WORLD HOSPITAL DIRECTORY
Anesthesiology Medical Medworm: Chronic Pain

  Back to "Medical Updates - Homepage"


Medworm: Chronic Pain - Recent Medical Updates

-->
[Clinical Picture] An unusual pathogen for prosthetic joint infection
In 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Occupational exposure and health problems among Polish denturists: a population‐based study in Łódź province
ConclusionsAnalyses 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)


A prospective, multicentre study on the use of epidermal grafts to optimise outpatient wound management
This 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...


Cost-effectiveness of manual therapy versus physiotherapy in patients with sub-acute and chronic neck pain: a randomised controlled trial
Conclusions 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)


Patient characteristics for different therapeutic strategies in the management ketamine cystitis
ConclusionsKC patients who already developed a contracted bladder with extremely small bladder capacity (&lt;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)


IJERPH, Vol. 13, Pages 343: EQ-5D-5L in the General German Population: Comparison and Evaluation of Three Yearly Cross-Section Surveys
Health-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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Melatonin reverses morphine tolerance by inhibiting microglia activation and HSP27 expression
In 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...


Fish oil attenuates persistent inflammatory pain in rats through modulation of TNF-α and resolvins
This 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&lt;0.01), CFO 460 (57.7%; p&lt;0.01), FO 460 (26.2%), compared to the augment promoted by CFA (549.7%; p&lt;0.001). Resolvin levels were increased in treated groups with resp...


Single-port videoscopic splanchnotomy for palliation of refractory chronic pancreatitis
CONCLUSIONS 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)


No laughing matter: nitrous oxide triggers serotonin syndrome in an anxious adolescent
A 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)


Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain
Conclusions 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Multi-Functional Diarylurea Small Molecule Inhibitors of TRPV1 with Therapeutic Potential for Neuroinflammation
Abstract 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...


Healthcare service use after lumbar spine MRI in general practice
The 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)


NGF selective inhibition therapy on facet joint pain
Purpose: 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)


Update on the anti-NGF treatments for OA pain: pathways, efficacy, side effects and their mechanisms, and lessons learned
Even 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)


New biomarkers of osteoarthritis
Purpose: 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Intra-articular magnetic capture increases the detection sensitivity of CTXII within the rat knee
Purpose: 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)


Biomarkers associated with rapid cartilage loss and bone destruction in osteoarthritis patients
Purpose: 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)


Subchondral bone biomarkers as predictors of OA pain progression; linking structural pathology and pain
Purpose: 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)


Inhibition of glial NF-KB abolishes pain in knee osteoarthritis model
Purpose: 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)


Do adipokines and inflammatory cytokines play a role in early knee osteoarthritis in a LatinoAmerican population?
Purpose: 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Development of a complex group self-management intervention and feasibility trial for osteoarthritis and chronic low back pain
Purpose: 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...


Suprapatellar synovial hypertrophy and reliability of the novel ultrasound assessment of suprapatellar recess in patients with recent knee injuries or early osteoarthritis
Purpose: 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)


Systematic review of costs and effects of self-management interventions for chronic musculoskeletal pain: Spotlight on analytic perspective and outcomes assessment
Purpose: 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)


Loss of ANP32A is associated with increased cartilage damage in osteoarthritis through an ATM-ROS dependent mechanism
Purpose: 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)


Identification of clinical phenotypes in the knee osteoarthritis population: data from the osteoarthritis initiative
Purpose: 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Differential synovial expression patterns in early osteoarthritis patients are associated with pain and with progression of joint damage
The 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)


TRPV1 antagonist for OA pain: preclinical in vivo results predict clinical outcome
Purpose: 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)


Developing a brain biomarker of pain in hand osteoarthritis using magnetic resonance spectroscopy
Purpose: 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)


Symptomatic OA predicts 12-year incidence of type 2 diabetes: role of pain induced sleep deprivation
Purpose: 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)


Low-dose SoluMatrix meloxicam results in clinically meaningful improvements in pain in a phase 3 study of patients with osteoarthritis
Purpose: 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


High-fat diet from weaning age induces defects in knee osteochondral junctions in young adult rats
Purpose: 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)


High mileage walking does not lead to osteoarthritis changes in the rat knee
Purpose: 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)


Is rugby playing load predictive of lower limb osteoarthritis in former international rugby players?
Purpose: 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)


Local and slow release of IL4-10 synerkine as a disease modifying therapy for osteoarthritis
Purpose: 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)


Intra-articular injection of a polymer/celecoxib formulation for long-term control of postoperative inflammation
Purpose: 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Disposition and ultimate fate of a PLA-PEG sustained release polymer after intra-articular injection
Purpose: 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)


Effect of combined therapy on the health-related quality of life in patients with hand osteoarthritis
Purpose: 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)


Exercise for chronic knee pain: a national cross-sectional questionnaire survey of GPs in the UK
This 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)


Evidence-Based Hernia Treatment in Adults.
CONCLUSION: 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)


Benzodiazepines May Be Worse Than Opioids: Negative Medication Effects in Severe Chronic Pain
This 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Prevalence and Correlates of Suicidal Thoughts and Suicide Attempts in People Prescribed Pharmaceutical Opioids for Chronic Pain
Discussion: 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)


A Critical Review of Neurobiological Factors Involved in the Interactions Between Chronic Pain, Depression, and Sleep Disruption
Conclusions: 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)


Migraine and Suicidal Behaviors: A Systematic Literature Review
Conclusions: 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)


Physical Activity to Reduce Systemic Inflammation Associated With Chronic Pain and Obesity: A Narrative Review
Discussion: 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 ...


Laparoscopic Repair of Cesarean Scar Defect “isthmocele”
Conclusion 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016.
Authors: 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...


Sacroiliac minimal invasive fusion compared to physical therapy: six-month outcome from a multicentre randomised controlled trial
BACKGROUND CONTEXT: Sacroiliac (SI) joint dysfunction is a common cause of chronic, unremitting lower back or buttocks pain. (Source: The Spine Journal)


A systematic review of pain and disability outcomes of pain neuroscience education (PNE) in the management of chronic low back pain
BACKGROUND 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)


‘I think positivity breeds positivity’: a qualitative exploration of the role of family members in supporting those with chronic musculoskeletal pain to stay at work
BACKGROUND 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)


The effect of classification-based cognitive functional therapy on spinal kinematics and function in subgroups of chronic low back pain
BACKGROUND 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Predictors of self-management in patients with chronic low back pain: study protocol
BACKGROUND 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)


Implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): protocol of a randomised, controlled trial
Discussion 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)


Medical cannabis associated with decreased opiate medication use in retrospective cross-sectional survey of chronic pain patients
Opioids 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)


Pain, alcohol use disorders and risky patterns of drinking among people with chronic non-cancer pain receiving long-term opioid therapy
(Source: Drug and Alcohol Dependence)


Pain after major elective orthopaedic surgery of the lower limb and type of anaesthesia: does it matter?
Conclusions 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


SCD Biochip: A Functional Red Blood Cell Adhesion Assay for Monitoring Sickle Cell Disease
Sickle 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)


When patient satisfaction is bad medicine
Editor’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...


Mom's Powerful Project Helps Parents Cope With Loss
On 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,&#160;and homelessness. "I named it On Coming Alive because to me, this was the process I was undergoing after a year from the pi...


RECOMMENDATIONS AND REPORTS: CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
(Source: CDC Morbidity and Mortality Weekly Report)


7 Game-Changing Things We've Learned About Sleep This Past Year
Sleep 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:&nbsp;Sleep is really good for you&nbsp;and&nbsp;sleep deprivation is really bad for you.&nbsp;But there have been some other interesting small findings along the way as well. In honor of World Sleep Day&nbsp;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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


WBRT vs. APBI: an interim report of patient satisfaction and outcomes.
CONCLUSIONS: 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)


The Forgotten Syndrome? Four Cases of Gradenigo's Syndrome and a Review of the Literature.
CONCLUSION: 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)


Ketamine-Induced Apoptosis in Normal Human Urothelial Cells
Recreational 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 ...


Epidemiology of chronic low back pain in US adults: National Health and Nutrition Examination Survey 2009‐2010
Conclusion: 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Patients aged 16‐45 years with chronic back pain of a short duration and maximally 1 SpA‐feature: Are additional tests needed to rule out axial spondyloarthritis? (results from the SPACE cohort)
Conclusion: 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)


Adult Midgut Malrotation Presented with Acute Bowel Obstruction and Ischemia
CONCLUSION 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)


Evaluating the effects of recombinant human bone morphogenetic protein-2 on pain-associated behaviors in a rat model following implantation near the sciatic nerve.
CONCLUSIONS 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...


Target to launch digital health section of devices in 500 stores
Target 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)


Jury slaps Johnson & Johnson with $500m verdict in Pinnacle hip bellwether
UPDATED March 18, 2016, with additional comment from DePuy, plaintiffs&#8217; and defendant&#8217;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&#8217; lead trial lawyer Mark Lanier. &#8220;There are thousands of these cases, and J&J needs to get responsible,&#8221; Lanier said. The 1s...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Study shows spinal cord stimulation reduces emotional aspect of chronic pain
(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)


What physicians are saying about the new CDC opioid guidelines
Officials 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...


Migraine, Chronic Vasculopathies, and Spreading Depolarization
(Source: Headache: The Journal of Head and Face Pain)


Juvenile Fibromyalgia: Different from the Adult Chronic Pain Syndrome?
Abstract 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...


HLA and anti-citrullinated protein antibodies: Building blocks in RA
Publication date: Available online 16 March 2016 Source:Best Practice &amp; 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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Effects of Narrow‐band IR‐A and of Water‐Filtered Infrared A on Fibroblasts
Abstract 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...


Analysis of the Abuse and Diversion of Buprenorphine Transdermal Delivery System
Prescription 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)


High resolution ultrasonography and magnetic resonance imaging in the evaluation of tendino-ligamentous injuries around ankle joint
Conclusion 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)


Day-to-day pain symptoms are only weakly associated with opioid craving among patients with chronic pain prescribed opioid therapy
(Source: Drug and Alcohol Dependence)


Patient-Reported Outcomes and Fibromyalgia
Fibromyalgia (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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic prostatitis induces urinary bladder hypersensitivity and sensitizes bladder afferents in the mouse
The 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)


Visceral fibromuscular dysplasia in a patient with chronic abdominal pain
(Source: Vascular Medicine)


Postnatal microcephaly and pain insensitivity due to a de novo heterozygous DNM1L mutation causing impaired mitochondrial fission and function
An 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&gt;A (p.G362S) mutation. Subsequent studies of patient skin fibroblasts showed markedly impaired mitochondrial fission and a par...


Opioid Use: A Public Health Crisis
In 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)


Mindfulness Meditation Reduces Pain, Bypasses Opioid Receptors
Effective 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Mindfulness Meditation Relieves Pain, but Works Differently Than Opioids in the Body
Previous 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)


CDC Releases Guideline for Prescribing Opioids for Chronic Pain
The 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...


CDC Releases Final Guideline for Prescribing Opioids for Chronic Pain
The CDC's final guideline for prescribing opioids for chronic pain is intended for primary care health professionals in outpatient settings. (Source: AAFP News)


CDC issues restrictive new guidelines for opioid painkillers
Stephen 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)


CDC Aims to Curb Painkiller Prescriptions
WASHINGTON (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 ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Is It Normal to Wake Up at Night?
Waking 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...


Silver-Collagen Dressing and High-voltage, Pulsed-current Therapy for the Treatment of Chronic Full-thickness Wounds: A Case Series.
Authors: 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...


Medical News Today: Opioid epidemic addressed as CDC issue new prescription guidelines
In 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)


CDC Issues Tough New Guidelines on Use of Prescription Painkillers
Title: 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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Health Tip: Use Proper Lifting Technique
Title: 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)


Unusual Symptomatic Multipartite Patella Associated with Quadriceps Fat Pad Edema
We 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)


Opioids are bad medicine for chronic pain, say new federal guidelines
Federal 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)


New CDC Guidelines Seek Doctors' Help In Fighting Opioid Epidemic
In an effort to curb America's deadly opioid crisis, federal health officials are urging doctors to largely avoid prescribing&#160;highly addictive painkillers like OxyContin and Vicodin when treating patients for chronic pain. The&#160;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.&#160; 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.&#160;In 2012 alone, doctors handed out&#160;259 million opioid prescriptions -- one bottle for every adult in the United States.&#160; "More than 40 Americans die each day from prescription opioid over...


CDC Issues New Guidelines for Opioid Prescribing (FREE)
By 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)


Recent developments in the treatment of acute syndesmotic injuries
Conclusion 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...


Midcingulate Cortex: Structure, Connections, Homologies, Functions and Diseases
Publication date: Available online 15 March 2016 Source:Journal of Chemical Neuroanatomy Author(s): A. Brent Midcingulate cortex (MCC) has risen in prominence as human imaging identifies unique structural and functional activity therein and this is the first review of its structure, connections, functions and disease vulnerabilities. The MCC has two divisions (anterior, aMCC and posterior, pMCC) that represent functional units and the cytoarchitecture, connections and neurocytology of each is shown with immunohistochemistry and receptor binding. The MCC is not a division of anterior cingulate cortex (ACC) and the “dorsal ACC” designation is a misnomer as it incorrectly implies that MCC is a division of ACC. Interpretation of findings among species and developing models of human dise...


Melatonin in Chronic Pain Syndromes
Abstract Melatonin is a neurohormone secreted by epiphysis and extrapineal structures. It performs several functions including chronobiotic, antioxidant, oncostatic, immune modulating, normothermal, and anxiolytic functions. Melatonin affects the cardiovascular system and gastrointestinal tract, participates in reproduction and metabolism, and body mass regulation. Moreover, recent studies have demonstrated melatonin efficacy in relation to pain syndromes. The present paper reviews the studies on melatonin use in fibromyalgia, headaches, irritable bowel syndrome, chronic back pain, and rheumatoid arthritis. The paper discusses the possible mechanisms of melatonin analgesic properties. On one hand, circadian rhythms normalization results in sleep improvement, which is inevitably di...


Importance of psychological factors for the recovery from a first episode of acute non-specific neck pain - a longitudinal observational study
Conclusions Psychological factors emerged from this study as relevant in the early phase of acute neck pain. Particularly persistent anxiety and depression at baseline might be risk factors for a transition to chronic pain that should be addressed in the early management of neck pain patients. (Source: Chiropractic and Manual Therapies)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


ThermoTRPs and Pain
The ability of the body to perceive noxious stimuli lies in a heterogeneous group of primary somatosensory neurons termed nociceptors. The molecular receptors of noxious mechanical, temperature, or chemical stimuli are expressed in these neurons and have drawn considerable attention as possible targets for analgesic development to improve treatment for the millions who suffer from chronic pain conditions. A number of thermoTRPs, a subset of the transient receptor potential family of ion channels, are activated by a wide range on noxious stimuli. In this review, we review the function of these channels and examine the evidence that thermoTRPs play a vital role in acute, inflammatory and neuropathic nociception. (Source: The Neuroscientist)


(ii) Posterior heel pain
Heel pain is widely perceived to be a minor ailment that usually runs a self limiting course. This is not always the case however, and a proportion of the millions of people affected each year will suffer chronic symptoms. Heel pain can be broadly classified as posterior or plantar heel pain. Posterior heel pain may be from non-insertional or insertional Achilles tendon problems, or occasionally due to pathology of the surrounding structures. Most sufferers will improve with a combination of time and proper stretching regimens. (Source: Orthopaedics and Trauma)


Cervical myelomeningocele associated with multiple spinal anomalies
A 28-year-old female patient presented with chronic pain and sensory loss in the cervical and dorsal region. Cervical spinal Magnetic Resonance Imaging (MRI) showed retraction and herniation of the cervical spinal cord and the adjacent dural structures to the paraspinal region through the fusion defect in the posterior aspect of the C6 vertebra which was compatible with myelomeningocele or spina bifida cystica. In addition to this rare developmental anomaly which accounts for only 1–5% of all neural tube defects, multi-level posterior fusion defects, large syringohydromyelia at the level of myelomeningocele, cerebellar tonsillar displacement into the craniocervical junction (Chiari malformation) and vertebral fusion between 2nd-3rd and 5th-6th cervical vertebrae were observed on the cerv...


The Sensitivity to Change and Responsiveness of the Adult Responses to Childrens Symptoms in Children and Adolescents With Chronic Pain
Conclusions&nbsp;Findings support the sensitivity to change and responsiveness of the Protect and Monitor scales among parents of youth with chronic pain. (Source: Journal of Pediatric Psychology)


Perceived function and physical performance are associated with pain and fatigue in women with fibromyalgia
Fibromyalgia is a condition characterized by chronic widespread muscle pain and fatigue and associated with significant impairment in perceived function and reduced physical performance. The purpose of this st... (Source: Arthritis Research and Therapy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Domains of quality of life affecting elderly patients with hand osteoarthritis: a qualitative study in the Asian perspective
ConclusionThe domains of concepts important to people with HOA in an Asian socio‐cultural context are not fully represented in the most commonly used instruments. Further studies on the selection of main domains relevant to HOA patients are necessary. (Source: APLAR Journal of Rheumatology)


Budget 2016: Sugar tax ‘not enough’
In response to today&rsquo;s Budget, we've welcomed the Government&rsquo;s decision to introduce a sugar tax in 2018 on sugary drinks, while warning that more needs to be done to make public health and the prevention of arthritis and other long-term conditions a priority. The Government estimates that the &lsquo;sugar tax&rsquo; will initially raise &pound;520 million through a levy on the sugar content of soft drinks. Over half of this money will be spent on primary school sports. Commenting on the news, Olivia Belle, our director of external affairs said: &ldquo;We welcome the Government&rsquo;s announcement to tax sugary drinks. We know that there are nearly 9 million people living with the pain of osteoarthritis in the UK and the risk of arthritis, particularly knee osteoarthritis, is ...


The European Portuguese adaptation of the Fear of Pain Questionnaire (FPQ-III)
Publication date: Available online 16 March 2016 Source:Revista Brasileira de Reumatologia (English Edition) Author(s): Susana Cardoso, Daniel Esculpi, Ana Rita Carvalho, Diana R. Pereira, Sandra Torres, Francisco Mercado, Fernando Barbosa In Portugal, it is estimated that chronic pain affects 36.7% of the population, constituting a multifactorial phenomenon with great impact at individual, family, community, and social levels. In the fear-avoidance model of pain, one of the most consistent consensual in the literature, the fear arises as one of the variables that can contribute to the development and maintenance of this condition. Thus, instruments for evaluating the fear of pain, as Fear of Pain Questionnaire (FPQ-III), may be useful in the conceptualization of the subjective ex...


The effect of Tai Chi on four chronic conditions--cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: a systematic review and meta-analyses
Conclusions The results demonstrated a favourable effect or tendency of Tai Chi to improve physical performance and showed that this type of exercise could be performed by individuals with different chronic conditions, including COPD, HF and OA. (Source: British Journal of Sports Medicine)


Effectivity of laparoscopic inguinal hernia repair (TAPP) in daily clinical practice: early and long-term result
Conclusion Laparoscopic repair can be applied to all types of inguinal hernia as a daily routine procedure with low rates of recurrences and chronic pain. Limiting factor may be extensive adhesions after previous major surgery in the lower abdomen. (Source: Surgical Endoscopy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


CDC Issues Opioid Guidelines for 'Doctor-Driven' EpidemicCDC Issues Opioid Guidelines for 'Doctor-Driven' Epidemic
Saying opioids were not a first-line therapy for chronic pain, the agency suggested limits for dosage and duration that have drawn objections from some medical societies. Medscape Medical News (Source: Medscape ObGyn and Womens Health Headlines)


CDC Releases Guideline for Prescribing Opioids for Chronic Pain
March 15, 2016 -- As part of the U.S. government’s urgent response to the epidemic of overdose deaths, the Centers for Disease Control and Prevention (CDC) today is issuing new recommendations for prescribing opioid medications for chronic pain,... (Source: Drugs.com - Pharma News)


Clinical and neurophysiological features of the hereditary neuropathy with liability to pressure palsy due to the 17p11.2 deletion
Conclusion HNPP presentation is variable and may include pain. The most frequent pattern is of an asymmetrical sensory and motor neuropathy with focal slowing at specific topographies on NCS.RESUMO A neuropatia hereditária com susceptibilidade à pressão (HNPP) é uma doença autossômica dominante que manifesta mononeuropatias recorrentes. Objetivo Avaliar as características clínicas e os estudos da condução nervosa (ECN) procurando particularidades diagnósticas. Método Revisamos as características clínicas de 39 e os ECN de 33 pacientes. Resultados História familiar ausente em 16/39 (41%). As manifestações iniciais foram: fraqueza em 24, dor em 6, déficit sensitivo em 5 e parestesias em 4. Dor foi referida por outros 3 pacientes. Os seguintes padrões de neuropatia foram ob...


CDC issues new guidelines for opioids
The Centers for Disease Control and Prevention has released new voluntary guidelines for primary care doctors on the use of opioids for chronic pain, Fox News and USA Today reported. (Source: WDSU.com - Health)


CDC Issues Tough Guidelines on Painkiller Use
To curb abuse, doctors should try non-narcotic options for most chronic pain not involving cancer, terminal illness (Source: WebMD Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


U.S. agency issues new guidelines to limit chronic use of opioids
(Reuters) - Addressing a growing "epidemic" of opioid overdoses and abuse of the prescribed painkillers in the United States, the Centers for Disease Control and Prevention on Tuesday released voluntary guidelines that instruct primary care doctors to sharply deter use of the medicines for chronic pain. (Source: Reuters: Health)


CDC Comes Down Hard on Opioids for Chronic Pain
(MedPage Today) -- Urges physicians not to use opioids first-line for chronic pain (Source: MedPage Today Geriatrics)


CDC Releases National Standards for Prescription Painkillers
The federal government published the first national standards for prescription painkillers on Tuesday in an attempt to combat the country&#8217;s prescription drug abuse crisis. The Centers for Disease Control and Prevention released the nonbinding rules to address use of medications known as opioids, the New York Times reported. The guidelines, which align with previous recommendations from addiction experts, suggest that primary care doctors first use ibuprofen and aspirin to treat pain. They also recommend that opioid treatment for short-term pain should last three days and not longer than seven days, less than current common prescriptions lasting two weeks to a month, the Times reported. &ldquo;It&rsquo;s become increasingly clear that opioids carry substantial risk but only uncertain ...


Erosive lichen planus: a therapeutic challenge
We present the case of a woman who developed oral and plantar erosive lichen planus associated with lichen planus pigmentosus and ungueal lichen planus that were diagnosed after several years. The patient failed to respond to multiple therapies requiring longstanding medication but remained refractory. Knowledge of the treatment options for erosive lichen planus is insufficient. Further research is required to clarify their effectiveness, ideally adopting an evidence-based methodology. (Source: Anais Brasileiros de Dermatologia)


CDC Issues Tough New Guidelines on Use of Prescription Painkillers
To curb abuse, doctors should try non-narcotic options for most chronic pain not involving cancer, terminal illness (Source: U.S. News - Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


New CDC Guidelines Aim To Reduce Painkiller Prescribing
WASHINGTON (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 general 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. RELATED: Emotional Gov. Baker Signs Law Aimed At Curbing Opioid Addiction The new recommendations — which doctors do not have to follow — represent an effort to reverse nearly t...


New CDC opioid guideline targets overprescribing for chronic pain
Nonopioid therapy is the preferred approach for managing chronic pain outside of active cancer, palliative, and end-of-life care, according to a new guideline released today by the Centers for... (Source: Clinical Neurology News)


Ventilation and the Response to Hypercapnia after Morphine in Opioid-naive and Opioid-tolerant Rats
Conclusions In rats, gaining tolerance to morphine analgesia does not reduce ventilatory depression effects when sedated and may inhibit recovery of ventilation. (Source: Anesthesiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


EARLY RELEASE: CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
(Source: CDC Morbidity and Mortality Weekly Report)


Intrinsic Brain Connectivity in Chronic Pain: A Resting-State fMRI Study in Patients with Rheumatoid Arthritis
Pär Flodin, Sofia Martinsen, Reem Altawil, Eva Waldheim, Jon Lampa, Eva Kosek, Peter Fransson (Source: Frontiers in Human Neuroscience)


Opioid‐Induced Constipation Survey in Patients with Chronic Noncancer Pain
Abstract Chronic pain patients relying on chronic opioid therapy are often challenged with opioid‐induced constipation (OIC), a difficult condition to treat that has a significant psychosocial impact on those who are affected (Bruner et al., J Pain Res, 8, 2015, 289). Unlike other side effects of opioids, OIC does not resolve over time during chronic opioid use, and treatments used for functional constipation often fail to provide adequate symptom relief (Nelson and Camilleri, Therap Adv Gastroenterol, 8, 2015, 206). Estimates of the prevalence of OIC vary. It has been reported that 15% to 90% of opioid users are affected by OIC (Gaertner et al., J Clin Gastroenterol, 49, 2015, 9; Wan et al., Am Health Drug Benefits, 8, 2015, 93; Coyne et al., Clinicoecon Outcomes Res, 6, 2014, 269). In ...


Lubiprostone for Opioid‐Induced Constipation Does Not Interfere with Opioid Analgesia in Patients with Chronic Noncancer Pain
DiscussionLubiprostone 24 μg BID administered for relief of OIC in patients with chronic noncancer pain does not interfere with opioid analgesia. (Source: Pain Practice)


A Comparison of Expectations of Physicians and Patients with Chronic Pain for Pain Clinic Visits
ConclusionWe found some agreement and some discordance of clinical expectations between pain patients and physicians. Patient factors may also impact on expectations and comorbidities. Findings from this study will help doctors consider patients' expectations in planning pain clinic visits, improve patient–doctor communication and pain management, and may lead to further hypothesis‐driven studies. (Source: Pain Practice)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Utilization of nanoparticle technology in rheumatoid arthritis treatment
Publication date: May 2016 Source:Biomedicine &amp; Pharmacotherapy, Volume 80 Author(s): Sanam Dolati, Sanam Sadreddini, Davoud Rostamzadeh, Majid Ahmadi, Farhad Jadidi-Niaragh, Mehdi Yousefi Rheumatoid arthritis (RA) is one of the common and severe autoimmune diseases related to joints. This chronic autoimmune inflammatory disease, leads to functional limitation and reduced quality of life, since as there is bone and cartilage destruction, joint swelling and pain. Current advances and new treatment approaches have considerably postponed disease progression and improved the quality of life for many patients. In spite of major advances in therapeutic options, restrictions on the routes of administration and the necessity for frequent and long-term dosing often result in systemi...


Chrysophyllum cainito leaves are effective against pre-clinical chronic pain models: Analysis of crude extract, fraction and isolated compounds in mice
Conclusions This data suggests that the CME effect involves interference in the production, release or action of some chemical mediators, such as PGE2, sympathetic amines, cytokines, etc. Part of these effects was observed with the CHCl3 fraction, emphasizing the prominent inhibition of neuropathic pain. The results also demonstrated that part of the CME effects are due to the presence of the triterpenes 1 and 2, but it is important to mention that we cannot discard the effects of countless other compounds presented in the crude extract, acting in a synergic way. Graphical abstract (Source: Journal of Ethnopharmacology)


Phenotypic features of chronic migraine
Conclusion Phenotype of chronic migraine may be associated with the course of chronification. Duration of illness and attack intensity were closely related with the presence of accompanying symptoms, although headache frequency was found to be inversely related to the presence of accompanying symptoms. Osmophobia was also a frequent symptom and was closely related with other accompanied symptoms, unlike vertigo and dizziness. Inclusion of osmophobia into the diagnostic criteria might improve accurate diagnosis of chronic migraine. (Source: The Journal of Headache and Pain)


Seeking Balance Between Pain Relief and Safety
Pain is a symptom common to numerous physical and psychiatric ailments and can often be managed by treating the underlying condition. However, in approximately 20 million patients each year, chronic pain persists despite treatment. Chronic pain is complex, heterogeneous, and poorly understood. Patients with chronic pain experience a decreased quality of life and increased risk for multiple comorbidities, costing society billions of dollars in reduced productivity annually. Therefore, equipping physicians with effective tools and guidelines for chronic pain management is of paramount importance. (Source: JAMA Neurology)


In chronic nonspecific neck pain, adding Alexander Technique lessons or acupuncture to usual care improved pain.
Authors: Baime MJ PMID: 26974729 [PubMed - as supplied by publisher] (Source: Annals of Internal Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


CDC Guideline for Prescribing Opioids for Chronic Pain
In an effort to address the epidemic of opioid misuse and related deaths from overdose in the United States, the Centers for Disease Control and Prevention (CDC) produced the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. This document is intended to offer “recommendations for prescribing opioids for chronic pain outside of active cancer, palliative, and end-of-life care.” The guideline focuses largely on the risks and benefits of opioid treatment and attempts to offer evidence to support their safe, efficacious, and appropriate use. (Source: JAMA Pediatrics)


How to Prescribe Exercise to Patients with Chronic Health Conditions (FREE)
By Kelly Young Edited by Jaye Elizabeth Hefner, MD A review in CMAJ offers advice on how to prescribe exercise to patients with chronic medical conditions, including chronic obstructive pulmonary disease, low back pain, knee or … (Source: Physician's First Watch current issue)


Understanding Co-occurring Emotion and Pain: The Role of Context Sensitivity from a Transdiagnostic Perspective
We present data that show that disclosure of pain is important emotionally, but that it is also a challenge to respond in manner that is sensitive to the social context. Indeed, disclosing how we feel emotionally or concerning pain might be helpful in some situations, but enhance the problem in others. Finally, we outline a hybrid treatment that combines exposure for pain (feared movements) and emotions (disclosure) with context sensitivity training. While such new treatments are promising, there remains a dire need for more clinical research to test and improve treatments for co-occurring emotional distress and pain. (Source: Journal of Contemporary Psychotherapy)


Learning from Physical Pain to Help with the Management of Emotional Pain
Abstract There may be important similarities between chronic emotional pain and chronic physical pain. Both forms of chronic pain may promote negative beliefs about the self and the future. Chronic emotional pain and chronic physical pain both serve to disrupt patients’ focus from their actions and goals. Techniques used for the treatment of physical pain may be translated into the treatment of emotional pain. Four core strategies are reviewed including: (1) reducing catastrophic interpretations, (2) increasing tolerance by promoting acceptance, (3) cultivating positive expectations, and (4) remaining flexible in movements and attitudes. Patients can learn to tolerate limitations while pursuing their goals. Clinicians can help patients to reduce emotional pain by making a series...


A rare case of Rapunzel syndrome with multiple small bowel intussusceptions and bowel obstruction
We report a case of a 5-year-old girl with Rapunzel syndrome causing multiple small bowel intussusceptions. We were unable to identify the main cause of this condition during laparoscopic reduction. Definite diagnosis was made after the development of gastrointestinal tract obstruction. Surgeons should consider the possibility of Rapunzel syndrome when diagnosing the main cause of intussusceptions. (Source: Formosan Journal of Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Opioid Prescribing for Chronic Pain
Since all drugs have adverse effects, the decision to prescribe always involves a weighing of benefits and risks. In the case of opioids prescribed for chronic pain (excluding life-threatening conditions such as cancer), we have no evidence of benefit with long-term use and much evidence of harm. However, “no evidence of benefit” is not the same as “evidence of no benefit,” especially when the patient in front of you has chronic pain and has tried nonopioid medications (eg, acetaminophen, ibuprofen) without relief or has been taking a stable dose of opioids for months or years and is asking you for a prescription. (Source: JAMA Internal Medicine)


The longitudinal impact of parent distress and behavior on functional outcomes among youth with chronic pain
In this study, we examined how parent factors assessed at a multidisciplinary pediatric pain clinic evaluation impact child psychological and functional outcomes over time. A cohort of 195 patients with chronic pain (ages 8-17) and their parents who presented for a multidisciplinary evaluation completed measures at baseline and at four-month follow-up. (Source: The Journal of Pain)


Pathophysiology of pruritus in primary localized cutaneous amyloidosis
ConclusionsSFN is present in PLCA. Pruritus in PLCA is likely associated with hypersensitivity of cutaneous nerve fibres, which may be related to an increased expression of epidermal IL‐31 receptors. Targeting IL‐31 receptors is therefore a potential therapeutic approach. (Source: British Journal of Dermatology)


Opioids for Chronic Pain
A new guideline is available from the Centers for Disease Control and Prevention on opioid prescribing for chronic pain. (Source: JAMA - Journal of the American Medical Association)


CDC Guideline for Prescribing Opioids for Chronic Pain, 2016
This guideline from the Centers for Disease Control and Prevention makes 12 recommendations to improve communication about opioids for chronic pain, to improve the safety and effectiveness of pain treatment, and to reduce risks associated with long-term opioid therapy. (Source: JAMA - Journal of the American Medical Association)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Ulnocarpal impingement and chronic triangular fibrocartilage complex tears
Ulnocarpal impingement syndrome is a common reason for ulnar sided wrist pain in athletes. Clinical history, imaging and physical examination are important when diagnosing and formulating a management plan. Gymnasts and baseball and racket playing athletes are at higher risk for ulnocarpal impingement due to repetitive wrist pronation and gripping. Overloading of the ulnocarpal joint can progress to ulnar head chondromalacia, triangular fibrocartilage complex tears, and lunotriquetral ligament damage. (Source: Operative Techniques in Sports Medicine)


An exploration of the extent and nature of reconceptualisation of pain following pain neurophysiology education: a qualitative study of experiences of people with chronic musculoskeletal pain
(Source: Patient Education and Counseling)


The Hand Motor Hotspot is not Always Located in the Hand Knob: A Neuronavigated Transcranial Magnetic Stimulation Study.
This study shows that the hMHS does not always correspond to the hand knob and M1 location in healthy subjects or patients. Therefore, image-guided navigation is needed to improve the anatomical accuracy of TMS targeting, even for M1. PMID: 26980192 [PubMed - as supplied by publisher] (Source: Brain Topography)


Role of corticosteroids in Functional Endoscopic Sinus Surgery - a systematic review and meta-analysis.
CONCLUSION: Pre-operative use of local and/or systemic corticosteroids in FESS, results in significantly reduced blood loss, shorter operative time and improved surgical field quality. Studies are limited on the intra-operative use of corticosteroids to reduce postoperative pain. Postoperative corticosteroids improve postoperative endoscopic scores in CRS and recurrence rates in cases of CRSwNP. PMID: 26970247 [PubMed - as supplied by publisher] (Source: Rhinology)


Automated assessment of intranasal trigeminal function.
CONCLUSION: We have demonstrated that the current approach is a reliable and valid measure of intranasal trigeminal function. PMID: 26970101 [PubMed - as supplied by publisher] (Source: Rhinology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Annabel’s journey: The story behind the movie “Miracles from Heaven”
Eight-year-old Annabel Beam was on a quest to find the perfect gift. During a 2010 trip from her Texas home to Boston Children’s Hospital, she asked her Mom to stop at the airport gift shop before boarding the plane. Annabel perused the aisles, examining each item in the hope of finding a token of appreciation for her gastroenterologist, Dr. Samuel Nurko, director of the Motility and Functional Gastrointestinal Disorders Center. Annabel spotted a cuddly teddy bear wearing blue doctors’ scrubs. She reached for the bear, squeezed its arm, and a musical rendition of “Doctor, Doctor, give me the news&#8230;” began to play. Annabel’s grin spread from ear to ear. “I want to give this to Dr. Nurko, Mommy,” said Annabel. The teddy bear symbolized the kindness and hope Nurko shared w...


Health Tip: Can You Tell if a Toe Is Broken?
Title: Health Tip: Can You Tell if a Toe Is Broken?Category: Health NewsCreated: 3/14/2016 12:00:00 AMLast Editorial Review: 3/14/2016 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Neural correlates of cough hypersensitivity in humans: evidence for central sensitisation and dysfunctional inhibitory control
Conclusions These findings provide insight into the central neurobiology of cough hypersensitivity and suggest that both central amplification of cough sensory inputs and reduced capacity to suppress cough motor behaviours define patients with problematic cough. (Source: Thorax)


Structural Brain Alterations in Community Dwelling Individuals with Chronic Joint Pain [PERIPHERAL NERVOUS SYSTEM]
CONCLUSIONS: The primary identified brain areas, the temporal and frontal lobes and the hippocampus, indicated involvement of emotional processing. The volumetric differences found indicated a sex-specific neuroplasticity in chronic pain. These results emphasized sex-specific and multidisciplinary pain treatment. (Source: American Journal of Neuroradiology)


Synthesis and Biological Evaluation of N-Aryl-N'-(5-(2-hydroxybenzoyl)pyrimidin-2-yl)guanidines as Toll-Like Receptor 4 Antagonists Synthesis of Guanidine-Based TLR4 Antagonists.
CONCLUSION: Our findings represent an important starting point for further studies of small-molecule agents targeting Toll-like receptors. PMID: 26972825 [PubMed - as supplied by publisher] (Source: Medicinal Chemistry)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The antinociceptive effects of ferulic acid on neuropathic pain: involvement of descending monoaminergic system and opioid receptors.
Authors: Xu Y, Lin D, Yu X, Xie X, Wang L, Lian L, Fei N, Chen J, Zhu N, Wang G, Huang X, Pan J Abstract Neuropathic pain can be considered as a form of chronic stress that may share common neuropathological mechanism between pain and stress-related depression and respond to similar treatment. Ferulic acid (FA) is a major active component of angelica sinensis and has been reported to exert antidepressant-like effects; however, it remains unknown whether FA ameliorate chronic constriction injury (CCI)-induced neuropathic pain and the involvement of descending monoaminergic system and opioid receptors. Chronic treatment with FA (20, 40 and 80 mg/kg) ameliorated mechanical allodynia and thermal hyperalgesia in von Frey hair and hot plate tasks, accompanied by increasing spinal noradre...


Chronic cervical radicular pain: time to tackle a new horizon.
Authors: Gomez-Rios MA, Freire Vila E PMID: 26967832 [PubMed - as supplied by publisher] (Source: Minerva Anestesiologica)


Effect of thoracic mobilization on respiratory parameters in chronic non-specific low back pain: A randomized controlled trial.
CONCLUSION: Subjects with non-specific chronic low back pain with or without radiation to lower limbs when treated with thoracic central PA mobilization, in addition to LBP specific treatment and breathing exercises, show an improvement in respiratory parameters and reduction in disability. PMID: 26966825 [PubMed - as supplied by publisher] (Source: Journal of Back and Musculoskeletal Rehabilitation)


Three week results of transforaminal epidural steroid injection in patients with chronic unilateral low back related leg pain: The relation to MRI findings and clinical features.
CONCLUSION: In patients with chronic low back related leg pain, MRI findings and neurologic assessment results failed to predict treatment response, whereas a positive Slump test predicted the best 3-week response to TESI. PMID: 26966817 [PubMed - as supplied by publisher] (Source: Journal of Back and Musculoskeletal Rehabilitation)


The Potential of Cesarean Section as a Causative Factor of Chronic Pelvic Pain
(Source: Revista Brasileira de Ginecologia e Obstetricia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Bone Pain in a 4-year-old Boy with Chronic Granulomatous Disease and History of Aspergillus pneumonia
No abstract available (Source: The Pediatric Infectious Disease Journal)


Blockade of Toll-Like Receptors (TLR2, TLR4) Attenuates Pain and Potentiates Buprenorphine Analgesia in a Rat Neuropathic Pain Model.
Authors: Jurga AM, Rojewska E, Piotrowska A, Makuch W, Pilat D, Przewlocka B, Mika J Abstract Accumulating evidence indicates that microglial TLR2 and TLR4 play a significant role in nociception. Experiments were conducted to evaluate the contribution of TLR2 and TLR4 and their adaptor molecules to neuropathy and their ability to amplify opioid effectiveness. Behavioral tests (von Frey's and cold plate) and biochemical (Western blot and qRT-PCR) analysis of spinal cord and DRG tissue were conducted after chronic constriction injury (CCI) to the sciatic nerve. Repeated intrathecal administration of LPS-RS (TLR2 and TLR4 antagonist) and LPS-RS Ultrapure (TLR4 antagonist) attenuated allodynia and hyperalgesia. Biochemical analysis revealed time-dependent upregulation of mRNA and/or pr...


Etiology of postanesthetic and postsedation events on the inpatient ward: data from a rapid response team at a tertiary care children's hospital
ConclusionRRT calls were most common for respiratory concerns. High ASA status, general anesthesia administration, and the presence of acute or chronic conditions prior to anesthetic administration predispose a patient to perioperative complications resulting in the need for an RRT call. (Source: Pediatric Anesthesia)


Methylglyoxal, A Metabolite Increased in Diabetes is Associated with Insulin Resistance, Vascular Dysfunction and Neuropathies.
CONCLUSION: The findings of this review suggesting methylglyoxal as an essential therapeutic target for managing diabetes in the future. PMID: 26965039 [PubMed - in process] (Source: Current Drug Metabolism)


Treatment of erosive oral lichen planus with methotrexate
ConclusionMethotrexate is a valuable therapeutic option in longstanding recalcitrant EOLP, particularly with respect to the improvement of subjective symptoms. Randomized controlled trials are required. (Source: JDDG)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Functional restoration programs in patients with chronic low back pain and body composition: No change in muscle mass assessed through Dual X-ray absorptiometry in 94 patients, a monocenter longitudinal study
Publication date: Available online 11 March 2016 Source:Joint Bone Spine Author(s): Carole Desthieux, Sabrina Dadoun, Violaine Foltz, Sylvie Rozenberg, Bruno Fautrel, Laure Gossec (Source: Joint Bone Spine)


Lack of confidence in the lower limb: Cognitive Functional Therapy (CFT) for a unilateral loading impairment in chronic non-specific low back pain. Case report
This case report presents the effect of Cognitive Functional Therapy (CFT) in a patient with chronic non-specific low back pain associated with unilateral loading impairment of the left lower limb. The patient believed surgery was the only possible way to treat the cause of the problem. The management of this idea was to change such belief. Manual therapy and active exercises were combined in order to encourage the patient to trust his back and lower limb again. One month and a half after the first appointment, the treatment resulted in complete absence of pain and disability. (Source: Manual Therapy)


Proximal tibiofibular joint pain versus peroneal nerve dysfunction: clinical results of closed-wedge high tibial osteotomy performed with proximal tibiofibular joint disruption
Conclusion CW-HTO using PTFJ disruption provides good clinical results in terms of medial knee pain and corrects the alignment sufficiently while avoiding peroneal nerve injury. However, the results of this study indicated that this technique might result in painful PTFJs. Thus, the surgeon should consider a possibly painful PTFJ, which can be a cause of chronic lateral knee pain when performing this technique. Level of evidence III. (Source: Knee Surgery, Sports Traumatology, Arthroscopy)


Neurofeedback reduces pain, increases quality of life for cancer patients suffering from chemotherapy-induced neuropathy
A new study evaluating the use of neurofeedback found a decrease in the experience of chronic pain and increase quality of life in patients with neuropathic pain, researchers report. (Source: ScienceDaily Headlines)


Vibrations to replace MRI scans for back pain?
Vibrating the spine may reveal more when it comes to treating back pain than...Read more on AuntMinnie.comRelated Reading: Public reporting does not reduce MRI scans for low back pain JAMA: Early imaging questionable for older adults with back pain PET/MRI spots neuroinflammation from chronic back pain Back problems? Skip the imaging, skip the surgery Study questions MRI for back injuries (Source: AuntMinnie.com Headlines)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Clinical and psychosocial aspects assessed by the research diagnostic criteria for temporomandibular disorder
Conclusion: some clinical and psychosocial factors are associated in patients with temporomandibular disorder, observing a variety of clinical diagnoses with a significant relationship between clinical diagnoses and the presence of non-specific physical symptoms with pain. Complaints of greater severity of physical symptoms were found in patients with multiple clinical diagnoses. (Source: Revista CEFAC)


Melatonin 4 mg as prophylactic therapy for primary headaches: a pilot study.
Authors: Bougea A, Spantideas N, Lyras V, Avramidis T, Thomaidis T Abstract There is growing evidence that headaches are connected to melatonin secretion. Our aim was to assess the potential effectiveness of melatonin for primary headache prevention. Forty-nine patients (37 with migraine and 12 with chronic tension-type headache, TTH) were prescribed oral melatonin, 4 mg, 30 minutes before bedtime for six months. Forty-one (83.6%) of the 49 patients completed the study, while eight dropped out for personal reasons. A statistically significant reduction in headache frequency was found between baseline and final follow-up after six months of treatment (p=0.033 for TTH patients and p&lt;0.001 for migraineurs). The Headache Impact Test score was significantly reduced in both groups of ...


Previous injury and chronic pain are associated with side of onset in Parkinson's disease - Tekin I, Vgontzas A, Lewis MM, Kothari S, Kong L, Lu Y, Vrana KE, Huang X.
BACKGROUND: Parkinson's disease (PD) motor symptoms are frequently asymmetric and the factors that influence the side of onset are unclear. OBJECTIVE: To explore whether peripheral injury and associated chronic limb pain may influence the side of o... (Source: SafetyLit)


Torque and muscle activation impairment along with insulin resistance are associated with falls in women with fibromyalgia - GÓes SM, Stefanello JM, Homann D, Lodovico A, Hubley-Kozey CL, Rodacki AL.
Fibromyalgia is a chronic pain condition associated with reduced muscle strength, which can lead to functional incapacity and higher risk of falls. PURPOSE: The study purpose was to compare maximal ankle joint torque, muscle activation and metaboli... (Source: SafetyLit)


Do You Prescribe Opioids for Chronic Pain?
(MedPage Today) -- Is chronic pain a safe indication for an opioid rx? (Source: MedPage Today Public Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


UCLA faculty voice: When it comes to breastfeeding, a mother’s health and happiness matter too
Vivien Burt Robin Berman Dr. Vivien Burt is a professor emeritus of psychiatry and biobehavioral sciences and the co-director of the Women’s Life Center at the Resnick Neuropsychiatric Hospital at UCLA. Dr. Sonya Rasminsky is an associate clinical professor of psychiatry at UC Irvine. Dr. Robin Berman is an associate professor of psychiatry at UCLA. This column appeared March 3 in the Washington Post’s “On Parenting” blog. Whoever said, “Don’t cry over spilled milk” couldn’t possibly have been talking about breast milk. As reproductive psychiatrists who specialize in treating women who suffer from depression and anxiety during pregnancy and the postpartum, we see far too many tearful new mothers for whom breastfeeding is a source of self-recrimination. Doggedly determine...


An exploratory study on the effectiveness of "Calmare therapy" in patients with cancer-related neuropathic pain: A pilot study.
CONCLUSIONS: Our preliminary results suggest that CT may be considered for cancer patients with various types of CNP. Large studies are necessary to confirm our findings and ascertain which additional CNP show positive response to CT. PMID: 26952672 [PubMed - in process] (Source: European Journal of Oncology Nursing)


Neurofeedback reduces pain, increases quality of life for cancer patients suffering from chemotherapy-induced neuropathy
(University of Texas M. D. Anderson Cancer Center) A new study from The University of Texas MD Anderson Cancer Center evaluating the use of neurofeedback found a decrease in the experience of chronic pain and increase quality of life in patients with neuropathic pain. (Source: EurekAlert! - Cancer)


One stage combined endoscopic and per-oral buccal fat pad approach for large oro-antral-fistula closure with secondary chronic maxillary sinusitis
Abstract There are numerous surgical approaches for oro-antral-fistula (OAF) closure. Secondary sinus disease is still considered by many experts a relative contra indication for primary closure. To describe a single-stage combined endoscopic sinus surgery and per-oral buccal fat pad (BFP) flap approach for large OAF causing chronic maxillary sinusitis. The records of all the patients with OAF and chronic manifestations of secondary rhinosinusitis that were treated between 2010 and 2013 in our tertiary care medical center were reviewed. The exclusion criteria were: OAF ≤ 5 mm, resolved sino-nasal disease, OAF secondary to malignancy, recurrent fistula, medical history that included radiotherapy to the maxillary bone and age &lt;18 years. Each procedure was performed by a te...


New Meniscus Implant Aims To Treat Knee Pain For Younger Patients
BOSTON (CBS) &#8212; Americans of all ages suffer from chronic knee pain due to meniscus injuries.  Most are too young to have replacement surgery, but there aren’t a lot of other options.  Dr. Mallika Marshall introduces us to one of the first patients in the nation to undergo a meniscus implant. “I couldn&#8217;t get up the hill,” says 44 year old Jim DiRico of Derry, New Hampshire.  “I had to stand and watch my two children climb a little bit of a hill that we have.  Being a dad I wanted to be involved.” But Jim couldn&#8217;t be involved because of severe pain in his right knee from a worn meniscus.  The meniscus is the shock-absorbing rubbery cushion in the knee which sits between the thigh bone and the shin bone. Meniscus implant made of a special medical grade plastic...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Rachis interventionnel
Publication date: March 2016 Source:Journal of Neuroradiology, Volume 43, Issue 2 Author(s): Mario Muto, Francesco Giurazza, Mario Tecame, Gianluigi Guarnieri In the last two decades, several percutaneous mini-invasive techniques have been developed in the field of interventional radiology related to the wide spectrum of spine pathology diseases: degenerative, traumatic and oncological. Oxygen-ozone nucleolysis, facet joint ablation and vertebral cementoplasty are well-known mini-invasive treatments to obtain pain relief in patients affected by radicular conflicts, vertebral porotic fractures, primary or secondary spine lesions and spine trauma. Oxygen-ozone nucleolysis is a safe and cost-effective approach to patients with sciatica refractive to conservative therapy, having demonstr...


Randomised controlled trial of n-butyl cyanoacrylate glue fixation versus suture fixation of mesh in laparoscopic totally extraperitoneal hernia repair
Conclusion: Using NBCA glue to fix the mesh in laparoscopic TEP hernia repair is effective and associated with less pain on day 7 as compared to suture fixation of the mesh. (Source: Journal of Minimal Access Surgery)


A prospective randomised controlled trial comparing chronic groin pain and quality of life in lightweight versus heavyweight polypropylene mesh in laparoscopic inguinal hernia repair
Conclusion: Outcomes following laparoscopic inguinal hernia repair using HW and LW mesh are comparable in the short-term as well as long-term. (Source: Journal of Minimal Access Surgery)


Younger age predicts greater effectiveness of spinal cord stimulation for chronic pain
Conclusions Our results suggest that younger age is associated with greater long-term effectiveness of spinal cord stimulation and therefore age may influence the success of SCS therapy with older patients having a greater tendency to failure. Earlier intervention may be beneficial in these chronic pain patients. (Source: Acta Neurochirurgica)


Responsiveness and minimal important change of the Pain Self-Efficacy Questionnaire and short forms in patients with chronic low back pain
The Pain Self-Efficacy Questionnaire (PSEQ) is a valid and reliable patient-reported instrument used to assess pain self-efficacy in patients with chronic low back pain (CLBP). Recently, the 2-item (PSEQ-2) and the 4-item (PSEQ-4) short versions were developed showing satisfactory measurement properties in mixed chronic pain populations. The aim of this study was to examine responsiveness and minimal important change (MIC) of PSEQ, PSEQ-2 and PSEQ-4 in patients with CLBP. We used a sample of 104 patients undergoing multimodal physical therapy designed to partly change pain self-efficacy beliefs. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


New approach for treatment of prolonged postoperative pain: APS Out-Patient Clinic
Conclusions The APS-OPC provides a fluent fast-track method of ensuring effective multimodal analgesia in the subacute recovery phase after surgery. Even strong opioids can be safely used after discharge and then tapered off in close supervision of the APS-OPC anaesthesiologist. As the APS-OPC was implemented in close collaboration with the MPC, the multidisciplinary resources are easily available during the course of the APS-OPC treatment. Implications The first two years of the APS-OPC have shown that a significant number of surgical patients benefit from continuing active pain management after discharge from hospital. This fast-track service provides physician-supervised titration of analgesics to improve pain relief in the subacute phase. An important task of the APS-OPC is to ensure ...


Anticipation of thermal pain in diverticular disease
Conclusions & InferencesThe HSDD group have altered anticipatory responses to thermal pain, similar to IBS group. The LSDD are similar to ADD group. This suggests underlying differences in pain pathophysiology, and the need for individualized treatment strategies to target the cause of their chronic pain. Symptomatic diverticular disease patients can be separated into low (LSDD) and high (HSDD) somatization groups based on Patient Health Questionnaire‐12 (PHQ‐12 SS) During anticipation of pain greater deactivations occur (shown in blue) in somatosensory, emotional, and descending noxious inhibitory control pain regions in the asymptomatic (ADD) compared to the symptomatic diverticular disease (SDD) and irritable bowel syndrome (IBS) groups There are fewer anticipatory differences ...


Chronic cluster headache and the pituitary gland
Conclusion Neuroimaging should be considered in all patients with CCH, especially those with an atypical presentation or evolution. Response to acute treatment does not exclude a secondary form of cluster headache. There may be shared pathophysiological mechanisms of primary and secondary cluster headache. (Source: The Journal of Headache and Pain)


Cytokine profile in degenerated painful intervertebral disc: variability with respect to duration of symptoms and type of disease
Neuroinflammation is supposed to play a crucial role in the generation of chronic pain. Numerous trials have documented the contribution of proinflammatory cytokines in pathophysiology of pain associated with peripheral and central nociception. Local and systemic expression of proinflammatory cytokines have been implicated as mediators of pain. Among these cytokines, TNF-α, IL-1β and IL-6 are especially notable attributed to their hyperalgesic impacts after nerve damage. (Source: The Spine Journal)


Parameters of low back pain chronicity among athletes: Associations with physical and mental stress
In the general population, physical and mental stress factors are linked to chronic low back pain (LBP). The aim of the present study was to examine this association among athletes. (Source: Physical Therapy in Sport)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Long-term quality of life and functionality after ventral hernia mesh repair
Conclusion LVHR and OVHR reduce chronic pain and physical impairment and improve long-term QoL. Hernia recurrence and persistent pain reduce the beneficial effect of hernia surgery. Dispositional optimism can modulate QoL reporting and improve functionality. (Source: Surgical Endoscopy)


Pharmacogenomics for personalized pain medicine.
Authors: Ko TM, Wong CS, Wu JY, Chen YT Abstract Pharmacogenomics aims to unravel the way that human genetic variation affects drug efficacy and toxicity. Genome-wide association studies and candidate gene findings suggest that genetic approaches may help choose the most appropriate drug and dosage while preventing adverse drug reactions (ADRs). Pain is an unpleasant feeling that usually results from tissue damage. The management of different types of pain (acute, chronic, inflammatory, neuropathic, or cancer) is challenging. Currently, drug intervention is the first-line therapy for resolving pain. However, differences in drug efficacy between individuals are common with pain medications. Moreover, some patients experience ADRs after being treated with specific pain drugs. This re...


Do we need to establish guidelines for patients with neuromodulation implantable devices, including spinal cord stimulators undergoing nonspinal surgeries?
CONCLUSIONS: The Food and Drug Administration safety information manual warns about the use of diathermy, concomitant implanted stimulation devices, lithotripsy, external defibrillation, radiation therapy, ultrasonic scanning, and high-output ultrasound, all of which can lead to permanent implant damage if not turned off prior to undertaking procedures. Lack of uniform guidelines makes intraoperative management, as well as remote anesthesia care of patients with previously implanted SCSs unsafe. PMID: 26958424 [PubMed] (Source: Surgical Neurology International)


Understanding Neuropathic Corneal Pain-Gaps and Current Therapeutic Approaches.
Authors: Goyal S, Hamrah P Abstract The richly innervated corneal tissue is one of the most powerful pain generators in the body. Corneal neuropathic pain results from dysfunctional nerves causing perceptions such as burning, stinging, eye-ache, and pain. Various inflammatory diseases, neurological diseases, and surgical interventions can be the underlying cause of corneal neuropathic pain. Recent efforts have been made by the scientific community to elucidate the pathophysiology and neurobiology of pain resulting from initially protective physiological reflexes, to a more persistent chronic state. The goal of this clinical review is to briefly summarize the pathophysiology of neuropathic corneal pain, describe how to systematically approach the diagnosis of these patients, and fin...


Q&A: Identifying gaps in the treatment of endometriosis
Despite the high prevalence of endometriosis – a condition that is estimated to affect about 10% of women of reproductive age – available treatments are inadequate for some women with chronic pain,... (Source: Clinical Endocrinology News)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Can “talking therapy” prevent chronic pain taking hold?
We&rsquo;re all too aware of the devastating impact chronic pain has on people&rsquo;s lives. Chronic pain is the most common symptom of fibromyalgia, a condition which affects around 1 in every 25 people. Yet we still understand relatively little about its causes and how to help people suffering with it. We believe that needs to change, so we&rsquo;re investing heavily in innovative research to build our understanding of what&rsquo;s behind chronic pain and develop new, improved treatments with the potential to transform quality of life for millions of people. Just one of the many research studies we're funding in this area is exploring if cognitive behavioural therapy (CBT), also known as &ldquo;talking therapy&rdquo;, could be the answer to preventing chronic widespread pain. Scientists...


Cloudy with a chance of pain? Researchers need you to find out if pain is linked to the weather
Have you ever noticed the pain you're feeling seems to change depending on whether it&rsquo;s damp or dry, blazing sunshine or cold and grey outside? With the help of thousands of people with arthritis from all over the UK and using a unique new smartphone app, scientists at the University of Manchester will be able to investigate the age-old theory that there&rsquo;s a link between the weather and the pain caused by arthritis. Get involved The research team are urging you to get involved in this world-first research study by tracking your pain symptoms each day on the Cloudy with a Chance of Pain app. Anyone in the UK with arthritis or chronic pain, aged over 17, can take part. All you&rsquo;ll need is a smartphone. Go to www.cloudywithachanceofpain.com to find out more. Using weather da...


