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Tue, 22 Mar 2016 08:07:51 +0100In 2012, an 84-year-old Chinese man presented with progressive, chronic left atraumatic knee pain and swelling. His medical history was notable for pulmonary tuberculosis treated in China in 1951 and rheumatoid arthritis diagnosed in 2006. His joint pain progressed despite use of disease modifying drugs and steroid injections. Antitumor necrosis factor inhibitors were not used because of concerns of tuberculosis reactivation. Clinical examination showed he had antalgic gait, knee effusion, stiffness, and joint-line tenderness. (Source: The Lancet Infectious Diseases)
Tue, 22 Mar 2016 06:26:00 +0100ConclusionsAnalyses of denturists’ occupational exposure in the Łódź province and epidemiological estimates of the health effects suggest the need for preventive measures. (Source: International Dental Journal)
Mon, 21 Mar 2016 17:22:08 +0100This study evaluates the feasibility of using a novel epidermal graft‐harvesting device (CelluTome) that allows pain‐free epidermal skin grafting in the outpatient clinic setting. A prospective series of 35 patients was performed in 2 centres, involving 10 acute and 25 chronic wounds. All patients were subjected to epidermal grafting in the outpatient specialist clinic, without the use of anaesthesia, and allowed to return home after the procedure. Completely healed wounds were noted in 22 patients (62·9%). The overall mean time for 50% and 100% reduction in wound size was 3·31 ± 2·33 and 5·91 ± 3·48 weeks, respectively. There was no significant difference in healing times between the acute and chronic wounds (50% reduction in wound size; acute 2·20 ± 0·91 wee...
Mon, 21 Mar 2016 00:00:00 +0100Conclusions From a societal perspective, MTU was not cost-effective in comparison with PT in patients with sub-acute and chronic non-specific neck pain for perceived recovery, functional status, and QALYs. As no clear total societal cost and effect differences were found between MTU and PT, the decision about what intervention to administer, reimburse, and/or implement can be based on the preferences of the patient and the decision-maker at hand. Trial registration ClinicalTrials.gov Identifier: NCT00713843 (Source: European Spine Journal)
Mon, 21 Mar 2016 00:00:00 +0100ConclusionsKC patients who already developed a contracted bladder with extremely small bladder capacity (<300 ml) with irreversible urinary tract change, partial cystectomy, and AE seems necessary for early restoration of a normal lower urinary tract function. The treatment outcome of AE is better than patients with conservative treatment. Neurourol. Urodynam. © 2016 Wiley Periodicals, Inc. (Source: Neurourology and Urodynamics)
Mon, 21 Mar 2016 00:00:00 +0100Health-related quality of life (HRQoL) is a key measure for evaluating health status in populations. Using the recent EQ-5D-5L for measurement, this study analyzed quality of life results and their stability over consecutive population surveys. Three cross-section surveys for representative samples of the general German population from 2012, 2013, and 2014 were evaluated using the EQ-5D-5L descriptive system and valuation by the Visual Analog Scale (VAS). Aggregated sample size reached 6074. The dimension with the highest prevalence of problems was pain/discomfort (31.7%). Compared with 2012 (59.3%), the percentage of participants in the best health state increased slightly in 2013 (63.4%) and 2014 (62%). Over the 3-year period, diabetes and heart disease had the strongest negative influen...
Mon, 21 Mar 2016 00:00:00 +0100In this study, we explored the possible mechanism of melatonin in diminishing morphine tolerance. Main methods Two intrathecal (i.t.) catheters were implanted in male Wistar rats for drug delivery. One was linked to a mini-osmotic pump for morphine or saline infusion. On the seventh day, 50μg of melatonin or vehicle was injected through the other catheter instantly after discontinuation of morphine or saline infusion; 3h later, 15μg of morphine or saline was injected. The antinociceptive response was then measured using the tail-flick test every 30min for 120min. Key findings The results showed that chronic morphine infusion elicited antinociceptive tolerance and upregulated heat shock protein 27 (HSP27) expression in the dorsal horn of the rat spinal cord. Melatonin pretreatment parti...
Mon, 21 Mar 2016 00:00:00 +0100This study investigates the effects of oral doses of omega-3 FA from FO and concentrated fish oil (CFO) in a model of sub-chronic IP, induced by Complete Freund's Adjuvant (CFA). Main methods IP was induced by intraplantar injection of CFA into the right hind paw of Wistar rats. Three groups were pre-treated with omega-3 FA: two groups received CFO (460mg of EPA/360mg of DHA and 690mg of EPA/540mg of DHA) and one group received natural FO (460mg EPA/300mg DHA), for 7days before IP induction (pre-treatment) and 5days after induction (treatment). Key findings TNF-α levels were reduced by CFO 690 (67.9%; p<0.01), CFO 460 (57.7%; p<0.01), FO 460 (26.2%), compared to the augment promoted by CFA (549.7%; p<0.001). Resolvin levels were increased in treated groups with resp...
