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Medworm: Chronic Pain - Recent Medical Updates

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Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis.
CONCLUSION: There is limited evidence for effectiveness of mindfulness-based interventions for patients with chronic pain. Better-quality studies are required. PMID: 26009534 [PubMed - in process] (Source: The British Journal of General 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>


Chronic venous disease and venous leg ulcers: An evidence-based update
Chronic venous disease (CVD) is a complex chronic vascular condition with multifaceted primary and secondary etiologies leading to structural and functional changes in veins and valves and blood flow of the lower legs. As a consequence, a spectrum of clinical manifestations arise, ranging from symptoms of mild leg heaviness and achiness to debilitating pain, and signs of skin changes, such as eczema and hemosiderosis, to nonhealing, heavily draining venous leg ulcers (VLUs). Triggers such as trauma to the skin are responsible for a large majority of VLU recurrences. (Source: Journal of Vascular Nursing)


Unravelling nocebo effect: the mediating effect of anxiety between anticipation and pain at wound dressing change
ConclusionAnticipation of pain triggers anxiety that can lead to increased pain. Relevance to clinical practiceThere is a need to incorporate evaluation of anxiety and personal expectations as part of comprehensive pain assessment. Clinicians should be aware of the impact of emotions and anticipation on overall pain experience. (Source: Journal of Clinical Nursing)


Inflammatory Claims About Inflammation
We all appreciate the elegance of simple solutions to complex problems. But we know too that simplicity can often masquerade as truth, hiding a more nuanced reality. Such is the case with inflammation, where pseudoscience, exaggerated claims, false promises, and dangerous oversimplification have dominated for too long. Here is a typical missive: "Inflammation controls our lives. Have you or a loved one dealt with pain, obesity, ADD/ADHD, peripheral neuropathy, diabetes, heart disease, stroke, migraines, thyroid issues, dental issues, or cancer? If you answered yes to any of these disorders you are dealing with inflammation." Well, no, inflammation does not control our lives. Like many others, this author claims inflammation is responsible for a huge range of maladies, ranging from Alzhei...


Prostanoids and NSAIDs in Cardiovascular Biology and Disease
Abstract Prostanoids and related arachidonic acid derivatives are important physiologic modulators in arteries, as well as mediators of inflammation, hemostasis, and cell proliferation. Their participation in atherosclerosis and in acute thrombotic events is complex, as demonstrated by untoward cardiovascular (CV) effects associated with clinical use of inhibitors of prostaglandin synthesis for treatment of chronic pain, inflammatory states, or cancer prophylaxis. Newer understanding of the pathophysiology of atherosclerosis and the pharmacology of prostanoids promises potential resolution of current problems resulting from the hazards of available prostanoid-altering drugs. (Source: Current Atherosclerosis Reports)


The effect of changing movement and posture using motion-sensor biofeedback, versus guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain-a multicentre, cluster-randomised, placebo-controlled, pilot trial
Conclusions: Individualised movement retraining using motion-sensor biofeedback resulted in significant and sustained improvements in pain and activity limitation that persisted after treatment finished. This pilot trial also refined the procedures and sample size requirements for a fully powered RCT.This trial (Australian New Zealand Clinical Trials Registry NCT01572779) was equally funded by dorsaVi P/L and the Victorian State Government. (Source: BMC Musculoskeletal Disorders)<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>


An autopsy case of myocardial infarction due to idiopathic thrombotic thrombocytopenic purpura
This report is a critical teaching case considering that its cause of sudden death may be arrhythmia due to a myocardial infarction including cardiac conduction system disorder by platelet microthrombi.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2113354005156739 (Source: Diagnostic Pathology)


Molecules, Vol. 20, Pages 10047-10064: A 1H-NMR-Based Metabonomic Study on the Anti-Depressive Effect of the Total Alkaloid of Corydalis Rhizoma
In this study, the antidepressive effect of the total alkaloid of YuanHu (YHTA) was investigated in a chronic unpredictable mild stress (CUMS) rat model using 1H-NMR-based metabonomics. Plasma metabolic profiles were analyzed and multivariate data analysis was applied to discover the metabolic biomarkers in CUMS rats. Thirteen biomarkers of CUMS-introduced depression were identified, which are myo-inositol, glycerol, glycine, creatine, glutamine, glutamate, β-glucose, α-glucose, acetoacetate, 3-hydroxybutyrate, leucine and unsaturated lipids (L7, L9). Moreover, a metabolic network of the potential biomarkers in plasma perturbed by CUMS was detected. After YHTA treatment, clear separation between the model group and YHTA-treated group was achieved. The levels of all the abnormal metabolit...


Physiotherapist-led neck-specific exercise improves pain, disability and self-efficacy in chronic whiplash-associated disorders
Publication date: Available online 29 May 2015 Source:Journal of Physiotherapy Author(s): Mark Elkins (Source: Journal of Physiotherapy)


Seroprevalence of HSV-1/2 and correlation with aggravation of oral mucositis in patients with squamous cell carcinoma of the head and neck region submitted to antineoplastic treatment
Conclusion The reactivation of HSV-1/2 was shown to be relatively infrequent and there was no correlation between presence of the virus and aggravation of oral mucositis resulting from antineoplastic treatment. (Source: Supportive Care in Cancer)


When acute pain becomes chronic
(Source: Anaesthesia)<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>


Tattoos last, but for 1 out 10, so does the pain
A new study suggests people suffer infections, itching and chronic complications for their body art. (Source: CNN.com - Health)


Pulsed Radiofrequency Treatment Enhances Dorsal Root Ganglion Expression of Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels in a Rat Model of Neuropathic Pain
In conclusion, PRF can upregulate HCN channel expression in the DRG of rats with sciatic nerve CCI. How this regulation of Ih in nociceptive afferents contributes to the suppression of neuropathic pain by PRF remains to be determined. (Source: Journal of Molecular Neuroscience)


A multilevel path model analysis of the relations between sleep, pain, and pain catastrophizing in chronic pain rehabilitation patients
Conclusion and implications These results call into question previous evidence that pain catastrophizing indirectly affects pain by way of its impact on sleep. Rather, our findings suggest that pain mediates the relationship between sleep and levels of pain catastrophizing. These results therefore underscore importance and value in collecting longitudinal data and potential influence on the conclusions gained with regards to sleep, pain and psychological variables. These findings may be of clinical importance when tailoring interventions for individuals with chronic pain and perhaps even more so for those with comorbid pain and sleep disturbance; prioritizing the treatment of sleep difficulties could result in improvements to pain-related outcomes. (Source: Scandinavian Journal of Pain)


Total knee arthroplasty – the optimal analgesic regime
This article examines and appraises the options for total knee arthroplasty in the current environment which mandates rapid discharge from hospital. Peripheral nerve blockade and multimodal analgesic options are covered in detail, along with newer techniques such as high volume local anaesthetic infiltration and infiltration with liposomal bupivacaine. Recommendations are made for the straightforward patient and the patient with chronic pain or opioid requirements. (Source: Trends in Anaesthesia and Critical Care)


Childbirth Pain and Postpartum Depression
Publication date: Available online 13 May 2015 Source:Trends in Anaesthesia and Critical Care Author(s): S. Kwok , D. Moo , S.T. Sia , A.S. Razak , B.L. Sng Childbirth pain is one of the most painful experiences of a mother’s life. In this review we investigate the association between childbirth pain and post partum depression. It is well documented that postpartum depression is an increasing concern which affects not only the mother but can impact the newborn’s development. Multiple factors seem to contribute to the likelihood of this depression developing such as the mother’s socio-econoimc background, age, education level, history of childhood abuse as well as pain catastrophizing traits. Severe acute pain is linked with an increased risk of chronic pain as well as postpartum de...<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>


Patient-reported outcomes in a large community-based pain medicine practice: evaluation for use in phenotype modeling
Conclusions: We conclude that the data available in a community practice can be a rich source of biopsychosocial information relevant to the phenotypes of chronic pain. It is anticipated that phenotype linkages to best treatments and outcomes can be constructed from this set of records. (Source: BMC Medical Informatics and Decision Making)


Machine-Based, Self-guided Home Therapy for Individuals With Severe Arm Impairment After Stroke: A Randomized Controlled Trial
This study compared self-guided, high-repetition home therapy with a mechanical device (the resonating arm exerciser [RAE]) to conventional therapy in patients with chronic stroke and explored RAE use for patients with subacute stroke. Methods. A total of 16 participants with severe upper-extremity impairment (mean Fugl-Meyer [FM] score = 21.4 &plusmn; 8.8 out of 66) &gt;6 months poststroke were randomized to 3 weeks of exercise with the RAE or conventional exercises. The primary outcome measure was FM score 1 month posttherapy. Secondary outcome measures included Motor Activity Log, Visual Analog Pain Scale, and Ashworth Spasticity Scale. After a 1-month break, individuals in the conventional group also received a 3-week course of RAE therapy. Results. The change in FM score was significa...


Belgian siblings of children with a chronic illness: Is their quality of life different from their peers?
To assess Belgian siblings&rsquo; self-reported quality of life (QoL) and the impact of illness on four different paediatric illnesses. Healthy siblings (n&nbsp;=&nbsp;131) of children with type 1 diabetes, cancer, congenital heart disease (CHD) and cystic fibrosis (CF) completed the Child Health Questionnaire and the Sibling Perception Questionnaire. Results were compared to those of a matched group of siblings of healthy children. Siblings reported a good QoL, similar to controls, with the exception that siblings reported better on the QoL domain pain (p&nbsp;&lt;&nbsp;.01). QoL was not related to time since diagnosis but the impact of illness was higher nearer to the time of diagnosis (r&nbsp;=&nbsp;&ndash;.39, p&nbsp;&lt;&nbsp;.001). QoL of siblings of children with CHD or cancer was l...


Medical Management of Tumor Lysis Syndrome, Postprocedural Pain, and Venous Thromboembolism Following Interventional Radiology Procedures
Semin intervent Radiol 2015; 32: 209-216DOI: 10.1055/s-0035-1549379The rapid expansion of minimally invasive image-guided procedures has led to their extensive use in the interdisciplinary management of patients with vascular, hepatobiliary, genitourinary, and oncologic diseases. Given the increased availability and breadth of these procedures, it is important for physicians to be aware of common complications and their management. In this article, the authors describe management of select common complications from interventional radiology procedures including tumor lysis syndrome, acute on chronic postprocedural pain, and venous thromboembolism. These complications are discussed in detail and their medical management is outlined according to generally accepted practice and evidence from t...


Assessment of spinal pain
Publication date: Available online 28 May 2015 Source:Best Practice &amp; Research Clinical Rheumatology Author(s): J. Braun , X. Baraliakos , A. Regel , U. Kiltz Spinal pain or back pain is a very common symptom that can have many reasons. The most studied location is low back pain, and it is considered to be nonspecific in the majority of cases. Only a small proportion of patients have axial inflammation as the major cause of their back complaints with chronic inflammatory back pain (IBP) as the most prominent clinical feature of spondyloarthritis (SpA). The recognition of IBP and patients with axial spondyloarthritis (axSpA) is challenging in primary care, and it is important to further facilitate the early diagnosis of SpA. Proposals for improving the referral of patients with 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>


Sex differences in knee loading in recreational runners
This study aimed to determine whether female recreational runners exhibit distinct knee loading compared to males. Fifteen male and fifteen female recreational runners underwent 3D running analysis at 4.0m.s-1±5%. Sagittal/ coronal joint moments, patellofemoral contact forces (PTF) and pressures (PCP) were compared between sexes. (Source: Journal of Biomechanics)


Combined contraceptive pills 'increase risk of blood clots'
Conclusion It is already well known that the combined oral contraceptive pill (&quot;the pill&quot;) is associated with increased risk of venous blood clots. It is also already known that risk can differ according to the type of progestogen in the pill. This study adds further evidence helping to quantify these risks. The study has numerous strengths. It has used two large GP databases covering large samples of the UK population, and containing reliable information on medical diagnoses and prescriptions made. The analyses were also adjusted for various confounders known to be associated with risk of blood clots. It demonstrates pill use in the previous year almost tripled risk of venous blood clot, with risk generally higher with the newer pills than the older ones – though there were so...


Novel expression pattern of neuropeptide Y immunoreactivity in the peripheral nervous system in a rat model of neuropathic pain
Conclusions: This is the first study to provide a comprehensive description of changes in NPY expression in the periphery after nerve injury. Novel expression of NPY in the skin comes mostly from sprouted sympathetic fibers. This information is fundamental in order to understand where endogenous NPY is expressed, and how it might be acting to modulate pain in the periphery. (Source: Molecular Pain)


Effect of manual versus mechanically assisted manipulations of the thoracic spine in neck pain patients: study protocol of a randomized controlled trial
The objective of this study is to compare the short- and long-term effects of manual versus mechanically assisted manipulations of the thoracic spine for neck pain patients.Methods/DesignA 6-month, randomized controlled trial consisting of 54 patients with acute or chronic neck pain patients will be conducted. Patients with no signs of major pathology and with little or no interference with daily activities will be recruited. Three treatment sessions with 4-day intervals will be carried out. The patients will be randomly assigned to receive either manually performed manipulations or electromechanical manipulations at the thoracic spine. The primary outcome is pain intensity as measured by the Visual Analogue Pain Rating Scale. The secondary outcome measures are neck physical disability usi...


The effect of decompressive surgery on lumbar paraspinal and biceps brachii muscle function and movement perception in lumbar spinal stenosis: a 2-year follow-up
Conclusion Impaired lumbar proprioception seems to improve shortly after decompressive surgery but tends to deteriorate again with longer follow-up despite the sustaining favorable clinical outcome. The surgery did not affect either the feed-forward or the feed-back muscle function, which indicates that the abnormal muscle activity in LSS is at least partly irreversible. (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>


Analytical comparison study of the clinical and radiological outcome of spine fixation using posterolateral, posterior lumber interbody and transforaminal lumber interbody spinal fixation techniques to treat lumber spine degenerative disc disease
Background: Degenerative disc disease is a common cause of chronic and disabling back pain that requires surgical intervention, posterolateral and posterior instrumental fixation (PLF), posterior lumber interbody fusion (PLIF) and transforaminal lumber interbody fusion (TLIF) are the techniques used to deal with such a problem.ObjectiveTo compare the clinical and radiological outcome of the variable surgical techniques used to deal with Lumber degenerative disc disease and to recommend the technique of choice. Methods: 120 patients were treated between 2003 and 2010 at king Abdullah university hospital for lumber disc disease. The patients were divided into three groups: Group I (PLF n = 30 [59 levels]); Group II (PLIF n = 40 [70 levels]); and Group III (TLIF n = 50 [96 levels]...


Psychosocial, musculoskeletal and somatoform comorbidity in patients with chronic low back pain: original results from the Dutch Transition Project
Conclusions. General practitioners should consider all the musculoskeletal symptoms when caring for patients with chronic LBP. Rather than systematically screening for specific psychological, social or somatoform disorders, they should consider with the patient how LBP and any type of potential comorbidity interfere with his/her daily functioning. (Source: Family Practice)


Hurt, tired and queasy: Specific variants in the ATPase domain of the TRAP1 mitochondrial chaperone are associated with common, chronic “functional” symptomatology including pain, fatigue and gastrointestinal dysmotility
In this study, provided clinical information and the exon sequence of the TRAP1 mitochondrial chaperone were retrospectively reviewed with a focus on the functional categories of chronic pain, fatigue and gastrointestinal dysmotility. Very-highly conserved TRAP1 variants were identified in 73 of 930 unrelated patients. Functional symptomatology is strongly associated with specific variants in the ATPase binding pocket. In particular, the combined presence of all three functional categories is strongly associated with p.Ile253Val (OR 7.5, P=0.0001) and with two other interacting variants (OR 18, P=0.0005). Considering a 1-2% combined variant prevalence and high odds ratios, these variants may be an important factor in the etiology of functional symptomatology. (Source: Mitochondrion)


[Research Articles] Shaping mycolactone for therapeutic use against inflammatory disorders
Inflammation adversely affects the health of millions of people worldwide, and there is an unmet medical need for better anti-inflammatory drugs. We evaluated the therapeutic interest of mycolactone, a polyketide-derived macrolide produced by Mycobacterium ulcerans. Bacterial production of mycolactone in human skin causes a combination of ulcerative, analgesic, and anti-inflammatory effects. Whereas ulcer formation is mediated by the proapoptotic activity of mycolactone on skin cells via hyperactivation of Wiskott-Aldrich syndrome proteins, analgesia results from neuronal hyperpolarization via signaling through angiotensin II type 2 receptors. Mycolactone also blunts the capacity of immune cells to produce inflammatory mediators by an independent mechanism of protein synthesis blockade. In...


m-Trifluoromethyl-diphenyl diselenide, a multi-target selenium compound, prevented mechanical allodynia and depressive-like behavior in a mouse comorbid pain and depression model
This study evaluated the effect of m-trifluoromethyl diphenyl diselenide [(m-CF3-PhSe)2], an organoselenium compound that has been reported to have both antinociceptive and antidepressant-like actions, in the comorbidity of chronic pain and depression induced by partial sciatic nerve ligation (PSNL) in an inflammatory approach. Mice were submitted to PSNL during 4 weeks and treated with (m-CF3-PhSe)2 acutely (0.1 – 10 mg/kg, i.g.) or subchronically (0.1 mg/kg, i.g., once a day during the 3rd and 4th weeks). Both treatments prevented PSNL-increased pain sensitivity and depressive-like behavior observed in von-frey hair (VFH) and forced swimming (FST) tests, respectively. These effects could be mainly associated with an anti-inflammatory action of (m-CF3-PhSe)2 which reduced the levels of ...<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>


Ultrasonography Leads to Accurate Diagnosis and Management of Painful Acromioclavicular Joint Cyst
DiscussionMusculoskeletal ultrasound is useful for diagnosis and management of refractory musculoskeletal conditions that are commonly misdiagnosed on physical examination and translucent to radiographic imaging. Musculoskeletal ultrasound allowed us to exclude rotator cuff pathology, identify ACJ cyst as the pain generator, classify it as a type 1 ACJ cyst, and aid in needle guidance for successful aspiration leading to full resolution of our patient's pain. (Source: Pain Practice)


Tapentadol for chronic musculoskeletal pain in adults.
CONCLUSIONS: Tapentadol extended release is associated with a reduction in pain intensity in comparison to placebo and oxycodone. However, the clinical significance of the results is uncertain due to the following reasons: modest difference between interventions in efficacy outcomes, high heterogeneity in some comparisons and outcomes, high withdrawals rates, lack of data for the primary outcome in some studies and impossibility to use BOCF as imputation method. Tapentadol is associated with a more favourable safety profile and tolerability than oxycodone. PMID: 26017279 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


A synthesis of qualitative research exploring the barriers to staying in work with chronic musculoskeletal pain.
CONCLUSIONS: Our innovation is to present an internationally relevant model based on a conceptual synthesis. This model highlights the adversarial work experience of people with chronic. The papers span 15 years of qualitative research. A significant finding is that these themes continue to pervade the current work environment for those in pain, and this has clear implications for education, social care and policy. Implications for Rehabilitation People with chronic pain face an adversarial struggle to maintain their credibility at work. Strategies to maintain personal credibility can have an adverse effect on working lives. Changes at a systems level are needed to facilitate continuance and return to work. Cultural changes in the way that we view people with pain would help to keep people...


New findings about mechanisms underlying chronic pain reveal novel therapeutic strategies
A critical role for a class of cells present in the brain and spinal cord, called microglia, has been discovered for those in pain. Researchers have found microglia to neuron signaling to be crucial in the development of pain hypersensitivity after injury, but also for one of the paradoxical effects morphine and other opioids sometimes produce, called hyperalgesia, which is an increase in pain sensitivity. (Source: ScienceDaily Headlines)


[Occipital nerve stimulation for refractory chronic migraine].
CONCLUSIONS: ONS is an effective, well tolerated and safe treatment for the prevention of chronic migraine and could emerge as a useful option for those patients with medically refractory chronic migraine. PMID: 26005075 [PubMed - in process] (Source: Revista de Neurologia)<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 intrathecal injection of rapamycin on pain threshold and spinal cord glial activation in rats with neuropathic pain.
CONCLUSIONS: Intrathecal injection of rapamycin may attenuate CCI-induced hyperalgesia and inhibit the activation of astrocyte. PMID: 26004146 [PubMed - as supplied by publisher] (Source: Neurological Research)


Diagnostic criteria in 72 women with erosive vulvovaginal lichen planus
ConclusionsThe most frequent findings in women with EVLP were symptoms of pain or burning, well‐demarcated red shiny areas or erosions at the introitus and scarring with loss of architecture. Our findings support the recently described diagnostic criteria for EVLP. (Source: Australasian Journal of Dermatology)


Is it necessary to strictly diagnose fibromyalgia syndrome in patients with chronic widespread pain?
Abstract The applicability of the American College of Rheumatology (ACR) 1990 and 2010 criteria for the diagnosis of fibromyalgia syndrome (FMS) was determined in 284 patients with chronic widespread pain (CWP) including those with regional and systemic painful disorders. On the basis of initial evaluation, patients were classified into three groups. Group 1, those without any comorbid disease (N = 105), group 2, those having regional non-inflammatory painful disorders (N = 104), and group 3, those with a diagnosis of an inflammatory rheumatic disease (N = 75). Overall, 65 % of the patients fulfilled the 1990 criteria, while 94 % of them fulfilled the 2010 criteria. Almost all of the patients (97 %) with CWP did meet at least one of the criteria set, regardless of w...


Peripartum changes of the sacroiliac joints on MRI: increasing mechanical load correlating with signs of edema and inflammation kindling spondyloarthropathy in the genetically prone
In conclusion, pregnancy and puerperium are associated with a host of acute findings in and around the SIJ, including BME, capsulitis, and enthesitis, reflecting most probably, mechanical load and hormonal changes. While the vast majority of symptoms abate within weeks to several months postpartum, 3.8 % of women go on to develop spondyloarthropathy. Diffuse SIJ BME and the presence of risk factors for spondyloarthropathy are predictive of a chronic course. (Source: Clinical Rheumatology)


Fentanyl Buccal Tablet: A New Breakthrough Pain Medication in Early Management of Severe Vaso‐Occlusive Crisis in Sickle Cell Disease
ConclusionsWe propose that VOCs might require breakthrough pain drug strategy as vaso‐occlusive phenomena and enhanced vasoconstriction promoting acute ischemic pain component exacerbate the continuous pain of VOCs. FBT might be a powerful and feasible tool in early management of acute pain during VOCs in emergency departments. (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>


Pain Management in Four‐Limb Amputation: A Case Report
We present the perioperative analgesic management of a patient with gangrene of the bilateral upper and lower extremities as a result of septic shock and prolonged vasopressor administration who underwent four‐limb amputation in a single procedure. A multimodal analgesic regimen was utilized, including titration of preoperative opioid and neuropathic pain agents, perioperative intravenous, epidural and peripheral nerve catheter infusions, and postoperative oral medication titration. More than 8 months postoperatively, the patient has satisfactory pain control with no evidence for phantom limb pain. To our knowledge, there have been no publications to date concerning analgesic regimens in four‐limb amputation. (Source: Pain Practice)


Inventory of Personal Factors Influencing Conditioned Pain Modulation in Healthy People: A Systematic Literature Review
ConclusionIt is advised for future studies to take these factors into account. Further research regarding the influence of oral contraceptives, catastrophizing, information about conditioning stimulation, distraction, physical activity, and genetics on CPM magnitude is required. (Source: Pain Practice)


Calibration of the Dutch‐Flemish PROMIS Pain Behavior item bank in patients with chronic pain
ConclusionsThe Dutch‐Flemish PROMIS Pain Behavior item bank was found to have good cross‐cultural validity, reliability and construct validity. The development of the Dutch‐Flemish PROMIS Pain Behavior item bank will serve as the basis for Dutch‐Flemish PROMIS short forms and computer adaptive testing (CAT). (Source: European Journal of Pain)


Abdominal Pain Caused by Spontaneous Rupture of a Liver Tumor
Question: A 47-year-old man was admitted to our hospital with an 8-hour history of intermittent abdominal pain that had developed suddenly. He had a history of liver cirrhosis and chronic hepatitis B virus infection for 10 years. Physical examination revealed tenderness of the right abdomen. His liver function was abnormal: γ-glutamyltransferase, 110U/L (normal range,10-60), alkaline phosphatase, 135U/L (normal range, 45-125), glutamate dehydrogenase, 22.4U/L (normal range, 0-7.4), prealbumin, 11.7 mg/dL (normal range, 17-40). (Source: Gastroenterology)


A dietary intervention for chronic diabetic neuropathy pain: a randomized controlled pilot study
Authors: A E Bunner, C L Wells, J Gonzales, U Agarwal, E Bayat & N D Barnard (Source: Nutrition and Diabetes)<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>


Insulin‐Like Growth Factor II (IGF‐II) Inhibits IL‐1β‐Induced Cartilage Matrix Loss and Promotes Cartilage Integrity in Experimental Osteoarthritis
This article is protected by copyright. All rights reserved (Source: Journal of Cellular Biochemistry)


Diagnostic criteria in 72 women with erosive vulvovaginal lichen planus.
CONCLUSIONS: The most frequent findings in women with EVLP were symptoms of pain or burning, well-demarcated red shiny areas or erosions at the introitus and scarring with loss of architecture. Our findings support the recently described diagnostic criteria for EVLP. PMID: 26010759 [PubMed - as supplied by publisher] (Source: The Australasian Journal of Dermatology)


Cognitive-behavioural treatment for subacute and chronic neck pain.
CONCLUSIONS: With regard to chronic neck pain, CBT was found to be statistically significantly more effective for short-term pain reduction only when compared to no treatment, but these effects could not be considered clinically meaningful. When comparing both CBT to other types of interventions and CBT in addition to another intervention to the other intervention alone, no differences were found. For patients with subacute NP, CBT was significantly better than other types of interventions at reducing pain at short-term follow-up, while no difference was found for disability and kinesiophobia. Further research is recommended to investigate the long-term benefits and risks of CBT including for the different subgroups of subjects with NP. PMID: 26006174 [PubMed - as supplied by publisher...


Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls
Conclusion Gluteus medius weakness and gluteal muscle tenderness are common symptoms in people with chronic non-specific LBP. Future investigations should validate these findings with quantitative measures as well as investigate the effect of gluteus medius strengthening in people with LBP. (Source: European Spine Journal)


Analgesia enhancement and prevention of tolerance to morphine: beneficial effects of combined therapy with omega‐3 fatty acids
ConclusionThis finding suggests a role for O3 as adjuncts to opioids in pain therapy and might contribute to the reduction of the occurrence of morphine side‐effects. (Source: Journal of Pharmacy and Pharmacology)<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>


Healthcare costs associated with elderly chronic pain patients in primary care
Conclusion Healthcare costs increased rapidly over time, largely due to hospitalization. Prevention strategies to limit hospitalizations in elderly appear to be the most useful in order to achieve cost savings in the future. (Source: European Journal of Clinical Pharmacology)


Transurethral intraprostatic injection of botulinum neurotoxin type A for the treatment of chronic prostatitis/chronic pelvic pain syndrome: results of a prospective pilot double‐blind and randomized placebo‐controlled study
ConclusionsTransurethral intraprostatic BoNT‐A injection maybe an effective therapeutic option in patients with CP/CPPS as it reduces pain and improves QoL. (Source: BJU International)


Acute opioid withdrawal is associated with increased neural activity in reward-processing centers in healthy men: A functional magnetic resonance imaging study
The objective and subjective signs and symptoms of opioid withdrawal are well-documented, and validated scales have been developed for their assessment (Handelsman et al., 1987). (Source: Drug and Alcohol Dependence)


Clinical Reasoning: A case of unilateral facial pain
A 62-year-old man admitted with B cell chronic lymphocytic leukemia (CLL) reported 2 weeks of progressive left-sided jaw and facial pain. He first noticed the pain occurring during prolonged chewing. It was exacerbated by teeth clenching and resolved with jaw rest. The patient described the pain as dull and gnawing without radiation. He also described a "knot" within his left "jaw muscles" at the mandibular angle. He had decreased range of motion, could not fully open his mouth, and felt that his jaw was misaligned. He was therefore placed on a soft mechanical diet. He denied a temporal headache or transient loss of vision. He was on his second day of obinutuzumab chemotherapy but was not on any other new medications. He had no history of trauma to his face, head, or neck. (Source: Neurolo...


Metabolic analysis of knee synovial fluid as a potential diagnostic approach for osteoarthritis
This article is protected by copyright. All rights reserved (Source: Journal of Orthopaedic 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>


Editorial: Voltage‐Gated Calcium 2.2 Channels: Therapeutic Target for Chronic Arthritic Pain?
(Source: Arthritis and Rheumatism)


Suppression of Peripheral Pain by Blockade of Voltage‐Gated Calcium 2.2 Channels in Nociceptors Induces RANKL and Impairs Recovery From Inflammatory Arthritis in a Mouse Model
ConclusionTaken together, our results indicate that alleviation of peripheral pain by blockade of CaV2.2‐ mediated calcium influx and signaling in nociceptor sensory neurons impairs recovery from induced arthritis and point to the potentially devastating effects of using CaV2.2 channel blockers as analgesics during inflammation. (Source: Arthritis and Rheumatism)


Calcitonin Gene‐Related Peptide–Expressing Sensory Neurons and Spinal Microglial Reactivity Contribute to Pain States in Collagen‐Induced Arthritis
ConclusionSensory neuron–derived CGRP sustains mechanical hypersensitivity and spinal microglial reactivity in CIA, suggesting that central mechanisms play critical roles in chronic inflammatory pain. Blockade of these central events may provide pain relief in rheumatoid arthritis patients. (Source: Arthritis and Rheumatism)


Prevalence of Chronic Axial Pain, Inflammatory Back Pain, and Spondyloarthritis in Diagnosed Psoriasis
ConclusionThere is a higher prevalence of lower axial pain, IBP, SpA, and alternating buttock pain associated with a prior diagnosis of psoriasis. These data may influence the way psoriasis patients are approached in primary care and specialty clinics. (Source: Arthritis Care and Research)


Behcet Colitis
Clinics in Colon and Rectal Surgery 2015; 28: 099-102DOI: 10.1055/s-0035-1547336Behcet disease (BD) is a chronic, multisystem, inflammatory disease characterized by variable clinical manifestations involving systemic vasculitis of both the small and large blood vessels. The majority of BD patients present with recurrent oral ulcers in combination with other manifestations of the disease, including genital ulcers, skin lesions, arthritis, uveitis, thrombophlebitis, gastrointestinal or central nervous system involvement. Gastrointestinal BD occurs in 3 to 25% of the BD patients and shares many clinical characteristics with inflammatory bowel disease (IBD). Consequently, the differentiation between IBD and gastrointestinal manifestation of BD is very difficult. Intestinal BD should be conside...<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>


Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It's Been ….
CONCLUSION: The literature suggests that the medicinal use of cannabis may have a therapeutic role for a multitude of diseases, particularly chronic pain disorders including headache. Supporting literature suggests a role for medicinal cannabis and cannabinoids in several types of headache disorders including migraine and cluster headache, although it is primarily limited to case based, anecdotal, or laboratory-based scientific research. Cannabis contains an extensive number of pharmacological and biochemical compounds, of which only a minority are understood, so many potential therapeutic uses likely remain undiscovered. Cannabinoids appear to modulate and interact at many pathways inherent to migraine, triptan mechanisms ofaction, and opiate pathways, suggesting potential synergistic or ...


Kaempferol and inflammation: From chemistry to medicine
Publication date: Available online 14 May 2015 Source:Pharmacological Research Author(s): Kasi Pandima Devi , Dicson Sheeja Malar , Seyed Fazel Nabavi , Antoni Sureda , Jianbo Xiao , Seyed Mohammad Nabavi , Maria Daglia Inflammation is an important process of human healing response, wherein the tissues respond to injuries induced by many agents including pathogens. It is characterized by pain, redness and heat in the injured tissues. Chronic inflammation seems to be associated with different types of diseases such as arthritis, allergies, atherosclerosis, and even cancer. In recent years natural product based drugs are considered as the novel therapeutic strategy for prevention and treatment of inflammatory diseases. Among the different types of phyto-constituents present in natural prod...


Benzodiazepines may be worse than opioids: negative medication effects in severe chronic pain - Gauntlett-Gilbert J, Gavriloff D, Brook P.
OBJECTIVES: Opioid prescription for non-malignant pain is increasing in Europe and the US. Research and guidance have focused on the potential for dependency and medical side effects with high doses. In contrast, benzodiazepines have received little attent... (Source: SafetyLit: All (Unduplicated))


Verum and sham acupuncture exert distinct cerebral activation in pain processing areas: a crossover fMRI investigation in healthy volunteers
Abstract Although acupuncture is effective for treating pain, its site-specificity is questioned. The aim was to compare the cerebral responses of needling applied to an acupuncture point to the needling of a sham point, using functional magnetic resonance imaging (fMRI). Twenty-one healthy male volunteers were enrolled. Manual stimulation of the acupuncture (ST44) and sham points on the dorsum of the left foot was applied during fMRI in a crossover manner. fMRI data analysis was performed contrasting the ST44 and the sham conditions. Stimulation intensity, subjective discrimination of the needling site and the incidence of “Qi” sensation were additionally recorded. Stimulation of ST44 acupoint, in comparison to the sham procedure, was associated with an increased fMRI-activa...


Sympathetic innervation of human muscle spindles.
Authors: Radovanovic D, Peikert K, Lindström M, Domellöf FP Abstract The aim of the present study was to investigate the presence of sympathetic innervation in human muscle spindles, using antibodies against neuropeptide Y (NPY), NPY receptors and tyrosine hydroxylase (TH). A total of 232 muscle spindles were immunohistochemically examined. NPY and NPY receptors were found on the intrafusal fibers, on the blood vessels supplying muscle spindles and on free nerve endings in the periaxial space. TH-immunoreactivity was present mainly in the spindle nerve and vessel. This is, to our knowledge, the first morphological study concerning the sympathetic innervation of the human muscle spindles. The results provide anatomical evidence for direct sympathetic innervation of the intrafusal ...<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>


EGb761 Ameliorates Neuropathic Pain by Scavenging Reactive Oxygen Species
Conclusion: Taken together, our results suggest that administration of EGb761 can ameliorate neuropathic pain, and further indicate that JNK, which is activated by both exogenous and endogenous ROS, might be the mechanism underlying the effects of EGb761 on CCI neuropathic pain.Pharmacology 2015;95:293-299 (Source: Pharmacology)


How to investigate: Chronic pain
Publication date: Available online 23 May 2015 Source:Best Practice &amp; Research Clinical Rheumatology Author(s): Matthew Hague , Nicholas Shenker Chronic pain is defined as an unpleasant sensory and emotional experience persisting longer than the normal process of healing, usually longer than 3 months. About a fifth of the world's population is believed to suffer from chronic pain. In Europe, chronic pain accounts for nearly 500 m lost working days, and it costs the European economy &gt;€34 billion (£28 billion) every year. Establishing a reliable diagnosis is the primary challenge in evaluating a patient with chronic pain. Common diagnoses not to miss include seronegative spondyloarthritides, endocrine abnormalities including severe vitamin D deficiency and polymyalgia rh...


Evolving spectrum of HIV-associated rheumatic syndromes
Publication date: Available online 23 May 2015 Source:Best Practice &amp; Research Clinical Rheumatology Author(s): Christine Fox , Karen Walker-Bone At the end of 2013, 35 million people worldwide were infected with HIV. The prognosis of HIV has been transformed by combination antiretroviral therapy (cART). Providing compliance is good, the use of cART has normalised the life expectancy of HIV-infected people leading to a growing population of people with chronic infection. Management of HIV patients has therefore needed to adapt in order to not only control viral activity but also manage long-term complications of HIV and cART. Rheumatological manifestations of HIV were first described in 1989. Since then, there have been case reports, case series and epidemiological studies descri...


Meta-analyses of pain studies: What we have learned
Publication date: Available online 23 May 2015 Source:Best Practice &amp; Research Clinical Rheumatology Author(s): Winfried Häuser , Thomas R. Tölle Meta-analysis is a statistical procedure that integrates the results of at least two independent studies. The biggest threats to meta-analysis are publication bias due to missing studies with negative results and low-quality evidence due to methodological limitations imposed by included studies. Tools to improve the quality of meta-analysis have been developed by the Cochrane Collaboration and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Meta-analyses of trials have demonstrated that pain responses in patients with chronic pain, following treatment, are not normally distributed but have a bimodal...


Physical exercise as non-pharmacological treatment of chronic pain: Why and when
Publication date: Available online 23 May 2015 Source:Best Practice &amp; Research Clinical Rheumatology Author(s): Kirsten R. Ambrose , Yvonne M. Golightly Chronic pain broadly encompasses both objectively defined conditions and idiopathic conditions that lack physical findings. Despite variance in origin or pathogenesis, these conditions are similarly characterized by chronic pain, poor physical function, mobility limitations, depression, anxiety, and sleep disturbance, and they are treated alone or in combination by pharmacologic and non-pharmacologic approaches, such as physical activity (aerobic conditioning, muscle strengthening, flexibility training, and movement therapies). Physical activity improves general health, disease risk, and progression of chronic illnesses such as 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>


Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism(s)
Publication date: Available online 23 May 2015 Source:Best Practice &amp; Research Clinical Rheumatology Author(s): Daniel J. Clauw Until recently, most clinicians considered chronic pain to be typically due to ongoing peripheral nociceptive input (i.e., damage or inflammation) in the region of the body where the individual is experiencing pain. Clinicians are generally aware of a few types of pain (e.g., headache and phantom limb pain) where chronic pain is not due to such causes, but most do not realize there is not a single chronic pain state where any radiographic, surgical, or pathological description of peripheral nociceptive damage has been reproducibly shown to be related to the presence or severity of pain. The primary reason for this appears to be that both the peripheral a...


Cognitive behaviour therapy plus aerobic exercise training to increase activity in patients with myotonic dystrophy type 1 (DM1) compared to usual care (OPTIMISTIC): study protocol for randomised controlled trial
DiscussionOPTIMISTIC will not only provide effectiveness data on an intervention that could fill a treatment-gap for DM1 patients but will also improve our understanding of the relevant determinants of the prognosis of DM1.Trial registrationRegistration number: Cinicaltrials.gov NCT02118779; registered 11 April 2014. (Source: Epidemiologic Perspectives and Innovations)


Hope for People with IBD and Those at Risk
Marla Dubinsky, MD Chief, Pediatric Gastroenterology and Hepatology, and Co-Director of the Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center Icahn School of Medicine at Mount Sinai Hope for People with IBD and Those at Risk Up to 1.3 million Americans have inflammatory bowel disease (IBD), a complex disorder of the immune system that results in uncontrolled inflammation of the gastrointestinal (GI) tract. Crohn's disease and ulcerative colitis are the two most common forms of IBD, causing severe GI symptoms, such as diarrhea, abdominal pain, and rectal bleeding, that can wreak havoc with everyday life. These symptoms can often be controlled with medication, but many people still cycle through periods of remission and flare-ups. Deep, long-term remission is possib...


