Fibromyalgia syndrome – a laser‐evoked potentials study unsupportive of small nerve fiber involvement

Abstract

Background

Fibromyalgia syndrome (FMS) is a chronic pain syndrome characterized by widespread pain and a variety of non‐pain symptoms. Central sensitivity phenomena are found consistently in FMS. Additionally, several researchers proclaimed that a subgroup of FMS patients may present with unrecognized peripheral small fiber neuropathy (SFN). Laser‐evoked brain potentials (LEP) are considered as a reliable method for the functional assessment of the thermo‐nociceptive system, including the evaluation of SFN.

Objectives

The aim of this retrospective study was to estimate the prevalence of thermo‐nociceptive system dysfunction based on LEPs in FMS.

Methods

LEP recordings of ninety‐two FMS patients and thirty‐nine age and sex‐matched healthy controls were selected from a database collected between 2003 and 2012 with standardized settings for laser stimulation and EEG recording. The N1, N2 and P2 LEP components were identified and characterized by peak latency and amplitude.

Results

None of the FMS patients showed signs of loss of function of the nociceptive responses evoked by Aδ‐nociceptor activation, compared to healthy controls. 6.5% of the FMS patients had N2‐P2 peak‐to‐peak amplitudes above the upper limit of the 99%‐confidence interval. N2‐P2 peak‐to‐peak amplitudes were negatively correlated with age, without age‐related differences between groups.

Conclusions

The characteristic signs of a damaged thermo‐nociceptive system as revealed by LEPs were absent in this large cohort of FMS patients.

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Erratum

In the article “Cost-Effectiveness and Cost-Utility of Internet-Delivered Exposure Therapy for Fibromyalgia: Results From A Randomized, Controlled Trial,” published in the January 2019 issue of The Journal of Pain (2019; 20:47-59), the median value for direct medical costs for iExp at post-treatment was incorrectly displayed in Table 2. The correct table appears below.

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Efficacy and harms of long‐term opioid therapy in chronic non‐cancer pain: Systematic review and meta‐analysis of open‐label extension trials with a study duration ≥ 26 weeks

Abstract

Background and Objective

This updated systematic review evaluated the efficacy, acceptability and safety of long‐term opioid therapy (LTOT) for chronic non‐cancer pain (CNCP).

Databases and Data Treatment

Clinicaltrials.gov, CENTRAL and MEDLINE were searched to June 2019. We included open‐label extension trials with a study duration ≥ 26 weeks of RCTs with ≥ two weeks duration. Pooled estimates of event rates of categorical data and standardized mean differences (SMD) of continuous variables were calculated using a random effects model.

Results

We added four new studies with 1154 participants for a total of 15 studies with 3590 participants. Study duration ranged between 26 and 156 weeks. Studies included patients with low back, osteoarthritis and neuropathic pain. The quality of evidence for every outcome was very low. 31.1% (95% Confidence interval [CI] 23.0% to 40.7%) of patients randomized at baseline finished the open label period. 14.1 % (95% CI 10.9% to 19.4%) of patients dropped out to due adverse events. In 6.3% (95 CI 3.9% to 10.1%) of patients serious adverse events and in 2.7% (95% CI 1.5% to 4.7%) aberrant drug behavior were noted. 0.5 % (95% CI 0.2% to 1.4%) of patients died.

Conclusions

Within the context of open‐label extension studies, opioids maintain reduction of pain and disability and are rather well tolerated and safe. LtOT can be considered in carefully selected and monitored patients with low back, osteoarthritis and neuropathic pain who experience a clinically meaningful pain reduction with at least tolerable adverse events in short‐term opioid therapy.

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High‐dose phenylephrine increases meningeal blood flow through TRPV1 receptor activation and release of calcitonin gene‐related peptide

Abstract

Background

The α₁‐adrenoceptor agonist, phenylephrine, is used at high concentrations as a mydriatic agent and for the treatment of nasal congestion. Among its adverse side effects transient burning sensations are reported indicating activation of the trigeminal nociceptive system.

Methods

Neuropeptide release, calcium imaging and meningeal blood flow recordings were applied in rodent models of meningeal nociception to clarify possible receptor mechanisms underlying these pain phenomena.

Results

Phenylephrine above 10 mM dose‐dependently released calcitonin gene‐related peptide (CGRP) from the dura mater and isolated trigeminal ganglia, while hyperosmotic mannitol at 90 mM was ineffective. The phenylephrine‐evoked release was blocked by the transient receptor potential vanilloid 1 (TRPV1) antagonist BCTC and did not occur in trigeminal ganglia of TRPV1‐deficient mice. Phenylephrine at 30 mM caused calcium transients in cultured trigeminal ganglion neurons responding to the TRPV1 agonist capsaicin and in HEK293T cells expressing human TRPV1. Local application of phenylephrine at micromolar concentrations to the exposed rat dura mater reduced meningeal blood flow, whereas concentrations above 10 mM caused increased meningeal blood flow. The flow increase was abolished by pre‐application of the CGRP receptor antagonist CGRP8‐37 or the TRPV1 antagonist BCTC.

Conclusions

Phenylephrine at high millimolar concentrations activates TRPV1 receptor channels of perivascular afferents and, upon calcium inflow, releases CGRP, which increases meningeal blood flow. Activation of TRPV1 receptors may underlie trigeminal nociception leading to cranial pain such as local burning sensations or headaches caused by administration of high doses of phenylephrine.

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Effects of genotype on TENS effectiveness in controlling knee pain in persons with mild to moderate osteoarthritis

Abstract

Background

This study examined the extent to which genetic variability modifies Transcutaneous Electrical Nerve Stimulation (TENS) effectiveness in osteoarthritic knee pain.

Methods

Seventy‐five participants with knee osteoarthritis were randomly assigned to either: 1) High Frequency TENS, 2) Low Frequency TENS, or 3) Transient Placebo TENS. Pain measures were collected pre‐ and post‐treatment. Participants were genotyped on genes implicated in central or peripheral pain pathways: NGFB, NTRK1, EDNRA, EDNRB, EDN1, OPRM1, TAC1, TACR1, BDNF, BDKRB1, 5HTT, COMT, ESR2, IL6, and IL1B. Genetic association using linear regression modeling was performed separately for the transient placebo TENS subjects, and within the High Frequency TENS + Low Frequency TENS participants, including TENS level as a covariate.

Results

In the placebo group, SNPs rs165599 (COMT) was significantly associated with an increased heat pain threshold (β = ‐1.87; p = .003) and rs6827096 (EDNRA) with an increased resting pain (β = 2.68; p = .001). Within the treatment groups, TENS effectiveness was reduced by the SNP rs6537485 (EDNRA) minor allele in relationship to mechanical sensation (β = 184.13; p = 5.5E‐9). Individuals with the COMT rs4680 minor allele reported lowered pain at rest after TENS (β = ‐42.30; p=.001), with a higher magnitude of pain reduction (28 unit difference) in the low‐frequency TENS group compared to the high‐frequency TENS group (β = 28.37; p = .0004).