Mon, 21 Mar 2016 00:00:00 +0100CONCLUSIONS We report the first series of single-port video-assisted thoracoscopic surgical (VATS) splanchnotomy for palliation of intractable pain due to chronic pancreatitis. From this small study, single-port VATS splanchnotomy seems to be a safe and effective alternative to multiportal or open procedures. (Source: Interactive CardioVascular and Thoracic Surgery)
Mon, 21 Mar 2016 00:00:00 +0100A 16-year-old girl with generalized anxiety disorder and chronic abdominal pain presented for elective upper endoscopy and colonoscopy. Her medication list included fluoxetine and buspirone. Because of severe preoperative anxiety, 50% nitrous oxide was administered to facilitate intravenous catheter placement. Despite this, the patient was extremely tearful, so general anesthesia was induced with the addition of 8% sevoflurane. (Source: Journal of Clinical Anesthesia)
Mon, 21 Mar 2016 00:00:00 +0100Conclusions This study showed that interlaminar epidural steroid injections can be as effective as transforaminal epidural steroid injections when performed at the nearest level of lumbar pathology using fluoroscopy in 12-month intervals. (Source: Brazilian Journal of Anesthesiology)
Mon, 21 Mar 2016 00:00:00 +0100Abstract Transient receptor potential vanilloid type 1 (TRPV1), a heat-sensitive calcium channel protein, contributes to inflammation as well as to acute and persistent pain. Since TRPV1 occupies a central position in pathways of neuronal inflammatory signaling, it represents a highly attractive potential therapeutic target for neuroinflammation. In the present work, we have in silico identified a series of diarylurea analogues for hTRPV1, of which 11 compounds showed activity in the nanomolar to micromolar range as validated by in vitro biological assays. Then, we utilized molecular docking to explore the detailed interactions between TRPV1 and the compounds to understand the contributions of the different substituent groups. Tyr511, Leu518, Leu547, Thr550, Asn551, Arg557, and Le...
Sun, 20 Mar 2016 18:07:33 +0100The objective of the study was to investigate the association between patient characteristics, back pain characteristics and MRI abnormalities (including lumbar degeneration) with subsequent specialist consultation and/or surgery in low back pain patients presenting for lumbar MRI as referred by their general practitioners. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:33 +0100Purpose: The lifetime prevalence of low back pain (LBP) is about 70-85%, with 10-20% experience experiencing chronic low back pain (LBP). Facet joint degeneration (FJD) by osteoarthritic changes is a common cause of LBP with an incidence of 15–45% among patients with chronic LBP. The overall objectives are to test the pharmacological efficacy of allosteric small molecule inhibitor of the TrkA pathway in FJD-induced chronic back pain, and to understand the underlying molecular pain pathways. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:33 +0100Even though current therapies for chronic musculoskeletal pain suffer from limited efficacy and significant side effects, there has been a lack of successful development of therapies using novel mechanisms over the last several decades. Inhibition of nerve growth factor (NGF) has emerged as a new mechanism that has shown some promise; with significant clinical efficacy and a side effect profile that is non-overlapping with other current therapies. The data on efficacy and side effects will be examined and the rationale for reinitiating clinical trials will be discussed. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:32 +0100Purpose: The pathological mechanism of osteoarthritis (OA) still remains unknown. It is known that the biochemical changes of OA has begun before a patient was diagnosed as OA using X-ray or magnetic resonance imaging (MRI). Early therapeutic intervention, such as performing the muscle strength training and anti-inflammatory treatment, has some clinical advantages for the reduction of symptom in OA patients. It will prevent chronic pain and improve the range of motion restriction. For these reasons, development of the useful biomarker for the early diagnosis of OA is expected. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:32 +0100Purpose: Osteoarthritis (OA) involves the slow, chronic degradation of articular joints, ultimately resulting in pain and disability. Molecular OA biomarkers diffuse from the OA-affected joint into blood and urine; and while urine and serum biomarkers have proven to be useful for early OA diagnosis, synovial fluid biomarkers may have greater potential for understanding ongoing disease processes. In particular, cartilage degradation products, levels of catabolic enzymes, inflammatory mediators, chemokines, and other molecules could serve as molecular biomarkers OA state and severity. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:32 +0100Purpose: Anti-NGF treatment results in clinically significant pain reduction. When combined with chronic NSAID treatment there is an increased risk of a distinct osteoarthritis phenotype described by rapid cartilage loss and bone destruction. Biomarkers of joint tissue metabolism and inflammation could provide insight into the pathophysiology of this interaction between anti-NGF treatment and NSAID use. Therefore an analysis was conducted to phenotype patients who are at higher risk of this joint safety event based on biochemical biomarkers. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:32 +0100Purpose: Osteoarthritis (OA) is a group of conditions that causes chronic pain and disability. It is considered a disease of the whole joint. The subchondral bone component of the joint is increasingly recognised as playing an important role in OA. Subchondral bone changes have been associated with radiographic OA. Preclinical and clinical studies suggest contributions of osteoclasts and subchondral bone remodelling to OA pain. Osteoclasts release the bone degrading enzymes, tartrate resistant acid phosphatase 5b (TRAP5b), and the protease cathepsin K during bone resorption. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:32 +0100Purpose: Clinical management of chronic joint pain evoked by osteoarthritis is a real challenge due to our limited understanding of the cellular mechanisms that initiate and develop chronic pain. It has been increasingly recognized that glial cells, such as microglia and astrocytes in the central nervous system play an important role in the development and maintenance of chronic pain. Notably, astrocytes make very close contacts with synapses and astrocyte reaction after nerve injury, arthritis, and tumor growth is more persistent than microglial reaction and displays a better correlation with chronic pain behaviors. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:31 +0100Purpose: Osteoarthritis (OA) is a chronic disease and the most prevalent form of arthritis. It is a major cause of pain and disability that globally affects millions of individuals. In last years, differents phenotypes have been described; the most consistent are: biomechanics, genetic, inflammatory, metabolic, and pain. In US population metabolic syndrome (MetS) is more prevalent in patients with OA (59%) vs. population without OA (23%),; on the other hand, inflammation has been described as an important risk factor in the development and progression of knee OA (KOA). (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:31 +0100Purpose: Self-management (SM) is consistently endorsed by clinical practice guidelines and policy makers for osteoarthritis (OA) and chronic low back pain (CLBP), but health service commissioners require robust evidence of its clinical and cost effectiveness prior to widespread implementation, which is currently lacking. The multifaceted nature of SM interventions with several interacting components that need to be tailored to the individual, and underpinned by a collaborative relationship between the patient and health-care professional within the local health service constitutes a complex intervention, notwithstanding the additional challenges of consistently delivering such an intervention in a group format if preferred, across a diverse range of health service settings with varying res...