Improving methodology when analyzing shockwave evidence
A recent publication showed that extracorporeal shockwave therapy (ESWT) was neither effective nor cost-effective for low back pain [1]. This conclusion came after performing a systematic review of shockwave treatments in chronic low back pain using a FairMed device. However, we believe these conclusions must be reviewed because FairMed used for these studies is not a shockwave device. No physical parameter characterizing the pressure curve of the FairMed device has been described. This system does not meet the International Society for Medical Shockwave Treatment standards [2]. (Source: The Spine Journal)


Screening method for major depressive disorders by questionnaire survey in patients with chronic spinal pain
I greatly appreciate the study by Choi et al. [1] on the screening ability of depression in patients with chronic spinal pain. The authors used five screening tests for depression, and Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) Axis I Disorders (SCID-I) was set as a gold standard of major depressive disorders (MDDs). They mainly used a receiver-operating characteristic (ROC) curve analysis to determine the superiority among screening tests. (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 Chronic Abdominal Pain Affecting the Well-Being of ChildrenPredictors of Chronic Abdominal Pain Affecting the Well-Being of Children
Abdominal pain is frequent among children, and may persist for years. Are there specific patient characteristics at initial evaluation that might predict prognosis one year later? Annals of Family Medicine (Source: Medscape Today Headlines)


Acupuncture-brain interactions as hypothesized by mood scale recordings
Mood expressions encompassing positive scales like “activity, elation, contemplation, calmness” and negative scales like “anger, excitement, depression, fatigue” were applied for introducing a new tool to assess the effects of acupuncture on brain structures. Traditional acupuncture points defined in the literature for their effects on task negative and task positive brain structures were applied to chronic disease patients supposed to have dominant negative mood scales. Burn-out syndrome (n=10) and female chronic pain patients (n=22) showed a significant improvement on positive mood scales and a decline in negative mood scales after 10 acupuncture sessions. (Source: Medical Hypotheses)


Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances.
CONCLUSIONS: PEG was associated with a lower probability of intervention failure, suggesting the endoscopic procedure may be more effective and safe compared with NGT. There is no significant difference in mortality rates between comparison groups, or in adverse events, including pneumonia related to aspiration. Future studies should include details of participant demographics including underlying disease, age and gender, and the gastrostomy technique. PMID: 25997528 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


[Delayed complications after pancreatic surgery : Pancreatic insufficiency, malabsorption syndrome, pancreoprivic diabetes mellitus and pseudocysts].
CONCLUSION: As the evidence is limited, an interdisciplinary and individually tailored approach for delayed pancreatic morbidity is recommended. PMID: 25997699 [PubMed - as supplied by publisher] (Source: Der Chirurg)


Rendezvous technique for recanalization of long-segmental chronic total occlusion above the knee following unsuccessful standard angioplasty.
CONCLUSION: The rendezvous technique is a feasible and effective treatment for chronic total occlusions above the knee when standard angioplasty fails. PMID: 26002783 [PubMed - as supplied by publisher] (Source: Vascular)<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>


Acupuncture–brain interactions as hypothesized by mood scale recordings
Mood expressions encompassing positive scales like “activity, elation, contemplation, calmness” and negative scales like “anger, excitement, depression, fatigue” were applied for introducing a new tool to assess the effects of acupuncture on brain structures. Traditional acupuncture points defined in the literature for their effects on task negative and task positive brain structures were applied to chronic disease patients supposed to have dominant negative mood scales. Burn-out syndrome (n=10) and female chronic pain patients (n=22) showed a significant improvement on positive mood scales and a decline in negative mood scales after 10 acupuncture sessions. (Source: Medical Hypotheses)


Subacute combined degeneration of the spinal cord in a patient abusing nitrous oxide and self-medicating with cyanocobalamin.
CONCLUSION: A patient who abused nitrous oxide chronically developed ataxia, paresthesia, and urinary retention while self-medicating with cyanocobalamin. A diagnosis of SCD was supported by MRI findings, symptoms, and the known relationship between nitrous oxide exposure and vitamin B12 deficiency. PMID: 25987690 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)


Clinical implications of patient-provider agreements in opioid prescribing.
Authors: Kraus CN, Baldwin AT, Curro FA, McAllister RG Abstract In June, 2012 the United States Food and Drug Administration (FDA) developed a "blueprint" for prescriber education as a means of directing Certified Medical Education (CME) activities that included content which would meet the regulatory requirements of the class-wide, longacting/ extended-release (LA-ER) opioid Risk Evaluation Mitigation Strategies (REMS). Within the blueprint is the suggested adoption of Patient-Provider Agreements (PPAs) to be used in association with opioid prescribing, but, to our knowledge, there have been no reported evaluations of the role played by opioid-agent PPAs in clinical practice, or of the perceptions of this regulatory mandate by clinicians. Therefore, we conducted a survey regarding...


Mindfulness as Effective as CBT in Pain CatastrophizingMindfulness as Effective as CBT in Pain Catastrophizing
Mindfulness-based stress reduction may be as effective as cognitive-behavior therapy in countering the catastrophizing thought patterns of people with chronic back pain. Medscape Medical News (Source: Medscape Medical News Headlines)


Novus Medical Detox Addresses Opioids for Chronic Pain: The “Silent...
Although little scientific evidence exists to support the safety and efficacy of long-term opioid use and despite deadly results, an estimated 8 million Americans use opioids in lieu of many other...(PRWeb May 21, 2015)Read the full story at http://www.prweb.com/releases/2015/05/prweb12738054.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>


Preoperative anxiety induces no clinically relevant effect on intraoperative nociceptive levels during breast surgery under general anesthesia
In conclusion, the level of nociception during breast surgery is not significantly affected by preoperative anxiety. (Source: Journal of Anesthesia)


Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial
Publication date: Available online 18 May 2015 Source:The Lancet Author(s): Robert Pickard , Kathryn Starr , Graeme MacLennan , Thomas Lam , Ruth Thomas , Jennifer Burr , Gladys McPherson , Alison McDonald , Kenneth Anson , James N'Dow , Neil Burgess , Terry Clark , Mary Kilonzo , Katie Gillies , Kirsty Shearer , Charles Boachie , Sarah Cameron , John Norrie , Samuel McClinton Background Meta-analyses of previous randomised controlled trials concluded that the smooth muscle relaxant drugs tamsulosin and nifedipine assisted stone passage for people managed expectantly for ureteric colic, but emphasised the need for high-quality trials with wide inclusion criteria. We aimed to fulfil this need by testing effectiveness of these drugs in a standard clinical care setting. Methods For this mu...


Psychological aspects of chronic musculoskeletal pain
Publication date: Available online 21 May 2015 Source:Best Practice &amp; Research Clinical Rheumatology Author(s): Leslie J. Crofford Chronic musculoskeletal pain, by its very nature, is associated with negative emotions and psychological distress. There are individual differences in personality, coping skills, behavioral adaptation, and social support that dramatically alter the psychological outcomes of patients with chronic pain. Patients who have an aspect of central pain amplification associated with mechanical or inflammatory pain and patients with fibromyalgia (FM) are likely to exhibit higher levels of psychological distress and illness behaviors. This manuscript discusses several different constructs for the association between chronic pain, central pain amplification, and ...


“Real-life” treatment of chronic pain: Targets and goals
Publication date: Available online 20 May 2015 Source:Best Practice &amp; Research Clinical Rheumatology Author(s): Jacob N. Ablin , Dan Buskila Treating chronic pain is a complex challenge. While textbooks and medical education classically categorize pain as originating from peripheral (nociceptive), neuropathic, or centralized origins, in real life each and every patient may present a combination of various pain sources, types, and mechanisms. Moreover, individual patients may evolve and develop differing types of pain throughout their clinical follow-up, further emphasizing the necessity to maintain clinical diligence during the evaluation and follow-up of these patients. Rational treatment of patients suffering from chronic pain must attempt at deconstructing complex pain cases, ...


Pain in systemic inflammatory rheumatic diseases
Publication date: Available online 19 May 2015 Source:Best Practice &amp; Research Clinical Rheumatology Author(s): Fabiola Atzeni , Ignazio Francesco Masala , Fausto Salaffi , Manuela Di Franco , Roberto Casale , Piercarlo Sarzi-Puttini The sometimes intense, persistent and disabling pain associated with rheumatoid arthritis (RA) and spondyloarthritis frequently has a multifactorial, simultaneously central and peripheral origin, and it may be due to currently active inflammation or joint damage and tissue destruction caused by a previous inflammatory condition. The symptoms of inflammatory pain symptoms can be partially relieved by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in central pain regulation mechanisms, 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>


Oxytocin and the modulation of pain experience: Implications for chronic pain management
Publication date: August 2015 Source:Neuroscience &amp; Biobehavioral Reviews, Volume 55 Author(s): Lincoln M. Tracy , Nellie Georgiou-Karistianis , Stephen J. Gibson , Melita J. Giummarra In an acute environment pain has potential protective benefits. However when pain becomes chronic this protective effect is lost and the pain becomes an encumbrance. Previously unheralded substances are being investigated in an attempt to alleviate the burden of living with chronic pain. Oxytocin, a neuropeptide hormone, is one prospective pharmacotherapeutic agent gaining popularity. Oxytocin has the potential to modulate the pain experience due to its ubiquitous involvement in central and peripheral psychological and physiological processes, and thus offers promise as a therapeutic agent. In this...


Hepatitis C virus infection and pain sensitivity in patients on methadone or buprenorphine maintenance therapy for opioid use disorders
Chronic pain is a global problem (Blyth et al., 2001; Gureje et al., 1998) and a frequent cause for seeking medical care (Andersson et al., 1999; Kroenke and Mangelsdorff, 1989; Mantyselka et al., 2001). Patients with a history of opioid use disorders appear to be particularly vulnerable to pain (Karasz et al., 2004; Rosenblum et al., 2003; Sheu et al., 2008). The prevalence of chronic pain among persons with opioid use disorders treated with opioid agonist therapy (OAT) ranges from 36 to 61% (Barry et al., 2009, 2013; Jamison et al., 2000; Rosenblum et al., 2003). (Source: Drug and Alcohol Dependence)


Islet Transplantation for Type 1 Diabetes, 2015: What Have We Learned From Alloislet and Autoislet Successes?
The therapeutic potential of pancreatic islet allotransplantation, in which human donor islets are used, as a treatment for type 1 diabetes (T1D) has fascinated diabetes researchers and clinicians for decades. At the same time, the therapeutic potential of total pancreatectomy and islet autotransplantation (TPIAT) (in which one&rsquo;s own islets are used) as a preventive treatment for diabetes in patients who undergo total pancreatectomy for chronic, painful pancreatitis has received relatively less attention. This is ironic, since the latter has been much more effective than the former in terms of successful glucose management and duration of efficacy. The reasons for this disparity can be partially identified. TPIAT receives very little attention in textbooks of internal medicine and ge...


Patient-centered care for chronic pain in the emergency department: a qualitative study
• Patient centered care must be individualized with culturally appropriate assessment.• Individualized care planning may ensure an effective transition of care.• Health care providers must deal ethically and respectfully with patients of all types.• Emergency department nurses can advocate for a model for patient centered care. (Source: International Emergency Nursing)


Muscle Monitoring and Maintenance as an End Point for Patients Treated for Cancer
In the past, people being treated for chronic disease, including cancer, were often advised by their physician to rest and reduce their physical activity. This is suitable advice if movement causes pain, cardiac or respiratory distress. Newer research indicates that exercise is not only safe but also feasible during cancer treatment, improving physical function and quality of life. (Source: Clinical Oncology)<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>


Microsurgical Spermatic Cord Denervation as a Treatment for Chronic Scrotal Content Pain: A Multicenter Open Label Trial
To prospectively evaluate the results of microsurgical spermatic cord denervation in a series of patients with chronic scrotal content pain in a multicenter study, including one center in Germany and three centers in Chile. (Source: The Journal of Urology)


Cost-effectiveness of stimulation of the sphenopalatine ganglion (SPG) for the treatment of chronic cluster headache: a model-based analysis based on the Pathway CH-1 study
Conclusions Our model-based analysis suggests that SPG stimulation for the treatment of chronic cluster headache, under the assumption of sustained therapy effectiveness, leads to meaningful gains in health-related quality of life and is a cost-effective treatment strategy in the German healthcare system. (Source: The Journal of Headache and Pain)


WITHDRAWN: Botulinum toxin for subacute/chronic neck pain.
CONCLUSIONS: Current evidence fails to confirm either a clinically important or a statistically significant benefit of BoNT-A injection for chronic neck pain associated with or without associated cervicogenic headache. Likewise, there was no benefit seen for disability and quality of life at four week and six months. PMID: 25994306 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


WITHDRAWN: Medicinal and injection therapies for mechanical neck disorders.
CONCLUSIONS: ??? PMID: 25994305 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Sex differences in cerebellar mechanisms involved in pain-related safety learning.
Authors: Labrenz F, Icenhour A, Thürling M, Schlamann M, Forsting M, Timmann D, Elsenbruch S Abstract Recent studies have suggested that the cerebellum contributes to the central processing of pain, including pain-related learning and memory processes. As a complex experience with multiple emotional and cognitive facets, the response to pain and its underlying neural correlates differ between men and women. However, it remains poorly understood whether and to what extent sex differences exist in the cerebellar contribution to pain-related associative learning processes. In the present conditioning study with experimental abdominal pain as unconditioned stimuli (US), we assessed sex-dependent differences in behavioral and neural responses to conditioned warning and safety cues in 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>


Treatment of pain in fibromyalgia patients with testosterone gel: Pharmacokinetics and clinical response.
Authors: White HD, Brown LA, Gyurik RJ, Manganiello PD, Robinson TD, Hallock LS, Lewis LD, Yeo KT Abstract To test our hypothesis that testosterone deficiency plays an important role in chronic pain, a Phase I/II pilot study was initiated with 12 fibromyalgia patients to verify that a daily dose for 28days with transdermal testosterone gel would 1) significantly and safely increase mean serum testosterone concentrations from low baseline levels to mid/high-normal levels, and 2) effectively treat the pain and fatigue symptoms of fibromyalgia. Pharmacokinetic data confirmed that serum free testosterone concentrations were raised significantly above baseline levels, by assessment of maximum hormone concentration (Cmax) and area under the curve (AUC) parameters: free testosterone Cmax ...


A novel use for testosterone to treat central sensitization of chronic pain in fibromyalgia patients.
Authors: White HD, Robinson TD Abstract Fibromyalgia is a diffuse chronic pain condition that occurs predominantly in women and may be under-reported in men. Symptoms include a loss of feeling of well-being and generalized widespread flu-like muscle aches and pain that fail to resolve due to central sensitization of nociceptive neurons. It has commonalities with a myriad of other chronic pain conditions which include PTSD, "Gulf War Syndrome", and various stress-induced conditions caused, for example, by viral infection, emotional or physical stress, trauma, combat, accident or surgery. It is not understood why some individuals are susceptible to this condition and others are not. White et al., elsewhere in this issue, present a clinical feasibility study designed to test the hypot...


Hypogonadism associated with long-term opioid therapy: A systematic review.
CONCLUSIONS: There is lack of high-quality studies to associate chronic opioid pain management with hypogonadism. At present, there is fair evidence to associate hypogonadism with chronic opioid pain management, and only limited evidence for treatment of OPISHD. PMID: 25985810 [PubMed - in process] (Source: Journal of Opioid Management)


Opioid regimens in patients with chronic pain with multiple cytochrome P450 defects.
Authors: Tennant F Abstract There is a subgroup of patients with chronic pain who have multiple cytochrome P450 enzyme defects. These patients tend to use opioids that are not metabolized by the CYP450 system and most apparently require a higher than average dosage. A significant number require nonoral administration. PMID: 25985808 [PubMed - in process] (Source: Journal of Opioid Management)


Functional Fecal Retention Visualized by 111In-DTPA Colon Transit Scintigraphy
We present small bowel and colon transit scintigraphy of a 14-year-old girl with history of chronic constipation, abdominal pain, weight loss, and poor response to medical treatment. After oral administration of 111In-DTPA in water, planar and SPECT/CT images showed normal small bowel transit time and functional fecal retention in colon transit study. (Source: Clinical Nuclear 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>


[Editors' Choice] Which receptor underlies chronic pain?
Finding that nicotinic receptors containing the a6 subunit, but not the a4, inhibit chronic pain points to a new set of potential therapeutic drugs. (Source: Signal Transduction Knowledge Environment)


Microsurgical Varicocele Repair on Men with Grade III Lesions and Chronic Dull Scrotal Pain: A Pilot Study
Conclusion: These results indicated that microsurgical varicocele repair may benefit patients with grade III lesions and chronic dull scrotal pain.Curr Urol 2014;8:29-31 (Source: Current Urology)


Changes in erectile organ structure and function in a rat model of chronic prostatitis/chronic pelvic pain syndrome
Summary There is a growing recognition of the association between chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and erectile dysfunction (ED); however, most of the reports are based on questionnaires which cannot distinguish between organic and functional ED. The purpose of this study was to determine the exact relationship between CP/CPPS and ED, and to investigate the changes in erectile organ structure and function in a rat model of CP/CPPS. We established a rat model of experimental autoimmune prostatitis (EAP), which is a valid model for CP/CPPS. Erectile function in EAP and normal rats was comparable after cavernous nerve electrostimulation. The serum testosterone and oestradiol levels, ultrastructure of the corpus cavernosum and expression of endothelial nitric oxide sy...


Combination Of Medical Marijuana, Opioids Does Not Increase Substance Abuse Risk, Study Finds
With nearly half of the country&nbsp;having already legalized&nbsp;the use of cannabis for medical purposes, physicians prescribing opioids for pain management have another alternative at their disposal. As medical marijuana laws become more relaxed, practitioners now have the option of treating&nbsp;chronic pain patients with prescription opioids, medical cannabis or both. Among many, however, there's a concern about the adverse effects in patients using both. (Source: Forbes.com Healthcare News)


Is Medicine Ignoring Key Influences on Chronic Pain? And Important Therapeutic Solutions?
No abstract available (Source: The Back Letter)<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>


Steroids No Better for Sciatica Pain Than Placebo, Study Finds
Title: Steroids No Better for Sciatica Pain Than Placebo, Study FindsCategory: Health NewsCreated: 5/19/2015 12:00:00 AMLast Editorial Review: 5/20/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Antinociceptive Efficacy of Retigabine in the Monosodium Lodoacetate Rat Model for Osteoarthritis Pain
Conclusion: Retigabine showed antinociceptive effects for OA pain in the MIA model at different times during pain development. Retigabine may be an alternative therapeutic treatment for OA.Pharmacology 2015;95:251-257 (Source: Pharmacology)


Prevalence and Role of a Low-Lying Peroneus Brevis Muscle Belly in Patients With Peroneal Tendon Pathologic Features: A Potential Source of Tendon Subluxation
Publication date: Available online 19 May 2015 Source:The Journal of Foot and Ankle Surgery Author(s): Roya Mirmiran , Chad Squire , Daniel Wassell A peroneus brevis low-lying muscle belly (LLMB) is a rare anomaly. A few published studies have supported the presence of this anomaly as an etiology for a peroneal tendon tear. However, the association between a peroneus brevis LLMB and tendon subluxation has not been well explored. In the present retrospective study, the magnetic resonance imaging (MRI) and intraoperative findings of 50 consecutive patients undergoing primary peroneal tendon surgery during a 5-year period were assessed. The sensitivity and specificity of MRI compared with the intraoperative findings for identifying peroneal tendon disease were investigated. The presence of ...


Lateral Hindfoot Impingement After Nonunion of Fracture of the Lateral Process of the Talus
We present the case of a patient with such an injury. The patient was treated operatively and was followed for 18 months. (Source: The Journal of Foot and Ankle Surgery)


Pulse‐dose radiofrequency can reduce chronic pain in trapezio‐metacarpal osteoarthritis: A mini‐invasive therapeutic approach
ConclusionsThe PDRF may be a safe, repeatable and effective short‐term pain management technique in patients with trapezio‐metacarpal OA. Larger, randomized controlled studies are indicated to better clarify the efficacy and utility of the PDRF. (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>


Fibromyalgia with chronic rheumatic diseases in South Korea: a comparison of clinical and American College of Rheumatology criteria
ConclusionsWe found a 10.4~34.2% prevalence of concomitant FM in the patients with chronic widespread pain. The 1990 ACR criteria were the most restrictive except for SLE. Although The 2010 ACR criteria had a wide spectrum, it can be used for FM diagnosis even in the patient with underlying rheumatic diseases. (Source: APLAR Journal of Rheumatology)


Telephone interview strategy can be used for screening inflammatory back pain in the community
ConclusionThe results of our study indicate that telephone surveys based on Calin's criteria for IBP has a moderate, almost substantial agreement with face‐to‐face interviews and can be used as an easily applicable, less expensive and time‐saving method in screening subjects for IBP. (Source: APLAR Journal of Rheumatology)


Hypothesis: Human papillomavirus vaccination syndrome—small fiber neuropathy and dysautonomia could be its underlying pathogenesis
This article forwards the hypothesis that small fiber neuropathy and dysautonomia could be the common underlying pathogenesis to the group of rare, but severe reactions that follow HPV vaccination. Clinicians should be aware of the possible association between HPV vaccination and the development of these difficult to diagnose painful dysautonomic syndromes. (Source: Clinical Rheumatology)


Update on the genetics of the fibromyalgia syndrome
Publication date: Available online 18 May 2015 Source:Best Practice &amp; Research Clinical Rheumatology Author(s): Jacob N. Ablin , Dan Buskila Fibromyalgia syndrome (FMS), a condition characterized by chronic widespread pain and tenderness, is a complex condition considered to represent a paradigm of centralized pain. FMS has demonstrated a clear familial aggregation, and hence it is considered to have a genetic background. Multiple candidate-gene studies have been conducted in this field, focusing on target genes that play a role in the transmission and processing of pain. While many of these have focused in the past on markers related to neurotransmitter systems such as catecholamines (catechol-O-methyltransferase (COMT)) and serotonin, novel target genes have recently emerged. I...


Quality of life and sexual satisfaction in women suffering from endometriosis: An Italian preliminary study
Discussion and conclusion Our results showed that the disease has a negative impact on many areas of the overall functioning and sexuality quality of life of women. Nevertheless, the existence of mediatory variables emerged, emphasising how the presence of a partner could be considered a protective value in the experience of pain, therefore stressing the need to adopt a bio-psychosocial perspective to study and fully understand the disease. (Source: Sexologies)<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>


Alcohol and Tobacco Use in Youth With and Without Chronic Pain
Conclusions&nbsp;Chronic pain may not increase risk for tobacco and alcohol use in adolescents. Research is needed to understand use of other substances in this medically vulnerable population. (Source: Journal of Pediatric Psychology)


Neuromuscular Ultrasound Imaging in Low Back Pain Patients with Radiculopathy
Patients suffering from chronic low back pain with associated radiculopathy (LBP-R), or sciatica, experience neuromuscular symptoms in the lower back and leg; however, research to date has focussed solely on the lower back. (Source: Manual Therapy)


Effects of focal muscle vibration on physical functioning in patients with knee osteoarthritis: a randomized controlled trial.
CONCLUSIONS: In this study, focal muscle vibration therapy has proven to be effective and safe in improving functioning of patients affected by mild to moderate chronic knee OA. CLINICAL REHABILITATION IMPACT: The use of focal muscle vibration therapy might be an additional and safe tool in the conservative management of knee OA. PMID: 25990196 [PubMed - as supplied by publisher] (Source: European Journal of Physical and Rehabilitation Medicine)


Evidence for a distinct neuro-immune signature in rats that develop behavioural disability after nerve injury
Conclusions: This study has defined individual differences in the immune response at peripheral and spinal sites following CCI in rats. These changes correlated with the degree of disability. Our data suggest that individual immune signatures play significant roles in the different behavioural trajectories following nerve injury, and in some cases may lead to persistent affective-motivational disturbances. (Source: Journal of Neuroinflammation)


Specific and number of comorbidities are associated with increased levels of temporomandibular pain intensity and duration
Conclusion This study shows that the number of comorbidities is positively associated with TMD pain duration and intensity. The presence of specific conditions, such as migraine and chronic fatigue syndrome, is associated with an increase in TMD intensity and duration. (Source: The Journal of Headache and 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>


Targeting the Affective Component of Chronic Pain: a Case Series of Deep Brain Stimulation of the Anterior Cingulate Cortex: Erratum
No abstract available (Source: Neurosurgery)


Endometriosis – Hope is at Hand
The post Endometriosis – Hope is at Hand appeared first on Hysterectomy Association. ‘Historically, the symptoms of inexplicable chronic pelvic pain have often been attributed to imagined madness, female weakness, promiscuity or hysteria’ Wikipedia on Endometriosis. Fortunately, the tide has turned on this outmoded way of thinking! Modern medicine recognises the painful truth about endometriosis and uterine fibroids to such an extent that Covance, the clinical research unit in Leeds, has an upcoming study which could provide hope for women suffering from these aggressive and often debilitating conditions. Currently, there is no existing drug which combats the full spectrum of endometriosis and fibroids symptoms. I have little doubt that these symptoms will be familiar to loads of you...


Newbridge Spine & Pain Now Offering Revolutionary Procedure for...
The top pain management clinics in Maryland, Newbridge Spine & Pain, are now offering a revolutionary treatment for chronic back and neck pain. The procedure, radiofrequency ablation, offers up to...(PRWeb May 19, 2015)Read the full story at http://www.prweb.com/releases/pain-clinic-md/frederick-dundalk-waldorf/prweb12732693.htm (Source: PRWeb: Medical Pharmaceuticals)


Buprenorphine Buccal Film Reduces Chronic Low Back PainBuprenorphine Buccal Film Reduces Chronic Low Back Pain
A new study has shown that buprenorphine delivered through a buccal film can reduce chronic low back pain with few adverse effects. Medscape Medical News (Source: Medscape Neurology and Neurosurgery Headlines)


ketoprofen (Discontinued brands: Nexcede, Orudis, Oruvail, Actron)
Title: ketoprofen (Discontinued brands: Nexcede, Orudis, Oruvail, Actron)Category: MedicationsCreated: 12/31/1997 12:00:00 AMLast Editorial Review: 5/19/2015 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>


Medical Pot-Painkiller Combo Isn't Always Recipe for Abuse
Title: Medical Pot-Painkiller Combo Isn't Always Recipe for AbuseCategory: Health NewsCreated: 5/18/2015 12:00:00 AMLast Editorial Review: 5/19/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Combined endovascular and endoscopic management of thoracic aortic pseudoaneurysm, mediastinal pseudocyst, and pancreatic pleural effusion due to chronic pancreatitis
A 49-year-old man presented to the cardiology unit with sudden-onset chest pain. His electrocardiogram and cardiac troponin levels were within normal limits. The patient had a history of alcohol abuse and had experienced episodes of abdominal pain for the previous 2 years. Contrast-enhanced CT (CECT) of the chest revealed bilateral pleural effusion and a descending thoracic aorta pseudoaneurysm (Fig. 1A). The surrounding mediastinum had a fluid collection that communicated with the abdominal pseudocyst (Fig. 1A, B). (Source: Gastrointestinal Endoscopy)


Erratum to: Relative frequency of chronic postoperative pain in patients operated for chronic otitis media
(Source: European Archives of Oto-Rhino-Laryngology)


Development of a High-Throughput Screening Assay to Identify Inhibitors of the Lipid Kinase PIP5K1C
Phosphatidylinositol 4-phosphate 5-kinases (PIP5Ks) regulate a variety of cellular processes, including signaling through G protein-coupled receptors (GPCRs), endocytosis, exocytosis, and cell migration. These lipid kinases synthesize phosphatidylinositol 4,5-bisphosphate (PIP2) from phosphatidylinositol 4-phosphate [PI(4)P]. Because small-molecule inhibitors of these lipid kinases did not exist, molecular and genetic approaches were predominantly used to study PIP5K1 regulation of these cellular processes. Moreover, standard radioisotope-based lipid kinase assays cannot be easily adapted for high-throughput screening. Here, we report a novel, high-throughput, microfluidic mobility shift assay to identify inhibitors of PIP5K1C. This assay uses fluorescently labeled phosphatidylinositol 4-p...


Comparison of Fluoroscopy and Ultrasound Guidance for Sacroiliac Joint Injection in Patients with Chronic Low Back Pain
ConclusionsUltrasound‐guided SIJ injection with fluoroscopic confirmation has similar accuracy and efficacy to fluoroscopy alone for SIJ injections in patients with chronic low back pain secondary to SIJ arthritis. (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>


Hyperbaric Oxygen Therapy: A New Treatment for Chronic Pain?
ConclusionsHBOT has been shown to reduce pain using animal models. Early clinical research indicates HBOT may also be useful in modulating human pain; however, further studies are required to determine whether HBOT is a safe and efficacious treatment modality for chronic pain conditions. (Source: Pain Practice)


Day‐to‐Day Changes of Auricular Point Acupressure to Manage Chronic Low Back Pain: A 29‐day Randomized Controlled Study
ConclusionThis study shows that APA is a promising pain management strategy that is not invasive and can be self‐managed by participants for CLBP. Given the day‐to‐day fluctuation in ratings, the tighter ecologic assessment of pain scores and other treatment parameters are an important pragmatic aspect of the design of chronic pain studies. (Source: Pain Medicine)


An overlooked cause of head- and neck-pain: Chronic canalithiasis, or Benign Paroxysmal Positional Vertigo – BPPV
Publication date: July 2015 Source:Scandinavian Journal of Pain, Volume 8 Author(s): Harald Breivik (Source: Scandinavian Journal of Pain)


Treatment of chronic canalithiasis can be beneficial for patients with vertigo/dizziness and chronic musculoskeletal pain, including whiplash related pain
Publication date: July 2015 Source:Scandinavian Journal of Pain, Volume 8 Author(s): Wenche Iglebekk , Carsten Tjell , Peter Borenstein Background and aim Chronic musculoskeletal pain, e.g. whiplash associated disorders (WAD), fibromyalgia and myalgia, causes significant burden on both the individual and on society as a whole. In a previous study, the authors concluded that there is a likely connection between chronic benign paroxysmal positional vertigo (BPPV)/canalithiasis and headache, neck pain, generalized pain, fatigue, cognitive dysfunctions as well as tinnitus. The balance dysfunction in BPPV/canalithiasis is dynamic and not static. This leads to a perpetual postural mismatch. The vicious cycle of a disturbed equilibrium control system may be the driving force behind the vicious ...


Intra- and postoperative intravenous ketamine does not prevent chronic pain: A systematic review and meta-analysis
Conclusions Based on the currently available data, there is currently not sufficient evidence to support a reduction in chronic pain due to perioperative administration of ketamine. Only the analysis of postoperative pain at rest after 1 month resulted in a marginally significant reduction of chronic postoperative pain using ketamine in the perioperative setting. Implications It can be hypothesised, that regional anaesthesia in addition to the administration of perioperative ketamine might have a preventive effect on the development of persistent postsurgical pain. An additional high-quality pain relief intra- and postoperatively as well after discharge could be more effective than any particular analgesic method per se. It is an assumption that a low dose infusion ketamine has to be admi...<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>


Experimental design and reporting standards for improving the internal validity of pre-clinical studies in the field of pain: Consensus of the IMI-Europain consortium
Conclusions More systematic research is needed to analyze how inadequate internal validity and/or experimental bias may impact reproducibility across pre-clinical pain studies. Addressing the potential threats to internal validity and the sources of experimental biases, as well as increasing the transparency in reporting, are likely to improve preclinical research broadly by ensuring relevant progress is made in advancing the knowledge of chronic pain pathophysiology and identifying novel analgesics. Implications We are now disseminating these Europain processes for discussion in the wider pain research community. Any benefit from these guidelines will be dependent on acceptance and disciplined implementation across pre-clinical laboratories, funding agencies and journal editors, but it i...


Single cases are complex Illustrated by Flink et al. ‘Happy despite pain: A pilot study of a positive psychology intervention for patients with chronic pain’
Publication date: April 2015 Source:Scandinavian Journal of Pain, Volume 7 Author(s): Stephen Morley (Source: Scandinavian Journal of Pain)


Happy despite pain: Pilot study of a positive psychology intervention for patients with chronic pain
Conclusions The results of this preliminary study indicate that a positive psychology intervention may have beneficial effects for some chronic pain patients. Although it is not to be expected that a limited positive psychology intervention on its own is sufficient to treat pain-related disability in chronic patients, our findings suggest that for some it may be an advantageous complement to enhance the effects of other interventions. Implications The results of this pilot study about the potential effects of a positive psychology intervention for chronic pain patients may be encouraging, warranting a larger randomized controlled study. Future studies may also concentrate on integrating positive psychology techniques into existing treatments, such as composite CBT-programs for chronic pai...


Osteopathic manipulative treatment for chronic nonspecific neck pain: A systematic review and meta-analysis
The objective of the current review was to assess the effectiveness of osteopathic manipulative treatment (OMT) in the management of chronic nonspecific neck pain regarding pain, functional status, and adverse events. (Source: International Journal of Osteopathic Medicine)


Lateral Hindfoot Impingement After Nonunion of Fracture of the Lateral Process of the Talus
We present the case of a patient with such an injury. The patient was treated operatively and was followed for 18 months. (Source: Journal of 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>


Surgical Success in Chronic Pancreatitis: Sequential Endoscopic Retrograde Cholangiopancreatography and Surgical Longitudinal Pancreatojejunostomy (Puestow Procedure)
Conclusion ERCP and stenting provide a therapeutic trial to assess possible benefit of a definitive duct drainage procedure. LPJ—the modified Puestow operation was safe and complication-free with good medium-term relief of symptoms. We were not able to identify a consistent etiology-associated outcome.[...]Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: European Journal of Pediatric Surgery)


Quality of life outcomes in women with endometriosis are highly influenced by recruitment strategies
STUDY QUESTION To what extent are outcome measures in endometriosis-related quality of life studies influenced by the setting in which patient recruitment is performed? SUMMARY ANSWER Quality of life outcomes in women with endometriosis are highly influenced by recruitment strategies. WHAT IS KNOWN ALREADY Most studies on quality of life in women with endometriosis are conducted in tertiary care centres or patient associations. It is conceivable that the setting in which patient recruitment is performed influences the quality of life results. This has not been investigated before. STUDY DESIGN, SIZE, DURATION Retrospective questionnaire based cohort study (part of the World Endometriosis Research Foundation (WERF) EndoCost study). The investigated women were recruited in three settings:...


Prevalence, management and burden of episodic and chronic headaches—a cross-sectional multicentre study in eight Austrian headache centres
Conclusion This study provides comprehensive data from eight Austrian headache centres for the first time. We found a substantial number of patients with CH including pMOH and its association with more common utilization of health care facilities and greater burden. The low use of prophylactic medication requires further examination. (Source: The Journal of Headache and Pain)


Treadmill Training Combined with Insulin Suppresses Diabetic Nerve Pain and Cytokines in Rat Sciatic Nerve.
CONCLUSIONS: Treadmill training combined with insulin therapy showed the best improvements in tactile allodynia and thermal hyperalgesia among our 3 treatment groups. The benefits of insulin intervention and treadmill training could be related to chronic inflammation (proinflammatory cytokines) and oxidative stress (MDA). PMID: 25993391 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)


Building bridges between doctors and patients: the design and pilot evaluation of a training session in argumentation for chronic pain experts
Conclusions: This study enriches the research in the field of medical education. In line with the findings of studies that explore the value of argumentation in different fields, argumentative discussion skills can be applied by doctors to express their views and to account for the views of patients without patronizing the interaction. In this paper, we provide a basis to reflect on the value of argumentation in enhancing patients’ right to autonomy and self-determination in interactions with their doctors. (Source: BMC Medical Education)<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>


Qing-Yi decoction in participants with severe acute pancreatitis: a randomized controlled trial
Conclusions: QYD could restore gastrointestinal motility to normal and reduce the infection rates in the SAP patients who completed a full course of QYD treatment according to per protocol analysis. (Source: Chinese Medicine)


[Acute abdomen due to complicated intramural duodenal hematoma. We report of a case and review in the literature].
CONCLUSIONS: Duodenal intramural hematoma secondary to chronic pancreatitis are rare, although the diagnosis should be made with imaging and, if suspected it, we start conservative treatment and surgery only in complicated cases. PMID: 26001766 [PubMed - as supplied by publisher] (Source: Cirugia y Cirujanos)


Could a simple magnet magic away all of your aches and pains?
Faith Eckersall, 50, Sophie Mullins, 32 and Sheila Wenborne, 55, all use magnets to ease a variety of different medical conditions including chronic back pain, arthritis and the menopause. (Source: the Mail online | Health)


Deciding When to Prescribe Opioids in Primary CareDeciding When to Prescribe Opioids in Primary Care
How do primary care physicians approach the challenges of prescribing opioids in the context of chronic noncancer pain management? BMC Family Practice (Source: Medscape Today Headlines)


Candida, chronic inflammation - How to heal and rid the body of pain
(NaturalNews) Inflammation is a natural, healthy response to cellular damage or a natural, healthy immune response to a perceived threat. The idea that inflammation can persist without serving a purpose is a misnomer that allows the cause of disease to go unchecked and ignored.When... (Source: NaturalNews.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>


Mindfulness-based stress reduction (MBSR) as sole intervention for non-somatisation chronic non-cancer pain (CNCP): protocol for a systematic review and meta-analysis of randomised controlled trials
Introduction Chronic non-cancer pain (CNCP) affects up to 50% of the world's population. It impacts negatively on quality of life; entailing high costs on our medical systems, and translates to economic burden due to work loss. Aetiology of CNCP is complex and multifactorial, embracing the somatosensory, cognitive and affective domains. Opioid analgesia and other invasive interventions are often inadequate for clinical management of CNCP. Recently, mindfulness-based stress reduction (MBSR) has become a popular therapy for various medical conditions, including CNCP. However, studies reported varying efficacies, and relevant systematic reviews have included clinical trials with inherent heterogeneity either in study conditions or types of interventions used. Our study aims to provide an upda...


Overlap between fibromyalgia tender points and Charcot's hysterical zones: A historical curiosity
A 50-year-old woman was referred for evaluation of a bizarre gait pattern, defined as a functional movement disorder. Comorbidities included depression, sleep disorder, and chronic generalized pain for more than 1 year. On clinical examination, she had pain upon touching 15 out of the 18 specified tender points (figure, A), suggesting the diagnosis of fibromyalgia. When questioned about pain, she fulfilled the diagnostic criteria for fibromyalgia, with a widespread pain index &gt;7 and a symptom severity scale score &gt;5.1 These fibromyalgia tender points are similar to the ones described by Charcot in 1890, defined as "zones hyst&eacute;rog&egrave;nes"&mdash;hysterical zones (figure, B), overlapping perfectly.2 (Source: Neurology)


Treatment of Secondary Osteonecrosis of the Knee with Local Debridement and Osteoprogenitor Cell Grafting
We report a series of young patients in whom the osteonecrotic lesion was openly debrided, and concentrated bone marrow osteoprogenitor cells (OPC) harvested from the iliac crest were placed in the defect. Twelve patients (fourteen knees) have undergone debridement and grafting of distal femoral osteonecrotic lesions. Age at surgery averaged 23 years. Follow-up averaged 5 years. None of the patients have undergone further surgery, or were taking medications for ipsilateral knee pain. (Source: The Journal of Arthroplasty)


The effectiveness of acupuncture versus clonazepam in patients with burning mouth syndrome.
CONCLUSIONS: Acupuncture and clonazepam are similarly effective for patients with BMS. PMID: 25987645 [PubMed - as supplied by publisher] (Source: Acupuncture in Medicine : journal of the British Medical Acupuncture Society)


Disease burden of rheumatic diseases in India: COPCORD perspective
Publication date: Available online 16 May 2015 Source:Indian Journal of Rheumatology Author(s): Arvind Chopra The maiden WHO ILAR COPCORD (community oriented program for control of rheumatic diseases) Bhigwan (1996–2014) demonstrated that musculoskeletal (MSK) pain was the commonest self-reported ailment in the community, soft tissue rheumatism, ill-defined MSK symptoms and osteoarthritis (OA) were the predominant disorders and about 10% cases suffered from inflammatory arthritis. The burden of rheumatoid arthritis (RA) was high with point prevalence of 0.7%. Bone and joint decade (BJD) India conducted several standardized and uniform surveys (2004–2010) all over India and collected data from over 55,000 persons at 12 sites. The pooled age sex adjusted (India census population 2001) ...<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>


Iyengar yoga may be suitable for inclusion in interdisciplinary chronic pain interventions, but evidence is limited
(Source: Focus on Alternative and Complementary Therapies)


Laparoscopic plug removal for femoral nerve colic pain after mesh & plug hernioplasty
Conclusion: In this study, laparoscopic hernioplasty proved useful for plug removal because laparoscopic instruments can easily grasp perilesional tissue, and laparoscopic approach has the benefit of isolating the plug for removal while preserving the onlay patch, and helpful for restoring peritoneal defects. Laparoscopic plug removal effectively resolved colic pain in the left thigh due to compression of the femoral nerve by a calcified plug. (Source: BMC Surgery)


Use of Prescription Pain Medications Among Medical Cannabis Patients: Comparisons of Pain Levels, Functioning, and Patterns of Alcohol and Other Drug Use.
CONCLUSIONS: Use of PPM among medical cannabis users was not identified as a correlate for more serious forms of alcohol and other drug involvement. However, longitudinal study designs are needed to better understand the trajectories of alcohol and other drug involvement over time among medical cannabis users. PMID: 25978826 [PubMed - as supplied by publisher] (Source: Journal of Studies on Alcohol and Drugs)


Knowledge and practice of nurses towards prevention of pressure ulcer and associated factors in Gondar University Hospital, Northwest Ethiopia
Conclusion: Knowledge and practice of the nurses regarding prevention of pressure ulcer was found to be inadequate. Having higher educational status, attending formal training and being experienced were positively associated with knowledge; while shortage of facilities and equipments, dissatisfaction with nursing leadership and inadequate staff number showed negative association with practice of nurse’s pressure ulcer prevention. In-service training and upgrading courses are some of the important steps to improve nurses’ knowledge and practice on prevention of ulcer pressure. (Source: BMC Nursing)


Patients with chronic non-specific low back pain who reported reduction in pain and improvement in function also demonstrated an improvement in gait pattern
Conclusions Significant differences exist between patients with CNSLBP and healthy controls in terms of gait pattern and self-assessed health status. The examined HBBT led to significant improvements in gait pattern, reduction in pain, improved function and increased quality of life. However, future studies should validate these results while comparing this treatment to other treatment modalities. (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>


Associations of borderline personality with pain, problems with medications and suicidality in a community sample of chronic non-cancer pain patients prescribed opioids for pain
This article aims to examine the prevalence and associations of BPD in a large community sample of CNCP patients and the association with medication problems and suicidality. (Source: General Hospital Psychiatry)


The Comparative Burden of Chronic Widespread Pain and Fibromyalgia in the United States
ConclusionFibromyalgia subjects were characterized by the greatest disease burden with more comorbidities and pain‐related medications, poorer health status, function, sleep, lower productivity, and higher costs. (Source: Pain Practice)


Barriers to treating pain
A study by Pain Concern has identified the main barriers to effective treatment of chronic pain are organisational issues, limited treatment options, patient wellbeing and difficulty in talking about the nature of the symptom. Scotsman Pain - A to Z of MS (Source: Multiple Sclerosis Trust)


Does Change in Self-reported Mindfulness Mediate the Clinical Benefits of Mindfulness Training? A Controlled Study Using the French Translation of the Five Facet Mindfulness Questionnaire
Abstract Mindfulness training improves mental health and psychological functioning. Although several questionnaires have been developed to measure mindfulness, the Five Facet Mindfulness Questionnaire (FFMQ) is currently one of the most widely used scales. However, uncertainty remains about whether the effects of mindfulness training can be unambiguously attributed to change in self-reported mindfulness. The present study was designed to answer three major questions: First, relative to a wait-list group, does participation in mindfulness training lead to changes in self-reported mindfulness among a mixed sample of individuals presenting stress-related problems, illness, anxiety, and chronic pain? Second, are changes in mindfulness associated with changes in psychological distress...