Understanding pain – what it is and why we feel it
This issue we're looking at pain. Why? Because more than 1 in 6 people struggle with the pain of arthritis every day. Pain may be a common symptom experienced by millions, but it's a deeply complex issue.&nbsp; Why do we feel pain? What is it about arthritis that causes pain? Why can two people have the same amount of deterioration in the joint but feel completely different levels of pain? These are just some of the questions you&rsquo;ve asked about pain which our experts have helped us to answer. What is pain? Put simply, pain is a protective mechanism that alerts your brain when damage has occurred. It&rsquo;s not just a sensation, it has emotional effects too &ndash; often making us feel upset or distressed. It can be caused by injury, by chemicals produced by inflammation or by dama...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Specialised Pro-Resolving Mediators of Inflammation in Inflammatory Arthritis
Conclusions SPM are present in chronic knee effusions and although the levels are lower than in plasma, the association between synovial fluid RvE2 and reduced pain scores suggests that synthesis of SPM at the site of inflammation is a relevant mechanism by which n-3FA alleviate the symptoms of arthritis. (Source: Prostaglandins, Leukotrienes and Essential Fatty Acids (PLEFA))


Effects of riluzole on P2X7R expression in the spinal cord in rat model of neuropathic pain
Publication date: 8 April 2016 Source:Neuroscience Letters, Volume 618 Author(s): Kai Jiang, Ying Zhuang, Ming Yan, Hui Chen, An-Qi Ge, Li Sun, Bei Miao Neuropathic pain is becoming an intractable health threat, with its profound effect on quality of life, thus posing a major challenge to clinical therapy. Despite the reported efficacy of riluzole in some pain models, the underlying mechanism remains largely unknown. The present study aimed to assess the effects of riluzole in a rat model of neuropathic pain induced by chronic constriction injury (CCI). Subsequent to model establishment, paw withdrawal latencies (PWLs) and the paw withdrawal mecha threshold (PWT) rapidly decreased, coupled with inhibited microglial activation and upregulated P2X7R expression in the spinal cord dor...


Does the co-existence of acute anterior uveitis and chronic back pain prompt primary care physicians to consider a diagnosis of axial spondyloarthritis?
We read with interest the article by Haroon et al1 indicating that approximately 40% of patients with acute anterior uveitis (AAU) have undiagnosed spondyloarthritis. Unfortunately, delay to diagnosis remains a huge challenge in axial spondyloarthritis (axSpA) despite the publication of the Assessment of SpondyloArthritis international Society (ASAS) classification criteria, which formally recognises the role of MRI in diagnosis.2 We recently reported that the mean delay in diagnosis among 1193 patients attending two large secondary care centres in the UK was 8.5&nbsp;years.3 Despite a 51% increase in new diagnoses since 2009, the delay in diagnosis has not improved and the presence of AAU was associated with an even longer delay. Given that the majority of axSpA patients present with chro...


Improving recognition of spondyloarthropathy in primary care: an unmet need
Thank you for the opportunity to respond to Maxwell et al&rsquo;s letter and their insightful comments regarding the delay to diagnosis in axial spondyloarthritis (axSpA). In their audit of patients with coexisting chronic back pain and acute anterior uveitis (AAU), it was noted that such patients are poorly evaluated for suspected SpA at primary-care level.1 Poor recognition and consequent late referral remains a major stumbling block towards &lsquo;overall success&rsquo; in axSpA. In our Dublin Uveitis Evaluation Tool (DUET) study, we also found that 62% of patients with undiagnosed SpA had previously consulted either their general practitioner (GP) or other allied health professionals with their backache but the diagnosis of SpA was not considered.2 The gatekeeper role of the GP cannot ...


Autoantibodies to citrullinated proteins induce joint pain independent of inflammation via a chemokine-dependent mechanism
Conclusions The data suggest that CXCL1/IL-8, released from osteoclasts in an autoantibody-dependent manner, produces pain by activating sensory neurons. The identification of this new pain pathway may open new avenues for pain treatment in RA and also in other painful diseases associated with autoantibody production and/or osteoclast activation. (Source: Annals of the Rheumatic Diseases)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Initial experience with application of single layer modified Kugel mesh for inguinal hernia repair: Case series of 72 consecutive patients.
CONCLUSION: The postoperative complication and recurrence rates of single-layer MK mesh herniorrhaphy was comparable with previously reported tension-free repair. Single-layer application is safe and feasible. A longer follow-up period and larger study group with a control group are needed to verify our method. PMID: 26971818 [PubMed - as supplied by publisher] (Source: Asian Journal of Surgery)


Loss of a Stem Cell Champion: An Appreciation of Nancy Reagan
The world was moved when former President Ronald Reagan wrote his brave open letter, revealing that he was "one of the millions ... who will be afflicted with Alzheimer's Disease." Even now, three sentences in that letter strike home to me and my family: He said: Unfortunately, as Alzheimer's Disease progresses, the family often bears a heavy burden. I only wish there was some way I could spare Nancy from this painful experience. When the time comes, I am confident that with your help she will face it with faith and courage... Although I never met anyone in the Reagan family, I have an idea of the "painful experience" the President saw ahead. Nancy Reagan's experience happened to a friend of mine. She (we'll call her C.) was a slender, delicate woman with medical problems of her own. H...


Opioids for chronic pain
Pearson ACS, Eldrige JS, Moeschler SM, Hooten WM (Source: Journal of Pain Research)


Research to focus on chronic pain care, informed consent for patient records
(Indiana University) An Indiana University-Purdue University Indianapolis researcher has been awarded $1.1 million to develop information-based tools to help primary care providers improve care for patients with chronic pain, a condition that affects 100 million Americans at a cost of $630 billion annually in health care costs and lost worker productivity. (Source: EurekAlert! - Social and Behavioral Science)


The Urinary Microbiome Differs Significantly between Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Controls as Well as between Patients with Different Clinical Phenotypes
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is both common and heterogeneous. Several urinary microbiome studies have failed to find consistent differences between patients and controls. (Source: Urology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic Caesarian section scar pain Treated with fascial scar release techniques: A case series
Describe outcomes of two subjects with chronically painful Caesarian section (C-section) scars following an intervention of specific myofascial scar release techniques. (Source: Journal of Bodywork and Movement Therapies)


Leg adjustments as a key: initial insights into quick‐release trials between healthy controls and chronic non‐specific low back pain patients
(Source: Acta Physiologica)


Multiple faces of protein interacting with C kinase 1 (PICK1): structure, function, and diseases
Publication date: Available online 9 March 2016 Source:Neurochemistry International Author(s): Yun-Hong Li, Nan Zhang, Ya-Nan Wang, Ying Shen, Yin Wang Protein interacting with C-kinase 1 (PICK1) has received considerable attention because it is the only protein that contains both PSD-95/DlgA/ZO-1 (PDZ) domain and Bin-Amphiphysin-Rvs (BAR) domain. Through PDZ and BAR domains, PICK1 binds to a large number of membrane proteins and lipid molecules, and is thereby of multiple functions. PICK1 is widely expressed in various tissues, particularly abundant in the brain and testis. In the central nervous system (CNS), PICK1 interacts with numerous neurotransmitters receptors, transporters, ion channels, and enzymes, and controls their trafficking. The best characterized function of PICK1 i...


Fibromyalgia patients report less pain and better quality of life with acupuncture.
Authors: Abstract Individually tailored acupuncture significantly lessens pain intensity in people with the chronic condition fibromyalgia, latest study results suggest. PMID: 26959439 [PubMed - in process] (Source: Nursing Standard)


Role of the RVM in Descending Pain Regulation Originating from the Cerebrospinal Fluid-Contacting Nucleus.
Authors: Fei Y, Wang X, Chen S, Zhou Q, Zhang C, Li Y, Sun L, Zhang L Abstract Evidence has suggested that cerebrospinal fluid-contacting nucleus (CSF-contacting nucleus) is correlated with the development and recurrence of pain. A recent research showed that the CSF-contacting nucleus acts as a component of the descending 5-hydroxytryptamine (5-HT) system and plays a role in descending pain inhibition. However, limited studies are conducted to investigate the relationship between the CSF-contacting nucleus and pain. In present study, we explored the effect of CSF-contacting nucleus on nociceptive behaviors in both normal and neuropathic rats via targeted ablation of the CSF-contacting nucleus in the brainstem, using cholera toxin subunit B-saporin (CB-SAP), a cytotoxin coupled to ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Endogenous CBS-H2S Pathway Contributes to the Development of CCI-Induced Neuropathic Pain.
In this study, the relationship between endogenous CBS-H2S pathway in L4-6 spinal cord and neuropathic pain was explored. A total of 163 adult Kunming mice were used in this study. CBS expression and H2S formation in L4-6 spinal cord were detected in the development of neuropathic pain firstly. Then, effect of AOAA, an CBS inhibitor, on treatment of neuropathic pain by chronic construction injury surgery (CCI) was detected. Pain thresholds and activation of NF-κB(p65), ERK1/2 and CREB were measured as biomarks of neuropathic pain. Results showed that CCI surgery significantly upregulated protein expression of CBS and H2S formation. Correlation analysis showed pain thresholds had negative relationships with protein expression of CBS and H2S formation. Treatment with AOAA, a CBS inhibitor, ...


Management of Postpartum Diastasis of the Pubic Symphysis.
Authors: Erickson D, Low J, Shumway J Abstract Conservative management is typically recommended for postpartum diastasis of the pubic symphysis, despite significant functional disability and chronic pain associated with this condition. With a reported incidence of 1:500, the authors describe diagnosis and management controversies with an additional review of relevant literature related to the management of this orthopedic condition. The case is of a 27-year-old woman diagnosed with 5.5-cm diastasis of the pubic symphysis after spontaneous vaginal delivery of a 5 lb 5 oz infant. She underwent early orthopedic surgical correction via open reduction and internal fixation. The patient achieved pain-free ambulation within 3 months of surgery, and returned to full activity at 6 months. P...


Lumbar Interspinous Process Fixation and Fusion with Stand-Alone Interlaminar Lumbar Instrumented Fusion Implant in Patients with Degenerative Spondylolisthesis Undergoing Decompression for Spinal Stenosis.
CONCLUSIONS: Stand-alone ILIF with interspinous bone grafting promotes vertebral fusion in most patients with lumbar stenosis and unstable Grade I DS undergoing BL or BDUL. PMID: 26949455 [PubMed] (Source: Asian Spine Journal)


Correlation of Vitamin D and Body Mass Index with Modic Changes in Patients with Non-Specific Low Back Pain in a Sub-Tropical Asian Population.
CONCLUSIONS: Vitamin D deficiency and obesity have significant relations with LBP. Low vitamin D levels is associated with Modic changes but whether they represent a subgroup of patients whose low backpain is associated with low vitamin D needs to be further evaluated. PMID: 26949453 [PubMed] (Source: Asian Spine Journal)


What Is the Difference Between Drug Dependent & Drug Addicted?
Kathleen&#8217;s Story Kathleen experienced a work related injury in which a box fell on her neck while she was standing on a ladder to retrieve something else from a high shelf. She suffered a C4 injury (the fourth cervical vertebra) which resulted in limited control of her shoulders and biceps. It was accompanied by a stinging sensation that she came to discover was related to damage to nerve fibers. She also noticed tingling and numbness in her fingers. It was diagnosed as neuropathic pain. Her doctor explained that the communication between her spine and brain was being mis-translated and that the signals were coming from locations below where feelings were interrupted. She was cautioned that this problem could be chronic. Prior to the accident, Kathleen had been vibrant and active. An...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Health Tip: Considering Shoe Inserts
Title: Health Tip: Considering Shoe InsertsCategory: Health NewsCreated: 3/8/2016 12:00:00 AMLast Editorial Review: 3/8/2016 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Chronic prostatitis/chronic pelvic pain syndrome: a review of evaluation and therapy
Chronic prostatitis&#47;chronic pelvic pain syndrome: a review of evaluation and therapy Prostate Cancer and Prostatic Diseases advance online publication, March 8 2016. doi:10.1038/pcan.2016.8 Authors: A S Polackwich & D A Shoskes (Source: Prostate Cancer and Prostatic Diseases)


Neurophysiological mechanisms in Acceptance and commitment therapy in opioid-addicted patients with chronic pain
Acceptance and Commitment Therapy (ACT) has been effectively utilized to treat both chronic pain and substance use disorder independently. Given these results and the vital need to treat the comorbidity of the two disorders, a pilot ACT treatment was implemented in individuals with comorbid chronic pain and opioid addiction. This pilot study supported using neurophysiology to characterize treatment effects and revealed that, following ACT, participants with this comorbidity exhibited reductions in brain activation due to painful stimulus and in connectivity at rest. (Source: Psychiatry Research: Neuroimaging)


Massage for Low-back Pain
Publication date: Available online 2 March 2016 Source:EXPLORE: The Journal of Science and Healing Author(s): Katrina Farber, L. Susan Wieland Background Low back pain (LPB) is one of the most common and costly musculoskeletal problems in modern society. It is experienced by 70% to 80% of adults at some time in their lives. Massage therapy has the potential to minimize pain and speed return to normal function. Objectives To assess the effects of massage therapy for people with non-specific LBP. Search methods We searched PubMed to August 2014, and the following databases to July 2014: MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Index to Chiropractic Literature, and Proquest Dissertation Abstracts.We also checked reference lists. There were no language restrictions used. Selection crit...


The aetiopathogenesis of fatigue: unpredictable, complex and persistent
Background Chronic fatigue syndrome is a common condition characterized by severe fatigue with post-exertional malaise, impaired cognitive ability, poor sleep quality, muscle pain, multi-joint pain, tender lymph nodes, sore throat or headache. Its defining symptom, fatigue is common to several diseases. Areas of agreement Research has established a broad picture of impairment across autonomic, endocrine and inflammatory systems though progress seems to have reached an impasse. Areas of controversy The absence of a clear consensus view of the pathophysiology of fatigue suggests the need to switch from a focus on abnormalities in one system to an experimental and clinical approach which integrates findings across multiple systems and their constituent parts and to consider multiple environ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Atypical chest pain in ACS: a trap especially for women.
Authors: Ricci B, Cenko E, Varotti E, Puddu PE, Manfrini O Abstract Not all acute coronary syndromes (ACS) exhibit the classic symptoms of chest pain. The diagnosis of ACS in patients without typical chest pain is often challenging. These patients are at increased risk for delayed or incorrect diagnosis, less aggressive treatment and high in-hospital mortality. The association between diabetes mellitus and absence of chest pain in ischemic heart disease is established. As well, it is known that women, more frequently than men, have atypical presentation. However, there is a lack of standardization in characterizing the population of patients with ACS and atypical presentation. The identification of other factors influencing and/or related with the absence of chest pain in ACS could...


The Pattern of Activity-Related Motion of the Hip Abductors Changes With Hip Pain.
Conclusion Increased Gmin motion during swing-phase and earlier Gmin and superficial Gmed motion in individuals with hip pain suggest an overall increase of muscle activity, possibly a protective behavior. J Orthop Sports Phys Ther, Epub 8 Mar 2016. doi:10.2519/jospt.2016.6132. PMID: 26954272 [PubMed - as supplied by publisher] (Source: Physical Therapy)


Induction of apoptosis and differentiation by atractylenolide-1 isolated from Atractylodes macrocephala in human leukemia cells.
Authors: Huang HL, Lin TW, Huang YL, Huang RL Abstract Atractylodes macrocephula Koidz (A. macrocephula, also known as Baizhu) is an important ingredient in several traditional Chinese herb complexes for the treatment of abdominal pain and gastroenterology diseases for thousands of years. We previously demonstrated the induction of ROS-mediated apoptosis by methanol extract of A. macrocephula in human leukemia cells. After purification and assessment of those active compounds from A. macrocephula ethanol extracts, in this study, we focused on the major active compound, atractylenolide I (ATL-I). Through MTT assay and morphology observation, we found cytotoxic effect of ATL-I in human K562 chronic myeloblastic leukemia (CML), U937 acute myeloblastic leukemia (AML) and Jurkat T lymph...


Selectivity of conditioned fear of touch is modulated by somatosensory precision
Abstract Learning to initiate defenses in response to specific signals of danger is adaptive. Some chronic pain conditions, however, are characterized by widespread anxiety, avoidance, and pain consistent with a loss of defensive response specificity. Response specificity depends on ability to discriminate between safe and threatening stimuli; therefore, specificity might depend on sensory precision. This would help explain the high prevalence of chronic pain in body areas of low tactile acuity, such as the lower back, and clarify why improving sensory precision may reduce chronic pain. We compared the acquisition and generalization of fear of pain‐associated vibrotactile stimuli delivered to either the hand (high tactile acuity) or the back (low tactile acuity). During acquisition, tact...


Structure-Activity Studies of Cysteine-Rich α-Conotoxins that Inhibit High Voltage-Activated Calcium Channels via GABAB Receptor Activation Reveal a Minimal Functional Motif.
Authors: Carstens BB, Berecki G, Daniel JT, Lee HS, Jackson KA, Tae HS, Sadeghi M, Castro J, O'Donnell T, Deiteren A, Brierley SM, Craik DJ, Adams DJ, Clark RJ Abstract α-Conotoxins are disulfide-rich peptides that target nicotinic acetylcholine receptors. Recently we identified several α-conotoxins that also modulate voltage-gated calcium channels by acting as G protein-coupled GABAB receptor (GABAB R) agonists. These α-conotoxins are promising drug leads for the treatment of chronic pain. To elucidate the diversity of α-conotoxins that act through this mechanism, we synthesized and characterized a set of peptides with homology to α-conotoxins known to inhibit high voltage-activated calcium channels via GABAB R activation. Remarkably, all disulfide isomers of the active α-co...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Capsule Commentary on Alford et al., Primary Care Patients with Drug Use Report Chronic Pain and Self-Medicate with Alcohol and Other Drugs
(Source: Journal of General Internal Medicine)


Evaluating the Risks of Opioid Use for Chronic Pain: Moving Beyond Overdose
(Source: Journal of General Internal Medicine)


Endovanilloid control of pain modulation by the rostroventromedial medulla in an animal model of diabetic neuropathy.
Authors: Silva M, Martins D, Charrua A, Piscitelli F, Tavares I, Morgado C, Di Marzo V Abstract The involvement of transient receptor vanilloid type-1 (TRPV1) channels in pain modulation by the brain remains understudied. The rostroventromedial medulla (RVM) plays a key role in conveying to the spinal cord pain modulatory influences triggered in higher brain centres, with co-existence of inhibitory (antinociceptive) and facilitatory (pronociceptive) effects. In spite of some reports of TRPV1 expression in the RVM, it remains unknown if endovanilloid signalling plays a direct role in local pain modulation. Here we used a model of diabetic neuropathy, the streptozotocin (STZ)-diabetic rat, to study the role of endovanilloid signalling in RVM-mediated pain modulation during chronic pa...


Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis.
Authors: Carey EP, Frank JW, Kerns RD, Ho PM, Kirsh SR Abstract In 2011, the Veterans Health Administration (VHA) implemented a pilot telementoring program across seven healthcare networks called the Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) for pain management. A VHA healthcare network is a group of hospitals and clinics administratively linked in a geographic area. We created a series of county-level maps in one network displaying (1) the location of Veterans with chronic pain, (2) VHA sites (i.e., coordinating center, other medical centers, outpatient clinics), (3) proportion of Veterans being seen in-person at pain specialty clinics, and (4) proportion of Veterans with access to a primary care provider participating in Pain SCAN-ECHO....


Opioid use and walking among patients with chronic low back pain.
This study examined the effect of a walking intervention on step counts among patients with chronic back pain who report opioid use. Data were collected as part of a randomized trial to reduce back-pain-related disability. Participants (n = 118 usual care, 111 intervention) were Veterans receiving care within one healthcare system. Step counts were collected at baseline, 6 mo, and 12 mo via an uploading pedometer. Self-reported opioid use was collected by survey. More than 40% (n = 99) of participants reported opioid use at baseline. After adjustment, the predicted mean step count for baseline opioid users assigned to the intervention increased by more than 1,200 steps compared with a reduction of nearly 400 steps for those assigned to usual care (between-group difference = 1,625 steps, p ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Association between pain outcomes and race and opioid treatment: Retrospective cohort study of Veterans.
We examined whether pain outcomes (pain interference, perceived pain treatment effectiveness) vary by race and then whether opioid use moderates these associations. These analyses are part of a retrospective cohort study among 3,505 black and 46,203 non-Hispanic, white Department of Veterans Affairs (VA) patients with diagnoses of chronic musculoskeletal pain who responded to the 2007 VA Survey of Healthcare Experiences of Patients (SHEP). We used electronic medical record data to identify prescriptions for pharmacologic pain treatments in the year after diagnosis (Pain Diagnosis index visit) and before the SHEP index visit (the visit that made one eligible to complete the SHEP); pain outcomes came from the SHEP. We found no significant associations between race and pain interference or pe...


Prevalence and correlates of painful conditions and multimorbidity in national sample of overweight/obese Veterans.
This study examined the prevalence and correlates of two common painful conditions (back pain and arthritis/joint pain) among overweight/obese Veterans in Veterans Health Administration (VHA) care. Participants (N = 45,477) completed the MOVE!23, a survey intended to tailor treatment for Veterans in VHA's MOVE! weight-management program. Overall, 72% of the sample reported painful conditions, with 10% reporting back pain, 26% reporting arthritis/joint pain, and 35% reporting both. We used multinomial logistic regression with "no pain" as the reference category to examine the association between painful conditions and participant characteristics. After multivariable adjustment, female Veterans had higher odds of reporting arthritis/joint pain and combined back and arthritis/joint pain than ...


72: Outcomes following physical therapy utilizing short-wave diathermy for the treatment of chronic pelvic pain
Short-wave diathermy (SWD) is a deep heat modality used to treat muscle spasm and inflammation. Its ability to target deep muscle groups makes it an ideal intervention for chronic pelvic pain, particularly pain due to non-relaxing pelvic floor dysfunction (NRPFD). The purpose of this study was to evaluate the benefits of SWD within a comprehensive physical therapy regimen for the treatment of chronic pelvic pain. (Source: American Journal of Obstetrics and Gynecology)


1: Addition of pudendal blocks to pelvic floor physical therapy for the treatment of pelvic pain: A randomized, placebo controlled trial
Chronic pelvic pain (CPP) is a challenging clinical problem affecting 14-24% of reproductive aged women. Pelvic floor tension myalgia (PFTM) is increasingly noted in patients with CPP. The purpose of this study was to assess if the addition of pudendal blocks to pelvic floor physical therapy will result in lower pain scores and shorter treatment duration. (Source: American Journal of Obstetrics and Gynecology)


5: Mindfulness-based stress reduction as a novel treatment for interstitial cystitis/bladder pain syndrome: A randomized controlled trial
This study’s objectives were to 1) explore whether MBSR, when used in addition to first and second line therapies as recommended by the American Urological Association guidelines, offered additional symptom improvement in IC/BPS based on validated questionnaires and 2) investigate MBSR’s feasibility and acceptability in patients with IC/BPS. (Source: American Journal of Obstetrics and Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Integrative Approach in Haemophillic Arthropathy of The Knee: a Case Report.
We report a case of arthroscopic synovectomy to reduce bleeding frequency in haemophilic arthropathy of the knee. Patient was a 15 years old male with haemophilic arthropathy of the left knee. We performed an arthroscopic synovectomy under tightly regulated factor VIII replacement therapy. There were villous synovial hypertrophy at all part of the joint, multiple bone and cartilage defect, and also anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) deficiency found intraoperatively. After 6 month follow up, subjective complain and bleeding frequency decreased significantly. The visual analog scale improved from 5-6 to 1-2, and the International Knee Documentation Committee Score increased from 49 to 66. Bleeding frequency decreased from 4-8 times per month to less than ...


One-year trajectories of motivation and physical activity in persons with disabilities.
CONCLUSION: Rehabilitation based on adapted physical activity is associated with improvement in autonomous motivation. However, improvement in motivation was not related to short- or long-term effects on physical activity. PMID: 26936650 [PubMed - as supplied by publisher] (Source: Journal of Rehabilitation Medicine)


Health conditions in people with spinal cord injury: Contemporary evidence from a population-based community survey in Switzerland.
DISCUSSION: A high prevalence of multimorbidity was found in community-dwelling persons with spinal cord injury. Treatment for some highly prevalent health conditions was infrequent. PMID: 26931074 [PubMed - in process] (Source: Journal of Rehabilitation Medicine)


Impairment of the Peritoneal Surface as a Decisive Factor for Intestinal Adhesions in Intraperitoneal Onlay Mesh Surgery - Introducing a New Rat Model.
CONCLUSION: This study introduces a model mimicking a clinical situation of e.g. hernia repair by intraperitoneally implanted meshes when mesh has contact with normal and with de-peritonealized intestine. The model might be useful for testing mesh types and coatings as well as other devices for their efficacy in adhesion prevention. The high adhesion scores of rats with local de-peritonealization compared with the low scores of animals with intact peritoneum indicate that the integrity of intestinal peritoneum is a decisive factor for adhesion formation. PMID: 26941568 [PubMed - in process] (Source: International Journal of Medical Sciences)


Prevalence and characteristics of fibromyalgia among HIV-positive patients in southern Israel.
CONCLUSIONS: Despite the dramatic improvement in management of HIV, FMS symptoms remain highly prevalent among these patients and are not directly correlated with indices of active disease. FMS is an important clinical issue to address among patients suffering from HIV infection. PMID: 26940885 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Rheumatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cutaneous findings in fibromyalgia syndrome and their effect on quality of life
Conclusion Genetic and pathophysiological studies to clarify the relationship between FMS and dermatologic disorders will provide more information on the association and common treatment of these disorders. (Source: Dermatologica Sinica)


Novel Oral Therapies for Opioid‐induced Bowel Dysfunction in Patients with Chronic Noncancer Pain
Opioid analgesics are frequently prescribed and play an important role in chronic pain management. Opioid‐induced bowel dysfunction, which includes constipation, hardened stool, incomplete evacuation, gas, and nausea and vomiting, is the most common adverse event associated with opioid use. Mu‐opioid receptors are specifically responsible for opioid‐induced bowel dysfunction, resulting in reduced peristaltic and secretory actions. Agents that reverse these actions in the bowel without reversing pain control in the central nervous system may be preferred over traditional laxatives. The efficacy and safety of these agents in chronic noncancer pain were assessed from publications identified through Ovid and PubMed database searches. Trials that evaluated the safety and efficacy of oral ...


Helicobacter pylori infection is high in paediatric nonulcer dyspepsia but not associated with specific gastrointestinal symptoms
ConclusionThe prevalence of H. pylori infection was high in Brazilian children with nonulcer dyspepsia, but was not associated with specific signs and symptoms, except for nausea. (Source: Acta Paediatrica)


From 200 BC to 2015 AD: an integration of robotic surgery and Ayurveda/Yoga.
CONCLUSIONS: Integration of Ayurveda, Yoga and minimally invasive robotic and VATS is acceptable to Indian patients and gives better clinical results and higher patient satisfaction. PMID: 26941975 [PubMed] (Source: Journal of Thoracic Disease)


[Musculoskeletal Pain and Vitamin D Deficiency in Children: A Pilot Follow-up Study of Vitamin D Therapy in Musculoskeletal/Orthopedic Conditions].
CONCLUSION This pilot study showed that vitamin D therapy possibly reduces pain intensity and improves mobility and daily functioning in children with musculoskeletal/orthopedic disorders, chronic recurrent pain, and vitamin D deficiency. Further follow-up and randomized studies are required in order to assess the validity of clinical recommendations. KEY WORDS: vitamin D, pain, musculoskeletal disorders, children, adolescents. PMID: 26936061 [PubMed - in process] (Source: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Investigational drugs for bladder pain syndrome (BPS) / interstitial cystitis (IC).
Authors: Chuang YC, Chermansky C, Kashyap M, Tyagi P Abstract INTRODUCTION: Bladder pain syndrome (BPS)/interstitial cystitis (IC) is associated with sensory lower urinary tract symptoms. Unfortunately, many of the existing oral treatments are ineffective in most patients of BPS/IC, which is the motivation for developing new drugs and therapeutic approaches. This review covers the latest drugs that have been investigated in BPS/IC patients. Intravesical treatments offer the opportunity to directly target the painful bladder with less systemic side effects. Areas Covered: In this review, the authors analyze the existing literature supporting the treatment of BPS/IC with conventional drugs including heparin, hyaluronic acid, chondroitin sulfate, and dimethylsulfoxide (DMSO). Furtherm...


Psychological aspects of juvenile fibromyalgia syndrome: a literature review
Resumo A síndrome da fibromialgia juvenil (SFJ) é uma condição dolorosa não inflamatória crônica que ocorre principalmente em meninas entre nove e 15 anos. Pode ser caracterizada por dores generalizadas e constantes em várias regiões do corpo, distúrbios do sono, fadiga diurna e estado de humor alterado. Fatores psicológicos e biológicos concomitantes resultaram na diminuição da capacidade de lidar com a dor. A qualidade de vida das crianças que sofrem de dores crônicas, e a de seus cuidadores, é severamente prejudicada e a ocorrência de sintomas de ansiedade e depressão é mais comum nessa população. Este estudo objetivou fazer uma revisão sistemática da literatura dos fatores psicossociais relacionados com a SFJ. Os achados revelam uma percepção divergente entre ...


Prevalence of chronic compartment syndrome of the legs: Implications for clinical diagnostic criteria and therapy
Conclusion Nocturnal leg pain or cramps is a common symptom. A significant part of the general population (7.6%) may have CCS of the legs, with symptoms ranging from very mild to severe. Implications Considering the high prevalence of CCS found in this study, it is likely that a large proportion of those presenting with muscular pain actually have CCS. These persons are usually advised to increase their physical training to achieve some degree of pain relief. However, CCS patients may instead experience both increased leg pain and a proximal myalgia, which is possibly a referred pain. A demanding “gold standard” test (requiring identification of elevated of intracompartmental pressures), unclear diagnostic criteria, poor long-term results from incomplete surgery, and an uncertain expl...


Fatigue Stress Fracture of the Talar Body: An Uncommon Cause of Ankle Pain
We report an uncommon cause of ankle pain due to a fatigue stress fracture of the body of the talus in a 32-year-old male social soccer player. Healing was achieved after weightbearing suppression for 6 weeks. Although rare, a stress fracture of the body of the talus should be considered in an athlete with a gradual onset of chronic ankle pain. Magnetic resonance imaging and bone scan are useful tools for early diagnosis. (Source: Journal of Foot and Ankle Surgery)


Wandering liver
A 4-year-old girl was evaluated at the Emergency Department because of chronic, intermittent, vague abdominal pain and chronic constipation. On physical examination, a mobile mass was palpable in the left flank. Blood test examinations were normal. Abdominal ultrasound showed a mobile liver in the transverse plane during patient positioning. Abdominal computed tomography (CT) confirmed the normal position of the liver with the patient in supine position (Fig 1), while the position of the liver changed from the right side to the left side of the abdomen when the patient was placed in the right lateral decubitus position (Fig 2). (Source: Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Sigmoid volvulus in children
A 10-year-old girl was evaluated at the Emergency Department because of a 2-day history of abdominal distension with pain and nonbilious vomiting. She had a 5-year history of chronic constipation, previously diagnosed as functional constipation. On physical examination, her abdomen was massively distended with voluntary guarding. Laboratory evaluation showed an elevated C-reactive protein (24 mg/dL, normal range 0–5 mg/dL). Abdominal radiograph showed a massively dilated colon (Fig 1). A nasogastric tube was placed, and a water-soluble contrast enema was obtained (Fig 2). (Source: Surgery)


Resveratrol attenuates neuropathic pain through balancing pro-inflammatory and anti-inflammatory cytokines release in mice.
Authors: Tao L, Ding Q, Gao C, Sun X Abstract Anti-inflammatory activity of resveratrol has been widely studied, while its beneficial effect on the management of neuropathic pain, a refractory chronic syndrome with pro-inflammation implicated in, is very little investigated. In the present study, the effects of different doses and various time window of administration of resveratrol were explored in a neuropathic mouse model of chronic constriction injury (CCI) of the sciatic nerve. It was demonstrated that pretreatment of resveratrol (5, 10, 20 and 40mg/kg) for 7 consecutive days before CCI did not alleviate neuropathic pain, while it clearly relieved the pain when administrated after CCI and such pain relief effect was more pronounced when administrated right after the peak of pa...


Caregiving During Young Adulthood
Embed from Getty Images When my mother's relatively routine spinal surgery went wrong nearly seventeen years ago, leaving her in chronic pain and unable to work, my brother gave up his life as he knew it. We call him "the sacrificial lamb." Like Jesus Christ before him, my older brother laid down his entire life at the feet of the people he loves. At 18 years old, my brother was entering his sophomore year in college. He was doing well with his mechanical engineering classes, made many friends, and enjoyed the occasional road trip out of state to go rock climbing. Our mother's surgery shattered his world. My brother came home from college for the weekend, thinking he'd only need to be present for the surgery -- he never returned. He spent his days helping our mother to the bathroom, cooki...


Analgesic opioid use in a health-insured epilepsy population during 2012
Conclusion The prevalences of analgesic opioid use, psychiatric diagnoses, and 16 pain conditions were significantly higher in the patient population with epilepsy than in the control population without epilepsy. Our study also showed how opioid use rate varied by gender, age category, and depression. The reasons for the greater prevalence of opioid use in people with epilepsy are unclear. It seems that increased pain prevalence is an important driver for the higher frequency of opioid use in people with epilepsy. Psychiatric illness and other factors also appear to contribute. Further analysis including more detailed clinical information that cannot be obtained through claims data alone will be required to provide more insight into opioid use in people with epilepsy. If opioid use is high...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


PROMIS Measures of Pain, Fatigue, Negative Affect, Physical Function and Social Function Demonstrate Clinical Validity across a Range of Chronic Conditions
To present an overview of a series of studies in which the clinical validity of the National Institutes of Health’s Patient Reported Outcome Measurement Information System (NIH; PROMIS®) measures was evaluated, by domain, across six clinical populations. (Source: Journal of Clinical Epidemiology)


Reliability of lumbar movement dysfunction tests for chronic low back pain patients
Assessment of lumbar movement dysfunction commonly comprises trunk range of motion (ROM), movement or control impairment (MCI), and reposition error (RE). Those assessments are typically based on visual observation. Consequently it is not possible to reliably quantify back movements for intersubject comparisons, or for monitoring changes before and after an intervention. Inertial measurement unit (IMU)-systems could be used to quantify these movement dysfunctions in clinical settings. The aim of this study was to evaluate the reliability of movement dysfunction tests when measured with a novel IMU-system. (Source: Manual Therapy)


An overview of the management of post-vasectomy pain syndrome.
This article reviews the current understanding of post-vasectomy pain syndrome, theories behind its pathophysiology, evaluation pathways, and treatment options. PMID: 26952956 [PubMed - as supplied by publisher] (Source: Asian Journal of Andrology)


PROMIS® Measures of Pain, Fatigue, Negative Affect, Physical Function and Social Function Demonstrate Clinical Validity across a Range of Chronic Conditions
To present an overview of a series of studies in which the clinical validity of the National Institutes of Health’s Patient Reported Outcome Measurement Information System (NIH; PROMIS®) measures was evaluated, by domain, across six clinical populations. (Source: Journal of Clinical Epidemiology)


PROMIS measures of pain, fatigue, negative affect, physical function, and social function demonstrate clinical validity across a range of chronic conditions
To present an overview of a series of studies in which the clinical validity of the National Institutes of Health's Patient Reported Outcome Measurement Information System (NIH; PROMIS) measures was evaluated, by domain, across six clinical populations. (Source: Journal of Clinical Epidemiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


PROMIS® measures of pain, fatigue, negative affect, physical function, and social function demonstrate clinical validity across a range of chronic conditions
To present an overview of a series of studies in which the clinical validity of the National Institutes of Health's Patient Reported Outcome Measurement Information System (NIH; PROMIS) measures was evaluated, by domain, across six clinical populations. (Source: Journal of Clinical Epidemiology)


But Will I Be a Beautiful Bride?
On August 13, 2016, I get to marry the love of my life. Every fiber of my soul cannot wait to be this man's wife. It took 13 years of dating, but I found him! I always imagined that meeting the right man would, to some degree, heal my body image issues. If someone else found me beautiful, certainly, I would finally be able to see the beauty in myself. Right?? For me, it was always the physical aspect I struggled with. I was raised to be very clear about my worth. I always believed that I was smart and kind and worthy of love, that I had a lot to offer someone. But I feared that if I wasn't thin enough, if I didn't meet the typical standards of "beauty", then that love may not happen for me. Before you scoff in disapproval, you should know how difficult it is to write that about oneself. Ad...


The Muscle You've Never Heard of But Need to Know
By Leslie Goldman When it comes to a tight core, most people picture six-pack abs. But a truly toned core is much more than what you see on the surface. Deep within your loins, the psoas (pronounced SO-az) muscle group partners with other muscles to stabilize and girdle the lower spine, promoting proper body alignment. "It's our most important skeletal muscle," says Jo Ann Staugaard-Jones, an advanced Pilates and Hatha yoga instructor and author of The Vital Psoas Muscle: Connecting Physical, Emotional, and Spiritual Well-Being. "The psoas is the only muscle connecting the spine to the legs, so it serves as the sole link between the upper and lower extremities." Even though you've never seen it, it creates movement and flow throughout the body, constantly contracting and releasing. Just li...


MassDevice.com +3 | The top 3 medtech stories for March 3, 2016
Say hello to MassDevice +3, a bite-sized view of the top three medtech stories of the day. This feature of MassDevice.com&#8217;s coverage highlights our 3 biggest and most influential stories from the day&#8217;s news to make sure you&#8217;re up to date on the headlines that continue to shape the medical device industry. &nbsp; 3. Virtual Incision’s inside-the-body surgical robot logs 1st-in-human use Virtual Incision this week announced the 1st-in-human use of its miniaturized robotically assisted surgical device, which was used in a colon resection procedures in Paraguay. The RASD is designed to operate entirely within the abdominal cavity via a single surgical incision. A spinout from the University of Nebraska, Virtual Incision raised $11.2 million last summer to fund a feasibilit...


Single-port onlay mesh repair of recurrent inguinal hernias after failed anterior and laparoscopic repairs.
CONCLUSION: Inguinal hernias recurring after two or more failed conventional anterior and laparoscopic repairs can be safely and efficiently treated with SIL-IPOM. PMID: 25848186 [PubMed - in process] (Source: JSLS : Journal of the Society of Laparoendoscopic Surgeons)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A protocol to recover needles lost during minimally invasive surgery.
CONCLUSIONS: On the basis of survey results and current literature, our protocol incorporates a camera survey of the abdomen, intraoperative fluoroscopic radiography, port inspection, and a quadrant-based systematic visual search for the recovery of needles lost during minimally invasive surgery. PMID: 25489212 [PubMed - indexed for MEDLINE] (Source: JSLS : Journal of the Society of Laparoendoscopic Surgeons)


FDA approves Medtronic’s Specify SureScan MRI-safe neurostim leads
Medtronic (NYSE:MDT) said today that the FDA approved its MRI-safe Specify SureScan spinal cord stimulation leads for treating chronic pain. The Fridley, Minn.-based medtech titan said the approval means it is the sole company to offer a full U.S. suite of SCS devices that are safe for full-body MRI scans. The Specify SureScan leads are due to hit the market later this month, Medtronic said. &#8220;The use of MRI as a diagnostic tool has grown significantly. Medtronic appreciates the opportunity to offer physicians the only full portfolio of SCS systems that allow patient access to full-body MRIs, facilitating optimal patient care and timely interventions,&#8221; vice president Julie Foster said in prepared remarks. &#8220;Medtronic remains committed to the advancement of spinal cord s...


Targeting Patient Subgroups With Chronic Low Back Pain for Osteopathic Manipulative Treatment: Responder Analyses From a Randomized Controlled Trial.
CONCLUSIONS: Subgrouping according to baseline levels of chronic LBP intensity and back-specific functioning appears to be a simple strategy for identifying sizeable numbers of patients who achieve substantial improvement with OMT and may thereby be less likely to use more costly and invasive interventions. (ClinicalTrials.gov number NCT00315120). PMID: 26927909 [PubMed - in process] (Source: Journal of the American Osteopathic Association)


Recovery From Chronic Low Back Pain After Osteopathic Manipulative Treatment: A Randomized Controlled Trial.
CONCLUSIONS: The OMT regimen was associated with significant and clinically relevant measures for recovery from chronic LBP. A trial of OMT may be useful before progressing to other more costly or invasive interventions in the medical management of patients with chronic LBP. (ClinicalTrials.gov number NCT00315120). PMID: 26927908 [PubMed - in process] (Source: Journal of the American Osteopathic Association)


Steroid Shot for Hip Pain May Carry Infection Risk If Too Close to Surgery
Title: Steroid Shot for Hip Pain May Carry Infection Risk If Too Close to SurgeryCategory: Health NewsCreated: 3/2/2016 12:00:00 AMLast Editorial Review: 3/3/2016 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic widespread pain is associated with worsening frailty in European men
Conclusion: the presence of CWP is associated with an increased risk of frailty in older European men. (Source: Age and Ageing)


Chronic pancreatitis
Publication date: Available online 2 March 2016 Source:The Lancet Author(s): Shounak Majumder, Suresh T Chari Summary Chronic pancreatitis describes a wide spectrum of fibro-inflammatory disorders of the exocrine pancreas that includes calcifying, obstructive, and steroid-responsive forms. Use of the term chronic pancreatitis without qualification generally refers to calcifying chronic pancreatitis. Epidemiology is poorly defined, but incidence worldwide seems to be on the rise. Smoking, drinking alcohol, and genetic predisposition are the major risk factors for chronic calcifying pancreatitis. In this Seminar, we discuss the clinical features, diagnosis, and management of chronic calcifying pancreatitis, focusing on pain management, the role of endoscopic and surgical intervention, an...


Personality and health in chronic pain: Have we failed to appreciate a relationship?
Publication date: July 2016 Source:Personality and Individual Differences, Volume 96 Author(s): C. Suso-Ribera, D. Gallardo-Pujol Pain research has failed to replicate personality-health associations found in the general population. Two hypotheses were tested in the present study. First, that methodological shortcomings found in previous research are responsible for the inconsistencies. Second, that pain is a contextual factor (i.e., moderator) influencing the relationship between personality and health. We enrolled 495 patients with chronic pain (mean age=58.54years, 63% women). Most had low back pain (59%). The study design was cross-sectional. We assessed the Five Factor Model of personality, several components of health, and pain intensity at the time of assessment. The relation be...


HPLC–DAD–MS identification of polyphenols from Passiflora leschenaultii and determination of their antioxidant, analgesic, anti-inflammatory and antipyretic properties
Publication date: Available online 18 February 2016 Source:Arabian Journal of Chemistry Author(s): Saravanan Shanmugam, Iniyavan Murugaiyan, Bruno dos Santos Lima, Mairim Russo Serafini, Adriano Antunes de Souza Araújo, Narendra Narain, Lucindo José Quintans-Júnior, Parimelazhagan Thangaraj Passion fruit (Passiflora leschenaultii DC), an endemic species to peninsular India, is traditionally used to treat various ailments such as dysentery, urinary stone disease and wounds. The present study aimed to investigate the antioxidant, analgesic, anti-inflammatory, antipyretic activities and chemical composition of leaf extracts of P. leschenaultii. Bioactive secondary metabolites such as total phenolics, tannins and flavonoids were quantified. Antioxidant activities were determined b...


Electrochemically triggered release of drugs
Publication date: Available online 3 March 2016 Source:European Polymer Journal Author(s): Sabine Szunerits, Florina Teodorescu, Rabah Boukherroub The release of drugs in a controlled manner over long-term periods has been recognized as one of the most promising biomedical technologies for treatment of certain types of diseases. Medical conditions such as cancer, diabetes and chronic pain require medications that must be dosed intermittently on demand and over a long period of time. The use of an electrical signal is considered as an attractive way when drug delivery on demand is requested. The approach is simple, safe, and inexpensive and has a wide range of possibilities to trigger the release. Changing the bias of the applied potential, the current density, using continuous or puls...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Erratum to ‘A biopsychosocial primary care intervention (Back on Track) versus primary care as usual in a subgroup of people with chronic low back pain: protocol for a randomised, controlled trial’ [JPHYS 61/3 (2015) 155]
Publication date: Available online 2 March 2016 Source:Journal of Physiotherapy Author(s): Reni MA van Erp, Ivan PJ Huijnen, Jeanine A Verbunt, Rob JEM Smeets (Source: Journal of Physiotherapy)


N-acetylcysteine Ameliorates Prostatitis via miR-141 Regulating Keap1/Nrf2 Signaling
In this study, we determined the effect of N-acetylcysteine (NAC) on prostatitis and the molecular mechanism involved in it. Male Sprague-Dawley rats were divided into three groups: control group (group A, n = 20), carrageenan-induced chronic nonbacterial prostatitis (CNP) model group (group B, n = 20), and carrageenan-induced CNP model group with NAC injection (group C, n = 20). Eye score, locomotion score, inflammatory cell count, cyclooxygenase 2 (COX2) expression, and Evans blue were compared in these three groups. The expression of miR-141 was determined by quantitative real-time PCR (qRT-PCR). Moreover, protein expressions of Kelch-like ECH-associated protein-1 (Keap1) and nuclear factor erythroid-2 related factor 2 (Nrf2) and its target genes were examined by Western blo...


The prevalence of functional dyspepsia using Rome III questionnaire among chronic hepatitis C patients
Hepatitis C virus (HCV) is a common chronic infection that is widely associated with symptoms of fatigue and abdominal pain. The aim of the present study was to determine the prevalence of functional dyspepsia... (Source: BMC Gastroenterology)


Randomised controlled trial of referral to a telephone-based weight management and healthy lifestyle programme for patients with knee osteoarthritis who are overweight or obese: a study protocol
Introduction Knee osteoarthritis (OA) is one of the most common chronic diseases worldwide and is associated with significant pain and disability. Clinical practice guidelines consistently recommend weight management as a core aspect of care for overweight and obese patients with knee OA; however, provision of such care is suboptimal. Telephone-based interventions offer a novel approach to delivery of weight management care in these patients. The aim of the proposed study is to assess the effectiveness of referral to a telephone-based weight management and healthy lifestyle programme, previously shown to be effective in changing weight, in improving knee pain intensity in overweight or obese patients with knee OA, compared to usual care. Methods and analysis A parallel, randomised control...


Does perceived injustice correlate with pain intensity and disability in orthopedic trauma patients?
Individuals who experience musculoskeletal trauma may construe the experience as unjust and themselves as victims. Perceived injustice is a cognitive construct comprised by negative appraisals of the severity of loss as a consequence of injury, blame, injury-related loss, and unfairness. It has been associated with worse physical and psychological outcomes in the context of chronic health conditions. The purpose of this study is to explore the association of perceived injustice to pain intensity and physical function in patients with orthopedic trauma. (Source: Injury)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Big rise in hip replacements over last decade
NHS data has shown that the number of hip replacement operations on people aged under 60 has risen 76% in the last decade. More and more people under the age of 60 are turning to hip replacement surgery as a remedy for chronic hip pain, according to new NHS data. The Royal College of Surgeons has analysed statistics released by the Health & Social Care Information Centre showing that hip replacements are becoming more common among younger patients, which is indicative of growing confidence in this type of treatment. The growing demand for hip replacements According to the data, there were 89,919 hip replacement operations conducted through the NHS in England in 2004&ndash;05, but this number rose by 47% to 122,154 in 2014&ndash;15. When looking specifically at people under the age of 6...


Development of a Feasible Implementation Fidelity Protocol Within a Complex Physiotherapy-Led Self-Management Intervention.
CONCLUSIONS: A feasible IFP was developed based on a two-phase development process involving intervention stakeholders. This study provides valuable information on the feasibility of rigorously addressing IF within physiotherapy interventions and provides recommendations for researchers wishing to address IF in similar areas. PMID: 26939605 [PubMed - as supplied by publisher] (Source: Physical Therapy)


The Use of Antiepileptics in Migraine Prophylaxis.
CONCLUSIONS: Available AEDs to prophylactically treat migraine are few but of robust clinical efficacy. Special care needs to be exerted with respect to their side effects. Future research is needed for a better understanding of their mechanisms of action in migraine. Such research has the potential of providing some insight into the pathophysiology of migraine. PMID: 26935348 [PubMed - as supplied by publisher] (Source: Headache)


Loss of Ca(2+)-permeable AMPA receptors in synapses of tonic firing substantia gelatinosa neurons in the chronic constriction injury model of neuropathic pain.


Does perceived injustice correlate with pain intensity and disability in orthopaedic trauma patients?
Individuals who experience musculoskeletal trauma may construe the experience as unjust and themselves as victims. Perceived injustice is a cognitive construct comprised by negative appraisals of the severity of loss as a consequence of injury, blame, injury-related loss, and unfairness. It has been associated with worse physical and psychological outcomes in the context of chronic health conditions. The purpose of this study is to explore the association of perceived injustice to pain intensity and physical function in patients with orthopaedic trauma. (Source: Injury)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Prehospital Naloxone Administration for Opioid-Related Emergencies
Opioid abuse is a major public health epidemic in the United States and Canada as the number of deaths related to opioid toxicity continues to rise. In 2013, there were 16,325 prescription opioidrelated deaths in the U.S., quadruple the number of deaths that occurred in 1999,1&nbsp;and an additional 8,257 deaths from heroin.2,3&nbsp;A similar situation exists in Canada.4 There have been multiple efforts to combat this crisis, including calls to improve opioid prescription practices, access to addiction treatment, and enhanced treatment tools and protocols for first responders. With the implementation of public naloxone (Narcan) distribution programs,5&nbsp;and administration of naloxone by police departments and first response programs,6&nbsp;naloxone is becoming widely available to treat ...


Graded group exercise and fear avoidance behavior modification in the treatment of chronic low back pain.
CONCLUSION: CLBP patients undergoing an 8-week intensive exercise approach incorporating both behavioral and physical conditioning principles showed both significant and clinically significant improvements in this observational case series. Long-term benefits were also seen in both the 6 and 12 month follow-up questionnaires although warrants further investigation due to limited survey return rate and study design. PMID: 26922849 [PubMed - as supplied by publisher] (Source: Journal of Back and Musculoskeletal Rehabilitation)


Effects of Pilates and trunk strengthening exercises on health-related quality of life in women with chronic low back pain.
CONCLUSIONS: An 8-week Pilates program improved HRQOL and reduced functional disability more than either a trunk strengthening exercise program or controls among women with CLBP. PMID: 26922845 [PubMed - as supplied by publisher] (Source: Journal of Back and Musculoskeletal Rehabilitation)


Health Tip: Help Prevent Back Pain During Sleep
Title: Health Tip: Help Prevent Back Pain During SleepCategory: Health NewsCreated: 3/2/2016 12:00:00 AMLast Editorial Review: 3/2/2016 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Neuropathic low back pain in clinical practice
ConclusionsChronic LBP often has an under‐recognized neuropathic component, which can be challenging to manage, and requires improved understanding and better diagnosis and treatment. What does this review add?Increased recognition and improved understanding of the neuropathic component of low back pain raises the potential for the development of mechanism‐based therapies.Open and retrospective studies suggest that agents like tapentadol and topical analgesics — such as the capsaicin 8% patch and the lidocaine 5% medicated plaster — may be effective options for the treatment of neuropathic low back pain in defined patient groups. (Source: European Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Response to Ruan et al. regarding: Multimodal nociceptive mechanisms underlying chronic pelvic pain
(Source: American Journal of Obstetrics and Gynecology)


Multimodal nociceptive mechanisms underlying chronic pelvic pain
(Source: American Journal of Obstetrics and Gynecology)


How Do We Understand Depression in People with Persistent Pain?
Abstract Depression and depressed mood are common in people with persistent (chronic) pain, exacerbating disability and worsening quality of life. Yet the relationship between persistent pain and depression remains unclear, despite its importance for designing or adapting interventions to address both pain and depression. Meta-analysis of cognitive and behavioral interventions designed for rehabilitation of persistent pain shows small benefits for distress. However, substantial variation between studies in patients’ baseline levels of depression and in quality of treatments militates against any clear conclusions. Apart from these interventions, longitudinal studies on chronic pain and depression in adults from clinical populations provide weak evidence that depression worsens p...


A Comprehensive Examination of Changes in Psychological Flexibility Following Acceptance and Commitment Therapy for Chronic Pain
Abstract Acceptance and commitment therapy (ACT) for chronic pain aims to improve patient functioning by fostering greater psychological flexibility. While promising, ACT treatment process research in the context of chronic pain so far has only focused on a few of the processes of psychological flexibility. Therefore, this study aimed to more comprehensively examine changes in processes of psychological flexibility following an ACT-based treatment for chronic pain, and to examine change in these processes in relation to improvements in patient functioning. Individuals with chronic pain attending an interdisciplinary ACT-based rehabilitation program completed measures of pain, functioning, depression, pain acceptance, cognitive fusion, decentering, and committed action at pre- and ...


Chronic Pain and Prescription Drug Use and Abuse: Emerging Research in General Internal Medicine
(Source: Journal of General Internal Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Learning to Manage Chronic Pain: The Patients’ Perspective
Conclusion The results of this analysis reinforce the effectiveness of the interdisciplinary CPMU program at improving patients’ quality of life. Findings may assist in the promotion of the program to stakeholders such as referral sources. The outcomes may also assist in the development of future programs that have similar goals. Concerns that arise within patients’ comments may assist clinicians in this program to make adjustments such that all unique needs are met. (Source: Pain and Therapy)


Role of neuromodulation and optogenetic manipulation in pain treatment.
Authors: Liu S, Li C, Xing Y, Wang Y, Tao F Abstract Neuromodulation, including invasive and non-invasive stimulation, has been used to treat intractable chronic pain. However, the mechanisms by which neuromodulation produces antinociceptive effect still remain uncertain. Optogenetic manipulation, a recently developed novel approach, has already proven its value to clinicians by providing new insights into mechanisms of current clinical neuromodulation methods as well as pathophysiology of nervous system diseases at the circuit level. Here, we discuss the principles of two neuromodulation methods (deep brain stimulation and motor cortex stimulation) and their applications in pain treatment. More important, we summarize the new information from recent studies regarding optogenetic m...


Interventions for helping people adhere to compression treatments for venous leg ulceration.
CONCLUSIONS: It is unclear whether interventions designed to help people adhere to compression therapy improve venous ulcer healing and reduce recurrence. There is a lack of trials of interventions that promote adherence to compression therapy for venous ulcers. PMID: 26932818 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Analgesic opioid use in a health-insured epilepsy population during 2012.
CONCLUSION: The prevalences of analgesic opioid use, psychiatric diagnoses, and 16 pain conditions were significantly higher in the patient population with epilepsy than in the control population without epilepsy. Our study also showed how opioid use rate varied by gender, age category, and depression. The reasons for the greater prevalence of opioid use in people with epilepsy are unclear. It seems that increased pain prevalence is an important driver for the higher frequency of opioid use in people with epilepsy. Psychiatric illness and other factors also appear to contribute. Further analysis including more detailed clinical information that cannot be obtained through claims data alone will be required to provide more insight into opioid use in people with epilepsy. If opioid use is hig...


OXN PR for chronic pain in older patients with cognitive impairment
Petr&ograve; E, Ruffini E, Cappuccio M, Guerini V, Belotti G, Fascendini S, Licini C, Marcassa C (Source: Neuropsychiatric Disease and Treatment)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Osteopathic manipulative treatment improves chronic back pain
Stephen FellerCHICAGO, March 1 (UPI) -- Osteopathic manipulative treatment can improve recovery from chronic low back pain and help patients avoid surgery, two recent studies show. (Source: Health News - UPI.com)


Opioid painkillers could make chronic pain worse as 'endorphins become less effective'
Josie Cowan, 24, from Bolton, has been taking strong, potentially addictive co-codamol pills for 12 years. They can make the pain seem worse through 'opioid-induced hyperalgesia'. (Source: the Mail online | Health)


Consultation on new products for specialised services
NHS England has launched a public consultation on a proposed number of new products for specialised services, including fampridine for multiple sclerosis in adult patients and ziconotide for chronic refractory cancer pain. The consultation is available from the NHS England website until 27 March 2016. (Source: The Pharmaceutical Journal)


Surgical Decompression of Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Racers: Comparative Long-term Results of Wide-Open Versus Mini-Open Fasciotomy
Conclusions: Surgical open or mini-invasive fasciotomy is equally successful in motorcycling racers with forearm CECS. Although the sensitivity of TRest is quite high in our series, further studies are still needed to validate its diagnostic value. Clinical Relevance: Surgical open or mini-invasive fasciotomy is equally successful in motorcycling racers with forearm CECS. (Source: Clinical Journal of Sport Medicine)


Abdominal Assessment
Abdominal pain is one of the most common complaints by patients, and assessment of abdominal pain and associated symptoms can be challenging for home healthcare providers. Reasons for abdominal pain are related to inflammation, organ distention, and ischemia. The history and physical examination are important to narrow the source of acute or chronic problems, identify immediate interventions, and when necessary, facilitate emergency department care. (Source: Home Healthcare Nurse)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Impact of a Sit-Stand Workstation on Chronic Low Back Pain: Results of a Randomized Trial
Conclusions: Our findings support the hypothesis that chronic LBP might be improved by the introduction of a SSW in an office environment. (Source: Journal of Occupational and Environmental Medicine)


Acupuncture and Related Therapies for Symptom Management in Palliative Cancer Care: Systematic Review and Meta-Analysis
Abstract: Available systematic reviews showed uncertainty on the effectiveness of using acupuncture and related therapies for palliative cancer care. The aim of this systematic review and meta-analysis was to summarize current best evidence on acupuncture and related therapies for palliative cancer care. Five international and 3 Chinese databases were searched. Randomized controlled trials (RCTs) comparing acupuncture and related therapies with conventional or sham treatments were considered. Primary outcomes included fatigue, paresthesia and dysesthesias, chronic pain, anorexia, insomnia, limb edema, constipation, and health-related quality of life, of which effective conventional interventions are limited. Thirteen RCTs were included. Compared with conventional interventions, meta-ana...