Sun, 20 Mar 2016 18:07:30 +0100Purpose: Early through to late stage knee osteoarthritis (KOA) has been linked with effusion-synovitis in the suprapatellar pouch and chronic inflammation has been particularly associated with pain. Recent studies also suggest that synovial hypertrophy (SH), especially when seen in the suprapatellar pouch or Hoffa's fat pad, is an independent predictor for development of radiographic KOA. Persistent SH has been reported in post-traumatic knees. Ultrasound (US) assessment has great potential value as a non-invasive, practical method of measuring chronic inflammation and monitoring response to treatment, both clinically and in future trials. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:30 +0100Purpose: Chronic musculoskeletal pain (CMP) conditions, particularly low back pain (LBP), are common and disabling conditions frequently requiring long-term management. Enabling individuals to self-manage (SM) their condition is widely endorsed within clinical practice guidelines and health policy recommendations internationally. However, the current evidence for the cost-effectiveness of SM is limited with little consensus. The outcome of economic evaluations is highly dependent on which costs and effects are included in the economic analysis. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:29 +0100Purpose: Osteoarthritis is one of the most common chronic musculoskeletal disorders and a cause of serious morbidity and disablement, particularly in the elderly population. Progressive damage to the articular cartilage and bone leads to pain and loss of joint function. The development of osteoarthritis is very complex, due to the activation of several signaling pathways in the different tissues composing the joint, and is influenced by both genetic and acquired or environmental risk factors. We have recently described an association between polymorphisms in the ANP32a gene and osteoarthritis. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:29 +0100Purpose: It has been hypothesised that the identification of clinical phenotypes or subgroups, characterized by different underlying mechanisms, would help in the optimal treatment allocation. In a previous systematic review of the literature, five main phenotypes were identified: Minimal Joint Disease (MJD), Biomechanical Overload (BO), Chronic Pain (CP), Inflammatory (I) and Metabolic divided in Metabolic Syndrome (MS) and Bone and Cartilage Metabolism (BCM). The aim of this study is to confirm and validate those clinical phenotypes in a KOA sample extracted from the Osteoarthritis Initiative (OAI) database. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:29 +0100The objectives of the present study were to identify common pathways that may determine progression of cartilage damage and osteophyte formation in OA. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:28 +0100Purpose: Chronic joint pain with pain at walking as major complaint affects a large portion of an aging population. Treatment options for this pain are insufficient, with side effects and less than full efficacy. Many hopes arose after discovery of the TRP channels, especially the TRPV1 receptor which reacts to increases in temperature but also to other stimuli such as acid environment and capsaicin. This lead to research for new drugs, and between 2006 and 2010 more than 20 patents/applications related to TRPV1 blockers for e.g., pain, inflammation and osteoarthritis were filed each year. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:28 +0100Purpose: Osteoarthritis (OA) is the most prevalent arthritis worldwide. The chronic nature of OA often leads to long-term disability, with pain being a major symptom for which people seek care. During established OA disease, chronic pain due to cartilage, synovial and bone damage may be aggravated by the process of “central sensitization”, whereby pain processing pathways in the central nervous system (CNS) become sensitized to peripheral nerve stimulation caused by degenerative and inflammatory disease processes. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:28 +0100Purpose: Type 2 diabetes (T2D) is a common comorbidity among individuals affected by large joint osteoarthritis (OA). Recent studies have shown that having T2D increases the prospective risk of total knee replacement. The role of OA and pain on incidence of T2D has not been explored. Disturbed sleep is a known risk factor of T2D and is frequently seen in people who suffer from chronic pain therefore an effect of OA on T2D may be mediated by pain induced sleep deprivation. The aim was to assess the role of radiographic OA, joint pain, and sleep deprivation on the prospective risk of developing T2D. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:28 +0100Purpose: Osteoarthritis (OA) is characterized by acute and chronic pain and reduced physical function. Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed to treat OA, but are associated with dose-related serious gastrointestinal, cardiovascular, and renal adverse events, leading health authorities to advise using the lowest effective dose for the shortest duration, consistent with individual patient treatment goals. SoluMatrix® meloxicam capsules have been developed using SoluMatrix Fine Particle Technology™ to provide efficacy at low doses. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:28 +0100Purpose: Obese children are at high risk of adult obesity and other chronic diseases. Obese adolescents may show signs of knee pain, disinclination to exercise due to progressive musculoskeletal discomfort, injuries, inefficient body mechanics and reduction in mobility. Recent MRI studies show cartilage lesions in the knee of very obese children and adolescents. Reduced mobility is a vicious circle active in the clinical course of obesity by directly precluding a centrally important management strategy in all chronic disease(s), namely spontaneous or prescribed physical activity. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:28 +0100Purpose: Osteoarthritis (OA) is the most common form of arthritis and is associated with chronic pain and reduced mobility. There is controversial evidence regarding the relationship between mechanical loading and OA. Specifically related to exercise, some studies have found a detrimental link between them, but others refute such a link, and suggest that exercise is an approach to prevent OA. Walking is known to put mechanical loads on the knee, and thus, brisk high mileage walking has been thought to be a good model to test the hypothesis that mechanical loading results in development and progression of knee OA in an otherwise healthy joint. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:27 +0100Purpose: Rugby union (rugby) is a full contact collision sport with global participation of over 7.23 million men, women and children across 120 countries. Osteoarthritis (OA) is a leading cause of pain and chronic disability globally, more commonly diagnosed in older populations. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:27 +0100Purpose: Knee osteoarthritis (OA) is a slowly progressive degenerative joint disease. It is characterized by cartilage tissue damage, bone changes, synovial inflammation and chronic pain. Successful therapy requires the development of a disease-modifying OA drug (DMOAD), which would combine the treatments of pain, tissue damage and inflammation, all in one molecule. The local application of a DMOAD via intra-articular injection would bring additional value to the treatment for two main reasons, (i) lower risk of systemic side effects and (ii) higher drug concentration and potential penetration of non-vascularised articular cartilage. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:27 +0100Purpose: Chronic inflammation after injury or surgical intervention drives catabolic metabolism and many downstream events that lead to osteoarthritis. The associated chronic pain creates abnormal muscle recruitment and gait patterns, leading to biomechanical overload of joint surfaces and associated tissues. Oral non-steroidal anti-inflammatory drugs (NSAIDs) control joint pain but prolonged usage puts patients at risk of cardiovascular, hepatic, renal and gastrointestinal complications. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:27 +0100Purpose: Chronic inflammation after injury and surgical intervention drives catabolic metabolism and many downstream events that lead to osteoarthritis. Pain, altered gait or muscle recruitment tissue destruction is some of the consequences that occur in both animals and human patients. Oral Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with cardiovascular, hepatic, renal and gastrointestinal complications. NSAIDs also alter hemostasis, so they are often avoided when anti-coagulant therapy is used. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:27 +0100Purpose: The diseases of the musculoskeletal system, accompanied by chronic pain and progressive functional impairment, in particular - osteoarthritis (OA) characterized by significant decrease of health-related quality of life (HRQL). The key factor affecting HRQL of patients with hand OA is the development of joint deformity and related aesthetic discomfort. Current guidelines do not contain any methods correcting this aspect. The purpose of our work was to evaluate the effect of combination therapy on HRQL of patients with different subtypes of hand OA. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 18:07:27 +0100This study aimed to investigate GPs’ use of exercise for CKP and to establish if current practice is in line with best available evidence. (Source: Osteoarthritis and Cartilage)
Sun, 20 Mar 2016 14:42:02 +0100CONCLUSION: The choice of procedure has been addressed by international guidelines based on high-level evidence. Surgeons should deviate from their recommendations only in exceptional cases and for special reasons. Guideline conformity implies that hernia surgeons must master both open and endoscopic/laparoscopic techniques. PMID: 26987468 [PubMed - in process] (Source: Deutsches Arzteblatt International)
Sun, 20 Mar 2016 06:07:24 +0100This study is the first to examine both opioid and benzodiazepine use together in chronic pain. We found the anticipated negative effects of opioid medication, and particularly consistent associations between benzodiazepine use and poor well-being. Future guidance on chronic pain prescription should focus on restricting benzodiazepine use. (Source: The Clinical Journal of Pain)
Sun, 20 Mar 2016 06:07:24 +0100Discussion: The study is one of the first to comprehensively examine general and pain-specific risk factors for suicidality in a large chronic pain sample in which suicidal ideation was common. A low pain self-efficacy score was the only factor independently associated past 12-month ideation-to-action. (Source: The Clinical Journal of Pain)
Sun, 20 Mar 2016 06:07:24 +0100Conclusions: This review is unique as it attempts to cast a broader net over the common neurobiological correlates that exist across these 3 conditions. It highlights the complexity of the interrelationships between these disorders and the importance of increasing our understanding of neurobiological factors associated with them. (Source: The Clinical Journal of Pain)
Sun, 20 Mar 2016 06:07:24 +0100Conclusions: Research has empirically documented a link between migraine and suicide ideation and behavior, particularly concerning the subtype of migraine with aura. Overall, nonfatal suicidal behavior among people with migraine has primarily been investigated, with only 2 studies analyzing suicide mortality. In addition, majority of studies originated from the United States or Canada (n=10). Future research should thoroughly define migraine and investigate link between migraine and suicide mortality. (Source: The Clinical Journal of Pain)
Sun, 20 Mar 2016 06:07:24 +0100Discussion: Systemic inflammation, mechanical overload, and autonomic dysfunction are associated with increased prevalence and severity of chronic pain in individuals with obesity. It has been proposed, therefore, that interventions that target systemic inflammation could help to reduce chronic pain in obese individuals. Reduction in abdominal fat has been shown to alleviate pain and reduce the systemic markers of inflammation that contribute to chronic pain. Interventions that include exercise prescription have been shown to reduce both abdominal fat and systemic inflammation. Furthermore, exercise is also known to reduce pain perception and improve mental health and quality of life that also improves pain outcomes. However, adherence to formal exercise prescription is poor and therefore ...
Sun, 20 Mar 2016 00:00:00 +0100Conclusion Laparoscopic repair, although not standardized, is a minimally invasive procedure that can be performed for treatment of uterine scar defects. Mobilization of the overlying bladder, resection of the isthmocele margins and secondary suturing of the remaining myometrial tissue appears to be an effective treatment option for these patients. (Source: Journal of Minimally Invasive Gynecology)
Sat, 19 Mar 2016 02:17:01 +0100Authors: Dowell D, Haegerich TM, Chou R Abstract This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, and recommendations are made on the basis of a systematic review of the scientific evidence while considering benefits and harms, values and preferences, and resource allocation. CDC obtained input from experts, stakehol...