Meditation Could Help Alleviate Gut Disorder Symptoms
By: Esha Dey Published: May 13, 2015 07:37am ET on LiveScience.com. If you thought meditation was only good for your emotional well-being, think again. A new study shows that meditation may actually alleviate the symptoms of two gut disorders by altering certain genetic signals. The study looked at people who had either irritable bowel syndrome (IBS) or irritable bowel disease (IBD). It found that doing yoga and meditating regularly for two months eased the symptoms associated with the two gut disorders, the researchers said. This mind-and-body intervention seemed to work by inducing genetic changes in the body, the study authors said. The findings suggest that stress-relieving meditation can suppress the activities of certain genes responsible for causing inflammation and other imm...<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>


Your Mysterious Nerve Pain Could Be Undiagnosed Celiac Disease, According To New Study
People with celiac disease are more than twice as likely to suffer from nerve damage than the general population, according to a recently published study in the medical journal JAMA Neurology. The association is so strong that the study authors suggest people with nerve damage should also be screened for celiac disorder in order to pinpoint potential treatment options, according to lead researcher Jonas Ludvigsson of the Swedish medical university Karolinska Institutet. "The current guidelines suggest that patients with neuropathy [nerve pain] should be screened for type 1 diabetes and certain vitamin deficiencies,” Ludvigsson told The Huffington Post. "I believe that in patients with neuropathy and none of these conditions, celiac screening is appropriate." Celiac disease is an auto...


New Clinical Decision Rule for Health Care Providers To Assess Patients’ Risk of Developing Chronic Pain
NCCIH-supported research develops clinical decision rule to identify people most likely to progress from acute to chronic low-back pain (Source: NCCAM Featured Content)


Researchers discover new ways to shut down signals involved in brain diseases
A research team has found new ways to block a pathway that may be responsible for several brain disorders, which could open the door to developing better treatments. Their work is focused on the protein NOS-1, which generates nitric oxide, a chemical signal that is linked to neurological disorders from neurodegeneration, stroke and chronic pain sensitivity to anxiety and depressive disorders. (Source: ScienceDaily Headlines)


Strong evidence still lacking on medical marijuana for pain
With increasing numbers of chronic pain patients experimenting with marijuana to get relief, physicians need to learn more about the plant and its constituents to counsel patients appropriately about its safety and possible analgesic benefits, according to a leading medical marijuana researcher. (Source: ScienceDaily Headlines)


Yoga and chronic pain have opposite effects on brain gray matter
Chronic pain is known to cause brain anatomy changes and impairments, but yoga can be an important tool for preventing or even reversing the effects of chronic pain on the brain, according to a new study. (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>


'Catching chlamydia': combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.
Authors: Parker RM, Bell A, Currie MJ, Deeks LS, Cooper G, Martin SJ, Del Rosario R, Hocking JS, Bowden FJ Abstract In Australia and elsewhere, chlamydia screening rates for those aged between 16 and 30 years continue to be low. Innovative, age-appropriate approaches are necessary to increase chlamydia screening among this target group to prevent short- and long-term consequences of the infection such as pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy and infertility. Studies have demonstrated that offering chlamydia screening in community pharmacies may be a useful adjunct to current screening services. Approximately 90% of Australians visit a pharmacy at least once a year. Chlamydia screening and education in community pharmacies with remuneration may provide ...


Traumatic brain injury in the US military: epidemiology and key clinical and research programs
Abstract Traumatic brain injury (TBI), and particularly concussion, is a major concern for the U.S. Military because of the associated short term disability, long term cognitive and pain symptoms suffered by some, and risk of prolonged or permanent neurologic injury if the Service member incurs a second TBI before full recovery from the first. Concussions were seen more often during the recent conflicts in Afghanistan and Iraq than in prior conflicts, such as the Vietnam War, because of the use of improvised explosive devices that typically caused non-penetrating closed head injury. Since 2000 more than 300,000 Service members were diagnosed with TBI, of which more than 80 % were concussions. Improved TBI screening tools also have identified a higher than expected incidence of co...


&#8220;You have to go through it and have your children&#8221;: reproductive experiences among women with vulvodynia
Conclusions: Women described strategies regarding reproduction such as finding a personally acceptable level of pain before planning pregnancy, and a resilience that allowed them to achieve their reproductive goals despite pain and perceived lack of assistance from healthcare providers. Therefore, future research should assess the benefits of increased psychosocial support from partners and professionals who may assist in improving resilience. (Source: BMC Pregnancy and Childbirth)


Association of antithyroid peroxidase antibody with fibromyalgia in rheumatoid arthritis
Abstract To investigate how autoimmune thyroiditis (ATD) affects the clinical presentation of established rheumatoid arthritis (RA) with particular reference to fibromyalgia and chronic widespread pain (CWP). A cohort of 204 patients with RA for whom the presence or absence of autoimmune thyroid antibodies was documented was examined for the relationships between thyroid autoantibodies and fibromyalgia or CWP. We identified 29 % who tested positive for antithyroid peroxidase antibodies (TPOAb). The anti-thyroglobulin antibody (TgAb) was found in 24 %. Among the thyroid autoantibody-positive patients, 40 % had a diagnosis of fibromyalgia or CWP versus 17 % for antibody negative patients. Logistic regression analyses (adjusted by age, sex, diabetes and BMI) indicated that TPOAb-...


Musculoskeletal pain in schoolchildren across puberty: a 3-year follow-up study
Conclusions: Female gender, BJHS and pubertal stage are important risk factors for persistence of MSP. Further studies are needed to evaluate the natural history of MSP towards adulthood and the role of the pubertal age. (Source: Pediatric 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>


Therapeutic value of spinal cord stimulation in irritable bowel syndrome: a randomized crossover pilot study
Irritable bowel syndrome (IBS) is characterized by abdominal pain and changed bowel habits. Spinal cord stimulation (SCS) has been used for treatment of chronic pain syndromes. Animal studies have shown SCS to reduce the reaction to colonic balloon distension, known to be increased in IBS patients. To elucidate the potential for SCS as treatment for IBS, a pilot study was performed. Ten IBS patients (age 26&ndash;56 yr) were recruited. A SCS system with a four-polar electrode was implanted at the T5-T8 level. After a 2-wk run-in, a randomized, crossover design SCS during 6 wk was compared with no stimulation, with an ensuing stimulation period for 12 wk; total study period 28 wk. Patients recorded pain level, pain attacks, diarrheas, and global quality of life in a diary. At end of the stu...


Common Questions About Chronic Low Back Pain.
Authors: Herndon CM, Zoberi KS, Gardner BJ Abstract More than 30% of U.S. adults report having experienced low back pain within the preceding three months. Although most low back pain is nonspecific and self-limiting, a subset of patients develop chronic low back pain, defined as persistent symptoms for longer than three months. Low back pain is categorized as nonspecific low back pain without radiculopathy, low back pain with radicular symptoms, or secondary low back pain with a spinal cause. Imaging should be reserved for patients with red flags for cauda equina syndrome, recent trauma, risk of infection, or when warranted before treatment (e.g., surgical, interventional). Prompt recognition of cauda equina syndrome is critical. Patient education should be combined with evidence-...


Objective and subjective outcome 3 years after synthetic transobturator nonabsorbable anterior mesh use in symptomatic advanced pelvic organ prolapse surgery
Conclusion The Perigee System gave a favorable result in both anatomical and subjective success rates with a low rate of mesh-related morbidities. The strength of the study reported here is its long-term follow up of a relatively large number of patients and the use of validated questionnaires. Limitations are that it is not a RCT; hence, selection and indication bias is unavoidable. The favorable outcome and low morbidities resulting from mesh use is from a single surgeon's perspective and may not be generalized to others. (Source: Gynecology and Minimally Invasive Therapy)


The effects of movement speed on kinematic variability and dynamic stability of the trunk in healthy individuals and low back pain patients
Our findings suggest that slower pace flexion-extension trunk movements are associated with more motor variation as well as local and orbital stability, implying less potential risk of injury for the trunk. Individuals with and without low back pain consistently recruited a closed-loop control strategy towards achieving trunk stability. Chronic low back pain patients exhibited more stable trunk movements over long-term periods, indicating probable temporary pain relief functional adaption strategies. (Source: Clinical Biomechanics)


Structural and functional brain abnormalities in chronic low back pain: A systematic review
The purpose of this systematic review is to analyze the available literature on structural and functional brain abnormalities in chronic low back pain (CLBP) using several brain magnetic resonance imaging (MRI) techniques. (Source: Seminars in Arthritis and Rheumatism)<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>


Re: Effectiveness of Acupuncture on Chronic Prostatitis-Chronic Pelvic Pain Syndrome Category IIIB Patients: A Prospective, Randomized, Nonblinded, Clinical Trial
E. V. Küçük, F. Y. Suçeken, A. Bindayı, U. Boylu, F. F. Onol and E. Gümüş (Source: The Journal of Urology)


Whole-body Magnetic Resonance Imaging in Chronic Recurrent Multifocal Osteomyelitis: Clinical Longterm Assessment May Underestimate Activity.
CONCLUSION: CRMO activity on longterm followup might have been underestimated. Our study demonstrates that clinical remission does not necessarily mean radiological remission. We therefore propose that all patients with CRMO, including patients in clinical remission, require longterm clinical followup and should undergo evaluation with WB-MRI on a regular basis until radiological remission or a steady state of disease is achieved. PMID: 25979713 [PubMed - as supplied by publisher] (Source: J Rheumatol)


Aggressive Therapy Reduces Disease Activity without Skeletal Damage Progression in Chronic Nonbacterial Osteomyelitis.
CONCLUSION: An aggressive treatment regimen in CNO improved clinical and imaging measures of disease activity without progression of skeletal damage. PMID: 25979712 [PubMed - as supplied by publisher] (Source: J Rheumatol)


[Profile of the patient with lumbar failed surgery syndrome at National Institute of Rehabilitation. Comparative analysis].
CONCLUSIONS: This study suggests that the diagnostic and treatment standards are different between healthcare centers, specifically between academic centers vs. private practice. PMID: 25986977 [PubMed - as supplied by publisher] (Source: Cirugia y Cirujanos)


Phantom Remodeling Effect of Dorsal Root Entry Zone Lesioning in Phantom Limb Pain Caused by Brachial Plexus Avulsion
Conclusions: The phantom arms and hands showed a prompt shortening and reduction in size, rather than a disappearance, following successful DREZ lesioning in patients with chronic phantom limb pain caused by brachial plexus avulsion.Stereotact Funct Neurosurg 2015;93:240-244 (Source: Stereotactic and Functional Neurosurgery)<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 Great Pot Experiment
Barcott is a journalist who has contributed to the New York Times, National Geographic and other publications. Scherer is TIME&rsquo;s Washington bureau chief. Portions of this article were adapted from Barcott&rsquo;s new book &ldquo;Weed the People, the Future of Legal Marijuana in America,&rdquo; from TIME Books, is now available wherever books are sold, including Amazon.com, Barnes & Noble and Indiebound. Yasmin Hurd raises rats on the Upper East Side of Manhattan that will blow your mind. Though they look normal, their lives are anything but, and not just because of the pricey real estate they call home on the 10th floor of a research building near Mount Sinai Hospital. For skeptics of the movement to legalize marijuana, the rodents are canaries in the drug-policy coal mine. For d...


Development of monosodium acetate-induced osteoarthritis and inflammatory pain in ageing mice
This study suggests that nocifensive responses to damaging stimuli are altered with advancing age and microglial response to peripheral damage is less robust. (Source: AGE)


The prevalence, impact and cost of chronic non-cancer pain in Irish primary schoolchildren (PRIME-C): protocol for a longitudinal school-based survey
Introduction Previous research has indicated that pain influences children's daily lives, resulting in absence from school, sleep problems, poor school performance and problems with social activities. Our study aims to characterise the nature, extent, impact and cost of chronic pain among Irish children. Methods and analysis Using cluster-systematic random sampling, primary schools will be invited to participate and 6000 5&ndash;12-year-olds asked to complete questionnaires in school classrooms, at time points 1&nbsp;year apart. Questionnaires will use internationally valid psychometric measures to assess a range of quality of life factors and chronic pain indicators among children, with corresponding parental/primary caregiver questions, which will be completed at home. Data will also be...


Zingiberaceae extracts for pain: a systematic review and meta-analysis
Conclusion: Our findings indicated that Zingiberaceae extracts are clinically effective hypoalgesic agents and the available data show a better safety profile than non-steroidal anti-inflammatory drugs. However, both non-steroidal anti-inflammatory drugs and Zingiberaceae have been associated with a heightened bleeding risk, and there have been no comparator trials of this risk. Further clinical studies are recommended to identify the most effective type of Zingiberaceae extract and rigorously compare safety, including bleeding risk. (Source: Nutrition Journal)


Quality of life and its association with direct medical costs for COPD in urban China
Conclusion: Impaired quality of life was significantly linked to increased medical costs for COPD patients and could be an important measure for policy- and decision-making in COPD care. (Source: Health and Quality of Life Outcomes)<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>


Re: Park et al.: The Presence of Chlamydia Is Associated With Increased Leukocyte Counts and Pain Severity in Men With Chronic Pelvic Pain Syndrome (Urology 2015;85:574-579)
It was with great interest that we read the article by Park et al,1 regarding the role of urinary chlamydial infection in patients with chronic prostatitis and/or chronic pelvic pain syndrome. In this stimulating article, the authors highlight that urinary chlamydial infection increased the pain and worsens the quality of life in the patients with chronic prostatitis and/or chronic pelvic pain syndrome.1 Recently, we focused our attention on the sexual dysfunction due to the Chlamydia trachomatis in chronic prostatitis patients. (Source: Urology)


Pain interference in youth with neurofibromatosis type 1 and plexiform neurofibromas and relation to disease severity, social‐emotional functioning, and quality of life
This study investigated the impact of pain in youth with NF1 and plexiform neurofibromas (PNs) and its relationship to disease factors, social‐emotional functioning, and quality of life (QOL) within a biopsychosocial framework. Caregivers of 59 children and adolescents with NF1 and PNs (6–18 years), and 41 of these youth (10–18 years), completed questionnaires assessing social‐emotional functioning and QOL, including an item on pain interference. Measures of disease severity included total PN volume by percent body weight and number of disease complications. Both caregiver (73%) and self‐report (59%) ratings indicated that pain interferes with the child's daily functioning despite 33% taking pain medication. Based on caregivers’ behavior ratings, more symptoms of anxiety and la...


Involvement of GITRL System in Immune Cells in Chronic Pain [Immunology]
In conclusion, GITRL expressed on macrophages drives cytokine release and T cell activation, resulting in neuropathic pain via GITR-dependent actions. The GITRL-GITR pathway might represent a novel target for the treatment of neuropathic pain. (Source: Journal of Biological Chemistry)


Pain Modulation by Lignans (Phyllanthin and Hypophyllanthin) and Tannin (Corilagin) Rich Extracts of Phyllanthus amarus in Carrageenan‐induced Thermal and Mechanical Chronic Muscle Hyperalgesia
In conclusion, we strongly suggest that the observed antihyperalgesic and antiinflammatory effects of P. amarus in current pain model are mediated via spinal or supraspinal neuronal mechanisms, mainly by inhibition of PGE2. Modulation of chronic muscular inflammation may be due to presence of phytoconstituents like phyllanthin, hypophyllanthin, and corilagin, which offers a promising means for treatment of chronic muscle pain. Copyright © 2015 John Wiley & Sons, Ltd. (Source: Phytotherapy Research)


How can the nursing profession alleviate the burden of chronic pain?
Authors: McCabe C, Deaton C, Baillie L, Lowes L, Norton C, Tod A, Carrick-Sen D, Robb E PMID: 25978289 [PubMed - as supplied by publisher] (Source: British Journal of 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>


A Comparative Clinicopathologic Study of Collagenous Gastritis in Children and Adults: The Same Disorder With Associated Immune-mediated Diseases
Collagenous gastritis is a rare condition characterized by surface epithelial damage, subepithelial collagen deposition, and a lamina propria inflammatory infiltrate. Previous studies have proposed 2 clinicopathologic subtypes: (1) children (18 y of age or younger) presenting with severe anemia, nodular gastric mucosa, and isolated gastric disease; and (2) adults with chronic watery diarrhea that is associated with diffuse collagenous involvement of the gastrointestinal tract. However, notable exceptions exist. In fact, broad variability in clinical presentation, etiology, treatment and disease course has been reported. To better define the clinicopathologic features of collagenous gastritis, we have collected 10 pediatric and 21 adult cases and describe their clinical, endoscopic, patholo...


Prescription pain medications and chronic headache in Denmark: implications for preventing medication overuse
Conclusions High prevalence of opioid use among people with CH may be due to inappropriate headache treatment or development of MOH among those treated for other pain conditions. While there were cases of triptan overuse, triptans remain underutilized among those with CH, suggesting that migraine may be under-recognized and inappropriately treated, leading to overuse of other medications. Education of physicians on appropriate headache management is essential for MOH prevention. There is a need to increase universal awareness about MOH as an adverse effect of long-term analgesic use. (Source: European Journal of Clinical Pharmacology)


When You Have Cancer And Can't Sleep
By Anna Medaris Miller for U.S. News Traci Gordon never had a problem falling asleep or staying asleep. In fact, she has a sleep disorder that causes her to sleep too much. “I could sleep through a whole weekend,” Gordon says. That all changed when Gordon, a 47-year-old administrative assistant in New York, began chemotherapy for breast cancer about seven years ago. The treatment threw her body into an artificial state of menopause, which caused unrelenting night sweats. “My memory of it was waking up five, six, seven times a night, absolutely dripping,” Gordon says. Each time, she would change her clothes, stand in front of the air conditioner and wonder how much of her fatigue was caused by the cancer, how much was caused by the treatment and how much was caused by her inabili...


Induction of cytoplasmic pattern in the form of "rods and rings" through the treatment of hepatitis C: a case report
This study attempts to clarify the relationship between this pattern not yet completely understood and the clinical picture of the patient. This pattern is characterized by 3–10 µm rods or rings with 2–5 µm in diameter scattered throughout the cytoplasm of the cell. Therefore, this new standard has been designated as "rods and rings" (RR). The antigenic target of this reaction was identified as inosine-5'-monophosphate dehydrogenase type 2 (IMPDH2) which is a key enzyme in the synthesis of purine nucleotides. The IMPDH2 enzyme aggregated or modified shaped RR in those patients treated with ribavirin may become antigenic and induce an autoimmune response. It is possible that interferon alpha stimulates the occurrence of anti-RR reactivity apparently induced by ribavirin. So far it is ...


Temporomandibular disorders in fibromyalgia syndrome: a short-communication
A síndrome da fibromialgia (SFM) é uma síndrome dolorosa crônica. A coexistência de uma condição dolorosa causada pela disfunção temporomandibular (DTM) e pela SFM tem sido frequentemente descrita por vários estudos. No entanto, a hipótese mais provável é que um conjunto de características da SFM pode levar ao aparecimento de sintomas de DTM e elas não são apenas condições coexistentes. Por isso, o objetivo deste estudo é apresentar uma revisão da literatura sobre a relação entre a fibromialgia e os sinais e sintomas da disfunção temporomandibular. Para este fim, fez-se uma pesquisa bibliográfica que envolveu o período de 1990 a 2013 nas bases de dados Medline, Pubmed, Lilacs e Scielo. Foram usadas as palavras-chave fibromialgia, disfunção temporomandibular e do...<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 climacteric on sexual dysfunctions in women with rheumatic diseases
A síndrome da fibromialgia (SFM) é uma síndrome dolorosa crônica. A coexistência de uma condição dolorosa causada pela disfunção temporomandibular (DTM) e pela SFM tem sido frequentemente descrita por vários estudos. No entanto, a hipótese mais provável é que um conjunto de características da SFM pode levar ao aparecimento de sintomas de DTM e elas não são apenas condições coexistentes. Por isso, o objetivo deste estudo é apresentar uma revisão da literatura sobre a relação entre a fibromialgia e os sinais e sintomas da disfunção temporomandibular. Para este fim, fez-se uma pesquisa bibliográfica que envolveu o período de 1990 a 2013 nas bases de dados Medline, Pubmed, Lilacs e Scielo. Foram usadas as palavras-chave fibromialgia, disfunção temporomandibular e do...


A Systematic Review of the Economic and Humanistic Burden of Gout
Conclusions The evidence confirms that gout has a growing overall prevalence and represents a significant burden in terms of both direct healthcare cost and HRQL outcomes. In light of this, effective urate-lowering treatments are likely to be valued if they can be clearly demonstrated to be both clinically effective and cost effective. Published data to support healthcare decision making in non-US countries with regards to treatments for gout are currently limited, which is a key limitation of the current evidence base. More research is also required to extend our understanding of the impact of gout on indirect costs, and a need also exists to develop a more comprehensive set of comparative HRQL utility assessments. (Source: PharmacoEconomics)


Current gene therapy using viral vectors for chronic pain.
Authors: Guedon JM, Wu S, Zheng X, Churchill CC, Glorioso JC, Liu CH, Liu S, Vulchanova L, Bekker A, Tao YX, Kinchington PR, Goins WF, Fairbanks CA, Hao S Abstract The complexity of chronic pain and the challenges of pharmacotherapy highlight the importance of development of new approaches to pain management. Gene therapy approaches may be complementary to pharmacotherapy for several advantages. Gene therapy strategies may target specific chronic pain mechanisms in a tissue-specific manner. The present collection of articles features distinct gene therapy approaches targeting specific mechanisms identified as important in the specific pain conditions. Dr. Fairbanks group describes commonly used gene therapeutics (herpes simplex viral vector (HSV) and adeno-associated viral vector (...


Efficacy and safety of ultrasound-guided interventional management in chronic pain patients: Cohort follow-up
Conclusions Ultrasound-guided interventional pain management is an effective and safe technique. (Source: Colombian Journal of Anesthesiology)


Disability and disability benefit seeking in chronic low back pain
Conclusions Patient characteristics differ between disability benefit seekers and those established on disability benefit payments. Depression may be a modifiable correlate of disability benefit seeking that if treated may reduce the number of patients who eventually come to depend on disability benefits. Additional data collection involving other pain syndromes is warranted to determine if these results are unique to CLBP or apply to other painful conditions. (Source: Occupational 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>


Effects of 6 Weeks of Balance Training on Chronic Ankle Instability in Athletes: A Randomized Controlled Trial
The objective of the present study was to determine the effectiveness of a 6-week balance training program on patients with Chronic Ankle Instability (CAI) in relation to the results obtained in Dynamic Balance, subjective feeling of instability and pain using a single-blind randomized controlled trial. 70 athletes were randomly assigned to control or intervention group. The control group performed their usual training, and the intervention group was administered the same usual activity in addition to a balance program. The paired t-test was performed to evaluate the change scores in each group. The t-test for independent samples was performed to evaluate between-group differences in change scores. Significance level was assigned for p-values less than 0.05 for all analyses. There were sig...


Pelvic fractures
Publication date: Available online 12 May 2015 Source:Surgery (Oxford) Author(s): Faiz S. Shivji , Conal Quah , Daren P. Forward Fractures of the pelvic ring are significant injuries that affect diverse population groups. They range from low-energy, stable fractures to high-energy, unstable injuries with a substantial morbidity and mortality. The osseous and ligamentous relationships involved in maintaining the stability of the pelvis are complex, and knowledge of these is essential to appropriately manage pelvic fractures. The mechanism of injury and force vectors involved may be used to predict pelvic instability, likely additional injuries, and management strategies. Initially, temporary stabilization, blood-based resuscitation, and appropriate imaging are required. Further haemorrha...


[Research Articles] The nicotinic {alpha}6 subunit gene determines variability in chronic pain sensitivity via cross-inhibition of P2X2/3 receptors
Chronic pain is a highly prevalent and poorly managed human health problem. We used microarray-based expression genomics in 25 inbred mouse strains to identify dorsal root ganglion (DRG)&ndash;expressed genetic contributors to mechanical allodynia, a prominent symptom of chronic pain. We identified expression levels of Chrna6, which encodes the &alpha;6 subunit of the nicotinic acetylcholine receptor (nAChR), as highly associated with allodynia. We confirmed the importance of &alpha;6* (&alpha;6-containing) nAChRs by analyzing both gain- and loss-of-function mutants. We find that mechanical allodynia associated with neuropathic and inflammatory injuries is significantly altered in &alpha;6* mutants, and that &alpha;6* but not &alpha;4* nicotinic receptors are absolutely required for periph...


Heightened Temporal Summation of Pain in Patients with Functional Gastrointestinal Disorders and History of Trauma.
CONCLUSIONS: Assessing for trauma history in patients with FGIDs could identify a subset at risk for greater central sensitization and pain-related symptoms. PMID: 25967582 [PubMed - as supplied by publisher] (Source: Annals of Behavioral Medicine)


Does Age Affect the Relationship Between Pain and Disability? A Descriptive Study in Individuals Suffering From Chronic Low Back Pain.
CONCLUSION: Although both young and older individuals showed a significant association between pain intensity and disability, the relationship between these 2 variables was more tenuous in older individuals than in young patients. Future research is essential to identify the factors underlying this age-related difference. PMID: 25973569 [PubMed - as supplied by publisher] (Source: Physical 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>


Treatment of Dyslipidemia with Statins and Physical Exercises: Recent Findings of Skeletal Muscle Responses
This study aimed to present the most recent results of specific literature about the effects of statins and its association with physical exercise on skeletal musculature. Thus, a literature review was performed using PubMed and SciELO databases, through the combination of the keywords “statin” AND “exercise” AND “muscle”, restricting the selection to original studies published between January 1990 and November 2013. Sixteen studies evaluating the effects of statins in association with acute or chronic exercises on skeletal muscle were analyzed. Study results indicate that athletes using statins can experience deleterious effects on skeletal muscle, as the exacerbation of skeletal muscle injuries are more frequent with intense training or acute eccentric and strenuous exercises...


Left Atrial Volume Index as Predictor of Events in Acute Coronary Syndrome
This study aimed to present the most recent results of specific literature about the effects of statins and its association with physical exercise on skeletal musculature. Thus, a literature review was performed using PubMed and SciELO databases, through the combination of the keywords “statin” AND “exercise” AND “muscle”, restricting the selection to original studies published between January 1990 and November 2013. Sixteen studies evaluating the effects of statins in association with acute or chronic exercises on skeletal muscle were analyzed. Study results indicate that athletes using statins can experience deleterious effects on skeletal muscle, as the exacerbation of skeletal muscle injuries are more frequent with intense training or acute eccentric and strenuous exercises...


Case 4/2015 A 48-year-old Male Patient with Coarctation of the Aorta, Bicuspid Aortic Valve and Normal Ascending Aorta
This study aimed to present the most recent results of specific literature about the effects of statins and its association with physical exercise on skeletal musculature. Thus, a literature review was performed using PubMed and SciELO databases, through the combination of the keywords “statin” AND “exercise” AND “muscle”, restricting the selection to original studies published between January 1990 and November 2013. Sixteen studies evaluating the effects of statins in association with acute or chronic exercises on skeletal muscle were analyzed. Study results indicate that athletes using statins can experience deleterious effects on skeletal muscle, as the exacerbation of skeletal muscle injuries are more frequent with intense training or acute eccentric and strenuous exercises...


Sickle-cell Anemia and Latent Diastolic Dysfunction: Echocardiographic Alterations
This study aimed to present the most recent results of specific literature about the effects of statins and its association with physical exercise on skeletal musculature. Thus, a literature review was performed using PubMed and SciELO databases, through the combination of the keywords “statin” AND “exercise” AND “muscle”, restricting the selection to original studies published between January 1990 and November 2013. Sixteen studies evaluating the effects of statins in association with acute or chronic exercises on skeletal muscle were analyzed. Study results indicate that athletes using statins can experience deleterious effects on skeletal muscle, as the exacerbation of skeletal muscle injuries are more frequent with intense training or acute eccentric and strenuous exercises...


Correct Anatomical Orientation of the Heart and Reflections on the Nomenclature Used in Daily Practice
This study aimed to present the most recent results of specific literature about the effects of statins and its association with physical exercise on skeletal musculature. Thus, a literature review was performed using PubMed and SciELO databases, through the combination of the keywords “statin” AND “exercise” AND “muscle”, restricting the selection to original studies published between January 1990 and November 2013. Sixteen studies evaluating the effects of statins in association with acute or chronic exercises on skeletal muscle were analyzed. Study results indicate that athletes using statins can experience deleterious effects on skeletal muscle, as the exacerbation of skeletal muscle injuries are more frequent with intense training or acute eccentric and strenuous exercises...<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>


Incremental Value Of 3D Transesophageal Echocardiography for The Assessment of Mitral Valve Prolapse
This study aimed to present the most recent results of specific literature about the effects of statins and its association with physical exercise on skeletal musculature. Thus, a literature review was performed using PubMed and SciELO databases, through the combination of the keywords “statin” AND “exercise” AND “muscle”, restricting the selection to original studies published between January 1990 and November 2013. Sixteen studies evaluating the effects of statins in association with acute or chronic exercises on skeletal muscle were analyzed. Study results indicate that athletes using statins can experience deleterious effects on skeletal muscle, as the exacerbation of skeletal muscle injuries are more frequent with intense training or acute eccentric and strenuous exercises...


7 Top Futurists Make Some Pretty Surprising Predictions About What The Next Decade Will Bring
From smartphone apps that can do seemingly everything to driverless cars and eerily humanlike robots, the past decade has seen dramatic advances in science and technology. What amazing advances are we likely to see in the next 10 years? To find out, HuffPost Science reached out to seven top futurists -- and they gave us some pretty surprising predictions. Keep reading to learn more. Dr. Michio Kaku, professor of theoretical physics at the City University of New York and author of "The Future of the Mind:" "In the next 10 years, we will see the gradual transition from an Internet to a brain-net, in which thoughts, emotions, feelings, and memories might be transmitted instantly across the planet. Scientists can now hook the brain to a computer and begin to decode some of our memories a...


FDA Approves Spinal Cord Stimulation System With Superiority Labeling
The FDA announced the approval the first implantable spinal cord stimulation (SCS) system to treat chronic back pain using high frequency (up to 10,000 Hz) stimulation without causing a common tingling side effect called paresthesia. Experts say Nevro&rsquo;s Senza SCS system represents a significant advance in SCS technology, and it is the only system to be FDA approved with superiority labeling. (Source: Medical Design Online News)


9 Common Symptoms Of Fibromyalgia And What To Do If You're Diagnosed
Today is National Fibromyalgia Awareness Day, which raises awareness for a chronic disorder that impacts an estimated five million adults in the United States, and is characterized by widespread pain and tenderness, often accompanied by fatigue, impaired memory and other physical issues. The condition may occur with other chronic pain conditions, such as osteoarthritis, rheumatoid arthritis and lupus. The exact cause of fibromyalgia is unknown, but researchers believe it could be the result of several factors, including genetics, illness and physical or emotional trauma, which lead to an abnormal processing of pain. In the video above from The Doctors, Maggie says she has suffered from fibromyalgia for over 10 years, but receiving the correct diagnosis was a challenge. “I started getti...


Spinal Stimulation System Relieves Pain Without Tingling
Title: Spinal Stimulation System Relieves Pain Without TinglingCategory: Health NewsCreated: 5/11/2015 12:00:00 AMLast Editorial Review: 5/12/2015 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>


Physical Activity and Health-Related QoL in Low Back PainPhysical Activity and Health-Related QoL in Low Back Pain
This study explores the connections. BMC Musculoskeletal Disorders (Source: Medscape Today Headlines)


Current gene therapy using viral vectors for chronic pain
The complexity of chronic pain and the challenges of pharmacotherapy highlight the importance of development of new approaches to pain management. Gene therapy approaches may be complementary to pharmacotherapy for several advantages. Gene therapy strategies may target specific chronic pain mechanisms in a tissue-specific manner. The present collection of articles features distinct gene therapy approaches targeting specific mechanisms identified as important in the specific pain conditions. Dr. Fairbanks group describes commonly used gene therapeutics (herpes simplex viral vector (HSV) and adeno-associated viral vector (AAV)), and addresses biodistribution and potential neurotoxicity in pre-clinical models of vector delivery. Dr. Tao group addresses that downregulation of a voltage-gated p...


Persistence with opioid treatment in Germany in patients suffering from chronic non-malignant or cancer pain
Current Medical Research & Opinion, Ahead of Print. (Source: Current Medical Research and Opinion)


Corticotropin-releasing factor receptor type 1 and type 2 interaction in irritable bowel syndrome
Abstract Irritable bowel syndrome (IBS) displays chronic abdominal pain or discomfort with altered defecation, and stress-induced altered gut motility and visceral sensation play an important role in the pathophysiology. Corticotropin-releasing factor (CRF) is a main mediator of stress responses and mediates these gastrointestinal functional changes. CRF in brain and periphery acts through two subtype receptors such as CRF receptor type 1 (CRF1) and type 2 (CRF2), and activating CRF1 exclusively stimulates colonic motor function and induces visceral hypersensitivity. Meanwhile, several recent studies have demonstrated that CRF2 has a counter regulatory action against CRF1, which may imply that CRF2 inhibits stress response induced by CRF1 in order to prevent it from going into an ...


Advances in NSAID Development: Evolution of Diclofenac Products Using Pharmaceutical Technology
Abstract Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) of the phenylacetic acid class with anti-inflammatory, analgesic, and antipyretic properties. Contrary to the action of many traditional NSAIDs, diclofenac inhibits cyclooxygenase (COX)-2 enzyme with greater potency than it does COX-1. Similar to other NSAIDs, diclofenac is associated with serious dose-dependent gastrointestinal, cardiovascular, and renal adverse effects. Since its introduction in 1973, a number of different diclofenac-containing drug products have been developed with the goal of improving efficacy, tolerability, and patient convenience. Delayed- and extended-release forms of diclofenac sodium were initially developed with the goal of improving the safety profile of diclofenac and providing conve...<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>


Interventions for the prediction and management of chronic postsurgical pain after total knee replacement: systematic review of randomised controlled trials
Conclusions Our systematic review highlights a lack of evidence about the effectiveness of prediction and management strategies for chronic postsurgical pain after total knee replacement. As a large number of people are affected by chronic pain after total knee replacement, development of an evidence base about care for these patients should be a research priority. (Source: BMJ Open)


Subgroups of US IRAQ and Afghanistan veterans: associations with traumatic brain injury and mental health conditions
The objective of this study was to identify subgroups of Iraq and Afghanistan veterans (IAVs) with distinct compositions of symptoms associated with TBI, PTSD, and depression. Our cross-sectional, observational study included 303,716 IAVs who received care in the Veterans Health Administration in 2010–2011. Symptoms and conditions were defined using International Classification of Diseases, Ninth Revision codes and symptom-clusters were identified using latent class analysis. We identified seven classes with distinct symptom compositions. One class had low probability of any condition and low health care utilization (HCU) (48 %). Other classes were characterized by high probabilities of mental health comorbidities (14 %); chronic pain and sleep disturbance (20 %); headaches and memory...


Assessment of family history of substance abuse for preventive interventions with patients experiencing chronic pain: A quality improvement project
This quality improvement project demonstrates that RN Care Managers, in a chronic pain programme, can assess for a family history of substance abuse in 5–10 min. Information informs treatment based on specific high risk criteria. Benefits include heightened awareness of the genetic and environmental risks associated with a family history of substance abuse, an opportunity to participate in motivational interventions to prevent or minimize consequences of substance use disorders, and likely substantial overall health‐care cost savings. (Source: International Journal of Nursing Practice)


Adverse childhood experiences influence development of pain during pregnancy
ConclusionsAdverse childhood experiences were associated with higher pain intensities and larger pain distributions in late pregnancy, which are risk factors for transition to chronic pain postpartum.This article is protected by copyright. All rights reserved. (Source: Acta Obstetricia et Gynecologica Scandinavica)


The societal burden of chronic pain in Japan: an internet survey
Conclusions The results suggest that chronic pain has a significant association in an individual’s health status, work productivity, daily activity impairment, healthcare resource use, and economic burden in Japan. Along with low treatment rates, a multidisciplinary approach may lead to an improved quality of life and reduce the economic burden among patients with chronic pain in Japan. (Source: Journal of Orthopaedic 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>


Rural-Urban Differences in the Prevalence of Chronic Disease in Northeast China
Rural&ndash;urban differences in the prevalence of chronic diseases in the adult population of northeast China are examined. The Jilin Provincial Chronic Disease Survey used personal interviews and physical measures to research the presence of a range of chronic diseases among a large sample of rural and urban provincial residents aged 18 to 79 years (N = 21 435). Logistic regression analyses were used. After adjusting for age and gender, rural residents had higher prevalence of hypertension, chronic ischemic heart disease, cerebrovascular disease, chronic low back pain, arthritis, chronic gastroenteritis/peptic ulcer, chronic cholecystitis/gallstones, and chronic lower respiratory disease. Low education, low income, and smoking increased the risk of chronic diseases in rural areas. Reduci...


Changing channels in pain and epilepsy: Exploiting ion channel gene therapy for disorders of neuronal hyperexcitability
Chronic pain and epilepsy represent major health concerns, together affecting hundreds of millions of people worldwide at a cost to the global economy of hundreds of billions of dollars [1,2]. In Europe, it is estimated that 0.6-0.7% of the general population suffers from epilepsy [3], and up to 20% will experience chronic pain at some point in their lives [4]. Despite the impressive array of drugs available to treat these disorders, a significant proportion of patients remains resistant to traditional pharmacotherapy; 25% of epilepsies are refractory in nature [5], and as many as two-thirds of chronic pain sufferers are dissatisfied with treatment efficacy [6]. (Source: FEBS Letters)


Altered cortical processing of observed pain in fibromyalgia syndrome patients
Fibromyalgia syndrome (FMS) is characterised by widespread chronic pain, fatigue, sleep disorders and cognitive-emotional disturbance. FMS patients exhibit increased sensitivity to experimental pain and pain-related cues, as well as deficits in emotional regulation. The present study investigated the spatio-temporal patterns of brain activations for observed pain in 19 FMS patients and 18 age-matched, healthy control subjects using event-related potential (ERP) analysis. Fibromyalgia patients attributed greater pain and unpleasantness to pain pictures relative to healthy control participants. (Source: The Journal of Pain)


Central sensitization and changes in conditioned pain modulation in people with chronic nonspecific low back pain: a case-control study.
Authors: Corrêa JB, Costa LO, de Oliveira NT, Sluka KA, Liebano RE Abstract Quantitative sensory testing is widely used in human research to investigate the state of the peripheral and central nervous system contributions in pain processing. It is a valuable tool to help identify central sensitization and may be important in the treatment of low back pain. The aim of this study was to evaluate changes in local and segmental hypersensitivity and endogenous pain inhibition in people with chronic nonspecific low back pain. Thirty patients with chronic low back pain and thirty healthy subjects were studied. Pressure pain thresholds (PPTs) were measured from the lumbar region and over the tibialis anterior muscle (TA). A cold pressor test was used to assess the activation of conditione...