Can Chronic Pain Patients Be Adequately Treated Using Generic Pain Medications to the Exclusion of Brand-Name Ones?
According to the Food and Drug Administration (FDA) reports, approximately 8 in 10 prescriptions filled in the United States are for generic medications, with an expectation that this number will increase over the next few years. The impetus for this emphasis on generics is the cost disparity between them and brand-name products. The use of FDA-approved generic drugs saved 158 billion dollars in 2010 alone. In the current health care climate, there is continually increasing pressure for prescribers to write for generic alternative medications, occasionally at the expense of best clinical practices. This creates a conflict wherein both physicians and patients may find brand-name medications clinically superior but nevertheless choose generic ones. The issue of generic versus brand medicatio...


Cannabinoid Hyperemesis Syndrome: An Emerging Drug-Induced Disease
Cannabinoid hyperemesis is a relatively rare but significant adverse effect of chronic marijuana use characterized by severe, cyclic nausea, vomiting, and abdominal pain and marked by compulsive hot-water bathing for temporary symptom relief. A 37-year-old African American male with no significant medical history other than the habitual abuse of marijuana was admitted for intractable nausea, vomiting, and abdominal pain. With the exception of abdominal skin hyperpigmentation and scarring secondary to the direct application of heat through a heating pad, physical examination of the abdomen was unremarkable. Laboratory studies revealed a mild leukocytosis and acute renal dysfunction. All diagnostic examinations were found to be unremarkable or noncontributory to the patient's presenting stat...


Cognitive Patient Education for Low Back Pain in Primary Care: A Cluster Randomized Controlled Trial and Cost-Effectiveness Analysis
Conclusion. This study showed no clinical or health economic benefits as a result of adding a cognitive education program to usual treatment for patients with subacute and chronic LBP. Potential weaknesses such as a long recruiting period and potentially low compliance with the cognitive intervention warrant a careful interpretation of the results. Level of Evidence: 3 (Source: Spine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Identification of Preliminary Prognostic Indicators for Back Rehabilitation in Patients With Nonspecific Chronic Low Back Pain: A Retrospective Cohort Study
Conclusion. Potentially, the preset exercises of the BR in this study design were not appropriate for the identified subgroup. The results of this study should be replicated in a RCT design that conforms to the necessary methodological steps in the identification of prognostic indicators and clinical prediction rules (CPRs). Level of Evidence: 3 (Source: Spine)


Prolong Exposure of NSAID in Patients With RA Will Decrease the Risk of Dementia: A Nationwide Population-Based Cohort Study
Abstract: Rheumatoid arthritis (RA), a chronic, systemic inflammatory disorder, primarily affects joints. Several studies have indicated that early inflammation, cardiovascular disease, and depression in patients were associated with a considerably increased risk of dementia. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for treating RA. NSAIDs facilitate alleviating RA-associated chronic pain, inflammation, and swelling. Therefore, we conducted this nationwide study for evaluating the association between the dementia risk and NSAID treatment in patients with RA. The RA cohort comprised patients aged 20 years and older who were newly diagnosed with RA between 2000 and 2011, with data obtained from the Registry of Catastrophic Illnesses Patient Database (RCIPD). Patients ...


A Nationwide Population-Based Cohort Study of Migraine and Organic-Psychogenic Erectile Dysfunction
Abstract: As chronic illnesses and chronic pain are related to erectile dysfunction (ED), migraine as a prevalent chronic disorder affecting lots of people all over the world may negatively affect quality of life as well as sexual function. However, a large-scale population-based study of erectile dysfunction and other different comorbidities in patients with migraine is quite limited. This cohort longitudinal study aimed to estimate the association between migraine and ED using a nationwide population-based database in Taiwan. The data used for this cohort study were retrieved from the Longitudinal Health Insurance Database 2000 in Taiwan. We identified 5015 patients with migraine and frequency matched 20,060 controls without migraine from 2000 to 2011. The occurrence of ED was followed ...


Systematic Review of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Abstract: Acupuncture is a promising therapy for relieving symptoms in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), which affects >15% of adult men worldwide. The aim of the study was to assess the effects and safety of the use of acupuncture for CP/CPPS. MEDLINE, EMBASE, CENTRAL, Web of Science, CBM, CNKI, Wang-Fang Database, JCRM, and CiNii were searched from their inception through 30 November 2015. Grey literature databases and websites were also searched. No language limits were applied. Only randomized controlled trials (RCTs) with CP/CPPS treated by acupuncture were included. Two reviewers extracted data and assessed the risk of bias of RCTs using the Cochrane Risk of Bias Tools, respectively. Seven trials were included, involving 471 participants. The result of m...


CHRONIC PAIN/FEVER RELIEF (Aspirin Delayed Release Tablets, 81 Mg) Tablet [We Care Distributor Inc.]
Updated Date: Mar 1, 2016 EST (Source: DailyMed Drug Label Updates)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Lower verbal intelligence is associated with diabetic complications and slower walking speed in people with Type 2 diabetes: the Maastricht Study
ConclusionsLower verbal intelligence was associated with the presence of some diabetic complications and with a slower walking speed, a measure of physical functioning. Educational level largely explained these associations. This implies that clinicians should be aware of the educational level of people with diabetes and should provide information at a level of complexity tailored to the patient.This article is protected by copyright. All rights reserved. (Source: Diabetic Medicine)


Duloxetine in OsteoArthritis (DOA) study: study protocol of a pragmatic open-label randomised controlled trial assessing the effect of preoperative pain treatment on postoperative outcome after total hip or knee arthroplasty
This study aims to evaluate the postoperative effects of preoperative screening and targeted duloxetine treatment of CS on residual pain compared with care-as-usual. Methods and analysis This multicentre, pragmatic, prospective, open-label, randomised controlled trial includes patients with idiopathic hip/knee OA who are on a waiting list for primary THA/TKA. Patients at risk for CS will be randomly allocated to the preoperative duloxetine treatment programme group or the care-as-usual control group. The primary end point is the degree of postoperative pain 6&nbsp;months after THA/TKA. Secondary end points at multiple time points up to 12&nbsp;months postoperatively are: pain, neuropathic pain-like symptoms, (pain) sensitisation, pain catastrophising, joint-associated problems, physical a...


A Survey of Headache Medicine Physicians on the Likeability of Headaches and Their Personal Headache History
ConclusionsHMS preferred to treat some disorders more than others, with EM most liked and NDPH least preferred, which may reflect how well patients with those disorders respond to treatment. The lifetime prevalence of EM among HMS is significantly greater than among neurologists, both significantly greater than EM in the general population. An explanation for the higher prevalence among neurologists is not certain but perhaps migraine is associated with a choice to become an HMS during or after neurology residency. The lifetime prevalence among HMS of CM may be and EC is much greater than among the general population for uncertain reasons. (Source: Headache: The Journal of Head and Face Pain)


The accuracy and acceptability of performing capillary blood glucose measurements at the earlobe
ConclusionThe earlobe is to be recommended as a safe alternative site for capillary blood glucose monitoring unless the patient is in a suspected hypoglycaemic state. (Source: Journal of Advanced Nursing)


Chronic respiratory symptoms and associated factors among cement factory workers in Dejen town, Amhara regional state, Ethiopia, 2015
Conclusion Chronic respiratory symptoms were highly prevalent among Dejen cement factory workers. Age, sex, education level, working department, smoking, work experience, and training were identified factors. Pre employment and on service training, smoking cessation programs, improving hygienic practices are important tasks in order to maintain the health and safety of workers. (Source: Multidisciplinary Respiratory Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pain as metaphor: metaphor and medicine
Like many other disciplines, medicine often resorts to metaphor in order to explain complicated concepts that are imperfectly understood. But what happens when medicine's metaphors close off thinking, restricting interpretations and opinions to those of the negative kind? This paper considers the deleterious effects of destructive metaphors that cluster around pain. First, the metaphoric basis of all knowledge is introduced. Next, a particular subset of medical metaphors in the domain of neurology (doors/keys/wires) are shown to encourage mechanistic thinking. Because schematics are often used in medical textbooks to simplify the complex, this paper traces the visual metaphors implied in such schematics. Mechanistic-metaphorical thinking results in the accumulation of vast amounts of data ...


Estimation of minimal clinically important change of the Japanese version of EQ-5D in patients with chronic noncancer pain: a retrospective research using real-world data
Quality of life (QoL) is routinely assessed and evaluated in medical research. However, in Japan, there is a lack of solid cutoff criteria for evaluating QoL improvement in chronic noncancer pain management. T... (Source: Health and Quality of Life Outcomes)


Central Neuropathic Pain Syndromes
Chronic pain is common in patients with neurologic complications of a central nervous system insult such as stroke. The pain is most commonly musculoskeletal or related to obligatory overuse of neurologically unaffected limbs. However, neuropathic pain can result directly from the central nervous system injury. Impaired sensory discrimination can make it challenging to differentiate central neuropathic pain from other pain types or spasticity. Central neuropathic pain may also begin months to years after the injury, further obscuring recognition of its association with a past neurologic injury. (Source: Mayo Clinic Proceedings)


ESCAPE-into the community - a community-based rehabilitation programme for elderly people with chronic joint pain
(Source: Perspectives in Public Health)


Newly Diagnosed Crohn's Disease in Patient with Familial Mediterranean Fever.
Authors: Akar T, Dindar G, Malkoç D, Karagözoğlu K, Kılavuz B, Üstündağ Y Abstract Chronic abdominal pain sometimes constitute a major challenge, specially when a patient has two diseases with dominant features of abdominal pain in both. At this point, clinicians face a daunting task both in diagnosing and treating an individual's  chronic abdominal pain. Similarly, familial Mediterranean fever disease and Crohn's disease have the same clinical features in terms of chronic abdominal pain, and inflammatory properties of these diseases. The association of familial Mediterranean fever disease and Crohn's disease is very rare and may lead to a remarkable challenge in both diagnosis and treatment. Here, we report a young man with FMF disease presented with extraordinary and into...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Mechanical Lumbar Traction: What Is Its Place in Clinical Practice?
Authors: Abstract evidence concludes that mechanical lumbar traction is not effective for treating acute or chronic nonspecific low back pain (LBP). However, many physical therapists continue to use it, primarily as an additional modality. Indeed, expert clinical opinion, theoretical models, and some research evidence suggest that certain patients with LBP respond positively to traction. A study published in the March 2016 issue of JOSPT investigates the effectiveness of traction in prone as an adjunct to an extension-oriented exercise program in patients with LBP and leg pain and explores whether a previously identified set of patient characteristics is associated with better outcomes from traction. In this Perspectives for Practice, the authors explain the impact of their findin...


Know Pain, Know Gain? A Perspective on Pain Neuroscience Education in Physical Therapy.
Authors: Louw A, Puentedura EJ, Zimney K, Schmidt S Abstract Chronic pain is incredibly complex, and so are decisions as to its treatment. During physical therapy care, pain neuroscience education (PNE) aims to help patients understand more about their pain from a biological and physiological perspective. Accompanying the growing evidence for the ability of PNE to reduce pain and disability in patients with chronic pain is an increased interest in PNE from scientists, educators, clinicians, and conference organizers. However, the rise in popularity of PNE has highlighted a historical paradox of increased knowledge not necessarily corresponding with improved care. This Viewpoint discusses the growth and popularity of PNE as well as critical future considerations such as clinical app...


Chronic Pelvic Pain in Women.
Authors: Speer LM, Mushkbar S, Erbele T Abstract Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. It is typically associated with other functional somatic pain syndromes (e.g., irritable bowel syndrome, nonspecific chronic fatigue syndrome) and mental health disorders (e.g., posttraumatic stress disorder, depression). Diagnosis is based on findings from the history and physical examination. Pelvic ultrasonography is indicated to rule out anatomic abnormalities. Referral for diagnostic evaluation of endometriosis by laparoscopy is u...


Factors Associated with Prescription of Opioids and Co-prescription of Sedating Medications in Individuals with HIV
Abstract Opioids are often prescribed for chronic pain, and opioid risks such as overdose and death are heightened when opioids are co-prescribed with other sedating medications. We investigated factors associated with chronic opioid prescription, alone and in combination with benzodiazepines and muscle relaxants, in a clinical cohort of individuals with HIV. We used multivariable logistic regression models to determine participant clinical and demographic characteristics that are associated with chronic prescription of opioids or chronic co-prescription of opioids with sedating medications. Among 1474 participants, chronic prescription of opioids occurred in 253 individuals (17.2 %), and chronic co-prescription occurred in 90 individuals (6.1 %). Age &gt;50, public insurance a...


Hemicrania continua may respond to repetitive sphenopalatine ganglion block: A case report.
CONCLUSION: SPG block using a local anesthetic may be an effective treatment for patients with HC, specifically for those who cannot tolerate indomethacin, or when this drug is contraindicated. PMID: 26926875 [PubMed - as supplied by publisher] (Source: Headache)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Which patients with chronic kidney disease have the greatest symptom burden? A comparative study of advanced CKD stage and dialysis modality
ConclusionsIn CKD, symptom burden is better understood when capturing the multidimensional aspects of a range of physical and psychological symptoms. Fatigue, pain and sexual dysfunction are key contributors to symptom burden, and these symptoms are often under‐recognised and warrant routine assessment. The CKD‐SBI offers a valuable tool for renal clinicians to assess symptom burden, leading to the commencement of timely and appropriate interventions. (Source: Journal of Renal Care)


Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain.
Authors: MacPherson H, ATLAS Project Team PMID: 26926698 [PubMed - in process] (Source: Annals of Internal Medicine)


Reported Outcomes of the Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain Article.
Authors: Drysdale H, Milosevic I, Goldacre B, COMPare Team PMID: 26926697 [PubMed - in process] (Source: Annals of Internal Medicine)


Antioxidant cocktail and pregabalin combination ameliorates pain recurrence after ductal clearance in chronic pancreatitis: results of a randomized, double blind, placebo‐controlled trial
ConclusionAntioxidant‐pregabalin combination results in significant relief in pain recurrence after ductal clearance in narcotic naïve patients with chronic calcific pancreatitis. This article is protected by copyright. All rights reserved. (Source: Journal of Gastroenterology and Hepatology)


Electromyographic Abnormalities Associated with Symptomatic Sacral Tarlov Cysts
Abstract Tarlov or perineural cysts (TC) are commonly overlooked as a cause of sacral and ischial pain, and urogenital and bowel problems. TC can be seen on MRI, but are often considered asymptomatic. This is especially true for smaller cysts. Moreover, there are only few diagnostic characteristics that can be used to confirm that the cysts are the cause of the symptoms. As a consequence, a lot of controversy remains regarding the clinical importance of TC. Because of this underdiagnosed condition, patients often suffer for several years from unrecognized chronic neuropathic pain and neurological conditions. In this article, case reports of three patients with giant and smaller symptomatic sacral cysts are presented, in which electromyographic testing was performed to demonstrate nerve dam...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Patterns and prevalence of medication use across the menstrual cycle among healthy, reproductive aged women
ConclusionsPatterns of medication use among reproductive age women vary across the menstrual cycle for certain types of medications, particularly in pain (e.g., Ibuprofen), antibiotics (e,g, Amoxicillin), and CNS (e.g., Adderall) medications. Future studies involving use of these types of medication in premenopausal women may need to consider the relationship of their use to the menstrual cycle. Copyright © 2016 John Wiley & Sons, Ltd. (Source: Pharmacoepidemiology and Drug Safety)


Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory
ConclusionThis study provides support for these CSI severity levels as a guideline for healthcare providers and researchers in interpreting CSI scores and evaluating treatment responsiveness. (Source: Pain Practice)


Sindbis virus as a human pathogen—epidemiology, clinical picture and pathogenesis
Summary Sindbis virus (SINV; family Togaviridae, genus Alphavirus) is an enveloped RNA virus widely distributed in Eurasia, Africa, Oceania and Australia. SINV is transmitted among its natural bird hosts via mosquitoes. Human disease caused by SINV infection has been reported mainly in South Africa and in Northern Europe. Vector mosquito abundance affects the annual incidence of SINV infections with occasional outbreaks of up to 1500 patients. Symptoms include fever, malaise, rash and musculoskeletal pain. In a significant portion of patients the debilitating musculoskeletal symptoms persist for years. Chronic disease after SINV infection shares many features with autoimmune diseases. Currently there is no specific treatment available. Recently SINV infections have been detected outside th...


Extensive versus functional endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps and asthma: A 1-year study.
CONCLUSION: EESS for patients with CRSwNP and with asthma may help to improve the subjective olfaction and endoscopic appearance. PMID: 26980396 [PubMed - in process] (Source: American Journal of Rhinology and Allergy)


Differences in the Sino-Nasal Outcome Test 22 and visual analog scale symptom scores in chronic rhinosinusitis with and without nasal polyps.
CONCLUSION: With controlling of covariates that may influence the severity of the disease, this study showed significant differences in symptom patterns and different aspects of HRQL impairment between patients with CRSwNP and patients with CRSsNP, however, with no difference in the total HRQL score. PMID: 26980391 [PubMed - in process] (Source: American Journal of Rhinology and Allergy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Evaluation of residual symptoms: A method to assess surgical outcomes for nasal polyposis.
CONCLUSION: This information is useful to warn patients about the difficulty of getting rid of all symptoms and that there is a chance that some symptoms remain or even reappear after NP surgery. PMID: 26980384 [PubMed - in process] (Source: American Journal of Rhinology and Allergy)


The Effect of Harmonic Technique vs End Range Loading Exercises on Pain and Disability in Patients With Non-Specific Chronic Low Back Pain: A Preliminary Study
The purpose of this study was to compare the effects of end range loading (ERL) vs harmonic technique (HT) on patients with chronic low back pain (LBP). (Source: Journal of Chiropractic Medicine)


Cognitive Behavioral Therapy plus Amitriptyline for Children and Adolescents with Chronic Migraine Reduces Headache Days to ≤4 Per Month
ConclusionsParticipants who received cognitive behavioral therapy and amitriptyline were more likely than participants who received headache education plus amitriptyline to reach the clinically meaningful outcome of less than or equal to 4 headache days per month at both time points. These results may help inform what treatment outcomes are possible for children and adolescents suffering from chronic migraine and provides further evidence for behavioral treatment to be considered as a key part of a first line treatment regimen. (Source: Headache: The Journal of Head and Face Pain)


Compound Found In Tarantula Venom May Help People Dealing With Chronic Pain
BOSTON (CBS) &#8212; It&#8217;s one of the most feared creatures out there, the tarantula. As it turns out, a compound found in the spider&#8217;s venom could serve as a powerful painkiller and could offer an alternative to conventional painkillers which can have nasty side effects. One challenge for scientists is to isolate the painkilling peptides from the toxins that can paralyze and kill a tarantula’s prey, but if they succeed, tarantula venom could be used to take the sting out of pain. (Source: WBZ-TV - Breaking News, Weather and Sports for Boston, Worcester and New Hampshire)


Prescribing opioids in primary care: Safely starting, monitoring, and stopping
CHRONIC PAIN AFFECTS an estimated 100 million Americans, at a cost of $635 billion each year in medical expenses, lost wages, and reduced productivity.1 It is often managed in primary care... (Source: Cleveland Clinic Journal of Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


New, Stronger FDA Warning for Essure Birth Control Implant
Federal health regulators plan to warn consumers more strongly about Essure, a contraceptive implant that has drawn thousands of complaints from women reporting chronic pain, bleeding and other health problems. (Source: NYT Health)


Osteopathic manipulative treatment improves low back pain, avoid surgery, studies find
Osteopathic manipulative treatment reduced pain and improved function in patients suffering from chronic, nonspecific low back pain, research shows. Further, patients reporting the worst pain and higher degrees of disability received the most substantial benefit from the treatments. (Source: ScienceDaily Headlines)


Coadministration of tramadol with aripiprazole and venlafaxine-The effect on spatial memory functions in male rats.
CONCLUSION: It can be assumed that chronic treatment with combinations of TRM+VEN or TRM+ARI is unlikely to cause memory impairment and interfere with either any antidepressant effect of VEN or any antipsychotic effect of ARI in patients suffering from chronic pain using TRM. PMID: 26922552 [PubMed - as supplied by publisher] (Source: Pharmacological Reports)


Preclinical Pharmacological Approaches in Drug Discovery for Chronic Pain.
Authors: Whiteside GT, Pomonis JD, Kennedy JD Abstract In recent years, animal behavioral models, particularly those used in pain research, have been increasingly scrutinized and criticized for their role in the poor translation of novel pharmacotherapies for chronic pain. This chapter addresses the use of animal models of pain used in drug discovery research. It highlights how, when, and why animal models of pain are used as one of the many experimental tools used to gain better understanding of target mechanisms and rank-order compounds in the iterative process of establishing structure-activity relationship. Together, these models help create an "analgesic signature" for a compound and inform the indications most likely to yield success in clinical trials. In addition, the autho...


The Pharmacology of Visceral Pain.
Authors: Johnson AC, Greenwood-Van Meerveld B Abstract Visceral pain describes pain emanating from the internal thoracic, pelvic, or abdominal organs. Unlike somatic pain, visceral pain is generally vague, poorly localized, and characterized by hypersensitivity to a stimulus such as organ distension. While current therapeutics provides some relief from somatic pain, drugs used for treatment of chronic visceral pain are typically less efficacious and limited by multiple adverse side effects. Thus, the treatment of visceral pain represents a major unmet medical need. Further, more basic research into the physiology and pathophysiology of visceral pain is needed to provide novel targets for future drug development. In concert with chronic visceral pain, there is a high comorbidity wit...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Antinociception by Sigma-1 Receptor Antagonists: Central and Peripheral Effects.
Authors: Romero L, Merlos M, Vela JM Abstract There is plenty of evidence supporting the modulatory role of sigma-1 receptors (σ1Rs) in nociception, mainly based on the pain-attenuated phenotype of σ1R knockout mice and on the antinociceptive effect exerted by σ1R antagonists, particularly in nonacute sensitizing conditions involving sustained afferent drive, activity-dependent plasticity/sensitization, and ultimately pain hypersensitivity, as it is the case in chronic pains of different etiology. Antinociceptive effects of σ1R antagonists both when acting alone and in combination with opioids (to enhance opioid analgesia) have been reported at both central and peripheral sites. At the central level, findings at the behavioral (animal pain models), electrophysiological (spinal ...


Sodium Channels in Pain and Cancer: New Therapeutic Opportunities.
Authors: Luiz AP, Wood JN Abstract Voltage-gated sodium channels (VGSCs) underpin electrical activity in the nervous system through action potential propagation. First predicted by the modeling studies of Hodgkin and Huxley, they were subsequently identified at the molecular level by groups led by Catterall and Numa. VGSC dysfunction has long been linked to neuronal and cardiac disorders with some nonselective sodium channel blockers in current use in the clinic. The lack of selectivity means that side effect issues are a major impediment to the use of broad spectrum sodium channel blockers. Nine different sodium channels are known to exist, and selective blockers are now being developed. The potential utility of these drugs to target diseases ranging from migraine, multiple sclero...


The Role of Store-operated Calcium Channels in Pain.
Authors: Munoz F, Hu H Abstract Store-operated calcium channels (SOCCs) are calcium-selective cation channels. Recently, there has been explosive growth in establishing the molecular mechanisms that mediate store-operated Ca(2+) entry (SOCE) and the role of this process in normal cellular function and disease states. SOCCs and its components appear to play an important role in many Ca(2+)-dependent processes in nonexcitable cells and are implicated in several possible disorders including allergies, multiple sclerosis, cancer, and inflammatory bowel disease. Recent studies have shown that SOCCs are expressed in the central nervous system (CNS) and involved in neuronal functions and pathological conditions, including chronic pain. In this chapter, we discuss SOCE and its physiologica...


Purinergic Mechanisms and Pain.
Authors: Burnstock G Abstract There is a brief introductory summary of purinergic signaling involving ATP storage, release, and ectoenzymatic breakdown, and the current classification of receptor subtypes for purines and pyrimidines. The review then describes purinergic mechanosensory transduction involved in visceral, cutaneous, and musculoskeletal nociception and on the roles played by receptor subtypes in neuropathic and inflammatory pain. Multiple purinoceptor subtypes are involved in pain pathways both as an initiator and modulator. Activation of homomeric P2X3 receptors contributes to acute nociception and activation of heteromeric P2X2/3 receptors appears to modulate longer-lasting nociceptive sensitivity associated with nerve injury or chronic inflammation. In neuropathic p...


Modulation of Chronic Pain by Metabotropic Glutamate Receptors.
Authors: Chiechio S Abstract Metabotropic glutamate receptors (mGluRs) belong to class C G-protein-coupled receptors. They are expressed throughout the nervous system on both neurons and glial cells. In the central nervous system (CNS), mGluRs are mainly located in the proximity of the synaptic cleft where they regulate glutamatergic transmission in addition to a number of other neurotransmitters. To date, eight subtypes of mGluRs (mGluR1-mGluR8) have been cloned and classified into three groups on the basis of sequence similarities, and pharmacological and biochemical properties. Consequently, group I mGluRs includes mGluR1 and mGluR5, group II mGluRs includes mGluR2 and mGluR3, and group III mGluRs consists of mGluR4, mGluR6, mGluR7, and mGluR8. With the exception of mGluR6, whos...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


MicroRNA-Based Biomarkers in Pain.
Authors: Ramanathan S, Ajit SK Abstract Biomarkers are measurable characteristics reflective of the physiological or diseased state and a crucial feature in rendering personalized medicine more precise. Dysregulated expression of circulating microRNAs (miRNAs) in bodily fluids is being explored as noninvasive clinical biomarker for a variety of disorders including chronic pain. High-precision qPCR-based signal amplification of these miRNAs enables the detection of small changes making them ideal biomarker candidates. Presence of circulating miRNAs in exosomes, small vesicles that mediate intercellular communication, opens up novel avenues for target intervention and biomarker discovery. miRNA signatures specific to different pain conditions, and their reversal on treatment in patie...


Perspectives and Trends in Pharmacological Approaches to the Modulation of Pain.
Authors: Barrett JE, Haas DA Abstract Pharmacological approaches to our understanding and treatment of pain have had a long history and have traditionally relied on very few drugs that either have significant side effects and abuse liability, such as the nonsteroidal anti-inflammatory drugs or the opioids, respectively, or those that have been developed for other conditions such as the tricyclic antidepressants. The pathophysiology of pain is undoubtedly complex, complicated in part by the fact that it is not a singular condition, and has a variety of etiologies and a number of associated comorbidities that make treatment interventions challenging. Moreover, there are changes in the central nervous system during the course of the development of chronic pain that, in a manner parall...


Medical News Today: Could tarantula venom help fight pain?
Tarantula venom could unlock new pain control methods to help millions of people with chronic conditions, say findings that may also open doors for treating other diseases. (Source: Health News from Medical News Today)


Opioid Drugs in Patients With Liver Disease: A Systematic Review
Conclusions: Pain management in patients with liver dysfunction is always challenging to physicians because of the adverse reactions of drugs, especially opioids. Opioids should be used cautiously since they can cause sedation, constipation and sudden encephalopathy effects. Since the clearance of these drugs in patients with hepatic insufficiency is decreased, the initial dose must be decreased, the intervals between doses should be increased and some patients need to be continuously assessed.,Results: In patients with liver disease, administration of opioid analgesics should be observed, accurately. As a general rule, lower doses of drugs should be administered at regular intervals based on the signs of drug accumulation. Secondly, the interactions of opioid drugs with different levels o...


Impact of depression and anxiety on burden and management of episodic and chronic headaches - a cross-sectional multicentre study in eight Austrian headache centres.
CONCLUSION: Depression and anxiety have a significant impact on quality of life and increase the burden in patients with EH and CH. Improved multidimensional treatment approaches are necessary to decrease disability on the personal, social and occupational level in these patients. PMID: 26920681 [PubMed - as supplied by publisher] (Source: Pain Physician)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A cohort study of elderly people in Bloemfontein, South Africa, to determine health-related quality of life and functional abilities.
CONCLUSIONS: Our results confirm that diseases result in pain and affect mobility and cognition in old age. Access to healthcare and services for older people involves recognition of the importance of health promotion and activities that will help prevent disease, and there should be a focus on maintaining independence, prevention and delay of disease, and disability treatment. This includes improving QoL in elderly people with existing disabilities. Reform of medical care services is essential to improve healthcare for the elderly and thus improve their QoL. PMID: 26915946 [PubMed - in process] (Source: South African Medical Journal)


Clinico-radiological improvement in an immunocompetent patient presented with scedosporium apiospermum osteomyelitis
Publication date: Available online 28 February 2016 Source:Journal of Clinical Orthopaedics and Trauma Author(s): Rahul Mohan, T.S. Gopakumar Scedosporium apiospermum is frequently found as a saprophyte in soil, sewage and contaminated water. Its manifestations in immunocompetent patients are usually localised and in immunodeficient patients, it causes invasive systemic diseases. We are reporting the case of a 40-year-old male, who presented with pain, oedema and multiple discharging sinuses over the lateral aspect of the left foot with history of thorn prick. On examination, there were multiple active sinuses with tenderness and local rise in temperature. Calcaneum on palpation showed a thickened and irregular surface with limitation of ankle and subtalar movements. Blood investigatio...


Gender Differences in Chronic Fatigue Syndrome
Conclusions The clinical phenotype of the men with CFS was young, single, skilled worker, and infection as the main triggering agent. Men had less pain and less muscle and immune symptoms, fewer comorbid phenomena, and a better quality of life. (Source: Reumatologia Clinica)


A Novel Selective Prostaglandin E 2 Synthesis Inhibitor Relieves Pyrexia and Chronic Inflammation in Rats
We report here the profile of a novel selective PGE2 synthesis inhibitor, compound A [N-[(1S,3S)-3-carbamoylcyclohexyl]-1-(6-methyl-3-phenylquinolin-2-yl)piperidine-4-carboxamide], in animal models of pyrexia and inflammation. The compound selectively suppressed the synthesis of PGE2 in human alveolar adenocarcinoma cell line A549 cells and rat macrophages. In the lipopolysaccharide-induced pyrexia model, this compound selectively reduced PGE2 production in cerebrospinal fluid and showed an anti-pyretic effect. In the adjuvant-induced arthritis model, compound A therapeutically decreased foot swelling in the established arthritis. Our data demonstrates that selective suppression of PGE2 synthesis shows anti-pyretic and anti-inflammatory effects, suggesting that selective PGE2 synthesis inh...


Nabilone for the Management of Pain
Nabilone, a synthetic cannabinoid, is approved in many countries including, but not limited to, Canada, the United States, Mexico, and the United Kingdom for the treatment of severe nausea and vomiting associated with chemotherapy. Clinical evidence is emerging for its use in managing pain conditions with different etiologies. We review the efficacy and safety of nabilone for various types of pain as well as its abuse potential, precautions and contraindications, and drug interactions; summarize pertinent clinical practice guidelines; and provide recommendations for dosing, monitoring, and patient education. Citations involving nabilone were identified through systematic reviews evaluating cannabinoids for pain. A systematic search (updated July 23, 2015) of the Ovid MEDLINE, EMBASE, PubMe...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Adverse events experienced by participants in a back pain walking intervention: A descriptive study
Conclusions Individuals with chronic back pain can safely engage in a pedometer-based, unsupervised walking program. However, patients may benefit from focused counseling about musculoskeletal risks with specific attention to injury prevention measures such as gradually incrementing activity levels. (Source: Chronic lllness)


Prolotherapy for Knee Osteoarthritis: A Descriptive Review
This article summarizes evidence from basic and clinical science for use of prolotherapy among patients with KOA. (Source: Current Physical Medicine and Rehabilitation Reports)


Tailored anterior tension-free repair for the treatment of recurrent inguinal hernia previously repaired by anterior approach
Conclusions Recurrent inguinal hernia previously treated by open anterior technique can be repaired using the same approach, often on an outpatient basis, with a low rate of recurrence and postoperative complications. To be safe and effective, the repair should be performed by appropriately trained surgeons, well versed in the use of different types of anaesthesia and surgical techniques depending on patient and hernia characteristics. (Source: Hernia)


Do manual therapy techniques have a positive effect on quality of life in people with tension-type headache? A randomized controlled trial.
CONCLUSIONS: All three treatments were effective at changing different dimensions of quality of life, but the combined treatment showed the most change. The results support the effectiveness of treatments applied to the suboccipital region for patients with TTH. CLINICAL REHABILITATION IMPACT: Manual therapy techniques applied to the suboccipital region, for as little as four weeks, offered a positive improvement in some aspects of quality of life of patient's suffering with TTH. PMID: 26928164 [PubMed - as supplied by publisher] (Source: European Journal of Physical and Rehabilitation Medicine)


Bone pain: current and future treatments.
Authors: Frost CØ, Hansen RR, Heegaard AM Abstract Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent p...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Home cage wheel running is an objective and clinically relevant method to assess inflammatory pain in male and female rats
Conclusions The present data indicate that home cage wheel running is a clinically relevant method to assess inflammatory pain in the rat. The decrease in activity caused by inflammatory pain and subsequent gradual recovery mimics the changes in activity caused by pain in humans. The tendency for pain-depressed wheel running to be greater in female than male rats is consistent with the tendency for women to be at greater risk of chronic pain than men. (Source: Journal of Neuroscience Methods)


Chronic pain and psychological distress among long-term social assistance recipients – An intolerable burden on those on the lowest steps of the socioeconomic ladder
Publication date: April 2016 Source:Scandinavian Journal of Pain, Volume 11 Author(s): Harald Breivik (Source: Scandinavian Journal of Pain)


Fifty years on the Visual Analogue Scale (VAS) for pain-intensity is still good for acute pain. But multidimensional assessment is needed for chronic pain
Publication date: April 2016 Source:Scandinavian Journal of Pain, Volume 11 Author(s): Harald Breivik (Source: Scandinavian Journal of Pain)


The role of social anxiety in chronic pain and the return-to-work process
Publication date: April 2016 Source:Scandinavian Journal of Pain, Volume 11 Author(s): Henrik Børsting Jacobsen, Silje Endresen Reme (Source: Scandinavian Journal of Pain)


Rare case of asymptomatic spontaneous coronary artery dissection
We present a case of a 46-year-old woman who presented to the emergency room after a syncopal episode. Most of her initial workup did not lead to any diagnosis. However, the transthoracic echocardiogram showed new onset left ventricular dysfunction. Further, cardiac evaluation showed a chronic coronary artery dissection in the proximal left anterior descending artery. Syncope was related to vasovagal event but rapid plasma reagin being positive led to the question of whether the coronary artery dissection was secondary to vasculitic manifestation of prior syphilis infection. More research is needed to answer this question and to find such an association. &lt;Learning objective: Spontaneous coronary artery dissection (SCAD) is a rare disease of young adults that can present acutely as a...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Open surgical treatment for postthrombotic syndrome.
Authors: Behrendt CA, Heidemann F, Rieß HC, Kleinspehn E, Kühme T, Atlihan G, Gebhardt C, Debus ES Abstract The postthrombotic syndrome counts as a frequent long-term complication after deep vein thrombosis with approximately 20%-50% of affected patients after deep vein thrombosis. The earliest that diagnosis of postthrombotic syndrome can be made is 6 months after deep vein thrombosis. Most patients suffer from swelling and chronic pain. In all, 5%-10% of patients may even develop venous ulcers. The complex etiology consists of limited venous drainage because of chronic occlusions and secondary insufficiencies of venous valves inducing non-physiological venous reflux. Conservative management, first of all compression therapy, is of crucial importance in treatment of postthrombot...


VISA-P questionnaire profile in volleyball and basketball athletes
Background: Patellar tendinopathy (PT) is a chronic injury highly prevalent in sports with large amount of jumping 1,2,3. Several studies use Victorian Institute of Sport Assessment Scale (VISA-P) questionnaire to clinically identify individuals with PT 1,2,3. VISA-P is a questionnaire adapted and validated for the Brazilian population, which quantifies patellar tendon pain and functional disability. Some studies indicates that PT is associated with sex, age and sports practice, however, there isn’t a consensus in the literature about the relationship of these variables with VISA-P score 2,3. (Source: Physical Therapy in Sport)


New "all-in-one" device for mesh plug hernioplasty: the Trabucco repair.
New "all-in-one" device for mesh plug hernioplasty: the Trabucco repair. Ann Ital Chir. 2015;86:570-4 Authors: Gossetti F, Massa S, Abbonante F, Calabria M, Ceci F, Viarengo MA, Manzi E, D'Amore L, Negro P Abstract UNLABELLED: Although Mesh Plug Repair (MPR) represents an effective method for the treatment of groin hernia, some criticisms still concern adverse effects related to the plug (shrinkage, chronic pain, migration and erosion). Different mesh and plug devices have been proposed in the past mostly to prevent migration but none of these achieved the same popularity as the cone or flower-shaped plug. Authors hereby present a pilot study with a new tridimensional device, denominated NeT Plug and Patch, that avoids any risk of migration. Results after 12 months fol...


Oxycodone with an opioid receptor antagonist: A review.
Authors: Davis MP, Goforth HW Abstract The rationale for putting opioid antagonists with an agonist is to improve pain control, to reduce side effects, and/or to reduce abuse. The combination of prolonged release (PR) oxycodone and naloxone reduces constipation as demonstrated in multiple studies and has been designated a tamper-resistant opioid by the Food and Drug Administration. Bioequivalence of the combination product compared with PR oxycodone has not been established. Several of the pivotal studies provided suboptimal laxative support in the control arm of the randomized trials. Two noninferiority trials have demonstrated equivalent analgesia between PR oxycodone and the combination product at doses of less than 120 mg of oxycodone per day. There appears to be an analgesic c...


A phase I study of D-methadone in patients with chronic pain.
Authors: Moryl N, Tamasdan C, Tarcatu D, Thaler HT, Correa D, Steingart R, Payne R, Obbens E Abstract UNLABELLED: D-Methadone is the d optical isomer of racemic mixture (DL-methadone) used clinically to treat pain and addiction in the United States. D-Methadone is practically devoid of opioid activity but maintains N-methyl-D-aspartate (NMDA) receptor antagonism. Evidence from extensive preclinical studies suggests that NMDA receptor antagonists attenuate neuronal plasticity, reverse opioid analgesic tolerance, and alleviate chronic pain states. The authors conducted a phase I open label study of D-methadone administered for the first time to patients with chronic pain to determine the safety and tolerability of D-methadone. In addition to their long-term regimen of opioids, the pa...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cannabinoids: Medical implications.
Authors: Schrot RJ, Hubbard JR Abstract Herbal cannabis has been used for thousands of years for medical purposes. With elucidation of the chemical structures of tetrahydrocannabinol (THC) and cannabidiol (CBD) and with discovery of the human endocannabinoid system, the medical usefulness of cannabinoids has been more intensively explored. While more randomized clinical trials are needed for some medical conditions, other medical disorders, like chronic cancer and neuropathic pain and certain symptoms of multiple sclerosis, have substantial evidence supporting cannabinoid efficacy. While herbal cannabis has not met rigorous FDA standards for medical approval, specific well-characterized cannabinoids have met those standards. Where medical cannabis is legal, patients typically see a...


New Directions in the Treatment of Chronic Pain: National Pain Strategy Will Guide Prevention, Management, and Research.
Authors: Worley SL Abstract More than four years after the release of a landmark report by the Institute of Medicine focused attention on pain in America, there are encouraging signs that the nation may be poised to undergo the "cultural transformation" advocated by the report. PMID: 26909001 [PubMed] (Source: P and T)


The painDETECT project - far more than a screening tool on neuropathic pain.
CONCLUSION: To date more than 300,000 patients were assessed, providing the basis for one of the world's largest datasets for chronic pain. Among others the extensive pool of PD-Q data triggered the idea of subgrouping patients on the basis of their individual sensory profiles which might in the future lead to a stratified treatment approach and ultimately to personalised therapy. Started as a healthcare utilisation project in Germany, the PD-Q is nowadays used for clinical and research purposes around the world. PMID: 26907456 [PubMed - as supplied by publisher] (Source: Current Medical Research and Opinion)


New onset stutter following electrode insertion in the ventrocaudalis nucleus for face pain
Deep brain stimulation (DBS) of the ventrocaudalis nucleus (Vc) of the thalamus is a last resort treatment for chronic refractory pain. DBS is generally a safe procedure, although it can result in functional disturbances depending on the site of stimulation. There has been one prior report of stuttering induced by microlesioning of the thalamus, as well as number of reports of stuttering induced by stimulation of the thalamus and other related structures in the brain. (Source: World Neurosurgery)


Optimizing Acute Pain Management in the Obese Patient: Treatment and Monitoring Considerations
THE CHALLENGES OF PROVIDING SAFE AND EFFECTIVE pain management for patients with obesity are present throughout the perioperative setting. Obesity is associated with chronic medical comorbidities, such as coronary artery disease, stroke, chronic kidney disease, nonalcoholic fatty liver disease, and type 2 diabetes.1 Other obesity-associated comorbidities include breast, endometrial, ovarian, colorectal, esophageal, kidney, pancreatic, and prostate cancers, chronic back pain, and osteoarthritis.1 The demand for bariatric surgery has risen markedly in recent years with the total number of surgeries performed in the United States and Canada reaching 220,000 in 2008 to 2009. (Source: Journal of PeriAnesthesia Nursing)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Analysis of Gut Microbiome Reveals Significant Differences Between Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Controls
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CPPS) is a common disorder with heterogeneous etiologies and clinical features. The gut microbiome is a metabolically active ecosystem linked to systemic conditions (gut-brain axis). We hypothesize that the gut microbiome will show alterations between CPPS patients and controls (Source: The Journal of Urology)


The relationship between perceived promotion of autonomy/dependence and pain-related disability in older adults with chronic pain: the mediating role of self-reported physical functioning
Abstract Chronic pain is prevalent among older adults and is usually associated with high levels of functional disability. Social support for the promotion of functional autonomy and dependence has been associated with pain-related disability and self-reported physical functioning. Nevertheless, these relationships need further inquiry. Our aims were to investigate: (1) the relationship between perceived promotion of autonomy/dependence and pain-related disability and (2) the extent to which self-reported physical functioning mediated these relationships. 118 older adults (Mage = 81.0) with musculoskeletal chronic pain completed the Portuguese versions of the revised formal social support for Autonomy and Dependence in Pain Inventory, the pain severity and interference scales of...


Impact of depression and anxiety on burden and management of episodic and chronic headaches – a cross-sectional multicentre study in eight Austrian headache centres
Conclusion Depression and anxiety have a significant impact on quality of life and increase the burden in patients with EH and CH. Improved multidimensional treatment approaches are necessary to decrease disability on the personal, social and occupational level in these patients. (Source: The Journal of Headache and Pain)


Fibromyalgia Pathogenesis and Treatment Options Update
Abstract This review article presents and summarizes up-to-date literature on the clinical manifestations, diagnosis, pathophysiological mechanisms, and treatment options for fibromyalgia patients. First, the most recent diagnostic criteria for fibromyalgia, as put forth by the American College of Rheumatology will be summarized. Clinical features, including chronic widespread pain, hyperalgesia, mood disorders, anxiety, and disturbed sleep patterns will be explored in-depth. The pathogenesis and pathophysiology of fibromyalgia involves alterations in multiple ascending and descending central nervous system pathways, as well as peripheral pathways, leading to heightened pain sensitivity. Risk factors have been studied extensively, and the most recent research focuses on various g...


Long-term results of combined ESWL and ERCP treatment of chronic calcific pancreatitis.
Conclusions For patients with CP and PDS ESWL combined with ET is an effective and safe treatment giving favorable long-term results. PMID: 26912383 [PubMed - as supplied by publisher] (Source: Scandinavian Journal of Gastroenterology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic pain following motor vehicle collision: a systematic review of outcomes associated with seeking or receiving compensation - Giummarra MJ, Ioannou L, Ponsford J, Cameron P, Jennings PA, Gibson SJ, Georgiou-Karistianis N.
OBJECTIVE: Motor vehicle collisions (MVC) are a major cause of injury, which frequently leads to chronic pain and prolonged disability. Several studies have found that seeking or receiving financial compensation following MVC leads to poorer recovery and w... (Source: SafetyLit)


Pain‐catastrophizing and fear‐avoidance beliefs as mediators between post‐traumatic stress symptoms and pain following whiplash injury – A prospective cohort study
ConclusionsThe present study adds important knowledge about the development of psychological distress and pain after whiplash injury. The finding, that PCS and FA mediated the effect of PTSS on pain intensity is a novel finding with important implications for prevention and management of whiplash‐associated disorders. What does this study add?The study confirms the mechanisms as outlined in the fear‐avoidance model and the mutual maintenance model.The study adds important knowledge of pain‐catastrophizing and fear‐avoidance beliefs as mediating mechanisms in the effect of post‐traumatic stress on pain intensity. Hence, cognitive behavioural techniques targeting avoidance behaviour and catastrophizing may be beneficial preventing the development of chronic pain. (Source: European ...


Social functioning in adulthood: Understanding long‐term outcomes of adolescents with chronic pain/fatigue treated at inpatient rehabilitation programs
ConclusionsA considerable number of these young adults still have pain/fatigue complaints in adulthood. More pain/fatigue pre‐treatment during adolescence predict impaired functioning in the work‐educational domain in young adulthood. What does this study add?This study examines the social participation of young adults who suffered from severe chronic pain/fatigue during adolescence.Predictors for social participation are reported, as are the differences between young adults with and without persistent pain/fatigue complaints. (Source: European Journal of Pain)


The association of C-reactive protein and serum amyloid P with blood stasis syndrome in Traditional Korean Medicine for general disease conditions: a cross-sectional, observational study
Conclusions These results demonstrated that CRP and SAP levels are potentially associated with the pathogenesis of BSS in TKM and they are involved in different aspects of BSS symptoms. (Source: European Journal of Integrative Medicine)


Brainstem processing of peripheral punctate stimuli in patients with and without chemotherapy-induced peripheral neuropathy: a prospective cohort functional MRI study
We report a preliminary analysis of the first 12 patients (60·6 [8·3], six women); six had colorectal cancer, four gynaecological cancer, and two lung cancer. Seven patients (three men, four women) developed chemotherapy-induced peripheral neuropathy. After data brain extraction, registration, B0 unwarping, and motion correction, FEAT was used for first and second level analysis. Mean group level comparisons between patients with and without the neuropathy were conducted with mixed-effects analysis (z threshold 2·3, regions considered significant at p&lt;0·05, cluster uncorrected for preliminary analysis) and adjusted for sex, age, and cancer type. Patients with chemotherapy-induced peripheral neuropathy had increased activation in the nucleus cuneiformis and primary somatosensory ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Opioid-induced constipation: advances and clinical guidance
Currently opioids are the most frequently used medications for chronic noncancer pain. Opioid-induced constipation is the most common adverse effect associated with prolonged use of opioids, having a major impact on quality of life. There is an increasing need to treat opioid-induced constipation. With the recent approval of medications for the treatment of opioid-induced constipation, there are several therapeutic approaches. This review addresses the clinical presentation and diagnosis of opioid-induced constipation, barriers to its diagnosis, effects of opioids in the gastrointestinal tract, differential tolerance to opiates in different gastrointestinal organs, medications approved and in development for the treatment of opioid-induced constipation, and a proposed clinical management a...


Experimental myocardial stem cell therapy for ST-elevation myocardial infarction: rationale and level of evidence.
Authors: Kastrup J, Mygind ND, Qayyum A, Mathiasen AB Abstract Ischemic heart disease (IHD) is one of the leading causes of death worldwide and is characterised by the formation of atherosclerotic plaques in the coronary arteries reducing the blood supply to the heart muscle causing ischemia. IHD can result in ST-elevation myocardial infarction (STEMI), chronic IHD and heart failure. The patients suffer from chest pain (angina), dyspnoea and a reduced quality of life. Common for all these conditions is loss of functional cardiomyocytes and endothelial cells. Stem cell therapy to regenerate injured myocardium is a new treatment option which has gained much interest in the last 10 - 15 years especially after STEMI. Many preclinical and clinical studies have shown encouraging results ...


Sacroiliitis or insufficiency fracture?
Abstract Sacral stress fracture and sacroiliitis are two conditions that present with pain. Sacral stress fractures are a rare cause of lumbar and hip pain. Sacral insufficiency fractures are a type of sacral stress fractures. Sacroiliitis represents inflammation of the sacroiliac joints. Coexistence of sacroiliitis and sacral insufficiency fracture (SIF) has not been reported before. Case 1: A 39-year-old woman reporting inflammatory back pain. Imaging revealed bilateral chronic sacroiliitis and bilateral SIF. Case 2: A 31-year-old woman presenting with left hip and inguinal pain. Imaging revealed left sacroiliitis and ipsilateral SIF. Calcium and vitamin D supplementation together with nonsteroidal anti-inflammatory drug (NSAID) treatment were given. Sulfasalazine was added to...


Influence of pro-algesic foods on chronic pain conditions.
This article focuses on four substances, monosodium glutamate, aspartame, arachidonic acid, and caffeine, where research shows that overconsumption may induce or worsen pain. For each substance, the mechanism whereby it may act to induce pain is examined, and any clinical trials examining the effectiveness of reducing the intake of the substance discussed. While all four substances are associated with pain, decreased consumption of them does not consistently reduce pain. PMID: 26900907 [PubMed - as supplied by publisher] (Source: Expert Review of Neurotherapeutics)


Case Reports Showing a Long-Term Effect of Subanesthetic Ketamine Infusion in Reducing L-DOPA-Induced Dyskinesias
We report on low-dose subanesthetic intravenous ketamine infusion treatment in Parkinson's disease (PD) patients by 5 case studies and show a long-lasting therapeutic benefit to reduce L-DOPA-induced dyskinesia (LID), improve on time, and reduce depression. Based on the literature we hypothesize that low-dose ketamine may act as a ‘chemical deep brain stimulation', by desynchronizing hypersynchronous oscillatory brain activity, including in the basal ganglia and the motor cortex. The presented PD case reports indicate tolerability, safety and long-term beneficial effects of low-dose ketamine infusion that should be further investigated in a properly controlled prospective clinical trial for treatment of LID, as well as the prevalent nonmotor features pain and depression in PD patients.Ca...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Gallbladder and Pancreas in Henoch-Schönlein Purpura: Review of the Literature
Conclusions: This analysis indicates that pancreato-biliary involvement is unusual in Henoch-Schönlein purpura. This complication deserves consideration in patients with especially severe abdominal pain. Finally, viral hepatitides and hepatitis vaccinations seem to be rare triggers of Henoch-Schönlein purpura. (Source: Journal of Pediatric Gastroenterology and Nutrition)


Maintenance of Pain in Children With Functional Abdominal Pain
Conclusions: The presence of IBS symptoms in school-age children with functional abdominal pain appears to predict persistence of abdominal pain over time, whereas anxiety does not. Prospective pain and stooling diaries and parent report of IBS symptoms were predictors of pain maintenance, but child report of symptoms was not. (Source: Journal of Pediatric Gastroenterology and Nutrition)


Prevalence of Anterior Cutaneous Nerve Entrapment Syndrome in a Pediatric Population With Chronic Abdominal Pain
Conclusions: ACNES is present in 1 of 8 adolescents presenting with CAP to a pediatric outpatient department of a teaching hospital. Simple physical examinational testing allows for the diagnosis. Treatments including nerve blocks or surgery are beneficial in most. (Source: Journal of Pediatric Gastroenterology and Nutrition)


Direct Costs of Acute Recurrent and Chronic Pancreatitis in Children in the INSPPIRE Registry
Conclusions: ARP and CP are uncommon childhood conditions. The severe burden of disease associated with these conditions and their chronicity results in high health care utilization and costs. Interventions that reduce the need for hospitalization could lower costs for these children and their families. (Source: Journal of Pediatric Gastroenterology and Nutrition)


Chronic hypertrophic nonunion of the Type II odontoid fracture causing cervical myelopathy: Case report and review of literature.
CONCLUSION: Rarely, nonunion of Type II odontoid fractures may be hypertrophic where both instability and compression cause neurological morbidity. Such cases require anterior transoral decompression, posterior cervical decompression, and instrumented fusions. PMID: 26904365 [PubMed] (Source: Surgical Neurology International)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Integrated, Team-Based Chronic Pain Management: Bridges from Theory and Research to High Quality Patient Care.
Authors: Driscoll MA, Kerns RD Abstract Chronic pain is a significant public health concern. For many, chronic pain is associated with declines in physical functioning and increases in emotional distress. Additionally, the socioeconomic burden associated with costs of care, lost wages and declines in productivity are significant. A large and growing body of research continues to support the biopsychosocial model as the predominant framework for conceptualizing the experience of chronic pain and its multiple negative impacts. The model also informs a widely accepted and empirically supported approach for the optimal management of chronic pain. This chapter briefly articulates the historical foundations of the biopsychosocial model of chronic pain followed by a relatively detailed di...


Advances in the Treatment of Neuropathic Pain.
Authors: Xu L, Zhang Y, Huang Y Abstract Neuropathic pain is pain that arises as a direct consequence of a lesion or diseases affecting the somatosensory system. Treatments for neuropathic pain include pharmacological, nonpharmacological, and interventional therapies. Currently recommended first-line pharmacological treatments include antidepressants and anticonvulsants (gabapentin and pregabalin). However, in some cases, pharmacological therapy alone fails to give adequate control of the chronic pain. New techniques have been invented and have been proved effective on neuropathic pain, such as behavioral, cognitive, integrative, and physical therapies. In this review, we focused on the advances in the treatment of central neuropathic pain, diabetic peripheral neuropathy, postherpe...


Pain Modulation and the Transition from Acute to Chronic Pain.
Authors: Heinricher MM Abstract There is now increasing evidence that pathological pain states are at least in part driven by changes in the brain itself. Descending modulatory pathways are known to mediate top-down regulation of nociceptive processing, transmitting cortical and limbic influences to the dorsal horn. However, these modulatory pathways are also intimately intertwined with ascending transmission pathways through positive and negative feedback loops. Models of persistent pain that fail to include descending modulatory pathways are thus incomplete. Although teasing out individual links in a recurrent network is never straightforward, it is imperative that understanding of pain modulation be fully integrated into how we think about pain. PMID: 26900066 [PubMed - in ...


Mas-Related G Protein-Coupled Receptors Offer Potential New Targets for Pain Therapy.
Authors: Tiwari V, Tiwari V, He S, Zhang T, Raja SN, Dong X, Guan Y Abstract The founding member of the Mas-related G-protein-coupled receptor (Mrgpr) family was discovered in 1986. Since then, many more members of this receptor family have been identified in multiple species, and their physiologic functions have been investigated widely. Because they are expressed exclusively in small-diameter primary sensory neurons, the roles of Mrgpr proteins in pain and itch have been best studied. This review will focus specifically on the current knowledge of their roles in pathological pain and the potential development of new pharmacotherapies targeted at some Mrgprs for the treatment of chronic pain. We will also discuss the limitations and future scope of this receptor family in pain tre...


Peripheral Nociceptors as Immune Sensors in the Development of Pain and Itch.
Authors: Wang T, Ma C Abstract The peripheral nervous system and the immune system perform a series of similar functionalities such as recognizing, responding, and adapting to external or internal stimuli despite significant morphological differences. The peripheral nervous system actively communicates and coordinates with the immune system to function as a unified defense system. The peripheral nervous system is highly regulated by the immune system, especially under inflammatory conditions. On the other hand, the nervous system can modulate the immune system via neurotransmitters and chemokines released by the peripheral nerve endings, particularly from nociceptors. In both physiological and pathological conditions, peripheral nociceptive (including pruriceptive) neurons may expr...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Neuropathic Pain: Sensory Nerve Injury or Motor Nerve Injury?
Authors: Liu XG, Pang RP, Zhou LJ, Wei XH, Zang Y Abstract Peripheral nerve injury often induces chronic neuropathic pain. Peripheral nerve is consisted of sensory fibers and motor fibers, it is questioned injury to which type of fibers is responsible for generation of neuropathic pain? Because neuropathic pain is sensory disorder, it is generally believed that the disease should be induced by injury to sensory fibers. In recent years, however, emergent evidence shows that motor fiber injury but not sensory fiber injury is necessary and sufficient for induction of neuropathic pain. Motor fiber injury leads to neuropathic pain by upregulating pro-inflammatory cytokines and brain-derived neurotrophic factor in pain pathway. PMID: 26900063 [PubMed - in process] (Source: Advances ...


Contemporary role of minimally invasive thoracic surgery in the management of pulmonary arteriovenous malformations: report of two cases and review of the literature.
We present two patients with symptomatic PAVM despite multiple embolizations: the first one with recurrent and persistent hemoptysis who underwent a thoracoscopic lobectomy, and the second one with chronic debilitating pleuritic pain subsequent to embolization who underwent a thoracoscopic wedge resection. Video-assisted thoracoscopic surgery (VATS) with lung resection was successfully performed in both patients, with complete resolution of their symptoms. We also review the literature regarding the contemporary role of surgery in PAVM, particularly thoracoscopy. PMID: 26904229 [PubMed] (Source: Journal of Thoracic Disease)


Secondary conditions in a community sample of people with spinal cord damage.
Conclusions Secondary conditions following spinal cord damage do not appear to be influenced by etiology. Prevention and management of secondary conditions following need to consider people with non-traumatic SCDys as well as those with traumatic SCI. PMID: 26899984 [PubMed - as supplied by publisher] (Source: Journal of Spinal Cord Medicine)


Postoperative analgesia
Publication date: Available online 23 February 2016 Source:Anaesthesia &amp; Intensive Care Medicine Author(s): Jessica L.R. Chapman, Abdul G. Lalkhen Pain should be regarded as a complex experience consisting of sensory, affective, behavioural and physiological components. Pain management is therefore best achieved by an approach which acknowledges the complex interactions between biological, psychological and sociocultural factors. Effective pain management requires thorough patient preparation and education to manage expectations and a robustly structured inpatient service for postoperative pain management and continuous staff education. Postoperative analgesia is one component of postoperative pain management and is essential for achieving patient satisfaction and enhanced reco...