Sat, 19 Mar 2016 01:34:48 +0100BACKGROUND CONTEXT: Sacroiliac (SI) joint dysfunction is a common cause of chronic, unremitting lower back or buttocks pain. (Source: The Spine Journal)
Sat, 19 Mar 2016 01:34:48 +0100BACKGROUND CONTEXT: Pain neuroscience education is employed in patients with chronic low back pain (CLBP) to reduce pain-related behaviours. However, its efficacy has not been systematically evaluated. (Source: The Spine Journal)
Sat, 19 Mar 2016 01:34:48 +0100BACKGROUND CONTEXT: It is proposed that ‘significant others’ (spouses/partners/close family members) are important sources of support in helping those with chronic musculoskeletal pain to remain at work, but the phenomenon remains largely unexplored. (Source: The Spine Journal)
Sat, 19 Mar 2016 01:34:48 +0100BACKGROUND CONTEXT: Chronic low back pain (CLBP) is a global problem with effective treatments unknown. Heterogeneity is thought responsible for lack of success. Classification-based cognitive functional therapy (CB-CFT) targeting person's pain mechanisms demonstrated efficacy. CB-CFT effect on spinal movement and function has not been studied. (Source: The Spine Journal)
Sat, 19 Mar 2016 01:34:48 +0100BACKGROUND CONTEXT: Self-management (SM) can be defined as individual's ‘ability to manage the symptoms, treatment, physical and psychological consequences and life-style modifications’. SM programmes for patients with chronic low back pain (CLBP) have failed to show clinically meaningful improvement in pain and disability, which potentially reflects difficulty in treatment matching in absence of extensive research on predictors of SM. (Source: The Spine Journal)
Sat, 19 Mar 2016 00:00:00 +0100Discussion This research is significant as it will be the first study to address the heterogeneity of whiplash by implementing a clinical pathway of care that matches evidence-based interventions to projected risk of poor recovery. The results of this trial have the potential to change clinical practice for WAD, thereby maximising treatment effects, improving patient outcomes, reducing costs and maintaining the compulsory third party system. (Source: Journal of Physiotherapy)
Sat, 19 Mar 2016 00:00:00 +0100Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. (Source: The Journal of Pain)
Sat, 19 Mar 2016 00:00:00 +0100(Source: Drug and Alcohol Dependence)
Sat, 19 Mar 2016 00:00:00 +0100Conclusions Patients with gonarthrosis and severe pain preoperatively may benefit from individualized pre- and intraoperative care, particularly preoperative analgesia and neuraxial anaesthesia. (Source: Brazilian Journal of Anesthesiology)
Sat, 19 Mar 2016 00:00:00 +0100Sickle cell disease (SCD) afflicts millions of people worldwide and is associated with considerable morbidity and mortality. Chronic and acute vaso-occlusion are the clinical hallmarks of SCD and can result in pain crisis, wide-spread organ damage, and early mortality. Even though the molecular underpinnings of SCD were identified over 60 years ago, there are no molecular or biophysical markers of disease severity that are feasibly measured in clinic. Abnormal cellular adhesion to vascular endothelium is at the root of vaso-occlusion. (Source: Translational Research)
Fri, 18 Mar 2016 22:12:00 +0100Editor’s note: The complexities of the opioid epidemic demand a comprehensive approach response. This practice perspective provides physician insights into one course of action that could contribute to the solution. By Joan Papp, MD, Case Western Reserve University and Metro Health Medical Center in Cleveland, and Jason Jerry, MD, Cleveland Clinic Foundation Pain management and the opioid epidemic The United States is confronting a tragic opioid epidemic—and the situation is getting worse. More American lives were lost in 2014 from drug overdose than during any previous year on record. According to the most recent data from the Centers for Disease Control and Prevention, the drug overdose death rate from opioids increased by 200 percent between the years 2000 and 2014. To put thi...
Fri, 18 Mar 2016 20:17:29 +0100On Oct. 27, 2014, Lexi Behrndt's son Charlie passed away at the age of 6 months. Now, over a year later, the Florida mom is joining with others who have experienced loss to share stories of grief and "rising from the ashes" through a project she calls "On Coming Alive." Behrndt invites others to write their stories of loss for the On Coming Alive website and social media accounts or share them with the hashtags #OCAStories and #oncomingalive. So far, hundreds have participated. While many of the participants are parents who, like Behrndt, have experienced child loss, there are also stories of domestic violence, depression, death of loved ones, sexual abuse, rape, and homelessness. "I named it On Coming Alive because to me, this was the process I was undergoing after a year from the pi...
Fri, 18 Mar 2016 16:34:10 +0100(Source: CDC Morbidity and Mortality Weekly Report)
Fri, 18 Mar 2016 15:47:50 +0100Sleep is one of the most essential elements of life. Every single human has experienced it, but when it comes to sleep, there is still so much we don't know. Why, for example, do we dream? And why can some people fall asleep within seconds, while others have to count sheep for an hour before getting some rest? As research on shut-eye continues to expand, two things remain clear: Sleep is really good for you and sleep deprivation is really bad for you. But there have been some other interesting small findings along the way as well. In honor of World Sleep Day March 18, we rounded up a few of the major findings from the past year. When you're done, may we suggest burying yourself under the comfiest blanket you can find and celebrate the holiday the way nature intende...
Fri, 18 Mar 2016 12:32:02 +0100CONCLUSIONS: APBI treated patients reported higher cosmetic satisfaction than patients in the matched WBRT cohort. Quality of life scores tended to improve over time. Multi-lumen catheters provided superior cosmetic results compared to single-lumen catheters. PMID: 26985193 [PubMed] (Source: Journal of Contemporary Brachytherapy)
Fri, 18 Mar 2016 07:14:02 +0100CONCLUSION: GS is a rare and potentially life-threatening complication to otitis media. GS can present in an acute and chronic form, and should be a differential diagnosis in the workup of unexplained sixth nerve palsy. PMID: 26979620 [PubMed - as supplied by publisher] (Source: Strabismus)
Fri, 18 Mar 2016 00:00:00 +0100Recreational abuse of ketamine has been associated with the emergence of a new bladder pain syndrome, ketamine-induced cystitis, characterized by chronic inflammation and urothelial ulceration. We investigated the direct effects of ketamine on normal human urothelium maintained in organ culture or as finite cell lines in vitro. Exposure of urothelium to ketamine resulted in apoptosis, with cytochrome c release from mitochondria and significant subsequent caspase 9 and 3/7 activation. The anesthetic mode-of-action for ketamine is mediated primarily through N-methyl d-aspartate receptor (NMDAR) antagonism; however, normal (nonimmortalized) human urothelial cells were unresponsive to NMDAR agonists or antagonists, and no expression of NMDAR transcript was detected. (Source: American Journal ...
