In October 2017, the United States government declared a state of public health emergency in response to the growing prescription opioid epidemic. Social, political, and medical rhetoric has recently demanded improvements in clinical pain control, prompting the publication of the “Guideline for Prescribing Opioids for Chronic Pain” by the Centers for Disease Control and Prevention (CDC) in March, 2016.31 Over the last decade, opioid use in the US has risen dramatically, with the number of prescriptions written by health care providers in 2012 (∼259 million) exceeding the total adult population (∼240 million).
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Tuesday, December 10, 2019
Two weeks of wearing a knee brace compared to minimal intervention on kinesiophobia at 2 and 6-weeks in people with patellofemoral pain: A randomized controlled trial
Publication date: Available online 10 December 2019
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Liliam B. Priore, Simon Lack, Carmen Garcia, Fabio M. Azevedo, Danilo de Oliveira Silva
Abstract
Objective
To investigate the effect of a knee brace compared with minimal intervention on self-reported kinesiophobia and function, objective function and physical activity level in individuals with patellofemoral pain (PFP).
Design
Single-blind randomized controlled trial [1:1], parallel
Participants
Fifty individuals with PFP.
Main Outcome Measures
Primary: Kinesiophobia (Tampa Scale of Kinesiophobia). Secondary: self-reported function (Anterior Knee Pain Scale), physical activity level (International Physical Activity Questionnaire) and objective function (forward step-down test). Outcomes were assessed at baseline (T0), at the end of the intervention (2-weeks) (T1) and at 6-weeks after baseline (T2).
Intervention
Participants were randomly assigned to one of two interventions groups: (i) use of knee brace for 2 weeks during daily living, sports or painful tasks (brace group); (ii) educational leaflet with information about PFP (leaflet group).
Results
The knee brace reduced kinesiophobia in people with PFP compared to minimal intervention with moderate effect size at T1 = mean difference (95%CI) -5.56 (-9.18 to -1.93) and T2 = -5.24 (-8.58 to -1.89). There was no significant difference in self-reported and objective function and physical activity level.
Conclusion
The knee brace improved kinesiophobia immediately after intervention (at 2-weeks) and at 6-weeks follow-up in people with PFP compared to minimal intervention. A knee brace may be considered within clinically reasoned paradigms to facilitate exercise-therapy interventions for people with PFP.
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Saturday, December 7, 2019
Effectiveness of platelet rich plasma injections for non-surgical management of carpal tunnel syndrome: a systematic review and meta-analysis of randomized controlled trials
Publication date: Available online 7 December 2019
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Michael Catapano, Joseph Catapano, Gregory Borschel, Seyed Mohammad Alavania, Lawrence R. Robinson, Nimish Mittal
Abstract
Objective
To systematically review and evaluate the efficacy and complication profile of platelet-rich plasma (PRP) injection into the carpal tunnel for management of carpal tunnel syndrome (CTS).
Data Sources
PubMed, MEDLINE, SCOPUS, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials, and Web of Sciences (from inception to January 1st, 2019).
Study Selection
Controlled trials addressing PRP for CTS.
Data Extraction
Two reviewers independently screened the titles, abstracts, and full texts, extracting data from eligible studies. The outcomes of interest were the visual analog score (VAS) for pain and the Boston Carpal Tunnel Questionnaire (BCTQ), including the subscales of the symptom severity scale (SSS) and the functional status scale (FSS). Other reported outcome measures and complications were analyzed descriptively.
Data Synthesis
Four randomized control studies satisfied the inclusion criteria and analyzed a total of 191 cases with a final follow-up of either 3 or 6-months. Control groups included splinting in two studies, corticosteroid injection in one study, and saline injection in one study. There was a statistically and clinically significant improvement in the BCTQ {Std. Mean Difference(95%CI) = -2.06[-3.41, -0.70], p=.003} between groups. Subgroup analysis showed significant improvement in SSS {Std. Mean Difference(95%CI) = -1.95[-3.65, -0.25], p=.02} but not for FSS {Std. Mean Difference(95%CI) = -2.19[-4.77, 0.40], p=.10}. There was a similar improvement in VAS and nerve conduction studies in those receiving PRP compared to controls. Complication rate in the included studies was low with 4/97 participants receiving PRP injections experiencing transient pruritis, burning and/or tingling.
Conclusion
PRP represents a promising therapy for patients with mild to moderate CTS; however, included studies were limited as follow-up was short, included patients were heterogeneous, and the number of included studies was low. Further investigation is necessary to determine its true efficacy and effect and to better delineate the long-term results in patients with CTS.
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Pressure Pain Threshold in Subjects with Piriformis Syndrome: Test-Retest, Intra-, and Inter-Rater Reliability, and Minimal Detectible Changes
Publication date: Available online 7 December 2019
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Abbas Tabatabaiee, Ismail Ebrahimi Takamjani, Javad Sarrafzadeh, Reza Salehi, Maryam Ahmadi.
Abstract
Objective
This study aimed to assess the test-retest, intra-, and interrater reliability of using the pressure pain threshold (PPT) in healthy and affected piriformis muscles and to estimate its absolute reliability. As a secondary objective, the degree of tenderness of the affected piriformis muscles was compared with healthy piriformis muscles.