Relationship between spicy food intake and chronic uninvestigated dyspepsia in Iranian adults
ConclusionsHigh consumption of spicy foods is associated with greater odds of CUD, frequent postprandial fullness and epigastric pain. Further studies, particularly of a prospective nature, are needed to confirm our findings. (Source: Journal of Digestive Diseases)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Association between plasma concentrations of linoleic acid-derived oxylipins and the perceived pain scores in an exploratory study in women with chronic neck pain
Chronic musculoskeletal pain may be associated with changes in the balance of algogenic and anti-nociceptive compounds, and such changes may be visible in plasma samples. We have undertaken an exploratory stud... (Source: BMC Musculoskeletal Disorders)


Joint Involvement Secondary to Epstein–Barr Virus
We describe a group of patients with Epstein–Barr virus (EBV) infection and joint involvement. Between February 2011 and January 2012, there were six cases in our unit. Two presented with a pattern similar to rheumatoid arthritis, three had polyarthralgia with an inflammatory pattern and only one patient had asymmetrical oligoarthritis of large joints. They were all women aged between 25 and 75 (4 were of child-bearing potential). Diagnosis in all the cases was made by exclusion of other possible causes and negative IgM were obtained for the rest of the “Herpesviridae” family viruses. In our series, EBV joint involvement was more common in women of childbearing potential. Clinical presentation was heterogeneous but was predominantly in the form of inflammatory joint pain. When it pre...


Resistance Training as a Tool for Preventing and Treating Musculoskeletal Disorders
Abstract The aging process is characterized by several physiological, morphological, and psychological alterations that result in a decreased functional and health status throughout the life span. Among these alterations, the loss of muscle mass and strength (sarcopenia) is receiving increased attention because of its association with innumerous age-related disorders, including (but not limited to) osteoporosis, osteoarthritis, low back pain, risk of fall, and disability. Regular participation in resistance training programs can minimize the musculoskeletal alterations that occur during aging, and may contribute to the health and well-being of the older population. Compelling evidence suggest that regular practice of resistance exercise may prevent and control the development of s...


Pathophysiology of interstitial cystitis/bladder pain syndrome
Publication date: December 2015 Source:Tzu Chi Medical Journal, Volume 27, Issue 4 Author(s): Qian-Shen Ke, Hann-Chorng Kuo Interstitial cystitis (IC) is a heterogeneous syndrome characterized by bladder pain and is associated with frequency and nocturia. Research findings have proposed several pathophysiological mechanisms including epithelial dysfunction, activation of mast cells, neurogenic inflammation, autoimmunity, and occult infection. One of the most common findings in IC bladders is denudation or thinning of the bladder epithelium, suggesting an altered regulation of urothelial homeostasis. Different phenotypes of IC have been explored including Hunner and nonHunner type IC (ulcer and nonulcer type IC), hypersensitive bladder, and bladder pain with and without functional somat...


Associations between demographics and health-related quality of life for chronic non-malignant pain patients treated at a multidisciplinary pain centre: a cohort study
Conclusions In order to improve treatment at a multidisciplinary pain centre, it may be of value to target treatments to different patient subgroups based on, amongst other things, age and employment status. (Source: International Journal for Quality in Health Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Evaluation of new approach to ultrasound guided stellate ganglion block
Conclusion: There is a significant variation in the anatomy of stellate ganglion at the level of C 6 and C 7 . Ultrasound guided lateral approach increases the efficacy of SGB by deposition of drug subfascially with real-time imaging. (Source: Saudi Journal of Anaesthesia)


A randomized placebo-controlled trial to evaluate a novel noninjectable anesthetic gel with thermosetting agent during scaling and root planing in chronic periodontitis patients
Conclusions: The NRS and VRS pain scores showed that the side treated with anesthetic gel was statistically more effective than the placebo in reducing pain during SRP. (Source: Saudi Journal of Anaesthesia)


Brief Psychological and Hypnotic Interventions in Chronic Pain Management
This article will explore how brief psychological approaches using hypnosis and imagery can be used with patients with chronic pain, predominantly in a Primary Care setting, although much that is discussed here could be applied in the Secondary sector. Chronic pain is defined as pain which endures for more than 6 months and may last for months or years. It serves no physiological purpose and persists after the time that ‘normal’ healing would be supposed to have taken place. Chronic pain may also range from that of cancer or arthritis, to that which seems to have no single or obvious physical causation. Teaching self-hypnosis and use of imagery can give these patients tools that they can use to help themselves, not only with pain, but also with the emotional distress that so often acc...


Efficacy of high-intensity laser therapy in the treatment of chronic neck pain: a randomized double-blind placebo-control trial
Abstract The aim of the study was to investigate the effect of high-intensity laser therapy (HILT) in treatment of patients with chronic neck pain (CNP) on cervical range of motion (ROM), pain, and functional activity. Sixty male patients participated in this study with mean (SD) age of 35.47 (4.18) years. Patients were randomly assigned into two groups and treated with HILT plus exercise (HILT + EX) and placebo laser plus exercise (PL + EX) in groups 1 and 2, respectively. The outcomes measured were cervical ROM, pain level by visual analog scale (VAS), and functional activity by neck disability index (NDI) score. Statistical analyses were performed to compare the differences between baseline and post-treatment. The level of statistical significance was set as p &lt; ...


P5: systemic mastocytosis presenting as cardiac tamponade with cd25+ pericardial mast cells
Conclusions SM with tamponade. Abstract P5 Figure 1 (Source: Journal of Investigative Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


P15: relapsing erosive polyarthritis associated with hidradenitis suppurativa
Conclusions In conclusion, we propose that inflammatory spondyloarthropathy may be a complication of HS. (Source: Journal of Investigative Medicine)


Chronic restraint stress exacerbates nociception and inflammatory response induced by bee venom in rats: the role of the P2X7 receptors.
CONCLUSION: Taken together, our data indicate that chronic restraint stress-enhanced nociception and inflammation in the BV pain model, possibly involving the P2X7R. PMID: 26900997 [PubMed - as supplied by publisher] (Source: Neurological Research)


Inflammatory Bowel Disease.
CONCLUSION: The treatment of chronic inflammatory bowel diseases requires individually designed therapeutic strategies and the close interdisciplinary collaboration of internists and surgeons. PMID: 26900160 [PubMed - in process] (Source: Deutsches Arzteblatt International)


Nerve Block Technique Might Help Ease Chronic Back Pain
Small study found half of patients still getting pain relief a year out from treatment Source: HealthDay Related MedlinePlus Page: Back Pain (Source: MedlinePlus Health News)


Nerve Block Technique Might Help Chronic Back Pain
Small study found half of patients still getting pain relief a year out from treatment (Source: WebMD Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Nerve Block Technique Might Help Ease Chronic Back Pain
Small study found half of patients still getting pain relief a year out from treatment (Source: WebMD Health)


GOSPEL 2 – Colchicine for the treatment of gout flares in France – a GOSPEL survey subgroup analysis. Doses used in common practices regardless of renal impairment and age
Conclusions This study draws attention to some misuse of colchicine in daily practice and the prescription of excessive doses especially in case of renal impairment. eGFR should be enforced in daily practice. (Source: Joint Bone Spine)


IJERPH, Vol. 13, Pages 255: The Effects of Forest Therapy on Coping with Chronic Widespread Pain: Physiological and Psychological Differences between Participants in a Forest Therapy Program and a Control Group
This study aimed to investigate the effects of a two-day forest therapy program on individuals with chronic widespread pain. Sixty one employees of a public organization providing building and facilities management services within the Seoul Metropolitan area participated in the study. Participants were assigned to an experimental group (n = 33) who participated in a forest therapy program or a control group (n = 28) on a non-random basis. Pre- and post-measures of heart rate variability (HRV), Natural Killer cell (NK cell) activity, self-reported pain using the visual analog scale (VAS), depression level using the Beck Depression Inventory (BDI), and health-related quality of life measures using the EuroQol Visual Analog Scale (EQ-VAS) were collected in both groups. The results showed that...


The specificity of mental pain in borderline personality disorder compared to depressive disorders and healthy controls
Conclusion On OMMP total score, mental pain was similarly elevated in BPD and DD. However, the narcissistic wounds sub-type of mental pain was a sensitive and specific diagnostic indicator of BPD and, therefore, may be an important aspect of BPD in need of increased focus in assessment and theoretical models. (Source: Borderline Personality Disorder and Emotion Dysregulation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Overlap and differences between patient and provider expectations for treatment outcomes: the case of acupuncture
Our study aimed to identify patient-provider clusters with different patterns of expectations for treatment outcomes. All patients (n= 885) received acupuncture treatment from physicians for their migraine, headache, osteoarthritis, or chronic low back pain. We identified six robust patient-provider expectation clusters (PPECs) (inter-classification reliability > 0.89) showing differences between patients and providers in their expected treatment responses (e.g., unrealistic optimists, optimistic doubters). (Source: The Journal of Pain)


Migraine headache and bipolar disorder comorbidity: A systematic review of the literature and clinical implications
Conclusions High rates of comorbidity exist between migraine and bipolar disorder, exceeding estimated prevalence rates for those conditions in the general population. Comorbidity may portend a more serious clinical course for dually afflicted individuals. Implications Clinicians need to structure treatment approaches to address concurrent migraine and bipolar disorder in dually afflicted individuals. Although further evidence-based investigation is warranted to inform optimal treatment approaches for both conditions concurrently, anticonvulsants (e.g., valproate, lamotrigine and topiramate); atypical antipsychotics (e.g., olanzapine or quetiapine); and calcium channel blockers (e.g., verapamil) may be considered. (Source: Scandinavian Journal of Pain)


Diacylglycerol lipase beta inhibition reverses nociceptive behavior in mouse models of inflammatory and neuropathic pain
Conclusions and ImplicationsThese findings suggest that local inhibition of DAGL‐β at the site of inflammation represents a novel avenue to treat pathological pain, with no apparent untoward side effects. (Source: British Journal of Pharmacology)


Downregulation of IL-10 secretion by Treg cells in osteoarthritis is associated with a reduction in Tim-3 expression
In conclusion, our results revealed an immunoregulatory disorder in OA independent of obesity, and demonstrated a potential mechanism in establishing the proinflammatory status of OA patients. (Source: Biomedicine and Pharmacotherapy)


Pain in Community-Dwelling Elderly African Americans
Conclusion: Our findings encourage multidisciplinary and interdisciplinary interventions to include pharmacotherapy, psychological support, and physical rehabilitation, specifically on neuropathic pain among aged African Americans with multiple chronic conditions. (Source: Journal of Aging and Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Impact of pain characteristics and fear-avoidance beliefs on physical activity levels among older adults with chronic pain: a population-based, longitudinal study
To explore the level of physical activity in a population based sample of older adults; to analyze the influence of pain characteristics and fear-avoidance beliefs as predictors of physical activity among olde... (Source: BMC Geriatrics)


Acupuncture for chronic knee pain: a protocol for an updated systematic review
Introduction The aim of this study is to evaluate the efficacy and safety of acupuncture for patients with chronic knee pain. Methods and analysis MEDLINE, EMBASE, CENTERAL, CINAHL and four Chinese medical databases will be searched from their inception to present. We will also manually retrieve eligible studies. Randomised controlled trials (RCTs) in which acupuncture is assessed as the sole treatment or as an adjunct treatment for chronic knee pain will be included. The primary outcome of our analysis is pain measured by the visual analogue scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale or the 11-point numeric rating scale (NRS). The secondary outcomes will include the quality of life, measured by the 36-item Short-Form Health Surve...


Improving the detection of chronic migraine: Development and validation of Identify Chronic Migraine (ID-CM)
Discussion ID-CM is a simple yet accurate tool that correctly classifies most individuals with migraine and CM. Further testing in other settings will also be valuable. (Source: Cephalalgia)


Effects of Exercise on Select Biomarkers and Associated Outcomes in Chronic Pain Conditions: Systematic Review
Discussion: It remains a question whether biomarkers can be used as objective measures for risk assessment, diagnosis, or evaluation or as surrogate endpoints in chronic pain. Adequate sample sizes, optimal exercise dose determination, study replications, and longitudinal research studies with consistent methodologies are warranted. Regardless, the potential translational value of biomarkers in chronic pain is evident. Advancing nursing research in biomarkers is vital for moving the nursing discipline and clinical chronic pain practice forward. Developing a biobehavioral perspective in chronic pain is also necessary for comprehensive management. (Source: Biological Research For Nursing)


Combined reconstructive surgery involving uterosacral colpopexy and anterior vaginal mesh implantation for pelvic organ prolapse
ConclusionThe satisfactory correction of pelvic organ prolapse was achieved using a combination of vaginal hysterectomy and uterosacral ligament colpopexy augmented by anterior vaginal mesh implantation. © 2016 Japan Society of Obstetrics and Gynecology (Source: Journal of Obstetrics and Gynaecology Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Return to Work in Patients with Chronic Musculoskeletal Pain: Multidisciplinary Intervention Versus Brief Intervention: A Randomized Clinical Trial
Conclusions: There were no differences between the groups on full-time RTW during the 24 months. However, the results indicate that MI hastens the return to work process in long-term sick leave through the increased use of partial sick leave. Trial Registration: http://www.clinicaltrials.gov with the registration number NCT01346423. (Source: Journal of Occupational Rehabilitation)


Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo.
This study compared the effects of local platelet-rich plasma, corticosteroid, and placebo injections in the treatment of chronic plantar fasciitis. In this double-blind study, patients were divided randomly into 3 groups. Local injections of platelet-rich plasma, corticosteroid, or normal saline were given. Patients were assessed with the visual analog scale for pain and with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot score before injection, at 3 weeks, and at 3-month follow-up. Mean visual analog scale score in the platelet-rich plasma and corticosteroid groups decreased from 7.44 and 7.72 preinjection to 2.52 and 3.64 at final follow-up, respectively. Mean AOFAS score in the platelet-rich plasma and corticosteroid groups improved from 51.56 and 55.72 prei...


Chronic low back pain treatment and quality of life
Ueberall MA, Eberhardt A, Mueller-Schwefe GHH (Source: International Journal of General Medicine)


Seattle autoimmune biotech KPI plans clinical trials, looks to raise $25M
Seattle-based KPI Therapeutics is looking to raise more than $25 million to undertake clinical development of its drugs. The company, which is developing drugs to treat autoimmune conditions and chronic pain, kicked off its fundraising at an industry conference earlier this month, CEO Charles Magness said. KPI is talking with institutional players and private equity groups, he said. It is considering funders ranging from venture capital firms to hedge funds, to the venture capital arms of pharmaceutical… (Source: bizjournals.com Health Care:Pharmaceuticals headlines)


Assessment of cutaneous allodynia in a chronic migraine population
Mathew PG, Cutrer FM, Garza I (Source: Journal of Pain Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Nerve Block Technique Might Help Ease Chronic Back Pain
TUESDAY, Feb. 23, 2016 -- A procedure that uses radio waves to treat chronic low back pain provided long-lasting relief to a small group of patients, researchers report. Called intradiscal biacuplasty (IDB), the procedure uses two water-cooled... (Source: Drugs.com - Daily MedNews)


Mindfulness program may ease chronic low back pain
(Reuters Health) – An eight-week group program focused on mindfulness-based stress reduction may help with short-term function and long-term pain for people with chronic low back problems, according to a new study. (Source: Reuters: Health)


Understanding Pain
By Drs. David Niesel and Norbert Herzog, Medical Discovery News Pain is so common, one in three Americans report experiencing it daily. The financial cost due to pain tops more than half a trillion dollars per year. In its most elemental form, pain is our body's way of letting us know that something is not right. Not surprisingly, all pain is not the same. The perception of pain is quite individualized, as everyone has a different pain scale that can vary due to factors such as gender and age. It is nearly impossible to objectively measure pain -- it is one of those things that people experience differently and it is completely self-reported, so the experience is personal and the scale of intensity is individualized. On the most basic level, pain can be classified as two types: acute (sh...


'Mindfulness' Might Help Older Adults With Back Pain
TUESDAY, Feb. 23, 2016 -- Mindful meditation may offer a measure of pain relief to seniors suffering from chronic lower back pain, new research suggests. The study involved nearly 300 older adults with long-term lower back pain, half of whom were... (Source: Drugs.com - Daily MedNews)


Leg adjustments as a key: initial insights into quick release trials between healthy controls and chronic non‐specific low back pain patients
This article is protected by copyright. All rights reserved. (Source: Acta Physiologica)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Abnormal Pain Response to Visual Feedback During Cervical Movements in Chronic Whiplash: An Experimental Study
ConclusionIn contrast to the healthy controls, visual feedback and sensorimotor incongruence did not alter pain thresholds in patients with chronic WAD. These findings suggest an abnormal pain response to visual feedback and somatosensory incongruence as well as failing mechanisms of pain inhibition in chronic WAD. (Source: Pain Practice)


Effect of Perioperative Intravenous Lidocaine Infusion on Acute and Chronic Pain after Breast Surgery: A Meta‐Analysis of Randomized Controlled Trials
ConclusionThe results indicate no significant benefits of intravenous lidocaine infusion in terms of acute postoperative pain. Although lidocaine seems to attenuate the risk of chronic pain after breast surgery, there is insufficient evidence to conclude that lidocaine infusion is of proved benefit because the results were based on a limited number of small trials. (Source: Pain Practice)


Clinical Uses of Intrathecal Therapy and Its Placement in the Pain Care Algorithm
We describe the appropriate use of intrathecal therapy in the management of severe chronic pain, based on current best practices. Topics addressed here include patient selection, trialing, dosing and titration, adverse event profiles, long‐term management, intrathecal therapy for cancer‐related pain, and the placement of intrathecal therapy in the pain care algorithm. In appropriately selected patients with chronic pain, intrathecal therapy can provide substantial pain relief with improved functioning and quality of life. Successful long‐term management requires ongoing patient monitoring for changes in efficacy and the occurrence of adverse events, with subsequent changes in intrathecal dosing and titration, the addition of adjuvant intrathecal agents, and the use of concomitant ora...


Implementing Treat‐to‐Target Practices for Chronic Pain Through Shared Decision Making: Requisites, Prospects, and Challenges
ConclusionConcerns about the ability of patients to participate in a collaborative implementation of T2T were not substantiated. Future studies can examine the subtle interplay of goals, assessments, and treatment decisions and clarify outstanding issues about the practice of clinical decision making. (Source: Pain Practice)


Management of Postherniorrhaphy Chronic Neuropathic Groin Pain: A Role for Dorsal Root Ganglion Stimulation
Abstract Chronic neuropathic groin pain is a sequela of hernia surgery that occurs at unacceptably high rates, causing widespread impacts on quality of life. Although the medical community is beginning to recognize the role of surgical technique in the initiation and maintenance of postherniorrhaphy neuropathic pain, little information exists regarding pain management strategies for this condition. This review presents a summary of the pain condition state, its treatment options, and treatment recommendations. Both literature review and clinical experience were used to develop a proposed a treatment algorithm for the treatment of postherniorrhaphy pain. The development of chronic pain may be prevented via a number of perioperative measures. For pain that is already established, some surgic...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Successful Graded Mirror Therapy in a Patient with Chronic Deafferentation Pain in Whom Traditional Mirror Therapy was Ineffective: A Case Report
Abstract A 43‐year‐old man had deafferentation pain in his right upper extremity secondary to brachial plexus avulsion from a traffic accident 23 years previously. On our initial examination, he had severe tingling pain with numbness in the right fingers rated 10 on the numerical rating scale. The body perception of the affected third and fourth fingers was distorted in the flexed position. Although he performed traditional mirror therapy (TMT) for 4 weeks in the same methods as seen in previous studies, he could not obtain willed motor imagery and pain‐alleviation effect. Therefore, we modified the task of TMT: Graded mirror therapy (GMT). GMT consisted of five stages: (1) observation of the mirror reflection of the unaffected side without imagining any movements of the affected sid...


Resilience moderates the association between chronic pain and depressive symptoms in the elderly
ConclusionsResilience was protective in the association of CWP with depressive symptoms in this analysis. Older adults with CWP may potentially benefit from interventions supporting resilience. Prospective research should investigate the protective role of resilience in the potentially self‐perpetuating relation between chronic pain and depressed affect. What does this study add?The association of chronic widespread pain with depressive symptoms in the elderly population is attenuated by resilience. (Source: European Journal of Pain)


Addictive Behaviors and Chronic Pain in a High-Risk Population: The Simple and Confounding Effects of Multiple Addictive Diseases
In this study, we use a cross-sectional design to examine the relationship between addictive behaviors and self-reported pain in a high-risk population of driving under the influence (DUI) violators. Our results suggest that individuals identified as having potentially dependent relationships with food, nicotine, drugs, alcohol, and sex have a greater likelihood of experiencing pain. However, the magnitude of the association varied significantly among the addictive domains and in relation to the severity and body location of the reported pain. Our results demonstrate simple and additive effects associated with the confounding relationships between multiple addictions and the likelihood of experiencing chronic pain. Potential explanations for these relationships range from the physiological...


A randomized double-blind placebo-controlled study to compare preemptive analgesic efficacy of novel antiepileptic agent lamotrigine in patients undergoing major surgeries
Conclusions: The study recommends the use of single oral dose lamotrigine as preemptive analgesic for effective postoperative pain control. (Source: North American Journal of Medical Sciences)


Nurse Practitioner Knowledge and Treatment Choices for Chronic Unexplained Orchialgia
Chronic pain, men's urology, and men's genital health issues are traditionally unrepresented in nurse practitioner (NP) curricula. This descriptive study compared 2 groups of NPs and their knowledge and treatment choices for an understudied male chronic pain condition: chronic unexplained orchialgia. The characteristics of the study population (n = 396) mirrored the NP population as a whole, and treatment and referral patterns mirrored suspected causes for both groups. The study findings reflect the growing specialization of NPs, suggesting that a urology focus and longer time in practice contributes to a more contemporary approach to identification and management of this condition. (Source: The Journal for Nurse Practitioners)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Selective nerve root blocks vs. caudal epidural injection for single level prolapsed lumbar intervertebral disc – A prospective randomized study
Conclusions Caudal epidural block is an easy and safe method with better pain relief and improvement in functional disability than selective nerve root block. Selective nerve root block injection is technically more demanding and has to be given by a skilled anesthetist. (Source: Journal of Clinical Orthopaedics and Trauma)


Delayed Union of a Jones Fracture in a Patient With Rothmund-Thomson Syndrome: A Case Report and Review of the Literature
We present the case of a 13-year-old female diagnosed with Rothmund-Thomson syndrome who demonstrated delayed union of her fifth metatarsal after a Jones fracture. She was treated conservatively for 6 weeks with non-weightbearing cast immobilization and was then transitioned to a controlled ankle motion walker for an additional 4 weeks. Two months later, however, she continued to experience pain, and, on radiographic examination, the fracture remained unchanged. Therefore, with her guardian's consent, the patient elected to undergo open reduction and internal fixation of the fifth metatarsal fracture. At 8 weeks postoperatively, the patient reported a subsidence of symptoms and had returned to normal activity. With our report, we hope to increase practitioner awareness that delayed bone he...


Modified retrorectus ventral hernia repair
Conclusions Retrorectus ventral hernia repair avoiding transfascial suture placement produces a functional repair with minimal chronic pain and a low rate of complications. (Source: The American Journal of Surgery)


Reoperation for groin pain after inguinal herniorrhaphy: does it really work?
Conclusions Although most patients do not experience immediate relief with R4GP, the majority receive some benefit in long-term follow-up. (Source: The American Journal of Surgery)


Even a “pigtail” distal end catheter can enter the epidural space after continuous paravertebral block
Abstract A woman with a medical history of breast cancer presented with chronic pain of the right hemithorax. To alleviate pain, a continuous paravertebral block was performed using a pigtail end catheter, introduced using ultrasound visualization (transversal technique at the inferior articular process of T6). Complete pain relief was observed. A few hours later, urinary retention was diagnosed and discharge from the ambulatory setting was canceled. On the following day, a new injection of local anesthetics through the catheter triggered paresthesia in the contralateral leg and a new urinary retention was diagnosed. A CT scan confirmed the epidural misplacement of the catheter. The latter was withdrawn, and the patient was released to home after the complete disappearance of her ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Activation of glial Glutamate transporter via MAPK p38 prevents enhanced and long-lasting non-evoked resting pain after surgical incision in rats.
In conclusion, our findings indicate a new spinal pathway by which non-evoked pain behavior after incision is modulated. The pathway is modality (non-evoked pain) and neuron (HT) specific and disturbance contributes to prolonged long-term pain after surgical incision. This may have therapeutic implications for the treatment of acute and - even more relevant -for prevention of chronic pain after surgery in patients. PMID: 26920805 [PubMed - as supplied by publisher] (Source: Neuropharmacology)


[Spanish consensus statement for diagnosis and treatment of paroxysmal nocturnal haemoglobinuria].
Authors: Villegas A, Arrizabalaga B, Bonanad S, Colado E, Gaya A, González A, Jarque I, Núñez R, Ojeda E, Orfao A, Ribera JM, Vicente V, Urbano-Ispizua Á, Grupo de Trabajo de HPN de la Sociedad Española de Hematología y Hemoterapia Abstract Paroxysmal nocturnal haemoglobinuria (PNH) is an acquired clonal disorder of the haematopoietic progenitor cells due to a somatic mutation in theX-linked phosphatidylinositol glycan class A gene. The disease is characterized by intravascular haemolytic anaemia, propensity to thromboembolic events and bone marrow failure. Other direct complications of haemolysis include dysphagia, erectile dysfunction, abdominal pain, asthenia and chronic renal failure (65% of patients). The disease appears more often in the third decade of life and there i...


Bilateral Thoracoscopic Splanchnotomy to Alleviate Pain in Chronic Pancreatic Disease.
We present a safe strategy that uses prone positioning and two thoracoscopic ports for either hemithorax, permitting easy exposure and simple dissection of the greater and lesser splanchnic nerves. In our experience, this technique provides excellent pain relief with a minimal postoperative stay and few postoperative adverse events. This intervention has the potential to reduce dependency on opioid agents and improve quality of life in carefully selected patients. PMID: 26897240 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)


Endo Announces Launch Of BELBUCA(TM) (Buprenorphine) Buccal Film For Chronic Pain Management
New opioid analgesic with novel drug delivery now available by prescription in U.S. DUBLIN, Feb. 22, 2016 -- (Healthcare Sales & Marketing Network) -- Endo Pharmaceuticals Inc., a subsidiary of Endo International plc (ENDP) (ENL.TO), today announced th... Biopharmaceuticals, Drug Delivery, Product LaunchEndo International, BELBUCA, buprenorphine, buccal film (Source: HSMN NewsFeed)


Chronic Migraine With Medication Overuse and OnabotulinumtoxinA: Two Positive Case Reports of a Modified Injection Protocol
(Source: Headache: The Journal of Head and Face Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Reduced volume of gray matter in patients with trigeminal neuralgia
In this study, twenty-eight TN patients (thirteen females; mean age, 45.86 years ±11.17) and 28 healthy controls (HC; thirteen females; mean age, 44.89 years ±7.67) were included. Using voxel-based morphometry (VBM), we detected abnormalities in gray matter volume in the TN patients. Based on a voxel-wise analysis, the TN group showed significantly decreased gray matter volume in the bilateral superior/middle temporal gyrus (STG/MTG), bilateral parahippocampus, left anterior cingulate cortex (ACC), caudate nucleus, right fusiform gyrus, and right cerebellum compared with the HC. In addition, we found that the gray matter volume in the bilateral STG/MTG was negatively correlated with the duration of TN. These results provide compelling evidence for gray matter abnormalities in TN and su...


Nonpharmacologic Approaches to Chronic Low Back Pain in Adults
Chronic pain is one of the most common conditions encountered by health care professionals, particularly among patients 65 years and older, and is associated with substantial disability and costs. Management of chronic pain in older adults is complicated by age-related physiologic changes, competing comorbidities that limit treatment choices, and numerous patient (eg, fear of deleterious effects of medications) and physician (eg, lack of training) barriers. One of the most significant barriers to effective management, however, is a limited evidence base to guide treatment decisions. Recent reviews have documented the paucity of high-quality randomized clinical trials in the field. Shortcomings include study durations of 12 weeks or less, a lack of study population diversity, and enrollment...


A Mind-Body Program for Older Adults With Chronic Low Back Pain
This randomized clinical trial investigates the effectiveness of a mind-body program at increasing function and reducing pain in older adults with chronic low back pain. (Source: JAMA Internal Medicine)


Insular Cortex is Critical for the Perception, Modulation, and Chronification of Pain
Abstract An increasing body of neuroimaging and electrophysiological studies of the brain suggest that the insular cortex (IC) integrates multimodal salient information ranging from sensation to cognitive-affective events to create conscious interoception. Especially with regard to pain experience, the IC has been supposed to participate in both sensory-discriminative and affective-motivational aspects of pain. In this review, we discuss the latest data proposing that subregions of the IC are involved in isolated pain networks: the posterior sensory circuit and the anterior emotional network. Due to abundant connections with other brain areas, the IC is likely to serve as an interface where cross-modal shaping of pain occurs. In chronic pain, however, this mode of emotional awaren...


Impact of a Chronic Pain Protocol on Emergency Department Utilization
ConclusionThrough instituting a chronic pain protocol, we found significant reductions in the number of return visits to a single ED and the number of controlled substance medications prescribed by all providers. Additional studies using similar protocols could help establish their impact on the care of patients suffering from chronic pain and the potential to reduce healthcare costs, ED overcrowding, and prescription drug abuse.This article is protected by copyright. All rights reserved. (Source: Academic Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Influence of chronic low back pain and fear of movement on the activation of the transversely oriented abdominal muscles during forward bending
Chronic low back pain (CLBP) and fear of movement (kinesiophobia) are associated with an overactivation of paravertebral muscles during forward bending. This impairs spine motor control and contributes to pain perpetuation. However, the abdominal muscles activation is engaged too in spine stabilization but its modulation with kinesiophobia remains unknown. Our study tested whether CLBP and kinesiophobia affected the activation pattern of abdominal muscles during trunk flexion/extension. (Source: Journal of Electromyography and Kinesiology)


Primary tracheo-bronchial tumours in children
Primary tracheobronchial tumours are rare lesions that can be benign or malignant, with different location along the airway tree.Symptoms may include wheezing, chronic pneumonia, asthma, chest pain, recurrent cough, atelectasis, haemoptysis and weight loss.Due to the heterogeneity of symptoms, diagnosis can be difficult and the airway involvement can lead progressively to a bronchial or tracheal obstruction.Due to the rarity of primary tracheobronchial tumours in children, there are not any oncological guidelines on pre-operative work-up, treatment and follow-up. (Source: Seminars in Pediatric Surgery)


Neuroimmune Physiology and Pathology.
Authors: Talbot S, Foster SL, Woolf CJ Abstract Evolution has yielded multiple complex and complementary mechanisms to detect environmental danger and protect tissues from damage. The nervous system rapidly processes information and coordinates complex defense behaviors, and the immune system eliminates diverse threats by virtue of mobile, specialized cell populations. The two systems are tightly integrated, cooperating in local and systemic reflexes that restore homeostasis in response to tissue injury and infection. They further share a broad common language of cytokines, growth factors, and neuropeptides that enables bidirectional communication. However, this reciprocal cross talk permits amplification of maladaptive feedforward inflammatory loops that contribute to the developm...


Laparoscopic surgical treatment of hepatic splenosis. A case report.
CONCLUSION: Hepatic splenosis is not a rare condition and should be considered with the differential diagnosis especially in patients who had previous splenectomy and absence of liver cirrhosis. Laparoscopic exploration should always be preferred for the diagnosis of uncertain liver mass. Few works report laparoscopic excision for liver splenosis. For experience at our Institution laparoscopic procedure has an important role to get the diagnosis and it is also a feasible approach for minimally invasive resection. KEY WORDS: Laparoscopy, Liver, Splenosis. PMID: 26893384 [PubMed - in process] (Source: Annali Italiani di Chirurgia)


Development of a New Adult Sickle Cell Disease Center Within an Academic Cancer Center: Impact on Hospital Utilization Patterns and Care Quality
Conclusion Findings suggest that embedding adult SCD centers within existing cancer centers can positively impact patterns of health care utilization and improve the quality of care. (Source: Journal of Racial and Ethnic Health Disparities)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


[Paravertebral block for management of acute postoperative pain and intercostobrachial neuralgia in major breast surgery].
CONCLUSIONS: Single-injection paravertebral block allows proper control of acute pain with less intraoperative and postoperative consumption of opioids but apparently it cannot prevent pain chronicity. Further studies are needed to clarify the role of paravertebral block in pain chronicity in major breast surgery. PMID: 26892620 [PubMed - as supplied by publisher] (Source: Revista Brasileira de Anestesiologia)


Connections from the rat dorsal column nuclei (DCN) to the periaqueductal gray matter (PAG)
Publication date: Available online 21 February 2016 Source:Neuroscience Research Author(s): Paolo Barbaresi, Emanuela Mensà Electrical stimulation of the dorsal columns (DCs; spinal cord stimulation; SCS) has been proposed to treat chronic neuropathic pain. SCS may activate a dual mechanism that would affect both the spinal cord and supraspinal levels. Stimulation of DCs or DC nuclei (DCN) in animals where neuropathic pain has been induced causes activation of brainstem centers including the periaqueductal gray (PAG), which is involved in the endogenous pain suppression system. Biotinylated dextran-amine (BDA) was iontophoretically injected into the DCN to analyze the ascending projection directed to the PAG. Separate injections into the gracile nucleus (GrN) and the cuneate nucleus (...


Urine trouble: Alterations in brain function associated with bladder pain
Chronic bladder pain is a debilitating condition often accompanied by alterations in affective and autonomic function. Many of the symptoms associated with chronic bladder pain are mediated by the central nervous system. In this review, data from preclinical animal models and human neuroimaging studies were analyzed and a theoretical supraspinal bladder pain network was generated. (Source: The Journal of Urology)


Paravertebral block versus thoracic epidural for patients undergoing thoracotomy.
CONCLUSIONS: Paravertebral blockade reduced the risks of developing minor complications compared to thoracic epidural blockade. Paravertebral blockade was as effective as thoracic epidural blockade in controlling acute pain. There was a lack of evidence in other outcomes. There was no difference in 30-day mortality, major complications, or length of hospital stay. There was insufficient data on chronic pain and costs. Results from this review should be interpreted with caution due to the heterogeneity of the included studies and the lack of reliable evidence. Future studies in this area need well-conducted, adequately-powered RCTs that focus not only on acute pain but also on major complications, chronic pain, length of stay and costs. PMID: 26897642 [PubMed - as supplied by publisher]...


Traumatic brain injury as a risk factor for Alzheimer's disease: Is inflammatory signaling a key player?
Authors: Djordjevic J, Sabbir MG, Albensi BC Abstract Traumatic brain injury (TBI) has become a significant medical and social concern within the last 30 years. TBI has acute devastating effects, and in many cases, seems to initiate long-term neurodegeneration. With advances in medical technology, many people are now surviving severe brain injuries and their long term consequences. Post trauma effects include communication problems, sensory deficits, emotional and behavioral problems, physical complications and pain, increased suicide risk, dementia, and an increased risk for chronic CNS diseases, such as Alzheimer's disease (AD). In this review, we provide an introduction to TBI and hypothesize how it may lead to neurodegenerative disease in general and AD in particular. In additi...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Effects of transcranial random noise stimulation (tRNS) on affect, pain and attention in multiple sclerosis.
CONCLUSIONS: This study suggests the role of tRNS in pain modulation, which could have been more evident with longer stimulation protocols. PMID: 26890095 [PubMed - as supplied by publisher] (Source: Restorative Neurology and Neuroscience)


'Spousal Revenge Syndrome'- description of a new chronic pelvic pain syndrome patient cohort.
Authors: Makovey I, Dolinga R, Shoskes DA Abstract Psychological factors may play a role in the pathophysiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This case series describes a cohort of 10 men presenting with CP/CPPS whose symptoms began after an extramarital sexual encounter, who strongly believed they had a sexually transmitted infection (STI) despite negative testing, and who have had no improvement with empiric antibiotic treatment. Patients' clinical presentation and physical exam findings are reviewed. All men were clinically phenotyped with the UPOINT system. Pelvic floor spasm and not infection was prominent in these men. Treatment recommendations are proposed and compliance assessed. PMID: 26892062 [PubMed - in process] (Source: Canadian Jo...


Redirecting Efforts to Achieve Patient Satisfaction in the Chronic Pain Clinic
No abstract available (Source: Regional Anesthesia and Pain Medicine)


Periprocedural Management of Direct Oral Anticoagulants: Comment on the 2015 American Society of Regional Anesthesia and Pain Medicine Guidelines
No abstract available (Source: Regional Anesthesia and Pain Medicine)


Real-Time Detection of Periforaminal Vessels in the Cervical Spine: An Ultrasound Survey
Conclusions: Small periforaminal arteries are prevalent along the lateral aspect of the cervical spine, adjacent to areas commonly targeted by nerve block procedures. Further trials are required to determine if ultrasound guidance can reduce the incidence of complications related to accidental vascular breach. (Source: Regional Anesthesia and Pain Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Sudden Intrathecal Drug Delivery Device Motor Stalls: A Case Series
Conclusions: Higher rates of device failure are associated with the use of off-label IT drugs. However, device failure may still occur while infusing only approved medications. Implanted patients should be properly informed and educated to differentiate and recognize the critical error alarm of their device as well as the signs and symptoms of IT medication overdose and withdrawal. (Source: Regional Anesthesia and Pain Medicine)


Ultrasound-Guided Pudendal Nerve Block at the Entrance of the Pudendal (Alcock) Canal: Description of Anatomy and Clinical Technique
Conclusions: This new technique is based on easily recognizable sonoanatomical patterns. It probably implies no risk of sacral plexus blockade, and the pudendal nerve is anesthetized before any branches ramify from the main trunk. This promising new technique must be validated in future clinical trials. (Source: Regional Anesthesia and Pain Medicine)


Chronic Pain and Heart Rate Variability in a Cross-Sectional Occupational Sample: Evidence for Impaired Vagal Control
Discussion: Our results suggest that the DIP indexed by vagal activity operationalized as RMSSD is disturbed in persons with chronic pain. Furthermore, the correlations between RMSSD and pain are different between those without and those with chronic pain. The findings are discussed, emphasizing changes in brain activity and the comorbid dysregulation of emotion in patients with chronic pain, to provide implications for the treatment of chronic pain. (Source: The Clinical Journal of Pain)


Sympathetic Dysfunction in Patients With Chronic Low Back Pain and Failed Back Surgery Syndrome
Conclusions: It was concluded that the sympathetic nervous system is affected in CLBP and FBSS patients with abnormalities in SSR and that the dysfunction of sympathetic nervous system may contribute to the intensity and chronicity of pain in these groups of patients. Moreover, a strong association was found between SSR and functional disabilities in these patients. (Source: The Clinical Journal of Pain)


Pain-related and Psychological Symptoms in Adolescents With Musculoskeletal and Sleep Problems
Discussion: Comorbid sleep and pain problems were associated with a higher incidence of pain-related and psychological symptoms. Sleep problems may therefore be an important modifiable risk factor for alleviating distress in adolescents with musculoskeletal pain. (Source: The Clinical Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


siRNA-mediated downregulation of GluN2B in the rostral anterior cingulate cortex attenuates mechanical allodynia and thermal hyperalgesia in a rat model of pain associated with bone cancer.
Authors: Xu Y, Wang G, Zou X, Yang Z, Wang Q, Feng H, Zhang M Abstract It has previously been suggested that the upregulation of GluN2B-containing N-methyl D-aspartate receptors (GluN2B) within the rostral anterior cingulate cortex (rACC) may contribute to the development of chronic pain. The present study used a rat model of bone cancer pain in order to investigate whether lentiviral-mediated delivery of small interfering RNAs targeting GluN2B (LV-GluN2B) could attenuate pain associated with bone cancer, by selectively decreasing GluN2B expression within the rACC. Sprague Dawley rats were inoculated with osteosarcoma cells into the intramedullary space of the right tibia in order to induce persistent bone cancer-associated pain. Intra-rACC administration of the lentiviral siRNA wa...


Controlled-release of opioids for improved pain management
Publication date: Available online 19 February 2016 Source:Materials Today Author(s): Charlotte Martin, Andy De Baerdemaeker, Jan Poelaert, Annemieke Madder, Richard Hoogenboom, Steven Ballet The adequate treatment of pain remains one of the major medical challenges. Morphine and other opioid drugs are most commonly used to counteract moderate to severe pain, but they are also increasingly accessed by patients with chronic non-malignant pain. To achieve long-term analgesia, opioid therapy still represents the standard treatment for chronic pain alleviation. This work presents an overview of current strategies aiming at controlled opioid release. Two important, and intrinsically linked, features are discussed in detail: the used formulations (i.e. polymer systems) and the applied dr...


Validation of a New Arabic Version of the Neuropathic Pain Diagnostic Questionnaire (DN4)
In conclusion, this new Arabic version DN4 questionnaire is a simple, reliable, and valid tool for discriminating between neuropathic and non‐neuropathic pain. It represents a useful tool in clinical setting and population‐based studies. (Source: Pain Practice)


The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities
The purpose of this study was to determine whether use of chiropractic manipulative treatment (CMT) was associated with lower healthcare costs among multiply-comorbid Medicare beneficiaries with an episode of chronic low back pain (cLBP). (Source: Journal of Manipulative and Physiological Therapeutics)


Clinical outcome of ovarian vein embolization in pelvic congestion syndrome
Conclusion From our and previous results, we can conclude that catheter directed OV coil embolization is a feasible procedure for treatment of pelvic congestion syndrome associated with OV incompetence. Presence of bilateral OV incompetence should always be investigated prior this therapy. Further prospective trials are required to assess the full benefits and efficacy of this technique, and to assess which may be the best embolic agent. (Source: Alexandria Journal of Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Transcriptional repressor DREAM regulates trigeminal noxious perception
This article is protected by copyright. All rights reserved. (Source: Journal of Neurochemistry)


Pain in the Elderly
Abstract Pain management in the elderly has increasingly become problematic in the USA as the aged population grows. The proportion of the population over 65 continues to climb and may eclipse 20 % in the next decade. In order to effectively diagnosis and treat these patients, a proper history and physical exam remain essential; pain assessment scales such as the Verbal Descriptor Scales (VDS), the Numerical Rating Scales (NRS), and the Visual Analogue Scales (VAS) often but not always prove beneficial. The conditions most frequently afflicting this population include osteoarthritis, diabetic neuropathy, post-herpetic neuralgia, and lower back pain which include spondylosis and radiculopathies. While the normal aging process does not necessarily guarantee symptoms of chronic pai...


Prevalence of Genu Recurvatum during Walking and Associated Knee Pain in Chronic Hemiplegic Stroke Patients: A Preliminary Survey
Although genu recurvatum during walking is a well-known issue in stroke rehabilitation, there are no reliable epidemiological data on its prevalence. The aim of the study was to investigate the prevalence of genu recurvatum during walking and associated knee pain among ambulatory community-dwelling patients with chronic hemiplegic stroke. (Source: Journal of Stroke and Cerebrovascular Diseases)


Congruency of body-related information induces somatosensory reorganization
Publication date: Available online 19 February 2016 Source:Neuropsychologia Author(s): Flavia Cardini, Matthew R. Longo Chronic pain and impaired tactile sensitivity are frequently associated with “blurred” representations in the somatosensory cortex. The factors that produce such somatosensory blurring, however, remain poorly understood. We manipulated visuo-tactile congruence to investigate its role in promoting somatosensory reorganization. To this aim we used the mirror box illusion that produced in participants the subjective feeling of looking directly at their left hand, though they were seeing the reflection of their right hand. Simultaneous touches were applied to the middle or ring finger of each hand. In one session, the same fingers were touched (for example both middle...


Surgical treatment of chronic non-insertional Achilles tendinopathy in runners using bipolar radiofrequency
Discussion Peritendon release combined with bipolar radiofrequency is presented as an effective solution in this condition, for which there is currently no consensus on the best treatment. In patients in whom the non-insertional Achilles tendinopathy persists after an appropriate conservative treatment for a sufficient period (at least 6 months), open adhesiolysis combined with bipolar radiofrequency is a safe and with a high success rate clinical and functional intervention. In high performance athletes this technique allows a return to previous activity in a high percentage of cases. (Source: Revista Espanola de Cirugia Ortopedica y Traumatologia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pulsed radiofrequency on radial nerve under ultrasound guidance for treatment of intractable lateral epicondylitis
We reported on two patients with intractable lateral epicondylitis suffering from elbow pain who did not respond to nonoperative treatments, but in whom the ultrasound-guided pulsed radiofrequency neuromodulation of the radial nerve induced symptom improvement. After a successful diagnostic nerve block, radiofrequency probe adjustment around the radial nerve was performed on the lateral aspect of the distal upper arm under ultrasound guidance and multiple pulsed treatments were applied. A significant reduction in pain was reported over the follow-up period of 12 weeks. (Source: Journal of Anesthesia)


Calmare wins $15m DoD contract
Pain mitigation company Calmare Therapeutics said yesterday it won a general supply order contract from the U.S. Department of Defense for an estimated $15 million over the next 60 months. The Fairfield, Conn.-based company&#8217;s flagship product is its Calmare Pain Therapy Device is designed as a non-invasive and non-addictive neuropathic pain treatment modality, and has FDA 510(k) clearance. &#8220;This is a momentous occasion in our company’s history as a military contractor. Our military contracts team has helped us overcome many obstacles to reach this significant milestone. We look forward to broadening our presence in the government contract space over the short- and long- term,&#8221; CEO Conrad Mir said in a press release. Calmare said its pain mitigation therapy is designed ...


Mentoring may help teens cope with chronic pain
(Reuters Health) – Adolescents dealing with chronic pain may benefit from the advice and support of a young adult who has learned to manage similar symptoms, a Canadian pilot study suggests. (Source: Reuters: Health)


A review of glucosamine for knee osteoarthritis: Why patented crystalline glucosamine sulfate should be differentiated from other glucosamines to maximize clinical outcomes.
Authors: Kucharz EJ, Kovalenko V, Szántó S, Bruyère O, Cooper C, Reginster JY Abstract The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm for knee osteoarthritis (OA) recommends symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) first line for the medium to long term management of OA, due to their ability to control pain, improve function, and delay joint structural changes. Among SYSADOAs, glucosamine is probably the most widely used intervention. In the present review of glucosamine for knee OA, we have investigated whether the evidence is greater for the patented crystalline glucosamine sulfate (pCGS) preparation (Rottapharm/Meda) than for other glucosamine formulations. Glucosamine is actually widely...


More Evidence On Insomnia and Chronic Pain
No abstract available (Source: Lippincott’s Bone and Joint Newsletter)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Acute Painful Ptosis Secondary to IgG4 Dacryoadenitis
A 48-year-old lorry driver presented with 3 weeks of blurred vision, pain and diplopia. There was a right upper lid ptosis with some restriction of eye movements. A CT revealed an enlarged lacrimal gland and lacrimal gland biopsy showed IgG4-positive plasma cells. The patient responded to oral prednisolone and fully recovered. As a condition which mimics a number of diseases, an IgG4-related disease presents a diagnostic challenge and ought to be considered in both acute and chronic presentations.Case Rep Ophthalmol 2016;7:108-111 (Source: Case Reports in Ophthalmology)


Managing chronic pain in primary care
This article discusses systematic strategies to facilitate safe, efficient, satisfactory, and quality care of patients with chronic pain in primary care. (Source: The Nurse Practitioner)


Cells to Society: Tackling Cardiovascular Disease / Distinguished Professor in Diabetes / Research News
This study followed women from late pregnancy to one-year postpartum to evaluate breastfeeding expectations and duration. &nbsp; &nbsp; Read more &nbsp; Research Highlights ...


Molecular signatures of age-associated chronic degeneration of shoulder muscles.
Authors: Raz Y, Henseler JF, Kolk A, Tatum Z, Groosjohan NK, Verwey NE, Arindrarto W, Kielbasa SM, Nagels J, 't Hoen PA, Nelissen RG, Raz V Abstract Chronic muscle diseases are highly prevalent in the elderly causing severe mobility limitations, pain and frailty. The intrinsic molecular mechanisms are poorly understood due to multifactorial causes, slow progression with age and variations between individuals. Understanding the underlying molecular mechanisms could lead to new treatment options which are currently limited. Shoulder complaints are highly common in the elderly, and therefore, muscles of the shoulder's rotator cuff could be considered as a model for chronic age-associated muscle degeneration. Diseased shoulder muscles were characterized by muscle atrophy and fatty infi...


Johnson & Johnson loses another pelvic mesh suit
A federal jury in Georgia deliberated for 3 hours yesterday before delivering a another loss to Johnson & Johnson (NYSE:JNJ) in a product liability lawsuit brought over pelvic mesh products. The jury in the U.S. District Court for Middle Georgia awarded plaintiff Teresa Taylor $400,000 in compensatory damages and $4 million in punitive damages after finding that the Mentor ObTape transobdturator vaginal sling she had implanted in March 2014 caused her injuries. The ObTape device was implantd to treat Taylor&#8217;s stress urinary incontinence, according to court documents. Taylor alleged that the device eroded, causing &#8220;chronic infections, pain, exacerbation of her urinary incontinence, and the need for multiple additional surgical procedures and medical treatment as well as the...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


ISPOG European Consensus Statement - chronic pelvic pain in women (short version).
Authors: Siedentopf F, Weijenborg P, Engman M, Maier B, Cagnacci A, Mimoun S, Wenger A, Kentenich H Abstract To date there is no international guideline on chronic pelvic pain available that focuses on medical, psychosomatic and psychological diagnostics and treatment of this complicated disease pattern. In this paper, a European working group, which was established in October 2010, aims to bridge this gap. The working group decided to use the current German guideline as source text and to transform it into a European consensus statement by deleting parts that apply only to the conditions of the German health system. The literature search included papers published up to and including December 2010, using Medline search and by adding some new search terms. This manuscript reports th...


Physical therapy and psychological intervention normalize cortisol levels and improve vitality in women with endometriosis.
In conclusion, the physical and psychological intervention protocol applied in this study to women suffering of endometriosis was effective in reducing perceived stress, normalizing cortisol levels, increasing vitality and improving physical functioning. PMID: 23094607 [PubMed - indexed for MEDLINE] (Source: Journal of Psychosomatic Obstetrics and Gynaecology)


The end of chronic pain? podcast
Scientists at University College London have made a discovery which makes mice pain-free, and have reversed painlessness in a woman with a rare condition.What do we know about the way we experience pain?What purpose does it serve, and could we be close to dealing with the kind of chronic pain not yet treatable with medicine? Continue reading... (Source: Guardian Unlimited Science)


HPLC-DAD-MS identification of polyphenols from Passiflora leschenaultii and determination of their antioxidant, analgesic, anti-inflammatory and antipyretic properties
Publication date: Available online 18 February 2016 Source:Arabian Journal of Chemistry Author(s): Shanmugam Saravanan, Murugaiyan Iniyavan, Bruno dos Santos Lima, Mairim Russo Serafini, Adriano Antunes de Souza Araújo, Narendra Narain, Lucindo José Quintans-Júnior, Thangaraj Parimelazhagan Passion fruit (Passiflora leschenaultii DC), an endemic species to peninsular India, is traditionally used to treat various ailments such as dysentery, urinary stone disease and wounds. The present study aimed to investigate the antioxidant, analgesic, anti-inflammatory, antipyretic activities and chemical composition of leaf extracts of P. leschenaultii. Bioactive secondary metabolites like total phenolics, tannins and flavonoids were quantified. Antioxidant activities were determined by D...


Clinical Micro-Dose Studies to Explore the Human Pharmacokinetics of Four Selective Inhibitors of Human Nav1.7 Voltage-Dependent Sodium Channels
Conclusion Based on the human PK data obtained from the microdose study and subsequent modelling, PF-05089771 provided the best opportunity to explore Nav1.7 blockade for the treatment of acute or chronic pain conditions. (Source: Clinical Pharmacokinetics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Performance and quality indicators for the management of non-cancer chronic pain: a scoping review protocol
Introduction Chronic pain is a public health problem of epidemic proportion in most countries with important physical, psychological, social and economic consequences. The management of chronic pain is complex and requires an integrated network approach between all levels of the healthcare system and the involvement of several health professionals from different disciplines. Measuring the performance of organisations that provide care to individuals with chronic pain is essential to improve quality of care and requires the use of relevant performance and quality indicators. A scoping review methodology will be used to synthesise the evidence on performance and quality indicators developed for non-cancer chronic pain management across the continuum of care. Methods and analysis The followi...


Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial.
CONCLUSION: Both therapeutic methods were effective in the treatment of knee osteoarthritis; however, sulfurous baths yielded longer-lasting effects than non-sulfurous water baths. CLINICAL REHABILITATION IMPACT: Baths in thermal waters, especially those in sulfurous waters, are effective in reducing pain and improving physical function in patients with knee osteoarthritis. PMID: 26899038 [PubMed - as supplied by publisher] (Source: European Journal of Physical and Rehabilitation Medicine)


Age and gender related neuromuscular pattern during trunk flexion-extension in chronic low back pain patients
The root mean square surface electromyographic activity of lumbar extensor muscles during dynamic trunk flexion and extension from standing has repeatedly been recommended to objectively assess muscle function... (Source: Journal of NeuroEngineering and Rehabilitation)


[Brown tumors in chronic hemodialysis patients].
CONCLUSION: Our work relates one of the most important series published of brown tumors and is characterized by the multifocal character of these tumors. PMID: 26907666 [PubMed - as supplied by publisher] (Source: Nephrologie and Therapeutique)


Chronic Abdominal Wall Pain.
CONCLUSION: Chronic abdominal wall pain is easily diagnosed on physical examination and can often be rapidly treated. Any physician treating patients with abdominal pain should be aware of this condition. Further comparative treatment trials will be needed before a validated treatment algorithm can be established. PMID: 26883414 [PubMed - in process] (Source: Deutsches Arzteblatt International)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A New Rehabilitation Tool in Fibromyalgia: The Effects of Perceptive Rehabilitation on Pain and Function in a Clinical Randomized Controlled Trial.
Conclusions. According to the results, the PS are as promising as the physical exercises, since results were similar. PMID: 26884794 [PubMed] (Source: Evidence-based Complementary and Alternative Medicine)


Shoulder Pain: It May Be an Easy Fix
Shoulder pain at night, pain when lifting a briefcase, pain with overhead activities -- even pain while brushing your hair can be caused by shoulder impingement. To understand shoulder pain, you first have to know a bit about how the shoulder is held together: In large part by the rotator cuff and acromion.[1] The rotator cuff is made up of tendons from the muscles that lift and guide shoulder motion.[2] The acromion is the bone on top of the shoulder; it acts as a roof to the shoulder joint.[3] When the space between the tendons and the bony roof narrows--which can be caused by bone spurs or inflammation--impingement occurs. The pain of impingement comes from the four tendons of the rotator cuff muscles impacting against the underside of the acromion.[4] Think of it as putting a tack be...


Don’t shrug off shingles
If you had chickenpox as a kid, there is a good chance you may develop shingles later in life. “In fact, one in three is predicted to get shingles during their lifetime,” says Dr. Anne Louise Oaklander, director of the Nerve Unit at Harvard-affiliated Massachusetts General Hospital. The same varicella-zoster virus that causes chickenpox also causes shingles. After the telltale spots of chickenpox vanish, the virus lies dormant in your nerve cells near the spinal cord and brain. When your immunity weakens from normal aging or from illnesses or medications, the virus can re-emerge. It then travels along a nerve to trigger a rash in the skin connected to that nerve. The rash often appears on only one side of your body. The most common locations are the chest, back, or stomach, or above on...


Post-herpetic Neuralgia: a Review.
Authors: Hadley GR, Gayle JA, Ripoll J, Jones MR, Argoff CE, Kaye RJ, Kaye AD Abstract Post-herpetic neuralgia (PHN) is a chronic neuropathic pain condition that persists 3 months or more following an outbreak of shingles. Shingles, also known as acute herpes zoster, is associated with the reactivation of the dormant varicella zoster virus in an individual who has experienced chicken pox. PHN is associated with persistent and often refractory neuropathic pain. Patients may experience multiple types of pain including a constant deep, aching, or burning pain; a paroxysmal, lancinating pain; hyperalgesia (painful stimuli are more painful than expected); and allodynia (pain associated with typically non-painful stimuli). The pharmacological treatment of PHN may include a variety of me...