Fri, 18 Mar 2016 00:00:00 +0100Conclusion: US adults with cLBP are socio‐economically disadvantaged, make frequent healthcare visits and are often covered by government‐sponsored health insurance. The clustering of behavioral, psychosocial, and medical issues should be considered in the care of Americans with cLBP. This article is protected by copyright. All rights reserved. (Source: Arthritis Care and Research)
Fri, 18 Mar 2016 00:00:00 +0100Conclusion: In these patients in a secondary care setting with 1 SpA‐feature at most, axSpA could not be ruled out without sacroiliac joint imaging and/or HLA‐B27 testing. This article is protected by copyright. All rights reserved. (Source: Arthritis Care and Research)
Fri, 18 Mar 2016 00:00:00 +0100CONCLUSION Malrotation should be considered in differential diagnosis in patients presented with acute abdomen and intestinal ischemia. Surgical intervention should be prompt to limit morbidity and mortality. (Source: International Journal of Surgery Case Reports)
Fri, 18 Mar 2016 00:00:00 +0100CONCLUSIONS In this study, rhBMP-2/ACS did not appear to induce pain independent of grossly visible ectopic bone formation. At the earliest time points, rhBMP-2 appeared to have a neuroprotective effect as evidenced by decreased pain exhibited by the rhBMP-2-treated animals in the CCI cohort, but this effect diminished over time, and by Day 28, the pain behavioral responses in the rhBMP-2-treated group were comparable to those in the group in which saline was applied to the nerve. In the Sham cohort, there was a dose-independent induction of pain at later time points, presumably due to new bone formation mechanically irritating the nerve. Histological examination revealed nerve lesions that appeared to be caused by mechanical trauma associated with surgical manipulation of the nerve during...
Thu, 17 Mar 2016 17:59:59 +0100Target has plans to launch a new digital health initiative next month online and in 500 of its 1,793 stores. Beyond knowing the stories will offer a new section for health devices, details on what, exactly, the launch will entail are scarce. One device that will be included is Quell, an FDA-cleared and smartphone-connected wearable for treating chronic pain from Waltham, Massachusetts-based Neurometrix. (Source: mobihealthnews)
Thu, 17 Mar 2016 17:57:49 +0100UPDATED March 18, 2016, with additional comment from DePuy, plaintiffs’ and defendant’s attorneys. A Texas federal jury today slapped Johnson & Johnson (NYSE:JNJ) subsidiary DePuy Orthopaedics with a $500 million judgment in favor of a quintet of plaintiffs who said the metal-on-metal Pinnacle hip implant caused their injuries. After a 2-month trial, jurors found that the Ultamet metal-on-metal version of the Pinnacle hips were defectively designed and that DePuy failed to warn patients about the risks. Jurors awarded about $130 million in total compensatory damages and about $360 million in punitive damages, said plaintiffs’ lead trial lawyer Mark Lanier. “There are thousands of these cases, and J&J needs to get responsible,” Lanier said. The 1s...
Thu, 17 Mar 2016 04:00:00 +0100(MediaSource) Researchers at The Ohio State University Wexner Medical Center have shown that patients with chronic pain can reduce their emotional response to the pain through spinal cord stimulation. (Source: EurekAlert! - Medicine and Health)
Thu, 17 Mar 2016 00:00:00 +0100Officials at the Centers for Disease Control and Prevention (CDC) Tuesday released clinical guidelines for prescribing opioids to help combat the nation’s overdose epidemic, and physicians were swift to respond. Physicians are embracing the concepts for reducing harm but simultaneously are pointing out serious shortcomings that will need to be addressed. What’s in the guidelines The guidelines, which were published in JAMA and on the CDC website, are intended for primary care clinicians who treat adult patients for chronic pain in outpatient settings. Their main goals are to help physicians improve communication with their patients about the benefits and risks of using prescription opioids for chronic pain, provide safer and more effective care for chronic pain, and reduce opioid u...
Thu, 17 Mar 2016 00:00:00 +0100(Source: Headache: The Journal of Head and Face Pain)
Thu, 17 Mar 2016 00:00:00 +0100Abstract While a majority of research has focused on adult fibromyalgia (FM), recent evidence has provided insights into the presence and impact of FM in children and adolescents. Commonly referred as juvenile fibromyalgia (JFM), youths, particularly adolescent girls, present with persistent widespread pain and cardinal symptoms observed in adult FM. A majority of youth with JFM continue to experience symptoms into adulthood, which highlights the importance of early recognition and intervention. Some differences are observed between adult and juvenile-onset FM syndrome with regard to comorbidities (e.g., joint hypermobility is common in JFM). Psychological comorbidities are common but less severe in JFM. Compared to adult FM, approved pharmacological treatments for JFM are lackin...
Thu, 17 Mar 2016 00:00:00 +0100Publication date: Available online 16 March 2016 Source:Best Practice & Research Clinical Rheumatology Author(s): Diane van der Woude, Anca I. Catrina Antibodies against citrullinated proteins (ACPAs) are specific for rheumatoid arthritis (RA). ACPA-positive RA is a chronic inflammatory disease resulting from the complex interaction between genetic (mainly HLA class II genes) and environmental factors (mainly smoking). Recent findings have offered new insights into where, when and how anti-citrulline immunity develops. Some studies have found that a mucosal site, such as the lungs, may function as the initiating site for the immune response against citrullinated proteins, in line with the known association between smoking and ACPA. Other studies, focusing rather on the HLA asso...