Osmophobia and allodynia are critical factors for suicidality in patients with migraine
Conclusions Osmophobia and allodynia are critical factors for suicidality in patients with migraine, after controlling for depression, anxiety, and CM. (Source: The Journal of Headache and 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>


TCF4 Mediates the Maintenance of Neuropathic Pain Through Wnt/β-Catenin Signaling Following Peripheral Nerve Injury in Rats
Abstract Neuropathic pain is elicited after a serious disorder of the nervous system and is along with the neural damage. It is usually chronic and challenging to treat. Transcription factor 4 (TCF4) is a key transcription factor of Wnt signaling system. Recent studies have shown that TCF4 interacts with β-catenin in the Wnt signaling pathway and coactivates downstream target genes in diverse systems. However, it is not well elucidated in the pathogenesis of neuropathic pain. In the present study, we investigated the role of TCF4 in the maintenance of neuropathic pain after chronic constriction injury (CCI) in rats. CCI induced persistent TCF4 upregulation in the dorsal root ganglion and spinal cord. Interestingly, TCF4 was mainly colocalized with neurons in the injured dorsal ro...


Things I Wish I'd Known When I Was Younger
I am 64 years old. There, I admit it. Women don't always want to admit their age, but there is one really good thing about seeing the decades roll by: I finally appreciate that "women's health" means different things at different times. For this year's National Women's Health Week, we're focusing on what steps women can take at different ages and stages to live a healthier life. And now that I am older, I'd like to share some of my thoughts on things I wish someone had told me when I was younger. In my 20s Fall in love with working out. Sometimes when you're young, you think you don't need to exercise. You can run, jump, and play with no problem and no weight gain, so why work out? But trust me: not making exercise a habit in your 20s makes it much harder to pick it up later in life. M...


Disabled woman finds insulting note on car
A woman with a chronic pain condition who parked in a handicapped-accessible parking spot found a note on her car that implied she wasn&#8217;t really handicapped and insulted her appearance. (Source: WDSU.com - Health)


Pregabalin for chronic pain: does one medication fit all?
Current Medical Research & Opinion, Ahead of Print. (Source: Current Medical Research and Opinion)<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>


FDA Approves New Spinal Cord Stimulator for Chronic Pain (FREE)
By Kristin J. Kelley Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH The FDA has approved an implantable spinal cord stimulation system (marketed as Senza) to help manage … (Source: Physician's First Watch current issue)


Development and Psychometric Evaluation of a German Version of the PROMIS(R) Item Banks for Satisfaction With Participation
The Patient Reported Outcomes Measurement Information System (PROMIS) initiative aims to provide reliable and precise item banks measuring patient-reported outcomes in different health domains. The aim of the present work was to provide a German translation of the PROMIS item banks for satisfaction with participation and to psychometrically test these German versions. Cognitive interviews followed a forward&ndash;backward translation. Distribution characteristics, unidimensionality, Rasch model fit, reliability, construct validity, and internal responsiveness were tested in 262 patients with chronic low back pain undergoing rehabilitation. Results for the final 13- and 10-item German static scales (Satisfaction with Participation in Social Roles&ndash;German version [PSR-G] and Satisfactio...


Clinical Reasoning: A patient with rapidly progressive sensory loss and imbalance
A 52-year-old man presented with sudden onset of acral paresthesia and imbalance. The patient did not have any recent illness, sick contacts, or travel abroad. He denied weakness, pain, bowel or bladder incontinence, dysphagia, dysarthria, or shortness of breath. On neurologic examination, 1 month into his symptoms, he had reduced muscle strength in his finger spread, extension, and flexion on both sides graded on Medical Research Council scale 4&ndash;/5 and in toe extensors &ndash;4/&ndash;4 and toe flexors &ndash;4/4. The rest of his muscle strength was normal. Reflexes were absent throughout. He had reduced sensation to all modalities in a length-dependent pattern up to his midshin and wrists on both sides. He was severely unsteady when walking and he could not tandem. Romberg was posi...


Short-term peripheral nerve stimulation ameliorates axonal dysfunction after spinal cord injury
There is accumulating evidence that peripheral motor axons deteriorate following spinal cord injury (SCI). Secondary axonal dysfunction can exacerbate muscle atrophy, contribute to peripheral neuropathies and neuropathic pain, and lead to further functional impairment. In an attempt to ameliorate the adverse downstream effects that developed following SCI, we investigated the effects of a short-term peripheral nerve stimulation (PNS) program on motor axonal excitability in 22 SCI patients. Axonal excitability studies were undertaken in the median and common peroneal nerves (CPN) bilaterally before and after a 6-wk unilateral PNS program. PNS was delivered percutaneously over the median nerve at the wrist and CPN around the fibular head, and the compound muscle action potential (CMAP) from ...


The SCOPE Protocol?for Primary Care-Based Chronic Pain Management (Frederic Stuart Leeds MD)
(Source: Family Medicine Digital Resources Library (FMDRL) Recently Uploaded)<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>


SCOPE: A Novel Scope-of-Practice-Based Paradigm for Empowering Family Physicians to Manage Chronic Nonmalignant Pain (F. Stuart Leeds MD)
PowerPoint version of Spring poster presentation - "final version" has improved readability, and is an exact representation of the physical poster that appeared during sessions at the Spring meeting. (Source: Family Medicine Digital Resources Library (FMDRL) Recently Uploaded)


Non‐thermal extremely low frequency magnetic field effects on opioid related behaviors: Snails to humans, mechanisms to therapy
In 1984, it was initially discovered in mice that an extremely low frequency magnetic field (ELF‐MF) could attenuate opiate induced analgesia. In the past 30 years, we defined some of ELF‐MF exposure and subject state conditions that can both increase and decrease nociception in snails and mice and can induce analgesia in humans. In our search for mechanisms and our desire to translate our findings to the treatment of chronic pain in humans, we pioneered the use of electroencephalography and magnetic resonance imaging to monitor effects during exposure. We have contributed to an understanding of the phenomena but a considerable amount remains to be done by us and those who have undertaken corroboratory and complimentary work. As the recipient of the 2013 d'Arsonval Award, I was invited...


Psychosocial experiences of chronic illness in individuals with an intellectual disability: A systematic review of the literature
Conclusions: There are unmet needs within this population, including a lack of assistance in understanding their illness. A substantial gap in the literature should be addressed through further empirical work. (Source: Journal of Intellectual Disabilities)


Pneumonia and Inflammatory Arthritis Caused by Unusual Occupational Exposure or a Life-Threatening Infection Resulting From a More Commonly Encountered Mechanism?
A 44-YEAR-OLD RENOVATION CONTRACTOR with a history of chronic low back pain developed symptoms consistent with an upper respiratory infection approximately 3 days after removing carpeting on which a decomposing human body recently had been discovered. The contractor was not wearing a respirator when he performed the work. He initially ignored his symptoms, but he eventually sought medical attention at a local community hospital complaining of a persistent fever, chills, night sweats, weight loss, a productive cough, dyspnea, orthopnea, and chest “heaviness” that was exacerbated with activity and partially relieved with rest. (Source: Journal of Cardiothoracic and Vascular Anesthesia)


Persistent Postmastectomy Pain and Pain-Related Physical and Emotional Functioning With and Without a Continuous Paravertebral Nerve Block: A Prospective 1-Year Follow-Up Assessment of a Randomized, Triple-Masked, Placebo-Controlled Study
Conclusions Adding a multiple-day, continuous ropivacaine infusion to a single-injection ropivacaine paravertebral nerve block may result in a lower incidence of pain as well as pain-related physical and emotional dysfunction 1 year after mastectomy. (Source: Annals of Surgical Oncology)<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 after surgical treatment of missed Monteggia fractures in children
We present a large series of patients treated in our Institution. Materials and methods The outcome of 22 children treated surgically between 1988 and 2011 for post-traumatic chronic radial head dislocation is reported. There were 12 girls and 10 boys with a mean age at surgery of 7.2 years (4.1–13.6). The mean interval between injury and treatment was 15.7 months (1–128). Nine patients underwent open reduction with removal of interposed tissue and repair (7) or Bell-Tawse reconstruction (2) of the annular ligament. Ten patients underwent osteotomy, gradual lengthening and angulation of the ulna by external fixation. Two patients underwent angular osteotomy of the proximal ulna with open wedge, open reduction in the radial head and reconstructi...


FDA Okays Senza SCS System Without Tingling for Chronic PainFDA Okays Senza SCS System Without Tingling for Chronic Pain
The FDA has approved the Senza spinal cord stimulation system, the first such system to relieve pain without paresthesia. FDA Approvals (Source: Medscape Neurology and Neurosurgery Headlines)


The Effect of Virtual Reality Distraction on Pain Relief During Dressing Changes in Children with Chronic Wounds on Lower Limbs
It has been demonstrated that patients with chronic wounds experience the most pain during dressing changes. Currently, researchers focus mostly on analgesics and appropriate dressing materials to relieve pain during dressing changes of chronic wounds. However, the effect of nonpharmacologic interventions, such as virtual reality distraction, on pain management during dressing changes of pediatric chronic wounds remains poorly understood. To investigate the effect of virtual reality distraction on alleviating pain during dressing changes in children with chronic wounds on their lower limbs. (Source: Pain Management Nursing)


Can a Single-legged Squat Provide Insight into Movement Control and Loading During Dynamic Sporting Actions in Athletic Groin Pain Patients?
CONCLUSION: For AGP patients, a SLS did not provide a meaningful insight into hip and pelvis control or loading during sporting movements that are associated with injury development. The usefulness of a SLS test in the assessment of movement control and loading in AGP patients is thus limited. The SLS provided a moderate insight into knee control while landing and therefore may be of use in the examination of knee injury risk. PMID: 25946707 [PubMed - as supplied by publisher] (Source: Journal of Sport Rehabilitation)


An algorithm for assessment and treatment of postherniorrhaphy pain
Conclusions In the present study, we implemented a diagnostic workup for patients with postherniorrhaphy inguinal pain to select those with neuropathic pain. Eighty-three percent of the patients with neuropathic groin pain obtained significant improvement of their pain scores after our protocolled treatment. The effect was achieved by nerve infiltrations and in some cases by an implanted PNS when the former was unsuccessful. (Source: Hernia)<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 articular pain in rheumatoid arthritis correlated with ultrasound power Doppler findings?
Conclusion Intra-articular PD was not correlated with pain symptom in this study. (Source: Clinical Rheumatology)


FDA approves spinal cord stimulation system that treats pain without tingling sensation
Today the U.S. Food and Drug Administration approved the Senza spinal cord stimulation (SCS) system (Senza System) as an aid in the management of chronic intractable pain of the trunk and/or limbs, including pain associated with failed back surgery syndrome, low back pain and leg pain. The Senza System can reduce pain without producing a tingling sensation called paresthesia by providing high frequency stimulation (at 10 KHz) and low stimulation amplitudes. (Source: Food and Drug Administration)


Clinical Depression Is a Strong Predictor of Poor Lumbar Fusion Outcomes Among Workers' Compensation Subjects
Conclusion. Overall, RTW rates after fusion were low, which was especially true for those with pre-existing depression. Depression was a strong negative predictor of postoperative RTW status. Psychological screening and treatment may be beneficial in these subjects. The poor outcomes in this study may highlight a more limited role for fusion among WC subjects with chronic low back pain where RTW is the treatment goal. Level of Evidence: 3 (Source: Spine)


Cost-Utility of Cognitive Behavioral Therapy for Low Back Pain From the Commercial Payer Perspective
Conclusion. CBT is a cost-effective approach to manage chronic LBP among commercial health plans members. Cost-effectiveness is demonstrated for multiple plan designs. Level of Evidence: 2 (Source: Spine)


Can We Convert Between Outcome Measures of Disability for Chronic Low Back Pain?
Conclusion. The lack of agreement between different outcome measures means that pooling of data on these different disability measurements in a meta-analysis is not recommended. Level of Evidence: 2 (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>


A Randomized, Double-blind, Placebo-Controlled Crossover Trial of Oxymorphone Hydrochloride and Propoxyphene/Acetaminophen Combination for the Treatment of Neurogenic Claudication Associated With Lumbar Spinal Stenosis
Conclusion: This trial failed to demonstrate a benefit of OH or PA in patients experiencing neurogenic claudication. Considering the potential negative side effects of chronic opioid use, additional research is necessary to evaluate the efficacy of sustained opioid treatment specifically for neurogenic claudication. Level of Evidence: 2 (Source: Spine)


Individual patient data meta-analysis of older adults suffering from chronic pain
Publication date: May 2015 Source:Integrative Medicine Research, Volume 4, Issue 1, Supplement Author(s): Claudia Witt , Rainer Luedtke , Klaus Linde , Friederike Martins , Andrew Vickers , Emily Vertosick (Source: Integrative Medicine Research)


Acupuncture differential effect on chronic and acute low back pain using fMRI
Publication date: May 2015 Source:Integrative Medicine Research, Volume 4, Issue 1, Supplement Author(s): Meena M. Makary , Jeungchan Lee , Jun-Hwan Lee , Eunyoung Lee , Jae-Young Shin , Vitaly Napadow , Geonho Jahng , Kyungmo Park (Source: Integrative Medicine Research)


Efficacy of action potential simulation and interferential therapy in the rehabilitation of patients with knee osteoarthritis
Conclusion: Short-term treatment with both APS and IFT could significantly reduce pain and improve physical function in patients with knee OA. (Source: Therapeutic Advances in Musculoskeletal Disease)


Endoscopic Thyroid Lobectomy using Bilateral Axillo‐Breast Approach: Surgical Techniques and Outcomes
ConclusionBilateral axillo‐breast approach is a feasible and cosmetically excellent technique in performing endoscopic thyroid lobectomy. It should be recommended for eligible patients who have strong emphasis on cosmetic outcomes. (Source: Surgical 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>


Complications with office-based venoplasties and stenting and its clinical correlation
Conclusions The correction of iliac vein outflow obstruction in office-based settings results in a low incidence of complications, such as thrombosis (2%), and average pain score of 2 of 10 on the Likert scale. The procedure is minimally invasive with minimal complications. (Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders)


Venous angioplasty and stenting improve pelvic congestion syndrome caused by venous outflow obstruction
Conclusions Nonthrombotic obstruction of the left CIV or IVC is an underappreciated cause of PCS. Venous angioplasty and stenting provide excellent short-term results for such patients, with resolution of chronic pelvic pain and dyspareunia. Venous obstruction should be considered and carefully evaluated in patients presenting with pelvic congestion, and treatment of obstruction alone may solve the patient's symptoms. (Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders)


Management of perforator vein aneurysms in the lower extremities
Conclusions PVAs are rare without causing significant symptoms locally. Diagnosis is made with duplex ultrasound because the affected vein is located below the deep fascia. As only one case in our series of 19 involved the deep veins, we believe that PVAs originate from superficial veins. The condition is relatively benign, and the treatment outcomes are very good with limited complications experienced. However, selective treatment of PVAs may not be needed for most of them as treatment of the superficial veins connecting with the PVA may be sufficient. (Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders)


Utility of iliac vein stenting in elderly population older than 80 years
Conclusions Iliac vein stenting appears to offer a safe and effective option in octogenarians and nonagenarians when compression fails, is difficult, or is impossible. (Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders)


Serum level of vascular endothelial growth factor decreased in chronic ketamine abusers
Ketamine, a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist was used widely in medicine, pain management and anesthesia. Its use as a recreational drug of abuse has become widespread after its hallucinogenic effects were discovered in 1970's. Ketamine provokes distinctive pathopsychological symptoms similar to schizophrenia, as well as cognitive impairments in humans and rodents (Becker et al., 2003; Aalto et al., 2005). A single intravenous dose of ketamine given to healthy volunteers produced acute psychotic symptoms, as well as impairment of memory (Krystal et al., 1994; Morgan et al., 2004). (Source: Drug and Alcohol Dependence)<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 and Decreased Opioid Efficacy: An Inflammatory Link
This article describes chronic pain as a disease process that has ineffective treatment modalities, explores the mechanisms of glial cell activation and inflammatory responses that lead to chronic pain and decreased opioid treatment efficacy, and hypothesizes novel chronic pain treatment modalities based on the glial cell inactivation and anti-inflammatory pathways. (Source: Pain Management Nursing)


A Comprehensive Review of Central Post-Stroke Pain
Although central post-stroke pain is widely recognized as a severe chronic neuropathic pain condition, its consolidated definition, clinical characteristics, and diagnostic criteria have not been defined due to its clinically diverse features. The present study was undertaken to comprehensively review current literature and provide a more complete picture of central post-stroke pain with respect to its definition, prevalence, pathophysiology, clinical characteristics, and diagnostic problems, and to describe the range of therapies currently available. (Source: Pain Management Nursing)


Staged treatment of a chronic patellar sleeve fracture using the Taylor spatial frame
We report a novel treatment using a Taylor spatial frame as part of a staged reconstruction to regain length of the extensor mechanism and maintain knee motion prior to performing primary repair of the avulsed patellar sleeve fragment. In our case, an 11-year-old male presented to our institution six months after sustaining a patellar sleeve fracture. (Source: The Knee)


Spinescope
The clinical entity known as discogenic back pain remains controversial. Four randomized trials have attempted to compare efficacy of surgical and non-surgical treatment with one trial showing improved results with surgery and the others showing comparable results. Mirza et al. performed a prospective observational cohort study to compare outcomes of community-based surgical and nonsurgerical treatments for patients with chronic back pain attributed to degeneration at one or two lumbar discs. (Source: Seminars in Spine Surgery)


Effects of Chronic Pelvic Pain on Heart Rate Variability in Women
Interstitial cystitis/bladder pain syndrome (IC/BPS) and myofascial pelvic pain (MPP) are frequently comorbid chronic pelvic pain disorders. Differences in bladder function between IC/BPS and MPP suggest that efferent autonomic function may differentiate these syndromes. Heart rate variability (HRV), defined as the difference in duration of successive heartbeats, serves as an index of autonomic function by measuring its ability to modify heart rate in response to neurophysiological changes. High frequency HRV (HF-HRV) was used as a reflection of more rapid vagally mediated (parasympathetic) changes, while low frequency HRV (LF-HRV) signified slower fluctuations related to baroreflex and sympathetic outflow. (Source: The Journal of 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>


Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial.
CONCLUSIONS: The present trial indicates that BAT led to greater improvements than ET for the patients with chronic WAD. Implications for Rehabilation Chronic whiplash-associated disorders are disabling and incur great costs to society often through inability to work. Exercise therapy (ET) may alleviate symptoms of chronic WAD. Basic body awareness therapy (BAT) is often a component of multimodal pain rehabilitation programs. In this randomized comparative trial, BAT increased physical functioning and led to greater pain reduction and social functioning 3 months after the end of treatment. PMID: 25955823 [PubMed - as supplied by publisher] (Source: Disability and Rehabilitation)


Craniovertebral junction instability as an extension of cocaine-induced midline destructive lesions: case report.
Authors: Brembilla C, Lanterna LA, Risso A, Bombana E, Gritti P, Trezzi R, Bonaldi G, Biroli F Abstract With the increasingly widespread illicit use of cocaine, a broad spectrum of clinical pathologies related to this form of drug abuse is emerging. The most frequently used method of administration of powdered cocaine is intranasal inhalation, or "snorting." Consequently, adverse effects of cocaine on the nasal tract are common. Habitual nasal insufflations of cocaine can cause mucosal lesions. If cocaine use becomes chronic and compulsive, progressive damage of the mucosa and perichondrium leads to ischemic necrosis of the septal cartilage and perforation of the nasal septum. Occasionally, cocaine-induced lesions cause extensive destruction of the osteocartilaginous structures of ...


Potential new painkiller provides longer lasting effects
Medications have long been used to treat pain caused by injury or chronic conditions. Unfortunately, most are short-term fixes or cause side effects that limit their use. Researchers have discovered a new compound that offers longer lasting painkilling effects, and shows promise as an alternative to current anesthetics. (Source: ScienceDaily Headlines)


MicroRNA-146a-5p attenuates neuropathic pain via suppressing TRAF6 signaling in the spinal cord
In this study, we found that in cultured astrocytes, TNF-α, IL-1β, or lipopolysaccharides (LPSs) induced rapid TRAF6 upregulation and delayed miR-146a-5p upregulation. In addition, miR-146a-5p mimic blocked LPS-induced TRAF6 upregulation, as well as LPS-induced c-Jun N-terminal kinase (JNK) activation and chemokine CCL2 expression in astrocytes. Notably, LPS incubation with astrocytes enhanced the DNA binding activity of AP-1 to the promoters of mir-146a and ccl2. TRAF6 siRNA or JNK inhibitor SP600125 significantly reduced LPS-induced miR-146a-5p increase in astrocytes. In vivo, intrathecal injection of TNF-α or LPS increased spinal TRAF6 expression. Pretreatment with miR-146a-5p mimic alleviated TNF-α- or LPS-induced mechanical allodynia and reduced TRAF6 expression. Finally, SNL indu...<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 37-Year-Old Man with Chronic Low Back Pain and Substance Abuse
Publication date: May 2015 Source:Journal of Emergency Nursing, Volume 41, Issue 3 Author(s): Daryl Ann Plotzker (Source: Journal of Emergency Nursing)


Musculoskeletal pain characteristics associated with lower balance confidence in community-dwelling older adults
To determine whether musculoskeletal pain (pain severity and number of chronic pain sites; single or multisite) is associated with balance confidence over and above previously established risk factors. (Source: Physiotherapy)


Electroacupuncture analgesia is associated with increased serum brain-derived neurotrophic factor in chronic tension-type headache: a randomized, sham controlled, crossover trial
Background: Chronic tension-type headache (CTTH) is characterized by almost daily headaches and central sensitization, for which electroacupuncture (EA) might be effective. The central nervous system (CNS) plasticity can be tracked in serum using the brain-derived neurotrophic factor (BDNF), a neuroplasticity mediator. Thus, we tested the hypothesis that EA analgesia in CTTH is related to neuroplasticity indexed by serum BDNF. Methods: We enrolled females aged 18–60 years with CTTH in a randomized, blinded, placebo-controlled crossover trial, comparing ten EA sessions applied for 30 minutes (2–10 Hz, intensity by tolerance) in cervical areas twice per week vs. a sham intervention. Treatment periods were separated by two washout weeks. Pain on the 10-cm visual analog scale (VAS) and s...


Introducing remote physical rehabilitation for patients with chronic disorders by means of telemedicine
This study involved an evaluation of a telemedicine service implemented as a partial replacement of a physical outpatient rehabilitation program. The telemedicine service was an exercise-based tele-rehabilitation service facilitating remote physical rehabilitation for patients suffering from chronic lower back pain or pulmonary disease. Effectiveness was evaluated with multiple outcomes on quality (complaints, disability and physical condition) and access (usability, satisfaction and motivational character of the service). Patients referred by their rehabilitation physician to a physical outpatient rehabilitation program between October 2009 and May 2010 were asked to participate in the control group. Patients referred to the program between June 2010 and December 2011 were asked to partic...


Evaluation of psychosomatic distress and its influence in the outcomes of lumbar fusion procedures for degenerative disorders of the spine
This study emphasizes the need for objective psychological screening on chronic low back pain patients and that although patients with abnormal DRAM scores benefit from surgery, they report inferior outcomes and satisfaction in comparison with the normal DRAM group. (Source: European Journal of Orthopaedic Surgery and Traumatology)<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>


Physical inactivity is associated with narrower lumbar intervertebral discs, high fat content of paraspinal muscles and low back pain and disability
Conclusions: Physical inactivity is associated with narrower intervertebral discs, high fat content of the multifidus and high-intensity low back pain and disability in a dose-dependent manner among community-based adults. Longitudinal studies will help to determine the cause and effect nature of these associations. (Source: Arthritis Research and Therapy)


Screening and referral for axial spondyloarthritis—need of the hour
Abstract Although axial spondyloarthritis (axSpA) is as prevalent as rheumatoid arthritis, it is commonly under recognized due to variety of reasons. AxSpA contributes to significant loss of function and disability among young adults. With the availability of newer assessment methods and effective therapeutic agents, early diagnosis and appropriate treatment are possible. As mechanical back pain is widely prevalent in general population, selection of patients with high likelihood of having axSpA and referral to rheumatologists is very important to allow prompt diagnosis and management of axSpA yet avoid improper utilization of resources. Various referral strategies have been developed for this purpose which have included patients with chronic back pain for &gt;3 months with age ...


The incremental burden of pain in patients with depression: results of a Japanese survey
The objective of this study was to quantify the incremental burden of physical pain among individuals in Japan diagnosed with depression. Methods: Data for individuals age 18 and older who reported a physician diagnosis of depression were obtained from the Japan National Health and Wellness Survey (NHWS). Respondents who also reported physical pain were matched to respondents who did not report pain using propensity scores and compared using bivariate statistics. Measures included Patient Health Questionnaire (PHQ-9) for depression severity, Medical Outcomes Study 12-Item Short Form Survey Instrument (SF-12v2) for health-related quality of life, the Work Productivity and Activity Impairment (WPAI) for work and activity impairment, and 6-month report of health care use. Results: Individuals...


Addressing Neuroplastic Changes in Distributed Areas of the Nervous System Associated With Chronic Musculoskeletal Disorders.
Authors: Pelletier R, Higgins J, Bourbonnais D Abstract Present interventions utilized in musculoskeletal rehabilitation are in large part guided by a biomedical model where peripheral structural injury is believed to be the sole driver of the disorder. There are however neurophysiological changes across different areas of the peripheral and central nervous system including peripheral receptors, dorsal horn of the spinal cord, brain stem, sensorimotor cortical areas and in the meso-limbic and prefrontal areas associated with chronic musculoskeletal disorders including chronic low back pain, osteoarthritis, and tendon injuries. These neurophysiological changes appear to be not only a consequence of peripheral structural injury but play a part in the pathophysiology of chronic muscul...


Aetiological factors of Budd-Chiari syndrome in Algeria.
CONCLUSION: The main aetiologic factor of BCS in Algeria is MPD. The frequency of celiac disease justifies its consideration when BCS is diagnosed in our region. PMID: 25937867 [PubMed] (Source: World Journal of Hepatology)<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>


Assessing pharmacologic and nonpharmacologic risks in candidates for kidney transplantation.
CONCLUSION: Consensus opinions of practitioners in transplantation pharmacy regarding the pharmacologic and nonpharmacologic factors that should be considered in assessing candidates for kidney transplantation are presented. PMID: 25941253 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)


Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia: Acceptability and Preliminary Efficacy
This study focuses on exploring the use of Virtual Reality (VR) as an adjunct to the activity management component. The aim of this study is to present the results of a small-sized randomized controlled trial to test the preliminary efficacy and acceptability of this component. Materials and Methods: The final sample was composed of 61 women diagnosed with FMS according to the American College of Rheumatology. The sample was randomly allocated to 2 conditions: VR treatment and treatment as usual. Results: Participants in the VR condition achieved significant improvements in the primary outcome: disability measured with the FIQ. The improvement was also significant in secondary outcomes, such as perceived quality of life and some of the coping strategies included in the Chronic Pain Coping ...


Using Health Information Technology to Improve Adherence to Opioid Prescribing Guidelines in Primary Care
Discussion: Implementation of an opioid dashboard led to increased adherence to certain opioid practice guidelines and a decline in COT. This may be attributable to more efficient team-based pain management facilitated by the dashboard and increased transparency of opioid prescription practices. Health Information Technology solutions such as clinical dashboards can increase adherence to practice guidelines. (Source: The Clinical Journal of Pain)


Piloting a Text Message–based Social Support Intervention for Patients With Chronic Pain: Establishing Feasibility and Preliminary Efficacy
Discussion: These findings establish the feasibility of collecting daily pain data using a mobile tracking App and provide significant implications and insight into a nuanced approach to reducing the daily experience of pain through mobile technology, especially because of its accessibility. (Source: The Clinical Journal of Pain)


Comparison of an Online Mindfulness-based Cognitive Therapy Intervention With Online Pain Management Psychoeducation: A Randomized Controlled Study
Conclusions: The results of the study provide evidence that although there were equivalent changes across outcomes of interest for participants in both conditions over time, the MIA program showed a number of unique benefits. However, the level of participant attrition in the study highlighted a need for further attention to participant engagement with online chronic pain programs. (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>


Impact of an Acceptance Facilitating Intervention on Patients’ Acceptance of Internet-based Pain Interventions: A Randomized Controlled Trial
Conclusions: Patients with chronic pain display a relatively low acceptance of Internet-based psychological pain interventions, which can be substantially increased by a short informational video. (Source: The Clinical Journal of Pain)


Individualized Guided Internet-delivered Cognitive-Behavior Therapy for Chronic Pain Patients With Comorbid Depression and Anxiety: A Randomized Controlled Trial
Discussion: One-year follow-up showed maintenance of improvements. We conclude that an individualized guided internet-delivered treatment based on cognitive-behavior therapy can be effective for persons with chronic pain comorbid emotional distress. (Source: The Clinical Journal of Pain)


A Systematic Review of Technology-assisted Self-Management Interventions for Chronic Pain: Looking Across Treatment Modalities
This article is a systematic review of technology-assisted self-management interventions for chronic nonheadache, noncancer pain in adults. We examined 3 treatment modalities: telephone, interactive voice response, and Internet. Electronic searches of OVID MEDLINE, OVID PsychINFO, and the Cochrane Database of Systematic Reviews were conducted. Forty-four articles including 9890 participants were reviewed. Results: Across modalities, the existing evidence suggests that technology-assisted psychological interventions are efficacious for improving self-management of chronic pain in adults. All modalities have been shown to provide benefit and no clearly superior modality has emerged. The primary gaps in the literature are lack of in-person comparison groups, lack of direct comparison among te...


Eli Lilly to open new innovation center with a focus on drug delivery devices
Indianapolis-based pharma giant Eli Lilly is opening a new drug delivery and innovation center in Kendall Square in Cambridge, Massachusetts. Construction will begin immediately, with the center opening by the end of the year for a planned staff of 30 scientists and engineers. Eli Lilly Senior Director of Global Corporate Communications Edward Sagebiel said one Eli [&#8230;] (Source: mobihealthnews)


Acute and chronic pseudo‐obstruction: a current update
Abstract Acute colonic pseudo‐obstruction (ACPO) and chronic intestinal pseudo‐obstruction (CIPO) are distinct clinical entities in which patients present similarly with symptoms of a mechanical obstruction without an occlusive lesion. Unfortunately, they also share the issues related to a delay in diagnosis, including inappropriate management and poor outcomes. Advancements have been made in our understanding of the aetiologies of both conditions. Several predisposing factors linked to critical illness have been implicated in ACPO. CIPO is a functional motility disorder, historically misdiagnosed, with unnecessary surgery being performed in many patients with dire consequences. This review discusses the pathophysiology, clinical and diagnostic features, and treatment of each. For ACPO...<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>


Subcutaneous Stimulation as an Additional Therapy to Spinal Cord Stimulation for the Treatment of Low Back Pain and Leg Pain in Failed Back Surgery Syndrome: Four‐Year Follow‐Up
ConclusionSCS combined with SubQ can be considered an effective long term treatment for low back pain in patients with FBSS for whom SCS alone is insufficient in alleviating their pain symptoms. (Source: Neuromodulation: Technology at the Neural Interface)


Clinically Relevant Effectiveness of Focused Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis: A Randomized, Controlled Multicenter Study
Conclusions: The results of the present study provide proof of the clinically relevant effect size of focused extracorporeal shock wave therapy without local anesthesia in the treatment of recalcitrant plantar fasciitis, with success rates between 50% and 65%. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. (Source: The Journal of Bone and Joint Surgery)


Effect of a kneeling chair on lumbar curvature in patients with low back pain and healthy controls: A pilot study
Conclusions Although healthy subjects showed more reduction in lordosis between standing and sitting, the chair effect was found in both CLBP patients and healthy subjects. (Source: Annals of Physical and Rehabilitation Medicine)


Diet-induced changes in n-3 and n-6 derived endocannabinoids and reductions in headache pain and psychological distress
Omega-3 and omega-6 fatty acids are biosynthetic precursors to endocannabinoids with antinociceptive, anxiolytic, and neurogenic properties. We recently reported that targeted dietary manipulation—increasing omega-3 fatty acids while reducing omega-6 linoleic acid (the H3-L6 intervention)—reduced headache pain and psychological distress among chronic headache patients. It is not yet known whether these clinical improvements were due to changes in endocannabinoids and related mediators derived from omega-3 and omega-6 fatty acids. (Source: The Journal of Pain)


Psychometric Properties of the Centrality of Pain Scale
The Centrality of Pain Scale (COPS) is a recently developed, patient-centered, 10-item self-report measure designed to assess how central, or dominating, individuals with chronic pain perceive pain in their life. The COPS previously underwent initial development and validation, and preliminary results suggested that the measure had excellent psychometric properties and COPS scores were associated with important clinical factors. The purpose of the present study is to examine the psychometric properties of the COPS in a sample of individuals with mixed chronic pain diagnoses (n=178) being treated at a US Veterans Affairs Medical Center. (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>


Conservative laparoscopic electrocoagulation adenomyolysis for the management of symptomatic adenomyosis
The objective of the study was to assess the safety and efficacy of conservative laparoscopic electrocoagulation adenomyolysis (CLEA) in the management of women with symptomatic adenomyosis. The study design is prospective observational study. The setting was Department of Obstetrics and Gynecology, Mansoura University Hospital. Thirty-nine premenopausal women, complaining of chronic pelvic pain and/or menorrhagia, were diagnosed to have adenomyosis by transvaginal ultrasonography (TVS) and/or magnetic resonance imaging (MRI), between June 2008 and June 2011. They were subjected to laparoscopic multiple uterine unipolar electrocoagulation diathermy punctures aiming at adenomyolysis. Women were evaluated before and at 3, 6, and 12 months after the procedure. Main outcome is the magnitude o...


Effects of intermedin on dorsal root ganglia in the transmission of neuropathic pain in CCI rats.
This article is protected by copyright. All rights reserved. PMID: 25951228 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Pharmacology and Physiology)


Vitamin D for the treatment of chronic painful conditions in adults.
CONCLUSIONS: The evidence addressing the use of vitamin D for chronic pain now contains more than twice as many studies and participants than were included in the original version of this review. Based on this evidence, a large beneficial effect of vitamin D across different chronic painful conditions is unlikely. Whether vitamin D can have beneficial effects in specific chronic painful conditions needs further investigation. PMID: 25946084 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Postoperative hemicrania continua-like headache - a case series
Conclusion The biology of hemicrania continua may be activated post-craniotomy just as can be seen with other primary headache disorders. (Source: The Journal of Headache and Pain)


What Hillary Clinton Could Do About the Opioid Crisis
During a recent campaign stop, presidential candidate Hillary Clinton promised to make the "quiet epidemic" involving heroin and prescription opioids an important part of her presidential campaign -- and, presumably, of her presidency, should she be elected. She mentioned the issue of substance misuse again in her highly publicized speech on criminal justice reform last week. As someone intimately familiar with the devastating impact of this public health crisis on individuals, families and communities, I was very pleased to hear this, and thought of several ways she could make good on her pledge. Here are five simple steps Clinton could take, as candidate or President, that could significantly shape the course of opioid addiction in the United States. 1. Define the problem in the ri...<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>


ER Doctors Cautious When Prescribing Narcotic Painkillers: Study
Title: ER Doctors Cautious When Prescribing Narcotic Painkillers: StudyCategory: Health NewsCreated: 5/4/2015 12:00:00 AMLast Editorial Review: 5/5/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Acupuncture relieves symptoms in chronic prostatitis/chronic pelvic pain syndrome: a randomized, sham-controlled trial
Acupuncture relieves symptoms in chronic prostatitis&#47;chronic pelvic pain syndrome: a randomized, sham-controlled trial Prostate Cancer and Prostatic Diseases advance online publication, May 5 2015. doi:10.1038/pcan.2015.13 Authors: S Sahin, M Bicer, G A Eren, S Tas, V Tugcu, A I Tasci & M Cek (Source: Prostate Cancer and Prostatic Diseases)


Oxytocin and the modulation of pain experience: A review
Publication date: Available online 5 May 2015 Source:Neuroscience &amp; Biobehavioral Reviews Author(s): Lincoln M. Tracy , Nellie Georgiou-Karistianis , Stephen J. Gibson , Melita J. Giummarra TRACY, L.M., N. Georgiou-Karistianis, S.J. Gibson and M.J. Giummarra. Oxytocin and the modulation of pain experience: A review. NEUROSCI BIOBEHAV REV XX(X) XXX-XXX, 2015. In an acute environment pain has potential protective benefits. However when pain becomes chronic this protective effect is lost and the pain becomes an encumbrance. Previously unheralded substances are being investigated in an attempt to alleviate the burden of living with chronic pain. Oxytocin, a neuropeptide hormone, is one prospective pharmacotherapeutic agent gaining popularity. Oxytocin has the potential to modulate th...


A Randomized, Placebo-Controlled Trial of Lubiprostone for Opioid-Induced Constipation in Chronic Noncancer Pain
Authors: M Mazen Jamal, Atoya B Adams, Jan-Peter Jansen & Lynn R Webster (Source: The American 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>


Biomarkers for diagnosis, monitoring of progression, and treatment responses in ankylosing spondylitis and axial spondyloarthritis
Abstract With the growing awareness of the impact of chronic back pain and axial spondyloarthritis and recent breakthroughs in genetics and the development of novel treatments which may impact best on early disease, the need for markers that can facilitate early diagnosis and profiling those individuals at the highest risk for a bad outcome has never been greater. The genetic basis of ankylosing spondylitis has been considerably advanced, and HLA-B27 testing has a role in the diagnosis. Knowledge is still incomplete of the rest of the genetic contribution to disease susceptibility, and it is likely premature to use extensive genetic testing (other than HLA-B27) for diagnosis. Serum and plasma biomarkers have been examined extensively in assessing disease activity, treatment respon...


Ocular neuropathic pain.
Authors: Rosenthal P, Borsook D Abstract As the biological alarm of impending or actual tissue damage, pain is essential for our survival. However, when it is initiated and/or sustained by dysfunctional elements in the nociceptive system, it is itself a disease known as neuropathic pain. While the critical nociceptive system provides a number of protective functions, it is unique in its central role of monitoring, preserving and restoring the optical tear film in the face of evaporative attrition without which our vision would be non-functional. Meeting this existential need resulted in the evolution of the highly complex, powerful and sensitive dry eye alarm system integrated in the peripheral and central trigeminal sensory network. The clinical consequences of corneal damage to t...


MicroRNA-146a-5p attenuates neuropathic pain via suppressing TRAF6 signaling in the spinal cord.
In this study, we found that in cultured astrocytes, TNF-α, IL-1β, or lipopolysaccharides (LPSs) induced rapid TRAF6 upregulation and delayed miR-146a-5p upregulation. In addition, miR-146a-5p mimic blocked LPS-induced TRAF6 upregulation, as well as LPS-induced c-Jun N-terminal kinase (JNK) activation and chemokine CCL2 expression in astrocytes. Notably, LPS incubation with astrocytes enhanced the DNA binding activity of AP-1 to the promoters of mir-146a and ccl2. TRAF6 siRNA or JNK inhibitor SP600125 significantly reduced LPS-induced miR-146a-5p increase in astrocytes. In vivo, intrathecal injection of TNF-α or LPS increased spinal TRAF6 expression. Pretreatment with miR-146a-5p mimic alleviated TNF-α- or LPS-induced mechanical allodynia and reduced TRAF6 expression. Finally, SNL indu...


Experimental new vaccine may help in the fight against shingles
If you had chickenpox as a child, the virus that caused it can re-emerge later in life — out of the blue — to cause shingles. This condition, also known as herpes zoster, consists of a rash on one side of the body, often accompanied by excruciating pain. The rash typically goes away in about a month, but in some people, the pain lingers for weeks, months, or even years. This chronic pain is called post-herpetic neuralgia. The virus that causes chickenpox, known as varicella-zoster, doesn&#8217;t necessarily disappear from the body after the chickenpox rash fades away. Instead, the virus can go into hiding, taking up residence in the nerve roots coming off the spinal cord. As the immune system becomes weaker with age, varicella-zoster may &#8220;wake up,&#8221; start to grow in a nerve ...