Conclusions

EDNRA and COMT are implicated in osteoarthritic knee pain and provide a basis for tailoring TENS interventions according to individual characteristics.

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Medication‐overuse headache: The effect of a patient educational program ‐ A randomized controlled trial

Abstract

Background

Little are known about the effects of non‐pharmacological interventions among medication‐overuse headache (MOH) patients, although non‐pharmacological approaches combined with pharmacological treatment are recommended. The objective was to evaluate the effect of an educational program as an add‐on to standard treatment.

Methods

MOH patients were randomized (1:1) in a single‐center setting to standard treatment with 12 weeks of education (I‐group) versus standard treatment (C‐group). The primary outcome was reduction in headache days/last month at nine months’ follow‐up. Secondary outcomes were headache intensity, acute medication intake, bothersomeness, disability, physical activity, and patient satisfaction. The between‐group differences were analyzed using a mixed‐effects model for repeated measurements with a between group factor (I‐group vs. C‐group) and a time factor (baseline, four months and nine months).

Results

Ninety‐eight patients were randomized (I‐group: n=48, C‐group: n= 50), with 40 and 39 patients completing the study, respectively. Intention‐to‐treat analyses showed that both groups experienced statistically significant reductions in headache days/last month (I‐group: ‐4±6 days (95% CI 2.47; 5.95), p<0.001) versus C‐group: ‐4±9 days ((95% CI 1.53; 6.79), p=0.003), but there were no significant differences between groups (mean±SE):Δ: 0.7 days ((95% CI, ‐2.50; 3.93), p= 0.66). At follow‐up, 85% from the I‐group and 86% from C‐group, no longer fulfilled the criteria for MOH.

Conclusion

The compliance rate was high, indicating that patients were motivated for receiving education, but we found no additional benefits of adding an educational program to standard treatment. Future research focusing on the MOH complexity, group heterogeneity, duration, and content of educational programs is warranted.

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Douleur Neuropathique 4 (DN4) stratifies possible and definite neuropathic pain after surgical peripheral nerve lesion

Abstract

Backgroung

Douleur Neuropathique 4 (DN4) is a screening questionnaire to help identify neuropathic pain (NP) in clinical practice and research. We tested the accuracy of the DN4 questionnaire in stratifying possible NP (pNP) and definite NP (dNP) in patients operated for breast cancer.

Methods

We studied 163 patients from a longitudinal cohort of breast cancer operated patients 4‐9 years after surgery. pNP or dNP were classified according to the NP grading system. Surgeon‐verified intercostobrachial nerve resection was used as a confirmatory test for dNP. A receiver‐operating characteristic (ROC) curve analysis was performed and the area under the curve (AUC) was calculated to test the diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of the DN4. Additionally, we studied clinical factors that associated with a positive screening outcome in the interview part of the DN4 (DN4i).

Results

DN4i and DN4 showed significant accuracy in stratifying patients with pNP or dNP with cut‐off scores 3 and 4 resulting to sensitivity of 66.2% and 79.4% and specificity of 77.8% and 92.6%, respectively. pNP and dNP patients showed differences in sensory descriptors of pain according to DN4i items. Screening positive on DN4i associated with dNP and younger age.

Conclusions

Full DN4 could stratify pNP and dNP patients in a chronic postsurgical NP patient group operated for breast cancer. Additionally, DN4i showed significant accuracy in stratifying pNP and dNP, but an examination is necessary to obtain proper accuracy. Demographic factors may have an impact on the screening outcome of DN4i.

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Exploring the relationship between male norm beliefs, pain‐related beliefs and behaviours: An online questionnaire study

Abstract

Background

Gender beliefs help explain the variation found in pain amongst men and women. Gender norms and expectations are thought to affect how men and women report and express pain. However, less is known about how such beliefs are related to pain outside of laboratory settings. The aim of this study was therefore to consider the relationship between beliefs in male role norms, pain and pain behaviours in men and women.

Methods

An online questionnaire study was conducted. A total of 468 adults (352 females), with or without pain, completed a series of self‐report measures relating to beliefs about pain and male role norms, as well as pain and general health behaviours.

Results

An experience of pain was associated with lower beliefs in traditional male norms. Endorsing stereotypical male norms was related to increased stigma associated with seeking professional help for pain in both men and women, but to a lesser extent associated with general health behaviours. There also seemed to be gender‐based beliefs associated with the expression of pain.

Conclusions

Together these findings suggest that beliefs in gender (male) norms are relevant to pain, and that there is utility in exploring variation in pain beyond binary male‐female categories.

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[Clinical Picture] A hairdresser's painful swollen left leg: artery compresses vein in May–Thurner syndrome

A 37-year-old hairdresser presented to our hospital with pain and swelling in her left leg and pain in her lower back. The pain in her back, which she thought was muscular, began as an ache, at the same time as the pain started in her leg, 5 days before. On the day of admission, over a period of 3 h, the back pain had become much worse and her leg had rapidly become swollen and more painful. As a hairdresser, she said she was on her feet for several hours every working day. She had no medical history of note: she did not smoke and was otherwise fit and well.

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Implant Design and the Anchoring Mechanism Influence the Incidence of Heterotopic Ossification in Cervical Total Disc Replacement at 2-year Follow-up

Study Design. A nonrandomized, prospective, and single-center clinical trial. Objective. The aim of this study was to determine whether the prosthesis design, and especially changes in the primary anchoring mechanism between the keel-based ProDisc C and the spike-based ProDisc Vivo, affects the frequency of heterotopic ossification (HO) formation over time. Summary of Background Data. The occurrence of motion-restricting HO as well as underlying risk factors has so far been a widely discussed, but not well understand phenomenon. The anchoring mechanism and the opening of the anterior cortex may be possible causes of this unwanted complication. Methods. Forty consecutive patients treated with the ProDisc C and 42 consecutive patients treated with the ProDisc Vivo were compared with respect to radiological and clinical outcome, with 2 years of follow-up. Clinical outcome scores included the Neck Disability Index (NDI), Visual Analogue Scale (VAS), and arm and neck pain self-assessment questionnaires. Radiological outcomes included the segmental lordosis and range of motion (ROM) of the index-segment as well as the occurrence of HO. Results. The clinical outcome parameters improved in both groups significantly. [ProDisc C: VAS arm and neck pain from 6.3 and 6.2 preoperatively to 0.7 and 1.3; NDI from 23.0 to 3.7; ProDisc Vivo: VAS arm and neck pain from 6.3 and 4.9 to 1.4 and 1.6, NDI from 34.1 to 8.7; 2-year follow-up (FU)]. The ProDisc Vivo cohort demonstrated a significantly lower incidence of HO than the ProDisc C group at 1-year FU (P = 0.0005) and 2-year FU (P = 0.005). Specifically, high-grade HO occurred in 9% versus 31%. Conclusion. These findings demonstrate that prosthesis designs that allow primary anchoring without violation of the cortical surface help to reduce the incidence of severe ossification, possibly affecting the functionality and mobility of the artificial disc device over of time. Level of Evidence: 3