Study Design
This study used a comparative and reliability-based design.
Setting
Rehabilitation clinic.
Participants
Thirty patients with unilateral piriformis muscle syndrome (30 affected and 30 healthy piriformis muscles) were recruited, and the PPT of both the healthy and affected piriformis muscles was recorded using digital algometry. Measurements of PPT were done by two raters (rater 1 and 2), which have selected at random order. The rater 1 repeated the PPT measurements 24-72 hours after initial assessment.
Interventions
Not applicable.
Main Outcome Measures
PPT.
Results
Excellent intra-rater intra-class coefficient (ICC) values were observed for the PPT of the affected piriformis (ICC: 0.86–0.96) and the healthy piriformis (ICC: 0.88–0.96) in the same session. The PPT measurements using digital algometry showed good-to-excellent inter-rater reliability (ICC: 0.64–0.92) and test-retest reliability (ICC: 0.72–0.95) in both the healthy and affected piriformis muscles. The findings revealed a significant decrease in the PPT of the affected piriformis muscle in comparison to the healthy piriformis muscle (mean difference 12.76 [95% confidence interval [CI]:15.69–9.82], P < 0.001).
Conclusion
Digital algometry is a reliable tool for measuring piriformis PPT, regardless of the testing session and the rater. Patients with unilateral piriformis muscle syndrome have increased tenderness and decreased PPT in the affected piriformis muscle in comparison to the healthy piriformis muscle.
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Thursday, December 5, 2019
Acute paraplegia in a healthy child
A previously healthy 12 year old girl presented to the emergency department with two days of bilateral leg pain and the inability to walk.She had no history of trauma, back pain, weight loss, night...
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Tuesday, December 3, 2019
Consultation prevalence among children, adolescents and young adults with pain conditions: A description of age‐ And gender differences
Abstract
Background
Pain is a common complaint presented in healthcare, but most epidemiological pain research has focused either on single pain conditions or on the adult population. The aim of this study was to investigate the 2017 consultation prevalence of a wide range of pain conditions in the general population of young people.
Methods
We used the Skåne Healthcare Register, covering prospectively collected data on all healthcare delivered (primary and secondary care) to the population in the region of Skåne, southern Sweden (population 2017 n = 1,344,689). For individuals aged 1–24 in 2017 (n = 373,178), we calculated the consultation prevalence, stratified by sex and age, and the standardised morbidity ratio (SMR) to assess overall healthcare consultation.
Results
A total of 58,981 (15.8%) individuals consulted at least once for any of the predefined pain conditions. Of these, 13.5% (n = 7,996) consulted four or more times for pain. Abdominal pain, joint pain/myalgia, headache and back/neck pain were the most common complaints. Overall, females had higher consultation prevalence than males: 17.6% versus 14.1% (p < .0001). SMR was 1.82 (95% CI = 1.74–1.87) for females with pain and 1.51 (95% CI = 1.42–1.56) for males with pain. Consultation prevalence increased with age, but this pattern varied between sex and pain condition.
Conclusions
Among individuals under the age of 25, a significant proportion consult for pain already in early ages, and they also have high healthcare consultation rates for conditions other than pain. The even higher consultation rates among young females need additional attention, both in the clinic and in research.
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Saturday, November 30, 2019
Differences in Antinociceptive Signaling Mechanisms Following Morphine and Fentanyl Microinjections into the Rat Periaqueductal Gray
Abstract
Background
Morphine and fentanyl are two of the most commonly used opioids to treat pain. Although both opioids produce antinociception by binding to mu‐opioid receptors (MOR), they appear to act via distinct signaling pathways.
Objective
This study will reveal whether differences in morphine and fentanyl antinociception are the result of selective activation of G‐protein signaling and/or selective activation of pre‐ or postsynaptic MORs.
Methods
The contribution of each mechanism to morphine and fentanyl antinociception was assessed by microinjecting drugs to alter G‐protein signaling or block potassium channels linked to pre‐ and post‐synaptic MORs in the ventrolateral periaqueductal gray (PAG) of male Sprague‐Dawley rats.
Results
Both morphine and fentanyl produced a dose dependent antinociception when microinjected into the PAG. Enhancement of intracellular G‐protein signaling by microinjection of the Regulator of G‐protein Signaling 4 (RGS4) antagonist CCG‐63802 into the PAG enhanced the antinociceptive potency of morphine, but not fentanyl. Microinjection of α‐dendrotoxin into the PAG to block MOR activation of presynaptic Kv + channels caused a significant rightward shift in the dose‐response curve of both morphine and fentanyl. Microinjection of tertiapin‐Q to block MOR activation of post‐synaptic GIRK channels caused a larger shift in the dose‐response curve for fentanyl than morphine antinociception.
Conclusions
These findings reveal different PAG signaling mechanisms for morphine and fentanyl antinociception. In contrast to fentanyl, the antinociceptive effects of morphine are mediated by G‐protein signaling primarily activated by presynaptic MORs.
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