A Review of Surgical and Nonsurgical Outcomes of Medial Knee Injuries
Medial-sided knee injuries can result in pain, instability, and loss of function. Many clinical studies have been written on the treatment of medial-sided knee injuries; however, the vast majority are isolated case series of surgical or nonoperative treatment regimens, and only a few randomized prospective clinical trials can be found in the literature that compare different treatment modalities. Comparison of these treatments is challenging due to the variety of medial-sided structures that can be involved, the multiple different approaches to treatment, and the variability of how objective and subjective clinical outcomes are reported. In this paper we report on the injuries by extent and type of anatomic structures damaged including partial medial-sided injuries, completed isolated medi...<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 genetic model for chronic widespread pain: Clinical comorbidities and psychological correlates
Background: The aim was to investigate the etiological structure underlying chronic widespread pain (CWP) by disentangling the covariation between CWP and previously reported comorbidities (i.e., depression) and psycho-affective correlates (i.e., anxiety, emotional stability and emotional intelligence) into genetic and environmental components. (Source: Journal of Psychosomatic Research)


Mood spectrum disorders in chronic pain patients
Background: Chronic pain is a complex syndrome that affects thinking, mood and behaviour (Nekovarova et al., 2014). It is strongly associated with major depressive disorders (30–40%) but few studies have investigated the prevalence of bipolar disorders in chronic pain patients (Holmes et al., 2012; Nicholl et al., 2014). (Source: Journal of Psychosomatic Research)


Pathogenetic psychosomatic mechanisms in chronic pain: Gender differences among syndromes
Background: Abnormal Illness Behaviour (AIB) and Somatosensory Amplification Scale (SSAS) are two of the main conditions underlying medically unexplained symptoms. (Source: Journal of Psychosomatic Research)


Somatoform pain patients during psychosomatic inpatient treatment — A clinical observation study
We examined whether there were systematic differences between young and old pain patients. (Source: Journal of Psychosomatic Research)


Mindfulness and chronic pain. What is next step?
Background: Several meta-analyses have been performed comprising less specific “mindfulness-derived” interventions. There is a lack of randomized, controlled clinical trials investigating the effects of the full MBSR mindfulness meditation program on chronic pain. (Source: Journal of Psychosomatic 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>


St. Jude Medical Completes Acquisition of Spinal Modulation, Inc.
Now complete, the acquisition of Spinal Modulation adds DRG stimulation technology to the St. Jude Medical chronic pain portfolio ST. PAUL, Minn.--(Healthcare Sales & Marketing Network)--St. Jude Medical, Inc. (STJ), a global medical device company, tod... Devices, Neurology, Mergers & AcquisitionsSt. Jude Medical, Spinal Modulation, Axium, Neurostimulator, neuromodulation (Source: HSMN NewsFeed)


Serotonin Syndrome in a Patient on Trazodone and Duloxetine Who Received Fentanyl following a Percutaneous Liver Biopsy
Serotonin syndrome is a rare but potentially life-threatening adverse drug reaction resulting from the use or overuse of serotonergic medications alone or in combination. Mild symptoms, overlapping features with similar conditions and clinician lack of awareness are the major reasons for an often missed diagnosis. Not surprisingly, this condition is significantly underreported as a potential complication of endoscopy if serotonergic medications are used periprocedurally for sedation and analgesia. Here we report the case of a patient with relapsed chronic hepatitis C on antidepressant medications who developed signs and symptoms of serotonin syndrome after a percutaneous liver biopsy. Review of the patient's medication list suggested a possible interaction between her home antidepressants ...


Effect of a muscle stretching program using the global postural reeducation method for patients with chronic low back pain: A randomized controlled trial
Discussions Based on the findings, a stretching program using the GPR method showed effective at improving pain, function, some quality of life aspects (emotional, limitations in physical functioning, vitality and mental health) and had no effect on depressive symptoms in patients with chronic low back pain. (Source: Joint Bone Spine)


Psychometric assessment of the Japanese version of the Revised Fibromyalgia Impact Questionnaire: reliability and validity
ConclusionThe current psychometric assessment of the JFIQR demonstrated that it is a reliable and valid questionnaire in Japanese patients with FM. Usefulness of the JFIQR in clinical studies and medical practice for Japanese‐speaking populations is expected. (Source: APLAR Journal of Rheumatology)


Spinal and Nucleus Caudalis Dorsal Root Entry Zone Lesioning for Chronic Pain: Efficacy and Outcomes
Conclusion Spinal and NC DREZ lesioning can provide effective relief in well selected patients with intractable chronic pain conditions arising from trigeminal pain, spinal cord injury, brachial plexus avulsions, post-herpetic neuralgia and phantom limb pain. (Source: World Neurosurgery)<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>


Juvenile idiopathic arthritis and physical activity: Possible inflammatory and immune modulation and tracks for interventions in young populations
Publication date: Available online 29 April 2015 Source:Autoimmunity Reviews Author(s): Emmanuelle Rochette , Pascale Duché , Etienne Merlin Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease characterized by persistent joint inflammation that manifests as joint pain and swelling and limited range of joint motion. In healthy subjects, the literature reports that physical activity has an anti-inflammatory effect. In JIA patients, exercise could be used as a therapeutic tool to counteract disease-related inflammation and thereby improve clinical symptoms, although transient flare of pain could be the price to pay. Indeed, in patients with a chronic inflammatory disease, physical activity is prone to exacerbate underlying inflammatory stress. Physical activity improves q...


Antiallodynic effects of alpha lipoic acid in an optimized RR‐EAE mouse model of MS‐neuropathic pain are accompanied by attenuation of upregulated BDNF‐TrkB‐ERK signaling in the dorsal horn of the spinal cord
Abstract Neuropathic pain may affect patients with multiple sclerosis (MS) even in early disease. In an experimental autoimmune encephalomyelitis (EAE)‐mouse model of MS, chronic alpha lipoic acid (ALA) treatment reduced clinical disease severity, but MS‐neuropathic pain was not assessed. Hence, we investigated the pain‐relieving efficacy and mode of action of ALA using our optimized relapsing‐remitting (RR)‐EAE mouse model of MS‐associated neuropathic pain. C57BL/6 mice were immunized with MOG35‐55 and adjuvants (Quil A and pertussis toxin) to induce RR‐EAE; sham‐mice received adjuvants only. RR‐EAE mice received subcutaneous ALA (3 or 10 mg kg−1 day−1) or vehicle for 21 days (15–35 d.p.i.; [days postimmunization]); sham‐mice received vehicle. Hindpaw hype...


Change in T2* Relaxation Time of Hoffa Fat Pad Correlates With Histologic Change in a Rat Anterior Cruciate Ligament Transection Model
This article is protected by copyright. All rights reserved (Source: Journal of Orthopaedic Research)


A systematic review of personality disorders and health outcomes.
Personality disorders (PDs) have been associated with a wide swath of adverse health outcomes and correspondingly high costs to health care systems. To date, however, there has not been a systematic review of the literature on health conditions among individuals with PDs. The primary aim of this article is to review research documenting the associations between PDs and health conditions. A systematic review of the literature revealed 78 unique empirical English-language, peer-reviewed articles examining the association of PDs and health outcomes over the past 15 years. Specifically, we reviewed research examining the association of PDs with sleep disturbance, obesity, pain conditions, and other chronic health conditions. In addition, we evaluated research on candidate mechanisms underlying...


Dry Endoscopic-Assisted Mini-Open Approach With Neuromonitoring for Chronic Hamstring Avulsions and Ischial Tunnel Syndrome
Publication date: Available online 4 May 2015 Source:Arthroscopy Techniques Author(s): Juan Gómez-Hoyos , Manoj Reddy , Hal D. Martin Chronic hamstring origin avulsions and ischial tunnel syndrome are common causes of posterior hip pain. Although physical therapy has shown benefits in some cases, recent evidence has reported better outcomes with surgical treatment in appropriately selected patients. The full-open approach has been the classic procedure to address this problem. However, the complications related to extensive tissue exposure and the proximity of the incision to the perianal zone have led to the description of full-endoscopic techniques. Achieving an accurate hamstring repair could be technically demanding with a full-endoscopic procedure. Accurate reattachment is crucial ...<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 of Physical Fitness with Pain in Women with Fibromyalgia: The al‐Ándalus project
Conclusions: Our results suggest that higher physical fitness is associated with lower levels of pain, lower pain‐related catastrophizing, and higher chronic pain self‐efficacy in women with FM. These results might have implications for future intervention studies in this population. This article is protected by copyright. All rights reserved. (Source: Arthritis Care and Research)


Obturator Neuralgia: A Rare Complication of Tension-free Vaginal Tape Sling—Complete Resolution After Laparoscopic Tension-free Vaginal Tape Removal
Conclusion In patients suffering from obturator neuralgia after a retropubic sling, surgeons should include the sling as a potential causative factor in the differential diagnosis. Surgeons should consider removing the sling based on the patient's symptoms. If the patient suffers from only vaginal pain and dyspareunia, then the surgeon should consider only the removal of the vaginal portion of the sling. In patients with obturator neuralgia, retropubic, and/or lower abdominal pain, one should consider a combined transvaginal and laparoscopic approach in an attempt to remove the majority of the sling and release tension between 2 points of fixation. (Source: Journal of Minimally Invasive Gynecology)


Periclitoral Endometriosis: The Dilemma of a Chronic Disease Invading a Rare Location
We present a unique case of periclitoral endometriosis, which to the best of our knowledge is the first in the literature. It is a 29-year-old nulligravida female with a painful fluctuant right periclitoral mass that had been growing with no response to antibiotic therapy. At the initial removal, pathology reported the lesion as endometriosis. The patient was placed on oral contraceptives, and she was noted to have monthly swelling and shrinking of the site with her menstrual cycles. When she went off hormonal contraception, she represented with the growing lesion 3.5 weeks after her last menses; she underwent re-excision. Because of the extension of the lesion medially and its adherence to the clitoral body, the decision was made to evacuate only as much of the capsule that could be safel...


Individuals with chronic low back pain demonstrate delayed onset of the back muscle activity during prone hip extension
Prone hip extension (PHE) is commonly used in the evaluation of the stability of the lumbopelvic region. There is little evidence of difference in muscle activity onset timing between healthy individuals and individuals with chronic low back pain (CLBP) during PHE. The purpose of this study was to determine if individuals with and without CLBP differ in the onset time of the trunk and hip extensor muscles activity during PHE. The participants were 20 patients with CLBP and 20 healthy individuals. (Source: Journal of Electromyography and Kinesiology)


Upregulation of α2δ-1 Calcium Channel Subunit in the Spinal Cord Contributes to Pelvic Organ Cross-Sensitization in a Rat Model of Experimentally-Induced Endometriosis.
We examined if the dysregulation of spinal Cavα2δ-1 subunit may play an important role in the development of ectopic growths-to-colon cross-sensitization in a rat model of experimentally-induced endometriosis. Our findings suggest that there was an increased Cavα2δ-1 expression in the dorsal horn and an ectopic growths-to-colon cross-sensitization in female rats with established endometriosis. Intrathecal administration of gabapentin (300 μg) remarkably reduced the ectopic growths-to-colon cross-sensitization in rats with established endometriosis. Furthermore, intrathecal injection of Cavα2δ-1 antisense oligodeoxynucleotides reversed the ectopic growths-to-colon cross-sensitization and also normalized the upregulation of spinal Cavα2δ-1 expression in endometriosis rats. The curr...<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>


Continuous wound infusion of ropivacaine for the control of pain after thoracolumbar spinal surgery: a randomized clinical trial
Conclusions Our results showed that local infusion of ropivacaine achieved similar analgesic effects to intravenous delivery of analgesic drugs, but significantly reduced incidence of nausea, vomiting and chronic pain. (Source: European Spine Journal)


Frailty among elderly adults in a rural area of Turkey.
CONCLUSIONS It is believed that this study will contribute considerably to understanding the health status and needs of elderly adults in Turkey and the health problems of this population as well as to planning the development of public health and geriatric services based on regional needs. PMID: 25925800 [PubMed - in process] (Source: Medical Science Monitor)


The hypnotic induction profile and absorption.
This study examined the relationship between scores on the Hypnotic Induction Profile (HIP) and the trait of absorption in three different clinical groups: Smokers (n = 226), Phobics (n = 95), and patients with Chronic Pain (n = 65). Two hypotheses were investigated. The first predicted that both the Eye-Roll sign (ERS) and Induction Score (IND) of the HIP would correlate similarly (r = .30) with scores on the Tellegen Absorption Scale (TAS), as has been previously reported with other measures of hypnotic responsivity in student samples. The second was that using a combination of both ERS and IND scores to predict TAS scores would result in a significant increase in forecasting accuracy over using either HIP measure alone. Both hypotheses were supported in all three clinical groups. Correl...


The construct validity of the Short Form-36 Health Survey for patients with nonspecific chronic neck pain
This study investigates construct validity of the SF-36 in these patients using 16 a-priori formulated hypotheses. Ninety-one patients admitted for rehabilitation completed the SF-36 before the rehabilitation program. SF-36 domain scores of patients with CNP were compared with general population reference values and standardized differences were calculated. For both the SF-36 physical and the mental component summary (PCS and MCS), differences between primary and tertiary care setting, men and women, age groups, litigants and nonlitigants, patients with and without compensation, and with ≥3 versus≤2 concomitant complaints were analyzed using independent t-tests. Differences between PCS and MCS scores were analyzed using a paired t-test. Twelve hypotheses were not rejected and four were...


Effects of therapeutic Tai Chi on balance, gait, and quality of life in chronic stroke patients
This study confirmed that therapeutic Tai Chi influences the balance, gait, and life quality of stroke patients. Therefore, therapeutic Tai Chi can be used as an effective exercise in combination with general physical therapy to improve the balance, gait, and quality of life in stroke patients. (Source: International Journal of Rehabilitation 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>


Peripheral nerve pathology in patients with severely affected complex regional pain syndrome type I
Complex regional pain syndrome type I (CRPS-I) is a chronic pain syndrome with no clinical evidence of nerve injury; however, recently, changes in muscle tissue have been found in case of CRPS-I. Our aim was to search for histological changes in peripheral nerves of amputated limbs from patients with therapy-resistant CRPS-I that could justify muscle tissue changes. Fifteen patients with CRPS-I (duration >1 year) were included. Multiple nerve samples were taken from upper (n=4) and lower (n=11) amputated limbs. Histological changes (signs of nerve fiber loss and regeneration), fiber diameters, fiber diameter distribution, and fiber density were studied through microscopy and morphometry. Samples from three healthy sural nerves were used as control data as well as data from the literature. ...


Prevalence of use of non-prescription analgesics in the Norwegian HUNT3 population: Impact of gender, age, exercise and prescription of opioids
Conclusions: Use of OTC analgesics is prevalent, related to chronic pain, female gender and physical inactivity. (Source: BMC Public Health)


Effect of the Duration of Chronic Pancreatitis on Pancreas Islet Yield and Metabolic Outcome Following Islet Autotransplantation
Conclusions The duration of CP could affect islet yield and metabolic outcomes. The time since the diagnosis of CP should be considered when selecting patients for islet autotransplantation. (Source: Journal of Gastrointestinal Surgery)


Minocycline does not affect long-term potentiation in the anterior cingulate cortex of normal adult mice
It has been reported that activated microglia plays important roles in chronic pain-related sensory signaling at the spinal cord dorsal horn. Less is known about the possible contribution of microglia to cortical plasticity that has been found to be important for chronic pain. In the present study, we used a 64-channel multi-electrode array recording system to investigate the role of microglia in cortical plasticity of the anterior cingulate cortex (ACC) in normal adult mice. We found that bath application of minocycline, an inhibitor of microglial activation, had no effect on postsynaptic LTP (post-LTP) induced by theta burst stimulation in the ACC. Furthermore, presynaptic LTP (pre-LTP) induced by the combination of low-frequency stimulation with a GluK1-containing kainate receptor agoni...


A Novel Anxiety and Affective Spectrum Disorder of Mind and Body-The ALPIM (Anxiety-Laxity-Pain-Immune-Mood) Syndrome: A Preliminary Report.
This study examined 76 consecutive outpatients with an anxiety disorder plus at least one somatic condition from three domains. More than 80% of the patients had panic attacks, fibromyalgia, and major depressive episodes. Associations were found between joint laxity and bipolar III, headache with bipolar II, and bipolar II with chronic fatigue syndrome. Significant relationships were demonstrated within and between domains, validating ALPIM as a syndrome. PMID: 25923849 [PubMed - in process] (Source: Journal of Neuropsychiatry and Clinical Neurosciences)<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>


Pulmonary embolism as the initial clinical presentation of Kimura disease: case report and literature review
We reported a 47-year-old male case presenting with pleural pain and dyspnoea and was found to have pulmonary embolism. After successful management of pulmonary embolism, he was noticed to have eosinophilia and lymphadenopathy. Pathologic examination of a resected lymph node has confirmed the diagnosis of Kimura disease. The patient was treated with corticosteroid and cyclosporine A, with a significant improvement of the symptoms and signs of Kimura disease and no recurrence of any thromboembolism. Associated literatures were reviewed to explore the pathogenesis underlying the thrombotic event in Kimura disease cases. It is suggested that hypereosinophilia may play a key role in thrombosis formation. The control of hypereosinophilia may contribute to the prevention of thrombosis and its re...


New-onset panic, depression with suicidal thoughts, and somatic symptoms in a patient with a history of lyme disease.
We present a case of a 37-year-old man with no known psychiatric history who developed panic attacks, severe depressive symptoms and suicidal ideation, and neuromuscular complaints including back spasms, joint pain, myalgias, and neuropathic pain. These symptoms began 2 years after being successfully treated for a positive Lyme test after receiving a tick bite. During inpatient psychiatric hospitalization his psychiatric and physical symptoms did not improve with antidepressant and anxiolytic treatments. The patient's panic attacks resolved after he was discharged and then, months later, treated with long-term antibiotics for suspected "chronic Lyme Disease" (CLD) despite having negative Lyme titers. He however continued to have subsyndromal depressive symptoms and chronic physical symptom...


Joint Pain a Major Issue in Chronic HCV Infection (CME/CE)
(MedPage Today) -- Smoking increases risk of arthralgias in hepatitis C. (Source: MedPage Today Gastroenterology)


Chronic Pain Follows Adverse Life Events
(MedPage Today) -- But biological stress markers don't show relation to chronic pain risk. (Source: MedPage Today Primary Care)


Could targeting epigenetic processes relieve chronic pain states?
This article will review the evidence obtained from animal studies indicating that epigenetic processes might regulate long-term pain states and then discuss the possibility that targeting epigenetic mechanisms might be useful for the management of chronic pain. Recent findings: Recent animal studies have reported injury-induced changes in epigenetic processes in the central nervous system. The picture that has emerged is that of very complex epigenetic programs that depend on the injury. However, some studies have reported the successful use of nonspecific epigenetic tools to improve the hypersensitivity that develops in animal models of long-term pain states. Summary: The field of epigenetics and pain is rapidly emerging but further investigation is needed to fully comprehend the contrib...<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>


Emerging potassium channel targets for the treatment of pain
Purpose of review: Poor management of chronic pain remains a significant cause of misery with huge socioeconomic costs. Accumulating research in potassium (K+) channel physiology has uncovered several promising leads for the development of novel analgesics. Recent findings: We now recognize that certain K+ channel subunits are directly gated to pain-relevant stimuli (Kv1.1, K2P) whereas others are specifically modulated by inflammatory processes (Kv7, BKCA, K2P). Genetic analyses illustrate that K+ channel gene variation can predict pain sensitivity (KCNS1, GIRKs), risk for persistent pain (KCNS1, GIRKs, TRESK) and analgesic effectiveness (GIRK2). Importantly, preclinical studies confirm that K+ channel dysfunction can be a pain trigger in traumatic neuropathies (Kv9.1/Kv2.1, Kv7, Kv1.2) a...


Emerging targets and therapeutic approaches for the treatment of osteoarthritis pain
Purpose of review: Osteoarthritis is a complex and often painful disease that is inadequately controlled with current analgesics. This review discusses emerging targets and therapeutic approaches that may lead to the development of better analgesics. Recent findings: Aberrant excitability in peripheral and central pain pathways drives osteoarthritis pain, reversing this via modulation of nerve growth factor, voltage-gated sodium channel, voltage-gated calcium channel and transient receptor potential vanilloid one activity, and increasing inhibitory mechanisms through modulation of cannabinoid and descending modulatory systems hold promise for osteoarthritis pain therapy. Somatosensory phenotyping of chronic pain patients, as a surrogate of putative pain generating mechanisms, may predict p...


Opioid-induced hyperalgesia: where are we now?
Purpose of review: Patients receiving chronic opioid treatment who develop paradoxical pain sensations, as well as worsening existing pain, can be diagnosed as suffering from opioid-induced hyperalgesia (OIH). As the worldwide population expands so too does the proportion of patients who experience pain that requires a strong opioid. Recognizing the symptoms of OIH and optimizing the use of morphine in the hospital setting is imperative. This review focuses on clinical data relating to evidence of OIH at the bedside and the novel techniques employed by healthcare providers in order to improve the heightened pain sensations experienced by susceptible patients. Recent findings: An increasing number of randomized prospective controlled trials report worsening patient pain following high-dose ...


Holding Grudges Is Bad for Our Health
It might be hard to imagine, but somewhere between 50 and 80 percent of people will experience a trauma at some point in their lives. To make matters worse, most traumas are perpetrated directly by other people -- sometimes even acquaintances, friends, and family members. Given these depressing statistics, it may be tempting to become angry or resentful, to view people as threats and little more. That's what some victims of trauma do, of course. They may hold grudges, harbor life-long resentment, and even seek retribution. Who could blame them? Perhaps this is why some mental health professionals teach that forgiveness is an important step in moving beyond such trauma. It seems obvious that unforgiveness is bad for mental health -- it's highly unpleasant to harbor anger or hurt for prolon...


Health Tip: Spotting Signs of Urinary Tract Infection
Title: Health Tip: Spotting Signs of Urinary Tract InfectionCategory: Health NewsCreated: 5/1/2015 12:00:00 AMLast Editorial Review: 5/1/2015 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>


Pyoderma Gangrenosum: A Difficult Diagnosis Best Managed in a Burn Treatment Center
Pyoderma gangrenosum (PG) is a rare immunological disorder with inexplicable white blood cell infiltration into the epidermis with necrosis and excruciating pain. Diagnosis is by exclusion which delays proper treatment. Surgical intervention often exacerbates wounds. Between 2004 and 2010, seven patients with PG were admitted to our burn treatment center (BTC). Multiple treatment modalities were used on these patients. An institutional review board–approved retrospective study investigated seven PG BTC admissions. Demographic information, symptom onset, time to diagnosis, admission or transfer, length of stay (LOS), use of corticosteroids, and prior surgery were collected. The average time to PG diagnosis was 18.7 days and the average wound surface area was 3.9%. The average patient age ...


Transdermal Buprenorphine, Opioid Rotation to Sublingual Buprenorphine, and the Avoidance of Precipitated Withdrawal: A Review of the Literature and Demonstration in Three Chronic Pain Patients Treated With Butrans
We present a case series of a novel method of sublingual buprenorphine introduction without an induction period, using the recently Food and Drug Administration-approved low-dose transdermal buprenorphine (Butrans; Purdue Pharma L.P.) as a bridge medication. In these cases, buprenorphine was started in opioid-dependent chronic noncancer pain patients who had taken short-acting opioid medications within hours of the initiation of the rotation. This method avoids the painful abstinence period and did not result in precipitated withdrawal or other significant adverse effects. (Source: American Journal of Therapeutics)


Retrospective Study on the Analgesic Activity of a Topical (TT-CTAC) Cream in Patients With Diabetic Neuropathy and Other Chronic Pain Conditions
The objective of this retrospective study was to evaluate the efficacy of a compounded topical cream (Transdermal Therapeutics). Two versions of TT-CTAC cream were evaluated: cream 6B and cream 7B. Both creams contain ketamine (10%), baclofen (2%), gabapentin (6%), amitriptyline (4%), bupivacaine (2%), and clonidine (0.2%). Additionally, one cream (7B) contains nifedipine (2%). The primary efficacy outcome was the change in numeric pain intensity score from pretreatment to posttreatment. Secondary outcomes were qualitative grading (excellent, good, poor, or no effect), reduction in oral medication, and avoiding referral to a pain specialist. Information on 283 patients was evaluated, 205 received the 7B and 78 received 6B creams. The pain score decreased by 2.4 ± 2.4 (35%) with the 6B cre...


Intralesional pentoxifylline in the treatment of lepromatous ulcers
Conclusion: Intralesional PTX has good efficacy and a high success rate in the treatment of lepromatous ulcers. (Source: Journal of the Egyptian Women’s Dermatologic Society)


Temporomandibular Joint Disorders Treated With Articular Injection: The Effectiveness of Plasma Rich in Growth Factors-Endoret
The objective of this study was to evaluate the effectiveness of the temporomandibular joint (TMJ) osteoarthritis treatment through articular injections of plasma rich in growth factors (PGRF)-Endoret. Thirteen patients (median age, 47.64 y; SD, 7.51; range, 40–64 y; male-female ratio, 2:11) with osteoarthritis of TMJ associated to chronic pain have been selected. They were treated with articular injections of PRGF-Endoret, measuring the maximum mouth opening and pain level before the first injection (t0), 30 days after just before the second (t1), and after 6 months (t2). Data were analyzed using the paired Student's t-test data. The visual analogue scale score at t0 is 7.69 (range, 4–10; SD, 1.9), whereas that at t1 is 1.54 (range, 0–5; SD, 1.74) and that at t2 is 0.23 (range, ...<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>


L-menthone confers antidepressant-like effects in an unpredictable chronic mild stress mouse model via NLRP3 inflammasome-mediated inflammatory cytokines and central neurotransmitters
Publication date: Available online 29 April 2015 Source:Pharmacology Biochemistry and Behavior Author(s): Jinsong Xue , Hongyan Li , Xueyang Deng , Zhanqiang Ma , Qiang Fu , Shiping Ma L-menthone (MTN) is an Chinese old remedy extracted from the genus Mentha. It has been widely used as a cooling agent and a counterirritant for pain relief, although its antidepressant-like effects have not yet been reported. The present study was designed to investigate whether MTN confers an antidepressant-like effect in mice exposed to unpredictable chronic mild stress (UCMS) and to explore its potential mechanisms. The effects of MTN on mouse behavioral changes were investigated in our study. We determined the levels of the nucleotide binding, oligomerization domain-like receptor family pyrin domain-co...


Small constrained SP1–7 analogs bind to a unique site and promote anti-allodynic effects following systemic injection in mice
Publication date: 9 July 2015 Source:Neuroscience, Volume 298 Author(s): A. Jonsson , R. Fransson , Y. Haramaki , A. Skogh , E. Brolin , H. Watanabe , G. Nordvall , M. Hallberg , A. Sandström , F. Nyberg Previous results have shown that the substance P (SP) N-terminal fragment SP1–7 may attenuate hyperalgesia and produce anti-allodynia in animals using various experimental models for neuropathic pain. The heptapeptide was found to induce its effects through binding to and activating specific sites apart from any known neurokinin or opioid receptor. Furthermore, we have applied a medicinal chemistry program to develop lead compounds mimicking the effect of SP1–7. The present study was designed to evaluate the pharmacological effect of these compounds using the mouse spared nerve inju...


Making Friends with Chronic Pain 9/06/99
Making friends with pain can help you cope - from your About.com Guide (Source: About.com Mental Health)


99mTc-NTP 15-5 Imaging for Cartilage Involvement in Experimental Rheumatoid Arthritis: Comparison with Routinely Used Molecular Imaging Methods and Sensitivity to Chronic Nonsteroidal Antiinflammatory Drug Treatment
Conclusion: These experimental results bring data in favor of the 99mTc-NTP 15-5 radiotracer for assessing, in vivo, cartilage remodeling in RA that could be used to monitor therapy. (Source: Journal of Nuclear Medicine)


Integrative medicine Patients have High stress, pain, and psychological Symptoms
Publication date: Available online 30 April 2015 Source:EXPLORE: The Journal of Science and Healing Author(s): Ruth Q. Wolever , Nikita S. Goel , Rhonda S. Roberts , Karen Caldwell , Benjamin Kligler , Jeffery A. Dusek , Adam Perlman , Rowena Dolor , Donald A. Abrams Integrative medicine (IM) is a rapidly growing field whose providers report clinical success in treating significant stress, chronic pain, as well as depressive and anxiety symptoms. While IM therapies have demonstrated efficacy for numerous physiological conditions, IM for psychological symptoms has been slower to gain recognition in the medical community. This large, cross-sectional study is the first of its kind to document the psychosocial profiles of 4182 patients at 9 IM clinics that form the BraveNet Practice-Based Re...<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 effects of topical application of metronidazole for treatment of chronic anal fissure: A randomized, controlled pilot study
Conclusion Topical antimicrobial treatment can be effective in patients with CAF provided the relevant microorganisms are correctly identified. (Source: Indian Journal of Gastroenterology)


Chronic Pain
Much has happened in the field of chronic pain in the past few decades. Things continue to change, even in the way chronic pain is characterized, as well as in treatment strategies. In the field of chronic pain, the University of Washington has a longstanding history of excellence in both research and clinical care. Among the leaders here include my good friend and colleague, Dr Jim Robinson. Dr Robinson came immediately to mind when thinking of who could edit a Physical Medicine and Rehabilitation Clinics of North America issue on chronic pain. (Source: Physical Medicine and Rehabilitation Clinics of North America)


Nonopioid Medications for Pain
Evidence of nonopioid analgesic effectiveness exceeds that for long-term opioids in chronic noncancer pain (CNCP), most with lower risk. Non-drug therapies such as cognitive behavioral therapy and physical activation are safer and also effective. Nonsteroidal antiinflammatory drugs are useful for inflammatory and nociceptive pain, share renal and variable gastrointestinal, bleeding and cardiovascular side effects. Antidepressants with noradrenergic activity (such as tricyclics and seroton-norepinephrine reuptake inhibitors) and neuromodulating anticonvulsant drugs (gabapentinoids and sodium-channel blockers) are proven to be effective for neuropathic and centralized pain. Ketamine and cannabinoids are other studied analgesics but have a less well-proven role in CNCP. (Source: Physical Medi...<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>


Injections for Chronic Pain
Although interventional procedures should be used cautiously in the setting of chronic pain, there is a role for a variety of injections to facilitate a patient’s overall rehabilitation program. There are many resources available, including a prior issue of Physical Medicine and Rehabilitation Clinics of North America, which discuss the more conventional spinal injections. The focus of this article is on lesser-known injection options for treating chronic pain. The authors separately discuss trigger point injections, regenerative injections (prolotherapy), and injections using botulin toxins. (Source: Physical Medicine and Rehabilitation Clinics of North America)


Complementary Medicine in Chronic Pain Treatment
This article discusses several issues related to therapies that are considered “complementary” or “alternative” to conventional medicine. A definition of “complementary and alternative medicine” (CAM) is considered in the context of the evolving health care field of complementary medicine. A rationale for pain physicians and clinicians to understand these treatments of chronic pain is presented. The challenges of an evidence-based approach to incorporating CAM therapies are explored. Finally, a brief survey of the evidence that supports several widely available and commonly used complementary therapies for chronic pain is provided. (Source: Physical Medicine and Rehabilitation Clinics of North America)


Psychiatric and Psychological Perspectives on Chronic Pain
This article describes psychiatric disorders that are highly prevalent among pain patients and also describes psychological processes that contribute to poor coping by the patients. Finally, it discusses factors that a physiatrist should consider in deciding whether to refer patients to psychiatrists versus psychologists. (Source: Physical Medicine and Rehabilitation Clinics of North America)


Radial shock wave treatment alone is less efficient than radial shock wave treatment combined with tissue-specific plantar fascia-stretching in patients with chronic plantar heel pain
Whether shock wave therapy or shock wave therapy combined with plantar fascia-specific stretching is more efficient in treating chronic plantar heel pain remains unclear. The aim of the study was to test the null hypothesis of no difference of these two forms of management for patients who had unilateral plantar fasciopathy for a minimum duration of twelve months and which had failed at least three other forms of treatment. (Source: International Journal of Surgery)


Chronic Pruritus: Histamine Is Not Always the Answer!
The experience of chronic pruritus can be tortuous. The management of chronic pruritus is notoriously difficult and the symptom is often met by therapeutic nihilism. Historically, that difficulty was heightened by an incomplete understanding of the pathophysiology of pruritus generally and certain pruritus syndromes specifically. Treatment was largely empirical. Frequently, the published trials of proposed treatment strategies concentrate on the efficacy of the treatment itself with cursory regard to the underlying pathophysiological mechanisms. (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>


Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults.
CONCLUSIONS: Since the last version of this review, the new included studies have not added high quality evidence to support the use of SSRIs or venlafaxine (a SNRI) as preventive drugs for tension-type headache. Over two months of treatment, SSRIs or venlafaxine are no more effective than placebo or amitriptyline in reducing headache frequency in patients with chronic tension-type headache. SSRIs seem to be less effective than tricyclic antidepressants in terms of intake of analgesic medications. Tricyclic antidepressants are associated with more adverse events; however, this did not cause a greater number of withdrawals. No reliable information is available at longer follow-up. Our conclusion is that the use of SSRIs and venlafaxine for the prevention of chronic tension-type headache is ...


Magnetic Fields and Intrathecal Pump Malfunction
Medical technology has impacted the overall life-expectancy. Many conditions traditionally considered fatal are now curable. Surviving chronic diseases and aging of the population have increased the number of people with chronic pain. Many devices are also available to manage severe refractory pain. As such, implantable drug-delivery system (IDDS) is a small battery-powered, programmable pump implanted under the subcutaneous tissue of the abdomen and connected to a small catheter tunneled into the spine. (Source: The American Journal of Emergency Medicine)


Large impacted pancreatic stone removed with single-operator pancreatoscopy and electrohydraulic lithotripsy
A 59-year-old man had chronic calcific pancreatitis secondary to alcohol and smoking. He had acute flares of pain and elevation of serum pancreatic enzymes. A CT scan revealed features of chronic pancreatitis, including large pancreatic duct calculi in the dilated main duct. On previous ERCP examination 2 months prior, removal of a 15-mm impacted pancreatic stone near the genu was not attempted because of its large size and a relatively narrow downstream duct. After a failed attempt to advance a 3-4-5F catheter dilator beyond the stone, a 5F Soehendra stent retriever (Cook Medical, Winston-Salem, NC) was advanced into the pancreatic duct upstream to the stone, and a pancreatic duct stent was placed. (Source: Gastrointestinal Endoscopy)


ESCAPE in Veterans
This randomized clinical trial of a stepped-care intervention for chronic pain resulted in statistically significant reductions in pain-related disability, pain interference, and pain severity in veterans with chronic musculoskeletal pain. (Source: JAMA Internal Medicine)


A 37-Year-Old Man with Chronic Low Back Pain and Substance Abuse
A 37-year-old man presented to an urgent care clinic with a report of chronic low back pain and a 1-day history of a pruritic rash on his chest, back, and extremities. The patient denied chest pain, fever, weakness, and any sensory, bowel, or bladder changes. He disclosed a history of tobacco consumption, but disavowed current or past alcohol, intravenous drug, or other substance abuse. The man was homeless, uninsured, had been incarcerated on 4 different occasions, and lacked a primary care or mental health provider. (Source: Journal of Emergency Nursing: JEN)<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>


Estimation of Medical Expenditure Associated with Opioids usage in Chronic Non-Cancer Pain: a cross-sectional study based on Medical Expenditure Survey and Panel data
Chronic or long-term pain disturbs numerous lives, which is one of the most prevalent reasons for doctor visits and reduces people’s quality of life. A common treatment for long-term non-cancer pain (CNCP) is long-term opioid therapy. However, the effectiveness of opioids for CNCP is still controversy and associated medical expenditure is vague. We investigated the impact of opioid treatment on the total medical expenditures for U.S. general population. (Source: Value in Health)


Hydrocodone: a review of the Literature
An estimated 100 million adults suffer from chronic pain in the US. The total cost of pain ranges from $560 to $635 billion in 2010, exceeding that of heart disease ($309 billion), cancer ($243 billion), and diabetes ($188 billion). The 2011 IOM report on pain states that effective pain management is “a moral imperative” for health care providers. Many pharmaceutical options are available to prescribers, most notably prescription opioids. Prescription opioids are analgesics which can be effective for the treatment of pain when monitored appropriately. (Source: Value in Health)


Correlation between Pain Catastrophizing scale and disease characteristics in Chronic Low Back Pain Patients
Psychosocial and environmental factors might have a potential causal relationship with chronic pain and the related disability. Psychosocial and environmental factors, socioeconomic status (SES) mediate the relationship among pain, disability, and can cause the morbidity and mortality among various conditions. Factor analyses of the Pain catastrophizing Scale (PCS) have shown that catastrophizing can be viewed as a multidimensional construct comprising elements of rumination, magnification and helplessness. (Source: Value in Health)


Cost-utility analysis of Pain Medications used to treat Adult Patients with Chronic Back Pain in the United States
Chronic back pain is a common health problem which is associated with considerable costs in United States. The largest categories for pain therapy costs include NSAID analgesics and opioids. However there has been limited evidence outlining the effectiveness in terms of quality of life of patients taking these pain medications for treating chronic back pain.Objective of this study is to perform a cost-utility analysis of chronic back pain patients using NSAIDS versus those using opioids alone and/ or combination opioid analgesics. (Source: Value in Health)


Cost minimization analysis of Equipotent Opioid Analgesics: Nationwide analysis of medicare Part D stand-alone prescription Drug Plans
Nearly 54 million Medicare beneficiaries, the overwhelming majority of whom are 65 plus years of age, reside in the US. Many beneficiaries suffer from chronic pain and need to use opioid analgesics for treatment. Medicare Part D is the outpatient prescription drug benefit available to beneficiaries through private insurance companies. Plan offerings differ across the country and each plan can have a different cost-sharing structure and formulary. We sought to examine the cost differences between therapeutically equivalent doses of opioid analgesics across all Medicare Part D Stand-alone prescription drug plans (PDPs). (Source: Value in 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>


Use of Hydrocodone/Acetaminophen: prevalence and estimating Emergency Department visits
The objective of this study was to estimate the impact of HC/APAP use in Texas on ED visits, based on the prevalence of HC/APAP prescriptions within the state. (Source: Value in Health)


Evaluating trends in Chronic Pain prevalence in the United States veterans Health Administration Population
The current study examined chronic pain prevalence in the U.S. Veterans Health Administration (VHA) population. (Source: Value in Health)


Conceptual Framework In Interstitial Cystitis / Bladder Pain Syndrome
This study aimed to build a conceptual framework in patients with IC/PBS which is a chronic debilitating condition characterized by pelvic pain, urinary urgency, and urinary frequency. It affects around 0.7-1 million people in the US and mostly middle aged women. Diagnostic criteria developed for research are not efficient and missing 60% of all cases. Uncertainty surrounds definition, etiology, diagnosis, natural history, true prevalence, and most effective treatment(s). (Source: Value in Health)


Impact of overweight/obesity on Arthritis–Attributable Burden And Health–Related Quality of Life Among Adults With Arthritis
This study aimed to determine the additional influence of overweight/obesity on arthritis–attributable burden (joint limitation, work limitation, social activity limitation, and joint pain) and HRQOL (general health status, physical HRQOL, mental HRQOL, activity limitations) among a representative national sample of adults with arthritis in the United States (US). (Source: Value in Health)


Does oral cholecalciferol supplementation improves pain intensity and disability in patients with chronic low back pain?
In the past decade many studies established relationship between vitamin D deficiency and chronic musculoskeletal pain including low back pain. Present study aimed to examine the effect of vitamin D3 supplementation in patients with chronic low back pain with low level of vitamin D. (Source: Value in 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>


Costs Description of Rheumatoid Arthritis Treatment In Chile For Patients Who Have Failed To Conventional Synthetic Dmards
Rheumatoid Arthritis (RA) is a chronic inflammatory disease which destroys synovial joints and generates pain; RA could disable patients and could be the cause of premature death. Its prevalence for Chile has been estimated in 0.46% (IC 95% 0.24-0.8). Available drugs for treatment include conventional synthetic Disease-Modifying Antirheumatic Drugs (csDMARDs), biological therapies and a new oral janus kinase inhibitor drug approved for treatment after failure of csDMARDs: tofacitinib. The aim of this study is to determine the direct costs associated with available therapies after csDMARDs failure. (Source: Value in Health)


Patient Reported outcome Profiles of Adults receiving medical care at Specialty Clinics for chronic pain and diabetes
To identify and compare the health outcomes profiles of adults receiving medical care at specialty clinics for symptomatic (chronic pain) and largely asymptomatic (diabetes) chronic conditions. (Source: Value in Health)


Comparison of the IASP grading system and S-LANSS in identification of Neuropathic pain in patients with Chronic Low Back Pain
Prevalence of neuropathic pain in patients with chronic low back pain is high. Screening for neuropathic pain is important because pharmacological management differs from nociceptive pain. There are various methods to assess the neuropathic pain. However these methods have shown different sensitivity and specificity in identifying the neuropathic pain. Present study compared the IASP grading system and S-LANSS in identification of neuropathic pain in patients with chronic low back pain. (Source: Value in Health)


Feasibility Of Using The Sf-36 Health Survey To Screen For Risk Of Major Depressive Disorder
To assess the feasibility of the SF-36v2 Mental Health (MH) domain and Mental Component Summary (MCS) scores in the classification of risk for major depressive disorder (MDD), and determine the cutoff scores in a US sample and chronic pain subpopulations. (Source: Value in Health)


Renal function and symptoms/adverse effects in opioid‐treated patients with cancer
ConclusionOnly severe constipation and loss of appetite were associated with low GFR in patients treated with morphine. Oxycodone and fentanyl, in relation to the symptoms studied, seem to be safe as used and titrated in routine cancer pain care. (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>


A 44-year-old man with abdominal pain, lung nodules, and hemoperitoneum.
Authors: Mostafavi M, Kamangar N Abstract A 44-year-old man presented with a 1-day history of sudden-onset abdominal pain. The pain was characterized as severe, diffuse, sharp, and nonradiating. Associated symptoms included nausea, vomiting, diarrhea, and subjective fevers. He was originally from El Salvador, but had not traveled in &gt; 10 years. Review of systems was positive for 2 weeks of dry cough with associated mild, bilateral, pleuritic chest pain and subjective weight loss. His medical history was notable for gout and end-stage renal disease secondary to chronic nonsteroidal antiinflammatory drug use, for which he attended hemodialysis sessions three times weekly. Surgical history consisted of a currently nonfunctioning left upper extremity fistula, a longstanding ri...