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Does Disordered Sleep Moderate the Relationship Between Pain, Disability and Downstream Health Care Utilization in Patients With Low Back Pain?: A Longitudinal Cohort From the US Military Health System

Study Design. Prospective cohort. Objective. The purpose of this study was to evaluate the influence of disordered sleep on the relationship between pain and health care utilization (HCU) and pain-related disability and HCU in individuals with low back pain (LBP). Summary of Background Data. Disordered sleep and pain influence LBP outcomes, but their relationship with health care seeking after an episode of LBP has not been investigated and could help identify who is at risk for long-term medical care. Methods. This study included patients with LBP participating in a self-management class at a large US military hospital between March 1, 2010 and December 4, 2012. Pain intensity, disability (Oswestry Disability Index), and sleepiness (Epworth Sleepiness Scale) were captured at baseline. Medical visits for a sleep disorder in the 12 months before the class and LBP-related healthcare utilization for the 12 months following the class were abstracted from the Military Health System Data Repository. Separate multivariate analyses evaluating pain intensity and disability as predictors of HCU were developed, with sleepiness and the presence of a sleep disorder as potential moderators. Analyses were adjusted for age, sex, history of back pain, and mental health comorbidities. Results. A total of 757 consecutive participants were included, with 195 (26.8%) diagnosed with a subsequent sleep disorder. Sleepiness was not a significant predictor of HCU. The main effects of disability, pain intensity, and presence of a sleep disorder were significant across all analyses, with higher disability, pain intensity, and presence of a sleep disorder associated with higher predicted visits and costs for LBP. The presence of a sleep disorder was not a significant moderator in any model. Conclusion. Higher pain intensity and disability predicted higher pain-related HCU in the year following a LBP self-management class. The presence of a sleep disorder diagnosis, as recorded in medical records, had a significant independent effect on LBP-related health care visits and costs beyond the influences of pain intensity, disability, and other key demographic and health-related characteristics, but did not moderate these relationships. Level of Evidence: 3

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Responsiveness of EQ-5D Youth version 5-level (EQ-5D-5L-Y) and 3-level (EQ-5D-3L-Y) in Patients With Idiopathic Scoliosis

Study Design. Prospective cohort study Objective. The aim of this study was to evaluate the responsiveness of EQ-5D Youth version (EQ-5D-Y) 5-level and 3-level in patients with idiopathic scoliosis Summary of Background Data. A new version of EQ-5D-Y increasing the number of response levels from 3 (3LY) to 5 (5LY) has been recently introduced. Although the validity and reliability of 5LY and 3LY for use in idiopathic scoliosis patients are compared, responsiveness of two questionnaires among children and adolescents is unknown. Methods. A total of 129 children or adolescents attending the spine clinics of a tertiary hospital in Hong Kong, China, completed 3LY and 5LY. At 3-month follow-up, 110 (85.2%) patients completed two EQ-5D-Y questionnaires, and the single-item Global Rating on Change Scale determining “worsened,”, “unchanged,”, or “improved” global health. Among those indicating “unchanged” in global health from baseline to follow-up, agreement in responses to each 3LY and 5LY item was examined. Mean changes in EQ-5D-Y scores during the past 3 months in patients with “worsened,” “unchanged,” and “improved” health were calculated. Results. Most patients (82.7%) reported no change in global health, whereas about 12.7% and 4.5% of them felt better and worse, respectively, compared to baseline. Among those reporting “unchanged health,” the “Looking after myself” item exhibited the largest proportion of agreement in responses (5LY: 96.36%; 3LY: 95.50%), followed by “Mobility” (5LY 90.91%; 3LY 90.99%), “Usual activities” (5LY 83.64%; 3LY 87.39%), “Pain/discomfort”(5LY 68.18%; 3LY 76.58%), and “Feeling worried/sad/unhappy” (5LY 66.36%; 3LY 72.07%). In the “improved” or “worsened” group, the 3-month follow-up 5LY and 3LY scores were higher or lower compared with baseline, respectively. Conclusion. The 5LY is demonstrated as responsive as the 3LY for patients with idiopathic scoliosis. Level of Evidence: 2

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Propensity-matched Comparison of Outcomes and Costs After Macroscopic and Microscopic Anterior Cervical Corpectomy Using a National Longitudinal Database

Study Design. A retrospective analysis of national longitudinal database. Objective. The aim of this study was to examine the outcomes and cost-effectiveness of operating microscope utilization in anterior cervical corpectomy (ACC). Summary of Background Data. The operating microscope allows for superior visualization and facilitates ACC with less manipulation of tissue and improved decompression of neural elements. However, many groups report no difference in outcomes with increased cost associated with microscope utilization. Methods. A longitudinal database (MarketScan) was utilized to identify patients undergoing ACC with or without microscope between 2007 and 2016. Propensity matching was performed to normalize differences between the two cohorts. Outcomes and costs were subsequently compared. Results. A total of 11,590 patients were identified for the “macroscopic” group, while 4299 patients were identified for the “microscopic” group. For the propensity-matched analysis, 4298 patients in either cohort were successfully matched according to preoperative characteristics. Hospital length of stay was found to be significantly longer in the macroscopic group than the microscopic group (1.86 nights vs. 1.56 nights, P <� 0.0001). Macroscopic ACC patients had an overall higher rate of readmissions [30-day: 4.2% vs. 3.2%, odds ratio (OR) = 0.76 (0.61–0.96), P = 0.0223; 90-day: 7.0% vs. 5.9%, OR = 0.82 (0.69–0.98), P = 0.0223]. Microscopic ACC patients had a higher rate of discharge to home [86.6% vs. 92.5%, OR = 1.91 (1.65–2.21), P <� 0.0001] and lower rates of new referrals to pain management [1.0% vs. 0.4%, OR = 0.42 (0.23–0.74), P = 0.0018] compared with macroscopic ACC. Postoperative complication rate was not found to be significantly different between the groups. Finally, total initial admission charges were not significantly different between the macroscopic and microscopic groups ($30,175 vs. $29,827, P = 0.9880). Conclusion. The present study suggests that the use of the operating microscope for ACC is associated with decreased length of stay, readmissions, and new referrals to pain management, as well as higher rate of discharge to home. Level of Evidence: 3

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Degenerative Disc Disease: What is in a Name?