St. Jude Gains FDA Approval For Cardiac Pacing, Neurostimulation Technologies
The FDA has approved two new technologies that expand St. Jude Medical&rsquo;s portfolio for cardiac resynchronization therapy (CRT) and neurostimulation in the U.S. market. St. Jude announced that its MultiPoint Pacing (MPP) technology would be added to the company&rsquo;s Quadra CRT device offerings in the beginning of 2016, and that the Axium Neurostimulator System was approved for dorsal root ganglion (DRG) stimulation for patients with chronic pain in their lower limbs. (Source: Medical Design Online News)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Occupational life trajectories in the context of chronic pain and immigration.
Conclusion and significance The experiences demonstrate an occupational life controlled by internal and external factors and may be understood as a disrupted occupational life trajectory. This knowledge may be helpful to occupational therapists supporting immigrant women's attempts to regain a structured life despite the constant presence of pain. PMID: 26757859 [PubMed - as supplied by publisher] (Source: Scandinavian Journal of Occupational Therapy)


Fibrin sealant for mesh fixation in laparoscopic groin hernia repair does not increase long-term recurrence
Conclusion We found no significant difference in long-term reoperation rates and clinical recurrences in patients undergoing TAPP repair with meshes fixated with fibrin sealant compared with tacks. (Source: Surgical Endoscopy)


Prevalence of lower urinary tract symptoms and level of quality of life in men and women with chronic pelvic pain.
CONCLUSIONS: A wide variety of symptoms and a negative impact on quality of life were shown. No differences in lower urinary tract symptoms were found between genders. Women were less sexually active than men. Chronic pelvic pain had a significantly higher negative impact on the level of quality of life in women than in men. PMID: 25438989 [PubMed - indexed for MEDLINE] (Source: Scandinavian Journal of Urology)


Determination of IL1 R2 , ANTXR2 , CARD9 , and SNAPC4 single nucleotide polymorphisms in Iranian patients with ankylosing spondylitis
Abstract Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown origin, while both genetic and environmental factors have been demonstrated to be etiologically involved. Recent genome-wide association and replication studies have suggested that anthrax toxin receptor 2 (ANTXR2), interleukin-1 receptor 2 (IL1R2), caspase recruitment domain-containing protein 9 (CARD9), and small nuclear RNA-activating complex polypeptide 4 (SNAPC4) seem to be associated with AS pathogenesis. This case–control study was performed on 349 unrelated AS patients and 469 age- and gender-matched healthy controls, to investigate whether these non-MHC genes (IL1R2 rs2310173, ANTXR2 rs4333130, CARD9 rs4077515, and SNAPC4 rs3812571) influence the AS risk in Iranian population. ANTXR2 rs4...


Understanding the Association Between Chronic Obstructive Pulmonary Disease and Current Anxiety: A Population-Based Study.
This study's objectives were to investigate the independent relationship between COPD and past-year Generalized Anxiety Disorder (GAD) in a population-based sample of adult Canadians and to identify significant correlates of GAD among COPD patients. A series of logistic regression analyses were conducted with a sample of 11,163 respondents aged 50+ from the 2012 Canadian Community Health Survey-Mental Health to determine the degree to which the direct association between COPD and GAD was attenuated by socio-demographic factors, social support, health behaviors, sleep problems, pain, functional limitations, and early childhood adversities. Additional analyses were completed using the sub-sample of those diagnosed with COPD (n = 746) to determine predictors of GAD. One in 17 (5.8%) of older ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Efficacy of a new once daily hydromorphone formulation in comparison with twice daily administration in chronic pain: A randomized, double-blind, cross-over study.
Conclusion - Although this study was of short duration and included a limited number of patients, the results confirm that the new HOD is similarly effective and safe as established HTD. PMID: 26824884 [PubMed - as supplied by publisher] (Source: Current Medical Research and Opinion)


Patients' perceptions of a chronic pain rehabilitation program: Changing the conversation.
CONCLUSIONS: Patients perceive behavioral skills to manage pain and physical reconditioning to be important components of a successful pain rehabilitation program. These findings can inform conversations with both physicians and patients about the importance of biopsychosocial approaches to pain management. Key limitations include a lack of racial/ethnic diversity, use of anonymous data that cannot be linked directly to patient outcomes, and reliance on self-report data. PMID: 26824738 [PubMed - as supplied by publisher] (Source: Current Medical Research and Opinion)


A retrospective analysis of the long-term test-retest stability of pain descriptors of the painDETECT questionnaire.
CONCLUSION: The individual PD-Q pain descriptors showed accurate test-retest stability as a prerequisite for use in repeated measurements (e. g. post baseline or follow up data) in clinical trials. PMID: 26636376 [PubMed - in process] (Source: Current Medical Research and Opinion)


Efficacy and safety of low-dose SoluMatrix meloxicam in the treatment of osteoarthritis pain: a 12-week, phase 3 study.
CONCLUSIONS: Low-dose SoluMatrix meloxicam may have a potential role as a new therapeutic option for the management of OA-related pain. PMID: 26503347 [PubMed - in process] (Source: Current Medical Research and Opinion)


Efficacy of intralesional recombinant human epidermal growth factor in chronic diabetic foot ulcers.
CONCLUSIONS: Intralesional EGF administration up to complete closure can be safe, effective and suitable to improve healing of chronic diabetic foot ulcer (DFU). PMID: 25856197 [PubMed - in process] (Source: Growth Factors)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Neural mobilization promotes nerve regeneration by nerve growth factor and myelin protein zero increased after sciatic nerve injury.
We examined the effects of NM on the regeneration of sciatic nerve after chronic constriction injury (CCI) in rats. The CCI was performed on adult male rats, submitted to 10 sessions of NM, starting 14 days after CCI. Then, the nerves were analyzed using transmission electron microscopy and western blot for neural growth factor (NGF) and myelin protein zero (MPZ). We observed an increase of NGF and MPZ after CCI and NM. Electron microscopy revealed that CCI-NM samples had high numbers of axons possessing myelin sheaths of normal thickness and less inter-axonal fibrosis than the CCI. These data suggest that NM is effective in facilitating nerve regeneration and NGF and MPZ are involved in this effect. PMID: 25489629 [PubMed - indexed for MEDLINE] (Source: Growth Factors)


Modulation of cytokine levels in ameliorative effects of pulsed magnetic field on an experimental model of Chronic Constriction Injury.
CONCLUSIONS: The present findings may suggest that PMF treatment may reverse the CCI-induced changes in neuropathic pain behaviors by decreasing the production of pro-inflammatory cytokines and increasing the anti-inflammatory cytokine production at the site of injury. PMID: 25792192 [PubMed - indexed for MEDLINE] (Source: International Journal of Radiation Biology)


Results From the Partnership for Advancement in Neuromodulation Registry: A 24‐Month Follow‐Up
ConclusionsMost patients experienced substantial pain relief and a significant improvement in all outcome measures. These results further support the safety, efficacy, and sustainability of SCS in clinical practice. (Source: Neuromodulation: Technology at the Neural Interface)


Survivorship and clinical outcomes after multi-level anterior lumbar reconstruction with stand-alone anterior lumbar interbody fusion or hybrid construct
Publication date: Available online 17 February 2016 Source:Journal of Clinical Neuroscience Author(s): Benjamin Chen, Yusuf T. Akpolat, Paul Williams, Darren Bergey, Wayne K. Cheng In multilevel disc disease, there is still uncertainty regarding whether multiple total disc replacement is more effective and safer than fusion. Our objective was to measure and compare the clinical outcome of multilevel hybrid constructs with stand-alone anterior lumbar interbody fusion (ALIF) using a retrospective analysis. Sixty-four patients with chronic low back pain determined to be from two or three-level degenerative disc disease were included. Thirty-three patients were treated with hybrid fusion and 31 with ALIF. Several parameters were retrospectively reviewed, including blood loss, operation ...


Effects of chronic constriction injury and spared nerve injury, two models of neuropathic pain, on the numbers of neurons and glia in the rostral ventromedial medulla
Publication date: 23 March 2016 Source:Neuroscience Letters, Volume 617 Author(s): Mai Lan Leong, Rebecca Speltz, Martin Wessendorf In previous studies we have reported that spinal nerve ligation (SNL), a model of neuropathic pain, results in the loss of over 20% of neurons in the rostral portion of the ventromedial medulla (RVM) in rats, 10days after SNL. The RVM is involved in pain modulation and we have proposed that loss of pain inhibition from the RVM, including loss of RVM serotonin neurons, contributes to the increased hypersensitivity observed after SNL. In the present study we examined whether RVM neuronal loss occurs in two other models of neuropathic pain, chronic constriction injury (CCI) and spared nerve injury (SNI). We found no evidence for neuronal loss 10days after ei...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A good preoperative response to transcutaneous electrical nerve stimulation predicts a better therapeutic effect of implanted occipital nerve stimulation in pharmacologically intractable headaches
In this study, the analgesic efficacy of transcutaneous electrical nerve stimulation (TENS) was tested for 1 to 3 months in 41 patients with pharmacologically intractable headache disorders of various origins, using a new technique of electrode placement over the occipital nerve. ONS electrodes were subsequently implanted in 33 patients (occipital neuralgia [n =15], cervicogenic headache [n =7], cluster headache [n =6], chronic migraine [n =5]) who had responded at least moderately to TENS. Assessment was performed up to five years after implantation (three years on average), based on the mean and maximum daily pain intensity scored on a 0-10 visual analogue scale and the number of headache days per month. Both TENS and chronic ONS therapy were found to be efficacious (57–76% improvement...


A patient-controlled, smartphone-based music intervention to reduce pain—A multi-center observational study of patients with chronic pain
Discussion/conclusions The use of the Music Care application within this setting proved good feasibility. The limitations of the present study and recommendations for future evaluations incorporating physiological outcome measurements are discussed. (Source: European Journal of Integrative Medicine)


Acupuncture inhibits liver injury induced by morphine plus acetaminophen through antioxidant system
Conclusion This study suggests that acupuncture may have a protective effect against the MP+APAP-induced hepatic damage through the amelioration of antioxidant defense systems. (Source: European Journal of Integrative Medicine)


The gut microbiota: A puppet master in the pathogenesis of endometriosis?
Endometriosis is a frequent gynecological disease with a complex, multifactorial etiology. It is characterized by the cyclic estrogen-driven proliferation and bleeding of endometriotic lesions, i.e. ectopic endometrial glands and stroma, outside the uterus. These lesions induce a chronic activation of the innate immune system within the peritoneal cavity, which is associated with the release of various inflammatory cytokines and angiogenic growth factors into the peritoneal fluid. This stimulates angiogenesis and further spread of the lesions, and triggers the typical pain symptomatic of the disease. (Source: American Journal of Obstetrics and Gynecology)


Chronic lower back pain in a young adult
(Source: APLAR Journal of Rheumatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The relationship between hypertension and health-related quality of life: adjusted by chronic pain, chronic diseases, and life habits in the general middle-aged population in Japan
Conclusions These results may be due to the sex difference in the light of the perception for health. (Source: Environmental Health and Preventive Medicine)


Oral aspirin for treating venous leg ulcers.
CONCLUSIONS: Low quality evidence from two trials indicate that there is currently insufficient evidence for us to draw definitive conclusions about the benefits and harms of oral aspirin on the healing and recurrence of venous leg ulcers. We downgraded the evidence to low quality due to potential selection bias and imprecision due to the small sample size. The small number of participants may have a hidden real benefit, or an increase in harm. Due to the lack of reliable evidence, we are unable to draw conclusions about the benefits and harms of oral daily aspirin as an adjunct to compression in VLU healing or recurrence. Further high quality studies are needed in this area. PMID: 26889740 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Ageing and Obesity indices influences the Tactile Spatial Acuity of the Low Back Regions: A cross-sectional study
Two-point discrimination threshold (TPDT) is increased in individuals with chronic low back pain. TPDT reference values and their determinants are required for clinical applications. Therefore, the aims of this research are to establish reference values for TPDT of the low back regions in healthy individuals, stratified for age, and to investigate the associations of demographic and anthropomorphic variables with TPDT. (Source: Manual Therapy)


NF-κB Signaling Pathway in Controlling Intervertebral Disc Cell Response to Inflammatory and Mechanical Stressors.
CONCLUSIONS: NF-κB signaling mediates catabolic and inflammatory responses to inflammatory and mechanical stimulation, but does not mediate the decrease in matrix synthesis under combined harmful stimulation. Identification of key control points in the cellular responses to inflammatory and mechanical stimuli will facilitate rational design of exercise based therapies as well as facilitate synergistic treatments of novel biochemical treatments with rehabilitation regimens. PMID: 26893504 [PubMed - as supplied by publisher] (Source: Physical Therapy)


[Pain syndrome of the musculoskeletal system in children and adolescents].
Authors: Höfel L, Draheim N, Häfner R, Haas JP Abstract Chronic pain syndromes in children and adolescents are defined as continuous or recurrent pain without an underlying causative diagnosis and lasting for more than 3 months. It is estimated that every fourth child in Germany suffers from chronic pain with every twentieth suffering from extreme recurrent pain. The incidence of chronic pain in children and adolescents is increasing with headache, abdominal pain and musculoskeletal pain being the most frequent. The quality of life declines not only due to the pain but to relieving postural and psychological factors, such as fear and sadness. School attendance, social activities and hobbies are mostly affected. This review summarizes the background of chronic pain syndromes and i...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Abstract P1-10-03: Biosimilar filgrastim in the treatment of patients with breast cancer undergoing neutropenia-inducing chemotherapy: A subanalysis of the NEXT study
ConclusionThese data demonstrate the safety and efficacy of biosimilar filgrastim in a real-world setting. The subanalysis illustrated that biosimilar filgrastim was effective and well tolerated in breast cancer patients in the curative and prophylactic setting. These results mirror those of the parent NEXT study, and show that biosimilar filgrastim is a valid alternative therapeutic option for chemotherapy-induced neutropenia in breast cancer patients.Citation Format: Albrand H, Kamioner D, Leprêtre S. Biosimilar filgrastim in the treatment of patients with breast cancer undergoing neutropenia-inducing chemotherapy: A subanalysis of the NEXT study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philad...


Abstract P5-09-13: The effect of bone pain-specific education vs general chemotherapy side-effect education on reported bone pain in patients (pts) with breast cancer receiving chemotherapy and pegfilgrastim
Conclusions: Our bone pain–specific educational program did not improve perceptions of bone pain reported by this pt population. Bone pain was highest in cycle 1, decreased in cycle 2, and then remained stable.Citation Format: Maxwell CL, Guinigundo AS, Vanni L, Morrow PK, Reiner M, Shih A, Klippel Z, Blanchard E. The effect of bone pain–specific education vs general chemotherapy side-effect education on reported bone pain in patients (pts) with breast cancer receiving chemotherapy and pegfilgrastim. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-09-13. (Source: Cancer Research)


Your patients may have unmet needs: 4 questions to ask
A deeper look into the way your patients experience care delivery can provide a new perspective into how your team coordinates care from the waiting room to the exam room to the parking lot. Learn four simple, physician-authored questions you can ask your patients to find out if your practice is meeting their needs. A new module from the AMA’s STEPS Forward™ collection, written by physicians from the Stanford University School of Medicine, shows you how to analyze your patient population’s clinical needs to build an intensive primary care practice. Check out the “STEPS in practice” section of the module to see how it’s working at Stanford. Though the module is designed to build an intensive primary care practice, knowing the care delivery experience and needs of your patien...


St. Jude wins FDA green light for Axium chronic pain device
St. Jude Medical (NYSE:STJ) said today it won FDA premarket approval for its Axium neurostimulator system using dorsal root ganglion stimulation. The device from St. Paul, Minn.-based St. Jude is designed to treat moderate to severe chronic intractable pain of the lower limbs in adult patients with complex regional pain syndrome. &#8220;The approval of St. Jude Medical’s DRG neurostimulation system represents an exciting new option for me to deploy in the fight against the focal and intractable chronic pain syndromes facing my patients every day. For the large and growing numbers of under-treated patients suffering from complex regional pain syndromes – like those resulting from total knee arthroscopy, foot surgery or hernia surgery – DRG stimulation can offer improved, long-lastin...


New pharmacological treatment options for irritable bowel syndrome with constipation.
Authors: Nusrat S, Miner PB Abstract INTRODUCTION: Constipation predominant irritable bowel syndrome (IBS-C) is a common disorder and accounts for a large number of ambulatory visits. Sensory abnormalities, that is, presence of abdominal pain and discomfort, distinguish IBS-C from chronic idiopathic constipation. AREA COVERED: This review focuses on the pharmacology, efficacy, safety, and future of prucalopride, YKP-10811, DSP-6952, dexloxiglumide, linaclotide, plecanatide, tenapanor, and elobixibat. EXPERT OPINION: It is now well established that treatment focusing only on bowel transit provides incomplete relief to patients with IBS-C. Improved understanding of pathophysiology of IBS-C has led to use of sensory end points like complete spontaneous bowel movements and the ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Current and emerging drugs for interstitial cystitis/bladder pain syndrome (IC/BPS).
Authors: Ogawa T, Ishizuka O, Ueda T, Tyagi P, Chancellor MB, Yoshimura N Abstract INTRODUCTION: Interstitial cystitis or bladder pain syndrome (IC/BPS) is a debilitating chronic disease characterized by suprapubic pain and lower urinary tract symptoms: however, the etiology is still unknown. Therefore, the long-lasting, effective treatments of IC/BPS are still not established, and the treatment is sometimes empirically selected depending on practitioners' experience and preference. AREA COVERED: In this review we focus on the current treatments, ongoing clinical trials, and several potential new drugs based on the results of basic and clinical research studies. First, we discuss the potential etiologies of IC/BPS that include altered barrier lining, afferent and/or central ner...


Emerging therapy for endometriosis.
Authors: Lindsay SF, Luciano DE, Luciano AA Abstract INTRODUCTION: Endometriosis is a chronic disease manifested by pain and infertility due to ectopic implantation of endometrial glands and stroma causing inflammation. Treatment of endometriosis utilizes a significant amount of health-care resources and requires chronic therapy. Management involves a combination of surgical and medical interventions and requires long-term treatment to avoid repeated surgeries. AREAS COVERED: Whereas medical therapies exist for management of endometriosis-related pain, each class has its limitations including side effects, cost, and known duration of relief of symptoms. Development of effective, well-tolerated medical therapies that are appropriate for long-term use is crucial to provide adequa...


Expert opinion on emerging drugs: chronic low back pain.
Authors: Hsu E, Murphy S, Chang D, Cohen SP Abstract INTRODUCTION: It is difficult to overestimate the personal and socioeconomic impact of chronic low back pain (CLBP). It is the leading cause of years lost to disability and poses the highest economic toll among chronic illnesses. Despite the strong need for extensive research efforts, few drugs have consistently demonstrated effectiveness for this condition. AREAS COVERED: In this review, the epidemiology, rationale for mechanism-based treatment, competitive environment and market trends, and the preclinical and clinical evidence supporting over 15 different classes of analgesic medications studied for CLBP or related pain conditions are discussed. Treatments are divided by drug category, type of CLBP they are likely to treat...


Activation of Peripheral μ-opioid Receptors by Dermorphin [ d -Arg2, Lys4] (1–4) Amide Leads to Modality-preferred Inhibition of Neuropathic Pain
Conclusions These findings suggest that DALDA may represent a potential alternative to current opioid therapy for the treatment of neuropathic pain and is likely to be associated with minimal adverse effects. (Source: Anesthesiology)


Golimumab for the treatment of axial spondyloarthritis.
Authors: Gelfer G, Perry L, Deodhar A Abstract Axial spondyloarthritis (axSpA) is a chronic, immune-mediated inflammatory disease of the axial skeleton that includes ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). Patients with AS experience chronic pain due to sacroiliac joint and spinal inflammation, and may develop spinal ankylosing with syndesmophyte formation. Tumor necrosis factor α inhibitors (TNFi) have shown promise in the management of AS and axSpA by targeting the underlying inflammatory process, and providing symptomatic relief. Whether they alter the progression of the disease is uncertain. Golimumab is a fully human IgG1 monoclonal antibody that targets and downregulates the pro-inflammatory cytokine TNF-α. The use of golimumab h...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Nigrostriatal dopaminergic depletion increases static orofacial allodynia
Conclusion This study demonstrates that nigrostriatal dopamine depletion exacerbates the neuropathic pain resulting from CCI-IoN. This effect is probably due to an action through descending pain inhibitory systems which increased pain sensitization at the MDH level. It demonstrates also an analgesic effect elicited by D2R activation at the segmental level. (Source: The Journal of Headache and Pain)


Clinical management of endometriosis-associated infertility
Abstract Endometriosis is a common chronic benign disease that affects reproductive age women and causes chronic pelvic pain and infertility. Despite its prevalence, the exact mechanisms of the pathogenesis of endometriosis-associated infertility are unknown, and precise standards of management have not yet been established. Medical and surgical treatments for endometriosis have different effects on the chance of conception, either spontaneously or via assisted reproductive technologies (ART). In this manuscript, we review the literature from years 1979 to 2015 to report on the proposed mechanism of endometriosis-associated infertility, the staging system of endometriosis for pregnancy outcomes and the current management of patients with endometriosis-associated infertility. (Sour...


Molecular mechanisms of biological aging in intervertebral discs
This article is protected by copyright. All rights reserved (Source: Journal of Orthopaedic Research)


Factors affecting results of fluoroscopy-guided facet joint injection: Probable differences in the outcome of treatment between pure facet joint hypertrophy and concomitant diseases
Conclusion: For low-back pain caused by facet hypertrophy, steroid injection around the facet joint is an effective treatment, but if there is an existing major pathology, it is not as effective. (Source: Journal of Craniovertebral Junction and Spine)


Arthroscopic synovectomy considerably reduces bleeding frequency and improves joint function in hemophilic patients with chronic synovitis
Conclusion Arthroscopic synovectomy, a less invasive procedure for HA, significantly reduced joint pain, prevented bleeding episodes, and improved joint function with few complications. (Source: Formosan Journal of Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Comparative mRNA analysis of behavioral and genetic mouse models of aggression
This study evaluated expression of genes differentially regulated in a stress (behavioral) mouse model of aggression with those from a recent genetic mouse model aggression. The study used a discovery‐replication design using two independent mRNA studies from mouse brain tissue. The discovery study identified strain (BALB/cJ and C57BL/6J) × stress (chronic mild stress or control) interactions. Probe sets differentially regulated in the discovery set were intersected with those uncovered in the replication study, which evaluated differences between high and low aggressive animals from three strains specifically bred to study aggression. Network analysis was conducted on overlapping genes uncovered across both studies. A significant overlap was found with the genetic mouse study sharing 1...


Correlates of depressive symptoms in individuals attending outpatient stroke clinics.
Conclusions High levels of depressive symptoms are common in the chronic phase post-stroke and were partially related to cognition, pain, therapy enrollment and lifestyle factors. Implications for Rehabilitation Stroke patients who report cognitive deficits, pain, tobacco use or being enrolled in therapy may experience increased depressive symptoms. A holistic perspective of disease and lifestyle factors should be considered while assessing risk of depressive symptoms in stroke patients. Patients at risk for depressive symptoms should be monitored at subsequent outpatient visits. PMID: 26883012 [PubMed - as supplied by publisher] (Source: Disability and Rehabilitation)


What Really Killed Glenn Frey
When Glenn Frey, a co-founder and driving force behind ’70s supergroup the Eagles, died on January 18, I wasn’t just saddened by the loss. I was deeply concerned about the manner of his death. News reports said Frey died from a combination of “complications” from rheumatoid arthritis (RA), one of the most debilitating chronic diseases. RA is an inflammatory autoimmune condition. It affects the entire body — particularly the joints. The body develops antibodies against its own joint tissues, breaking them down. A modern inflammatory diet, genetic factors and food allergies all play a role in developing RA. Environmental toxins and pollutions also trigger inflammation and contribute to the disease. But there’s a dark subtext to Frey’s death that you’ll never hear about from ...


Scapholunate kinematics of asymptomatic wrists in comparison with symptomatic contralateral wrists using four-dimensional CT examinations: initial clinical experience
Conclusion In patients with wrist pain suspicious for SLIL injury and inconclusive radiographs, SL interval increase can be detected with 4DCT in the symptomatic wrist compared to the asymptomatic wrist. (Source: Skeletal Radiology)


Tailored acupuncture lessens pain intensity in chronic pain (fibromyalgia)
Nine weekly sessions of individually tailored acupuncture lessen perceived pain intensity, and improve functional capacity and quality of life, in people with the chronic pain condition, fibromyalgia, finds new research. (Source: ScienceDaily Headlines)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Brain and behavior changes associated with an abbreviated 4‐week mindfulness‐based stress reduction course in back pain patients
ConclusionsAn abbreviated MBSR course may be an effective complementary intervention that specifically improves back pain symptoms and frontal lobe regulation of emotional awareness, while the traditional 8‐week course may be necessary to detect unique improvements in total anxiety and cognitive aspects of depression. An abbreviated form of mindfulness‐based stress reduction training in back pain patients showed positive impact on back pain, somatic‐affective aspects of depression, and changes in fMRI response to awareness in changes of one's emotional state. We provide insight regarding MBSR's neural mechanism of action, and suggest there may be a dose–response for observing benefits, depending on the symptom. (Source: Brain and Behavior)


Evaluation of oxygen saturation values in different body positions in healthy individuals
ConclusionAll of the oxygen saturation values measured in the five different body positions were in the normal range. Although oxygen saturation values were within the normal range in the five different body positions, post hoc analysis showed that the best oxygenation was in the ‘sitting upright’ position while the lowest oxygenation was in the supine position. Relevance to clinical practiceBased on the results of this research, it can be concluded that the differences among oxygen saturation values according to the different body positions were statistically significant. (Source: Journal of Clinical Nursing)


A rare case of multiple small bowel intussusceptions and bowel obstruction caused by Rapunzel syndrome
We report a case of a 5-year-old girl with Rapunzel syndrome causing multiple small bowel intussusceptions. We were unable to identify the main cause of this condition during laparoscopic reduction. Definite diagnosis was made after the development of gastrointestinal tract obstruction. Surgeons should consider the possibility of Rapunzel syndrome when diagnosing the main cause of intussusceptions. (Source: Formosan Journal of Surgery)


Tailored acupuncture lessens pain intensity of fibromyalgia
And improves functional capacity and quality of life; effects still evident a year laterRelated items from OnMedicaAcupuncture may benefit COPD patientsAcupuncture doesn’t improve chronic knee painPleasure and pain circuitry disrupted in brains of fibromyalgia patientsThe pain of fibromyalgia (Source: OnMedica Latest News)


Differences in Symptom Burden Among Patients with Moderate, Severe, or Very Severe Chronic Obstructive Pulmonary Disease
The symptom experience of patients with chronic obstructive pulmonary disease (COPD) is extremely complex. It is characterized by multiple co-occurring symptoms. However, very few studies have described this experience in COPD patients. (Source: Journal of Pain and Symptom Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Management of Analgesia Through Multiple Phases of Trauma
Abstract Managing the pain in a patient with traumatic injuries can be a delicate and difficult task. In the acute phase the options for pain control are often limited to opioids, which must be administered cautiously as to not further disrupt the homeostasis of an already fragile patient. Careful management of sedation during this period is also crucial to patient comfort and stability. In the recovery phase, a multimodal approach to pain control is preferred, utilizing opioid and non-opioid medications, regional and neuraxial blocks if appropriate, and other treatments to help limit the patient’s discomfort. Multimodal therapy may also more effectively prevent long-term sequelae including conversion to a chronic pain syndrome and opioid dependence and abuse. (Source: Curre...


Hyperpigmented Reticulated Patch in an Older Man
A 67-year-old man receiving rituximab for membranous nephropathy presented with volume overload and a hyperpigmented, gray-brown patch on his mid and lower back. He reported long-term use of a heating pad for chronic back pain but denied experiencing burns or thermal trauma. What would you do next? (Source: JAMA)


Invasive occipital nerve stimulation for refractory chronic cluster headache: what evolution at long-term? Strengths and weaknesses of the method
Conclusions Up to nine years after implantation, iONS is still effective in most patients with drCCH. Concomitant preventive drugs remain often necessary. Forty percent of patients reverse to episodic CH, possibly by natural history. iONS is not a benign procedure but device-related complications appear similar to those reported with other invasive neurostimulators. (Source: The Journal of Headache and Pain)


Complications Following Anorectal Surgery
Clinics in Colon and Rectal Surgery 2016; 29: 014-021DOI: 10.1055/s-0035-1568145Anorectal surgery is well tolerated. Rates of minor complications are relatively high, but major postoperative complications are uncommon. Prompt identification of postoperative complications is necessary to avoid significant patient morbidity. The most common acute complications include bleeding, infection, and urinary retention. Pelvic sepsis, while may result in dramatic morbidity and even mortality, is relatively rare. The most feared long-term complications include fecal incontinence, anal stenosis, and chronic pelvic pain.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and ...


Effects of chronic shoulder pain on quality of life and occupational engagement in the population with chronic spinal cord injury: preparing for the best outcomes with occupational therapy.
Conclusion Shoulder pain is a serious complication following SCI and the Ecology of Human Performance Model and Self-Efficacy Theory can be utilized in conjunction for a framework to evaluate, treat and prevent shoulder pain and its devastating effects on occupational engagement and quality of life in the spinal cord injured population. Thereafter, rehabilitation professionals will have a greater understanding of these interactions to serve as a guide for evaluation and intervention planning to promote optimal occupational engagement through limiting the experiences of occupational injustices for those with SCI and shoulder pain. Implications for Rehabilitation Musculoskeletal pain at the shoulder joint and depression are common complications following spinal cord injury that limit occupat...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Musculoskeletal pain in children and adolescents.
Conclusion Musculoskeletal pain conditions are often recurrent in nature, occurring throughout the life-course. Attempts to understand these conditions at a time close to their initial onset may offer a better chance of developing effective prevention and treatment strategies. PMID: 26886462 [PubMed - as supplied by publisher] (Source: Physical Therapy)


Central Pain Following Cord Severance for Cephalosomatic Anastomosis.
Authors: Canavero S, Bonicalzi V Abstract One of the key obstacles to a successful head transplant is the possible onset of central pain, a chronic pain condition that would impair the quality of life of the transplantee. In this review, we provide the reader with a knowledge of this neglected aspect of the head transplant initiative and outline the management should this eventuality occur. PMID: 26880305 [PubMed - as supplied by publisher] (Source: CNS Neuroscience and Therapeutics)


Effect of dexmedetomidine and cold stress in a rat model of neuropathic pain: role of interleukin-6 and tumor necrosis factor-α.
Authors: Farghaly HS, Mahmoud AM, Abdel-Sater KA Abstract Dexmedetomidine (Dex) is a novel Alpha 2- adrenoceptor agonist. It decreases sympathetic tone and attenuates the stress responses to anesthesia and surgery. People exposed to cold suffer unpleasant thermal pain, which is experienced as stress and causes the release of noradrenaline from the sympathetic terminals. The present study investigated the effects of cold stress and dexmedetomidine on chronic constriction injury (CCI) model of the sciatic nerve in rats. Sixty four male Wistar rats were divided into seven groups of eight rats each: repeated cold stress (RCS) group, sham RCS group, CCI group, sham CCI group, Dex-treated group received a single dose of Dex (5μg/kg), CCI+Dex group, CCI+RCS group. Interleukin-6 (IL-6) an...


Acupuncture ‘reduces pain intensity’ in fibromyalgia
Tailored acupuncture lessens chronic pain intensity in patients with fibromyalgia and improves functional capacity and quality of life, according to Spanish researchers. (Source: Nursing Times)


How residents in one state are fighting the opioid epidemic
Amidst the national opioid epidemic, resident physicians in Massachusetts have taken matters into their own hands to improve public health and promote safe prescribing in their state. Learn how they gained access to a critical tool and put themselves in a better position to reduce prescription opioid misuse and provide more informed care to their patients. Accessing the state’s prescribing database In Massachusetts, the state’s prescription drug monitoring program (PDMP), an electronic database that physicians can consult to learn, among other things, patients’ controlled substance histories, has been in place since 1992. Although several major teaching hospitals exist in the Boston area alone, resident physicians have never had access to this database to check their patient’s ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Crowdfunded Research Into Phantom Limb Pain Treatment
Researchers from Brunel university and Poole hospital seeking to raise money to treat phantom limb pain using new portable 3D hologram technology (Source: Disabled World)


Pelvic inflammatory disease can leave women infertile but often has no symptoms
Pelvic inflammatory disease is an infection of a woman’s reproductive organs, often triggered by an STI. Left untreated, it can cause infertility, chronic pelvic pain and ectopic pregnancy. (Source: the Mail online | Health)


Erratum to Does Chronic Pain Alter the Normal Interaction Between Cardiovascular and Pain Regulatory Systems? Pain Modulation in the Hypertensive-Monoarthritic Rat
Incorrect grant funding information was published in this article. The corrected information appears below. (Source: The Journal of Pain)


Is a negative urine drug screen truly negative?
A 36-year-old patient has a history of seizures and chronic pancreatitis secondary to a car accident that led to pancreatic trauma. He has been on oxycodone and OxyContin for 6months with suboptimal pain control. He had a history of frequent requests for more pain medication and early refills. The patient was admitted to our hospital for a pancreatitis flare. He was due for a urine drug screen (UDS) by his primary care provider, but because the patient was admitted to the hospital at the same time, the test was performed during his hospital stay. (Source: Journal of Clinical Anesthesia)


Not by the Red on My Chinny Chin Chin: A Case of Mandibular Osteomyelitis in a 5-Year-Old Girl
Osteomyelitis is not an uncommon emergency department diagnosis in pediatric patients, and most cases are in the lower extremities. Children can present with acute, subacute, or chronic erythema, pain, swelling, or decreased use of the extremity; some patients will also have fever or elevated serum inflammatory markers, or both. (Source: The Journal of Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Headache and Chronic Subdural Hematoma
(Source: Headache: The Journal of Head and Face Pain)


Clinical Reasoning: A 62-year-old woman with bizarre behavior and recurrent episodes of behavioral arrest
A 62-year-old woman was brought to the emergency department by family members after experiencing 3 episodes of behavioral and speech arrest over the past day, with the third episode reportedly ending in convulsive shaking. Her medical history was significant for chronic abdominal and low back pain, for which she had been taking diazepam for the past 9 years, at a stable dose of 10 mg 4 times daily, in addition to tramadol 50&ndash;100 mg every 6 hours as needed. She also had a history of migraine headaches and was taking Topamax 100 mg twice daily. There was no history of seizure. (Source: Neurology)


Post-herpetic Neuralgia: a Review
Abstract Post-herpetic neuralgia (PHN) is a chronic neuropathic pain condition that persists 3 months or more following an outbreak of shingles. Shingles, also known as acute herpes zoster, is associated with the reactivation of the dormant varicella zoster virus in an individual who has experienced chicken pox. PHN is associated with persistent and often refractory neuropathic pain. Patients may experience multiple types of pain including a constant deep, aching, or burning pain; a paroxysmal, lancinating pain; hyperalgesia (painful stimuli are more painful than expected); and allodynia (pain associated with typically non-painful stimuli). The pharmacological treatment of PHN may include a variety of medications including alpha-2 delta ligands (gabapentin and pregabalin), other...


Botulinum Toxin: Pharmacology and Therapeutic Roles in Pain States
Abstract Botulinum toxin, also known as Botox, is produced by Clostridium botulinum, a gram-positive anaerobic bacterium, and botulinum toxin injections are among the most commonly practiced cosmetic procedures in the USA. Although botulinum toxin is typically associated with cosmetic procedures, it can be used to treat a variety of other conditions, including pain. Botulinum toxin blocks the release of acetylcholine from nerve endings to paralyze muscles and to decrease the pain response. Botulinum toxin has a long duration of action, lasting up to 5 months after initial treatment which makes it an excellent treatment for chronic pain patients. This manuscript will outline in detail why botulinum toxin is used as a successful treatment for pain in multiple conditions as well as...


Current Concepts Review: Arthroscopic Treatment of Anterior Ankle Impingement
Anterior ankle impingement is most often described as anterior ankle pain with restricted dorsiflexion as a result of either tibiotalar osteophytes and/or soft tissue impingement [1–3]. It is a common cause of chronic ankle pain and is particularly common in athletes that sustain repetitive dorsiflexion movements [4]. Morris and McMurray provided early descriptions of anterior impingement, coining the condition as “athlete's ankle” and “footballer's ankle”, respectively [4,5]. Since then, substantial investigation into the pathology has occurred and the terminology was replaced with “anterior ankle impingement syndrome”. (Source: Foot and Ankle Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Using venous blood gas analysis in the assessment of COPD exacerbations: a prospective cohort study
Conclusions Arterial sampling is more difficult and more painful than venous sampling. There is good agreement between pH and values derived from venous and arterial blood, and between pulse oximetry and arterial blood gas oxygen saturations. These agreements could allow the initial assessment of COPD exacerbations to be based on venous blood gas analysis and pulse oximetry, simplifying the care pathway and improving the patient experience. (Source: Thorax)


Effects of Narrow‐band IR‐A and of Water‐filtered Infrared A (wIRA) on Fibroblasts
This article is protected by copyright. All rights reserved. (Source: Photochemistry and Photobiology)


Living with an Older Person Dying from Cancer, Lung Disease or Dementia: Health Outcomes from a General Practice Cohort Study
Increasing numbers of people will die from chronic disease. Families contribute significantly to end-of-life care but their role may not be recognized. (Source: Journal of Pain and Symptom Management)


An evaluation of central sensitization in patients with sickle cell disease
Central sensitization (CS), nociceptive hyper-excitability known to amplify and maintain clinical pain, has been identified as a leading culprit responsible for maintaining pain in several chronic pain conditions. Recent evidence suggests that it may explain differences in the symptom experience of individuals with sickle cell disease (SCD). Quantitative sensory testing (QST) can be used to examine CS and identify individuals that may have a heightened CS profile. The present study categorized patients with SCD based on QST responses into a high or low CS phenotype and compared these groups on measures of clinical pain, vaso-occlusive crises, psychosocial factors, and sleep continuity. (Source: The Journal of Pain)


Resilience and vulnerability in individuals with chronic pain and physical disability.
Conclusions: The present study suggested a valuable contribution of both resilience and vulnerability factors to pain outcomes, with the additional caveat that resilience factors uniquely impact specific outcomes—particularly those that are more psychosocially focused—above and beyond vulnerability factors. Taken together, this highlights the importance of considering resilience factors in addition to vulnerability factors for individuals with chronic pain. Additional research is needed to explore other factors that could be considered representative of the resilience construct and more attention should be focused on evaluating the effects of interventions that seek to build an individual’s assets. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: Rehabilitation P...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Why Do Patients with Chronic Inflammatory Rheumatic Diseases Discontinue Their Biologics? An Assessment of Patients' Adherence Using a Self-report Questionnaire.
CONCLUSION: Five predictive factors of this SD were identified, which should be assessed in routine with patients with CIRD receiving biologic treatment: pain, treatment history, self-administration of injections, negative beliefs about treatment, and a lack of perceived medical and social support. PMID: 26879361 [PubMed - as supplied by publisher] (Source: J Rheumatol)


Living With an Older Person Dying From Cancer, Lung Disease, or Dementia: Health Outcomes From a General Practice Cohort Study
Increasing numbers of people will die from chronic disease. Families contribute significantly to end-of-life care, but their role may not be recognized. (Source: Journal of Pain and Symptom Management)


Common Questions About Chronic Prostatitis.
Authors: Holt JD, Garrett WA, McCurry TK, Teichman JM Abstract Chronic prostatitis is relatively common, with a lifetime prevalence of 1.8% to 8.2%. Risk factors include conditions that facilitate introduction of bacteria into the urethra and prostate (which also predispose the patient to urinary tract infections) and conditions that can lead to chronic neuropathic pain. Chronic prostatitis must be differentiated from other causes of chronic pelvic pain, such as interstitial cystitis/bladder pain syndrome and pelvic floor dysfunction; prostate and bladder cancers; benign prostatic hyperplasia; urolithiasis; and other causes of dysuria, urinary frequency, and nocturia. The National Institutes of Health divides prostatitis into four syndromes: acute bacterial prostatitis, chronic bac...


Workplace adjustments 'can benefit people with chronic pain'
A new study from Australia has highlighted the need for bosses to provide more adjustments and flexibility in the workplace to people suffering chronic pain, in order to help them stay productive. Led by La Trobe University, the research aimed to explore the various means of support available to employees with chronic pain to help them succeed in their jobs, basing their conclusions on interviews with 35 working people. Maintaining productive employment can be a significant challenge for people with persistent pain caused by conditions such as arthritis, as their pain makes it hard for them to carry out certain tasks or work regular hours without special allowances being made. For this study, subjects were questioned on topics such as their employment status, the challenges they faced a...


Auricular acupuncture for spinal cord injury related neuropathic pain: a pilot controlled clinical trial.
Conclusion This pilot study has provided proof of concept that BFA has clinically meaningful effect on the modulation of SCI neuropathic pain. PMID: 26869339 [PubMed - as supplied by publisher] (Source: Journal of Spinal Cord Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Medical decision-making inspired from aerospace multisensor data fusion concepts.
This article presents a multisensor data fusion methodology based on the capabilities provided by aerospace systems to evaluate the effects of electronic and pen-and-paper diaries on pain. We examined English-language studies of randomized controlled trials that use computerized systems and the Internet to collect data about chronic pain complaints. These studies were obtained from three data sources: BioMed Central, PubMed Central and ScienceDirect from the year 2000 until 30 June 2012. Based on comparisons of the reported pain intensity collected during pre- and post-treatment in both the control and intervention groups, the proposed multisensor data fusion model revealed that the benefits of technology and pen-and-paper are qualitatively equivalent [Formula: see text]. We conclude that ...


Characteristics of patients seeking health information online via social health networks versus general Internet sites: a comparative study.
CONCLUSIONS: Identifying needs of social health network surfers will allow planning unique contents and enhancing social health sites. Physicians might advise patients to use them to obtain support and information regarding their conditions, possibly leading to improved compliance and self-management. PMID: 24475937 [PubMed - indexed for MEDLINE] (Source: Informatics for Health and Social Care)


Post-Ebolavirus disease syndrome: what do we know?
Authors: Carod-Artal FJ Abstract As the current Zaire ebolavirus disease outbreak in West Africa fades, the health problems of the more than 16,500 survivors have come to light. A wide range of mental and physical symptoms may occur during the convalescence stage. Reported symptoms of "post-Ebolavirus disease syndrome" (PEVDS) include chronic joint and muscle pain, fatigue, anorexia, hearing loss, blurred vision, headache, sleep disturbances, low mood and short-term memory problems. PEVDS has been associated with a decrease in functionality and difficulties to return to work. Further studies are needed to fully categorize the clinical spectrum of PEVDS. Diagnostic criteria and surrogate markers for the early diagnosis of PEVDS, and implementation of specialized health services to t...


Post-Ebolavirus disease syndrome: What do we know?
Authors: Carod-Artal FJ Abstract As the current Zaire ebolavirus disease outbreak in West Africa fades, the health problems of the more than 16,500 survivors have come to light. A wide range of mental and physical symptoms may occur during the convalescence stage. Reported symptoms of "post-Ebolavirus disease syndrome" (PEVDS) include chronic joint and muscle pain, fatigue, anorexia, hearing loss, blurred vision, headache, sleep disturbances, low mood and short-term memory problems. PEVDS has been associated with a decrease in functionality and difficulties to return to work. Further studies are needed to fully categorize the clinical spectrum of PEVDS. Diagnostic criteria and surrogate markers for the early diagnosis of PEVDS, and implementation of specialized health services to t...


Common gynecological challenges in adolescents with sickle cell disease.
Authors: Stimpson SJ, Rebele EC, DeBaun MR Abstract Sickle cell anemia is one of the most common genetic blood disorders worldwide. Individuals with sickle cell disease (SCD) experience clinical manifestations such as chronic anemia, developmental delay, vaso-occlusive pain, acute chest syndrome, and neurological complications. Adolescent girls with SCD face unique gynecological challenges including delayed puberty marked by a later onset in menarche, vaso-occlusive pain associated with their menstrual cycle, and underdiagnosed abnormal uterine bleeding. This review focuses on these challenges with particular emphasis on delayed menarche and vaso-occlusive pain episodes associated with menstruation, in addition to the evaluation and initial management of heavy menstrual bleeding fo...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Rifaximin for the treatment of diarrhea-predominant irritable bowel syndrome.
This article considers the pharmacology of rifaximin, the evidence for its use in IBS, and the safety and tolerability of the drug. PMID: 26753693 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)


Novel Pharmaceutical Options For Treating Fibromyalgia.
Authors: Piercarlo SP, Chiara GM, Alberto B, Rossella T, Manuela DF, Fabiola A Abstract Fibromyalgia is a chronic disorder whose symptoms have a devastating effect on patients' lives as they limit their ability to engage in everyday working and social activities, and make it difficult to maintain normal relationships with family, friends and employers. None of the currently available drugs are fully effective against the whole spectrum of symptoms of pain, fatigue, sleep disturbances and depression, but increasing efforts by the pharmaceutical industry have led to the introduction of new investigational drugs and new formulations of older drugs, as well as studies of the possibility of applying drugs currently used for other diseases. The aim of this review is to summarise the data...


Innovations in classical hormonal targets for endometriosis.
Authors: Pluchino N, Freschi L, Wenger JM, Streuli I Abstract Endometriosis is a chronic disease of unknown etiology that affects approximately 10% of women in reproductive age. Several evidences show that endometriosis lesions are associated to hormonal imbalance, including estrogen synthesis, metabolism and responsiveness and progesterone resistance. These hormonal alterations influence the ability of endometrial cells to proliferate, migrate and to infiltrate the mesothelium, causing inflammation, pain and infertility. Hormonal imbalance in endometriosis represents also a target for treatment. We provide an overview on therapeutic strategies based on innovations of classical hormonal mechanisms involved in the development of endometriosis lesions. The development phase of new mo...


Novel investigational drugs for constipation-predominant irritable bowel syndrome: a review.
Authors: Mosińska P, Salaga M, Fichna J Abstract INTRODUCTION: Constipation-predominant irritable bowel syndrome (IBS-C) is a functional gastrointestinal (GI) disorder with an unknown etiology. A number of the drugs tested for IBS-C have also been applied to chronic constipation and chronic idiopathic constipation. Unfortunately, due to severe adverse effects, many drugs envisioned for IBS-C had been withdrawn from the market. Nevertheless, a number of potential new agents for this indication are now under development. Areas covered: The following review describes the most recently developed agents in preclinical as well as Phase 1 and Phase 2 clinical studies. Information was obtained from published literature, abstracts and the latest results found in Clinicaltrial.gov database....


An overview of early drug development for endometriosis.
Authors: Leone Roberti Maggiore U, Ferrero S Abstract INTRODUCTION: Endometriosis is an estrogen-dependent chronic disease of women of fertile age requiring chronic therapy. Although available drugs have good efficacy and safety profiles, some patients experience partial or no improvement of pain with conventional treatment and recurrence of symptoms after discontinuation of the therapies. For these reasons, many new compounds are currently under investigation for the treatment of endometriosis. AREAS COVERED: This review offers the reader a complete and updated overview on emerging therapies for the treatment of endometriosis. The authors describe, in detail, the laboratory and clinical studies on these therapies and highlight the potential advantages and limitations associate...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Therapies in early development for the treatment of opiate addiction.
Authors: Rodríguez-Arias M, Aguilar MA, Miñarro J Abstract INTRODUCTION: Opiate drugs are psychoactive substances used to manage severe pain. However, their chronic use is associated with the development of addiction. Opiate addiction represents a significant public health concern. AREAS COVERED: This review focuses on the most recent advances in the pharmacological treatment of opiate addiction, from those being tested in clinical trials (Phase I and II), to preclinical studies that point to new targets. Readers will gain knowledge of the wide variety of treatments used to treat opiate addiction, including their strengths and weaknesses, and the promising pharmacological targets identified by preclinical research. EXPERT OPINION: Among the currently available agonist the...


Investigational sigma-1 receptor antagonists for the treatment of pain.
Authors: Vela JM, Merlos M, Almansa C Abstract INTRODUCTION: The sigma-1 receptor (σ1R) is a ligand-regulated molecular chaperone that interacts with other proteins, including NMDA and opioid receptors, to modulate their activity. Convergent evidence indicates that σ1R antagonists exert inhibitory effects (and agonists stimulatory effects) on pain by stepping down the intracellular signaling cascades involved in transduction of noxious stimuli and plastic changes (i.e., sensitization phenomena) associated with chronic pain states. AREAS COVERED: This review addresses three primary domains. The first focuses on mechanisms underlying the antinociceptive effects of σ1R antagonists. The second addresses evidence gained using pharmacological tools and experimental drugs in the di...


Measuring Treatment Outcomes in Comorbid Insomnia and Fibromyalgia: Concordance of Subjective and Objective Assessments
Conclusions:Actigraphy was generally more concordant with PSG than with diaries, which are the recommended assessment for diagnosing insomnia. However, actigraphy showed greater sensitivity to treatment-related changes than PSG; PSG failed to detect any improvements, but actigraphy demonstrated changes in WASO and SE, which were also found with diaries. In comorbid insomnia/fibromyalgia, actigraphy may therefore have utility in measuring treatment outcomes.Citation:Mundt JM, Crew EC, Krietsch K, Roth AJ, Vatthauer K, Robinson ME, Staud R, Berry RB, McCrae CS. Measuring treatment outcomes in comorbid insomnia and fibromyalgia: concordance of subjective and objective assessments. J Clin Sleep Med 2016;12(2):215&#8211;223. (Source: Journal of Clinical Sleep Medicine : JCSM)


Characterization of pain originating from oral mucosal lesions.
CONCLUSIONS: Mucosal pain is generally burning in quality, with a higher level of pain-related unpleasantness than pain intensity. In about half of the cases, pain awakens the person from sleep, a feature that correlated to female gender and pain intensity. Pain intensity or unpleasantness was not related to the size or number of lesions. PMID: 26868467 [PubMed - in process] (Source: Herpes)


Autoantibody pain
Publication date: Available online 12 February 2016 Source:Autoimmunity Reviews Author(s): Andreas Goebel As autoantibodies bind to target tissues, Fc-region dependent inflammation can induce pain via mediators exciting nociceptors. But recently another possibility has emerged, where autoantibody binding to nociceptors can directly cause pain, without inflammation. This is thought to occur as a result of Fab-region mediated modification of nerve transduction, transmission, or neuropeptide release. In three conditions, complex regional pain syndrome, anti-voltage gated potassium channel complex autoimmunity, and chronic fatigue syndrome, all associated with no or only little inflammation, initial laboratory-, and trial-results have suggested a potential role for autoantibody-mediated mec...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Possible alternative therapies for oral lichen planus cases refractory to steroid therapies
Publication date: Available online 13 February 2016 Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Huamei Yang, Yuanqin Wu, Hui Ma, Lu Jiang, Xin Zeng, Hongxia Dan, Yu Zhou, Qianming Chen Oral lichen planus (OLP) is a chronic inflammatory disorder with multifactorial etiopathogenesis. Immune dysregulation plays a critical role in the development and progression of this disease. Patients’ life may be affected by pain caused by atrophic-erosive lesions. Treatment is usually symptomatic given the obscure etiology. Topical steroids remain the mainstay of management. However, their therapeutic benefits are not always evident. There are substantial data on the possible therapeutic strategies that are effective in OLP cases refractory to steroids. Thi...


Planning for Perioperative Pain Management
Publication date: Available online 13 February 2016 Source:Hospital Medicine Clinics Author(s): Rebecca Dale, Tiffany Chen, Jane BallantyneTeaser Preoperative visits should include the formulation of a pain control plan that is shared with the patient and individualized to the patient’s prior pain experiences, comorbidities, and surgical procedure. Multimodal strategies using regional anesthesia and opioid-sparing analgesics should be implemented when possible to improve pain control and minimize opioid use and the associated adverse effects. Patient controlled analgesia is a particularly useful strategy for patients chronically on opioids because of substance abuse or chronic pain. Patients with advanced age, renal impairment, and cirrhosis are particularly vulnerable to altered ph...


β-caryophyllene, a dietary cannabinoid, complexed with β-cyclodextrin produced anti-hyperalgesic effect involving the inhibition of Fos expression in superficial dorsal horn
Publication date: Available online 13 February 2016 Source:Life Sciences Author(s): Lucindo J. Quintans-Júnior, Adriano A.S. Araújo, Renan G. Brito, Priscila L. Santos, Jullyana S.S. Quintans, Paula P. Menezes, Mairim R. Serafini, Gabriel F. Silva, Flavio M.S. Carvalho, Nicole K. Brogden, Kathleen A. Sluka Aims Evaluate the anti-hyperalgesic effect of the complex containing β-caryophyllene (βCP) and β-cyclodextrin (βCD) in a non-inflammatory chronic muscle pain mice model and investigated its action on superficial dorsal horn of the lumbar spinal cord. Main methods The βCP-βCD complex were prepared and characterized through the DSC, TG/DTG, FTIR, XRD and SEM. The model of chronic muscle pain was induced by two injections of pH4.0 saline (20μL) into left gastrocnemius...


Histologic and sonographic features of holmium laser in chronic venous disease treatment.
CONCLUSION: HOL significantly reduces the calibre of the GSV. The endothelial lining is spared, while the remaining wall is thickened by a hyalinization-like process. PMID: 26871395 [PubMed - as supplied by publisher] (Source: International Angiology)


Cost-effectiveness analysis of oxycodone with naloxone versus oxycodone alone for the management of moderate-to-severe pain in patients with opioid-induced constipation in Canada.
CONCLUSION: The clinical effectiveness of oxycodone/naloxone in managing pain and OIC compared to CR oxycodone alone resulted in low cost-utility estimates. PMID: 26535790 [PubMed - as supplied by publisher] (Source: Journal of Medical Economics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Prospective Evaluation of a Panel of Plasma Cytokines and Chemokines as Potential Markers of Pelvic Endometriosis in Symptomatic Women
Conclusion: Although previously shown to be altered in women with endometriosis compared to healthy women, the tested cytokines and chemokines were not useful to predict the presence of endometriosis among symptomatic women. This finding suggests that inflammatory markers modified by endometriosis may also be altered by other conditions associated with similar symptoms, which limits their use in clinical practice.Gynecol Obstet Invest (Source: Gynecologic and Obstetric Investigation)


The effects of an intraperitoneal single low dose of ketamine in attenuating the postoperative skin/muscle incision and retraction-induced pain related to the inhibition of N-methyl-d-aspartate receptors in the spinal cord
Conclusions Our datas suggested that NMDARs play important roles in SMIR-induced CPOP. A single intraperitoneal low dose of ketamine could attenuate SMIR-induced CPOP, which might be associated with the inhibition of NMDARs. Our finding might provide a new, simple method of addressing CPOP. (Source: Neuroscience Letters)


Increased Risk of Depression Recurrence After Initiation of Prescription Opioids in Noncancer Pain Patients
Several studies have shown that chronic opioid analgesic use is associated with increased risk of new-onset depression. It is not known if patients with remitted depression are at increased risk of relapse after exposure to opioid analgesics. A retrospective cohort design using patient data from the Veterans Health Administration (VHA; n = 5,400), and Baylor Scott & White Health (BSWH; n = 842) was performed with an observation period in the VHA from 2002 to 2012 and in the BSWH from 2003 to 2012. (Source: The Journal of Pain)


Chronic Migraine in Children and Adolescents
Abstract Chronic migraine is defined as having more than 15 headache days in a month, half of these showing migraine features, for at least 3 months. It is a chronic painful syndrome with aspects such as psychiatric comorbid, decreased quality of life, and environmental and intrinsic psychological factors that make face-to-face treatment difficult. Children and adolescent migraine differ from adults as a result of growing brain and evolving disorder. In this paper, we will emphasize the definition, diagnosis, epidemiology, burden of life, and management of chronic migraine in children and adolescent. (Source: Current Pain and Headache Reports)


Mobilisation of the thoracic spine in the management of spondylolisthesis
Segmental instability due to lumbar spondylolisthesis is a potential cause of chronic low back pain. Hypomobility of the spine results in compensatory segmental hypermobility of the segment above or below restricted segments. Therefore, the aim of the study is to determine the effects of mobilisation of the hypomobile upper thoracic spine along with conventional flexion exercises and stretching of short hip flexors on the degree of slippage and the functions of the persons with lumbar spondylolisthesis. (Source: Journal of Bodywork and Movement Therapies)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Gulf War Illness Major Health Effect Linked to Gulf War Military Service
Although more than $500 million in federally funded research on Persian Gulf War veterans has produced many findings, there has been little substantial progress in the overall understanding of health effects, particularly Gulf War illness, resulting from military service in the war, says a new Academies report. Aligning with conclusions in a 2010 report, the committee that carried out the latest study said veterans who were deployed to the Gulf War appear to have an increased risk for Gulf War illness, chronic fatigue syndrome, functional gastrointestinal conditions, and mental health disorders such as post-traumatic stress disorder, generalized anxiety disorder, depression, and substance abuse. There is some evidence that service during the conflict is linked to amyotrophic lateral sclero...


Ritonavir Use in Human Immunodeficiency Virus-Positive Surgical Patients Is Not Associated with an Increase in Postoperative Critical Respiratory Events.
This study evaluated whether highly active antiretroviral therapy for human immunodeficiency virus (HIV) including ritonavir is independently associated with increased critical respiratory events after general anesthesia with opioid analgesia. The impact of ritonavir on hepatic microsomal enzymes was considered due to the effect of these enzymes on opioid metabolism. Medical records of over 1900 patients were reviewed, and those of 941 patients met inclusion criteria and were analyzed. Chronic treatment with ritonavir was not associated with critical respiratory events in HIV-positive patients. PMID: 26861563 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)


Can the Dying Phase Be Masked by the Use of Dexamethasone? A Case Report.
Authors: van Esch HJ, Lokker ME, Geijteman EC, van der Heide A, van Zuylen L Abstract Recognition of the dying phase, i.e., the period during which death is expected to occur within hours or days, is important because it enables marking the imminence of death, informing the patient and his relatives, and adjusting care where needed. Careful communication about a patient's limited prognosis prepares patients and their family for impending death and saying goodbye. The authors describe two cases of patients dying a relatively unexpected death in a hospice, which is uncommon in this setting. These unexpected deaths had a severe impact on the relatives and on the professional care team. Both patients used dexamethasone. The authors postulate that there is a relationship between the use...