Chronic multisite pain in adolescent girls and boys with emotional and behavioral problems: the Young-HUNT study
Abstract The aim of this study was to assess the prevalence of chronic multisite pain with high disability in relation to emotional or behavioral problems and resilience factors in adolescence. A second aim was to investigate if resilience factors could attenuate the associations between psychiatric symptoms and chronic multisite pain. The study was based on a large cross-sectional study carried out in Norway between 2006 and 2008 and included 7,070 adolescents aged 13–19 years. Chronic multisite pain was defined as pain at least once a week during the last 3 months, scoring high on a disability index, and occurring in three or more locations. Chronic multisite pain was prevalent among adolescents with high scores (&gt;85 %) for anxiety/depression, social anxiety, conduct or...


Altered viscerotopic cortical innervation in patients with irritable bowel syndrome
Conclusions & InferencesThese preliminary findings illustrate how a chronic visceral pain syndrome and brain structure are related in the cohort examined, and because of their indication that IBS diagnosis is associated with anatomic neuropathology of potential neurological relevance in this patient sample. Visual representation of WM connections innervating S1 in a representative study patient. Depicted is a frontal view of the left and right postcentral gyri (red) together with the WM connections innervating S1. WM tracts connecting the postcentral gyri to the corticospinal tracts are drawn in bright green and highlighted by green arrows. (Source: Neurogastroenterology and Motility)


Evaluation of accelerated corneal collagen cross‐linking for the treatment of bullous keratopathy in eight dogs (10 eyes)
ConclusionsCXL is a useful treatment option for BK in dogs, despite the short‐lasting effects on corneal thickness. Patient comfort improved rapidly after a single procedure, although CXL did not achieve resolution of corneal edema. Treatment protocols may be refined to produce more durable effects on corneal edema. (Source: Veterinary Ophthalmology)


Injections for Chronic Pain.
Authors: Singh V, Trescot A, Nishio I Abstract Although interventional procedures should be used cautiously in the setting of chronic pain, there is a role for a variety of injections to facilitate a patient's overall rehabilitation program. There are many resources available, including a prior issue of Physical Medicine and Rehabilitation Clinics of North America, which discuss the more conventional spinal injections. The focus of this article is on lesser-known injection options for treating chronic pain. The authors separately discuss trigger point injections, regenerative injections (prolotherapy), and injections using botulin toxins. PMID: 25952063 [PubMed - as supplied by publisher] (Source: The Medical 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>


Subthalamic Nucleus Deep Brain Stimulation
Parkinson disease (PD) is known to affect multiple neurotransmitter systems, resulting in both motor and nonmotor symptoms. Pain is an underrecognized but important nonmotor symptom of PD that may be very disabling and is known to impair quality of life. While significant progress has been made in ameliorating motor symptoms using pharmacological, rehabilitative, and surgical treatments, the treatment of pain in this context has not received sufficient attention. A literature review noted a reported prevalence of pain in PD of 40% to 85%, yet only about half of patients with PD who felt pain took analgesics. Classifying PD-related pain into its subtypes is important for rational treatment, and the most common subtypes of pain in PD are musculoskeletal and dystonic, with central neuropathic...


Pathophysiology of primary burning mouth syndrome with special focus on taste dysfunction: a review
This article is protected by copyright. All rights reserved. (Source: Oral Diseases)


Elective hand surgery after axillary lymph node dissection for cancer.
Authors: Lee RJ, LaPorte DM, Brooks JT, Schubert CD, Deune EG Abstract After axillary lymph node dissection (ALND), patients are cautioned against ipsilateral interventional procedures to avoid the theoretical increased risk of postoperative complications, particularly lymphedema. The authors' goal was to evaluate the complications of elective hand surgery after ALND. The authors reviewed patients presenting to their hand clinic from 1998 to 2011, selecting those with a diagnosis of breast cancer or melanoma and a history of previous ALND; the authors excluded those treated nonoperatively and those treated with elective surgery in the contralateral hand. Average age of the 22 patients meeting the criteria (20 with a history of breast cancer, 6 with preexisting lymphedema) was 53.9 ...


Microglia in the spinal cord and neuropathic pain
This article is protected by copyright. All rights reserved. (Source: Journal of Diabetes Investigation)


Frequency of Migraine Headaches in Patients With Fibromyalgia
ConclusionThe results of this study suggest that migraine headaches are common in patients with fibromyalgia. Clinicians who care for either population must be aware that these conditions commonly overlap and can significantly increase a patient's cumulative disease burden. (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>


Efficacy and Safety of White Willow Bark (Salix alba) Extracts
Willow bark extract has been used for thousands of years as an anti‐inflammatory, antipyretic, and analgesic. In spite of its long history of use, relatively few human and animal studies have been published that confirm anecdotal observations. A small number of clinical studies have been conducted that support the use of willow bark extracts in chronic lower back and joint pain and osteoarthritis. Willow bark extracts also are widely used in sports performance and weight loss products presumably because of anti‐inflammatory and analgesic activities, although no human studies have been published that specifically and directly document beneficial effects. In recent years, various in vitro and animal studies have demonstrated that the anti‐inflammatory activity of willow bark extract is...


Pharmaceutical Opioid Use and Dependence among People Living with Chronic Pain: Associations Observed within the Pain and Opioids in Treatment (POINT) Cohort
ConclusionsIn this population of people taking opioids for CNCP, consumption of higher doses was associated with increased risk of problematic behaviors, and was more likely among people with a complex profile of physical and mental health problems. (Source: Pain Medicine)


Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It's Been …
ConclusionThe literature suggests that the medicinal use of cannabis may have a therapeutic role for a multitude of diseases, particularly chronic pain disorders including headache. Supporting literature suggests a role for medicinal cannabis and cannabinoids in several types of headache disorders including migraine and cluster headache, although it is primarily limited to case based, anecdotal, or laboratory‐based scientific research. Cannabis contains an extensive number of pharmacological and biochemical compounds, of which only a minority are understood, so many potential therapeutic uses likely remain undiscovered. Cannabinoids appear to modulate and interact at many pathways inherent to migraine, triptan mechanisms ofaction, and opiate pathways, suggesting potential synergistic or ...


Current and Emerging Treatments for Irritable Bowel Syndrome with Constipation and Chronic Idiopathic Constipation: Focus on Prosecretory Agents
Irritable bowel syndrome with constipation (IBS‐C) and chronic idiopathic constipation (CIC) are two common functional gastrointestinal disorders that impair quality of life and pose a significant economic burden to the health care system. Current therapeutic options include lifestyle modifications, over‐the‐counter (OTC) agents, antispasmodics, serotonin agonists, and lubiprostone and linaclotide, two prosecretory prescription drugs approved for the treatment of IBS‐C and CIC. This review discusses the efficacy and safety of current treatments and emerging therapies for the treatment of IBS‐C and CIC, with a focus on the prosecretory agents. A search of the PubMed database (1966–November 2014) was performed to identify relevant articles; clinical trials on emerging agents were...


RADIOLOGY REPORT: 2 cases to test your skills.
Authors: Gibson GN, Dunn DP Abstract A 28-year-old G0P0 woman with a history of chronic pelvic fullness presented with acute lower abdominal/pelvic pain. A pelvic exam showed mild cervical motion tenderness without vaginal discharge or palpable adnexal mass. Initial blood work was drawn and the patient was sent for a pelvic ultrasound with differential considerations including pelvic inflammatory disease, ovarian torsion, and intrauterine or ectopic pregnancy. PMID: 26009739 [PubMed - in process] (Source: The Journal of Family 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>


The Rate of Magnetic Resonance Imaging in Patients With Spinal Cord Stimulation
Conclusion. There is a high need for MRI in this chronic back and leg pain SCS population, with a significant portion being completed on locations outside of the spine. This analysis highlights a need for MRI-conditional SCS devices that grant access of patients with SCS to this imaging modality. Level of Evidence: 3 (Source: Spine)


Integrative medicine has positive impact on patient activation, chronic pain, depression
(GYMR) The use of integrative medicine interventions leads to significant improvements in patient activation and patient-reported outcomes in the treatment of chronic pain, depression, and stress, according to a new report released by The Bravewell Collaborative. The findings are based on data collected by the Patients Receiving Integrative Medicine Interventions Effectiveness Registry, the first-ever patient registry on integrative medicine. (Source: EurekAlert! - Medicine and Health)


Record $374B Spent on Drugs: The Pain Medicine News Report
(MedPage Today) -- What Jennifer Aniston teaches us about chronic pain. (Source: MedPage Today Psychiatry)


Assessment of chronic pain: A practice update
Publication date: Available online 7 April 2015 Source:International Journal of Orthopaedic and Trauma Nursing Author(s): Beverley Wellington , Sandra Flynn , Wendy Duperouzel , Sylvia Treloar (Source: International Journal of Orthopaedic and Trauma Nursing)


Fibrocalculous pancreatic diabetes: a case report
Conclusion: This case report demonstrates a rare form of secondary diabetes in a middle aged female, without a childhood history of abdominal pain suggestive of pancreatitis, indicating late onset disease. Therefore a high index of suspicion is necessary even though the diagnostic criteria indicates the presence of childhood onset of disease. (Source: BMC Research Notes)<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 chronic recurrent /pubic bone stress in a Premier League footballer: evaluating the evidence base and application of a nine-point management strategy
The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent chronic groin pain and evaluate the evidence of the interventions. (Source: Physical Therapy in Sport)


The lateral prefrontal cortex mediates the hyperalgesic effects of negative cognitions in chronic pain patients
While high levels of negative affect and cognitions have been associated in chronic pain conditions with greater pain sensitivity, the neural mechanisms mediating the hyperalgesic effect of psychological factors in patients with pain disorders are largely unknown. In this cross-sectional study, we hypothesized that 1) catastrophizing modulates brain responses to pain anticipation, and that 2) anticipatory brain activity mediates the hyperalgesic effect of different levels of catastrophizing, in fibromyalgia (FM) patients. (Source: The Journal of Pain)


Trauma, Social Support, Family Conflict, and Chronic Pain in Recent Service Veterans: Does Gender Matter?
ConclusionsResults underscore the potential importance of developing and testing gender specific models of chronic pain that consider the relative roles of trauma, social support, and family conflict. (Source: Pain Medicine)


When Is Helping your Partner with Chronic Pain a Burden? The Relation Between Helping Motivation and Personal and Relational Functioning
ConclusionsApplying SDT in a context of pain provides new insights into why chronic pain affects partners and how partners impact patient outcome. Directions for future research are outlined. (Source: Pain Medicine)


Chronic Pain Patients' Impressions of an Emergency Department Opioid Prescribing Guideline Poster
ConclusionsThe vast majority of patients with chronic pain in this cohort believes that a pain guideline poster is reasonable and should be posted in the ED. However, a small percentage of patients reported that they would feel intimidated by such a poster and that it would prevent them from staying to get care, a result meant to inform hospitals and policy‐makers deciding if such posters should be displayed. (Source: 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>


Attitudes and Beliefs of Working and Work‐Disabled People with Chronic Pain Prescribed Long‐Term Opioids
ConclusionThe results of this study suggest several tentative hypotheses about why patients on chronic opioid therapy value opioids, and identified several areas for systematic investigation in the future. (Source: Pain Medicine)


Menstrual‐Cycle and Menstruation Disorders in Episodic vs Chronic Migraine: An Exploratory Study
ConclusionWe conclude that chronic migraine is possibly more often than episodic migraine associated with menstrual‐cycle disorders in general and dysmenorrhea, without impact on menstruation sensitivity of the headaches. (Source: Pain Medicine)


Erythema Ab Igne
A 23-year-old woman, with a history of esophageal atresia status postsurgical correction and chronic abdominal pain on high-dose fentanyl, presented with increasing abdominal pain and a dark, net-like rash on her back. She reported that her pain was usually controlled with opioids, marijuana (one joint per day), and hot showers, but had recently worsened. She noted that the rash appeared 1 year prior and had faded and resurfaced during that period. She also reported occasionally using a heated towel in the area to relieve abdominal pain radiating to her back. (Source: The Journal of Emergency Medicine)


Integrative medicine Patients have High stress, pain, and psychological Symptoms
Integrative medicine (IM) is a rapidly growing field whose providers report clinical success in treating significant stress, chronic pain, as well as depressive and anxiety symptoms. While IM therapies have demonstrated efficacy for numerous physiological conditions, IM for psychological symptoms has been slower to gain recognition in the medical community. This large, cross-sectional study is the first of its kind to document the psychosocial profiles of 4182 patients at 9 IM clinics that form the BraveNet Practice-Based Research Network (PBRN). (Source: Explore)


Inhibition of microglial activity alters spinal wide dynamic range neuron discharge and reduces microglial Toll-like receptor 4 expression in neuropathic rats.
This study aimed to evaluate the role of microglial activation on the hyper-responsiveness of wide dynamic range neurons (WDR) and Toll-like receptor 4 (TLR4) expressions in a chronic constriction injury (CCI) model of neuropathic pain in rats. Adult male Wistar rats (230 ± 30 g) underwent surgery for induction of CCI neuropathy. Six days after surgery, administration of minocycline (10, 20, and 40 mg/kg, i.p.) was initiated and continued until day 14. After administration of the last dose of minocycline or saline, a behavioral test was conducted, then animals were sacrificed and lumbar segments of the spinal cord were collected for Western blot analysis of TLR4 expression. The electrophysiological properties of WDR neurons were investigated by single unit recordings in separate groups. T...<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 painful inheritance--patient perspectives on living with polycystic kidney disease: thematic synthesis of qualitative research
Conclusions The erratic onset of pain contributes to the substantial unpredictability of daily living and prevents patients from establishing long-term life goals. Decisions about family planning, genetic testing of children and disclosure involves making profoundly difficult judgments about ethical parental responsibility. Patient engagement in pain management, strategies for self-care, counselling to reduce the burden of &lsquo;genetic guilt&rsquo; and specific family planning decision support tools may be priorities for care to improve patient-centred outcomes in ADPKD. (Source: Nephrology Dialysis Transplantation)


Abstract CS1-2: Contralateral prophylactic mastectomy: Patient preferences and risk perceptions
Recent studies have revealed increasing rates of contralateral prophylactic mastectomy (CPM) among women with unilateral early stage breast cancer. Bilateral mastectomy at diagnosis of unilateral breast cancer is particularly common among young women, with younger age consistently identified as a predictor of CPM. This trend for more surgery rather than less has raised concerns, given the lack of evidence for a survival benefit from CPM and the relatively low risk of contralateral breast cancer for most women in this setting. Although mastectomy is a safe procedure and major complications are rare, there are potential negative consequences including cosmetic concerns and clinically significant potential long-term sequelae such as numbness of the chest skin and chronic pain and decreased fu...


Pain in adolescents with spinal muscular atrophy and Duchenne and Becker muscular dystrophy.
CONCLUSION: Pain is a frequent problem in adolescents with spinal muscular atrophy and dystrophinopathy. The assessments used enable an understanding both of the nature and scope of pain and of the impact of pain in everyday life. The study highlights the importance of assessing pain in a systematic manner and offering an individual approach to interventions designed to reduce pain in this population. PMID: 25978940 [PubMed - as supplied by publisher] (Source: European Journal of Paediatric Neurology)


Look beyond Catechol-O-Methyltransferase genotype for cathecolamines derangement in migraine: the BioBIM rs4818 and rs4680 polymorphisms study
Conclusions COMT genotype does not influence migraine susceptibility or phenotype, even considering rs4818 polymorphism and peculiar clinical subtypes. This finding prompts to go over COMT to explain catecholamine derangement in migraine, exploring enzymes involved in catecholamines synthesis and catabolism, such as monoamine-oxidase, dopamine beta-hydroxylase, tyrosine-hydroxylase or tyrosine-decarboxylase, among others. (Source: The Journal of Headache and Pain)


Low-dose SoluMatrix diclofenac in the treatment of osteoarthritis: A 1-year, open-label, Phase III safety study.
CONCLUSION: SoluMatrix diclofenac treatment for up to 1 year was generally well tolerated in patients with OA pain and associated with improvement in quality of life measures. TRIAL REGISTRATION: www.clinicaltrials.gov identifier: NCT01510912. PMID: 25913498 [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>


Few Sickle Cell Patients Receiving Beneficial Drug, Study Finds
Title: Few Sickle Cell Patients Receiving Beneficial Drug, Study FindsCategory: Health NewsCreated: 4/28/2015 12:00:00 AMLast Editorial Review: 4/29/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Calf Muscle Pump Stimulation as a Means to Reduce Symptoms of Fibromyalgia Syndrome
Fibromyalgia (FM) is a debilitating chronic condition that often affects women in midlife with widespread pain that interrupts attempts to exercise. The purpose of this pilot study was to test the efficacy of calf muscle pump (CMP) stimulation as an adjuvant therapy for FM by (1) assessing the correlation of the level of symptoms, as measured by the revised Fibromyalgia Impact Questionnaire (FIQR), and blood pressure (BP), (2) measuring change in mean FIQR scores for subjects who use a CMP-stimulation device for 12 weeks, and (3) measuring the correlation of total device usage and the level of symptoms as measured by the FIQR. The 29 male and female participants (mean age = 47.3 years) were screened using the Widespread Pain Index (WPI), Symptom Severity (SS) score, and the FIQR. Participa...


Increased prevalence of two mitochondrial DNA polymorphisms in functional disease: Are we describing different parts of an energy-depleted elephant?
Publication date: Available online 29 April 2015 Source:Mitochondrion Author(s): Richard G. Boles , Essam A. Zaki , Jonathan R. Kerr , Kingshuk Das , Sawona Biswas , Ann Gardner About 20% of the population suffers from “functional syndromes”. Since these syndromes overlap greatly in terms of co-morbidity, pathophysiology (including aberrant autonomic activity) and treatment responses, common predisposing genetic factors have been postulated. We had previously showed that two common mitochondrial DNA (mtDNA) polymorphisms at positions 16519 and 3010 are statistically associated with the functional syndromes of migraine, cyclic vomiting syndrome and non-specific abdominal pain. Herein, among individuals with mtDNA haplogroup H (HgH), the presence of these two mtDNA polymorphisms were a...


Vitamin D Deficiency and Pain: Clinical Evidence of Low Levels of Vitamin D and Supplementation in Chronic Pain States
Conclusion There remains a growing body of both clinical and laboratory evidence pointing to a potential relationship between low levels of 25-hydroxy vitamin D and a variety of chronic pain states. More focused research involving large RCTs is necessary. (Source: Pain and Therapy)


A Plunging Case of Intermittent Dysphagia
Question: A 71-year-old woman with a history of gastroesophageal reflux disease and chronic intermittent dysphagia presented with progressively worsening dysphagia for solid foods over the past three days. The patient also complained of reflux, without weight loss, and has never had food impaction requiring bolus removal. Upon presentation, the patient denied any nausea, vomiting, abdominal pain. Laboratory results were unremarkable. (Source: 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>


Palmitoylethanolamide relieves pain an2d preserves pancreatic islet cells in a murine model of diabetes.
Authors: Donvito G, Bettoni I, Comelli F, Colombo A, Costa B Abstract We previously demonstrated that the intraperitoneal administration of palmitoylethanolamide (PEA) in mice with chronic constriction injury of the sciatic nerve evoked a relief of both thermal hyperalgesia and mechanical allodynia in neuropathic mice. Since diabetic neuropathy is one of the most common long-term complications of diabetes, we explored the ability of PEA to also relief this kind of chronic pain, employing the well-established streptozotocin-induced animal model of type 1 diabetes. Our findings demonstrated that PEA relieves mechanical allodynia, counteracts nerve growth factor deficit, improves insulin level, preserves Langherans islet morphology reducing the development of insulitis in diabetic mic...


Drug targets of migraine and neuropathy: treatment of hyperexcitability.
Authors: L V, Z M, A B, J T Abstract Migraine and neuropathic pain are common causes of chronic pain. The exact pathomechanism has not been fully clarified for either disorder, but their pathophysiological backgrounds involve several similar mechanisms. Peripheral sensitization occurs in the neuronal elements of the dorsal root ganglion or the trigeminal ganglion, while central sensitization appears in the second-order neurons in the dorsal horn of the spinal cord or the trigeminal nucleus caudalis. Central neuronal hyperexcitability has been implicated in both disorders, and the emerging evidence suggests alterations in the glutamatergic neurotransmission and N-methyl-D-aspartate-receptor activation. Migraine and neuropathic pain additionally share certain clinical features, such ...


Role of pituitary adenylate-cyclase-activating polypeptide in nociception and migraine Running title: PACAP: nociception and migraine.
Authors: Tajti J, Tuka B, Botz B, Helyes Z, Vecsei L Abstract Pituitary adenylate cyclase-cctivating polypeptide (PACAP) and its receptors are widely distributed at different levels of the pain-processing pathway. Its action at the peripheral sensory nerve terminals has been found to be divergent; it can exert both pro- and anti-nociceptive effects, depending on the mode of administration (local or systemic) and the mechanism of the pain process (acute or chronic, inflammatory or neuropathic). In the central nervous system it exerts mainly neuronal excitation, leading to increased nociceptive signalling. Since the clinical data strongly suggest the involvement of PACAP in the pathophysiology of migraine, special emphasis is placed on examinations of its role and the mechanisms of a...


Abstract 241: Evaluation of the Parameters of the Euro Qol- 5 D Questionnaire Among Patients With Ischemic Heart Disease With Normal and Elevated BMI [Session Title: Poster Session II]
Conclusion: Our study revealed that Ischemic heart disease patients with obesity had impaired QoL in terms of health, mobility, usual activity, discomfort and anxiety. Hence non-obese ischemic heart disease patients had a better sense of overall wellbeing. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 312: A Tablet Computer-based System to Incorporate Patient-reported Outcomes Into Routine Care for Patients Presenting for Coronary Angiography [Session Title: Poster Session III]
Conclusions: Our program demonstrates that the integration of patient-reported outcomes measurement is technically feasible in a real-world care environment. We share our experiences to provide others with a model for similar programs, and to accelerate implementation nationwide by helping others avoid pitfalls. We believe expansion of similar programs nationally may lead to more robust quality measurement infrastructure and higher-value care for patients. (Source: Circulation: Cardiovascular Quality and Outcomes)<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>


Circumcision plus antibiotic, anti-inflammatory, and α-blocker therapy for the treatment for chronic prostatitis/chronic pelvic pain syndrome: a prospective, randomized, multicenter trial
Conclusions Our findings show that circumcision plus antibiotic, anti-inflammatory, and α-blocker therapy for CP/CPPS patients resulted in improved NIH-CPSI scores compared with medication therapy only. (Source: World Journal of Urology)


Relationships between severity of signs and symptoms and quality of life in patients with chronic venous disease
CONCLUSIONS: There were positive correlations between CEAP and both VAPS and VCSS. Chronic Venous Insufficiency progressively affects quality of life (SF-36). Physical and emotional aspects are more severe at later stages of CVD. Vitality, Mental Health and Role Social can be negatively impacted from the early stages of the disease. CONTEXTO: A doença venosa crônica (DVC) é a causa mais frequente dos sintomas vasculares que acometem os membros inferiores. É pouco estudada a relação entre seus sinais clínicos, a intensidade dos sintomas, e a qualidade de vida do indivíduo acometido. OBJETIVOS: Verificar se existe uma relação positiva entre a progressão da doença e a gravidade dos sintomas e a piora na qualidade de vida. MÉTODOS: Avaliamos 91 membros com classificação clínica...


Gene Expression Profiling Analysis of Patients With Ankylosing Spondylitis: Retracted.
Conclusion: MYH9, BCL11B, PTPRC, CD3G, CD247, CD4, IL7R, and PRF1 might have a correlation with AS. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved. (Source: Journal of Spinal Disorders and Techniques)


The evolution of chronic opioid therapy and recognizing addiction
ABSTRACT: Chronic pain is one of the most common complaints in the United States. Opioids have become a frequently prescribed treatment for patients with chronic nonmalignant pain. Concurrently, opioid use disorders have risen to epidemic levels. Studies investigating iatrogenic opioid addiction have been of limited quality. Aberrant drug-related behaviors may be warning signs of impending addiction. Proper screening and close monitoring are essential for managing patients on opioids for chronic nonmalignant pain. (Source: Journal of the American Academy of Physician Assistants)


Mo1389 Extracorporeal Shock Wave Lithotripsy (ESWL) Followed by Same Day Endoscopic Treatment for the Management of Pain in Chronic Calcific Pancreatitis (Ccp). a Single Center Experience
Pancreatic duct (PD) calculi are common in patients with CCP, and can be a major cause of pain due to obstruction with upstream ductal dilation. ESWL is an alternative to surgery in patients with large stones not amenable to simple endoscopic removal. The aim of this study is to determine usefulness and success of ESWL followed by ERCP for the treatment of painful CCP. (Source: Gastrointestinal 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>


Mo1392 Covered Metal Stent Placement Using Santorini's Duct (Minor Papilla) for Pain Management in Chronic Calcific Pancreatitis - Feasibility and Safety
Pain control in chronic calcific pancreatitis is often unsatisfactory. Both endoscopic and surgical drainage procedures have been described for management of intractable or recurrent severe pain. Pancreatojejunostomy has been shown to be more effective than endoscopic management (using plastic stents) of main pancreatic duct stricture (PDS).1, 2,. Recently fully covered-self expanding metal stent (FC-SEMS) placement across PDS has been assessed as a new endoscopic approach with the aim of achieving enhanced PD drainage3, 4. (Source: Gastrointestinal Endoscopy)


Mo1585 Role of Endoscopic Capsule in Patients With Chronic Diarrhea and Abdominal Pain of Unknown Origin
Capsule endoscopy (CE) is a diagnostic method that enables visualization of intraluminal bowel, diagnosing disorders not diagnosed effectively. (Source: Gastrointestinal Endoscopy)


Why It's OK to Complain
Maybe it's because I've lived with health issues my whole life. Maybe it's because I'm a new mom. Maybe it's just me... or maybe it's not. But I've long felt the necessity to stay strong and never complain. Perhaps I felt as if I were betraying all the strong, fierce feminists that came before me. I've always thought that if I complained, asked for help, or took a break that it somehow meant I was giving in and letting my struggles get the best of me. Thankfully, I'm here to tell you that that's just not true. It really is OK to complain sometimes. It wasn't easy to allow myself the freedom to complain. Honestly, it still isn't easy even now. I still hesitate sometimes when asking for help. And when I do ask for help, I'm convinced that the other person is secretly mad that I bothered the...


Prevalence of chronic pain in low-income and middle-income countries: a systematic review and meta-analysis
Publication date: 27 April 2015 Source:The Lancet, Volume 385, Supplement 2 Author(s): Tracy Jackson , Sarah Thomas , Victoria Stabile , Xue Han , Matthew Shotwell , Kelly McQueen Background The global burden of chronic pain and disability could be related to unmet surgical needs. This systematic review and meta-analysis aims to characterise existing data regarding the prevalence and associations of chronic pain in low-income and middle-income countries; this is essential to allow better assessment of its relationship to pre-operative and post-operative pain as emergency and essential surgical services are expanded. Methods According to PRISMA guidelines, we searched PubMed, PsycInfo, and Cochrane registries for articles published before Dec 31, 2013, using the search terms “pain AND ...


Behavioral and Cognitive–Behavioral Approaches to Treating Patients with Chronic Pain: Thinking Outside the Pill Box
Abstract Chronic pain is a prevalent and disabling problem. It is a complex, multifactorial disorder that requires a comprehensive biopsychosocial conceptualization. In this paper we provide an update on research implicating the importance of the behavioral and cognitive factors in chronic pain. In addition to the significant co-variations among self-reported symptoms, recent advancement in the imaging technology provides a better understanding of the neurophysiological basis of those psychosocial factors in chronic pain. Additionally, we discuss several variations of behavioral and cognitive–behavioral approaches to chronic pain, including operant–behavioral and cognitive–behavioral (including Acceptance and Commitment Therapy, internet-adapted, exposure based on the Fear 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>


Involvement of nuclear factor kappa B in the maintenance of persistent inflammatory hypernociception
Publication date: Available online 19 April 2015 Source:Pharmacology Biochemistry and Behavior Author(s): Guilherme R. Souza , Thiago M. Cunha , Rangel L. Silva , Celina M. Lotufo , Waldiceu A. Verri Jr. , Mani I. Funez , Christiane F. Villarreal , Jhimmy Talbot , Lirlandia P. Sousa , Carlos A. Parada , Fernando Q. Cunha , Sergio H. Ferreira The pathophysiology of chronic inflammatory pain remains poorly understood. In this context, we developed an experimental model in which successive daily injection of prostaglandin E2 (PGE2) for 14days into rat hind paws produces a persistent state of hypernociception (i.e. decrease in mechanical nociceptive threshold). This state persists for more than 30days after discontinuing PGE2 injection. In the present study, we investigated the participation...


A safer alternative: Cannabis substitution as harm reduction
ConclusionsCannabis substitution can be an effective harm reduction method for those who are unable or unwilling to stop using drugs completely. More research is needed on cannabis as a safer alternative. [Lau N, Sales P, Averill S, Murphy F, Sato S, Murphy S. A safer alternative: Cannabis substitution as harm reduction. Drug Alcohol Rev 2015] (Source: Drug and Alcohol Review)


In Vivo and Systems Biology Studies Implicate IL-18 as a Central Mediator in Chronic Pain
Inflammation is associated with peripheral neuropathy, however the interplay among cytokines, chemokines, and neurons is still unclear. We hypothesized that this neuroinflammatory interaction can be defined by computational modeling based on the dynamics of protein expression in the sciatic nerve of rats subjected to chronic constriction injury. Using Dynamic Bayesian Network inference, we identified interleukin (IL)-18 as a central node associated with neuropathic pain in this animal model. Immunofluorescence supported a role for inflammasome activation and induction of IL-18 at the site of injury. (Source: Journal of Neuroimmunology)


Calcitonin gene‐related peptide in the joint: contributions to pain and inflammation
Arthritis is the commonest cause of disabling chronic pain, and both osteoarthritis (OA) and rheumatoid arthritis (RA) remain major burdens on both individuals and society. Peripheral release of calcitonin gene‐related peptide (CGRP) contributes to the vasodilation of acute neurogenic inflammation. Contributions of CGRP to the pain and inflammation of chronic arthritis, however, are only recently being elucidated. Animal models of arthritis are revealing the molecular and pathophysiological events that accompany and lead to progression of both arthritis and pain. Peripheral actions of CGRP in the joint might contribute to both inflammation and joint afferent sensitisation. CGRP and its specific receptors are expressed in joint afferents, and upregulated following arthritis induction. Per...


The Genetics of Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a common disabling systemic inflammatory disorder that causes chronic joint destruction. However, by most assessments, the consequences of treated disease have become less severe during the past 20 years. An armamentarium of second-line drugs, including methotrexate and biologic agents such as tumor necrosis factor (TNF) inhibitors, in combination with widely accepted treatment strategies, which include early treatment and treatment that targets low disease activity, has led to a reduction in disease activity for patients with RA throughout much of the developed world. Despite highly effective treatments, approximately 20% of patients continue to experience pain, disability, and joint destruction. In addition, even with effective treatment, RA has been linked t...<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>


Alterations in serotonin, transient receptor potential channels and protease-activated receptors in rats with irritable bowel syndrome attenuated by Shugan decoction.
CONCLUSION: SGD alleviated VHL and attenuated colon motility in IBS, partly by regulating TRPV1, TRPV4, TRPA1, PAR2, 5-HT, CgA and SERT, and reducing CGRP and TNF-α level. PMID: 25944998 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)


FDA enters consent decree with Medtronic, Inc.
The U.S. Food and Drug Administration announced today the filing of a consent decree against Medtronic, Inc., and two of the company’s officers—S. Omar Ishrak and Thomas M. Tefft —for repeatedly failing to correct violations, related to the manufacture of Synchromed II Implantable Infusion Pump Systems, medical devices that deliver medication to treat primary or metastatic cancer, chronic pain and severe spasticity. These violations occurred at the company’s Neuromodulation facilities in Columbia Heights, Minnesota, where the devices are manufactured. (Source: Food and Drug Administration)


U.S. Physicians Finally Growing Wary of Opioids for Chronic Pain
No abstract available (Source: Lippincott’s Bone and Joint Newsletter)


Core Outcome Measure Index for low back patients: do we miss anxiety and depression?
Conclusion The questions exploring anxiety and depression have good intrinsic and psychometric capacities (i.e., no floor or ceiling effects and high correlations with full-length scales) and did not significantly modify the psychometrics of the original COMI questionnaire. The COMIAD offers the possibility to include the psychological dimension in the multidimensional evaluation without significantly affecting questionnaire length. (Source: European Spine Journal)


Effective Treatment of Dyssynergic Defecation Using Sacral Neuromodulation in a Patient With Cerebral Palsy
Conclusions: In patients with systemic medical problems contributing to defecatory dysfunction and bowel incontinence, such as cerebral palsy, sacral neuromodulation was found to provide significant relief of bowel symptoms in addition to associated abdominal pain. As a result of intervention, the patient reported significant improvement in quality of life and less limitations due to dyssynergic defecation. (Source: Female Pelvic Medicine and Reconstructive 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>


APSC2015-1033 Assessment of High Sensitivity C-Reactive Protein in ETT Positive Patients With Normal Coronary Angiogram
About 30% of coronary angiographies done for chest discomfort and positive stress cardiac testing are normal. Patients with chest pain with normal coronary arteries have coronary microvascular endothelial dysfunction and myocardial ischemia. Elevated hs-CRP levels have been related to atherogenesis and endothelial dysfunction. Little is known whether low grade chronic inflammation is a pathogenic mechanism. (Source: CVD Prevention and Control)


The Somatosensory Link in Fibromyalgia: Functional Connectivity of the Primary Somatosensory Cortex Is Altered by Sustained Pain and Is Associated With Clinical/Autonomic Dysfunction
ConclusionOur study demonstrates that both somatic and nonsomatic dysfunction in FM, including clinical pain, pain catastrophizing, autonomic dysfunction, and amplified temporal summation, are closely linked with the degree to which evoked deep tissue pain alters S1 connectivity to salience/affective pain‐processing regions. Additionally, diminished connectivity between S1 subregions during the rest phase in FM may result from ongoing widespread clinical pain. (Source: Arthritis and Rheumatism)


George Weisz, Chronic Disease in the Twentieth Century: A History
(Source: Social History of Medicine)


Peripheral FAAH and soluble epoxide hydrolase inhibitors are synergistically antinociceptive
Publication date: July 2015 Source:Pharmacological Research, Volume 97 Author(s): Oscar Sasso , Karen Wagner , Christophe Morisseau , Bora Inceoglu , Bruce D. Hammock , Daniele Piomelli We need better medicines to control acute and chronic pain. Fatty acid amide hydrolase (FAAH) and soluble epoxide hydrolase (sEH) catalyze the deactivating hydrolysis of two classes of bioactive lipid mediators – fatty acid ethanolamides (FAEs) and epoxidized fatty acids (EpFAs), respectively – which are biogenetically distinct but share the ability to attenuate pain responses and inflammation. In these experiments, we evaluated the antihyperalgesic activity of small-molecule inhibitors of FAAH and sEH, administered alone or in combination, in two pain models: carrageenan-induced hyperalgesia in mice ...


Mystery Case: Cholesterol granuloma of the petrous apex in Gradenigo syndrome
A 60-year-old woman was admitted to our department after a 2-month history of double vision and periorbital pain. Neurologic examination showed a right abducens nerve palsy and neuralgia in the right V1 trigeminal branch. Brain MRI revealed a hyperintense nonenhancing expansile lesion of the right petrous apex (figure) suggestive of cholesterol granuloma.1,2 Gradenigo syndrome is traditionally characterized by the triad of otorrhea, diplopia, and pain in the trigeminal territory due to suppurative otitis media, but it may be associated with other less common etiologies as cholesteatomas, chronic osteomyelitis, intracranial lymphomas, nasopharyngeal carcinoma, and infectious petrositis.3 (Source: Neurology)<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>


Patient led goal setting in chronic low back pain- what goals are important to the patient and are they aligned to what we measure?
The use of standardised outcome measures in the management of chronic low back pain (cLBP) is recognised worldwide. They are used to guide the health care professional (HCP) in their clinical reasoning as well as benchmarking treatment goals and success. Outcome measures are based on quantitative parameters creating the benefit of determining specific treatment goals, and hence they are ideal for assessing outcomes [1]. Several investigations into the use of outcome measures by physiotherapists have found that measures usually focus on impairments of pain, range of motion (ROM) (eg. (Source: Patient Education and Counseling)


Mayo Clinic News Network Headline 4/27/15
In today's Mayo Clinic News Network Headline with Vivien Williams: April is IBS Awareness Month. IBS (irritable bowel syndrome) is a common and chronic disorder that affects the large intestine, causing cramping, abdominal pain, bloating, gas, diarrhea and constipation. Mayo Clinic gastroenterologist Dr. Yuri Saito says 1 out of 10 adults may suffer from IBS and provides tips on how to manage [...] (Source: News from Mayo Clinic)


The role of alpha5 nicotinic acetylcholine receptors in mouse models of chronic inflammatory and neuropathic pain.
Authors: Bagdas D, AlSharari SD, Freitas K, Tracy M, Damaj MI Abstract The aim of the present study was to determine the impact of α5 nicotinic acetylcholine receptor (nAChR) subunit deletion in the mouse on the development and intensity of nociceptive behavior in various chronic pain models. The role of α5-containing nAChRs was explored in mouse models of chronic pain, including peripheral neuropathy (chronic constriction nerve injury, CCI), tonic inflammatory pain (the formalin test) and short and long-term inflammatory pain (complete Freund's adjuvant, CFA and carrageenan tests) in α5 knock-out (KO) and wild-type (WT) mice. The results showed that paw-licking time was decreased in the formalin test, and the hyperalgesic and allodynic responses to carrageenan and CFA injection...