Study Design. A systematic search and review Objective. The aim of this study was to investigate the term, degenerative disc disease, to elucidate its current usage and inform clinical, research, and policy recommendations. Summary of Background Data. Degenerative disc disease has long been a dominant concept in common, painful spinal disorders. Yet, despite its pervasiveness and important clinical consequences and controversies, there has not been a systematic examination of its use and meaning in the scientific literature. Methods. We conducted a systematic search of publications using the term degenerative disc disease from 2007 through 2016 in Ovid MEDLINE (R), Embase, CINAHL, and Scopus. Two investigators independently reviewed all publications in the primary sample. Publication and author identifiers, and qualitative study descriptors were extracted. Finally, the definition of degenerative disc disease was placed in one of eight categories. Data were summarized using descriptive statistics. Results. Degenerative disc disease appeared in the titles of 402 publications in the primary sample and increased in frequency by 189% from the first to the last 3 years of the decade. No single definition was used in the majority of publications, and most frequently, the term was used without any definition provided (30.1%). In other cases, degenerative disc disease specifically included radiculopathy or myelopathy (14.4%), or only back or neck pain (5.5%), or was equated with disc degeneration regardless of the presence of symptoms (15.4%), or with discogenic pain or disc degeneration as a presumed cause of axial pain (12.7%). Another 7.2% comprised a mix of broad ranging findings and diagnoses. The most notable differences in definitions occurred between surgeons and other disciplines, and when applied to cervical versus lumbar regions. Conclusion. Despite longstanding use and important consequences, degenerative disc disease represents an underdeveloped concept, with greatly varying, disparate definitions documented. Such inconsistencies challenge clear, accurate communication in medicine and science, create confusion and misconceptions among clinicians, patients and others, and hinder the advancement of related knowledge. Level of Evidence: 4

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Investigating intraindividual pain variability: methods, applications, issues, and directions

Pain is a dynamic experience subject to substantial individual differences. Intensive longitudinal designs best capture the dynamical ebb and flow of the pain experience across time and settings. Thanks to the development of innovative and efficient data collection technologies, conducting an intensive longitudinal pain study has become increasingly feasible. However, the majority of longitudinal studies have tended to examine average level of pain as a predictor or as an outcome, while conceptualizing intraindividual pain variation as noise, error, or a nuisance factor. Such an approach may miss the opportunity to understand how fluctuations in pain over time are associated with pain processing, coping, other indices of adjustment, and treatment response. The present review introduces the 4 most frequently used intraindividual variability indices: the intraindividual SD/variance, autocorrelation, the mean square of successive difference, and probability of acute change. In addition, we discuss recent development in dynamic structural equation modeling in a nontechnical manner. We also consider some notable methodological issues, present a real-world example of intraindividual variability analysis, and offer suggestions for future research. Finally, we provide statistical software syntax for calculating the aforementioned intraindividual pain variability indices so that researchers can easily apply them in their research. We believe that investigating intraindividual variability of pain will provide a new perspective for understanding the complex mechanisms underlying pain coping and adjustment, as well as for enhancing efforts in precision pain medicine. Audio accompanying this abstract is available online as supplemental digital content at https://ift.tt/360is2E.

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Family history of pain and risk of musculoskeletal pain in children and adolescents: a systematic review and meta-analysis

Emerging evidence suggests that musculoskeletal (MSK) pain should be viewed from a biopsychosocial perspective and consider the influence of family factors. We conducted a review with meta-analysis to provide summary estimates of effect of family history of pain on childhood MSK pain and explore whether specific family pain factors influence the strength of the association (PROSPERO CRD42018090130). Included studies reported associations between family history of pain and nonspecific MSK pain in children (age <19 years). The outcome of interest was MSK pain in children. We assessed the methodological quality using a modified version of the Quality in Prognosis Studies instrument and quality of evidence for the main analyses using the GRADE criteria. After screening of 7281 titles, 6 longitudinal and 23 cross-sectional studies were included. Moderate quality evidence from 5 longitudinal studies (n = 42,131) showed that children with a family history of MSK pain had 58% increased odds of experiencing MSK pain themselves (odds ratio [OR] 1.58, 95% confidence interval 1.20-2.09). Moderate quality evidence from 18 cross-sectional studies (n = 17,274) supported this finding (OR 2.02, 95% 1.69-2.42). Subgroup analyses showed that the relationship was robust regardless of whether a child's mother, father, or sibling experienced pain. Odds were higher when both parents reported pain compared with one ([mother OR = 1.61; father OR = 1.59]; both parents OR = 2.0). Our findings show moderate quality evidence that children with a family history of pain are at higher risk of experiencing MSK pain. Understanding the mechanism by which this occurs would inform prevention and treatment efforts.

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Sustained efficacy of kangaroo care for repeated painful procedures over neonatal intensive care unit hospitalization: a single-blind randomized controlled trial

Preterm neonates hospitalized in the neonatal intensive care unit undergo frequent painful procedures daily, often without pain treatment, with associated long-term adverse effects. Maternal-infant skin-to-skin contact, or kangaroo care (KC), and sweet-tasting solutions such as sucrose are effective strategies to reduce pain during a single procedure; however, evidence of sustained efficacy over repeated procedures is limited. We aimed to determine the relative sustained efficacy of maternal KC, administered alone or in combination with 24% sucrose, to reduce behavioral pain intensity associated with routine neonatal procedures, compared with 24% sucrose alone. Stable preterm infants (n = 242) were randomized to receive KC and water, KC and 24% sucrose, or 24% sucrose before all routine painful procedures throughout their neonatal intensive care unit stay. Pain intensity, determined using the Premature Infant Pain Profile, was measured during 3 medically indicated heel lances distributed across hospitalization. Maternal and neonatal baseline characteristics, Premature Infant Pain Profile scores at 30, 60, or 90 seconds after heel lance, the distribution of infants with pain scores suggesting mild, moderate, or severe pain, Neurobehavioral Assessment of the Preterm Infant scores, and incidence of adverse outcomes were not statistically significantly different between groups. Maternal KC, as a pain-relieving intervention, remained efficacious over time and repeated painful procedures without evidence of any harm or neurological impact. It seemed to be equally effective as 24% oral sucrose, and the combination of maternal KC and sucrose did not seem to provide additional benefit, challenging the existing recommendation of using sucrose as the primary standard of care.