Microglial polarization dynamics in dorsal spinal cord in the early stages following chronic sciatic nerve damage
In this study, microglia numbers, morphology and gene profiles were examined in the dorsal spinal cord of rats over 14 days following sciatic nerve chronic constriction injury (CCI). The morphology of some microglia changed from a surveying to an activated state within 1 day of CCI. Neuropathic pain developed within seven to 14 days following injury and microglia numbers were increased, with almost all in the dorsal spinal cord morphologically defined as activated. At day one after CCI, both M1 and M2 microglia-related genes were increased but only M1 microglia-related genes remained elevated at day seven and 14 thereafter. These results indicate that both M1 and M2 microglia were activated in the dorsal spinal cord one day after CCI but the microglia skewed towards M1 phenotype during the...


Development of the Sensory Hypersensitivity Scale (SHS): a self-report tool for assessing sensitivity to sensory stimuli
Abstract Sensory hypersensitivity is one manifestation of the central sensitization that may underlie conditions such as fibromyalgia and chronic fatigue syndrome. We conducted five studies designed to develop and validate the Sensory Hypersensitive Scale (SHS); a 25-item self-report measure of sensory hypersensitivity. The SHS assesses both general sensitivity and modality-specific sensitivity (e.g. touch, taste, and hearing). 1202 participants (157 individuals with chronic pain) completed the SHS, which demonstrated an adequate overall internal reliability (Cronbach’s alpha) of 0.81, suggesting the tool can be used as a cross-modality assessment of sensitivity. SHS scores demonstrated only modest correlations (Pearson’s r) with depressive symptoms (0.19) and anxiety (0.28), ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Differential contribution of orexin receptors within the ventral tegmental area to modulation of persistent inflammatory pain
ConclusionFormalin test, a model of persistent inflammatory pain, mimics the conditions encountered in clinical situations. Pain modulatory role of orexinergic system in the formalin test through a neural pathway from the LH to the VTA provides the evidence that orexins can be useful therapeutic targets for chronic pain treatment. What does this study add?There is a pathway from the lateral hypothalamus (LH) to the ventral tegmental area (VTA) which modulates biphasic formalin‐induced pain.Blockade of VTA orexin receptors dose‐dependently reduces LH‐induced analgesia during both phases.Anti‐analgesic effect of orexin receptor antagonists is more considerable during the late phase.Contribution of orexin‐1 receptors to mediation of LH‐induced analgesia is more than orexin‐2 rec...


C5a and pain development: An old molecule, a new target
Publication date: Available online 6 February 2016 Source:Pharmacological Research Author(s): Andreza U. Quadros, Thiago M. Cunha Pain is a distressing sensation, resulting from real or potential tissue damage. It is crucial to protect our body, but it can be so intense that it requires treatment. Furthermore, in some circumstances, pain can become persistent/chronic, such as that triggered by inflammatory disease or neuropathy. Treatments for pain are still a clinical challenge. An advance in the knowledge of the neurobiological mechanisms involved in the genesis of acute and chronic pain might be the fundamental approach for developing novel classes of analgesic drugs. In this context, there is emerging evidence indicating that C5a, a component of the complement system, and its cell ...


The rostral ventromedial medulla control of cutaneous vasomotion of paws and tail in the rat: implication for pain studies
Thermal neutrality in rodents is achieved by large cyclic variations of the sympathetic drive of the vasomotion of the tail and paws, the most widely used target organs in current acute or chronic animal models of pain. Given the pivotal functional role of rostral ventromedial medulla (RVM) in nociception and rostral medullary raphe (rMR) in thermoregulation, two largely overlapping brain regions, we aimed at circumscribing the brainstem regions that are the source of premotor afferents to sympathetic preganglionic neurons that control the vasomotor tone of the tail and hind paws. A thermometric infrared camera recorded indirectly the vasomotor tone of the tail and hind paws. During the control period, the rat was maintained in vasoconstriction by preserving a stable, homogeneous, and cons...


Foraminal lumbar root schwannoma
A 55-year-old male patient with a past medical history of living-donor renal transplant 10 years ago presented with chronic right radicular pain along the course of right L5 nerve for several months duration. In his neurological examination, he had sensorial disturbance along right L5 dermatome. Plain radiographs of the lumbar spine showed enlargement of the right neural foramen without bone destruction (Fig 1). Magnetic resonance imaging revealed a soft tissue mass in the right L4-L5 neural foramen causing neural foraminal widening and bone remodeling. (Source: The Spine Journal)


Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain
To evaluate whether clinical anxiety in children presenting to a pediatric pain management center is associated with a poorer treatment response for those who completed pain-focused cognitive behavioral therapy (CBT). (Source: The Journal of Pediatrics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Tendinopathy
Abstract Chronic tendon injuries are a common cause of pain and of restriction of sports or daily life. Even though a number of published studies have focused on tendon injuries, healing and treatment, the pathogenesis still remains enigmatic. The pathogenesis of chronic tendon injuries is considered multifactorial, however the precise role of each predisposing factor remains incompletely understood. The association between tendinopathy and pain should also be clarified, as the presence of tendinopathic lesions does not always lead to symptoms, but they are the necessary pre-existing conditions for spontaneous tendon ruptures. In this article, the histological features, the pathogenetic theories of tendinopathy, and the possible sources of pain are reviewed. (Source: Current Physi...


TLR2 Regulates NGF Via NF-{kappa}B [Molecular Bases of Disease]
In this study we investigated if TLR activation regulates NGF and which signaling mechanisms control this response in intervertebral discs. TLR2 agonists, TLR4 agonists, or IL-1β (control) treatment increased NGF, brain-derived neurotrophic factor (BDNF), and IL-1β gene expression in human disc cells isolated from healthy, pain-free organ donors. However, only TLR2 activation or IL-1β treatment increased NGF protein secretion. TLR2 activation increased p38, ERK1/2, and p65 activity and increased p65 translocation to the cell nucleus. JNK activity was not affected by TLR2 activation. Inhibition of NF-κB, and to a lesser extent p38, but not ERK1/2 activity, blocked TLR2-driven NGF up-regulation at both the transcript and protein levels. These results provide a novel mechanism of NGF regu...


A Mixed-Methods, Randomized, Controlled Feasibility Trial to Inform the Design of a Phase III Trial to Test the Effect of the Handheld Fan on Physical Activity and Carer Anxiety in Patients With Refractory Breathlessness
The handheld fan is an inexpensive and safe way to provide facial airflow, which may reduce the sensation of chronic refractory breathlessness, a frequently encountered symptom. (Source: Journal of Pain and Symptom Management)


Combat exposure is associated with cortical thickness in Veterans with a history of chronic pain
Chronic Pain (CP) has been associated with changes in gray matter integrity in the cingulate and insular cortex. However, these changes have not been studied in Veterans, despite high prevalence rates of CP and interactions with combat-derived disorders. In the current study, 54 Veterans with a history of CP and 103 Veterans without CP were recruited from the Translational Research Center for Traumatic Brain Injury and Stress Disorders (TRACTS). Cortical thickness from structural MRI scans was determined using the FreeSurfer software package. (Source: Psychiatry Research: Neuroimaging)


Possible alternative therapies for oral lichen planus cases refractory to steroid therapies
Oral lichen planus (OLP) is a chronic inflammatory disorder with multifactorial etiopathogenesis. Immune dysregulation plays a critical role in the development and progression of this disease. Patients’ life may be affected by pain caused by atrophic-erosive lesions. Treatment is usually symptomatic given the obscure etiology. Topical steroids remain the mainstay of management. However, their therapeutic benefits are not always evident. There are substantial data on the possible therapeutic strategies that are effective in OLP cases refractory to steroids. (Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Neural Mechanisms Underlying Anxiety-Chronic Pain Interactions.
Authors: Zhuo M Abstract Chronic pain is a major medical problem that is resistant to conventional medical intervention. It also causes emotional changes such as anxiety and fear. Furthermore, anxiety or fear often enhances the suffering of pain. Based on recent studies, I propose chronic anxiety triggered by injury or chronic pain is mediated through presynaptic long-term potentiation (LTP) in the anterior cingulate cortex (ACC), a key cortical region for pain perception. Conversely, NMDA receptor-dependent postsynaptic LTP plays a more important role in behavioral sensitization in chronic pain. Thus, postsynaptic and presynaptic LTP in ACC neurons are likely the key cellular mechanisms for causing chronic pain and its associated anxiety, respectively. This suggests potential targ...


Impact of Nitrate Use on Survival in Acute Heart Failure: A Propensity-Matched Analysis [Heart Failure]
Conclusions In acute decompensated heart failure, use of nitrates acutely in the emergency department setting was not associated with improvement in short-term or near-term survival. Our study does not support generalized use of nitrates when the primary goal of therapy is to reduce mortality. (Source: JAHA:Journal of the American Heart Association)


A Randomized Pilot Study on the Effects of an Adapted Mindfulness-Based Intervention for Adolescents with Chronic Pain
(Source: PEDIATRICS)


Coordinate‐based (ALE) meta‐analysis of brain activation in patients with fibromyalgia
Abstract There are an increasing number of neuroimaging studies that allow a better understanding of symptoms, neural correlates and associated conditions of fibromyalgia. However, the results of these studies are difficult to compare, as they include a heterogeneous group of patients, use different stimulation paradigms, tasks, and the statistical evaluation of neuroimaging data shows high variability. Therefore, this meta‐analytic approach aimed at evaluating potential alterations in neuronal brain activity or structure related to pain processing in fibromyalgia syndrome (FMS) patients, using quantitative coordinate‐based “activation likelihood estimation” (ALE) meta‐analysis. 37 FMS papers met the inclusion criteria for an ALE analysis (1,264 subjects, 274 activation foci). A ...


Chronic pain in mice relieved by blocking protein
Stephen FellerLONDON, Feb. 11 (UPI) -- Blocking a protein related to stress can relieve chronic pain, researchers found in a recent study with mice. (Source: Health News - UPI.com)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Is Timing of Medical Therapy Related to Outcome in Painful Chronic Pancreatitis?
Conclusions: Pregabalin can be added as adjuvant analgesic at any time point during the disease course of CP. (Source: Pancreas)


Mood-Enhancing Drugs Could Also Provide Relief For Chronic Pain
A class of drugs being studied to treat certain mood disorders may also be able to relieve chronic pain by acting on a gene involved in regulating the body’s reaction to stress. (Source: Forbes.com Healthcare News)


Medical News Today: Blocking a stress protein may treat chronic pain
Blocking a stress-regulating protein called FKBP51 was found to reduce chronic pain in mice, suggesting the protein may be a promising drug target for the condition. (Source: Health News from Medical News Today)


fMRI evidence for a reduction in affective processing of thermal pain in responders of transcutaneous vagal nerve stimulation (TVNS)
Although the transcutaneous vagal nerve stimulation (TVNS) is increasingly used in treatment of chronic pain, the underlying mechanism is unclear. The goal of this study was to analyse the cerebral effects of TVNS under experimental pain in fMRI. (Source: Clinical Neurophysiology)


ID 99 – Functional connectivity study on repetitive transcranial magnetic stimulation for central post-stroke pain
This study aimed to investigate functional connectivity specific to CPSP and functional connectivity alteration associated with pain relief by rTMS. (Source: Clinical Neurophysiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


ID 454 – Somatosensory evoked potentials in pathological autorhythmicity detection in patients with chronic myofascial pain
Objectivation of functional shifts in nervous system through sensory evoked potentials at chronic nociceptive afferentation induced by pathological neuronic autorhythmicity. (Source: Clinical Neurophysiology)


ID 100 – Chronic post stroke central pain: Increased success rate of chronic epidural motor cortex stimulation using somatotopic, navigated repetitive TMS for patient selection and implant placement
The outcome at group level of neuromodulation for central pain using stimulation of motor cortices is limited, though for some, there are large effects. Thus, there is a need for selection of patients. (Source: Clinical Neurophysiology)


ID 416 – Motor cortex stimulation for chronic pain relief using repetitive magnetic stimulation (rTMS): 20Hz versus Theta-Burst, which is better?
To compare the efficacy of two different modalities of rTMS (20Hz and Theta-Burst) in relieving chronic neuropathic pain. (Source: Clinical Neurophysiology)


ID 56 – Fibromyalgia and psychoacustic stimulation: An EEG study on pain modulation
Fibromyalgic Sindrome is characterized by chronic musculoskeletal pain, mood and sleep disorders and weakness. Classical analgesic therapies are often uneffective, for this reason we aim to study the effects of a non-pharmacological treatment: psychoacustic stimulation through binaural beats. Our purpose is to investigate cortical activation in patients and self-reporting pain intensity. (Source: Clinical Neurophysiology)


A Systematic Review of the Treatment for Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES)
Conclusion There is significant pain relief following injections and anterior neurectomy. Awareness of the diagnosis is important. The validity of currently used diagnostic criteria needs to be evaluated in additional studies. (Source: The American Journal of Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The Use of Botulinum Toxin in the Management of Headache Disorders
Semin Neurol 2016; 36: 092-098DOI: 10.1055/s-0036-1571443Headache disorders can be further classified as episodic (&lt; 15 headache days per month) or chronic (≥15 headache days per month for more than 3 months). Chronic migraine (CM) requires that headaches occur on 15 or more days a month for more than 3 months. These headaches must be migraines on at least 8 days per month. There are seven botulinum toxin (BoNT) serotypes (A1, A2, A3, B, C1, D, E, F, and G). All serotypes inhibit acetylcholine release, although their intracellular target proteins, physiochemical characteristics, and potencies are different. Its mechanism of action in pain is being investigated. Botulinum toxin type A (BoNT-A) has been the most widely studied serotype for therapeutic purposes. A major clinical advantag...


Hyaluronic acid versus Saline intra‐articular injections for amelioration of chronic knee osteoarthritis: A canine model
This article is protected by copyright. All rights reserved (Source: Journal of Orthopaedic Research)


In Search of Concomitant Alterations of Dopaminergic and Neurotensinergic Systems in Stress Conditions.
Authors: Rodríguez de Lores Arnaiz G, Antonelli MC Abstract The aim of the present article is to review experimental evidence which suggest joint involvement of both the dopaminergic and neurotensinergic systems in stress conditions. At present, the concept of stress refers to an environmental demand exceeding the normal regulatory ability of an organism, particularly during unpredictable and uncontrollable situations. Chronic stress yields devastating effects including cognitive and working memory dysfunctions, for which neurotransmission mediated by the catecholamines dopamine and noradrenaline is crucial. Catecholamine synthesis depends on the rate-limiting enzyme, tyrosine hydroxylase, whose expression is associated with working memory and the response to chronic stress. Neuro...


Re: Lifestyle and Risk of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in a Cohort of United States Male Health Professionals
We read this article with great interest. The authors evaluated the correlation between lifestyle and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and observed no significant findings. The study cohort included a large number of male health care professionals with long-term followup. An advantage was that well educated health professionals could reply to the questionnaire with more precision. To avoid reverse causation, the authors did a sensitivity analysis and found independent correlations between lifestyle and CP/CPPS vs associated lower urinary tract symptoms (LUTS). (Source: The Journal of Urology)


[Therapy recommendations in a pediatric outpatient pain clinic : Adherence and effectiveness of implementation].
CONCLUSION: The adherence level as well as the estimated effectiveness regarding the majority of pain-related recommendations was high. Some recommendations had low adherence rates and low estimated effectiveness. These results can help to further improve the performance of outpatient clinics for children and adolescents with chronic pain. PMID: 26868854 [PubMed - as supplied by publisher] (Source: Schmerz)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Glial Cells are Involved in Itch Processing.
Authors: Andersen HH, Arendt-Nielsen L, Gazerani P Abstract Recent discoveries in itch neurophysiology include itch-selective neuronal pathways, the clinically relevant non-histaminergic pathway, and elucidation of the notable similarities and differences between itch and pain. Potential involvement of glial cells in itch processing and the possibility of glial modulation of chronic itch have been identified recently, similarly to the established glial modulation of pain. This review outlines the similarities and differences between itch and pain, and how different types of central and peripheral glial cells may be differentially involved in the development of chronic itch akin to their more investigated role in chronic pain. Improvements are needed in the management of chronic itc...


Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial.
CONCLUSIONS: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients. PMID: 26864057 [PubMed - as supplied by publisher] (Source: Physiotherapy Theory and Practice)


Interactions of Opioids and HIV Infection in the Pathogenesis of Chronic Pain
Bolong Liu, Xin Liu, Shao-Jun Tang (Source: Frontiers in Microbiology)


Blocking a Stress-Related Gene Relieves Chronic Pain
Inhibiting the activity of a protein involved in the body&rsquo;s stress response can ease chronic pain in mice. (Source: The Scientist)


Pain Symptoms Associated with Opioid Use amon Vulnerable Persons with HIV: An exploratory study with implications for palliative care and opioid abuse prevention.
Authors: Knowlton AR, Nguyen TQ, Robinson AC, Harrell PT, Mitchell MM Abstract Current or former injection drug users with human immunodeficiency virus (HIV) are at high risk for pain, which adversely affects their quality of life and may increase their risk for illicit drug use or relapse. We explored associations between pain symptoms and substance use among injection-drug-using study participants with HIV who had histories of heroin use. Using generalized estimating equations and controlling for prior substance use, we found that pain in each six-month period was associated with the use of heroin and prescription opioids, but not the use of nonopioid drugs or alcohol. Routine clinical assessment and improved management of pain symptoms may be needed for persons with HIV and a hi...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Australia set to legalize cultivation of medical cannabis
SYDNEY (Reuters) - Australia is expected to legalize the cultivation of cannabis for medical or scientific purposes with a bill introduced to parliament on Wednesday -- the first step towards doctors eventually prescribing it to patients with chronic pain. (Source: Reuters: Health)


Prevention of renal complications induced by non-steroidal anti-inflammatory drugs.
Authors: Vučković S, Vujović KS, Medić B, Srebro D, Mostić D Abstract Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the treatment of pain, inflamation and fever. They are usually well tollerated in healthy persons, but in patients with risk factors (advanced age, renal impairment, heart failure, liver disease, concurrent medications with antihypertensive drugs), NSAIDs can induce serious renal adverse effects. They include sodium and water retention with edema, worsening of heart failure, hypertension, hyponatremia, hyperkalemia, acute kidney injury, chronic kidney disease, renal papillary necrosis and acute interstitial nephritis. The majority of these adverse effects are due to the inhibition of prostaglandins synthesis and they are dose and dura...


Endopelvic free anchor minisling technique for stress urinary incontinence treatment: 10 years of experience
Conclusions EFA is a viable, safe, and effective technique for treating UI due to urethral hypermobility. (Source: International Urogynecology Journal)


[Research Articles] The stress regulator FKBP51 drives chronic pain by modulating spinal glucocorticoid signaling
We report that FKBP51 (FK506 binding protein 51) is crucial for the full development and maintenance of long-term pain states. Indeed, FKBP51 knockout mice, as well as mice in which silencing of FKBP51 is restricted to the spinal cord, showed reduced hypersensitivity in several persistent pain models in rodents. FKBP51 deletion did not compromise the detection of acute painful stimuli, a critical protective mechanism. Moreover, the intrathecal administration of the specific FKBP51 inhibitor SAFit2 reduced the severity of an established pain state, confirming the crucial role of spinal FKBP51 in nociceptive processing. Finally, glucocorticoid signaling, which is known to modulate persistent pain states in rodents, was impaired in FKBP51 knockout mice. This finding suggested that FKBP51 regu...


Non-steroidal anti-inflammatory drugs for chronic low back pain.
CONCLUSIONS: Six of the 13 included RCTs showed that NSAIDs are more effective than placebo regarding pain intensity. NSAIDs are slightly more effective than placebo regarding disability. However, the magnitude of the effects is small, and the level of evidence was low. When we only included RCTs at low risk of bias, differences in effect between NSAIDs and placebo were reduced. We identified no difference in efficacy between different NSAID types, including selective versus non-selective NSAIDs. Due to inclusion of RCTs only, the relatively small sample sizes and relatively short follow-up in most included trials, we cannot make firm statements about the occurrence of adverse events or whether NSAIDs are safe for long-term use. PMID: 26863524 [PubMed - as supplied by publisher] (Sourc...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


ZiconotideMonotherapy: A Systematic Review of Randomised Controlled Trials.
DISCUSSION: The results suggest that ziconotide is beneficial for pain reduction in chronic neuropathic pain. However, there remain some methodological issues that may call into question the validity of the results. It is evident that more work needs to be conducted to further validate the efficacy of ziconotide and to discover new areas of use. PMID: 26861472 [PubMed - as supplied by publisher] (Source: Current Neuropharmacology)


[Chronic low back pain : Comparison of mobilization and core stability exercises].
CONCLUSION: With regard to their daily complaints, patients with cLBP can be treated using standardized mobilization exercises in addition to core stability exercises. PMID: 26864586 [PubMed - as supplied by publisher] (Source: Der Orthopade)


Total Cost of Care Will Define Value Propositions
As they move increasingly toward a value-based model, health care systems are also being expected to take on more risk, so every contributor to the total cost of care will increasingly be scrutinized in terms of the value that it brings. Now, life science business leaders have an unrivalled opportunity to learn from senior clinicians and healthcare administrators exactly how these latest trends in the US healthcare landscape are set to impact their commercial organizations. During an extensive live Q&A session on Friday, February 12, three senior healthcare experts will provide privileged insight into “How 2016 Healthcare Trends will Shape Market Access Strategies” as part of an expert roundtable with CMR Institute. Taking place at 12 noon ET, this live webinar will offer partici...


New health evidence gives women informed choice in the prolapse surgery debate
New evidence published in the Cochrane Library highlights benefits and harms of using artificial mesh when compared with tissue repair in the surgical treatment of vaginal prolapse. Slightly better repair with mesh needs to be weighed carefully against increased risk of harms.A new Cochrane Review summarizes evidence that addresses a long-standing controversy in the surgical repair of vaginal prolapse. It will help women and surgeons to make better informed choices about surgical treatment, and reinforces the need for careful consideration of the advantages and disadvantages of grafting artificial material compared with using tissue to repair the anatomy of the vagina.A vaginal prolapse occurs when the walls of the vagina become weak and collapse inwards. This can be a distressing disorder...


Peripheral nerve field stimulation for chronic neuropathic pain: a single institution experience
Conclusions PNFS can be considered an effective and safe option to treat carefully selected, drug-resistant and chronic neuropathic pain patients; the reversibility of the procedure and its lack, at least in our hands, of long-term complications may contribute to wider use of this procedure. (Source: Acta Neurochirurgica)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Difficult defecation in constipated patients and its relationship to colonic disorders
Conclusions This study demonstrates that difficult defecation is part of a more generalized colorectal dysfunction in both irritable bowel syndrome and in functional constipation patients with an overlap of symptomatology. It also demonstrates the relative inadequacy of the Rome III criteria to describe the relationship between constipation and difficult defecation. (Source: International Journal of Colorectal Disease)


Intrathecal Ziconotide: Dosing and Administration Strategies in Patients With Refractory Chronic Pain
ConclusionsClinical trials and experience confirm the feasibility and usefulness of IT ziconotide in the management of refractory chronic pain. Emerging evidence suggests that additional IT delivery options may further expand the usefulness and benefits of ziconotide. (Source: Neuromodulation)


Applying a Part of the Daily Dose as Boli May Improve Intrathecal Opioid Therapy in Patients With Chronic Pain
ConclusionsIntermittent bolus administration may be helpful for increasing the efficacy of intrathecal opioid therapy of chronic pain. (Source: Neuromodulation)


Impact on quality of life of a nursing intervention programme for patients with chronic non‐cancer pain: an open, randomized controlled parallel study protocol
DiscussionIf significant effects were detected, impact on quality of life through a nurse‐led programme would offer a complementary service to existing pain clinics for a group of patients with frequent unmet needs. (Source: Journal of Advanced Nursing)


Posttraumatic Stress Disorder After Sexual Abuse in Adolescent Girls
This article will describe PTSD following sexual abuse and its impact on presenting complaints, such as sexually transmitted infections, contraception, and chronic pain, for the pediatric and adolescent gynecology (PAG) clinician. Treatment approaches, including the use of antidepressants and anxiolytics, as well as evidenced based psychotherapies, will be highlighted. (Source: Journal of Pediatric and Adolescent Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Preliminary Treatment of Achilles Tendinopathy Using Low-Intensity Pulsed Ultrasound
Conclusions. LIPUS is an additional noninvasive treatment modality for chronic Achilles tendinopathy that may potentially help improve clinical symptoms and delay and/or prevent the need for surgical intervention. While LIPUS is easy to use, well-tolerated, and has promising early clinical results, further research is needed to determine the long-term benefits, disadvantages, and cost-effectiveness of this alternative treatment for tendinopathy. Levels of Evidence: Therapeutic, Level IV: Case series (Source: Foot and Ankle Specialist)


Symptomatic Bipartite Medial Cuneiform: Report of Five Cases and Review of the Literature
Bipartition of the medial cuneiform is a well-described but rarely seen anatomic variant. The majority of literature focuses on anatomic description and incidents based on studies of archeological collections. Symptomatic cases can be overlooked or misdiagnosed initially given the vague complaint of pain either chronic in nature or following an acute injury that could result in a myriad of foot conditions. Treatment ranges from orthotics, immobilization, injection therapy, and surgery. Presented here is a series of 5 cases treated successfully with conservative and surgical measures. Levels of Evidence: Therapeutic, Level IV (Source: Foot and Ankle Specialist)


Ankle Impingement Caused by an Intra-articular Plica: A Report of 2 Cases
We present 2 cases of ankle impingement occurring in the setting of equivocal examination and imaging findings. In both cases, arthroscopy revealed a likely congenital, intra-articular plica. Levels of Evidence: Therapeutic, Level IV: Case Study (Source: Foot and Ankle Specialist)


A Rare Case of Glomus Tumor of the Great Toe: An Analysis of Behavior at This Rare Site
Glomus tumor, originally known as an angioneuromyoma, is a benign neoplasm arising from specialized structures called glomus bodies, involved in thermoregulation. Although it has been reported at a number of sites in the body, this rare tumor is most commonly seen in the subungual areas of the digits of the hand. Only a handful of lesions have been reported in the toes. Because most foot conditions are treated by podiatrists and dermatologists, orthopaedic surgeons are generally unaccustomed to making early diagnoses. The purpose of this case report is to alert the attending surgeon regarding the possibility of glomus tumor as a cause of chronic toe pain. Also it has been observed that the behavior of this tumor varies with the site of occurrence&mdash;whether digital or extradigital. So w...


Does vitamin D supplementation alleviate chronic nonspecific musculoskeletal pain? A systematic review and meta-analysis
The objective of the present study is to evaluate the effectiveness of vitamin D supplementation in the management of CNMP through a systematic review and meta-analysis. According to PRISMA guidelines, PubMed, Embase, Web of Science, Cochrane and Scopus electronic databases were searched for randomised controlled trials comparing vitamin D supplementation to a control or placebo in CNMP patients; the search was not limited by language or date. Meta-analysis was performed using the mean and standardised mean difference which was computed with 95 % confidence intervals, and overall effect size was calculated. Both fixed and random effects models were used in meta-analysis to account for heterogeneity in the studies. The initial search identified 107 studies, of which 10 were potentially rel...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The effectiveness of balneotherapy in chronic neck pain
Abstract The aim of this study was to investigate the effectiveness of balneotherapy (BT), which is applied in addition to physical therapy (PT), in the treatment of chronic neck pain. Sixty patients with chronic neck pain were divided into study (n = 30) and control (n = 30) groups. All of the patients in both groups were treated with a 15-session standard PT program consisting of hot pack, ultrasound, and transcutaneous electrical stimulation. Patients in the study group were also treated with a 15-session BT program lasting 20 min/day in addition to the standard PT program. Visual analogue scale (VAS), modified neck disability index (mNDI), and Nottingham Health Profile (NHP) scores of all patients were evaluated at three different times as pretreatment, posttreatment,...


A Systematic Review of the Treatment for Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES)
Abdominal cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked cause of chronic abdominal pain. We aim to outline the current available literature concerning the treatment of patients diagnosed with ACNES. (Source: American Journal of Surgery)


Thoracic dysfunction in whiplash-associated disorders: a systematic review and meta-analysis protocol
Discussion This is the first study to bring together evidence of thoracic dysfunction post whiplash and provide new insights into the scope and nature of thoracic dysfunction in WAD. With current management options being largely focused to a primary neck complaint and many patients going to become chronic in their presentations, this review may stimulate research and clinical interest in a largely under investigated, yet anatomically and kinematically related, spinal region. Systematic review registration PROSPERO CRD42015026983. (Source: Systematic Reviews)


Low back pain as seen in orthopedic clinics of a Nigerian Teaching Hospital
Conclusion: Low back pain of mechanical origin (recurrent and chronic in a significant proportion of patients) is predominant in our environment. This pattern calls for prevention as well as the early and appropriate care of the patient with low back pain. (Source: Nigerian Journal of Clinical Practice)


Prevalence and determinants of medication non‐adherence in chronic pain patients: a systematic review
ConclusionNon‐adherence to analgesic medication use is very common in the chronic pain population. The choice for pharmacological therapy should not only be based upon pain diagnosis but should also take the risks of non‐adherence into account. The value of adherence monitoring or adherence enhancing interventions has to be investigated in future studies. (Source: Acta Anaesthesiologica Scandinavica)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic non‐cancer pain and the epidemic prescription of opioids in the Danish population: trends from 2000 to 2013
ConclusionsThe use of opioids has increased in Denmark, especially among elderly women. The concurrent use of BZD/BZD‐related drugs has decreased from 2010 to 2013, but still one‐third of long‐term opioid users were co‐medicated. (Source: Acta Anaesthesiologica Scandinavica)


A systematic review of the treatment for abdominal cutaneous nerve entrapment syndrome
Abdominal cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked cause of chronic abdominal pain. We aim to outline the current available literature concerning the treatment of patients diagnosed with ACNES. (Source: American Journal of Surgery)


St. Jude launches new OCT system
Cardiac technology developer St. Jude Medical has launched its Optis Mobile...Read more on AuntMinnie.comRelated Reading: St. Jude obtains CE Mark for MRI chronic pain unit FDA approves St. Jude Medical's paddle lead St. Jude commences trial of OCT guidance FDA clears St. Jude's MR-conditional spinal stimulation system St. Jude launches 3D vessel system in Japan (Source: AuntMinnie.com Headlines)


Research finds no easy answers to use of drug screening for pain patients
Doctors who treat patients suffering from chronic pain face a quandary, according to research. Monitoring patients through urine drug screenings, part of the standard protocol to ensure patient safety, is associated with an increase in the odds that the patients won't return for future treatment. (Source: ScienceDaily Headlines)


Quality of Life and Economic Burden in Recessive Dystrophic Epidermolysis Bullosa.
CONCLUSION: RDEB had a profound impact on QoL and economic burden. Compared with other dermatologic diseases, RDEB showed severe symptoms and QoL was seriously impaired. Most patients sustained economic burdens, especially on preparing dressing materials. Younger patients experienced more economic burdens. PMID: 26848213 [PubMed] (Source: Annals of Dermatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Intrathecal Morphine Infusion Therapy in Management of Chronic Pain: Present and Future Implementation in Korea.
CONCLUSION: The high cost of initiating ITMP infusion therapy is challenging; however, the present results may encourage more patients to consider ITMP therapy. PMID: 26847303 [PubMed - in process] (Source: Yonsei Medical Journal)


Validation of the Korean Version of the DN4 Diagnostic Questionnaire for Neuropathic Pain in Patients with Lumbar or Lumbar-Radicular Pain.
CONCLUSION: The present study demonstrated the good discriminatory power of DN4 between nociceptive pain and neuropathic component pain in patients with lumbar or lumbar-radicular pain. PMID: 26847299 [PubMed - in process] (Source: Yonsei Medical Journal)


Research finds no easy answers to use of drug screening for pain patients
(University of Houston) Doctors who treat patients suffering from chronic pain face a quandary, according to research from the University of Houston and the University of Texas Medical Branch. Monitoring patients through urine drug screenings, part of the standard protocol to ensure patient safety, is associated with an increase in the odds that the patients won't return for future treatment. (Source: EurekAlert! - Social and Behavioral Science)


What Factors Influence Linear Growth After Transplantation?
Discussion Growth is a defining characteristic of children. Children are expected to have normal height, weight and head circumference growth velocities for their specific age. A review of mid-parental height determination and other growth parameters can be found here. For children with chronic illness and organ dysfunction or failure, their bodies cannot be expected to continue to have normal growth and therefore these children often have failure of normal growth for any and all of the growth parameters. For children facing organ failure or high risk or relapsed cancers, organ transplantation can be life-saving, but is not without its own problems including neurocognitive abnormalities, psychosocial dysfunction, endocrine abnormalities, bone abnormalities, primary or secondary malignancy...


The clinical consequences of sucrase-isomaltase deficiency
Abstract Primary sucrase-isomaltase deficiency, originally thought to be a homozygous recessive disorder, has been found to have numerous genetic variants that alone or in combination (compound heterozygosity) express varying degrees of clinical illness, most commonly causing chronic diarrhea, abdominal pain, and bloating. These symptoms are also present with secondary sucrase-isomaltase deficiency. Recent investigations are providing evidence that sucrase-isomaltase deficiency is more prevalent and of greater clinical significance than previously suspected. Further research is required to correlate the specific genotypes and phenotypes with their clinical expressions and to determine the most appropriate treatment algorithm for these patients. (Source: Molecular and Cellular Ped...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Nutrient Insufficiencies/Deficiencies in Children With Sickle Cell Disease and Its Association With Increased Disease Severity
ConclusionsOur findings show that patients with SCD commonly have multiple nutrient insufficiencies/deficiencies and support the growing evidence for the link between low zinc and increased VOC. It also indicates that increased nutrient insufficiencies/deficiencies are associated with increased disease severity in SCD. Prospective studies with larger samples are needed to further elucidate the relationship between nutrient deficiencies and SCD, and to determine whether nutrient supplementation can improve the disease course. (Source: Pediatric Blood and Cancer)


Pain and Cognitive Function Among Older Adults Living in the Community
Conclusions. Our findings point to the need for further research to understand how chronic pain may contribute to decline in cognitive function and to determine strategies that may help in preventing or managing these potential consequences of pain on cognitive function in older adults. (Source: Journals of Gerontology Series A: Biological Sciences and Medical Sciences)


Oral Palmitoylethanolamide Treatment Is Associated with Reduced Cutaneous Adverse Effects of Interferon-β1a and Circulating Proinflammatory Cytokines in Relapsing–Remitting Multiple Sclerosis
Abstract Palmitoylethanolamide (PEA) is an endogenous lipid mediator known to reduce pain and inflammation. However, only limited clinical studies have evaluated the effects of PEA in neuroinflammatory and neurodegenerative diseases. Multiple sclerosis (MS) is a chronic autoimmune and inflammatory disease of the central nervous system. Although subcutaneous administration of interferon (IFN)-β1a is approved as first-line therapy for the treatment of relapsing–remitting MS (RR-MS), its commonly reported adverse events (AEs) such as pain, myalgia, and erythema at the injection site, deeply affect the quality of life (QoL) of patients with MS. In this randomized, double-blind, placebo-controlled study, we tested the effect of ultramicronized PEA (um-PEA) added to IFN-β1a in the t...


Coping styles and disability in patients with hand osteoarthritis
Conclusion. In patients with hand OA, joint-specific factors and coping styles decreasing activity and pacing were both associated with disability. Our results suggest that interventions should aim at joint-specific complaints as well as changing coping styles to improve functional outcome. (Source: Rheumatology)


Respiratory dysfunction in patients with chronic neck pain: what is the current evidence?
Respiratory function of patients with neck pain has not been given much consideration in usual clinical practice. The problem has however been highlighted occasionally by renown clinical scientists and recently there is a growing interest in the investigation of respiratory function in this clinical population. The aim of this review is to critically present the emerging evidence and discuss the similarities and differences observed. Although the evidence for some respiratory parameters is conflicting, it seems to be generally agreed that others such as maximal voluntary ventilation, strength of respiratory muscles, chest mechanics and partial pressure of arterial carbon dioxide are affected in patients with chronic neck pain. (Source: Journal of Bodywork and Movement Therapies)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Subdural empyema following lumbar facet joint injection: An exceeding rare complication
We report a rare case of a 47-year-old female patient who developed a left L4/5 facet septic arthrosis with an associated subdural empyema and meningitis following facet joint injection. This case is unique, as to the best of our knowledge no other case of subdural empyema following facet joint injection has been reported in the literature. Furthermore this case serves to highlight the potential serious adverse sequelae of a routine and apparently innocuous intervention. The need for medical practitioners to be alert to and respond rapidly to the infective complications of facet joint injection cannot be understated. (Source: Polish Journal of Neurology and Neurosurgery)


Exercise therapy for chronic fatigue syndrome.
CONCLUSIONS: Patients with CFS may generally benefit and feel less fatigued following exercise therapy, and no evidence suggests that exercise therapy may worsen outcomes. A positive effect with respect to sleep, physical function and self-perceived general health has been observed, but no conclusions for the outcomes of pain, quality of life, anxiety, depression, drop-out rate and health service resources were possible. The effectiveness of exercise therapy seems greater than that of pacing but similar to that of CBT. Randomised trials with low risk of bias are needed to investigate the type, duration and intensity of the most beneficial exercise intervention. PMID: 26852189 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Prevalence of Diabetes and Health-Related Quality of Life Among Rural-to-Urban Nong Zhuan Fei Migrants in an Urban Area of Northern China, 2013.
CONCLUSION: The Chinese government hopes to integrate an additional 250 million people into city living by 2025. As the NZF population increases, so may the prevalence of diabetes associated with the change from a rural to an urban lifestyle. Action is needed now by public health professionals to prevent a possible diabetes crisis in NZF communities in the future. PMID: 26843683 [PubMed - in process] (Source: Public Health Reports)


Cognitive Behavioral Therapy Formulation With Chronic Pain
(Source: Journal of Cognitive Psychotherapy)


Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
Conclusions The management of headaches associated with neck pain should include exercise. Patients who suffer from chronic tension-type headaches may also benefit from relaxation training with stress coping therapy or multimodal care. Patients with cervicogenic headache may also benefit from a course of manual therapy. (Source: European Spine Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The association between metacognitions and the impact of Fibromyalgia in a German sample
Fibromyalgia is a chronic condition of unknown aetiology, characterised by widespread pain, sleep disturbances, and fatigue. In this paper we examined the relationship metacognitions and the impact of Fibromyalgia in a German sample, detailing the translation and validation of a self-report metacognitive instrument. (Source: Journal of Psychosomatic Research)


Role of Protease-Activated Receptor 2 in the development of lower urinary tract dysfunction
We reported that the mast cell-tryptase-PAR2 axis plays a critical role in the development of chronic pain in experimental autoimmune prostatitis (EAP), a mouse model of CP/CPPS. We therefore examined whether PAR2 activation mediates lower urinary tract dysfunction. (Source: The Journal of Urology)


[Long-term Application of Opioids for Non-Tumor Associated Pain - Impact of the S3 Guidelines for the Field of Orthopaedic Surgery and Trauma Surgery].
Discussion: Opioid analgetics are a treatment option for particular pain syndromes (arthritis, back pain). However, the latest S3 guidelines emphasise patient education and therapy. The indication, effects, side effects and therapeutic objectives should be regularly assessed, both before and during treatment. Once therapeutic goals have been achieved, measures such as physical therapy, physiotherapy or psychotherapy should be continued, whereas opioid dosage should be gradually reduced. PMID: 26844856 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Orthopadie und Unfallchirurgie)


Case complexity in patients with chronic nonspecific musculoskeletal pain: a Delphi and feasibility study
The objective of this study was to explore case complexity and to initiate the development of a case complexity index (CCI). A three-round Delphi study among clinicians involved in multidisciplinary Pain Rehabilitation Programs was performed to identify important factors that are assumed to influence functioning in patients with CMP. The 10 most important factors were used to initiate the development of a CCI, with mean ratings of importance per factor as weights. The feasibility of the CCI was tested in a pilot study on 16 patients with CMP. In the first round, 166 factors were identified; in the second round, the 10 most important factors were selected; in the third round, relative weights of each factor were calculated, ranging from 1.75 (features of complaints) to 3.56 (psychiatric dis...


Simple SpA screening tool works in U.S. population
People under the age of 45 with chronic back pain for more than 3 months can be reliably identified as having axial spondyloarthritis (axSpA) if they have one or more of three SpA disease features,... (Source: Rheumatology News)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cure: A Journey Into the Science of Mind Over Body review – can illness be ‘all in your head’?
From placebos and ‘kissing it better’ to hypnosis and Lourdes – a level-headed look at alternatives to prescription drugsThere are certain kinds of illnesses that seem to cause great distress to doctors; and there are certain kinds of patients that medicine seems almost incapable of helping. It can seem to some people that doctors are almost hostile to them. We often read in illness memoirs of doctors who have been dismissive, and patients being told: “it’s all in your head”, “you’re imagining it”, “your symptoms aren’t real” (whatever that means).I have in mind a patient I saw last Monday morning. Mr Hutchens (not his real name) has been depressed for many years, since losing his job because of his chronic back pain, sustained after an apparently minor road acciden...


Helicobacter Pylori Associated Gastritis Increases Risk of Colorectal Polyps: a Hospital Based-Cross-Sectional Study in Nakhon Ratchasima Province, Northeastern Thailand.
CONCLUSIONS: This study showed that Helicobacter pylori associated gastritis is associated with an increased risk of colorectal polyps, especially adenomas with dysplasia in the Thai population. Patients with Helicobacter pylori-associated gastritis may benefit from concurrent colonoscopy for diagnosis of colorectal polyps as a preventive and early treatment for colorectal cancer. PMID: 26838234 [PubMed - in process] (Source: Asian Pacific Journal of Cancer Prevention)


Pilot study shows meditation can help US veterans manage chronic pain
(American University) A small pilot study conducted at the Washington, DC Veterans Affairs Medical Center reveals that veterans who practiced meditation reported a 20 percent reduction in pain intensity (how bad pain hurts or feels), as well as pain interference, how pain interferes with everyday aspects of life, such as sleep, mood, and activity level. (Source: EurekAlert! - Medicine and Health)


The Impact of Spinal Cord Stimulation on Sleep Patterns
DiscussionWe demonstrate that insomnia scores on ISI improve with SCS at six‐month follow‐up. Further, we find that improvements in pain correlate with these ISI improvements. (Source: Neuromodulation)


Flow cytometry as an improved method for the titration of Chlamydiaceae and other intracellular bacteria
In this study we compared the use of flow cytometry with microscopy and Fluorospot for the titration of C. suis as a representative of other intracellular bacteria. Titer determination via Fluorospot was unreliable, while titration via microscopy led to a linear read‐out range of 16 − 64 dilutions and moderate reproducibility with acceptable standard deviations within and between investigators. In contrast, flow cytometry had a vast linear read‐out range of 1,024 dilutions and the lowest standard deviations given a basic training in these methods. In addition, flow cytometry was faster and material costs were lower compared to microscopy. Flow cytometry offers a fast, cheap, precise, and reproducible alternative for the titration of intracellular bacteria like C. suis. © 2016 In...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Baroreflex mechanisms in Irritable Bowel Syndrome: Part I. Traditional indices
Conclusions These findings indicate that different cardiovascular mechanisms are associated with IBS development and the increase and decrease of severity of IBS symptoms. Their assessment suggests ways to personalize treatment of IBS. (Source: Physiology and Behavior)


Development and Evaluation of the Psychometric Properties of the CKD-MBD Knowledge and Behavior Questionnaire (CKD-MBD-KB) for Patients with Chronic Kidney Disease
Chronic kidney disease-mineral and bone disorder (CKD-MBD) is one of the most complicated morbidities among patients with end-stage renal disease. At present, a specific questionnaire assessing relevant knowledge and behavior for patients with CKD-MBD is still unavailable. (Source: Journal of Pain and Symptom Management)


Novel application of high‐dose rate brachytherapy for severe, recalcitrant palmoplantar pustulosis
We present the case of a 36‐year‐old man with severe PPP who had treatment failure with multiple medical therapies but showed marked improvement with high‐dose rate brachytherapy. Brachytherapy has the advantage of providing a conformal dose distribution over complex curved surfaces, such as the foot and ankle. Our observations suggest that brachytherapy may be a well‐tolerated treatment option for patients with severe, refractory PPP. (Source: Clinical And Experimental Dermatology)


Pain self‐management training increases self‐efficacy, self‐management behaviours and pain and depression outcomes
ConclusionA combined intervention increased patient self‐management behaviours and self‐efficacy to manage symptoms among primary care patients with chronic musculoskeletal pain and depression. Receipt of the full dose of the entire PSM programme was related to improvements in pain interference and depression severity. What does this study add?A nurse‐led six‐session PSM programme increased self‐efficacy as well as specific behaviours such as strengthening and stretching exercises, progressive muscle relaxation and visualization.There was a dose–response in that attending a greater proportion of the PSM sessions led to greater improvement in both pain and depression outcomes. (Source: European Journal of Pain)


Medical cannabis: considerations for the anesthesiologist and pain physician
Conclusion The science of medical cannabis and the need for education of healthcare professionals and patients require continued effort. Although cannabinoids work to decrease pain, there is still a need to confirm these beneficial effects clinically and to exploit them with acceptable benefit-to-risk ratios. (Source: Canadian Journal of Anesthesia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Anterior sacral meningocele presenting as right adnexal cyst
A 47-year old woman presented with chronic pelvic pain for 6 months. There was no history of trauma or surgical operation. Pelvic ultrasound (US) was performed. Pelvic US revealed an anechoic cyst in the right pelvic areas. The origin of the cyst could not be determined during the US examination. The magnetic resonance (MR) imaging showed a thin-walled cystic lesion in the right adnex. The lesion was not associated with the ovaries. In the posterior, it was communicating with the spinal subarachnoid space (Figure 1A-C). (Source: The Spine Journal)


Forecasting the future pain in hip OA: can we rely on pain trajectories?
Hip osteoarthritis (OA) is a common disorder, with nearly 5 million adults older than 50 years in the United States having both radiographically apparent changes and near-daily hip pain.1 About 20 million additional adults have radiographic changes to their hip but experience no or only intermittent pain. The pain and functional disability caused by symptomatic hip OA can be immense; persons with hip OA report quality of life comparable to those who have rheumatoid arthritis or chronic obstructive pulmonary disease. (Source: Osteoarthritis and Cartilage)


Role of Free Iliac Crest Flap in Foot and Ankle Reconstruction
Conclusions The free iliac crest flap is a feasible option for extensive compound fractures and bone-healing complications in the foot and ankle. It can also be used to achieve ankle arthrodesis when other techniques have failed and in patients at high risk for amputation.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Journal of Reconstructive Microsurgery)


A study of the psychometric properties of 12-item World Health Organization Disability Assessment Schedule 2.0 in a large population of people with chronic musculoskeletal pain.
CONCLUSIONS: The present data indicate that the Finnish translation of the 12-item WHODAS 2.0 is a valid instrument for measuring restrictions of activity and participation among patients with chronic musculoskeletal pain. PMID: 26851249 [PubMed - as supplied by publisher] (Source: Clinical Rehabilitation)


Laparoscopic Appendectomy for Chronic Right Iliac Fossa Pain: Correlating Histology with Outcome.
This study collected prospective data for a single surgeon's series of laparoscopic appendectomy performed for CRIF pain between 2003 and 2014. RESULTS: Forty patients with a median age of 13 years (range 5-19 years) underwent laparoscopic appendectomy for CRIF pain. Twenty-nine patients (73%) had macroscopically normal appendixes, but histological changes were identified in 28 patients (70%). Other findings at laparoscopy included gynecological pathology (ovarian/para-ovarian cysts), unfixed mobile caecum, and a well-defined peritoneal band extending from the caecum to the anterolateral abdominal wall (caeco-peritoneal band). Patients were followed up for a median of 2 months (range 1-15 months). All patients reported resolution of CRIF pain. DISCUSSION: Laparoscopic appendectomy ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Medical cannabis: considerations for the anesthesiologist and pain physician.
CONCLUSION: The science of medical cannabis and the need for education of healthcare professionals and patients require continued effort. Although cannabinoids work to decrease pain, there is still a need to confirm these beneficial effects clinically and to exploit them with acceptable benefit-to-risk ratios. PMID: 26850063 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)


[Pain-related parental behavior : Maternal and paternal responses to chronic pain of their child and modifications following inpatient interdisciplinary pain treatment].
CONCLUSION: Pain-related solicitous behavior can be modified by the interdisciplinary inpatient treatment of chronic pain in children and changes in solicitous behavior seem to be closely related to parental catastrophizing. This association should be considered when dealing with parents of children with chronic pain and also within the framework of future research projects. PMID: 26847081 [PubMed - as supplied by publisher] (Source: Schmerz)


Neuropeptide S modulates the amygdaloidal HCN activities (Ih) in rats: Implication in chronic pain.
We report that NPS inhibits hyperpolarization-activated cyclic nucleotide-gated (HCN) channel current (Ih) in the rat's amygdala through activation of NPSR. This NPS effect is mediated through ERK1/2 phosphorylation in a subset of pyramidal-like neurons located in the medial amygdala. The characters of the recorded Ih suggest a major role for HCN1 activity in this process. Inhibition of Ih by NPS stimulates the glutamatergic drive onto fast spiking intra-amygdalolidal GABAergic interneurons, which in turn facilitates GABA release onto pyramidal-like neurons. Moreover, the HCN1 expression is increased in the amygdala of rats with peripheral nerve injury and intra-amygdaloidal administration of the HCN channel inhibitor ZD7288 attenuates nociceptive behavior in these rats. These results sugg...


Systemic administration of vitamins C and E attenuates nociception induced by chronic constriction injury of the sciatic nerve in rats.
Authors: Riffel AP, de Souza JA, Santos MD, Horst A, Scheid T, Kolberg C, Belló-Klein A, Partata WA Abstract Antioxidants have been tested to treat neuropathic pain, and α-Tocopherol (vitamin E - vit. E) and ascorbic acid (vitaminC - vit. C) are potent antioxidants. We assessed the effect of intraperitoneal administration of vit. C (30mg/kg/day) and vit. E (15mg/kg/day), given alone or in combination, on the mechanical and thermal thresholds and the sciatic functional index (SFI) in rats with chronic constriction injury (CCI) of the sciatic nerve. We also determined the lipid hydroperoxides and total antioxidant capacity (TAC) in the injured sciatic nerve. Further, we assessed the effects of oral administration of vit. C+vit. E (vit. C+E) and of a combination of vit. C+E and gaba...


Development and Evaluation of the Psychometric Properties of the CKD-MBD Knowledge and Behavior (CKD-MBD-KB) Questionnaire for Patients With Chronic Kidney Disease
Chronic kidney disease–mineral and bone disorder (CKD-MBD) is one of the most complicated morbidities among patients with end-stage renal disease. At present, a specific questionnaire assessing relevant knowledge and behavior for patients with CKD-MBD is still unavailable. (Source: Journal of Pain and Symptom Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Better quality of care may reduce risk of death for patients on opioid painkillers
Better quality of care may reduce the risk of death for patients who are prescribed opioid painkillers for chronic pain, say Yale researchers. Their study offers evidence that supports recommendations from clinical practice guidelines encouraging physicians to engage patients with mental health services and substance abuse treatment, as well as to avoid co-prescriptions for sedatives. (Source: ScienceDaily Headlines)


Oral ketamine for the treatment of pain and treatment-resistant depression†.
ConclusionsOral ketamine, given for longer time periods in the described doses, appears to be well tolerated, but few studies have systematically examined the longer-term negative consequences. The short- and longer-term depression outcomes as well as side-effects need to be studied with rigorous randomised controlled trials. PMID: 26834167 [PubMed - in process] (Source: The British Journal of Psychiatry for Mental Science)


Chronic Intussusception Caused by Diffuse Large B-Cell Lymphoma in a 6-Year-Old Girl Presenting with Abdominal Pain and Constipation for 2 Months.
Authors: Choi SH, Han SA, Won KY Abstract The classical triad of abdominal pain, vomiting, and bloody stool is absent in chronic intussusception for more than 2 weeks. Here, we report a 6-year-old female with recurrent abdominal pain for 2 months. Ultrasonography of the abdomen revealed an ileocolic-type intussusception. The lesion accompanying the tight fibrous adhesion was treated by resection and ileocolic anastomosis. It was diagnosed as intussusception with diffuse large B-cell lymphoma. A high index of suspicion for abdominal pain in children should result in the correct diagnosis and appropriate management. PMID: 26839490 [PubMed - in process] (Source: Journal of Korean Medical Science)


Predictive Factors of Mortality in Population of Patients with Paroxysmal Nocturnal Hemoglobinuria (PNH): Results from a Korean PNH Registry.
Authors: Jang JH, Kim JS, Yoon SS, Lee JH, Kim YK, Jo DY, Chung J, Sohn SK, Lee JW Abstract Paroxysmal nocturnal hemoglobinuria (PNH) is a progressive, systemic, life-threatening disease, characterized by chronic uncontrolled complement activation. A retrospective analysis of 301 Korean PNH patients who had not received eculizumab was performed to systematically identify the clinical symptoms and signs predictive of mortality. PNH patients with hemolysis (lactate dehydrogenase [LDH] ≥ 1.5 × the upper limit of normal [ULN]) have a 4.8-fold higher mortality rate compared with the age- and sex-matched general population (P &lt; 0.001). In contrast, patients with LDH &lt; 1.5 × ULN have a similar mortality rate as the general population (P = 0.824). Thromboembolism (TE) (odds ratio...


Serum Troponin I Level for Diagnosis of Acute Coronary Syndrome in Patients with Chronic Kidney Disease.
CONCLUSIONS: Serum levels of cardiac troponin I and creatine kinase-myocardial bound were not suitable to diagnose ACS in CKD patients (stages 3 to 5); therefore, we suggest using other diagnostic attempts in similar conditions. More evaluation is needed to confirm these findings. PMID: 26837675 [PubMed - in process] (Source: Iranian Journal of Kidney Diseases)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Functional MRI may help identify new, effective painkillers for chronic pain sufferers
New research may allow new, more effective and safer pain medications to reach patients who suffer from chronic pain sooner. (Source: ScienceDaily Headlines)


Platelet-Rich Plasma Compared With Other Common Injection Therapies in the Treatment of Chronic Lateral Epicondylitis.
Authors: Rodik T, McDermott B Abstract CLINICAL SCENARIO: Lateral epicondylitis (LE) is a relatively common pathology capable of producing chronic debilitation in a variety of patients. A newer treatment for orthopedic conditions is platelet-rich plasma (PrP) local injection. Focused Clinical Question: Is PrP a more appropriate injection therapy for LE than other common injections such as corticosteroid or whole blood? Summary of Key Findings: Four studies were included: 1 randomized controlled trial (RCT), 2 double-blind RCTs, and 1 cohort study. Two studies involved comparisons of PrP injection to corticosteroid injection. One of the studies involved a 2-y follow-up while another involved a 1-y follow-up. Another study involved the comparison of PrP injection with whole-blood inj...


Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial.
Authors: Cui JZ, Geng ZS, Zhang YH, Feng JY, Zhu P, Zhang XB Abstract Intracutaneous sterile water injection (ISWI) is used for relief of low back pain during labor, acute attacks of urolithiasis, chronic neck and shoulder pain following whiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief of acute low back pain (aLBP). A total of 68 patients (41 females and 27 males) between 18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an 11-point visual analogue scale [VAS]) were recruited and randomly assigned to receive either ISWIs (n=34) or intracutaneous isotonic saline injections (placebo treatment; n=34). The primary outcome was improvement...


Facet orientation and tropism: Associations with asymmetric lumbar paraspinal and psoas muscle parameters in patients with chronic low back pain.
CONCLUSIONS: Muscular asymmetries may develop in the lumbar region of the spine, which are associated with facet asymmetry in patients with chronic low back pain. Longitudinal studies are needed to understand the causal relationship between facet orientation and tropism and muscular asymmetry in future. PMID: 26836843 [PubMed - as supplied by publisher] (Source: Journal of Back and Musculoskeletal Rehabilitation)


Scapulothoracic muscle strength in individuals with neck pain.
CONCLUSIONS: Significant within subject differences were found between sides for the LT and MT while significant between group differences were identified for all three muscles tested. PMID: 26836839 [PubMed - as supplied by publisher] (Source: Journal of Back and Musculoskeletal Rehabilitation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Investigation of the relationship between kinesiophobia, physical activity level and quality of life in patients with chronic low back pain.
CONCLUSION: The kinesiophobia adversely affect the quality of life limiting the physical activity status of patients with chronic low back pain. PMID: 26836836 [PubMed - as supplied by publisher] (Source: Journal of Back and Musculoskeletal Rehabilitation)


Pediatric obesity: Causes, symptoms, prevention and treatment.
Authors: Xu S, Xue Y Abstract Pediatric or childhood obesity is the most prevalent nutritional disorder among children and adolescents worldwide. Approximately 43 million individuals are obese, 21-24% children and adolescents are overweight, and 16-18% of individuals have abdominal obesity. The prevalence of obesity is highest among specific ethnic groups. Obesity increases the risk of heart diseases in children and adults. Childhood obesity predisposes the individual to insulin resistance and type 2 diabetes, hypertension, hyperlipidemia, liver and kidney diseases and causes reproductive dysfunction in adults. Obesity in children is a major health concern of the developed world. The National Health and Nutrition Examination Survey has reported that the prevalence of obesity is on ...