Patient led goal setting in chronic low back pain—What goals are important to the patient and are they aligned to what we measure?
The use of standardised outcome measures in the management of chronic low back pain (cLBP) is recognised worldwide. They are used to guide the health care professional (HCP) in their clinical reasoning as well as benchmarking treatment goals and success. Outcome measures are based on quantitative parameters creating the benefit of determining specific treatment goals, and hence they are ideal for assessing outcomes [1]. Several investigations into the use of outcome measures by physiotherapists have found that measures usually focus on impairments of pain, range of motion (ROM) (e.g. (Source: Patient Education and Counseling)


Epidermolysis bullosa acquisita of MRSA skin carrier: a case of successful total hip arthroplasty.
CONCLUSIONS: Although care must be taken by medical professionals to avoid the prescription of unnecessary antibiotics, when used appropriately, there appears to be substantial benefits to be gained in the field of joint replacement for patients who are at high risk of infection. PMID: 25952910 [PubMed - as supplied by publisher] (Source: Hip 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>


Novel micropatterns mechanically control fibrotic reactions at the surface of silicone implants.
Authors: Majd H, Scherer SS, Boo S, Ramondetti S, Cambridge E, Raffoul W, Friedrich M, Pittet B, Pioletti D, Hinz B, Pietramaggiori G Abstract Over the past decade, various implantable devices have been developed to treat diseases that were previously difficult to manage such diabetes, chronic pain, and neurodegenerative disorders. However, translation of these novel technologies into clinical practice is often difficult because fibrotic encapsulation and/or rejection impairs device function after body implantation. Ideally, cells of the host tissue should perceive the surface of the implant being similar to the normal extracellular matrix. Here, we developed an innovative approach to provide implant surfaces with adhesive protein micropatterns. The patterns were designed to promot...


Synovial Chondromatosis of the Temporomandibular Joint Successfully Treated by Surgery
Abstract Synovial chondromatosis (SC) is a chronic process, defined as a reactive cartilaginous proliferation, characterized by formation of cartilaginous nodules, usually loose in the joint space of the synovial membrane. It mainly affects large joints such as knee, hip, shoulder, and elbow, commonly in male patients. However, its manifestation in the Temporomandibular joint (TMJ), is a rare finding, occurring predominantly in females. This paper reports a case of a woman who presented to the service of Stomatology complaining of mouth opening limitations and pain in her left pre-auricular region. After clinical and radiographic analyses, the condition was diagnosed as SC of the TMJ. The loose bodies within the TMJ were removed under general anesthesia. Histological and follow-up...


Pyogenic pancreatic abscess mimicking pancreatic neoplasm: a four-case series.
We report four patients who each presented with a pancreatic mass at the pancreas head or body without acute pancreatitis. The presenting symptoms were abdominal pain, fever, or weight loss. Abdominal CT scans showed low-density round masses at the pancreas head or body with/without lymphadenopathy. In each case, a PET-CT scan showed a mass with a high SUV, indicating possible malignancy. Comorbid diseases were identified in all patients: chronic pancreatitis and thrombus at the portal vein, penetrating duodenal ulcer, distal common bile duct stenosis, and diabetes mellitus. Diagnoses were performed by laparoscopic biopsy in two patients and via EUS fine needle aspiration in one patient. One patient revealed a multifocal microabscess at the pancreatic head caused by a deep-penetrating duod...


Delayed upper extremity paresthesia post permanent implantation of five lead spinal cord stimulator for low back and lower extremity pain: a case report
Spinal cord stimulator (SCS) implantation is an effective tool for treatment of various conditions that include complex regional pain syndrome, peripheral vascular disease, neuropathic pain, refractory angina, and failed back surgery syndrome (FBSS). SCSs are placed in the thoracic region to treat low back pain and lower extremity radicular pain. Permanent SCS is indicated for chronic nonmalignant pain of neuropathic origin with a positive trial. [1] Complications of SCS have been reported at 30%-40%, with hardware related problems, as in lead failure and migration, more common than infection. (Source: Clinical Neurology and Neurosurgery)


Theta-frequency phase-locking of single anterior cingulate cortex neurons and synchronization with the medial thalamus are modulated by visceral noxious stimulation in rats
In conclusion, these results reveal theta oscillations and theta-frequency phase-locking as prominent features of neural activity in the ACC and a candidate neural mechanism underlying acute visceral pain. (Source: Neuroscience)<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>


Walking speed and balance performance are associated with Short-Form 8 bodily pain domain in Brazilian older female
Conclusion In summary, bodily pain is significantly associated with poor maximum walking speed, balance, and QOL physical functioning; these findings are reflective of poor QOL. Assessing bodily pain is simple and can help diagnose further problems. Moreover, improvements in physical conditioning may promote greater health and QOL in this population. (Source: Journal of Clinical Gerontology and Geriatrics)


A prospective study of perceived injustice in whiplash victims and its relationship to recovery
The objectives of this paper are to to measure levels of perceived injustice in whiplash victims and determine the relationship to recovery at 6-month post-injury. Consecutive acute whiplash patients completed the Injustice Experience Questionnaire, at presentation, and also 3- and 6-month post-injury. At each of these two follow-up points, participants were examined for recovery. Of an initial 134 participants, 130 participants were followed up at 3 months and 124 at 6 months. At the 3-month follow-up, 62 % (80/130) of participants reported recovery from their injuries. At 6 months, 80 % (99/124) reported recovery. The initial Injustice Experience Questionnaire score was low, with a mean score of 6.0 ± 1.0 (range 5–10) out of a maximum of 48. The mean score at 3-month follow-u...


Long lasting anti-hemophilia factor safe in kids, experts say
Children with hemophilia A require three to four infusions each week to prevent bleeding episodes, chronic pain and joint damage. A new, extended therapy combines recombinant factor VIII with a fusion protein that allows the molecule to remain in the circulation longer -- translating into a need for less frequent treatment. (Source: ScienceDaily Headlines)


Traumatic Displacement of a Maxillary Primary Canine Tooth into the Middle Nasal Concha Presenting as Chronic Facial Pain: A Case Report.
Authors: Bušic N, Mihovilovic A, Poljak NK, Macan D Abstract The case of a 32-year-old woman who sustained a nasal bone fracture and dental trauma at the age of 9 is described in this article. Misdiagnosis of the dental displacement into the middle turbinate at the initial examination led to chronic facial pain. The cause of the pain was incorrectly diagnosed or misinterpreted by several medical specialists, including an otolaryngologist, neurologist, physiatrist, ophthalmologist, internist, radiologist, oral surgeon, dentist, and the patient's family physician. Finally, 23 years after the dental trauma, a multislice computed tomogram revealed that the primary maxillary canine was dislocated into the right middle nasal concha. The tooth, which had become embedded into necrotic, in...


Persistent Neuropathic Pain Influences Persistence Behavior in Rats.
CONCLUSION: These results suggest that persistent pain influences behavioral regulation and that animals experiencing persistent pain may have difficulty adapting to environmental demands. PMID: 25905537 [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>


Painful Temporomandibular Disorders Are Common in Patients with Postural Orthostatic Tachycardia Syndrome and Impact Significantly upon Quality of Life.
CONCLUSION: TMD are common in patients with PoTS. They have a significant, additional impact on patients' quality of life and should therefore be screened for at an early stage in PoTS. PMID: 25905533 [PubMed - as supplied by publisher] (Source: Journal of Orofacial Pain)


Comorbidity Between Depression and Anxiety in Patients with Temporomandibular Disorders According to the Research Diagnostic Criteria for Temporomandibular Disorders.
CONCLUSION: Multidimensional assessment enabled differentiation between findings of depression, anxiety, somatization, and comorbidity in subgroups of TMD patients. The findings of no statistically significant differences between subgroups of TMD patients as to anxiety and comorbidity support previous studies on TMD and anxiety, which suggest a less significant role of anxiety in chronic TMD patients as compared to depression and somatization. PMID: 25905531 [PubMed - as supplied by publisher] (Source: Journal of Orofacial Pain)


Subtyping Patients with Temporomandibular Disorders in a Primary Health Care Setting on the Basis of the Research Diagnostic Criteria for Temporomandibular Disorders Axis II Pain-Related Disability: A Step Toward Tailored Treatment Planning?
CONCLUSION: The results suggest that GCPS-related disability scoring can be used as a simple screening instrument in primary care settings to identify individuals with different, clinically relevant psychosocial subtypes. PMID: 25905530 [PubMed - as supplied by publisher] (Source: Journal of Orofacial Pain)


Narrative review of the safety and efficacy of marijuana for the treatment of commonly state-approved medical and psychiatric disorders.
Authors: Belendiuk KA, Baldini LL, Bonn-Miller MO Abstract The present investigation aimed to provide an objective narrative review of the existing literature pertaining to the benefits and harms of marijuana use for the treatment of the most common medical and psychological conditions for which it has been allowed at the state level. Common medical conditions for which marijuana is allowed (i.e., those conditions shared by at least 80 percent of medical marijuana states) were identified as: Alzheimer's disease, amyotrophic lateral sclerosis, cachexia/wasting syndrome, cancer, Crohn's disease, epilepsy and seizures, glaucoma, hepatitis C virus, human immunodeficiency virus/acquired immunodeficiency syndrome, multiple sclerosis and muscle spasticity, severe and chronic pain, and sev...


The use of the antimicrobial peptide piscidin (PCD)-1 as a novel anti-nociceptive agent.
Authors: Chen WF, Huang SY, Liao CY, Sung CS, Chen JY, Wen ZH Abstract The antimicrobial peptide piscidin (PCD)-1 has been reported to have antibacterial and immunomodulatory functions. Here, we investigated the anti-neuropathic properties of PCD-1, in order to determine its potential as a compound to alleviate pain. Treatment with PCD-1 suppressed the inflammatory proteins COX-2 and iNOS in murine macrophage (RAW264.7) and microglial (BV2) cell lines stimulated by lipopolysaccharide (LPS). For studies of the effect of PCD-1 in vivo, mononeuropathy in rats was induced by chronic constriction injury (CCI), and the resulting anti-nociceptive behaviors were compared between CCI controls and CCI rats given intrathecal injections of PCD-1. Much like gabapentin, PCD-1 exerts anti-nocice...<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 Parturient With Implanted Spinal Cord Stimulator: Management and Review of the Literature
Abstract: Spinal cord stimulation (SCS) is an approved treatment for complex regional pain syndrome and other chronic pain conditions. These devices enable women with chronic pain to maintain relatively normal lives, with some encountering pregnancy. Use of previously implanted SCS systems in pregnant women is considered controversial due to lack of long-term prospective studies evaluating both maternal and fetal safety. Seven patients at a university pain clinic were identified as having SCS implanted before becoming pregnant. Data on these patients before, during, and after labor were collected through chart review and patient interview. Onset of labor varied among the 7 patients (2 preterm and 5 term). Mode of anesthesia for delivery included 4 neuraxial anesthetics, with 3 successfully...


Impact of Pregabalin on the Occurrence of Postthoracotomy Pain Syndrome: A Randomized Trial
Conclusions: Pregabalin did not reduce the incidence of PTPS in this study. Future research on PTPS should focus on the impact of regional analgesia on central sensitization. (Source: Regional Anesthesia and Pain Medicine)


Prevalence and predictors of persistent post‐surgical pain 12 months after thoracotomy
ConclusionOur results show that preoperative pain is a predominant predictor of future pain. This implies that patients presenting with a chronic pain condition prior to surgery should be assessed thoroughly preoperatively and have an individually tailored analgesic regimen. (Source: Acta Anaesthesiologica Scandinavica)


Validation of a new risk assessment tool: The Brief Risk Questionnaire.
This study indicates that the BRQ could be a useful new tool for clinicians in conducting opioid risk assessment. PMID: 25901482 [PubMed - in process] (Source: Journal of Opioid Management)


Root cause analysis of prescription opioid overdoses.
CONCLUSIONS: Patients at risk for OD can be identified and ODs potentially prevented. Opportunities for intervention include routine screening of patients using RxOs for psychosocial distress and coping, flagging of high-risk patients, care pathways for high-risk patients, clinician and patient training on OD prevention, and developing abuse-deterrent formulations of RxOs. PMID: 25901478 [PubMed - in process] (Source: Journal of Opioid 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>


Long lasting anti-hemophilia factor safe in kids
(Children's Hospital Los Angeles) Children with hemophilia A require three to four infusions each week to prevent bleeding episodes, chronic pain and joint damage. A new, extended therapy combines recombinant factor VIII with a fusion protein that allows the molecule to remain in the circulation longer -- translating into a need for less frequent treatment. (Source: EurekAlert! - Medicine and Health)


Resident and nurse reports of potential adverse drug reactions
Conclusions Nurses and patients reported a lot of potential ADRs. The type of ADRs they reported was different and complementary. Questioning residents about specific potential ADRs may increase the awareness of ADRs. (Source: European Journal of Clinical Pharmacology)


Objective and subjective outcome 3 years after synthetic transobturator non-absorbable anterior mesh in symptomatic advanced pelvic organ prolapse surgery
Conclusion The Perigee System gave a favorable result in both anatomical and subjective success rate with a low rate of mesh related morbidities. The strength of the study reported here is its long-term follow-up of a relatively large number of patients and the use of validated questionnaires. Limitations are that it is not an RCT; hence, selection and indication bias is unavoidable. The good outcome and low morbidities resulting from mesh use is from a single surgeon’s perspective and may not be generalized to others. (Source: Gynecology and Minimally Invasive Therapy)


Evaluation and Management of Chronic Scrotal Content Pain
Abstract Chronic scrotal content pain (CSCP) is a common patient complaint which virtually all urologists will encounter in practice. While our understanding of the pathophysiology and management has increased in recent years, CSCP remains a frustrating process for both the patient and physician given that there currently is no standardized protocol for treatment or evaluation. The following article is a literature review regarding the pathophysiology and current medical and surgical options for CSCP. We also provide an updated evaluation and treatment algorithm. (Source: Current Urology Reports)


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
This study will investigate the difference in (cost) effectiveness between a biopsychosocial primary care intervention, Back on Track, and primary care physiotherapy as usual in a subgroup of adults with chronic low back pain. Design Double-blind, multicentre (n = 8), randomised, controlled trial. Participants Eighty-six adults with chronic low back pain, aged 18 to 65 years, experiencing low to moderate levels of disability and in whom the contributing role of psychosocial factors to this disability is restricted. Intervention The Back on Track intervention: four individual and eight group sessions, based on biopsychosocial approaches from multidisciplinary pain rehabilitation programs and provided by trained physiotherapists. Control Primary care physiotherapy as usual. Measurements...<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>


Midfoot arthrodesis
Midfoot arthritis is associated with disabling chronic foot pain that affects activities of daily living. Females, patients with high body mass index (BMI) and tight gastrocnemius muscle have been identified as potential risk factors [1]. The causes can be either primary osteoarthritis (OA), inflammatory eg. rheumatoid arthritis (RA), or post-traumatic, with the latter being identified in the literature as the commonest [2–4]. (Source: Foot and Ankle Surgery)


Functional mu opioid receptor polymorphism (OPRM1 A(118) G) associated with heroin use outcomes in Caucasian males: A pilot study.
CONCLUSIONS: These preliminary findings, consistent with extant data, illustrate a role for OPRM1 allelic variation on heroin use characteristics, and provide support for considering genotype in heroin treatment and relapse prevention. (Am J Addict 2015;XX:1-7). PMID: 25911999 [PubMed - as supplied by publisher] (Source: American Journal on Addictions)


Clinical Assessment of Endovascular Stenting Compared with Compression Therapy Alone in Post-thrombotic Patients with Iliofemoral Obstruction.
CONCLUSIONS: Endovascular treatment is a safe, effective, and feasible method to correct the iliofemoral obstruction of PTS. Only post-thrombotic patients with severe PTS as assessed by the Villalta score appear to benefit from the endovascular treatment. PMID: 25920630 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)


Microarchitectural and mechanical characterization of the sickle bone.
This study utilized micro-CT and biomechanical testing to determine the relationship between the bone morphology, tissue mineral density, and trabecular and cortical microarchitecture of 10- and 21-week-old femurs from transgenic sickle male mice and littermates with sickle trait, as well as a wild-type control. While bone tissue mineral density did not vary among the genotypes at either age, variation in bone microstructure were observed. At 10 weeks, healthy and trait mice exhibited similar morphology within the cortical and trabecular bone, while sickle mice exhibited highly connected trabeculae. Within older femurs, sickle and trait specimens displayed significantly fewer trabeculae, and the remaining trabeculae had a more deteriorated geometry based on the structure model index. Thinn...


Preface to the Special Issue on Pain Management
Abstract The World Health Organization (2004) estimates that 60 million people suffer from chronic noncancer pain (CP). The preface to the Special Issue on Pain Management reviews the prevalence rates of chronic noncancer pain (CP) in various countries around the world and the rate of comorbid health and psychological conditions. The article lists the topics covered in the journal which focus on treatment of chronic pain conditions. Article topics cover general treatment approaches, psychological assessment instruments, the psychological interview of the CP patient, and the treatment of insomnia and sleep disturbances, two major sequelae of CP. Best practice guidelines in the treatment of chronic pain call for referral for cognitive behavior therapy. However, rational emotive beha...<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 Clinician’s Perspective on Treating Patients Suffering from Insomnia and Pain
This article discusses the current state of sleep and pain therapies, looks at three clinical cases in which patients suffered from primary insomnia and chronic pain, and proposes a treatment protocol. (Source: Journal of Rational-Emotive and Cognitive-Behavior Therapy)


How Important Is Mode of Administration in Treatments for Rheumatic Diseases and Related Conditions?
Abstract Many new drugs do not offer clinical benefits over existing treatments but provide potentially more convenient modes of administration. These include how frequently a treatment is given, how it is delivered, who gives the treatment, and whether there are any associated local adverse reactions. We reviewed studies in rheumatology that ask patients and society the value they assign to these aspects of treatment in comparison to the benefits and side effects and costs. We find that mode of administration is generally valued by both patients and society, but the extent depends on the context of the disease and the study participants. Respondents with a more severe disease seem to assign less value to mode and frequency of administration, and prioritize improvement in pain an...


Co‐application of lidocaine and QX‐572 induces divergent pain behaviours in mice
ConclusionsOur results provide evidence that QX‐572 induced sensory‐selective blockade and co‐injection of QX‐572 and LDC enhance pain blockade, as evident from formalin‐treated mice. (Source: Journal of Pharmacy and Pharmacology)


Evaluation of a home-based transcranial direct current stimulation (tDCS) treatment device for chronic pain: study protocol for a randomised controlled trial
This article reports the protocol for a randomised, sham-controlled, double-blinded crossover study in which patients with chronic neuropathic pain (n = 24) will receive anodal, cathodal and sham tDCS over M1. All patients will have previously completed a study of rTMS of the motor cortex and have been designated as responders or non-responders to this modality.Patients receive all three tDCS stimulation types by self-administration. We assess the effect on pain scores [numerical rating scale (NRS)], self reported health status (Short Form-36 Health Survey) and anxiety/depression (Hospital Anxiety and Depression Scale). A linear mixed model with fixed effects will analyse changes in pain scores from pre- to post- interventions. Analysis will be carried out on an intention-to-treat basi...


[Surgical treatment of sternoclavicular joint instability with tenodesis].
We present our results with open reduction and internal fixation through an autologous gracilis tendon transplant or fiber tape in 8 patients treated surgically. The operative stabilisation of the sternoclavicular joint reduces pain level and improves function of the shoulder. This technique provides an effective surgical procedure for treatment of symptomatic sternoclavicular joint instability. OBJECTIVE: Restoration of the function and aspect of the sternoclavicular joint. INDICATIONS: Chronic and painful instabilities. CONTRAINDICATIONS: Local infection, tumor. SURGICAL TECHNIQUE: The gracilis tendon graft is harvested as previously described by Petersen. Direct incision over the sternoclavicular joint. Sharp dissection of the periostal sleeve and partial release of ste...<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>


Assessing the Psychometric Properties of an Activity Pacing Questionnaire for Chronic Pain and Fatigue.
CONCLUSIONS: Developed to be widely used across a heterogeneous group of patients with chronic pain and/or fatigue, the APQ-26 is multifaceted and demonstrates reliability and validity. Further study will explore the effects of pacing on patients' symptoms to guide therapists towards advising pacing themes with empirical benefits. PMID: 25908522 [PubMed - as supplied by publisher] (Source: Physical Therapy)


Tolerability of Biphasic-Release Hydrocodone Bitartrate/Acetaminophen Tablets (MNK-155): A Phase III, Multicenter, Open-Label Study in Patients With Osteoarthritis or Chronic Low Back Pain.
This study aimed to assess the tolerability of the extended use (≤35 days) of MNK-155, a biphasic (immediate-release/extended-release) hydrocodone bitartrate/N-acetyl-p-aminophenol (acetaminophen) (IR/ER HB/APAP) 7.5/325-mg fixed-dose combination analgesic agent, in patients with chronic noncancer pain (CNCP) caused by osteoarthritis or chronic low back pain. IR/ER HB/APAP tablets deliver 25% of the HB dose and 50% of the APAP dose by IR and the remainder by ER over a 12-hour dosing interval. Although IR/ER HB/APAP is being developed for the management of moderate to severe acute pain, this model of CNCP was used for assessing tolerability over a term longer than would be possible in a model of acute pain. METHODS: This Phase III, multicenter, open-label study enrolled patients with ...


Are Depressive Symptomatology, Self-Efficacy, and Perceived Social Support Related to Disability and Quality of Life in Patients With Chronic Migraine Associated to Medication Overuse? Data From a Cross-Sectional Study.
CONCLUSIONS: Adding information on psychosocial variables to headache features improved our ability to understand disability and QoL of CM-MO patients. We deem that the inclusion of psychosocial variables in standard evaluation protocols may contribute to the global assessment of CM-MO patients, and eventually to their success in reducing the personal and social impact of this condition. Future longitudinal studies are needed to confirm this hypothesis. PMID: 25913219 [PubMed - as supplied by publisher] (Source: Headache)


Is the Zumba fitness responsible for low back pain?
Conclusions We verified that Zumba is not responsible for low back pain. Furthermore, we revealed that Zumba can increase the normal functional activity of the spine. On the basis of this data, we can recommend the practice of this sport on a regular basis for the healthy population, without worrying about the risk of overloading the spine. Further studies are necessary to check whether the patients with chronic spine disease may practice Zumba. (Source: Musculoskeletal Surgery)


Lumbar subcutaneous edema and degenerative spinal disease in patients with low back pain: a retrospective MRI study
Conclusions LSE is highly associated with spondylolisthesis, facet arthropathy and BMI, suggesting underestimation of its clinical impact as an integral component in chronic lumbar back pain. Longitudinal simultaneous X-ray/MRI studies should be conducted to test the relationship of LSE with lumbar spinal instability and low back pain. (Source: Musculoskeletal 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>


How much does the Dallas Pain Questionnaire score have to improve to indicate that patients with chronic low back pain feel better or well?
Conclusions These values give information of paramount importance for clinicians in interpreting change in DPQ values over time. Authors should be encouraged to report the percentage of patients who reach MCII and PASS values in randomized clinical trials and cohort studies to help clinicians to interpret clinical results. (Source: European Spine Journal)


Eosinophilic Enteritis
Conclusion: Eosinophilic enteritis is generally considered as a benign disease with no relapse, but half of the patients may present a more complex natural history characterized by unpredictable relapses and a chronic course.Dig Dis 2015;33:183-189 (Source: Digestive Diseases)


Discovery could impact study of chronic pain conditions
Researchers have uncovered the critical role in pain processing of a gene associated with a rare disease. Their breakthrough paves the way for a better understanding of chronic pain conditions, they say. (Source: ScienceDaily Headlines)


Complex regional pain syndrome type I: a comprehensive review
ConclusionsThe pharmacological treatment of CRPS I is empirical and insufficiently effective. Further research is needed regarding the therapeutic modalities discussed in the guidelines. Physical therapy is widely recommended as a first‐line treatment. The efficacy of local anesthetic sympathetic blockade as treatment for CRPS I is questionable. (Source: Acta Anaesthesiologica Scandinavica)


Climbing mountains: “I won’t let ulcerative colitis define me”
Mark Donohue craves outdoor activity. While most were braving Old Man Winter’s 2015 wrath, this 19-year-old Ticonderoga, New York native embraced Mother Nature and hiked to the summit of his home state&#8217;s Black Mountain, tackled the slopes in Colorado and pond-skated locally with friends. Mark says his love of the great outdoors and his quest to climb new personal heights has never been overshadowed by ulcerative colitis. “I won’t let the disease define me,” says Donohue, a college freshman at Binghamton University in New York. “I take it in stride, stay positive and don’t let ulcerative colitis dictate the kind of person I want to be.” Ulcerative colitis isn’t slowing Mark Donohue down. Watch Mark’s amateur video recapping his 2015 winter adventures. Mark’s jou...<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>


Montr&eacute;al discovery could impact the study of chronic pain conditions
(Institut de recherches cliniques de Montreal) Researchers at the IRCM led by Artur Kania, PhD, uncovered the critical role in pain processing of a gene associated with a rare disease. Their breakthrough, published in The Journal of Neuroscience, paves the way for a better understanding of chronic pain conditions. (Source: EurekAlert! - Medicine and Health)


Low Back Pain in the Emergency Department—Are the ACR Appropriateness Criteria Being Followed?
Conclusions The majority of patients presenting to the ED with low back pain did not undergo imaging. The vast majority of those who underwent imaging were appropriately imaged, based on the ACR Appropriateness Criteria. (Source: Journal of the American College of Radiology)


Exercise training improves physical fitness in patients with pulmonary arterial hypertension: a systematic review and meta-analysis of controlled trials
Background: Pulmonary arterial hypertension (PAH) is a progressive disorder characterized by hypertension in the pulmonary arteries. PAH leads to symptoms such as shortness of breath, dizziness, leg edema and chest pain, impacting heavily on quality of life. The aim of this systematic review and meta-analysis was to determine the effect of exercise training to improve physical fitness and functionality in patients with PAH. Methods: A search was conducted for controlled trials using the databases Medline, Embase, SPORT Discus and Cochrane Central Register of Controlled Trials. Studies were included if at least 80% of the participants presented with group 1 PAH and if the intervention consisted of an exercise training program of at least 3 weeks duration. Data were extracted on study quali...


Structural and Functional Basis of Chronic Pelvic Pain Syndrome during Combined Chronic Cystitis and Adenomyosis
Comprehensive clinical and morphological examination of 60 female patients with chronic pelvic pain syndrome after combined chronic cystitis and adenomyosis was carried out. In all patients, the complex urodynamic examination revealed various disturbances of urination and stasis-like abnormalities of circulation in vesical and uterine walls. The pathomorphological peculiarities of the urogenital disorders during combination of adenomyosis and cystitis (of the combined proliferative and erosive/destructive type) is manifested by more pronounced destructive and inflammatory changes in urothelium characterized by the formation of superficial and deep erosions as well as by association of erosive/destructive damages to the urothelium with proliferative and metaplastic changes. Combined treatme...<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>


Trends in opioid prescribing and co‐prescribing of sedative hypnotics for acute and chronic musculoskeletal pain: 2001–2010
ConclusionsOpioid prescribing for acute and chronic musculoskeletal pain increased from 2001 to 2010, plateauing from 2006 to 2010 for chronic pain visits. Co‐prescribing of opioids and sedative hypnotics is common and may represent a target for interventions to improve the safety of opioid prescribing. Copyright © 2015 John Wiley & Sons, Ltd. (Source: Pharmacoepidemiology and Drug Safety)


An unusual cause of duodenal obstruction in adults
Conclusion: Although intestinal malrotation is generally discovered near birth, our case demonstrates that physicians should consider this diagnosis at advanced age as well. In addition, particularly radiologic findings are supportive in diagnosing malrotation. (Source: Arab Journal of Gastroenterology)


German Language Adaptation of the Headache Management Self‐Efficacy Scale (HMSE‐G) and Development of a New Short Form (HMSE‐G‐SF)
ConclusionsBoth the 25‐item version and the 6‐item version appear to be valid, reliable measures of self‐efficacy beliefs. These scales will allow clinicians to identify headache sufferers with low levels of headache‐specific self‐efficacy with the goal of enhancing this expectancy for improvement. The new short form can help accomplish this goal without adding significantly to the burden of the self‐report assessment batteries used in clinical settings. (Source: Headache: The Journal of Head and Face Pain)


Headache, Cerebral Aneurysms, and the Use of Triptans and Ergot Derivatives
ConclusionAssociations between some headaches and aneurysms may exist. Some chronic headaches may respond to surgical aneurysm repair while others may worsen. These associations are undefined by current literature because of variable results, study methods, and limited data. Prospective studies are needed which incorporate pre‐ and post‐procedure headache character and diagnosis, aneurysm characteristics, type of aneurysm repair, associated risk factors for worsening post‐procedure headache, and ultimately combining all of these data to better predict headache outcome following surgical aneurysm treatment. Lastly, the caution and avoidance of triptan and ergot derivative use for migraine in the setting of aneurysm is not supported by the current evidence, and much of this concern may...


The Role of Fear of Pain in Headache
ConclusionsFOP differentiates migraineurs from those without headache and plays a significant role in primary headache, particularly in headache‐related disability. Findings build upon and extend those from previous chronic pain studies and highlight the need for longitudinal and experimental studies to further explore this construct in headache. (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>


Pain after totally extraperitoneal (TEP) hernia repair might fade out within a year
Conclusion Moderate-to-severe pain after TEP hernia repair is self-limiting, with less than 1 % of the patients reporting moderate pain 1 year postoperatively. (Source: Hernia)


Associations between Neuroticism and Depression in Relation to Catastrophizing and Pain-Related Anxiety in Chronic Pain Patients
This study tested associations between neuroticism, depression, and indices of catastrophizing and pain-related anxiety among persons seeking treatment for chronic non-malignant pain. We hypothesized, as a higher-order personality trait, neuroticism would remain uniquely associated with both pain catastrophizing and pain-related anxiety, even after accounting for current symptoms of depression. A retrospective study design assessed depression (as measured by the Centers for Epidemiologic Studies-Depression scale), neuroticism (measured with the Neuroticism-Extraversion-Openness Personality Inventory), the Pain Catastrophizing Scale, and the Pain Anxiety Symptom Score in a consecutive series of patients (n=595) admitted to a 3-week outpatient pain treatment program from March 2009 through J...


Psychological factors and personality traits associated with patients in chronic foot and ankle pain
Publication date: Available online 7 April 2015 Source:Fuß &amp; Sprunggelenk (Source: Fuss and Sprunggelenk)


Foot compartment syndrome – a clinical review
Publication date: March 2015 Source:Fuß &amp; Sprunggelenk, Volume 13, Issue 1 Author(s): Andrew K. Sands , Stefan Rammelt , Arthur Manoli 2nd Foot compartment syndrome is a serious clinical entity that typically results from high-energy fractures and crush injuries. Up to ten anatomic compartments may be distinguished in the foot, and foot compartment syndrome may be combined with compartment syndrome of the lower leg through a communication via the deep posterior compartment. The diagnosis of foot compartment syndrome is primarily a clinical one with increasing pain, exaggerated by toe stretching, swelling with loss of skin wrinkling, and neurovascular deficits later in the course despite rest and elevation. In unconscious patients multiple stick needle measurements are useful for...


The Quantitative Analgesic Questionnaire: A Tool to Capture Patient-Reported Chronic Pain Medication Use
The extent to which patients take chronic pain medications as prescribed is not well studied, and there are no generally agreed-upon measures. The Quantitative Analgesic Questionnaire (QAQ) is a new instrument designed to comprehensively document patient-reported medication use, generate scores to quantify it (by individual drug, class, and/or overall), and compare it (qualitatively and/or quantitatively) to the regimen as prescribed. (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>


Endoscopic management of esophago-mediastinal fistula secondary to mediastinal tuberculosis infection
A 45-year-old male with chronic myeloid leukemia (bcr/abl positive) was treated with imatinib mesylate. After 2 months of treatment, the patient presented with fever, diaphoresis, cough, thoracic pain, and progressive dyspnea. Melena developed subsequently. (Source: Gastrointestinal Endoscopy)


Spilled gallstones after laparoscopic cholecystectomy associated with pelvic pain
Pelvic gallstones associated with chronic pelvic pain 9 years after laparoscopic cholecystectomy. (Source: American Journal of Obstetrics and Gynecology)


Association between changes in lumbar Modic changes and low back symptoms over a two-year period
Conclusion: Change in the extent of M1 associated positively with changes in low back symptoms. (Source: BMC Musculoskeletal Disorders)


Patients with Pelvic Floor Muscle Spasm have a Superior Response to Pelvic Floor Physical Therapy at Specialized Centers
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a common condition that often requires multimodal therapy. CPPS patients have a high incidence of pelvic floor spasm, which can be treated with pelvic floor physical therapy (PFPT), however this is a specialized skill. We wished to compare outcomes of PFPT as part of multimodal therapy in CPPS patients between those treated at our institution and elsewhere. (Source: The Journal of Urology)


Risk factors for postoperative recurrence of spontaneous pneumothorax treated by video-assisted thoracoscopic surgery
CONCLUSIONS VATS blebectomy and parietal pleurectomy is a safe procedure for treatment of spontaneous pneumothorax in young patients, with a 6% long-term recurrence rate in our experience. Postoperative recurrence significantly correlates with female gender and with prolonged air leakage after surgery. (Source: Interactive CardioVascular and Thoracic 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>


German Language Adaptation of the Headache Management Self-Efficacy Scale (HMSE-G) and Development of a New Short Form (HMSE-G-SF).
CONCLUSIONS: Both the 25-item version and the 6-item version appear to be valid, reliable measures of self-efficacy beliefs. These scales will allow clinicians to identify headache sufferers with low levels of headache-specific self-efficacy with the goal of enhancing this expectancy for improvement. The new short form can help accomplish this goal without adding significantly to the burden of the self-report assessment batteries used in clinical settings. PMID: 25904007 [PubMed - as supplied by publisher] (Source: Headache)


The Role of Fear of Pain in Headache.
CONCLUSIONS: FOP differentiates migraineurs from those without headache and plays a significant role in primary headache, particularly in headache-related disability. Findings build upon and extend those from previous chronic pain studies and highlight the need for longitudinal and experimental studies to further explore this construct in headache. PMID: 25903510 [PubMed - as supplied by publisher] (Source: Headache)


Whole body vibration training in patients with COPD: A systematic review.
Authors: Gloeckl R, Heinzelmann I, Kenn K Abstract In recent years, several studies have shown that whole body vibration training (WBVT) may be a beneficial training mode in a variety of chronic diseases and conditions such as osteoporosis, fibromyalgia, multiple sclerosis, or chronic low back pain. However, a systematic review on the effects of WBVT in patients with chronic obstructive pulmonary disease (COPD) has not been performed yet. An extensive literature search was performed using various electronic databases (PubMed, Embase, LILACS, and PEDro). They were searched from inception until September 20, 2014, using key words like "COPD" and "whole body vibration training." A total of 91 studies could be identified and were screened for relevance by two independent reviewers. Six...


Nigrostriatal dopaminergic depletion produces orofacial static mechanical allodynia
ConclusionOur data show that unilateral and bilateral dopamine depletion promoted trigeminal SMA comparable to that obtained after CCI‐IoN. This allodynia can be alleviated by D2R activation, making D2R agonist a potential analgesic for orofacial neuropathic pain. (Source: European Journal of Pain)


A confirmatory factor analysis of the Resilience Scale adapted to chronic pain (RS-18): new empirical evidence of the protective role of resilience on pain adjustment
Conclusions These findings give empirical support to the consideration of resilience as a protective variable in chronic pain adjustment and highlight the consideration that improving resilient behaviour could be an important target for the treatment of pain patients. (Source: Quality of Life 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>


Chronic pelvic pain: Protocol in the unit
Chronic pelvic pain (CPP) in women is infraumbilical pain lasting longer than six months, intermittent or continuous, and motivates medical consultation. CPP in the UK in the community-based studies was 29%. The prevalence of CPP in Spain is estimated at 22.9% in the general population, with a significant difference and a higher incidence in the female sex. (Source: Maturitas)


Current evidence on risk factors for knee osteoarthritis related to hormones or reproductive history
Purpose: Knee osteoarthritis (OA) is a chronic disease that causes pain, functional limitations and long-term disabilities and is one of the most prevalent chronic diseases worldwide. Knee OA is conceptualized as a complex condition involving several interrelated etiological factors. This project aims to review the literature on factors related to hormones or reproductive history associated with knee OA onset or progression. (Source: Maturitas)


'Tamper-Proof' Narcotic Painkiller May Be Curbing Abuse: Study
Title: 'Tamper-Proof' Narcotic Painkiller May Be Curbing Abuse: StudyCategory: Health NewsCreated: 4/20/2015 12:00:00 AMLast Editorial Review: 4/21/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Transcranial direct current stimulation and exercises for treatment of chronic temporomandibular disorders: a blind randomised‐controlled trial
This study suggests that there is no additional benefit in adding tDCS to exercises for the treatment of chronic TMD in young adults. (Source: Journal of Oral Rehabilitation)


What Causes Eye Pain?
Abstract Eye pain is an unpleasant sensory and emotional experience including sensory-discriminative, emotional, cognitive, and behavioral components and supported by distinct, interconnected peripheral and central nervous system elements. Normal or physiological pain results of the stimulation by noxious stimuli of sensory axons of trigeminal ganglion (TG) neurons innervating the eye. These are functionally heterogeneous. Mechano-nociceptors are only excited by noxious mechanical forces. Polymodal nociceptors also respond to heat, exogenous irritants, and endogenous inflammatory mediators, whereas cold thermoreceptors detect moderate temperature changes. Their distinct sensitivity to stimulating forces is determined by the expression of specific classes of ion channels: Piezo2 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>


1-2-3 Tiers for Precepting Patients With Chronic Nonmalignant Pain (Martha Rumschlag MD)
(Source: Family Medicine Digital Resources Library (FMDRL) Recently Uploaded)


Sucrose-induced analgesia during early life modulates adulthood learning and memory formation
In conclusion, chronic pain induction during early life induced short memory impairment, and pretreatment with sucrose prevented this impairment via mechanisms that seem to involve BDNF. As evident in the results, sucrose, whether alone or in the presence of pre-noxious stimulation, increases pain threshold in such circumstances; most likely via a mechanism that involves an increase in endogenous opioids. (Source: Physiology and Behavior)


Effect of N-acetylcysteine on the spinal-cord glutathione system and nitric-oxide metabolites in rats with neuropathic pain
Publication date: 21 May 2014 Source:Neuroscience Letters, Volume 569 Author(s): Andréa Horst , Carolina Kolberg , Maira S. Moraes , Ana Paula K. Riffel , Isabela A. Finamor , Adriane Belló-Klein , Maria Amália Pavanato , Wania A. Partata Since N-acetylcysteine (NAC) is a donor of cysteine, we studied the relationship between NAC and concentration of oxidized and reduced glutathione (GSH/GSSG ratio), and glutathione peroxidase (GPx) and glutathione-S-transferase (GST) activities in the lumbosacral spinal cord of rats with chronic constriction injury (CCI) of the sciatic nerve that received NAC (150mg/kg/day, i.p.) or 0.9% saline solution for 3 or 10 days. Hydrogen peroxide (H2O2) and nitric-oxide (NO) metabolites were also measured. Von Frey hair and hot-plate tests showed hyperalgesi...


Menstruation pulls the trigger for inflammation and pain in endometriosis
Publication date: Available online 19 April 2015 Source:Trends in Pharmacological Sciences Author(s): Alexis Laux-Biehlmann , Thomas d’Hooghe , Thomas M. Zollner Endometriosis is a chronic, hormone-dependent, inflammatory disease, characterized by the presence and growth of endometrial tissue outside the uterine cavity. It affects 5–10% of the female population of reproductive age and is frequently associated with moderate to severe pain, subfertility, and a marked reduction in health-related quality of life. Here, we propose a new pathophysiological concept of endometriosis, summarizing recent findings in one unifying picture. We propose menstruating tissue as the trigger for inflammatory pain in endometriosis through the activation of innate immune cells and peripheral nerve ending...


The role of Blastocystis sp. as an etiology of irritable bowel syndrome
Conclusions It is most likely that the presence of Blastocystis in the human intestine plays a significant role in IBS. On the other hand, it is still not known if Blastocystis is the etiological agent responsible for this type of gut dysfunction. There are many reports in the literature which are mutually exclusive. More studies are needed to confirm this hypothesis. (Source: Polish Annals 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>


Enhanced Psychological Health Among Chronic Pain Clients Engaged in Hope-Focused Group Counseling
This article presents studies that examined the extent to which a hope-focused group counseling intervention enhances hope and well-being in two community-based samples of participants (N =10 and N = 24) experiencing chronic pain. A pilot study (Study 1a) and a main study (Study 1b) both used a one-group, pretest&ndash;posttest design to determine whether participants experienced changes regarding their hope, well-being, acceptance of pain, and catastrophizing of pain. Both studies showed that participants experienced numerous and significant changes from pre- to post-intervention, including improvements in well-being and pain acceptance in Study 1a and improvements in hope, well-being, and catastrophizing cognitions in Study 1b. Self-reported pain severity, assessed only in Study 1a, did ...