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Altered microbiome composition in individuals with fibromyalgia

Fibromyalgia (FM) is a prevalent syndrome, characterised by chronic widespread pain, fatigue, and impaired sleep, that is challenging to diagnose and difficult to treat. The microbiomes of 77 women with FM and that of 79 control participants were compared using 16S rRNA gene amplification and whole-genome sequencing. When comparing FM patients with unrelated controls using differential abundance analysis, significant differences were revealed in several bacterial taxa. Variance in the composition of the microbiomes was explained by FM-related variables more than by any other innate or environmental variable and correlated with clinical indices of FM. In line with observed alteration in butyrate-metabolising species, targeted serum metabolite analysis verified differences in the serum levels of butyrate and propionate in FM patients. Using machine-learning algorithms, the microbiome composition alone allowed for the classification of patients and controls (receiver operating characteristic area under the curve 87.8%). To the best of our knowledge, this is the first demonstration of gut microbiome alteration in nonvisceral pain. This observation paves the way for further studies, elucidating the pathophysiology of FM, developing diagnostic aids and possibly allowing for new treatment modalities to be explored.

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Gait- and Posture-Related Factors Associated With Changes in Hip Pain and Physical Function in Patients With Secondary Hip Osteoarthritis: A Prospective Cohort Study

Publication date: November 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 11

Author(s): Hiroshige Tateuchi, Haruhiko Akiyama, Koji Goto, Kazutaka So, Yutaka Kuroda, Noriaki Ichihashi

Abstract

Objective

To identify gait- and posture-related factors associated with changes in hip pain and physical function in patients with hip osteoarthritis (OA).

Design

Prospective cohort study.

Setting

Clinical biomechanics laboratory of a university.

Participants

Consecutive sampling of female patients with mild-to-moderate secondary hip OA (N=30).

Main Outcome Measures

Hip pain (visual analog scale) and physical function (physical component summary of the Medical Outcomes Study 36-Item Short-Form Health Survey) were measured at baseline and 12 months later. With changes in hip pain and physical function as dependent variables, linear regression analyses were performed with gait- and posture-related factors as independent variables with and without adjustment for age, joint space width, and hip pain or physical function at baseline. Posture-related factors included angles of thoracic kyphosis, lumbar lordosis, sacral inclination, spinal inclination, and spinal mobility. Gait-related factors were walking speed, steps per day, joint angles, external hip joint moment impulses, and daily cumulative hip moments.

Results

Multiple linear regression analyses showed that limited hip extension (adjusted standardized B coefficient [95% confidence interval]: −0.52 [−0.88 to −0.17]) and limited external rotation angles (−0.51 [−0.85 to −0.18]) during walking were associated with the worsening of hip pain. An increased thoracic kyphosis (−0.54 [−0.99 to −0.09]), less sacral anterior tilt (0.40 [0.01-0.79]), reduced thoracic spine mobility (0.59 [0.23-0.94]), less steps per day (0.53 [0.13-0.92]), and a slower walking speed (0.45 [0.04-0.86]) were associated with deterioration in physical function.

Conclusions

Gait- and posture-related factors should be considered when assessing risk and designing preventive interventions for the clinical progression of secondary hip OA.

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Whole Body Vibration Exercise for Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Publication date: November 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 11

Author(s): Yulin Dong, Wu Wang, Jiejiao Zheng, Su Chen, Jun Qiao, Xueqiang Wang

Abstract

Objective

This study systematically reviews previous work on the effects of whole body vibration exercise (WBVE) on pain associated with chronic musculoskeletal disorders.

Data Sources

Seven electronic databases (PubMed, Embase, CINAHL, Web of Science, Cochrane, Physiotherapy Evidence Database [PEDro], and the China National Knowledge Infrastructure) were searched for articles published between January 1980 and September 2018.

Study Selection

Randomized controlled trials involving adults with chronic low back pain (CLBP), osteoarthritis (OA), or fibromyalgia were included. Participants in the WBVE intervention group were compared with those in the nontreatment and non-WBVE control groups.

Data Extraction

Data were independently extracted using a standardized form. Methodological quality was assessed using PEDro.

Data Synthesis

Suitable data from 16 studies were pooled for meta-analysis. A random effects model was used to calculate between-groups mean differences at 95% confidence interval (CI). The data were analyzed depending on the duration of the follow-up, common disorders, and different control interventions.

Results

Alleviation of pain was observed at medium term (standardized mean difference [SMD], -0.67; 95% CI, -1.14 to -0.21; I², 80%) and long term (SMD, -0.31; 95% CI, -0.59 to -0.02; I², 0%). Pain was alleviated in osteoarthritis (OA) (SMD, -0.37; 95% CI, -0.64 to -0.10; P<.05; I², 22%) and CLBP (SMD, -0.44; 95% CI, -0.75 to -0.13; P<.05; I², 12%). Long-term WBVE could relieve chronic musculoskeletal pain conditions of OA (SMD, -0.46; 95% CI, -0.80 to -0.13; P<.05; I², 0%). WBVE improved chronic musculoskeletal pain compared with the treatment “X” control (SMD, -0.37; 95% CI, -0.61 to -0.12; P<.05; I², 26%), traditional treatment control (SMD, -1.02; 95% CI, -2.44 to 0.4; P>.05; I², 94%) and no treatment control (SMD, -1; 95% CI, -1.76 to -0.24; P<.05; I², 75%).

Conclusions

Evidence suggests positive effects of WBVE on chronic musculoskeletal pain, and long durations of WBVE could be especially beneficial. However, WBVE does not significantly relieve chronic musculoskeletal pain compared with the traditional treatment. Further work is required to identify which parameters of WBVE are ideal for patients with chronic musculoskeletal pain.

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Intradialytic Resistance Training Improves Functional Capacity and Lean Mass Gain in Individuals on Hemodialysis: A Randomized Pilot Trial

Publication date: November 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 11

Author(s): Lorena Cristina Curado Lopes, João Felipe Mota, Jonato Prestes, Raquel Machado Schincaglia, Debora Mendes Silva, Nayara Pedatella Queiroz, Ana Tereza Vaz de Souza Freitas, Fábio Santos Lira, Maria do Rosário Gondim Peixoto

Abstract

Objective

To compare the effects of high vs moderate loads of intradialytic resistance training (RT) on body composition, sarcopenia prevalence, functional capacity, inflammatory markers, and quality of life (QoL) in individuals on hemodialysis.

Design

A pilot randomized clinical trial.

Setting

Two hemodialysis centers.

Participants

Individuals on hemodialysis (N=80; 51% men, aged 30-75y) in treatment for at least 3 months, adequately dialyzed (Kt/V≥1.2, where K is dialyzer clearance in mL/min, t is time, and V is volume of water) with vascular access via arteriovenous fistula.