Thu, 17 Mar 2016 00:00:00 +0100Abstract Exposures of the skin with electromagnetic radiation of wavelengths between 670 nm and 1400 nm are often used as a general treatment to improve wound healing and reduce pain, for example, in chronic diabetic skin lesions. We investigated the effects of water‐filtered infrared A (wIRA) and of narrow‐band IR‐A provided by a light‐emitting diode LED (LED‐IR‐A) irradiation in vitro on 3T3 fibroblast cultures under defined conditions with and without glyoxal administration. Glyoxal triggers the formation of advanced glycation end products, thereby mimicking a diabetic metabolic state. Cell viability and apoptotic changes were determined by flow cytometry after vital staining with Annexin V, YO‐PRO‐1 and propidium iodide (PI), and by SubG1 assay. Mitochondrial function a...
Thu, 17 Mar 2016 00:00:00 +0100Prescription opioid abuse and diversion are major causes of morbidity and mortality in the United States. The buprenorphine transdermal delivery system (BTDS) is indicated for the treatment of moderate to severe chronic pain and provides a continuous dose of 5, 7.5, 10, 15 or 20 micrograms per hour of buprenorphine for 7 days.Quarterly rates of abuse and diversion of BTDS were compared to four comparator groups: 1) other buprenorphine products, 2) fentanyl patches, 3) extended-release (ER) opioid tablets/capsules, and 4) ER tramadol. (Source: The Journal of Pain)
Thu, 17 Mar 2016 00:00:00 +0100Conclusion US is an excellent tool for imaging soft tissue abnormalities, as it allows rapid, in-expensive detailed examination of the structures of the ankle joint. US and MRI are two complementary tools of investigation with the former being used as primary effective tool of investigation and the latter is done to confirm the diagnosis. (Source: The Egyptian Journal of Radiology and Nuclear Medicine)
Thu, 17 Mar 2016 00:00:00 +0100(Source: Drug and Alcohol Dependence)
Thu, 17 Mar 2016 00:00:00 +0100Fibromyalgia (FM) is classified as a chronic pain condition accompanied by symptoms of fatigue, sleep problems, problems with cognition, negative mood, limited functional status, and the presence of other chronic overlapping pain conditions. Comprehensive assessment of all of these components can be challenging. This paper provides an overview of patient-reported approaches that can be taken to assess FM in the contexts of diagnosis, symptom monitoring, phenotyping/characterization, and for purposes of clinical trials. (Source: Rheumatic Disease Clinics of North America)
Thu, 17 Mar 2016 00:00:00 +0100The objective of this study was to determine the extent of: 1] changes in immunomodulatory mediators in both the prostate and bladder after inflammation of the prostate and 2] bladder function and bladder afferent sensitization. (Source: The Journal of Urology)
Thu, 17 Mar 2016 00:00:00 +0100(Source: Vascular Medicine)
Thu, 17 Mar 2016 00:00:00 +0100An emerging class of mitochondrial disorders is caused by mutations in nuclear genes affecting mitochondrial dynamics and function. One of these is the DNM1L gene encoding the dynamin‐related protein 1 (DRP1), which is pivotal in the mitochondrial fission process. Here, we describe a patient with a novel dominant‐negative, de novo DNM1L mutation, which expands the clinical spectrum. The patient reported here exhibits a chronic neurological disorder, characterized by postnatal microcephaly, developmental delay, and pain insensitivity. Muscle biopsy disclosed decreased respiratory chain complex IV activity. Exome sequencing showed a de novo heterozygous c.1084G>A (p.G362S) mutation. Subsequent studies of patient skin fibroblasts showed markedly impaired mitochondrial fission and a par...
Thu, 17 Mar 2016 00:00:00 +0100In response to concerns about overdose deaths in the U.S. due to prescribed opioid pain killers, the Centers for Disease Control and Prevention (CDC) released new guidelines to help primary care doctors determine when and how best to prescribe them to patients, particularly those with noncancer-related chronic pain. The CDC recommends physicians avoid prescribing opioids such [...] (Source: News from Mayo Clinic)
Wed, 16 Mar 2016 22:11:32 +0100Effective management of pain is a major medical challenge in our country at the present time. An estimated 11.2% of the U.S. adult population suffers from chronic pain and the economic cost of pain is well over half a trillion dollars a year. (Source: NCCAM Featured Content)
Wed, 16 Mar 2016 20:33:54 +0100Previous research has shown that mindfulness meditation helps relieve pain, but researchers have been unclear about how the practice induces pain relief—specifically, if meditation is associated with the release of naturally occurring opiates. Results from a new study, funded in part by the National Center for Complementary and Integrative Health, demonstrate that mindfulness meditation does not rely on the endogenous opioid activity to reduce pain, which is an important consideration for using meditation to treat chronic pain. (Source: NCCAM Featured Content)
Wed, 16 Mar 2016 20:26:00 +0100The Centers for Disease Control and Prevention (CDC) has issued a guideline for clinicians who are prescribing opioids for chronic pain that is not associated with cancer, palliative care, or end-of-life care. The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment options for pain management, improve patient outcomes, and reduce the number of people who develop opioid use disorder, overdose, or experience other adverse events related to these drugs.“The new guideline really points out the dangers of the liberal prescribing of opioids,” said Petros Levounis, M.D, M.A., an addiction expert and chair of the Department of Psychiatry at Rutgers New Jersey Medical School. “Addiction psychiatry has been at the forefront of the fight agai...