The unhappy triad: pain, sleep complaints, and internalizing symptoms - Koffel E, Krebs EE, Arbisi PA, Erbes CR, Polusny MA.
There is limited understanding of the etiology and temporal relations of chronic pain, sleep complaints, and depression/anxiety. Several models have been proposed by which sleep disruption represents a common mechanism for the comorbidity of these symptoms... (Source: SafetyLit)


Chronic widespread pain after motor vehicle collision typically occurs through immediate development and nonrecovery: results of an emergency department-based cohort study - Hu J, Bortsov AV, Ballina L, Orrey DC, Swor RA, Peak D, Jones J, Rathlev N, Lee DC, Domeier R, Hendry P, Parry BA, McLean SA.
Motor vehicle collision (MVC) can trigger chronic widespread pain (CWP) development in vulnerable individuals. Whether such CWP typically develops through the evolution of pain from regional to widespread or through the early development of widespread pain... (Source: SafetyLit)


Better quality of care may reduce risk of death for patients on opioid painkillers
(Yale University) Better quality of care may reduce the risk of death for patients who are prescribed opioid painkillers for chronic pain, say Yale researchers. Their study, published Feb. 4 in the Journal of General Internal Medicine, offers evidence that supports recommendations from clinical practice guidelines encouraging physicians to engage patients with mental health services and substance abuse treatment, as well as to avoid co-prescriptions for sedatives. (Source: EurekAlert! - Social and Behavioral Science)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Implications of Sensorineural Hearing Loss With Hydrocodone/Acetaminophen Abuse.
This report describes a patient who experienced hearing loss from hydrocodone/acetaminophen abuse. PMID: 26835162 [PubMed] (Source: The Primary Care Companion for CNS Disorders)


Durability of Benefit From Repeated Intravenous Lidocaine Infusions in Fibromyalgia Patients: A Case Series and Literature Review.
Authors: Marks DM, Newhouse A Abstract Fibromyalgia is a painful disorder with no curative treatments, and available medications typically provide partial relief of pain. Reported here is the effective use of serial intravenous lidocaine infusions for the chronic management of 3 patients with fibromyalgia. The details of the infusion procedure are described, and relevant literature is reviewed. Lidocaine infusions should be considered in fibromyalgia patients who are refractory to other treatments, and a positive response to 1 infusion may justify repeated infusions for chronic management. PMID: 26835161 [PubMed] (Source: The Primary Care Companion for CNS Disorders)


A Validation and Generality Study of the Committed Action Questionnaire in a Swedish Sample with Chronic Pain
Conclusion The development, translation and further validation of the CAQ is an important step forward in evaluating the utility of the psychological flexibility model to the treatment of chronic pain. The CAQ can both assist researchers interested in mediators of chronic pain treatment and further enable research on change processes within the psychological flexibility model. (Source: International Journal of Behavioral Medicine)


Estimating the true global burden of mental illness
Publication date: February 2016 Source:The Lancet Psychiatry, Volume 3, Issue 2 Author(s): Daniel Vigo, Graham Thornicroft, Rifat Atun We argue that the global burden of mental illness is underestimated and examine the reasons for under-estimation to identify five main causes: overlap between psychiatric and neurological disorders; the grouping of suicide and self-harm as a separate category; conflation of all chronic pain syndromes with musculoskeletal disorders; exclusion of personality disorders from disease burden calculations; and inadequate consideration of the contribution of severe mental illness to mortality from associated causes. Using published data, we estimate the disease burden for mental illness to show that the global burden of mental illness accounts for 32·4% of ye...


Adolescent With Weight Loss and Abdominal Pain
This article briefly reviews the emergency department approach to the differential diagnosis of weight loss, pelvic pain, and adnexal masses in adolescent girls with a concise summary of the clinical manifestations and laboratory testing for human immunodeficiency virus among adolescents. (Source: Clinical Pediatric Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Percutaneous endoscopic cecostomy (introducer method) in chronic intestinal pseudo‐obstruction: Report of two cases and literature review
We report on two patients with recurrent episodes of chronic intestinal pseudo‐obstruction (CIPO). A 50‐year‐old woman with severe multiple sclerosis and an 84‐year‐old man with Parkinson's disease and dementia had multiple hospital admissions because of pain and distended abdomen. Radiographic and endoscopic findings showed massive dilation of the colon without any evidence of obstruction. Conservative management resolved symptoms only for a short period of time. As these patients were poor candidates for any surgical treatment we carried out percutaneous endoscopic colostomy by placing a 20‐Fr tube in the cecum with the introducer method. The procedure led to durable symptom relief without complications. We present these two cases and give a review through the existing litera...


Imaging-Guided Core-Needle Breast Biopsy: Impact of Meditation and Music Interventions on Patient Anxiety, Pain, and Fatigue
Conclusions Listening to guided meditation significantly lowered biopsy pain during imaging-guided breast biopsy; meditation and music reduced patient anxiety and fatigue without compromising radiologist–patient communication. These simple, inexpensive interventions could improve women’s experiences during core-needle breast biopsy. (Source: Journal of the American College of Radiology)


Case Study
This case illustrates the complexity and interrelationship of osseous pathology with peripheral nerve entrapment and neuromata. She had an iatrogenic nerve injury of a branch of the medial dorsal cutaneous nerve causing her painful scar. Secondarily, she developed an injury to her common peroneal nerve from the cast immobilization, resulting in palsy/drop foot. The tarsal tunnel entrapment was likely a sequela of the cast immobilization and chronic swelling. Her postoperative chronic pain was compounded by the failure to use grommets with the polymeric silicon (Silastic) implant at the initial surgery, leading to a breakdown of the implant with subsequent detritic synovitis. (Source: Clinics in Podiatric Medicine and Surgery)


Efficacy and Safety of DP-R202 in Patients with Chronic Artery Occlusive Disease: Multicenter Randomized Double-Blind Active-Controlled Parallel Group Phase III Clinical Study.
This study was a 12-week, multicenter, randomized, double-blinded, active-controlled, parallel group comparative Phase III clinical trial. One hundred fifty-one volunteer patients with PAD were randomized to receive DP-R202 300 mg once daily or Anplag Table 100 mg TID for 12 weeks. The primary end point was a change in patient assessment of lower leg pain intensity with the use of a visual analog scale (VAS) after 12 weeks of treatment. Results after 4, 8, and 12 weeks of treatment were compared with baseline and between treatment groups, and all patients were assessed for adverse events (AEs), clinical laboratory data, and vital signs. FINDINGS: Two hundred thirty-one patients from 25 medical centers were assessed, and 151 were enrolled and randomly assigned to 1 of 2 treatment groups...


From hospitalist to rapper: The story of ZDoggMD
You may have heard of ZDoggMD—the rapping doctor whose parody music videos on medical topics like electronic health records (EHR), re-admission and sepsis have acquired millions of views. But who is the physician behind the persona? Primary care physician Michael Rakotz, MD, director of chronic disease prevention with the AMA’s Improving Health Outcomes initiative, sat down with Zubin Damania, MD, to talk about burnout, discuss EHRs and find out how he came to be the Youtube rapping sensation ZDoggMD. The burnout story that started it all Dr. Rakotz: “When did you first realize that you were facing burnout?” Dr. Damania: “For me it was really a slow creep. I started my career in hospital medicine …. I had a wonderful hospital job with mentorship with interns, medical st...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Role of Transient Receptor Potential Channels in Paclitaxel- and Oxaliplatin-induced Peripheral Neuropathy.
Authors: Taguchi K Abstract   Peripheral neuropathy is a common adverse effect of paclitaxel and oxaliplatin treatment. The major dose-limiting side effect of these drugs is peripheral sensory neuropathy. The symptoms of paclitaxel-induced neuropathy are mostly sensory and peripheral in nature, consisting of mechanical allodynia/hyperalgesia, tingling, and numbness. Oxaliplatin-induced neurotoxicity manifests as rapid-onset neuropathic symptoms that are exacerbated by cold exposure and as chronic neuropathy that develops after several treatment cycles. Although many basic and clinical researchers have studied anticancer drug-induced peripheral neuropathy, the mechanism is not well understood. In this review, we focus on (1) analysis of transient receptor potential vanilloid 1 (TR...


[Conversion disorder in an internal medicine department: A series of 37 cases].
CONCLUSION: This case series confirms that the DSM-IV-TR criterion of "psychogenicity" (later abandoned in DSM-5) is highly problematic in clinical practice. It suggests a close relationship between conversion disorder and unexplained chronic pain. PMID: 26827119 [PubMed - as supplied by publisher] (Source: L Encephale)


Boston Scientific, Bard escape joint pelvic mesh trial
Boston Scientific (NYSE:BSX) and C.R. Bard (NYSE:BCR) yesterday won the 1st trial in a pelvic mesh lawsuit against 2 companies after a Kansas City jury voted 10-2 that their implants were not defective and didn&#8217;t cause plaintiff Eve Sherrer&#8217;s injuries. Sherrer alleged that Bard’s Align and Boston Scientific’s Solyx products used a polypropylene mesh that reacts to tissue by becoming brittle, and that the companies failed to warn patients about the products’ attendant risks, seeking $28 million in damages. Manufacturers of pelvic mesh products, designed to treat female urinary incontinence and pelvic organ prolapse, face some 70,000 lawsuits spanning 3 multi-district litigations. Only a few have made it to trial, with juries recording 17 wins for plaintiffs and 5 for t...


Managing medical comorbidities in patients with depression to improve prognosis.
Authors: Thase ME Abstract Medical comorbidities contribute to poor antidepressant response, treatment resistance, and poor outcomes in many patients with depression. Depression can co-occur with thyroid conditions, chronic pain conditions, central nervous system disorders, and more. Inflammatory conditions such as diabetes and obesity are also associated with depression, and the connection between inflammation and depression may lead to testing that could better match patients to specific antidepressant treatment. Interventions for patients with depression and a comorbid medical condition include careful selection of antidepressant therapy as well as psychotherapy and adjunctive agents. PMID: 26829434 [PubMed - in process] (Source: Journal of Clinical Psychiatry)


Health Tip: Prevent Heel Pain
Title: Health Tip: Prevent Heel PainCategory: Health NewsCreated: 2/3/2016 12:00:00 AMLast Editorial Review: 2/3/2016 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Outcomes and reflections on a consensus-building workshop for developing a spinal cord injury-related chronic pain research agenda.
Conclusions The consensus workshop provided an initial roadmap for research on SCI-related chronic pain, and supported five pilot projects on the identified priorities. Reflections on the current research landscape in Canada and abroad suggest increased activity towards addressing pain post-SCI but evidence-based approaches are still lacking. PMID: 26828394 [PubMed - as supplied by publisher] (Source: Journal of Spinal Cord Medicine)


Immediate and One Week Effects of Laterally Wedge Insoles on Gait Biomechanics in Healthy Females
Osteoarthritis is a disease associated with significant morbidity and is a leading cause of chronic pain and limited activity in the elderly population [1]. Approximately 12-16% of individuals above 65 years of age are diagnosed with knee osteoarthritis (KOA) [2], and it is estimated that approximately 45% of the U.S. population will develop KOA [3]. KOA also creates significant economic burdens in both direct healthcare costs and indirect costs [4,5]. Epidemiological data indicates a higher prevalence of radiographic KOA in women than in men [6]. (Source: Gait and Posture)


Deep Spine Infection After Acupuncture in the Setting of Spinal Instrumentation
Conclusions Acupuncture is sometimes pursued as part of a multimodality pain management program for back pain, but it is not without risk and can lead to infection. Deep infection from acupuncture may contaminate existing spinal instrumentation and require operative debridement, implant removal, and long-term antibiotic therapy. Accordingly, there is an increased risk for deformity progression in this scenario related to the implant removal. (Source: Spine Deformity)


The Relationship Among Neuromuscular Impairments, Chronic Back Pain, and Mobility in Older Adults
Conclusions The neuromuscular impairment profiles associated with mobility function among older adults with back pain vary compared with older adults without back pain. (Source: PMandR)


Investigation of the effect of traditional Chinese medicine on pain and inflammation in chronic nonbacterial prostatitis in rats
Summary According to traditional Chinese medicine, the symptoms of chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CNP/CPPS) may be treated using a cocktail of herbs that stimulate blood circulation (‘activating blood circulation formula’). We investigated the effect of three doses of this formula on a rat model of CNP/CPPS. Male Wistar rats were injected with a saline extract of male sex accessory glands on days 0 and 30 to induce prostatitis and then treated daily by gavage between days 32 and 60. Treatment with low, medium and high doses of activating blood circulation formula resulted in an almost total rescue of paw withdrawal threshold at day 60, and treatment with the highest dose also significantly decreased prostate inflammation (assessed histopathologically). W...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Frequency and characteristics of healthcare visits associated with chronic pain: results from a population-based Canadian study
Conclusion Interventions aimed at reducing healthcare costs for chronic pain should target individuals living with multiple chronic conditions. Research is needed to develop and test interventions that focus on the needs of these groups. Identifying the risk factors for high healthcare use and improving self-management may reduce healthcare visits. (Source: Canadian Journal of Anesthesia)


Duodenum-preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis.
CONCLUSIONS: Low quality evidence suggested that DPPHR may result in shorter hospital stay than PD. Based on low or very low quality evidence, there is currently no evidence of any difference in the mortality, adverse events, or quality of life between DPPHR and PD. However, the results were imprecise and further RCTs are required on this topic. Future RCTs comparing DPPHR with PD should report the severity as well as the incidence of postoperative complications and their impact on patient recovery. In such trials, participant and observer blinding should be performed and the analysis should be performed on an intention-to-treat basis to decrease the bias. In addition to the short-term benefits and harms such as mortality, surgery-related complications, quality of life, length of hospital ...


The Association Between Receipt of Guideline-Concordant Long-Term Opioid Therapy and All-Cause Mortality
Conclusions Providers should use caution in initiating LtOT in conjunction with benzodiazepines and untreated SUDs. Patients receiving LtOT may benefit from multi-modal treatment that addresses chronic pain and its associated comorbidities across multiple disciplines. (Source: Journal of General Internal Medicine)


Frequency and characteristics of healthcare visits associated with chronic pain: results from a population-based Canadian study.
CONCLUSION: Interventions aimed at reducing healthcare costs for chronic pain should target individuals living with multiple chronic conditions. Research is needed to develop and test interventions that focus on the needs of these groups. Identifying the risk factors for high healthcare use and improving self-management may reduce healthcare visits. PMID: 26846618 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)


Immediate and 1 week effects of laterally wedge insoles on gait biomechanics in healthy females
Osteoarthritis is a disease associated with significant morbidity and is a leading cause of chronic pain and limited activity in the elderly population [1]. Approximately 12–16% of individuals above 65 years of age are diagnosed with knee osteoarthritis (KOA) [2], and it is estimated that approximately 45% of the U.S. population will develop KOA [3]. KOA also creates significant economic burdens in both direct healthcare costs and indirect costs [4,5]. Epidemiological data indicate a higher prevalence of radiographic KOA in women than in men [6]. (Source: Gait and Posture)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Highlights from 2015
Your achievements A massive thank you to everyone who ran, hosted coffee mornings and bake sales, jumped out of planes and trekked across the country and indeed the world to fundraise for us. More than 1,300 of you took on a challenge or donated your time and fundraising skills in 2015. Together, you raised over &pound;780,000! If you&rsquo;d like to join Team A in 2016 and help raise money for our work, have a look at our events or contact localfundraising@arthritisresearchuk.org Improving care for people with arthritis In 2015 we continued to support healthcare professionals to provide the best care to people with arthritis. We reached over 3,500 GPs at conferences and through our core skills e-learning package. As a result, we estimate over 2.1 million musculoskeletal-related consult...


Genital Lichen Sclerosus in Male Patients: A New Treatment with Polydeoxyribonucleotide
Lichen sclerosus (LS) is an inflammatory and chronic disease that causes itching, pain, dysuria, urinary retention, dyspareunia and sexual dysfunction, in both men and women. The first line pharmacological treatment is based on the use of topical steroids, which have proved their efficacy in 60-70% of cases but with a high rate of relapses in time (50-80% of the patients of both sexes). The purpose of our non-randomised prospective pilot study was to evaluate the efficacy and tolerability of a new loco regional therapy with polydeoxyribonucleotides (PDRN) in the treatment of male genital LS. PDRN is an healing and anti-dystrophic drug with anti-inflammatory effects, through the reduction of cytokine. Twenty one male patients suffering from genital LS were recruited. All the patients were s...


Evaluation of endometriosis-associated pain and influence of conventional treatment: a systematic review
This study aimed to evaluate pain levels in women with endometriosis, focusing on the influence of conventional treatment in controlling this variable. To do so, a literature search was conducted in the Medline/Pubmed databases, with 119 scientific articles found. After applying the inclusion and exclusion criteria, 27 were selected for reading and elaboration of this review. Thus, 9 studies evaluated the contribution of surgery, 17 the use of drugs to reduce pain levels in patients with endometriosis and one assessed surgical and medical treatment. The main results of these searches are presented and discussed in this revision. Surgery and the use of drugs provided reduced pain scores in patients with endometriosis but nevertheless exhibit disadvantages, such as risk of recurrence and sid...


THE INTESTINAL MICROBIOTA AND THE ROLE OF PROBIOTICS IN IRRITABLE BOWEL SYNDROME: a review
Irritable bowel syndrome is a common, chronic relapsing gastrointestinal disorder that affects 7%-22% of the population worldwide. According to Rome III Criteria, the disorder is defined by the coexistence of abdominal discomfort or pain associated with an alteration in bowel habits. Its pathophysiology is not completely understood but, in addition to some important abnormalities, the disturbed intestinal microbiota has also been described supported by several strands of evidence. The treatment of irritable bowel syndrome is based upon several therapeutic approaches but few have been successful or without adverse events and more recently the gut microbiota and the use of probiotics have emerged as a factor to be considered. Probiotics are live micro-organisms which when consumed in adequat...


Painkillers Don't Ease Disability Due to Nerve Damage: Study
Title: Painkillers Don't Ease Disability Due to Nerve Damage: StudyCategory: Health NewsCreated: 2/1/2016 12:00:00 AMLast Editorial Review: 2/2/2016 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Preliminary Evaluation of the Values Tracker: A Two-Item Measure of Engagement in Valued Activities in Those With Chronic Pain
Engagement in valued activities is an important outcome, particularly in treatments that aim to enhance quality of life in those with chronic conditions. The present study describes the initial evaluation of the Values Tracker (VT), a two-item measure of values engagement, in 302 treatment-seeking adults with chronic pain. Hierarchical regression analyses were conducted to examine the utility of the VT in the statistical prediction of pain-related functioning, after controlling for demographic variables, pain intensity, and pain-related distress. Across analyses, pain intensity accounted for significant variance (range R2 = .06-.09) with pain-related distress adding additional unique variance (range R2 = .07-.19). The VT accounted for additional unique variance (range R2 = .02-.17) for all...


Myofascial Triggerpoint Release (MTR) for Treating Chronic Shoulder Pain: A New Approach
This study comprehensively evaluated a myofascial triggerpoint release (MTR) technique for shoulder pain. (Source: Journal of Bodywork and Movement Therapies)


Chronic Exertional Compartment Syndrome
Increased tissue pressure within a fascial compartment may be the result from any increase in volume within its contents, or any decrease in size of the fascial covering or its distensibility. This may lead to symptoms of leg tightness, pain or numbness brought about by exercise. There are multiple differential diagnoses of exercise induced leg pain and the proper diagnoses of chronic exertional compartment syndrome (CECS) is made by a careful history and by exclusion of other maladies and confirmed by compartment syndrome testing as detailed in this text. Surgical fasciotomies for the anterior, lateral, superficial and deep posterior compartments are described in detail along with ancillary procedures for chronic shin splints that should allow the athlete to return to competitive activity...


Effects of Apremilast on Pruritus and Skin Discomfort/Pain Correlate With Improvements in Quality of Life in Patients With Moderate to Severe Plaque Psoriasis.
Authors: Sobell JM, Foley P, Toth D, Mrowietz U, Girolomoni G, Goncalves J, Day RM, Chen R, Yosipovitch G Abstract Pruritus and skin discomfort/pain negatively impact health-related quality of life (HRQoL). The effects of apremilast, an oral phosphodiesterase inhibitor, on pruritus, skin discomfort/pain, and patient global assessment of psoriasis disease activity (PgAPDA) were assessed in moderate/severe chronic plaque psoriasis patients in the phase 3 ESTEEM trials. Significant improvements in pruritus and skin discomfort/pain observed at Week 2 with apremilast versus placebo (both studies, p &lt; 0.0001) were sustained through Week 32. Among apremilast-treated patients, improvements in pruritus visual analog scale (VAS) scores correlated with Dermatology Life Quality Index sc...


Gender Differences in Patients with Fibromyalgia Undergoing Cognitive‐Behavioral Therapy for Insomnia: Preliminary Data
ConclusionsDifferential responses to treatment between men and women were observed in some sleep‐ and pain‐related variables. Outcomes show the needed to design different treatments for men and women with FM is discussed. (Source: Pain Practice)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Peripheral nerve blocks in patients with Ehlers-Danlos syndrome, hypermobility type: a report of 2 cases
Ehlers-Danlos syndrome is an inherited disorder of collagen production that results in multiorgan dysfunction. Patients with hypermobility type display skin hyperextensibility and joint laxity, which can result in chronic joint instability, dislocation, peripheral neuropathy, and severe musculoskeletal pain. A bleeding diathesis can be found in all subtypes of varying severity despite a normal coagulation profile. There have also been reports of resistance to local anesthetics in these patients. (Source: Journal of Clinical Anesthesia)


Efficacy and safety of Myofascial-meridian Release Acupuncture (MMRA) for chronic neck pain: a study protocol for randomized, patient- and assessor-blinded, sham controlled trial
The purpose of this study is to evaluate the efficacy and safety of myofascial-meridian release acupuncture (MMRA) in the treatment of chronic neck pain compared with sham acupuncture. (Source: BMC Complementary and Alternative Medicine)


Positive effects of low level laser therapy (LLLT) on Bouchard's and Heberden's osteoarthritis.
CONCLUSIONS: LLLT is a safe, non-invasive, efficient and efficacious means to reduce pain and swelling and to increase joint mobility in patients suffering from Heberden's and Bourchard's OA. Further randomized controlled studies are needed to examine medium- to long-term effects as well as the ideal LLLT parameters. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc. PMID: 26833862 [PubMed - as supplied by publisher] (Source: Hand Surgery)


Correction: Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain.
Authors: PMID: 26829916 [PubMed - in process] (Source: Annals of Internal Medicine)


Evaluation of Pain, Dyspnea, and Goals of Care Among Adults With Cystic Fibrosis: A Comprehensive Palliative Care Survey.
CONCLUSION: Pain and dyspnea are common among adults with CF. Few had an advance directive in place, but most are open to discussing EOLC issues. Results of this single-center study may not represent the entire population, thus a multicenter investigation should be pursued. PMID: 26843535 [PubMed - as supplied by publisher] (Source: The American Journal of Hospice and Palliative Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Positive effects of low level laser therapy (LLLT) on Bouchard's and Heberden's osteoarthritis
ConclusionsLLLT is a safe, non‐invasive, efficient and efficacious means to reduce pain and swelling and to increase joint mobility in patients suffering from Heberden's and Bourchard's OA. Further randomized controlled studies are needed to examine medium‐ to long‐term effects as well as the ideal LLLT parameters. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc. (Source: Lasers in Surgery and Medicine)


Systemic inflammatory cytokine analysis to monitor biomaterial augmented tissue healing.
CONCLUSIONS: Analysis of systemic inflammation biomarkers confirmed inflammation elicited by surgeries and meshes irrespective of their composition. However, at an early postoperative endpoint (i.e., 1 week), some biomarkers, namely, IL-18 and RANTES, appeared to discriminate the noncomposite mesh from the composite materials, although in this study all materials successfully repaired the defects without recurrence or external indicators of postoperative chronic pain. PMID: 26847499 [PubMed - as supplied by publisher] (Source: The International Journal of Artificial Organs)


Myofascial triggerpoint release (MTR) for treating chronic shoulder pain: A novel approach
This study comprehensively evaluated a myofascial triggerpoint release (MTR) technique for shoulder pain. (Source: Journal of Bodywork and Movement Therapies)


Best Bet For Neck Pain?
I heard that the Alexander Technique and acupuncture are the best treatments for chronic neck pain. Can you tell me about these approaches? Which one would be best? (Source: Dr. Weil Q and A)


Medical News Today: Chronic pain may be linked to genetic changes in the immune system
Chronic pain following injury may involve epigenetic changes, implying a potential future role for medications that target specific genes. (Source: Health News from Medical News Today)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Drug Counselors’ Attitudes Toward Nonpharmacologic Treatments for Chronic Pain
Conclusions: Findings indicate that methadone drug counselors perceive several nonpharmacologic evidence-based pain treatments as efficacious for methadone-maintained patients with chronic pain and counselors would be willing to refer their patients to these therapies if they were available. If some of these nonpharmacologic interventions were shown to be effective in methadone maintenance treatment, they have the potential to address, at least in part, the routine undertreatment of pain in this vulnerable patient population. (Source: Journal of Addiction Medicine)


Perioperative Continuous Ropivacaine Wound Infusion in Laparoscopic Cholecystectomy: A Randomized Controlled Double-blind Trial
Wound infusion with local anesthetics has been used for postoperative pain relief with variable results. This randomized, controlled, double-blind clinical trial examines the effect of ropivacaine infusion on pain after laparoscopic cholecystectomy. A total of 110 patients were randomly assigned to 2 groups. After induction of anesthesia a 75-mm catheter was inserted subcutaneously and connected to an elastomeric pump containing either 0.75% ropivacaine (ropivacaine group) or normal saline (control group) for 24 hours postoperatively. Before skin closure, each hole was infiltrated with 2 mL of 0.75% ropivacaine or normal saline according to randomization. Pain at rest, pain during cough, and analgesic consumption were recorded in the postanesthesia care unit and at 2, 4, 8, 24, and 48 hour...


Why Do Niches Develop in Caesarean Uterine Scars? Hypotheses on the Aetiology of Niche Development
Obstet Gynecol Surv 2016;71(2):83–84 There has been a substantial increase over last few decades in rates of cesarean section (CS) worldwide. Increasing CS rates have heightened awareness of gynecological symptoms after a CS, such as postmenstrual spotting, dysmenorrhea, chronic pelvic pain, and dyspareunia. (Source: Obstetrical and Gynecological Survey)


A Survey of Innovative Reimbursement Models in Spine Care
Conclusion. Payment models outside of the traditional fee-for-service paradigm are emerging in spine care. Providers that preemptively adopt bundled payments can increase patient volumes from payers seeking cost-effective care. Going forward, organizations should begin considering reimbursement models that focus on noninterventional spine care. Finally, developments in spine reimbursement may apply to other procedure-based specialties, including orthopedics and cardiology. Level of Evidence: 5 (Source: Spine)


Cervical Intradural Disc Herniation Causing Progressive Quadriparesis After Spinal Manipulation Therapy: A Case Report and Literature Review
Abstract: Cervical intradural disc herniation (IDH) is an extremely rare condition, comprising only 0.27% of all disc herniations. Three percent of IDHs occur in the cervical, 5% in the thoracic, and over 92% in the lumbar spinal canal. There have been a total of 31 cervical IDHs reported in the literature. The pathogenesis and imaging characteristics of IDH are not fully understood. A preoperative diagnosis is key to facilitating prompt intradural exploration in patients with ambivalent findings, as well as in preventing reoperation. The purpose of reporting our case is to remind clinicians to consider the possibility of cervical IDH during spinal manipulation therapy in patient with chronic neck pain. The patient signed informed consent for publication of this case report and any accomp...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Bilateral Neuropathy of Primary Sensory Neurons by the Chronic Compression of Multiple Unilateral DRGs.
Authors: Xie YB, Zhao H, Wang Y, Song K, Zhang M, Meng FC, Yang YJ, He YS, Kuang F, You SW, You HJ, Xu H Abstract To mimic multilevel nerve root compression and intervertebral foramina stenosis in human, we established a new animal model of the chronic compression of unilateral multiple lumbar DRGs (mCCD) in the rat. A higher occurrence of signs of spontaneous pain behaviors, such as wet-dog shaking and spontaneous hind paw shrinking behaviors, was firstly observed from day 1 onward. In the meantime, the unilateral mCCD rat exhibited significant bilateral hind paw mechanical and cold allodynia and hyperalgesia, as well as a thermal preference to 30°C plate between 30 and 35°C. The expression of activating transcription factor 3 (ATF3) was significantly increased in the ipsilatera...


Adapting the ABCDEF Bundle to Meet the Needs of Patients Requiring Prolonged Mechanical Ventilation in the Long-Term Acute Care Hospital Setting: Historical Perspectives and Practical Implications.
This article is about such an extrapolation from the intensive care unit (ICU) to the long-term acute care hospital (LTACH) setting. Chronic critical illness is an emerging, disabling, costly, and yet relatively silent epidemic that is central to both of these settings. The number of chronically critically ill patients requiring prolonged mechanical ventilation is expected to reach unprecedented levels over the next decade. Despite the prevalence, numerous distressing symptoms, and exceptionally poor outcomes associated with chronic critical illness, to date there is very limited scientific evidence available to guide the care and management of this exceptionally vulnerable population, particularly in LTACHs. Recent studies conducted in the traditional ICU setting suggest interprofessional...


Oral ketamine for the treatment of pain and treatment-resistant depression [Review articles]
Conclusions Oral ketamine, given for longer time periods in the described doses, appears to be well tolerated, but few studies have systematically examined the longer-term negative consequences. The short- and longer-term depression outcomes as well as side-effects need to be studied with rigorous randomised controlled trials. (Source: The British Journal of Psychiatry)


Comparative effectiveness of conservative interventions for non-specific chronic spinal pain: Physical, behavioural/psychologically informed or combined? A systematic review and meta-analysis
Non-specific chronic spinal pain (NSCSP) is highly disabling. Current conservative rehabilitation commonly includes physical and behavioural interventions, or a combination of these approaches. Physical interventions aim to enhance physical capacity by using methods such as exercise, manual therapy and ergonomics. Behavioural and/or psychologically informed interventions aim to enhance behaviours, cognitions or mood by using methods such as relaxation and cognitive behavioural therapy (CBT). Combined interventions aim to target both physical and behavioural and/or psychological factors contributing to patients’ pain by using methods such as multidisciplinary pain management programmes. (Source: The Journal of Pain)


Increasing Neuroplasticity to Bolster Chronic Pain Treatment: A Role for Intermittent Fasting and Glucose Administration?
Neuroplastic changes in brain structure and function are not only a consequence of chronic pain but are involved in the maintenance of pain symptoms. Thus, promotion of adaptive, treatment-responsive neuroplasticity represents a promising clinical target. Emerging evidence about the human brain's response to an array of behavioral and environmental interventions may assist in identifying targets to facilitate increased neurobiological receptivity, promoting healthy neuroplastic changes. Specifically, strategies to maximize neuroplastic responsiveness to chronic pain treatment could enhance treatment gains by optimization of learning and positive central nervous system adaptation. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa
Abstract Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is likely due to the lack of evidence based treatment guidelines. The purpose of this study was to promote a holistic evidence-based approach which implemented Level of Evidence and Strength of Recommendation for the treatment of HS. Based upon the European Dermatology Forumguidelines for the management of HS, evidence-based approach was explored for the treatment of HS. The diagnosis of HS should be made by a dermatologist or other healthcare professional with expert knowledge in HS. All patie...


Clinical presentations, risk factors, treatment and outcomes in patients with splanchnic vein thrombosis: a single-center experience
Abstract Splanchnic vein thrombosis (SVT) is an uncommon form of venous thrombosis. Management can be challenging due to underlying conditions, increased bleeding risk, and lack of evidence from clinical trials. We sought to characterize the presentation and management of patients with SVT at a large tertiary hospital. A total of 43 patients’ electronic medical records were reviewed. Median age at diagnosis was 43 (18–71). Sixteen patients had isolated portal vein thrombosis (37.2 %), and 16 (37.2 %) had thrombosis involving multiple splanchnic veins. Abdominal pain was the most common clinical presentation (67.4 %). Thrombophilia was present in 18 patients (41.9 %), nine had underlying liver disease (20.9 %) and seven had inflammatory bowel disease (16.3 %). Thirty-nine...


Frequency of dressing changes for central venous access devices on catheter-related infections.
CONCLUSIONS: The best available evidence is currently inconclusive regarding whether longer intervals between CVAD dressing changes are associated with more or less catheter-related infection, mortality or pain than shorter intervals. PMID: 26827714 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Local anesthetic injections with or without steroid for chronic non-cancer pain: a protocol for a systematic review and meta-analysis of randomized controlled trials
Discussion Our review will evaluate both the effectiveness and the adverse events associated with steroid plus LA vs. LA alone for CNCP, evaluate the quality of the evidence using the GRADE approach, and prioritize patient-important outcomes guided by IMMPACT recommendations. Our results will facilitate evidence-based management of patients with chronic non-cancer pain and identify key areas for future research. Trial registration PROSPERO CRD42015020614 (Source: Systematic Reviews)


Fear-Avoidance Beliefs and Chronic Pain.
Authors: Gatchel RJ, Neblett R, Kishino N, Ray CT Abstract Fear-avoidance (FA) beliefs are significantly associated with the experience of pain, especially when the pain becomes chronic in nature. The anticipated threat of intense pain will often result in the constant vigilance and monitoring of pain sensations, which, in turn, can cause even low-intensity sensations of pain to become unbearable for the person. Just the anticipation of increased pain or reinjury can further stimulate avoidance behaviors. A vicious cycle may develop, in which fears of increased pain or reinjury contribute to the avoidance of many activities, leading to inactivity and, ultimately, to greater disability. Anyone who assesses and treats pain-related disability should also be prepared to assess and trea...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Military service and other socioecological factors influencing weight and health behavior change in overweight and obese Veterans: a qualitative study to inform intervention development within primary care at the United States Veterans Health Administration
Conclusions Unique factors influence weight management in Veterans. Findings will inform development of a technology-assisted weight management intervention with tailored counseling and goal-setting within primary care at the VHA. (Source: BMC Obesity)


[Efficacy, tolerability and safety of cannabinoids for chronic neuropathic pain : A systematic review of randomized controlled studies].
CONCLUSION: Cannabinoids were marginally superior to placebo in terms of efficacy and inferior in terms of tolerability. Cannabinoids and placebo did not differ in terms of safety during the study period. Short-term and intermediate-term therapy with cannabinoids can be considered in selected patients with chronic neuropathic pain after failure of first-line and second-line therapies. PMID: 26830780 [PubMed - as supplied by publisher] (Source: Schmerz)


Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa.
Authors: Gulliver W, Zouboulis CC, Prens E, Jemec GB, Tzellos T Abstract Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is likely due to the lack of evidence based treatment guidelines. The purpose of this study was to promote a holistic evidence-based approach which implemented Level of Evidence and Strength of Recommendation for the treatment of HS. Based upon the European Dermatology Forumguidelines for the management of HS, evidence-based approach was explored for the treatment of HS. The diagnosis of HS should be made by a dermatologist or other...


Prevalence and burden of osteoarthritis amongst older people in Ireland: findings from The Irish LongituDinal Study on Ageing (TILDA)
Conclusions: OA is a common and multifaceted condition, with comparable prevalence of self-reported OA in Ireland with similar populations. Assessment and management should focus on potentially modifiable factors such as BMI, pain, physical limitations, polypharmacy and fear of falling. More research is required to understand the complex inter-relationships between these and other risk-associated variables. (Source: The European Journal of Public Health)


Direct and Indirect Costs of Chronic and Episodic Migraine in the United States: A Web‐Based Survey
ConclusionThe results of this study build on previous results of the AMPP Study, demonstrating that headache‐related direct, indirect, and total costs are significantly greater among individuals with chronic migraine than with episodic migraine in the United States. (Source: Headache: The Journal of Head and Face Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Right fronto-insular white matter tracts link cognitive reserve and pain in migraine patients
Conclusions Long-term chronic migraine patients show abnormalities in anterior white matter tracts, particularly of the right hemisphere, involved in pain modulation emotion, cognition and resilience. Robustness in these areas is associated with a higher cognitive reserve, which in turn might result in a lower tendency to migraine chronification. (Source: The Journal of Headache and Pain)


Advanced Innovations for Pain
Chronic pain represents one of the most important public health problems in terms of both the number of patients afflicted and health care costs. Most patients with chronic pain are treated with medications as the mainstay of therapy, and yet most medically treated patients continue to report ongoing pain. Additionally, adverse effects from pain medications represent a major challenge for clinicians and patients. Spinal cord stimulation and intrathecal drug delivery systems are well-established techniques that have been utilized for over 25 years. (Source: Mayo Clinic Proceedings)


Evaluation of Quality of Life, Functioning, Disability, and Work/School Productivity Following Treatment with an Extended‐Release Hydrocodone Tablet Formulated with Abuse‐Deterrence Technology: A 12‐month Open‐label Study in Patients with Chronic Pain
ConclusionsPatients receiving hydrocodone ER showed early numeric improvements in functioning that continued throughout this 12‐month study. (Source: Pain Practice)


"We're all in this together": A qualitative study of predominantly low income minority participants in a yoga trial for chronic low back pain.
CONCLUSIONS: Yoga is a multidimensional treatment for low back pain that has the potential to favorably impact health in a predominantly low-income minority population. PMID: 26860799 [PubMed - in process] (Source: Complementary Therapies in Medicine)


Altered function of intracortical networks in chronic lateral epicondylalgia
ConclusionsThese data provide evidence of less intracortical inhibition mediated by both GABAA and GABAB receptors, and less intracortical facilitation in the M1 contralateral to the affected ECRB in individuals with LE compared with healthy controls. Similar changes were not present in the M1 contralateral to the unaffected ECRB. These changes may provide the substrate for M1 reorganization in chronic LE and could provide a target for future therapy. What does this study addLateral epicondylalgia (LE) is a common musculoskeletal condition characterized by elbow pain and sensorimotor dysfunction. The excitability and organization of the motor cortical representation of the wrist extensor muscles is altered in LE, but the mechanisms that underpin these changes are unknown. evidence of less ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


NPY Y1 receptor signaling masks spinal pain transmission by inhibiting adenylyl cyclase 1, TRPA1, and TRPV1
Endogenous spinal NPY exerts tonic and long-lasting inhibitory control of nociceptive transmission, impeding the transition from acuteto chronic pain. For example, when the pain associated with inflammation or nerve injury was allowed to resolve for several weeks, intrathecal administration of the NPY Y1 receptor (Y1R) antagonist BIBO3304 reinstated pain (“BIBO-induced pain reinstatement”) in a dose-dependent manner. These data indicate that Y1R signaling is part of an endogenous braking mechanism that masks alasting sensitization of pain transmission neurons in the dorsal horn of the spinal cord. (Source: Neuropeptides)


Inguinal Hernia Repair Using Self-adhering Sutureless Mesh: Adhesix™: A 3-Year Follow-up with Low Chronic Pain and Recurrence Rate.
In conclusion, the use of the self-adhering sutureless mesh for inguinal hernia repair has been proving itself as effective as the traditional mesh. Adhesix™ is associated with low chronic pain rate, recurrence rate, and postoperative complications rate, and can be safely adopted as the sole technique for inguinal hernia repair. PMID: 26874131 [PubMed - in process] (Source: The American Surgeon)


A new kind of spatial inattention associated with chronic limb pain?
This article is protected by copyright. All rights reserved. (Source: Annals of Neurology)


Recurrent Pediatric Perianal Swelling.
Authors: Cordova J, Chugh A, Rivera Rivera ED, Young S Abstract Pediatric inflammatory bowel disease is a chronic gastrointestinal disease consisting of Crohn's disease (CD) and ulcerative colitis (UC). Both disease processes can share similar clinical symptoms including abdominal pain, diarrhea, hematochezia, and weight loss; CD can also be complicated by penetrating and fistulizing disease. Perianal skin tags, perianal abscesses, recto-cutaneous fistulae, and rectal stenosis are among the phenotypic characteristics of perianal CD. Current treatment strategies are focused on the surgical drainage of abscesses and the closure of fistulous tracts as well as controlling intestinal inflammation with the use of immunomodulators (6-mercaptopurine and methotrexate) and biologics (inflixi...


The Role of Health Locus of Control in Evaluating Depression and Other Comorbidities in Patients with Chronic Pain Conditions, A Cross‐Sectional Study
ConclusionsThe study shows that patients with an internal locus of control are less depressed compared to patients with fatalistic views on their health/pain in the chance group. The chance dimension of the Multidimensional Health Locus of Control scale was found to be a potential predictor of psychiatric comorbidities such as depression in the chronic pain patient population. (Source: Pain Practice)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Anti‐angiogenic therapy (bevacizumab) in the management of oral lichen planus
Oral lichen planus (OLP), a mucocutaneous chronic inflammatory disease, is conventionally managed using topical corticosteroid therapy. Given the fact that OLP is strongly linked to angiogenesis, anti‐angiogenic drugs, such as bevacizumab, might be introduced as an alternative treatment for contraindicated, non‐responsive patients. The aim of the present study was to report the short‐term effectiveness and safety of intralesional bevacizumab injection in the management of atrophic/erosive OLP. A case series study was conducted in patients with atrophic/erosive OLP in the buccal mucosa, assigned to receive either 2.5 mg of bevacizumab, by intralesional injection (n = 20, test), or topical 0.1% triamcinolone acetonide ointment (n = 20, control). The size, score, and pain intensity...


Analgesic Adherence in Recently Discharged Trauma Patients: An Integrative Literature Review
Trauma is defined as injuries to tissue and organs resulting from mechanical, thermal, chemical, or electrical mechanisms. There is evidence to suggest that patients admitted to hospital for their injuries do not adhere to prescribed analgesic regimens once discharged; however, the causes and potential solutions of this have not been fully explored. Patients who have inadequate pain relief also experience delayed return to work, psychological stress, disability, and chronic pain. Objectives: To identify causes of and solutions to analgesic regimen nonadherence in recently discharged trauma patients. (Source: Pain Management Nursing)


Editorial comment to The efficacy of acupuncture in managing patients with chronic prostatitis/chronic pelvic pain syndrome: A systemic review and meta‐analysis
(Source: Neurourology and Urodynamics)


Non‐HIV‐associated Kaposi sarcoma in an immunosuppressed melanoma patient treated with dabrafenib
Summary What is known and objectiveCutaneous toxicities are commonly seen with BRAF inhibitors, frequently involving painful hyperkeratosis of the feet. We illustrate an unexpected diagnosis of extensive bilateral pedal Kaposi sarcoma masquerading as BRAF inhibitor‐related toxicity in a patient treated with dabrafenib for metastatic melanoma. Case SummaryA HIV‐negative, non‐diabetic, Italian man with a history of myasthenia gravis and metastatic melanoma presented with enlarging macular/plaque‐like rash on his feet preceded by bilateral plantar shooting pains. The rash progressed in the context of acute‐on‐chronic immunosuppression and was initially thought due to commencement of the BRAF inhibitor (BRAFi) dabrafenib. Histopathological findings from skin biopsies revealed Kapos...


Longer Delay From Chronic Pain to Spinal Cord Stimulation Results in Higher Healthcare Resource Utilization
ConclusionsHCRU increased in the year following SCS implantation with longer pain‐to‐SCS time. These results suggest that considering SCS earlier in the care continuum for chronic pain may improve patient outcomes, with reductions in hospitalizations, clinic visits, and opioid usage. (Source: Neuromodulation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Hemicrania continua may respond to repetitive sphenopalatine ganglion block: A case report
ConclusionSPG block using a local anesthetic may be an effective treatment for patients with HC, specifically for those who cannot tolerate indomethacin, or when this drug is contraindicated. (Source: Headache: The Journal of Head and Face Pain)


The Use of Antiepileptics in Migraine Prophylaxis
ConclusionsAvailable AEDs to prophylactically treat migraine are few but of robust clinical efficacy. Special care needs to be exerted with respect to their side effects. Future research is needed for a better understanding of their mechanisms of action in migraine. Such research has the potential of providing some insight into the pathophysiology of migraine. (Source: Headache: The Journal of Head and Face Pain)


Azacitidine‐Induced Pericarditis: A Case Series
This article is protected by copyright. All rights reserved. (Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy)


Traumatic Exposure History as a Risk Factor for Chronic Pain in Adult Patients with Sickle Cell Disease.
This article describes the impact of the integration of a licensed clinical social worker (LCSW) with expertise in behavioral health on identification of risk factors for chronic pain in a cohort of adults with sickle cell disease. Authors conducted a retrospective chart review of all visits to the adult sickle cell center during the first six months of LCSW integration. Demographics, clinical history, and LCSW notes were reviewed. Overall, 71 patients were introduced to the LCSW; 55 percent of them had chronic pain. Patients with chronic pain were older, used opioids daily, took hydroxyurea, reported higher daily pain scores, and underwent more acute care visits and hospitalizations for pain with longer stays. Fifty-eight (81 percent) patients requested concrete social work services such ...


Importance of Pharmacological Evaluation in the Treatment of Poststroke Pain by Spinal Cord Stimulation
ConclusionWe speculate that the pharmacological evaluation of CPSP patients can be a useful tool for selecting candidates for SCS. (Source: Neuromodulation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Comparative Effectiveness of Conservative Interventions for Nonspecific Chronic Spinal Pain: Physical, Behavioral/Psychologically Informed, or Combined? A Systematic Review and Meta-Analysis
Nonspecific chronic spinal pain (NSCSP) is highly disabling. Current conservative rehabilitation commonly includes physical and behavioral interventions, or a combination of these approaches. Physical interventions aim to enhance physical capacity by using methods such as exercise, manual therapy, and ergonomics. Behavioral/psychologically informed interventions aim to enhance behaviors, cognitions, or mood by using methods such as relaxation and cognitive behavioral therapy. Combined interventions aim to target physical and also behavioral/psychological factors contributing to patients' pain by using methods such as multidisciplinary pain management programs. (Source: The Journal of Pain)


Effects of Saffron (Crocus sativus L.) Stigma Extract and its ActiveConstituent Crocin on ...
This study was designed to investigate the therapeutic effects of saffron (Crocus Sativus L) and its main constituent crocin on neuropathic pain behavioral responses induced by chronic constriction injury (CCI) in rats. Adult male Wistar rats (200 to 250 g) were randomly assigned into 5 groups: Sham + saline, CCI + saline, CCI+ saffron (30 mg/kg), CCI +crocin (15 mg/kg) and CCI + crocin (30 mg/kg). CCI was induced by applying 4 loose ligatures around the sciatic nerve. Two weeks after nerve lesion, injections of saline, saffron or crocin were started and continued until 26th day post-surgery. Pain behavioral responses including mechanical allodynia (von Frey filament testing) and thermal hyperalgesia were measured in 14, 17, 20, 23, 26, and 40th days after CCI. CCI significantly increased ...


Reports of perceptual distortion of the face are common in patients with different types of chronic oro‐facial pain
This study demonstrates that many chronic oro‐facial pain patients may experience perceptual distortions. Future studies may clarify the mechanisms underlying perceptual distortions, which may point towards new complementary strategies for the management of chronic oro‐facial pain. (Source: Journal of Oral Rehabilitation)


Up-regulation of immunomodulatory effects of mouse bone-marrow derived mesenchymal stem cells by tetrahydrocannabinol pre-treatment involving cannabinoid receptor CB2.
Authors: Xie J, Xiao D, Xu Y, Zhao J, Jiang L, Hu X, Zhang Y, Yu L Abstract Chronic pain is commonly and closely correlated with inflammation. Both cannabinoid signaling and mesenchymal stem cells (MSCs) have been demonstrated to reduce inflammatory pain. Although cannabinoid signaling is essential for mesenchymal stem cell survival and differentiation, little is known about its role in modulatory effect of MSCs on inflammation and pain sensitivity. Here we showed that mouse bone-marrow derived MSCs (BM-MSCs) expressed both cannabinoid receptor type 1 and 2 (CB1 and CB2). CB2 expression level in BM-MSCs increased with their maturation. In addition, we found that tetrahydrocannabinol (THC) activated CB2 receptor and ERK signaling, consequently enhancing the modulation of MSCs on inf...


Psychopharmacology of Chronic Pain: A Focus on Antidepressants and Atypical Antipsychotics.
Authors: Khouzam HR Abstract Chronic pain is considered one of the most prevalent causes of costly and disabling medical conditions. This review will define chronic pain and its categories and then will summarize the effectiveness and side effects associated with the use of various antidepressants, including the tricyclics, the selective serotonin reuptake inhibitors, the serotonin norepinephrine reuptake inhibitors, other miscellaneous antidepressants and the atypical antipsychotics in the treatment of chronic pain. PMID: 26821680 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Back pain, tendons, Tiger Woods: all grist for the mill for sports medicine clinicians
Sports Doctors Australia is proud to be in its fourth year as one of BJSM's 23 member societies. This issue will touch a chord&mdash;pleasant or unpleasant&mdash;with most primary care practitioners. Clinicians are well aware of the inability to change the course of chronic low back pain in many people. When yet another patient comes in with persisting back pain, it may trigger a heart-sinking response or be seen as a challenge. Back pain&mdash;are we making progress? For a long time, we clinicians have tried to attack this problem through the reductionist model, believing that the more we understand about the cause of the pain, the more likely we were to improve the outcomes. J&oslash;rgen Jevne (see page 198) editorialises where we have gone wrong in our approach to finding a structural ...


Multidisciplinary biopsychosocial rehabilitation for chronic low back pain (PEDro synthesis)
This section features a recent systematic review that is indexed on PEDro, the Physiotherapy Evidence Database (http://www.pedro.org.au). PEDro is a free, web-based database of evidence relevant to physiotherapy. &nbsp;Kamper SJ, Apeldoorsn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ 2015;350:h444. Background Low back pain (LBP) is a highly prevalent health condition, being the leading cause of years lived with disability, around the world.1 2 It is not unusual for people with chronic LBP (symptoms persisting for more than 3&nbsp;months)3 to experience signs of anxiety and depression, with effects on social, recreational and work life.4 Recognition of these potential psychosocial facto...


[Myelopathy secondary to an aneurysmal bone cyst of thoracic spine].
CONCLUSION: Despite their low incidence, aneurysmal bone cysts of the spine must be taken into account in the differential diagnosis of spinal bone tumours as a possible cause of subacute or chronic compressive myelopathy. Full surgical removal of the tumour is considered the preferred treatment, which is often curative and is associated with a good prognosis of the patient in the long term. PMID: 26815849 [PubMed - in process] (Source: Revista de Neurologia)


Management of patients with issues related to opioid safety, efficacy and/or misuse: a case series from an integrated, interdisciplinary clinic.
CONCLUSIONS: The core components of our approach-biopsychosocial assessment and multimodal treatment planning with an emphasis on promoting functional goals and safety using clear communication and a patient-centered stance-should guide providers in the management of similar clinical scenarios. More evidence is needed to definitively guide specific interventions and points of clinical equipoise. PMID: 26818474 [PubMed - in process] (Source: Addiction Science and Clinical Practice)


Dental Hygienist-Led Chronic Disease Management System to Control Early Childhood Caries
Conclusions ECC disease control requires meaningful engagement of patients and parents by the oral health care team in order to assist them with making behavioral changes in the unique context of their families and communities. The traditional dentist/hygienist/assistant model needs to evolve to a collaborative partnership between care providers and patients/families. This partnership will be focused on systematic risk assessment and behaviorally-based management of the disease itself, with sensitivity toward the familial environment. Early pilot study results demonstrate reductions in rates of new caries, dental pain and referral to the operating room compared to baseline rates. Dental hygienists are the appropriate team members to lead this approach due to their expertise in behavior cha...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Management of acute pain
Publication date: Available online 30 January 2016 Source:Surgery (Oxford) Author(s): Kiran K. Koneti, Martin Jones Acute pain is an important fear for most patients and influences their recovery and overall experience. Poorly treated, it could lead to undesirable effects and patient dissatisfaction. Hence, it is important to understand, assess and treat acute pain effectively. Pain is regarded as the fifth vital sign and should be addressed as important as other vital parameters. Management of pain involves team work, including acute pain services, especially in dealing with complex problems. Management of pain ideally starts at the pre-assessment visit or from first presentation to the clinician. It is important to anticipate and treat acute pain effectively, which may prevent the de...


Effect of spinal monoaminergic neuronal system dysfunction on pain threshold in rats, and the analgesic effect of serotonin and norepinephrine reuptake inhibitors
Publication date: 26 February 2016 Source:Neuroscience Letters, Volume 615 Author(s): Ryuta Tamano, Mitsuhiro Ishida, Toshiyuki Asaki, Minoru Hasegawa, Shunji Shinohara Dysfunction in the central serotonin (5-HT) and norepinephrine (NE) systems cause depression and pain. Descending spinal pain modulatory pathways are important in the analgesic mechanisms of antidepressants, particularly serotonin and norepinephrine reuptake inhibitors (SNRIs). While many non-clinical studies have demonstrated the roles of central monoaminergic systems in pain, there is little evidence to illuminate the direct contribution of spinal descending pain modulatory systems independently of depressive-like behavior. To examine the effects of dysfunction of spinal monoaminergic systems on pain sensitivity, w...


Infection in Venous Leg Ulcers: Considerations for Optimal Management in the Elderly
Abstract Venous leg ulcers are the most common cause of chronic leg wounds, accounting for up to 70 % of all chronic leg ulcers and carrying with them a significant morbidity, especially for elderly patients. Among people aged 65 years and older, the annual prevalence is 1.7 %. Billions of dollars per year are spent caring for patients with these often difficult-to-heal and sometimes recurrent chronic wounds. Chronic non-healing wounds of the lower extremities are susceptible to microbial invasion and can lead to serious complications, such as delayed healing, cellulitis, enlargement of wound size, debilitating pain, and deeper wound infections causing systemic illness. Recognition and treatment of the infected venous leg ulcer is an essential skill set for any physician caring...


Prescription drug coverage and chronic pain
In this study, I examine whether increased access to prescription drugs due to the introduction of the Medicare Part D program in 2006 led to better management of pain among the elderly. While prior work has identified increases in the utilization of analgesics due to the introduction of Medicare Part D, the extent to which this increase in drug use actually improved the well-being of older adults is not known. Using data from the Health and Retirement Study, I employ a difference-in-differences strategy that compares pre versus post 2006 changes in pain related outcomes between Medicare eligible persons and a younger ineligible group. I find that Medicare Part D significantly reduced pain related activity limitations among a sample of older adults who report being troubled by pain. (Sourc...