Interventions

The 12 weeks of intradialytic RT was performed 3 times per week. The training groups were: high-load intradialytic group (HLG, 8-10 repetitions), moderate-load intradialytic group (MLG, 16-18 repetitions), and control group (CG, stretching exercise). The total training volume was equalized among training groups.

Main Outcome Measures

Lean leg mass was assessed by a dual-energy x-ray absorptiometry; functional capacity was assessed by Short Physical Performance Battery and Timed Up and Go test; and QoL was assessed by Kidney Disease QoL Instrument, inflammatory markers, and sarcopenia.

Results

After the training period, the HLG increased lean leg mass compared with the CG. The HLG also displayed improvements in the pain and physical function domains. The skeletal muscle index and functional capacity increased in both RT protocols. The prevalence of sarcopenia was reduced 14.3% and 25% in the MLG and HLG, respectively, while there was an increase of 10% in the CG. No differences were observed in cytokines after intervention.

Conclusions

High-load intradialytic RT was associated with gains in lean leg mass and QoL while functional capacity, appendicular muscle mass, and sarcopenia status were improved regardless of the RT load.

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Effect of Psychomotricity in Combination With 3 Months of Active Shoulder Exercises in Individuals With Chronic Shoulder Pain: Primary Results From an Investigator-Blinded, Randomized, Controlled Trial

Publication date: November 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 11

Author(s): Kim Gordon Ingwersen, Jette Wessel Vobbe, Lise Lang Pedersen, Lilli Sørensen, Niels Wedderkopp

Abstract

Objective

To evaluate whether psychomotor therapy (PMT) in combination with usual care active exercise (AE) rehabilitation for the shoulder is superior to merely AE.

Design

The trial was a single-center, stratified (by corticosteroid injection [yes or no]), randomized, and controlled superiority trial.

Setting

Shoulder unit of the orthopedic department at Hospital Lillebaelt, Vejle Hospital.

Participants

Eligible participants (N=87) were adults aged 18-75 years with shoulder complaints lasting for at least 3 months, in addition to a score equal to or below 3 on the Multidimensional Assessment of Interoceptive Awareness score. Furthermore, patients had at least a visual analog scale pain score of 2 at rest, 3 at night, and 5 in activity (range: 0-10).

Interventions

Patients were randomized to 12 weeks of AE (control group) or in combination with 5 PMT sessions (intervention group).

Main Outcome Measure

The primary outcome was the patient-reported outcome score Disability of the Arm, Shoulder and Hand questionnaire. The primary endpoint was 12 weeks after baseline.

Results

There was no between-group difference in function between the intervention group and control group.

Conclusions

Our results showed no additional benefit on patient-reported function and pain from PMT over usual care in patients with long-lasting shoulder pain and low body awareness. This finding suggests that PMT adds no additional benefit to patients’ recovery in relation to pain and active function in comparison to standard care.

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

Publication date: November 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 11

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 ultrasound (US)-guided subacromial injection in patients with subacromial impingement syndrome (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; (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 analog scale (VAS) scores for pain at rest, at night, and during overhead activities, were evaluated at baseline and at the first and third months postintervention.

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 postinjection.

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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Predicting Mobility Limitations in Patients With Total Knee Arthroplasty in the Inpatient Setting

Publication date: November 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 11

Author(s): Eleanor Shu-Xian Chew, Seng-Jin Yeo, Terry Haines, Julian Thumboo, Ross Allan Clark, Hwei-Chi Chong, Cheryl Lian Li Poon, Felicia Jie-Ting Seah, Darren Keng Jin Tay, Nee Hee Pang, Celia Ia Choo Tan, 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 patients (N=2300) 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 determined a priori 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% confidence interval, 0.68-0.75) 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 body mass index, 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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Comorbidities in Patients With End-Stage Knee OA: Prevalence and Effect on Physical Function

Publication date: November 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 11

Author(s): Won Bin Kim, Bo Ryun Kim, Sang Rim Kim, Eun Young Han, Kwang Woo Nam, So Young Lee, Suh Min Ji, Jong Hyun Kim

Abstract

Objective

To investigate the prevalence of comorbidities and their effect on physical function, quality of life (QOL), and pain, in patients with end-stage knee osteoarthritis (OA).

Design

A cross-sectional study.

Setting

A rehabilitation facility at university hospital.

Participants

Patients (N=577; 503 women and 74 men) diagnosed with end-stage knee OA between October 2013 and June 2018.

Intervention

Not applicable.

Main Outcome Measures

Comorbidities were as follows: osteoporosis, presarcopenia, degenerative spine disease, diabetes, and hypertension. All patients completed the following performance-based physical function tests: stair-climbing test (SCT), 6-minute walk test (6MWT), timed Up and Go (TUG) test, and gait analysis. Self-reported physical function and pain were measured using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and a visual analog scale (VAS), respectively, and self-reported QOL was measured using EuroQoL 5 dimensions (EQ-5D) questionnaire.

Results

Univariate analyses revealed that patients with osteoporosis had significantly higher scores in SCT ascent, SCT descent, TUG, WOMAC pain tests, and lower scores in 6MWT, gait speed, and cadence tests than those without osteoporosis. Patients with presarcopenia recorded higher scores in SCT ascent, TUG, EQ-5D, and lower scores in 6MWT and gait speed tests than those without presarcopenia. Patients with degenerative spine disease showed higher scores in WOMAC pain and lower scores in gait speeds than those without degenerative spine disease. Patients with diabetes showed higher scores in SCT ascent than those without diabetes, and patients with hypertension showed lower scores in 6MWT than those without hypertension. After adjusting age, sex, and body mass index, SCT descent retained significant association with osteoporosis, SCT ascent showed independent association with presarcopenia and diabetes, and WOMAC pain revealed significant association with degenerative spine disease.

Conclusion

The results confirm associations between comorbidities, performance-based and self-reported physical functions, and QOL in patients with end-stage knee OA.

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Shorter vs Longer Immobilization After Surgery for Thumb Carpometacarpal Osteoarthritis: A Propensity Score-Matched Study

Publication date: November 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 11

Author(s): Jonathan Tsehaie, Robbert M. Wouters, Reinier Feitz, Harm P. Slijper, Steven E.R. Hovius, Ruud W. Selles, Hand-Wrist Study Group

Abstract

Objective

To investigate if shorter immobilization is noninferior to longer immobilization after Weilby procedure for thumb carpometacarpal osteoarthritis

Design

Prospective cohort study with propensity score matching.

Setting

Data collection took place in 16 outpatient clinics for hand surgery and hand therapy.

Participants

A total of 131 participants with shorter immobilization and 131 participants with longer immobilization (N=262).

