

Over 40 percent of adults in the US experience chronic pain, often chronic spinal (back and neck) pain,30,31 and this pain is expensive to the healthcare system32 and to employers.43 Recently a number of nonpharmacologic interventions have been found to be safe and effective, and included in treatment guidelines for chronic spinal pain.7,38,44,45 The lists of recommended interventions include therapies that require ongoing visits to providers such as acupuncturists, physical therapists, and chiropractors.

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PAIN-RELATED FEAR, PAIN INTENSITY AND FUNCTION IN INDIVIDUALS WITH CHRONIC MUSCULOSKELETAL PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS

Chronic pain is a global health issue.48 The most prevalent chronic pain condition is chronic musculoskeletal pain (MSK).22 The global prevalence of chronic MSK ranges from 11.4% to 60%.28 It is the second cause of physical and work disability after mental and behavioural disorders.29,153,154 The socioeconomic burden due to chronic MSK is huge for the individual and society.112,154 Direct (e.g. opioid consumption) and indirect (e.g. loss productivity) annual economic costs amount to 164.7 billion Euros14 and 576 billion Dollars145 in Europe and the USA, respectively.

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Effectiveness of Prescription Monitoring Programs in Reducing Opioid Prescribing, Dispensing, and Use Outcomes: A Systematic Review

North America is amid an opioid crisis, which has its roots in opioid prescribing for non-cancer pain.37 Each year, 1 in 7 Canadians take a prescribed opioid on the advice of their physician,59 a rate second only to the United States in highest prescribing worldwide.36 In the United States, 2.4 million people meet the criteria for severe opioid use disorder (OUD) involving dependence on opioid analgesic medications, heroin, or both.37 These high levels of opioid use have led to many problems, including an increase in reported opioid misuse,7 illicit opioid use,35 overdoses and death,4,19 drug diversion, and crime,4,5,23 along with a substantial economic impact.

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Development and Characterization of An Injury-free Model of Functional Pain in Rats by Exposure to Red Light

There are an increasing number of reports pointing to biological effects of exposure to different colors of light. For example, blue light has been associated with sleep and metabolic regulations10,15,48 and light therapy has been used to control depression.20,26 Exposing patients’ skin to light of 830 nanometer wavelength accelerated wound healing.52 Different wavelengths of light significantly reduced the release of pronociceptive interleukin-6 (405nm-blue) and interleukin-8 (405nm blue, 532nm green, and 650nm red) in a time-dependent manner.

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Acute abdominal pain in an older patient

An 84 year old woman with a history of atrial fibrillation, angina, and transient ischaemic attack presented to the emergency department with vomiting and acute abdominal pain, most severe in the...

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