Predominant role of spinal P2Y1 receptors in the development of neuropathic pain in rats.
In this study we assessed the role of P2Y1 receptors in several neuropathic pain models in the rat. Furthermore, we analyzed the expression of P2Y1 receptors in the ipsilateral dorsal root ganglia (DRG) and dorsal part of the spinal cord during the development and maintenance of neuropathic pain. We also determined the effect of the P2Y1 receptor antagonist on the expression of P2Y1 receptors. Chronic constriction injury (CCI), spared nerve injury (SNI) or spinal nerve ligation (SNL) produced tactile allodynia from 1 to 14 days after nerve injury. CCI, SNI and SNL enhanced expression of P2Y1 receptors in DRG but not in the dorsal part of the spinal cord at 1-3 days after injury. Intrathecal injection of the selective P2Y1 receptor antagonist MRS2500, but not vehicle, reduced tactile allody...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic Pain in the Ambulatory Palliative Care Setting: A Distinct Entity from Acute Pain? (S744)
Acute pain is common in ambulatory palliative care (APC), and includes pain related to progression of serious illness and at the end of life. Chronic pain is pain lasting > 3 months, beyond the period of normal tissue healing. It has a unique pathophysiology, and I negatively impacts health outcomes. Acute pain management typically involves opioids; treatment of chronic pain often limits opioids and focuses on physical therapy, treatment of comorbid mood disorders, and pain self-management/coping. (Source: Journal of Pain and Symptom Management)


Personal Growth, Symptom Burden and Uncertainty in Heart Failure (S725)
Heart failure (HF) is a chronic disease associated with unpredictable trajectories, significant symptom burden, and diminished quality of life (QOL). National guidelines recommend that palliative care (PC) be considered in early stages of life-limiting chronic illnesses, such as HF. Personal growth (PG), which is the ability to perceive positive psychosocial outcomes through significant adversity, is now being examined in addition to QOL in people with serious illnesses, but it has been little studied in HF. (Source: Journal of Pain and Symptom Management)


Measurement of Pain and Health-Related Quality of Life Measures in Adult Males with Hemophilia: Initial Observations of Disease Impact (S724)
Hemophilia is a rare genetic bleeding disorder characterized by acute, painful bleeds as well as chronic arthropathy. No standardized recommendations exist to measure pain and its subsequent impact on health-related quality of life (HRQoL) measures in adult patients with hemophilia (PWH). (Source: Journal of Pain and Symptom Management)


Naloxegol for Treating Opioid-Induced Constipation n Patients with Non-Cancer Pain (S710)
Opioid-induced constipation (OIC) affects 40%–80% of patients receiving opioids to manage chronic non-cancer pain, which can negatively impact quality of life and effective pain management. OIC results when opioid agonist effects at mu-opioid receptors in the enteric nervous system reduce gastrointestinal (GI) transit and secretions. Over-the-counter laxatives are often ineffective. Naloxegol is an approved, orally administered, peripherally acting mu-opioid receptor antagonist (PAMORA) that specifically targets the mechanism of OIC. (Source: Journal of Pain and Symptom Management)


Antithrombotic Therapy upon Discharge to Hospice Care (S763)
Patients transitioning to hospice care face difficult decisions regarding continuation of chronic medications. (Source: Journal of Pain and Symptom Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Artists' Perspectives on Encounters with Palliative Inpatients, a Qualitative Study (S758)
In January, 2015, our Palliative Medicine Program teamed up with our cancer center’s Arts and Humanities Program to send artists to perform for palliative inpatients at bedside. Current literature supports the positive impact of music and art on patients with chronic illnesses. However, the encounter between artist and patient is not just one-directional; it is a rich interaction where both individuals are affected. After each encounter with our palliative patients, artists wrote down their thoughts to encourage self-reflection and self-care. (Source: Journal of Pain and Symptom Management)


Considering Care: A Descriptive Study of Moral Distress (S747)
Moral distress involves stressful situations in which moral values are challenged. As patient acuity rises, staff will likely face more situations presenting ethical dilemmas that may result in moral distress. Our academic medical center serves a multicultural community that includes a large population of a minority, faith-based group, which influences decisions to utilize life-sustaining therapy (LST). Patients on the respiratory care unit (RCU) have a mean age of 82, have chronic ventilator-dependent respiratory failure, and often utilize additional LST (tube feeding, dialysis, vasopressors). (Source: Journal of Pain and Symptom Management)


Palliative Wound Care (P12)
The concept of palliation for chronic wounds is a relatively new concept within the past ten years. Palliation recognizes and accepts nonhealing endpoints as appropriate care and uses nonhealing strategies to comfort patients and improve quality of life. There is no formal education on palliative wound care at this time, other than scattered individual lectures at various wound care symposiums and the annual palliative wound conference held for the past four years. There are many hospice caregivers who desire more information on specific treatments available and on approaches to management of chronic wounds in terminally ill patient. (Source: Journal of Pain and Symptom Management)


Smooth Sailing in Advanced Illness Transitions of Care: Optimizing Medication Management from Palliative Care to Hospice Care (P05)
Medications play a very large role in the management of chronic illnesses in advanced illness. The purpose of this all-day preconference is to wrestle with optimizing medication management in the most common advanced illnesses at the end of life including metabolic syndrome, heart failure, COPD, dementia, ALS and other disease states. Particular attention will be paid to medication-related issues in transitions of care between palliative care and hospice care, including medication and dosage formulation selection, therapeutic goal setting, monitoring and dosage titration aimed at optimizing symptom control. (Source: Journal of Pain and Symptom Management)


Intervention to Integrate Palliative Care into Transitional Care for Older Adults: Potential Challenges Identified by Clinicians (S798)
Poorly managed symptoms and lack of advance care planning (ACP) for older adults with chronic conditions may lead to unwanted hospital readmissions and eventual death in the hospital. Integration of palliative care into post-hospitalization primary care is a promising strategy to improve care for this population. (Source: Journal of Pain and Symptom Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Yes, I Can Live with Less Pain: A Pain Educational Intervention Improving Patient-Centered Care and Attitudes Among Older Adults (S784)
Uncontrolled chronic pain is very common among older adults (OA). Pain is a complex symptom with subjective measurements that is also difficult to manage due to social stigma related to treatment. (Source: Journal of Pain and Symptom Management)


Setting the Agenda: What do Academic Hospitalists Want to Learn from Their Palliative Care Colleagues? (TH310B)
Hospitalists are on the front lines of providing care for the increasing numbers of patients with chronic serious illnesses. Given the high clinical volume and intensity of hospitalist practice, it is important to optimize educational interventions to create the most “high-yield” experiences. A survey investigation was intended to explore educational perceived needs in primary palliative care among academic hospitalists. (Source: Journal of Pain and Symptom Management)


In-Hospital Mortality Among California’s Jail and Prison Inmates: The Need for Improved Data on the Causes of Death (TH360A)
California incarcerates nearly 10% of U.S. prisoners. While prisoners experience poor health and early mortality, little is known about the chronic conditions or causes of death of prisoners who die in our community hospitals. (Source: Journal of Pain and Symptom Management)


A Culturally Responsive Approach to Advance Care Planning: A New Communication Framework Tool to Reduce Racial Disparities in End-of-Life Care (TH358)
Our country’s population is growing older, becoming more diverse, and surviving longer with chronic conditions. Healthcare professionals must develop skills to provide culturally sensitive care while practicing in an already overburdened healthcare system. Advance care planning is the process of establishing patient and family-centered goals of care in the event of life-threatening illness, and these sensitive conversations are integral to providing quality end-of-life care. Newer models have demonstrated that through efficient and early advance care planning we can achieve the IHI Triple Aim of improved healthcare quality, improved patient satisfaction, and reduced end-of-life cost within a patient-centered model of care. (Source: Journal of Pain and Symptom Management)


Outpatient Pediatric Palliative Medicine: Complex Lives, Comprehensive Services (FR440D)
Pediatric palliative services nationwide enroll children with life-limiting, but not acutely life threatening chronic illness. Children receiving inpatient palliative services, the most prevalent service delivery model, have a survival rate of nearly 75% at one year. In response to the long survival rate of pediatric palliative care patients and the need for outpatient palliative services, University Health System (UHS) developed a medical home clinic that provides integrated palliative and primary care for children with medical complexity or incurable illness. (Source: Journal of Pain and Symptom Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Advance Care Planning and HIV in the Post-Antiretroviral Therapy Era: A Narrative Review (FR481B)
Since the advent of antiretroviral therapy (ART), HIV has transitioned from a rapidly fatal illness to a chronic disease with multi-morbidity, and providers are faced with an emerging population with unique advance care planning (ACP) needs. (Source: Journal of Pain and Symptom Management)


Growing Up with Our Kids! Caring for Childhood Diseases You Will See as an Adult HPM Provider (FR455)
Children with chronic, life-limiting illnesses are living longer. As a result of improved technology and a better understanding of disease processes, many of these children are surviving into adulthood and transitioning from the pediatric medical world to adult care. Transitional care for young people with life-limiting illnesses is a complex issue. These young people often experience multiple, concurrent transitions, including a variety of organizational and illness transitions, as well as the adjustment from childhood to adulthood. (Source: Journal of Pain and Symptom Management)


Outcomes of In-Hospital Cardiopulmonary Resuscitation in Patients with Chronic Kidney Disease (SA527D)
Advance care planning including code status discussion is an essential part of the medical care of patients with chronic kidney disease (CKD). There is little information on the outcomes of cardiopulmonary resuscitation (CPR) in these patients. (Source: Journal of Pain and Symptom Management)


“Why Do I Still Hurt?” An Integrated Model of Survivorship and Palliative Care (SA523)
The late- and long-term effects of cancer and its treatment leave an expanding population of cancer survivors struggling with transitions into survivorship. The multidisciplinary palliative care team is ideally positioned to manage and coordinate care for these patients. Cancer survivors in the US today number 13.7 million with 5%-10% experiencing pain severe enough to cause functional impairment. Certain subpopulations of cancer survivors are disproportionately affected. Chronic postmastectomy pain can affect up to 50% of breast cancer survivors with more than 30% of patients reporting above average pain 10 years after treatment. (Source: Journal of Pain and Symptom Management)


Using Film to Foster Empathetic Partnerships Between Care Providers and Family Caregivers (SA521)
Fragmentation in the US healthcare system has frayed the critical relationships among caregivers and healthcare providers. Yet, caregivers are on the frontlines managing complicated chronic illnesses, assisting with day-to-day functioning, and providing direct palliative care to manage symptoms and improve quality of life. While meeting loved one’s needs, caregivers navigate an increasingly complex and confusing health system. Students and providers receive little, if any, training on the vital role caregivers play on the healthcare team and how effective partnering optimizes patient care throughout the illness trajectory and at end-of-life. (Source: Journal of Pain and Symptom Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Scrambler Therapy for Chronic Neuropathic Pain (SA514)
Pain remains one of the most common clinical problems and causes of debility, disability, and lost productivity. (Simon L, 2012; Institute of Medicine 2011) Neuropathic pain is particularly vexing as relief is often incomplete and associated with significant medication side effects. Spinal cord stimulation is effective, with pain reductions of 50%-90% reported in well-designed randomized trials (Deer TR, 2014) but is invasive, permanent, and expensive (over $75,000/implant.) Scrambler Therapy (ST) is a new way of relieving pain by giving artificial nerve impulses to simulate “non-pain” information along the damaged pathways to repair damaged nerve pathways, capturing the nerve pathways much like spinal cord stimulation. (Source: Journal of Pain and Symptom Management)


It's Like Heart Failure: It's Chronic and It Will Kill You: Exploring Hospice and Palliative Care Clinicians' Experiences with Burnout (SA538B)
Clinical palliative care is stressful, with self-reported burnout rates as high as 62% among clinicians. To date, there has been scant qualitative investigation into the causes, ameliorators, and effects of this pervasive phenomenon. Alarming as such statistics may be, quantitative estimates in isolation cannot disentangle the predisposing, situational, and protective factors related to one’s experience of burnout; absent rigorous mixed-methods appraisal of the lived experience of burnout, feasible solutions to address burnout may be out of reach. (Source: Journal of Pain and Symptom Management)


Oversleeping: The Effects and Health Risks of Sleeping Too Much
This article originally appeared on the Amerisleep blog. Rosie Osmun is the Creative Content Manager at Amerisleep, a progressive memory foam mattress brand focused on eco-friendly sleep solutions. Rosie writes more posts on the Amerisleep blog about the science of sleep, eco-friendly living, leading a healthy lifestyle and more. -- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. (Source: Healthy Living - The Huffington Post)


Adhesions to Mesh after Ventral Hernia Mesh Repair Are Detected by MRI but Are Not a Cause of Long Term Chronic Abdominal Pain.
Conclusion. MRI can detect adhesions between bowel and abdominal wall in a fair reliable way. Adhesions are formed both after open and laparoscopic hernia mesh repair and are not associated with chronic pain. PMID: 26819601 [PubMed] (Source: Gastroenterology Research and Practice)


Compressive neuropathy of the first branch of the lateral plantar nerve: a study by magnetic resonance imaging
Conclusion: Fatty atrophy of the abductor digiti quinti muscle is strongly associated with neuropathic alterations of the first branch of the lateral plantar nerve. The present study showed a significant association between plantar fasciitis and ankle varices with grade IV atrophy of the abductor digiti quinti muscle.Resumo Objetivo: Avaliar a prevalência de achados isolados que causam compressão do primeiro ramo do nervo plantar lateral em pacientes com queixa de dor crônica no calcanhar, cujos exames de ressonância magnética mostraram atrofia gordurosa seletiva completa do músculo abdutor do quinto dedo. Materiais e Métodos: Estudo retrospectivo, analítico e transversal. Selecionamos exames de ressonância magnética do retropé de 90 pacientes que apresentavam atrofia muscular g...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


[Editors' Choice] A double-drug approach for chronic pain
Author: Peter Stern (Source: ScienceNOW)


[Pain] A double-drug approach for chronic pain
Chronic pain is a major reason why people visit a doctor. Unfortunately, the underlying causes of chronic pain are still poorly understood. To gain more insight, Ren et al. – [Read More] (Source: Editors' Choice)


Risk for Opioid Misuse Among Emergency Department Cancer Patients
ConclusionsThe risk of opioid misuse among cancer patients is substantial. Screening for opioid misuse in the ED is feasible. (Source: Academic Emergency Medicine)


Is There a Benefit for Liposomal Bupivacaine Compared to a Traditional Peri-Articular Injection in Total Knee Arthroplasty Patients With a History of Chronic Opioid Use?
We examined whether a novel suspended release local anesthetic, liposomal bupivacaine (LB) would improve pain control and decrease opioid consumption after TKA compared to a standard periarticular injection, in opioid dependent patients. (Source: The Journal of Arthroplasty)


Risk for Opioid Misuse Among Emergency Department Cancer Patients.
CONCLUSIONS: The risk of opioid misuse among cancer patients is substantial. Screening for opioid misuse in the ED is feasible. PMID: 26824227 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Multiple Crush Concept Applied to Multiple Nerves in Leprous Neuropathy
There is a large reservoir of leprosy patients, no longer contagious, due to multidrug therapy, who are considered cured and are becoming increasingly disabled due to progressive chronic nerve entrapment in the upper and lower extremities. After a review of the history of understanding leprous neuropathy, an approach is outlined based on the approach taken to relieve pain and restore sensation that prevents ulcers and amputations in diabetics with neuropathy and superimposed nerve compressions. The results of the first application of this approach in an indigenous area for leprosy, Guayaquil, Ecuador, is discussed with implications for international care of this neglected patient population. (Source: Clinics in Podiatric Medicine and Surgery)


Paraspinous lidocaine injection for chronic nonspecific low back pain: A randomized controlled clinical trial
In this large, sham-controlled, randomized trial, we examined the efficacy of the combination of standard treatment and paraspinous lidocaine injection compared with standard therapy alone in chronic low back pain. There is little research-based evidence for the routine clinical use of paraspinous lidocaine injection for low back pain. A total of 378 subjects with nonspecific chronic low back pain were randomized to 3 groups: paraspinous lidocaine injection, analgesics, and exercises (group 1- LID-INJ); sham paraspinous lidocaine injection, analgesics, and exercises (group 2- SH-INJ); and analgesics and exercises (group 3- STD-TTR). (Source: The Journal of Pain)


Trends in Opioid Dosing Among of Washington State Medicaid Patients Before and After Opioid Dosing Guideline Implementation
We report here on opioid dosing in the WA Medicaid fee-for-service population for 273,200 adults with a paid claim for an opioid prescription between 4-1-2006 and 12-31-2010. (Source: The Journal of Pain)


Physical activity, psychiatric distress, and interest in exercise group participation among individuals seeking methadone maintenance treatment with and without chronic pain.
CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Low levels of physical activity and low interest in exercise group participation among patients entering MMT point to the need for and likely challenges of implementing exercise interventions in MMT. (Am J Addict 2016;XX:1-7). PMID: 26824197 [PubMed - as supplied by publisher] (Source: American Journal on Addictions)


[Ankle impingement : Indications and arthroscopic therapy].
Authors: Buchhorn T, Koch M, Weber J, Ziai P Abstract Ankle impingement syndromes are one of the most frequent chronic and posttraumatic pathologies of the ankle joint. Anterior and posterior impingement result from the abutting of anatomical structures leading to pain and limitation in the range of motion of the ankle joint. Ankle impingement can be classified based on the localization or the underlying cause. Besides chronic ankle pain, further symptoms are movement and load-dependent swelling of the ankle joint and limitations in dorsiflexion and plantar flexion. The clinical symptoms and physical examination play an essential role in diagnosing soft tissue impingement, whereas various imaging techniques are important for the diagnostics of bony impingement. From a therapeutic p...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Activation of mGluR1 Contributes to Neuronal Hyperexcitability in the Rat Anterior Cingulate Cortex via Inhibition of HCN Channels.
Authors: Gao SH, Wen HZ, Shen LL, Zhao YD, Ruan HZ Abstract Neuronal hyperexcitability in the anterior cingulate cortex (ACC) is considered as one of the most important pathological changes responsible for the chronification of neuropathic pain. However, the underlying mechanisms remain elusive. In the present study, we investigated the possible mechanisms using a rat model of chronic constriction injury (CCI) to the sciatic nerve. We found a substantial decrease in hyperpolarization-activated/cyclic nucleotide-gated (HCN) currents in layer 5 pyramidal neurons (L5 PNs) in ACC slices, which dramatically increased the excitability of these neurons. This effect could be mimicked in sham slices by activating group 1 metabotropic glutamate receptors, and be blocked in CCI slices by inhi...


Is There a Benefit for Liposomal Bupivacaine Compared to a Traditional Periarticular Injection in Total Knee Arthroplasty Patients With a History of Chronic Opioid Use?
We examined whether a novel suspended release local anesthetic, liposomal bupivacaine (LB) would improve pain control and decrease opioid consumption after TKA compared to a standard periarticular injection in opioid-dependent patients. (Source: The Journal of Arthroplasty)


Trends in Opioid Dosing Among Washington State Medicaid Patients Before and After Opioid Dosing Guideline Implementation
We report on opioid dosing in the WA Medicaid fee-for-service population for 273,200 adults with a paid claim for an opioid prescription between April 1, 2006 and December 31, 2010. (Source: The Journal of Pain)


Helicobacter pylori infection is high in paediatric non‐ulcer dyspepsia but not associated with specific gastrointestinal symptoms
ConclusionThe prevalence of H. pylori infection was high in Brazilian children with non‐ulcer dyspepsia, but was not associated with specific signs and symptoms, except for nausea.This article is protected by copyright. All rights reserved. (Source: Acta Paediatrica)


3 Simple Exercises to Eliminate Knee Pain
By Pete Egoscue About 1 in 4 Americans suffers from knee pain, according to a 2011 study published in the Annals of Internal Medicine. Rather than ignore that wincing discomfort until it's unbearable, see if you can ease the ouch with these three simple strengthening exercises from Sonima's pain and anatomy advisor, Pete Egoscue. You may be surprised to find that the pain you feel in your knee is due to weakness and instability in other areas of the body. The exercises demonstrated in this video--sitting knee pillow squeezes, supine foot circles and point flexes, and sitting abductor press--build strength and mobility in the lower body, particularly the ankles, calves, and thighs, to better support the joints' movements and thereby eliminate knee pain. Related: How to Fix Chronic Knee Pain...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


[Neurolitic block of the lumbar sympathetic chain improves chronic pain in a patient with critical lower limb ischemia].
CONCLUSION: Neurolitic block of the lumbar sympathetic chain is an effective and safe treatment option for pain control in patients with critical limb ischemia patients in whom the only possible intervention would be limb amputation. PMID: 26809966 [PubMed - as supplied by publisher] (Source: Revista Brasileira de Anestesiologia)


New drug could be safer, non-addictive alternative to morphine
A painkiller has been developed that is as strong as morphine but isn't likely to be addictive and with fewer side effects, according to a new study. Opium-based drugs are the leading treatments for severe and chronic pain, but they can be highly addictive. Their abuse results in thousands of overdose deaths in the United States annually. (Source: ScienceDaily Headlines)


Palmitoylethanolamide, a Special Food for Medical Purposes, in the Treatment of Chronic Pain: A Pooled Data Meta-analysis.
CONCLUSION: These results confirm that PEA might represent an exciting, new therapeutic strategy to manage chronic and neuropathic pain associated with neuroinflammation. PMID: 26815246 [PubMed - as supplied by publisher] (Source: Pain Physician)


In errata.
Authors: Pain Physician Journal J Abstract In Response: The Cause of Fatal Respiratory Depression Is Combination of Clindamycin and Fentanyl, Rather than TramadolHanbin Wu, MM, and Gao Wu, MMDepartment of Clinical Pharmacy150 Jimo RoadShanghai 200120, China.E362CRPS: Early Lumbar Sympathetic Block is Better Compared to Other Interventions"Shikha Awal MD, Rajashree Madabushi MD, Anil Agarwal MD, and Varun Singla MDDepartment of AnaesthesiologySanjay Gandhi Postgraduate Institute of Medical Sciences,Rae Bareilly Road, LucknowE363There was a typo in the names of the authors in Coxib Safety in Patients with Inflammatory Bowel Diseases: A Meta-analysis Pain Physician 2015; 18:599-607. Correct spelling is:Claudio De Angelis, MDSharmila Fagoonee, PhDThere was an error in author affiliatio...


Pulsed Radiofrequency Reduced Neuropathic Pain Behavior in Rats Associated with Upregulation of GDNF Expression.
CONCLUSIONS: The findings suggest that the application of PRF at the impaired SN relieved reduced the CCI-induced NP by through regulating the upregulation of the GDNF expression in the nervous tissues. PMID: 26815249 [PubMed - as supplied by publisher] (Source: Pain Physician)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


rTMS in Alleviating Mild TBI Related Headaches - A Case Series.
CONCLUSIONS: rTMS offers a non-invasive treatment option for MTBI-HA. The tested treatment protocol was well tolerated by the patients and can be adopted for future randomized controlled studies in further validating the treatment efficacy. PMID: 26815263 [PubMed - as supplied by publisher] (Source: Pain Physician)


Intrathecal Pump Exposure to Electromagnetic Interference: A Report of Device Interrogation following Multiple ECT Sessions.
CONCLUSION: Communication with multiple entities (patient, family, consulting physicians, and device manufacturer) and maintaining vigilance through device interrogation both before and after EMI exposure are appropriate safeguards to mitigate the risk and detect potential adverse events of EMI with intrathecal drug delivery systems. Given the infrequent reports of device exposure to ECT, best practices may be derived from experience with EMI exposure from magnetic resonance imaging (MRI). Although routine EMI exposure to intrathecal drug delivery systems should be avoided, we describe one patient with repeated exposure to ECT without apparent complication. PMID: 26815262 [PubMed - as supplied by publisher] (Source: Pain Physician)


Percutaneous and Endoscopic Adhesiolysis in Managing Low Back and Lower Extremity Pain: A Systematic Review and Meta-analysis.
CONCLUSION: The evidence is Level I or strong that percutaneous adhesiolysis is efficacious in the treatment of chronic refractory low back and lower extremity pain. Percutaneous adhesiolysis may be considered as a first-line treatment for chronic refractory low back and lower extremity pain. The evidence is Level II to III that spinal endoscopy is effective in the treatment of chronic refractory low back and lower extremity pain. Key words: Spinal pain, chronic low back pain, post lumbar surgery syndrome, epidural scarring, adhesiolysis, endoscopy, radicular pain. PMID: 26815254 [PubMed - as supplied by publisher] (Source: Pain Physician)


Impact of Urine Drug Screening on No Shows and Dropouts among Chronic Pain Patients: A Propensity-Matched Cohort Study.
CONCLUSIONS: The results indicate that UDS is associated with increased no-shows and dropout from clinic subject to limitations of observational studies such as selection bias and confound by unobserved variables. These results serve as a call for additional prospective randomized studies to understand the impact of UDS, and where the patients might go when they dropout from the clinic. PMID: 26815253 [PubMed - as supplied by publisher] (Source: Pain Physician)


Widespread Pressure Pain Hyperalgesia in Chronic Nonspecific Neck Pain with Neuropathic Features: A Descriptive Cross-Sectional Study.
CONCLUSIONS: Widespread pressure pain hyperalgesia was detected in patients with CNSNP with NF, but not in patients with CNSNP with No-NF. Patients with CNSNP presented bilateral pressure pain hyperalgesia over the cervical region and a decreased cervical ROM compared to healthy controls. However, no differences were found between the 2 CNSNP groups. These findings suggest differences in the mechanism of pain processing between patients with CNSNP with NF and No-NF. PMID: 26815252 [PubMed - as supplied by publisher] (Source: Pain Physician)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Upregulation of the Purinergic Receptor Subtype P2X3 in the Trigeminal Ganglion Is Involved in Orofacial Pain Induced by Occlusal Interference in Rats.
CONCLUSION: Upregulated P2X3R expression in the TG may contribute to orofacial pain development induced by an occlusal interference. P2X3R may be a therapeutic target for chronic TMJ or masseter muscle pain. PMID: 26817033 [PubMed - as supplied by publisher] (Source: Journal of Orofacial Pain)


Efficacy of Herpes Simplex Virus Vector Encoding the Human Preproenkephalin Gene for Treatment of Facial Pain in Mice.
CONCLUSION: Topically administered KHPE produced a significant antinociceptive effect in the TIC mouse model of chronic facial neuropathic pain. This is the first report in which a gene therapeutic approach reduced trigeminal pain-related behaviors in an established pain state in mice. PMID: 26817032 [PubMed - as supplied by publisher] (Source: Journal of Orofacial Pain)


Inflammatory Cytokines and Sleep Disturbance in Patients with Temporomandibular Disorders.
CONCLUSION: Patients with TMD, especially those with high disability, had elevated plasma cytokine levels and increased ESS and PSQI scores suggestive of sleep disturbance. PMID: 26817030 [PubMed - as supplied by publisher] (Source: Journal of Orofacial Pain)


Explanatory Models of Illness and Treatment Goals in Temporomandibular Disorder Pain Patients Reporting Different Levels of Pain-Related Disability.
CONCLUSION: Illness explanations and goals for treatment differ in patients reporting different levels of TMD pain-related disability. PMID: 26817028 [PubMed - as supplied by publisher] (Source: Journal of Orofacial Pain)


Self-Reported Migraine and Chronic Fatigue Syndrome Are More Prevalent in People with Myofascial vs Nonmyofascial Temporomandibular Disorders.
CONCLUSION: Individuals with myofascial TMD had a higher prevalence of self-reported migraine and chronic fatigue syndrome than those with nonmyofascial TMD. PMID: 26817027 [PubMed - as supplied by publisher] (Source: Journal of Orofacial Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Altered Expression of Cytoskeletal and Axonal Proteins in Oxaliplatin-Induced Neuropathy
Conclusions: These results suggest that changes in the protein levels of the regulatory and structural proteins are due to oxaliplatin-induced neurotoxicity and imply that there is a direct link between structural changes in the central nervous system and chemotherapy-induced neurotoxicity.Pharmacology 2016;97:146-150 (Source: Pharmacology)


Herbal Medicine for Low Back Pain: A Cochrane ReviewHerbal Medicine for Low Back Pain: A Cochrane Review
Are herbal medicines a safe and effective option for sufferers of chronic low back pain? Spine (Source: Medscape Orthopaedics Headlines)


UK-based researchers launch app-based study to examine connection between weather and pain
Researchers from the University of Manchester have launched an app-based study, called Cloudy with a Chance of Pain, that will study the relationship between the weather and chronic pain in the UK.  The initiative was launched in partnership with Arthritis Research UK, health app company uMotif, New York-based Office for Creative Research, and the University’s Health e-Research Centre. (Source: mobihealthnews)


Risk factors for depression and fatigue among survivors of hematopoietic cell transplantation
CONCLUSIONSRates of depression and fatigue in this group of survivors suggest a high symptom burden. Better screening, referral, and interventions are needed. Cancer 2016. © 2016 American Cancer Society. (Source: Cancer)


Regional Versus General Anesthesia in Surgical Patients With Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications?
No abstract available (Source: Survey of Anesthesiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Why are doctors writing opioid prescriptions — even after an overdose?
A group of researchers at Boston Medical Center recently looked at nearly 3,000 patients who had survived an opioid-related overdose between 2000 and 2012. According to their recently published study, over 90% of these patients continued to receive opioid medications from doctors — even after their overdose. Given the soaring numbers of opioid-related overdose deaths and heightened scrutiny on how these medications are being over-prescribed, the study findings are alarming and disturbing. The researchers identified almost 3,000 patients nationwide who had had a nonfatal overdose while being treated with opioid medications for chronic pain. These patients were followed for 300 days, on average, after their overdose. During those 300 days, an additional 7% of the patients overdosed a secon...


Balancing cardiovascular and gastrointestinal risks in nonsteroidal anti-inflammatory drugs use in patients with osteoarthritis: guidelines summary from an international expert group addressing.
Authors: Mosleh W, Farkouh ME Abstract Over the past two decades, extensive research has assessed the use of traditional NSAIDs, and the newer cyclooxygenase-2 (COX-2) inhibitor drugs in the treatment of chronic pain syndromes. Proper NSAID use has been a subject of significant debate, bringing together multidisciplincary researchers and clinicians to discuss the risks and benefits of these therapies. Current guidelines discussing the proper use of NSAIDs do not address the issue of the risks of COX-2 selective NSAIDs and ns-NSAIDs at both the gastrointestinal and cardiovascular systems of either class of drugs with low-dose aspirin. Accordingly, a multidisciplinary expert group organized to review current evidence, with the aim of developing statements devoted guide clinicians in ...


Harnessing the knowledge of animal toxins to generate drugs
Publication date: Available online 27 January 2016 Source:Pharmacological Research Author(s): V.O. Zambelli, K.F.M. Pasqualoto, G. Picolo, A.M. Chudzinski-Tavassi, Y. Cury Animal toxins present high selectivity and specificity for their molecular targets, and have long been considered as prototypes for developing novel drugs, with some successful cases. In this regard, the variety of molecules found in animal venoms, which can be capable of affecting vital physiological systems, have providing the development of studies focusing on turning those molecules (toxins) into therapeutics to treat several diseases, such as chronic pain, hypertension, thrombosis, cancer, and so on. However, some important issues have been responsible for disrupting the toxin-based drug discovery projects. I...


Dextromethorphan: An update on its utility for neurological and neuropsychiatric disorders
Publication date: Available online 28 January 2016 Source:Pharmacology &amp; Therapeutics Author(s): Linda Nguyen, Kelan L. Thomas, Brandon P. Lucke-Wold, John Z. Cavendish, Molly S. Crowe, Rae R. Matsumoto Dextromethorphan (DM) is a commonly used antitussive and is currently the only FDA-approved pharmaceutical treatment for pseudobulbar affect. Its safety profile and diverse pharmacologic actions in the central nervous system have stimulated new interest for repurposing it. Numerous preclinical investigations and many open-label or blinded clinical studies have demonstrated its beneficial effects across a variety of neurological and psychiatric disorders. However, the optimal dose and safety of chronic dosing are not fully known. This review summarizes the preclinical and cli...


Lateral Hypothalamic Stimulation Reduces Hyperalgesia Through Spinally Descending Orexin-A Neurons in Neuropathic Pain
No evidence to date shows that lateral hypothalamic (LH) stimulation produces orexin-A-mediated antinociception in the spinal cord dorsal horn (SCDH) in a model of neuropathic pain. We conducted experiments to examine the effect of orexin-A-mediated LH stimulation in female rats with chronic constriction injury (CCI) on thermal hyperalgesia. Rats receiving carbachol into the LH demonstrated antinociception on both the left CCI and right nonligated paws (p &lt; .05). Rats were given carbachol in the LH followed by intrathecal injection of the orexin-1 (OX1) receptor antagonist SB-334867, which blocked LH-induced antinociception compared with control groups (p &lt; .05) in the left paw, but not in the right paw. These findings support the hypothesis that LH stimulation produces antinocicepti...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Adapting the ABCDEF Bundle to Meet the Needs of Patients Requiring Prolonged Mechanical Ventilation in the Long-Term Acute Care Hospital Setting: Historical Perspectives and Practical Implications
This article is about such an extrapolation from the intensive care unit (ICU) to the long-term acute care hospital (LTACH) setting. Chronic critical illness is an emerging, disabling, costly, and yet relatively silent epidemic that is central to both of these settings. The number of chronically critically ill patients requiring prolonged mechanical ventilation is expected to reach unprecedented levels over the next decade. Despite the prevalence, numerous distressing symptoms, and exceptionally poor outcomes associated with chronic critical illness, to date there is very limited scientific evidence available to guide the care and management of this exceptionally vulnerable population, particularly in LTACHs. Recent studies conducted in the traditional ICU setting suggest interprofessional...


Fibromyalgia: management strategies for primary care providers
ConclusionAlthough there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting. (Source: International Journal of Clinical Practice)


Elevated TNF-α is associated with pain and physical disability in mucopolysaccharidosis types I, II, and VI
Conclusions Higher TNF-α levels are implicated in the pain and decreased physical function present in individuals with MPS despite treatment with ERT and/or HCT, suggesting that TNF-a inhibition could potentially be a useful adjunctive therapy. Further investigation into the role of TNF-α inhibition in MPS to decrease pain and improve physical function is indicated. (Source: Molecular Genetics and Metabolism)


Three kinds of Ganoderma lucidum polysaccharides attenuate DDC-induced chronic pancreatitis in mice
This study was to characterize chemical structures of GLPS3 and determine their effects on diethyldithiocarbamate (DDC)-induced CP in mice. The total sugar content of GLPS3 from fermentation broth (GLPS3-Ⅰ), cultured mycelia (GLPS3-Ⅱ) and fruiting body (GLPS3-Ⅲ) was 90.4%, 92.2% and 91.8% respectively. GLPS3-Ⅰ, GLPS3-Ⅱ and GLPS3-Ⅲ were composed of Glu:Gal:Ara:Xyl, Glu:Gal:Ara:Xyl:Man:Rha, and Glu:Gal:Xyl:Man:Rha:Fuc, with molar ratio of 2.82: 1.33: 1.26: 0.87, 5.84: 2.23: 0.72:1.38: 1.40: 0.51 and 5.34: 2.72: 1.14: 1.10: 0.33: 0.38, respectively. The antioxidative activity of GLPS3-Ⅱfrom cultured mycelia in vitro is higher than other two polysaccharides. The superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in serum were increased while the malondialdehyde (MDA) ...


Lower Extremity Focused Neurologic Examination
A focused lower extremity neurologic evaluation aids in the diagnosis of lower extremity nerve pathology. Injuries to the peripheral neural infrastructure can result in chronic neuropathic pain and discomfort. The most common etiologies of chronic neuropathic pain are from peripheral distal pathologies. A complete lower extremity neurologic evaluation includes sensory, motor, and deep tendon reflexes. Additional specific attention to the geographic anatomic testing of peripheral sensory and motor nerves is essential in eliciting a correct etiologic diagnosis for peripheral neural pain and dysfunction. (Source: Clinics in Podiatric Medicine and Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Identification and Management of Chronic Pain in Primary Care: a Review
Abstract Chronic pain is a common, complex, and challenging condition, where understanding the biological, social, physical and psychological contexts is vital to successful outcomes in primary care. In managing chronic pain the focus is often on promoting rehabilitation and maximizing quality of life rather than achieving cure. Recent screening tools and brief intervention techniques can be effective in helping clinicians identify, stratify and manage both patients already living with chronic pain and those who are at risk of developing chronic pain from acute pain. Frequent assessment and re-assessment are key to ensuring treatment is appropriate and safe, as well as minimizing and addressing side effects. Primary care management should be holistic and evidence-based (where pos...


An unusual cause of chronic nausea and abdominal pain
Question: A 65-year-old woman presented for evaluation of postprandial nausea and abdominal pain of 5 years’ duration. The nausea was not associated with vomiting and was controlled with an antiemetic. The abdominal pain was predominantly located in the right upper quadrant; she had undergone a cholecystectomy decades before the onset of these symptoms. Owing to intractable pain, she had been started on daily opioid analgesics. She had a smoking history of >50 pack-years, and did not consume alcohol heavily. (Source: Gastroenterology)


Neuromuscular response amplitude to mechanical stimulation using large-array surface electromyography in participants with and without chronic low back pain
The present study aimed to compare the neuromuscular response under various mechanical stimulations of the lumbar spine in participants with and without chronic low back pain (cLBP). (Source: Journal of Electromyography and Kinesiology)


Outcomes and Return to Activity After Operative Repair of Chronic Latent Syndesmotic Instability
Conclusion: This study presents a treatment method that can be instituted at the time of diagnosis for syndesmotic injuries with greater than 4 mm of diastasis that were treated with debridement and stabilization. The results of this treatment technique are promising, with significant improvements in subjective outcome scores and a high rate of return to running sports. Level of Evidence: Level IV, retrospective case series. (Source: Foot and Ankle International)


Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review.
Authors: Veehof MM, Trompetter HR, Bohlmeijer ET, Schreurs KM Abstract The number of acceptance- and mindfulness-based interventions for chronic pain, such as acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), increased in recent years. Therefore an update is warranted of our former systematic review and meta-analysis of studies that reported effects on the mental and physical health of chronic pain patients. Pubmed, EMBASE, PsycInfo and Cochrane were searched for eligible studies. Current meta-analysis only included randomized controlled trials (RCTs). Studies were rated for quality. Mean quality did not improve in recent years. Pooled standardized mean differences using the random-effect model were c...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Opioid Prescribing for Chronic Pain — Achieving the Right Balance through Education
New England Journal of Medicine, Volume 374, Issue 4, Page 301-303, January 2016. (Source: New England Journal of Medicine)


Your body’s “other” pulse
When I take a patient’s pulse, I’m really checking to make sure their heart is beating in rhythm and their blood is flowing regularly. It wasn’t until much later that I learned your body has another pulse — your “dural pulse.” In the 1970s, Dr. John Upledger discovered the dural pulse. He was studying dural tubes at the College of Osteopathic Medicine at Michigan State University. The dural tube is a membrane surrounding your spinal cord. It’s filled with cerebral spinal fluid. Dr. Upledger noticed that this spinal fluid moves with a set rhythm. In fact, this dural pulse beats at 6 to 12 cycles per minute. While the dural pulse is still completely ignored by Western medicine, this central nervous system network of tissues, bones and fluids at the core of your body beats like ...


Intranasal abuse potential, pharmacokinetics, and safety of once-daily, single-entity, extended-release hydrocodone (HYD) in recreational opioid users - Harris SC, Cipriano A, Colucci SV, Kapil RP, Geoffroy P, Hopyan T, Levy-Cooperman N.
This study evaluated the intranasal abuse potential an... (Source: SafetyLit)


A survey of spinal cord stimulator use by chronic pain patients while driving - Simopoulos TT, Rosa H, Wootton J, Eichman DS, Gill JS.
OBJECTIVE: The study aims to assess utilization of spinal cord stimulator (SCS) devices while driving a vehicle and potential association with motor vehicle accidents (MVAs). MATERIALS AND METHODS: A telephone survey study was conducted in two phas... (Source: SafetyLit)


Exercise and cognitive functioning in people with chronic whiplash-associated disorders: a controlled laboratory study - Ickmans K, Meeus M, De Kooning M, de Backer A, Kooremans D, Hubloue I, Schmitz T, Van Loo M, Nijs J.
Study Design Controlled laboratory study. Background Besides their persisting pain, people with chronic WAD commonly deal with cognitive dysfunctions. In healthy individuals aerobic exercise has a positive effect on cognitive performance and preliminary ev... (Source: SafetyLit)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Will the National Pain Strategy Offer an Effective And Balanced Approach to Chronic Pain?
No abstract available (Source: The Back Letter)


NYU/UCLA $2.4 million to study non-psychotropic cannabinoids to suppress chronic cancer pain
(New York University) The purpose of the five-year, $2,494,784 R01 grant from the National Institutes of Health National Cancer Institute is to test PRCBs for oral cancer and chemotherapy-induced peripheral neuropathy pain reduction. (Source: EurekAlert! - Biology)


Orthopaedic Perspective on Barefoot and Minimalist Running.
Authors: Roth J, Neumann J, Tao M Abstract In recent years, there has been a movement toward barefoot and minimalist running. Advocates assert that a lack of cushion and support promotes a forefoot or midfoot strike rather than a rearfoot strike, decreasing the impact transient and stress on the hip and knee. Although the change in gait is theorized to decrease injury risk, this concept has not yet been fully elucidated. However, research has shown diminished symptoms of chronic exertional compartment syndrome and anterior knee pain after a transition to minimalist running. Skeptics are concerned that, because of the effects of the natural environment and the lack of a standardized transition program, barefoot running could lead to additional, unforeseen injuries. Studies have show...


Tungiasis-associated morbidity in pigs and dogs in endemic villages of Uganda
Conclusions: The pattern of clinical manifestations in pigs and dogs were very similar to those reported from affected humans and rats. The important morbidity associated with animal tungiasis makes the disease a serious veterinary health problem in sub-Saharan Africa warranting treatment and control for optimal animal production. (Source: Parasites and Vectors)


Rapid Electrocardiogram Evolution in a Dialysis Patient
A 74-year-old man with a history of chronic kidney disease and diabetes presented to the Emergency Department with 1 day of generalized weakness after reportedly missing dialysis 2 days earlier and subsequently on the day of presentation. He denied any other recent health changes, including fever, chest pain, nausea, or abdominal pain. His initial electrocardiogram (ECG) showed a wide complex tachycardia at 120 beats/min, without distinct p-waves (Figure 1). Intravenous access was immediately secured, and blood was obtained for point-of-care labs as well as formal laboratory testing. (Source: The Journal of Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Effect of respiratory exercises on neck pain patients: A pilot study
Conclusions Respiratory exercise contributes to improvement in respiratory muscle endurance and reduces pain who is enduring from CNP. (Source: Polish Annals of Medicine)


Endometriosis and irritable bowel syndrome: a dilemma for the gynaecologist and gastroenterologist
Key content Chronic pelvic pain has a significant impact on health services, accounting for 20% of gynaecological referrals. The overlap between irritable bowel syndrome and endometriosis, two of the leading causes of chronic pelvic pain, should not be overlooked. Visceral sensitivity has been demonstrated in both conditions, further highlighting their similarities. Close communication between gastroenterologists and gynaecologists should help to distinguish the causative condition and improve management. Learning objectives To understand the aetiology, pathology, clinical presentation and current national guidance on endometriosis and irritable bowel syndrome. To increase awareness of visceral hypersensitivity and its significance. To appreciate the importance of good history taki...


Frequency of axial spondyloarthritis diagnosis among patients seen by United States rheumatologists for evaluation of chronic back pain
Conclusion Among patients with chronic back pain for ≥3 months beginning at age &lt;45 years, the presence of ≥1 of 3 SpA features is an effective way to identify patients with possible axSpA. This article is protected by copyright. All rights reserved. (Source: Arthritis and Rheumatism)


Alterations in Gray Matter Volume are Associated with Reduced Evoked‐Pain Connectivity following Acute Pregabalin Administration
Conclusion. Short‐term PGB treatment alters brain structure and evoked‐pain connectivity, and these decreases were associated with reduced clinical pain. We speculate that these fairly rapid changes in GMV may be related to brain neuroplasticity. It is unknown if these effects are generalizable to other chronic pain states. This article is protected by copyright. All rights reserved. (Source: Arthritis and Rheumatism)


Meshfixation in open and endoscopic inguinal hernia repair
Summary Unfortunately, neither new operation techniques nor advancements in mesh development could change the fact that chronic pain remains the most severe postoperative complication in open and laparoscopic hernia surgery. The main reason seems to be nerve injury due to mesh fixation. New fixation techniques like fibrin sealing, self-fixating meshes and no fixation have replaced conventional traumatic fixation devices. The guidelines by the European Hernia Society and the International Endoscopic Hernia Society represent for the first time a publication of evidence-based data. This review illustrates a practical overview of open and laparoscopic fixation techniques based on these guidelines and up to date studies. (Source: European Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Epidural Electrical Stimulation for Stroke Rehabilitation: Results of the Prospective, Multicenter, Randomized, Single-Blinded Everest Trial
Conclusions. The primary analysis pertaining to efficacy of EECS during upper limb motor rehabilitation in chronic stroke patients was negative at 4 weeks postrehabilitation. A better treatment response was observed in a subset of patients eliciting stimulation induced upper limb movements during motor threshold assessments performed prior to each rehabilitation session. Post hoc comparisons indicated treatment effect differences at 24 weeks, with the control group showing significant decline in the combined primary outcome measure relative to the investigational group. These results have the potential to inform future chronic stroke rehabilitation trial design. (Source: Neurorehabilitation and Neural Repair)


Epidural Cortical Stimulation as a Treatment for Poststroke Aphasia: A Systematic Review of the Literature and Underlying Neurophysiological Mechanisms
Conclusions. Due to the small number of existing cases in the literature, the strength of the evidence is still low. Two main hypotheses of neurobiological mechanisms have been explored: either using continuous stimulation to modify cortical perilesional inhibition or using intermittent stimulation during the speech and language therapy sessions to explore synaptic plasticity and long-term potentiation or depression. To establish the role of epidural stimulation and the relevant stimulation protocols and parameters, large randomized controlled trials are mandatory. We suggest avenues of investigation. (Source: Neurorehabilitation and Neural Repair)


Randomized Controlled Pilot Trial of Behavioral Insomnia Treatment for Chronic Migraine With Comorbid Insomnia
ConclusionsBehavioral treatment of comorbid insomnia in individuals with CM produced large reductions in headache frequency, though some improvement in headache occurred with a behavioral intervention not focused on modifying sleep. Among the CBTi group only, both headache frequency and sleep parameters continued to improve after treatment, suggesting the presence of enduring effects over time. Directly treating insomnia using components of stimulus control and sleep restriction holds promise for reducing comorbid migraine. Development of and comparison to a truly inert pseudotherapy control presents unique challenges that future studies should address. (Source: Headache: The Journal of Head and Face Pain)


Botulinum Toxin Type A for Neuropathic Pain in Patients with Spinal Cord Injury
This article is protected by copyright. All rights reserved. (Source: Annals of Neurology)


Three kinds of Ganoderma lucidum polysaccharides attenuate DDC-induced chronic pancreatitis in mice.
This study was to characterize chemical structures of GLPS3 and determine their effects on diethyldithiocarbamate (DDC)-induced CP in mice. The total sugar content of GLPS3 from fermentation broth (GLPS3-Ⅰ), cultured mycelia (GLPS3-Ⅱ) and fruiting body (GLPS3-Ⅲ) was 90.4%, 92.2% and 91.8% respectively. GLPS3-Ⅰ, GLPS3-Ⅱ and GLPS3-Ⅲ were composed of Glu:Gal:Ara:Xyl, Glu:Gal:Ara:Xyl:Man:Rha, and Glu:Gal:Xyl:Man:Rha:Fuc, with molar ratio of 2.82: 1.33: 1.26: 0.87, 5.84: 2.23: 0.72:1.38: 1.40: 0.51 and 5.34: 2.72: 1.14: 1.10: 0.33: 0.38, respectively. The antioxidative activity of GLPS3-Ⅱfrom cultured mycelia in vitro is higher than other two polysaccharides. The superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in serum were increased while the malondialdehyde (MDA) ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cloudy with a chance of pain app investigates link between pain and weather
It&rsquo;s a mystery that&rsquo;s perplexed people for over 2,000 years, but now University of Manchester scientists are on the verge of working out if the weather affects pain in people with arthritis and other conditions, all thanks to the public and their smartphones. Cloudy with a Chance of Pain, which we've funded, is the world's first smartphone-based study to investigate the association between pain and the weather. Participants can download the app to their phone to record how they&rsquo;re feeling, while local weather data is automatically collected using the phone's GPS. To take part, participants must: be in the UK have arthritis or chronic pain be aged over 17 have a smartphone The app can be downloaded at www.cloudywithachanceofpain.com 'A big citizen science experim...


eTect Announces Initiation of a Clinical Study Using Its Novel Ingestion Event Monitoring System to Reliably Track Opioid Use for Pain Management
This study has been designed to evaluate use of the ID-Cap System in monitoring and improving medication adherence. Additional clinical validation studies in partnership with pharmaceutical companies, the NIH, and academic research organizations are planned for 2016. eTect’s technology enables an objective measurement of medication ingestion with real-time reporting of time-stamped dose ingestion events, ensuring that this important information is available to doctors who need it to provide the best care to their patients. The ID-Cap System allows a definitive understanding of medication-taking behavior that has the potential to transform how medications are evaluated by clinical researchers, prescribed by doctors, and used by patients. Medication Adherence Nonadherence to prescribed med...


Terminology of chronic pain
Peppin JF, Schatman ME (Source: Journal of Pain Research)


Calcific tendinitis of the rotator cuff.
Authors: ElShewy MT Abstract Calcific tendinitis within the rotator cuff tendon is a common shoulder disorder that should be differentiated from dystrophic calcification as the pathogenesis and natural history of both is totally different. Calcific tendinitis usually occurs in the fifth and sixth decades of life among sedentary workers. It is classified into formative and resorptive phases. The chronic formative phase results from transient hypoxia that is commonly associated with repeated microtrauma causing calcium deposition into the matrix vesicles within the chondrocytes forming bone foci that later coalesce. This phase may extend from 1 to 6 years, and is usually asymptomatic. The resorptive phase extends from 3 wk up to 6 mo with vascularization at the periphery of the calci...


Opioids Do Not Improve Physical Function In Patients With Neuropathic Pain
While opioids may alleviate pain in some chronic pain patients, their effectiveness when it comes to restoring physical function in patients with neuropathic pain could be considered finite. (Source: Forbes.com Healthcare News)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Many Chronic Pain Sufferers May Overuse Nonprescription Painkillers
Title: Many Chronic Pain Sufferers May Overuse Nonprescription PainkillersCategory: Health NewsCreated: 1/25/2016 12:00:00 AMLast Editorial Review: 1/26/2016 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Rotator Cuff Injury
Title: Rotator Cuff InjuryCategory: Diseases and ConditionsCreated: 1/26/2016 12:00:00 AMLast Editorial Review: 1/26/2016 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Opioid-induced constipation, use of laxatives, and health-related quality of life
Conclusions The results suggest a high degree of moderate to very severe abdominal symptoms, a high degree of self-management of opioid-induced constipation, a low degree of satisfaction with laxative, and low health-related quality of life of patients suffering from chronic pain necessitating long-term opioid treatment, subsequent constipation and laxatives use. Implications Patients suffering from OIC with low quality of life and remaining symptoms despite use of two or more laxatives are a vulnerable patient group in need of optimized healthcare management, who also might benefit from more specific and innovative therapy. (Source: Scandinavian Journal of Pain)


Low-Dose Ketamine in Chronic Critical Illness
We report a case series on the observed effects of low-dose ketamine infusions in 4 critically ill patients with varying complications related to prolonged critical illness. Doses of ketamine infusion ranged from 0.5 to 4 &mu;g/kg/min. A low-dose ketamine infusion was used to reduce agitation in a patient requiring high doses of sedatives and analgesics. In a second patient, ketamine improved depression and anxiety symptoms. In a third patient, ketamine may have facilitated liberation from mechanical ventilation. In a fourth patient, ketamine was used for palliation to avoid lethargy. Ketamine may be considered to help decrease agitation, manage pain, facilitate opioid and benzodiazepine withdrawal, prevent respiratory depression, and potentially manage depression and anxiety in chronicall...


Ultrasound-guided pulsed radiofrequency treatment of the pudendal nerve in chronic pelvic pain.
Authors: Ozkan D, Akkaya T, Yildiz S, Comert A Abstract Chronic pelvic pain is a condition that can be caused by pudendal neuralgia, interstitial cystitis, piriformis syndrome and neuropathy of the ilioinguinal, iliohypogastric and genitofemoral nerves. Based on three case reports this article discusses the clinical effectiveness of pulsed high-frequency radiofrequency (PRF) treatment applied to the pudendal nerve under ultrasound guidance in medicinally treated patients with chronic pelvic pain. PMID: 26811947 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic Pain Status, Nicotine Withdrawal, and Expectancies for Smoking Cessation Among Lighter Smokers.
CONCLUSIONS: These findings suggest that individuals with chronic pain may constitute an important subgroup of tobacco smokers who tend to experience lower confidence and greater difficulty when attempting to quit. Future research would benefit from replicating these findings among older and more diverse samples of heavier tobacco smokers, and extending this work to the study of prospective relations between chronic pain status and cessation-relevant processes/outcomes over the course of a quit attempt. PMID: 26813264 [PubMed - as supplied by publisher] (Source: Annals of Behavioral Medicine)


Fibromyalgia and bipolar disorder: emerging epidemiological associations and shared pathophysiology.
Authors: Bortolato B, Berk M, Maes M, McIntyre RS, Carvalho AF Abstract Fibromyalgia (FM) is a prevalent disorder defined by the presence of chronic widespread pain in association with fatigue, sleep disturbances and cognitive dysfunction. Recent studies indicate that bipolar spectrum disorders frequently co-occur in individuals with FM. Furthermore, shared pathophysiological mechanisms anticipate remarkable phenomenological similarities between FM and BD. A comprehensive search of the English literature was carried out in the Pubmed/MEDLINE database through May 10th, 2015 to identify unique references pertaining to the epidemiology and shared pathophysiology between FM and bipolar disorder (BD). Overlapping neural circuits may underpin parallel clinical manifestations of both diso...


Analgesic effect of recombinant GABAergic cells in a model of peripheral neuropathic pain.
Authors: Jergova S, Gajavelli S, Varghese MS, Shekane P, Sagen J Abstract Chronic neuropathic pain represents clinically challenging state with poor response to current treatment options. Long-term management of chronic pain is often associated with the development of tolerance, addiction and other side effects, reducing the therapeutic value of treatment. Alternative strategies based on cell therapy and gene manipulation, balancing the inhibitory and excitatory events in the spinal cord, may provide sustained pain relief in the long term. Transplantation of GABAergic cells has been successfully used to enhance inhibition and to restore physiological spinal pain processing. However, since the underlying mechanism of chronic pain development involves changes in several pain signalin...


Many Chronic Pain Sufferers May Overuse OTC Meds
They run risk of stomach bleeds, ulcers, liver damage from meds, doctors say (Source: WebMD Health)


Arizona Pain Specialists Now Offering Peripheral Nerve Stimulation for...
The top Phoenix pain management centers, Arizona Pain Specialists, are now offering peripheral nerve stimulation treatment for over ten chronic pain conditions. The treatments are offered at five...(PRWeb January 25, 2016)Read the full story at http://www.prweb.com/releases/phoenix-pain-management/peripheralnervestimulator/prweb13173351.htm (Source: PRWeb: Medical Pharmaceuticals)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pacific Medical Care in San Diego is Now Offering Revolutionary...
Pacific Medical Care is now offering a revolutionary effective treatment for chronic neck and back pain. The treatment, radiofrequency ablation, is covered by insurance and offered by the Board...(PRWeb January 25, 2016)Read the full story at http://www.prweb.com/releases/back-pain-sandiego/radiofrequency-ablation/prweb13179450.htm (Source: PRWeb: Medical Pharmaceuticals)


Many Chronic Pain Sufferers May Overuse Nonprescription Painkillers
They run risk of stomach bleeds, ulcers, liver damage from meds, doctors say Source: HealthDay Related MedlinePlus Pages: Chronic Pain, Drug Reactions, Pain Relievers (Source: MedlinePlus Health News)


Solving America’s opioid crisis: Remember the patient
Physicians, medical organizations and public health experts around the nation all have shared reasons why the opioid overdose epidemic must be top of mind in the medical world, and it comes down to one focus—the patient. A panel of experts recently gave recommendations that lead the way to making patient-focused pain management possible. Reducing the stigma of chronic pain One important aspect of the efforts to combat the opioid epidemic is reducing stigma so that patients with chronic pain do not lose access to the care that they need. “What is our role as physicians in this current problem?” asked John A. Renner, MD, president of the American Academy of Addiction Psychiatry and professor of psychiatry at Boston University School of Medicine, speaking to physician leaders at t...


Cerebellar direct current stimulation modulates pain perception in humans.
CONCLUSIONS: tcDCS modulates pain perception and its cortical correlates. Since it is effective on both N1 and N2/P2 components, we speculate that the cerebellum engagement in pain processing modulates the activity of both somatosensory and cingulate cortices. Present findings prompt investigation of the cerebellar direct current polarization as a possible novel and safe therapeutic tool in chronic pain patients. PMID: 25777683 [PubMed - in process] (Source: Restorative Neurology and Neuroscience)


Relationships Between Tobacco Abuse and Self-Assessment of Health.
Authors: Gawlikowska-Sroka A, Dzięciołowska-Baran E, Szczurowski J Abstract Smoking cigarettes negatively influences the functioning of the body. Among other effects, it has an important impact on the respiratory system, circulation, and behavior. It leads to morphological and physiological changes in organs and tissues, so it can change mood. The aim of this study was to assess the relationships between tobacco abuse and self-assessment of health. The survey was conducted among Polish (243) and foreign (80) medical students at the Pomeranian Medical University in Szczecin, Poland. The study was based on a survey questionnaire of the authors' own design, comprising open and multi-choice questions. Our questionnaire was based on the international standard questionnaire from the He...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Current Strategies in Anesthesia and Analgesia for Total Knee Arthroplasty.
Authors: Moucha CS, Weiser MC, Levin EJ Abstract Total knee arthroplasty is associated with substantial postoperative pain that may impair mobility, reduce the ability to participate in rehabilitation, lead to chronic pain, and reduce patient satisfaction. Traditional general anesthesia with postoperative epidural and patient-controlled opioid analgesia is associated with an undesirable adverse-effect profile, including postoperative nausea and vomiting, hypotension, urinary retention, respiratory depression, delirium, and an increased infection rate. Multimodal anesthesia-incorporating elements of preemptive analgesia, neuraxial perioperative anesthesia, peripheral nerve blockade, periarticular injections, and multimodal oral opioid and nonopioid medications during the perioperati...


Relieving pain … with light?
Consider this scenario: A patient is home recovering from knee surgery to repair an ACL tear. Her pain medications are wearing off, and the surgical cuts are starting to throb. Reaching over to the table she picks up what’s essentially a souped-up laser pointer, points it at the surgical wound and turns it on. Within seconds, the pain starts to fade. This picture isn’t as far-fetched as you might think. In a pair of simultaneous papers, Boston Children’s Hospital’s Daniel Kohane, MD, PhD, and his laboratory recently reported their efforts to create not one, but two methods for packaging long-lasting local anesthetics in microspheres that could be injected in advance by a surgeon or anesthesiologist and that would release the drugs when zapped with a laser. Both methods have one go...


CANVAS an update: clinical presentation, investigation and management.
CONCLUSIONS: CANVAS is an increasingly recognised cause of late-onset ataxia and disequilibrium, and is likely to be a recessive disorder. PMID: 25564090 [PubMed - indexed for MEDLINE] (Source: Journal of Vestibular Research: Equilibrium and Orientation)


Downregulation of the spinal dorsal horn clock gene Per1 expression leads to mechanical hypersensitivity via c-jun N-terminal kinase and CCL2 production in mice
Publication date: Available online 23 January 2016 Source:Molecular and Cellular Neuroscience Author(s): Norimitsu Morioka, Munenori Saeki, Tatsuhiko Sugimoto, Takuya Higuchi, Fang Fang Zhang, Yoki Nakamura, Kazue Hisaoka-Nakashima, Yoshihiro Nakata Disturbances of circadian rhythm and dysregulation of clock gene expression are involved in the induction of various neurological disorder states, including chronic pain. However, the relationship between the CNS circadian-clock gene system and nociception remains poorly defined. Significant circadian oscillations of Period (Per1, Per2), Bmal1 and Cryptochrome 1 (Cry1) mRNA expression have been observed in the lumbar spinal dorsal horn of naïve mice. The current study examined the expression of clock genes in the lumbar spinal dorsal...