Intervention

Shorter immobilization (3-5 days plaster cast followed by a thumb spica orthosis including wrist until 4 weeks postoperatively) was compared with longer immobilization (10-14 days plaster cast followed by a thumb spica orthosis including wrist until 6 weeks postoperatively) after Weilby procedure for first carpometacarpal joint osteoarthritis. Propensity score matching was used to control for confounders.

Main Outcome Measures

Outcomes were pain measured with a visual analog scale and hand function measured with the Michigan Hand Outcomes Questionnaire at 3 and 12 months. Secondary outcomes were complications, range of motion, grip and pinch strength, satisfaction with treatment, and return to work.

Results

No significant differences were found in visual analog scale pain (effect size, 0.03; 95% confidence interval [CI], −0.21 to 0.27) or the Michigan Hand Outcomes Questionnaire (effect size, 0.01; 95% CI, −0.23 to 0.25) between the groups at 3 months or at 12 months. Furthermore, no differences were found in complication rate or in other secondary outcomes.

Conclusions

In conclusion, shorter immobilization of 3-5 days of a plaster cast after Weilby procedure is equal to longer immobilization for outcomes on pain, hand function, and our secondary outcomes. These results indicate that shorter immobilization is safe and can be recommended, since discomfort of longer immobilization may be prevented and patients may be able to recover sooner, which may lead to reduced loss of productivity. Future studies need to investigate effectiveness of early active and more progressive hand therapy following first carpometacarpal joint arthroplasty.

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Relationship between gliding and lateral femoral pain in patients with trochanteric fracture

Publication date: Available online 21 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Kengo Kawanishi, Shintarou Kudo, Katsushi Yokoi

Abstract

Objectives

To investigate the association between gliding and lateral femoral pain (LFP) with trochanteric fracture (TF).

Design

Prospective, cohort study.

Setting

The survey was conducted at approximately 3 weeks and 11 weeks postoperatively.

Participants

Patients (N=23) with TF after surgery.

Interventions

Not applicable.

Main Outcome Measure

Pain was assessed using a numerical rating scale for the following five conditions: rest pain, tenderness pain, stretch pain (SP), contraction pain, and weight-loading pain (LP). Based on LP, the subjects were divided into two groups, severe and moderate. Gliding of both the vastus lateralis muscle (VL) and subcutaneous tissue (SC) were recorded during knee motion using B-mode ultrasonography with a 12 MHz linear transducer fixed on the lateral thigh using an original fixation device. Particle image velocimetry analysis software was adapted to create the flow velocity of both VL and SC from echo imaging, and two regions of interest were selected on the VL and SC. Gliding was calculated using a coefficient of correlation from each time series data-set.

Results

Gliding and pain (stretch/contraction) were significantly different between the two groups at 3 weeks postoperation. Changes in both LP (r=0.49) and SP (r=0.42) correlated significantly with improvements in gliding.

Conclusion

Patients with LP after surgery for TF showed decreased gliding during recovery, and an improvement in gliding was associated with improvements in both LP and SP.

Graphical abstract

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Gamma Oscillations Shape Pain in Animals and Humans

Publication date: Available online 19 October 2019

Source: Trends in Cognitive Sciences

Author(s): Markus Ploner, Joachim Gross

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Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

Abstract

Objective

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design

A cross-sectional study of a population-based cohort of older adults

Setting

Urban and suburban communities in a large metropolitan area

Participants

Community-living participants (n=302) aged 70 years and older recruited from a previous population-based cohort

Interventions

Not applicable.

Main Outcome Measures

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability, were assessed under single and dual-task conditions involving cognitive challenges (e.g. counting backwards). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions

These findings suggest that chronic pain contributes to decrements in gait including slower gait speed and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

Abstract

Objective

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design

A cross-sectional study of a population-based cohort of older adults

Setting

Urban and suburban communities in a large metropolitan area

Participants

Community-living participants (n=302) aged 70 years and older recruited from a previous population-based cohort

Interventions

Not applicable.

Main Outcome Measures

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability, were assessed under single and dual-task conditions involving cognitive challenges (e.g. counting backwards). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions

These findings suggest that chronic pain contributes to decrements in gait including slower gait speed and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

Abstract

Objective

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design

A cross-sectional study of a population-based cohort of older adults

Setting

Urban and suburban communities in a large metropolitan area

Participants

Community-living participants (n=302) aged 70 years and older recruited from a previous population-based cohort

Interventions

Not applicable.

Main Outcome Measures

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability, were assessed under single and dual-task conditions involving cognitive challenges (e.g. counting backwards). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions

These findings suggest that chronic pain contributes to decrements in gait including slower gait speed and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

Abstract

Objective

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design

A cross-sectional study of a population-based cohort of older adults

Setting

Urban and suburban communities in a large metropolitan area

Participants

Community-living participants (n=302) aged 70 years and older recruited from a previous population-based cohort

Interventions

Not applicable.

Main Outcome Measures

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability, were assessed under single and dual-task conditions involving cognitive challenges (e.g. counting backwards). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions

These findings suggest that chronic pain contributes to decrements in gait including slower gait speed and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

Abstract

Objective

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design

A cross-sectional study of a population-based cohort of older adults

Setting

Urban and suburban communities in a large metropolitan area

Participants

Community-living participants (n=302) aged 70 years and older recruited from a previous population-based cohort

Interventions

Not applicable.

Main Outcome Measures

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability, were assessed under single and dual-task conditions involving cognitive challenges (e.g. counting backwards). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions

These findings suggest that chronic pain contributes to decrements in gait including slower gait speed and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

Abstract

Objective

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design

A cross-sectional study of a population-based cohort of older adults

Setting

Urban and suburban communities in a large metropolitan area

Participants

Community-living participants (n=302) aged 70 years and older recruited from a previous population-based cohort

Interventions

Not applicable.

Main Outcome Measures

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability, were assessed under single and dual-task conditions involving cognitive challenges (e.g. counting backwards). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions

These findings suggest that chronic pain contributes to decrements in gait including slower gait speed and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

Abstract

Objective

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design

A cross-sectional study of a population-based cohort of older adults

Setting

Urban and suburban communities in a large metropolitan area

Participants

Community-living participants (n=302) aged 70 years and older recruited from a previous population-based cohort

Interventions

Not applicable.

Main Outcome Measures

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability, were assessed under single and dual-task conditions involving cognitive challenges (e.g. counting backwards). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions

These findings suggest that chronic pain contributes to decrements in gait including slower gait speed and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

Abstract

Objective

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design

A cross-sectional study of a population-based cohort of older adults

Setting

Urban and suburban communities in a large metropolitan area

Participants

Community-living participants (n=302) aged 70 years and older recruited from a previous population-based cohort

Interventions

Not applicable.