Wed, 16 Mar 2016 19:31:00 +0100The CDC's final guideline for prescribing opioids for chronic pain is intended for primary care health professionals in outpatient settings. (Source: AAFP News)
Wed, 16 Mar 2016 14:34:53 +0100Stephen FellerATLANTA, March 16 (UPI) -- The CDC issued new guidelines recommending doctors prescribe opioid painkillers for a week or less, and that chronic pain not be treated with the drugs at all. (Source: Health News - UPI.com)
Wed, 16 Mar 2016 14:09:00 +0100WASHINGTON (AP) — Prescription painkillers should not be a first choice for treating common ailments like back pain and arthritis, according to new federal guidelines designed to reshape how doctors prescribe drugs like OxyContin and Vicodin. Amid an epidemic of addiction and abuse tied to these powerful opioids drugs, the Centers for Disease Control and Prevention is urging primary care doctors to try physical therapy, exercise and over-the-counter pain medications before turning to painkillers for chronic pain. Opioid drugs include medications like morphine and oxycodone as well as illegal narcotics like heroin. The new recommendations — which doctors do not have to follow — represent an effort to reverse nearly two decades of rising painkiller use, which public health officials ...
Wed, 16 Mar 2016 12:27:58 +0100Waking up at night is common. Is it a normal part of sleep? It's common to wake up during sleep. In fact, most people wake two or three times during the night. We can all remember a time, when as teenagers or young children, sleep was a continuous period of unawareness or oblivion that lasted between eight or nine hours, or even longer. However, that is not normal adult sleep. Indeed, once we pass our teens, sleep tends to be lighter and awakenings during sleep more frequent. In women by the age of 50, it's normal to wake 3-4 times per night. Humans don't sleep for eight hours continuously Historically if you read about how human sleep has been described over thousands of years, it has been described as three to four hours of deeper sleep after the sun goes down followed by a period of be...
Wed, 16 Mar 2016 11:32:01 +0100Authors: Zhou K, Krug K, Stachura J, Niewczyk P, Ross M, Tutuska J, Ford G Abstract Research suggests high-voltage, pulsed-current electric therapy (HVPC) is safe and effective for treating chronic wounds, and some data suggest silver- and collagen-based dressings may facilitate healing. A combination therapy utilizing both HVPC and silver-collagen dressing may present clinical advantages. To explore the effect of the combined therapy for chronic full-thickness wounds, a prospective, consecutive case series study was conducted. All participants were adults with wounds of at least 6 weeks' duration. After obtaining informed consent, patient and wound characteristics were obtained, wounds were assessed and measured, and patients received 2 to 3 HVPC treatments per week followed by ap...
Wed, 16 Mar 2016 10:00:00 +0100In a bid to curb the epidemic of prescription opioid overdose in the US, the CDC have released new guidelines for doctors prescribing opioids for chronic pain. (Source: Health News from Medical News Today)
Wed, 16 Mar 2016 07:00:00 +0100Title: CDC Issues Tough New Guidelines on Use of Prescription PainkillersCategory: Health NewsCreated: 3/15/2016 12:00:00 AMLast Editorial Review: 3/16/2016 12:00:00 AM (Source: MedicineNet Chronic Pain General)
Wed, 16 Mar 2016 07:00:00 +0100Title: Health Tip: Use Proper Lifting TechniqueCategory: Health NewsCreated: 3/16/2016 12:00:00 AMLast Editorial Review: 3/16/2016 12:00:00 AM (Source: MedicineNet Chronic Pain General)
Wed, 16 Mar 2016 02:26:54 +0100We present a case of unusual bilateral symptomatic multipartite patella in an adult who presented with quadriceps fat pad edema and mass effect as well as slightly edematous signal changes within the bone fragments on MRI. This case indicates that symptomatic partite patella can also present with edema-like imaging findings in the adjacent soft tissue due to chronic mechanical irritation. Published on 2016-03-15 14:37:13 (Source: Journal of the Belgian Society of Radiology)
Wed, 16 Mar 2016 02:17:00 +0100Federal health officials speaking in unusually blunt terms Tuesday called on the American medical community to turn away from treating common ailments with highly addictive painkillers, saying the nation’s prescription drug epidemic was a “doctor-driven” crisis.The appeal accompanied the release... (Source: Los Angeles Times - Science)
Wed, 16 Mar 2016 01:37:30 +0100In an effort to curb America's deadly opioid crisis, federal health officials are urging doctors to largely avoid prescribing highly addictive painkillers like OxyContin and Vicodin when treating patients for chronic pain. The new guidelines, issued Tuesday by the Centers for Disease Control and Prevention, are directed at primary care providers, who issue about half of all opioid prescriptions. Since 1999, such prescriptions and sales have quadrupled in the United States, a boom that the CDC said has "helped create and fuel" the current epidemic of opioid abuse and overdose. In 2012 alone, doctors handed out 259 million opioid prescriptions -- one bottle for every adult in the United States. "More than 40 Americans die each day from prescription opioid over...
Wed, 16 Mar 2016 00:00:00 +0100By Kelly Young Edited by Lorenzo Di Francesco, MD, FACP, FHM The CDC has issued 12 new recommendations for clinicians prescribing opioids for pain outside of cancer treatment or palliative care. The full guideline is published in MMWR. Among the recommendations: For chronic … (Source: Physician's First Watch current issue)
Wed, 16 Mar 2016 00:00:00 +0100Conclusion If placed correctly and malreduction is prevented the syndesmotic screw remains the ‘Gold standard’ in the treatment of acute syndesmotic injury. One tricortical 3.5mm screw placed within 2–4cm of the tibial plafond is usually enough. An additional tricortical screw may be added if there is doubt considering stability or in case of poor bone stock. There is a growing body of evidence that the syndesmotic screw does not need routine removal. Only in cases with complaints of pain or stiffness, where the screws do not loosen or break, the screws might be removed after a minimum of eight weeks. Syndesmotic malreduction is associated with less favorable outcome and carries the risk of the development of chronic instability and posttraumatic ankle arthritis. (Source: Fuss and Sp...