Main Outcome Measures

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability, were assessed under single and dual-task conditions involving cognitive challenges (e.g. counting backwards). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions

These findings suggest that chronic pain contributes to decrements in gait including slower gait speed and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

Abstract

Objective

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design

A cross-sectional study of a population-based cohort of older adults

Setting

Urban and suburban communities in a large metropolitan area

Participants

Community-living participants (n=302) aged 70 years and older recruited from a previous population-based cohort

Interventions

Not applicable.

Main Outcome Measures

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability, were assessed under single and dual-task conditions involving cognitive challenges (e.g. counting backwards). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions

These findings suggest that chronic pain contributes to decrements in gait including slower gait speed and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

Abstract

Objective

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design

A cross-sectional study of a population-based cohort of older adults

Setting

Urban and suburban communities in a large metropolitan area

Participants

Community-living participants (n=302) aged 70 years and older recruited from a previous population-based cohort

Interventions

Not applicable.

Main Outcome Measures

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability, were assessed under single and dual-task conditions involving cognitive challenges (e.g. counting backwards). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions

These findings suggest that chronic pain contributes to decrements in gait including slower gait speed and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

Abstract

Objective

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design

A cross-sectional study of a population-based cohort of older adults

Setting

Urban and suburban communities in a large metropolitan area

Participants

Community-living participants (n=302) aged 70 years and older recruited from a previous population-based cohort

Interventions

Not applicable.

Main Outcome Measures

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability, were assessed under single and dual-task conditions involving cognitive challenges (e.g. counting backwards). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions

These findings suggest that chronic pain contributes to decrements in gait including slower gait speed and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

Abstract

Objective

To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design

A cross-sectional study of a population-based cohort of older adults

Setting

Urban and suburban communities in a large metropolitan area

Participants

Community-living participants (n=302) aged 70 years and older recruited from a previous population-based cohort

Interventions

Not applicable.

Main Outcome Measures

Gait parameters including gait speed, stride length, double support and swing characteristics, and variability, were assessed under single and dual-task conditions involving cognitive challenges (e.g. counting backwards). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results

Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions

These findings suggest that chronic pain contributes to decrements in gait including slower gait speed and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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The low down on back pain . . . and other stories

Low back painLow back pain is the world’s leading cause of disability. Although there are guidelines for diagnosis and management, they are not always fully implemented in primary care. A cluster...

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Severe back pain in an older man

This abdominal computed tomography (CT) scan (fig 1) shows gastric dilation, a massive amount of air in the stomach wall (gastric pneumatosis) (white arrows), and a large volume of intramural gastric...

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Opioid prescribing is rising in many countries

Opioids are effective in managing acute and cancer pain.1 However, their effectiveness in chronic pain is uncertain, with limited evidence of consistent pain relief beyond 12 weeks. Tolerance and...

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Clinical and Radiographic Outcome of Patients With Cervical Spondylotic Myelopathy Undergoing Total Disc Replacement

Study Design. A nonrandomized, prospective, and single-center clinical trial. Objective. The aim of this study was to investigate the clinical and radiographic efficacy of ProDisc Vivo cervical total disc replacement (cTDR) in patients with clinical and radiographic documented cervical spondylotic myelopathy (CSM), due to degenerative changes at the index level. Summary of Background Data. Decompression and fusion is still the gold standard in patients with cervical myelopathy. Very limited data are available regarding the application of cTDR in patients with clinical and radiological documented CSM in context of clinical and radiographic outcomes. Methods. Clinical outcome scores included the Neck Disability Index (NDI), Visual Analogue Scale (VAS), arm and neck pain self-assessment questionnaires as well as the Nurick grade and the Japanese Orthopaedic Association (JOA) score. The radiological outcome included the range of motion (ROM), the segmental and global (C2-C7) lordosis, and the occurrence of heterotopic ossifications. Results. Eighteen consecutive patients (10 males, 8 females) with documented clinical and radiological signs of myelopathy were included in this investigation. The study population had a mean age of 52.4 years and a follow-up period of 20.3 months in average (range 3–48 months). The mean range ROM of the index level stayed consistent with 6.8° preoperatively and 7.2° (P = 0.578) at the last follow-up; the global lordosis in neutral position changed from 3.5° to 14.2° significantly (P = 0.005) in mean. The JOA score improved from 11.3 to 16.6 (P <� 0.001) as well as the NDI 36.7 to 10.3 (P <� 0.001) and the VAS score from 5.7/6.1 (arm/neck) to 1.3/2.0 (P <� 0.001/P <� 0.001). The mean Nurick grade was 1.33 preoperatively and dropped down in all cases to Nurick grade of 0 (P <� 0.001). Conclusion. cTDR (with ProDisc Vivio) in patients with CSM yielded good clinical and radiographic outcomes and found as a reliable, safe, and motion-preserving surgical treatment option, although its indication is very limited due to numerous exclusion criteria. Level of Evidence: 4

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The Microsurgical Treatment of Lumbar Disc Herniation: A Report of 158 Patients With a Mean Follow-up of More Than 32 Years

Study Design. Level 3, cohort study. Objective. The aim of this study was to assess long-term clinical outcome, and rate of reoperation following microsurgical subtotal discectomy (MSD). Summary of Background Data. Lumbar disc herniation (LDH) is a common cause of discomfort. Studies with >25 years of follow-up are rare and the reported rate of clinical success and reoperation are not well understood. Methods. Retrospectively, files with complete documentation of preoperative and postoperative neurological status, process during hospitalization, detailed report of MSD, outpatient visit notes, and full contact information of patients who underwent MSD for the treatment of LDH with a minimum follow-up of 25 years were reviewed. Patients were contacted for personal follow-up assessment which included Oswestry Disability Index (ODI), EQ-5D, and MacNab criteria, usage of pain medication for leg and back pain, limitations in daily life, and repeated procedures at the lumbar spine. Results. A total of 355 patients were randomly selected and contacted for final follow-up and 158 patients with a mean follow-up 32 years participated in the study. Clinical success rate was 86.0%, mean ODI was 9% (0–58%), 69.6% of the patients were pain free, 13.9% of patients reported the daily intake of pain medication for back and leg pain. Reoperations were performed in 47 of the patients (29.7%), whereas the rate for recurrent disc herniation at the same level was 8.2%. Reoperation within the first 2 years after initial MSD had negative influence on clinical success. The preoperative physical working status and sex and working status had no influence on the clinical success. Conclusion. The MSD is an effective technique to achieve a high rate of patient satisfaction, and high rate of functional recovery. The overall reoperation rate is 30% within 30 years but only 8.2% of the patients underwent reoperation because of recurrent disc herniation at the same level. Level of Evidence: 3

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