Chronic dry eye symptoms after LASIK: parallels and lessons to be learned from other persistent post-operative pain disorders
Laser in-situ keratomileusis (LASIK) is a commonly performed surgical procedure used to correct refractive error. LASIK surgery involves cutting a corneal flap and ablating the stroma underneath, with known damage to corneal nerves. Despite this, the epidemiology of persistent pain and other long-term outcomes after LASIK surgery are not well understood. Available data suggest that approximately 20-55% of patients report persistent eye symptoms (generally regarded as at least 6 months post-operation) after LASIK surgery. While it was initially believed that these symptoms were caused by ocular surface dryness, and referred to as “dry eye,” it is now increasingly understood that corneal nerve damage produced by LASIK surgery resembles the pathologic neuroplasticity associated with othe...


Low Back and Lower Limb Muscle Performance in Male and Female Recreational Runners With Chronic Low Back Pain.
Conclusion Runners with chronic LBP exhibited diminished knee extensor strength compared to healthy runners. Male runners with chronic LBP demonstrated additional deficits in lumbar multifidus activation. J Orthop Sports Phys Ther, Epub 21 Apr 2015. doi:10.2519/jospt.2015.5460. PMID: 25899213 [PubMed - as supplied by publisher] (Source: Physical Therapy)


Mitigation of Experimental, Chronic Post-Thoracotomy Pain by Preoperative Infiltration of Local Slow-Release Bupivacaine Microspheres.
CONCLUSIONS: Local slow release of bupivacaine subcutaneously from the MS-Bupi formulation suppresses postoperative mechanical hypersensitivity for ≥4 weeks after experimental thoracotomy. Systemic bupivacaine from this treatment has no effect on this hypersensitivity. PMID: 25902323 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)


Endocarditis and spondylodiscitis associated with tunneled cuffed hemodialysis catheters: hospitalizations with poor outcomes.
CONCLUSIONS: A high index of suspicion is critical in the early recognition and management of both of these infections. PMID: 25907533 [PubMed - as supplied by publisher] (Source: The International Journal of Artificial Organs)<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 Results of Motor Cortex Stimulation in the Treatment of Chronic, Intractable Neuropathic Pain
Conclusions: MCS was more effective in the treatment of chronic neuropathic pain of central poststroke pain and peripheral neuropathic pain types than in the treatment of SCI pain in the long-term follow-up.Stereotact Funct Neurosurg 2015;93:212-218 (Source: Stereotactic and Functional Neurosurgery)


Adverse Childhood Experiences & Post-traumatic Stress Disorder
Repeated adverse childhood experiences (ACEs) can change the body, brain, nervous system and ultimately an entire life. You may be incredibly resilient. The person with an easier life and more harmonious childhood may appear more resilient, but they have not been tested in the same ways. You may be an incredibly resourceful person &#8212; likewise, life has probably helped you hone these skills. You may be highly intelligent, empathic, kind or creative. You may feel very connected to your spiritual self. You may be navigating life from your heart and your smarts and yet wonder it&#8217;s not coming together for you. Trauma It’s a big word, trauma. We hear it most often when talking about returned service people who develop post-traumatic stress disorder (PTSD) after experiencing the horr...


St. Jude Medical pulls the trigger on Spinal Modulation buy
St. Jude Medical says it exercised the buyout option on its deal with Spinal Modulation and its Axium chronic pain device. St. Jude MedicalNews Well, Mergers & Acquisitions, Neuromodulation/Neurostimulation, Pain Managementread more (Source: Mass Device)


St. Jude to buy maker of chronic pain device
St. Jude Medical Inc. will buy a California maker of a spinal cord stimulator for treating chronic pain. Little Canada-based St. Jude will pay $175 million for Spinal Modulation when the deal closes, it said Monday. It will make more payments when Spinal Modulation's device receives U.S. regulatory approval and if the business hits revenue goals. St. Jude received an exclusive option to buy Spinal Modulation Inc. for up to $300 million in 2013, when it made a $40 million investment in the company. St.… (Source: bizjournals.com Health Care:Biotechnology 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>


Video Capsule Endoscopy in Patients with Chronic Abdominal Pain with or without Associated Symptoms: A Retrospective Study
Conclusions VCE for CAP has a lower rate of abnormal findings than other indications. However, VCE is a useful diagnostic tool that can help provide a possible etiology of CAP in patients with associated symptoms. However, a change in management from VCE is likely to be limited to those with a history of Crohn’s disease. (Source: PLoS One)


Precision of image-based registration for intraoperative navigation in the presence of metal artifacts: Application to corrective osteotomy surgery
Bone fractures are very common [1] and are mostly treated by closed reduction. In this procedure the aim of the physician is to align the bone segments without surgical intervention. Approximately 5% of the distal radius fractures [2,3] result in a symptomatic malunion. Such a malunion [4] may lead to a reduced function of the limb, chronic pain, and may finally lead to early osteoarthritis. In severe malunion cases the bone segments may be realigned by surgical treatment with a procedure called a corrective osteotomy [4]. (Source: Medical Engineering and Physics)


Managing chronic orofacial pain: A qualitative study of patients', doctors', and dentists' experiences.
CONCLUSIONS: Current management of COFP is ineffective and unsatisfactory for patients and practitioners, which impacts on their relationship. Fundamental barriers to accessing and implementing psychological interventions for COFP arise from ineffective communication between physicians and patients, and between medical and dental practitioners. Statement of contribution What is already known on this subject? COFP is characterized by persistent pain in the face, mouth, or jaws that are not the result of organic disease or physical trauma. Patients with COFP present to both medical and dental services and receive sub-optimal care. No studies have examined the experiences of managing this problem from the perspectives of dentists, general practitioners and patients. What does this study add? ...


Factors associated with work ability in patients with chronic whiplash-associated disorder grade II-III: A cross-sectional analysis.
CONCLUSION: Condition-specific and psychosocial factors are associated with self-perceived work ability of individuals with chronic whiplash-associated disorder. PMID: 25882646 [PubMed - as supplied by publisher] (Source: Journal of Rehabilitation Medicine)


Usefulness scale for patient information material (USE) - development and psychometric properties
Background: One economical way to inform patients about their illness and medical procedures is to provide written health information material. So far, a generic and psychometrically sound scale to evaluate cognitive, emotional, and behavioral aspects of the subjectively experienced usefulness of patient information material from the patient’s perspective is lacking. The aim of our study was to develop and psychometrically test such a scale. Methods: The Usefulness Scale for Patient Information Material (USE) was developed using a multistep approach. Ultimately, three items for each subscale (cognitive, emotional, and behavioral) were selected under consideration of face validity, discrimination, difficulty, and item content.The final version of the USE was subjected to reliability analy...<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 risk factors for patient-reported joint pain among patients with HIV/Hepatitis C coinfection, Hepatitis C monoinfection, and HIV monoinfection
Conclusion: Patient-reported joint pain was prevalent among all three groups, but more common among chronic HCV-monoinfected than either HIV/HCV-coinfected or HIV-monoinfected patients. A prior diagnosis of arthritis and current smoking were risk factors for patient-reported joint pain among both HCV-infected and HIV-infected patients. (Source: BMC Musculoskeletal Disorders)


Parental Neuropathic Pain Influences Emotion-Related Behavior in Offspring Through Maternal Feeding Associated with DNA Methylation of Amygdale in Rats.
This study investigated whether neuropathic pain affects maternal care and assessed the effect of parental neuropathic pain on the development of neuropathic pain and emotion among offspring. Our results showed that mother rats suffered from chronic constriction injury (CCI) exhibited defective maternal care. The offspring fed by CCI mother rats (own or cross-fed) showed a significant increase in anxiety and anxiety-related behavior compared with that fed by sham-operated mother rats. The offspring fed by CCI mother rats also displayed decreased oxytocin expression in their supraoptic nucleus than that fed by sham-operated mother rats. Moreover, DNA methyltransferase (DNMT)1 expression in the amygdale was increased, whereas DNMT3a and DNMT3b expressions remained the same in offspring fed b...


Efficacy of Aerobic Exercise for Treatment of Chronic Low Back Pain: A Meta-Analysis
Conclusion: The current meta-analysis provides reliable evidence that aerobic exercise could effectively diminish pain intensity and improve the physical and psychologic functioning of CLBP patients. Thus, aerobic exercise may be a good choice in the treatment for CLBP. (Source: American Journal of Physical Medicine and Rehabilitation)


Subtalar Instability
Subtalar instability is a common clinical entity. Clinicians should have a high index of suspicion of this diagnosis in patients who have been diagnosed with chronic lateral ankle instability but have failed standard management and have continued pain in the sinus tarsi. As with ankle instability, nonoperative management is the initial mainstay of treatment. Operative management includes ligamentous reconstruction of key lateral stabilizers of the subtalar joint. Future research on this subject should be focused at improving diagnosis and recognition of this entity. (Source: Foot and Ankle Clinics)


Increasing frequency of severe clinical toxicity after use of 2,4-dinitrophenol in the UK: a report from the National Poisons Information Service
Conclusions The study indicates a substantial recent increase in clinical presentations with toxicity caused by exposure to DNP in the UK with an associated high mortality. Further steps are needed to warn potential users of the severe and sometimes fatal toxicity that may occur after exposure to this compound. (Source: Emergency Medicine 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>


Agreement in dry eye management between optometrists and general practitioners in primary health care in the Netherlands
Dry eye disease (DED) is a multi-factorial chronic ocular disease, with significant impact on visual functioning and daily life. This highly symptomatic, chronic condition is experienced by patients in a variety of symptoms that range from ocular discomfort to pain, from an impaired visual performance to photophobia, and so careful questioning is important for good diagnosis [1−4]. The multi-factorial nature of DED makes it difficult to define in one symptom or by any single current investigative technique, and, most importantly, no single treatment works for all. (Source: Contact Lens and Anterior Eye)


The over-production of TNF-α via Toll-like receptor 4 in spinal dorsal horn contributes to the chronic postsurgical pain in rat
Conclusions These findings suggest that the upregulation of TNF-α via TLR4 contributes to the development of CPSP in spinal dorsal horn. (Source: Journal of Anesthesia)


Pain Assessment: A Practical Guide for Researchers and Clinicians
Abstract Pain is one of the most universal experiences of humankind, affecting all populations across the globe. In the United States over 100 million individuals are reported to be suffering with chronic pain (Institute of Medicine in Relieving pain in America: a blueprint for transforming prevention, care, education and research, The National Academies Press, Washington, 2011) and approximately 80 % of all medical visits stem directly from pain complaints (Quartana et al. in Expert Rev Neurother 9:745–758, 2009). This paper discusses a recent movement toward standardization of the pain assessment process to improve the quality of patient reported outcomes in clinical trials through the work of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IM...


Idiopathic hypertrophic craniocervical pachymeningitis
Conclusions HCP can be diagnosed by MRI and laboratory investigations. In this case corticosteroid treatment was effective, although care must be taken when slowly reducing the dose. This case highlights HCP as a cause of progressive cerebellomedullar and cervical spinal cord symptoms. (Source: European Spine Journal)


The effect of 1 gram of acetaminophen twice daily for 12 weeks on alanine transaminase levels - A randomized placebo-controlled trial.
CONCLUSIONS: Regular, daily use of acetaminophen at half the maximum recommended daily dose for 12 weeks in a healthy adult population is associated with a small elevation in mean ALT of no probable clinical significance. Further assessment of the effects on liver function of the maximum recommended dose of acetaminophen is required. PMID: 25899926 [PubMed - as supplied by publisher] (Source: Clinical Biochemistry)<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>


How we are treating our systemic patients with primary Sjögren syndrome? Analysis of 1120 patients.
CONCLUSION: The management of pSS should be organ-specific, using low dose GCS in patients with moderate systemic activity, limiting the use of high dose GCS and second-line therapies to refractory or potentially severe scenarios. The use of systemic therapies for dryness, chronic pain or fatigue is not warranted. PMID: 25899085 [PubMed - as supplied by publisher] (Source: International Immunopharmacology)


[QUIPSambulant : An instrument for quality assurance in acute pain therapy after outpatient operations].
DISCUSSION: By reducing items on the QUIPS documentation sheets with respect to items relevant for outpatient surgery and redesigning three questions in the patient outcome questionnaire, a new QUIPS module for the QA of postoperative pain in an ambulatory setting is now available for both patients and surgeons. The necessity for quality management (QM) with regard to postoperative pain therapy after outpatient surgery can be considered assured. To what extentthe newly adapted QM tool QUIPSambulant will be deemed suitable in a routine hospital setting remains to be seen and requires ongoing investigation. PMID: 25894613 [PubMed - as supplied by publisher] (Source: Schmerz)


Zonisamide for neuropathic pain in adults.
CONCLUSIONS: The review found a lack of evidence suggesting that zonisamide provides pain relief in any neuropathic pain condition. Effective medicines with much greater supportive evidence are available. PMID: 25879104 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)


The Best Way To Protect Against Tendon Injuries Is Not Stretching
By Roxanne Nelson (Reuters Health) - Tendon injuries are common in sports, and there are many schools of thought on how to avoid them. But a new analysis of past research finds that stretching doesn't help and might even raise the risk of injury for some. Shock absorbing insoles, and hormone replacement therapy for postmenopausal women, on the other hand, did offer protection for some, the researchers found. "Stretching is often viewed as an empirically accepted method to prevent sports injuries, including tendinopathy," write the authors, led by Janne A. Peters from the University Medical Center Groningen in the Netherlands. "However, there is no scientific evidence that confirms this," they point out in Journal of Science and Medicine in Sport. Tendons ...


Possible changes in energy-minimizer mechanisms of locomotion due to chronic low back pain - a literature review
This study aimed: a) to describe the main energy-minimizer mechanisms of locomotion; b) to check if there are signs of damage on the mechanical and energetic characteristics of the locomotion due to chronic low back pain (CLBP) which may endanger the energy-minimizer mechanisms. This study is characterized as a narrative literature review. The main theory that explains the minimization of energy expenditure during the locomotion is the inverted pendulum mechanism, by which the energy-minimizer mechanism converts kinetic energy into potential energy of the center of mass and vice-versa during the step. This mechanism is strongly influenced by spatio-temporal gait (locomotion) parameters such as step length and preferred walking speed, which, in turn, may be severely altered in patients with...<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>


Adding Additional Acute Medications to a Triptan Regimen for Migraine and Observed Changes in Headache‐Related Disability: Results From the American Migraine Prevalence and Prevention (AMPP) Study
ConclusionsWhile the effects of adding vs staying consistent on the outcome of headache‐related disability varied by medication type added and headache frequency strata, in general, these results suggest that for individuals with migraine, adding acute therapies to current triptan use is generally not associated with reductions in headache‐related disability. The results were strongest among persons with HFEM and CM. These results identify important unmet medical needs in current migraine management, especially among patients with high‐frequency migraine, and suggest that alternative treatment strategies are needed to improve patient outcomes. (Source: Headache: The Journal of Head and Face Pain)


Acute Treatment Optimization in Episodic and Chronic Migraine: Results of the American Migraine Prevalence and Prevention (AMPP) Study
ConclusionEstimates of the latent variable scores for the mTOQ‐6 revealed persistent low levels of treatment optimization for both EM and CM, though treatment optimization is worse for CM. (Source: Headache: The Journal of Head and Face Pain)


Pain characteristics of adolescent spinal pain
Background: Although adolescent spinal pain increases the risk for chronic back pain in adulthood, most adolescents can be regarded as healthy. The aim of the present study was to provide data on localization, intensity and frequency of adolescent spinal pain and to investigate which physical and psycho-social parameters predict these pain characteristics.MethodOn the occasion of Spine Day, an annual event where children and adolescents are examined by chiropractors on a voluntary basis for back problems, 412 adolescents (10 to 16 years) were tested (by questionnaire and physical examination). Pain characteristics (localization, intensity, and frequency) were identified and evaluated using descriptive statistics. Regression analyses were performed to investigate possible influencing psych...


Woman left unable to eat any food for more than a YEAR after developing excruciating pancreatic condition 
When Kyli WIlfson of North Carolina was 26, she woke up with excruciating stomach pain. Diagnosed with chronic pancreatitis, she was unable to eat without feeling like her insides were burning. (Source: the Mail online | Health)


SLU researchers show that A3 adenosine receptor can activate 'off signals' for pain
(Saint Louis University) Pain is the most common reason that people seek medical attention, but the available treatments are not always successful at relieving pain in patients with chronic pain. Saint Louis University researchers found that drugs targeting the A3 adenosine receptor can 'turn off' pain signals in the spinal cord to provide relief from chronic pain. (Source: EurekAlert! - Medicine 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>


Prescription Opioid Misuse: Effective Methods for Reducing the Epidemic
Opinion statement Prescription opioid misuse has been a significant epidemic during the past decade. Formulations of prescription opioids with different mechanisms of abuse-deterrence have been developed or are currently under development. Given that these medications are substantially more difficult to use in an illicit fashion and minimize the potential for euphoria and/or create an aversive experience when over-ingested, they represent an important next step in pharmacological innovation. Immediate decreases in nonmedical use and in associated overdose mortality and adverse events have been observed after a highly abused opioid, OxyContin, was changed into an abuse-deterrent formulation. However, this reduction in OxyContin use may have simply shifted the drug of choice towards...


Translation, Cultural Adaptation, and Validation of Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and Self‐Complete Leeds Assessment of Neuropathic Symptoms and Signs (S‐LANSS) Questionnaires into the Greek Language
ConclusionsThe LANSS and the S‐LANSS diagnostic tools have been translated and validated into the Greek language and can be adequately used to assist the identification of neuropathic pain in everyday clinical practice. (Source: Pain Practice)


Myocardial Infarction after Physical Exertion in a Healthy Young Patient with Coronary Artery Ectasia and Sickle Cell Trait
A 29-year-old African American male was admitted for non-ST-segment-elevation myocardial infarction (MI). He was previously a healthy person who did not take medications. His past medical history included sickle cell trait (SCT), chronic hematuria and hospitalization for sickle pain crisis as a child. He was hunting for deer and started to have substernal chest pain while dragging one uphill for 400 meters. He was in mild distress, but his vital signs were normal. Laboratory workup revealed white blood cell count of 8,400/mm3, hemoglobin of 14.8g/dL, hematocrit of 43.60%, and platelets count of 161,000/mm3. (Source: International Journal of Cardiology)


Improved Pain Relief With Burst Spinal Cord Stimulation for Two Weeks in Patients Using Tonic Stimulation: Results From a Small Clinical Study
ConclusionsA majority of subjects reported improved pain relief using burst compared with tonic stimulation. Most subjects experienced less paresthesia during burst and preferred burst citing better pain relief. (Source: Neuromodulation)


Applicability of the Nursing Outcomes Classification (Noc) to the Evaluation of Cancer Patients with Acute or Chronic Pain in Palliative Care
To verify the clinical applicability of the Nursing Outcomes Classification (NOC) to the evaluation of cancer patients with a nursing diagnosis of Acute or Chronic Pain in a palliative care unit. (Source: Applied Nursing Research : ANR)<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>


Precepting Patients With Chronic Nonmalignant Pain (Martha Rumschlag MD)
(Source: Family Medicine Digital Resources Library (FMDRL) Recently Uploaded)


Does Chronic Pelvic Pain Syndrome Have an Infectious Etiology?
(Source: The Journal of Urology)


Re: Association of Pain and Depression in those with Chronic Low Back Pain: The Mediation Effect of Patient Sexual Functioning
A. H. Pakpour, M. Nikoobakht and P. Campbell (Source: The Journal of Urology)


Changing beliefs for changing movement and pain: Classification-based cognitive functional therapy (CB-CFT) for chronic non-specific low back pain
This case report presents the effect of classification-based cognitive functional therapy in a patient with chronic disabling low back pain. The patient was assessed using a multidimensional biopsychosocial classification system and was classified as having flexion pattern of movement impairment disorder. Management of this patient was to change her belief that bending over and sitting would cause damage to her disc, combined with active exercises for graded exposure to lumbar flexion to restore normal movement. (Source: Manual Therapy)


Can neck exercises enhance the activation of the semispinalis cervicis relative to the splenius capitis at specific spinal levels?
The deep cervical extensor, semispinalis cervicis, displays changes in behaviour and structure in people with chronic neck pain yet there is limited knowledge on how activation of this muscle can be emphasized during training. Using intramuscular electromyography (EMG), this study investigated the activity of the deep semispinalis cervicis and the superficial splenius capitis muscle at two spinal levels (C2 and C5) in ten healthy volunteers during a series of neck exercises: 1. Traction and compression, 2. (Source: Manual 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>


The Contribution of Differential Opioid Responsiveness to Identification of Opioid Risk in Chronic Pain Patients
The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) predicts increased risk of opioid misuse in chronic pain patients. We evaluated whether higher SOAPP-R scores are associated with greater opioid reinforcing properties, potentially contributing to their predictive utility. Across two counterbalanced laboratory sessions, 55 chronic low back pain sufferers completed the SOAPP-R at baseline, and measures of back pain intensity, evoked pain responsiveness (thermal, ischemic), and subjective opioid effects after receiving intravenous morphine (0.08 mg/kg) or saline placebo. (Source: The Journal of Pain)


Attitudes towards the use and acceptance of eHealth technologies: a case study of older adults living with chronic pain and implications for rural healthcare
Conclusions: eHealth has the potential to overcome some traditional challenges of providing rural healthcare, however roll out needs to be gradual and begin by supplementing, not substituting, existing care and should be mindful of individual’s circumstances, capability and preferences. Acceptance of technology may relate to existing levels of personal and social contact, and may be greater where technological help is not perceived to be replacing in-person care. (Source: BMC Health Services Research)


Theoretical Considerations for Chronic Pain Rehabilitation.
Authors: Lotze M, Moseley GL Abstract Conventional rehabilitation of patients with chronic pain is often not successful and frustrating for the team. However, theoretical developments and substantial advances in our understanding of the neurological aspects of chronic pain, is changing these experiences. Modern theoretical models of pain consider it a perceptual inference that reflects a 'best guess' that protective action is required. We argue that keen observation, and open and respectful clinician-patient and scientist-clinician relationships, have been critical for the emergence of effective rehabilitation approaches and will be critical for further improvements. We emphasise the role in modern pain rehabilitation of reconceptualising the pain itself by Explaining Pain, careful...


Successful Management of Severe Unilateral Lower Extremity Lymphedema in an Outpatient Setting.
DISCUSSION: Delayed diagnosis and treatment of non-cancer related lymphedema result in increased severity and impaired mobility, making this a unique complex condition requiring modifications to CDT in the outpatient setting. This case report demonstrates successful outpatient management of a patient with severe unilateral lower extremity lymphedema and impaired mobility. PMID: 25882483 [PubMed - as supplied by publisher] (Source: Physical Therapy)


Pilot Randomized Trial Comparing Intersession Scheduling of Biofeedback Results to Individuals with Chronic Pain: Influence on Psychologic Function and Pain Intensity.
CONCLUSIONS: Systematically reducing the frequency of external visual feedback during HRV biofeedback training was associated with reduced reactivity to chronic pain. Results of this pilot study should be confirmed with a larger randomized study. PMID: 25888657 [PubMed - as supplied by publisher] (Source: Physica Medica)<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>


Manual Therapy, Therapeutic Patient Education, and Therapeutic Exercise, an Effective Multimodal Treatment of Nonspecific Chronic Neck Pain: A Randomized Controlled Trial.
CONCLUSION: Differences between experimental groups and the control group were found in the short and medium term. A multimodal treatment is a good method for reducing disability in patients with nonspecific chronic neck pain in the short and medium term. PMID: 25888653 [PubMed - as supplied by publisher] (Source: Physica Medica)


The impact of chronic pain on opioid addiction treatment: a systematic review protocol
Discussion This review will capture the experience of treatment outcomes for a sub-population of opioid addiction patients and provide an opportunity to distinguish the best quality guidelines for OST. If chronic pain truly does result in negative consequences for opioid addiction patients, it is important we identify which OSTs are most appropriate for chronic pain patients as well as ensure the treatment guidelines incorporate this information. Systematic review registration PROSPERO CRD42014014015 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014014015#.VS1Qw1wkKGM (Source: Systematic Reviews)


Tramadol and the risk of fracture in an elderly female population: a cost utility assessment with comparison to transdermal buprenorphine - Hirst A, Knight C, Hirst M, Dunlop W, Akehurst R.
INTRODUCTION: Opioid treatment for chronic pain is a known risk factor for falls and/or fractures in elderly patients. The latter cause a significant cost to the National Health Service and the Personal Social Services in the UK. Tramadol has a higher risk... (Source: SafetyLit: All (Unduplicated))


Trigeminal Neuralgia: Causes & Treatment Information
Trigeminal neuralgia is a form of chronic pain condition that affects a person's trigeminal nerve. The nerve carries sensation from a person's face to their brain. People with this condition find that even mild stimulation of their face, such as from putting on makeup or even brushing their teeth, might trigger a burst of excruciating pain. (Source: Disabled World)


Paracetamol may blunt feelings of pleasure as well as pain
ConclusionThis small study found some slight differences in the way a group of people taking paracetamol reacted to a range of images, compared to a group of people taking a placebo. Though an RCT is the &quot;gold standard&quot; of studies for determining whether a medication causes an effect, both groups need to be evenly matched for a variety of potentially confounding factors.There is no information about the participants, other than the impression that they are all students, as they were given course credits for partaking in the study. It is not clear whether the groups were matched in terms of age, sex, ethnicity, whether they had children, or indeed whether they liked cats.  The study is interesting, but no conclusions can be drawn as to whether paracetamol can dull emotional react...<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, Depression, and Cardiovascular Disease: A National Multicenter Study
Conclusion: In conclusion, these data illustrate important interrelationships between secondary complications following SCI, as well as raise the possibility of neuropathic pain (versus nociceptive pain) as a novel and emerging risk factor for CVD.Neuroepidemiology 2015;44:130-137 (Source: Neuroepidemiology)


Oncologic pain relief: strategies told by adolescents with cancer
In view of the negative impact of pain on the quality of life of cancer patients, identifying and stimulating the use of effective strategies to minimize these painful feelings is highly relevant for care. The aim of this study was to identify painful experiences of adolescents with cancer and to get to know their strategies for pain relief. This is an exploratory research, using qualitative data analysis. Semistructured interviews were held with nine adolescents with cancer, who reported on acute, recurring and chronic, physical and emotional painful experiences. To relieve these pains, they described pharmacological and non-pharmacological strategies, including: distraction, presence of relatives, bed positioning, cooperation to accomplish procedures and keeping up positive thinking. The...


Microdebrider‐assisted intracapsular Tonsillectomy in adults with chronic or recurrent tonsillitis
ConclusionTonsillectomy reduced symptoms of chronic or recurrent tonsillitis in adults with remarkable effectiveness. Microdebrider‐assisted ICTE reduced symptoms as effectively as conventional ECTE. ICTE was associated with lower morbidity, but residual tonsils occurred in almost half of patients, costs were higher, and the intracapsular approach was more intricate and time‐consuming. Level of Evidence1b. Laryngoscope, 2015 (Source: The Laryngoscope)


Acute Migraine Treatment in Adults
This study aims to review current medical office‐based acute migraine therapy in adults and provides readers with an organized approach to this important facet of migraine treatment. A general literature review includes a review of several recent published guidelines. Acetaminophen, 4 nonsteroidal anti‐inflammatory drugs (NSAIDs) (ibuprofen, acetylsalicylic acid [ASA], naproxen sodium, and diclofenac potassium), and 7 triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan) have good evidence for efficacy and form the core of acute migraine treatment. NSAID–triptan combinations, dihydroergotamine, non‐opioid combination analgesics (acetaminophen, ASA, and caffeine), and several anti‐emetics (metoclopramide, domperidone, and prochlo...


Adrenergic signaling mediates mechanical hyperalgesia through activation of P2X3 receptors in primary sensory neurons of rats with chronic pancreatitis
The mechanism of pain in chronic pancreatitis (CP) is poorly understood. The aim of this study was designed to investigate roles of norepinephrine (NE) and P2X receptor (P2XR) signaling pathway in the pathogenesis of hyperalgesia in a rat model of CP. CP was induced in male adult rats by intraductal injection of trinitrobenzene sulfonic acid (TNBS). Mechanical hyperalgesia was assessed by referred somatic behaviors to mechanical stimulation of rat abdomen. P2XR-mediated responses of pancreatic dorsal root ganglion (DRG) neurons were measured utilizing calcium imaging and whole cell patch-clamp-recording techniques. Western blot analysis and immunofluorescence were performed to examine protein expression. TNBS injection produced a significant upregulation of P2X3R expression and an increase...<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>


Cell‐based therapy for preventing postoperative adhesion and promoting regeneration after hepatectomy
Abstract Postoperative adhesion is a critical clinical issue after almost all abdominal or pelvic surgeries including liver surgery. Postoperative adhesion causes several complications, such as small bowel obstruction and chronic abdominal pain. Furthermore, it makes reoperation much more difficult, leading to increased mortality and morbidity rate. Postoperative adhesion is particularly problematic for repeated hepatectomy, since hepatic malignant neoplasm recurs frequently and repeated hepatectomy is widely used as one of the most curative treatments. Several treatments to reduce postoperative adhesion have been developed, which include laparoscopic surgery, administration of pharmacological agents and use of prophylactic barrier materials. However, none of them are optimal. We have prop...


Mercury Poisoning as a Cause of Intracranial Hypertension
Mercury poisoning is a rare but fatal toxicologic emergency. Neurologic manifestations involving the central nervous system are seen usually with chronic mercury intoxication. The most commonly seen complaints are headache, tremor, impaired cognitive skills, weakness, muscle atrophy, and paresthesia. Here, we present a male patient who was chronically exposed to elemental mercury and had papilledema and intracranial hypertension without parenchymal lesion in the central nervous system. A 12-year-old male patient was referred to our emergency room because of severe fatigue, generalized muscle pain and weakness, which was present for a month. Physical examination revealed painful extremities, decreased motor strength and the lack of deep tendon reflexes in lower extremities. He had mixed typ...


Health literacy as a moderator of health-related quality of life responses to chronic disease among Chinese rural women
Conclusions: Health literacy modified the impacts of chronic disease on HRQoL, and low health literacy group reported less HRQoL impacts related to chronic disease. Research should address health literacy issues as well as root causes of health disparities for vulnerable populations. (Source: BMC Women's Health)


Acute Migraine Treatment in Adults.
This study aims to review current medical office-based acute migraine therapy in adults and provides readers with an organized approach to this important facet of migraine treatment. A general literature review includes a review of several recent published guidelines. Acetaminophen, 4 nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, acetylsalicylic acid [ASA], naproxen sodium, and diclofenac potassium), and 7 triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan) have good evidence for efficacy and form the core of acute migraine treatment. NSAID-triptan combinations, dihydroergotamine, non-opioid combination analgesics (acetaminophen, ASA, and caffeine), and several anti-emetics (metoclopramide, domperidone, and prochlorperazine)...


Inappropriate shock from a subcutaneous implantable cardioverter-defibrillator due to transcutaneous electrical nerve stimulation
A 24-year-old man with a history of idiopathic ventricular fibrillation underwent implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD). At implantation, the primary sensing vector was automatically chosen, defibrillation testing at 65 J was successful, and conditional (210 bpm) and shock-only zones (240 bpm) were programmed. Approximately 5 months after implant, because of chronic back pain the patient applied a transcutaneous electrical nerve stimulation (TENS) device (model 7000, Current Solutions) to his lower back. (Source: Heart Rhythm)<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>


Acceptance of Vulvovaginal Pain in Women with Provoked Vestibulodynia and Their Partners: Associations with Pain, Psychological, and Sexual Adjustment
ConclusionsFindings suggest that psychological interventions for PVD should target increasing couples' vulvovaginal pain acceptance in order to improve women's pain and the sexual and psychological functioning of both members of the couple. Boerner KE and Rosen NO. Acceptance of vulvovaginal pain in women with provoked vestibulodynia and their partners: Associations with pain, psychological, and sexual adjustment. J Sex Med **;**:**–**. (Source: The Journal of Sexual Medicine)


National study of chronic disease self‐management: 6‐month and 12‐month findings among cancer survivors and non‐cancer survivors
ConclusionsFindings suggest that participation in CDSMP, an evidence‐based chronic disease self‐management intervention not specifically tailored for cancer survivorship, may significantly improve physical and psychosocial health status and key health and healthcare behaviors among cancer survivors. Additional research is needed to elucidate cancer survivors' unique needs and examine the benefits of tailored versions of CDSMP. Nevertheless, CDSMP, available at scale nationally and internationally, is a promising intervention for cancer survivors and should be considered a valuable component of survivorship care. Copyright © 2015 John Wiley & Sons, Ltd. (Source: Psycho-Oncology)


The Need for an Integrated Cognitive-Behavioral Model for Co-occurring Chronic Pain and Insomnia
Abstract Cognitive-behavioral models for both insomnia and pain are well established. Few studies have addressed the cognitive-behavioral aspects of these conditions occurring together with a unified model. Worry, rumination, catastrophizing, monitoring, misperceptions, dysfunctional beliefs, and safety behaviors are reviewed. Sleep hygiene among those with co-occurring pain and insomnia is also discussed. It is proposed that more concerted efforts are needed to develop an integrated cognitive-behavioral model to address insomnia and pain as a complex integrated phenomenon. (Source: Journal of Rational-Emotive and Cognitive-Behavior Therapy)


Weight stigma in physiotherapy practice: Patient perceptions of interactions with physiotherapists
Weight management is increasingly considered part of physiotherapists’ scope of practice in order to improve patient outcomes by, for example, reducing load on joints, or improving chronic pain. However, interactions with patients involving weight may result in patient perceptions of negative judgment from health professionals, which can result in poorer health outcomes. How physiotherapist/patient interactions involving weight are perceived by patients has not yet been investigated. (Source: Manual Therapy)


Decision support for chronic pain care: how do primary care physicians decide when to prescribe opioids? a qualitative study
Conclusions: This study identified and described primary care physicians’ struggles to deliver high quality care as they seek and make decisions based on an array of incomplete, conflicting, and often untrusted patient information. Decision support systems, education, and other interventions that address these challenges may alleviate primary care physicians’ struggles and improve outcomes for patients with chronic pain and other challenging conditions. (Source: BMC Family 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>


Diet in irritable bowel syndrome
Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder that is characterized by intermittent abdominal pain/discomfort, altered bowel habits and abdominal bloating/distension. This review aimed at presenting the recent developments concerning the role of diet in the pathophysiology and management of IBS. There is no convincing evidence that IBS patients suffer from food allergy/intolerance, and there is no evidence that gluten causes the debated new diagnosis of non-coeliac gluten sensitivity (NCGS). The component in wheat that triggers symptoms in NCGS appears to be the carbohydrates. Patients with NCGS appear to be IBS patients who are self-diagnosed and self-treated with a gluten-free diet. IBS symptoms are triggered by the consumption of the poorly absorbed fermen...


Sudden death in young persons with uncontrolled asthma - a nationwide cohort study in Denmark
Background: Asthma is a common chronic disease among young adults, and several studies have reported increased mortality rates in patients with asthma. However, no study has described sudden unexpected death in a nationwide setting in patients with uncontrolled asthma. We defined uncontrolled asthma as a previous hospital admittance because of asthma (of any severity) or when asthma was considered to have influenced the death according to the death certificate. The purpose of this study is to increase the medical focus on young persons with uncontrolled asthma and thereby hopefully aid in preventing sudden unexpected deaths. We therefore aimed to describe clinical characteristics, symptoms, causes of death, and contact with the healthcare system prior to sudden unexpected death in young pe...


Weight stigma in physiotherapy practice: Patient perceptions of interactions with physiotherapists
Weight management is increasingly considered part of physiotherapists' scope of practice in order to improve patient outcomes by, for example, reducing load on joints, or improving chronic pain. However, interactions with patients involving weight may result in patient perceptions of negative judgement from health professionals, which can result in poorer health outcomes. How physiotherapist/patient interactions involving weight are perceived by patients has not yet been investigated. (Source: Manual Therapy)


Fibromyalgia Quiz: Test Your Medical IQ
Title: Fibromyalgia Quiz: Test Your Medical IQCategory: MedicineNet QuizCreated: 11/10/2010 2:34:00 PMLast Editorial Review: 4/13/2015 7:32:23 PM (Source: MedicineNet Chronic Pain General)


DePuy ASR Lawsuit News: Federal Court Overseeing Thousands of Claims...
Bernstein Liebhard LLP is representing numerous clients in the DePuy ASR hip recall litigation, all of whom allegedly experienced chronic pain, metallosis, premature device failure and other...(PRWeb April 12, 2015)Read the full story at http://www.prweb.com/releases/depuy-asr-recall-lawsuit/depuy-asr-settlement/prweb12645881.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>


What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain?
DiscussionA state-of-the-art review was conducted to synthesize evidence related to lifestyle factors (not smoking, healthy diet, healthy weight, optimal sleep and manageable stress, as well as physical activity) and musculoskeletal health, with special reference to chronic pain. The findings support that health behaviour change competencies (examination/assessment and intervention/treatment) may warrant being included in first-line management of chronic pain, either independently or in conjunction with conventional physical therapy interventions. To address knowledge gaps in the literature however three lines of clinical trial research are indicated: 1) to establish the degree to which traditional physical therapy interventions prescribed for chronic pain augment the benefits of lifestyle...


Inhibition of FAAH reduces nitroglycerin-induced migraine-like pain and trigeminal neuronal hyperactivity in mice
There is evidence to suggest that a dysregulation of endocannabinoid signaling may contribute to the etiology and pathophysiology of migraine. Thus, patients suffering from chronic migraine or medication overuse headache showed alterations in the activity of the arachidonoylethanolamide (AEA) degrading enzyme fatty acid amide hydrolase (FAAH) and a specific AEA membrane transporter, alongside with changes in AEA levels. The precise role of different endocannabinoid system component is, however, not clear. (Source: European Neuropsychopharmacology)


Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial
Conclusions The BI method provides GPs with a simple and effective instrument that reduces medication-overuse and headache frequency in patients with MOH. Trial registration number NCT01314768. (Source: Journal of Neurology, Neurosurgery and Psychiatry)


Promoting the role of pharmacists in chronic pain management: how can we make an impact on policy and practice?
(Source: International Journal of Pharmacy Practice)


Severe intrinsic acute kidney injury associated with therapeutic doses of acetaminophen
Abstract Acetaminophen is a commonly used medication to manage fever and pain in children and the drug is generally considered to be safe when used at appropriate therapeutic dosages. Recently, we encountered the case of a 3‐year‐old Japanese girl who suffered from severe intrinsic acute kidney injury (AKI) after therapeutic doses of acetaminophen for a fever due to viral infection. Renal biopsy indicated severe acute tubular necrosis with a significant striped interstitial fibrosis and mild interstitial inflammation. Unfortunately, she developed chronic kidney disease thereafter. This is the youngest case of biopsy‐proven severe intrinsic AKI associated with therapeutic doses of acetaminophen. Acetaminophen, even if administered at therapeutic dosages, may be dangerous in selected 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>


The relationships between pain, disability, and health-related quality of life: an 8-year follow-up study of female home care personnel.
CONCLUSIONS: The development of disability differed from that of low-back pain intensity. Spreading of pain and pain intensity across the anatomical regions influenced disability and quality of life over 8 years. When assessing pain, it seems important to determine the spread of pain rather than just focusing on the area with intense pain. Implications for Rehabilitation Spreading of pain and the average intensity of pain across the involved anatomical regions have importance for future pain and disability and quality of life. The clinical assessment of subjects with chronic pain prior to rehabilitation interventions has to determine the spreading of pain rather than just focusing on the area with the most intense pain. The different developments over time for pain intensity and disability...


Orthostatic intolerance and postural tachycardia syndrome as suspected adverse effects of vaccination against human papilloma virus.
CONCLUSIONS: In a population referred for symptoms of orthostatic intolerance and other symptoms consistent with autonomic dysfunction that began in close temporal association with a quadrivalent HPV vaccination, we identified a 60% prevalence of POTS. Further work is urgently needed to elucidate the potential for a causal link between the vaccine and circulatory abnormalities and to establish targeted treatment options for the affected patients. PMID: 25882168 [PubMed - as supplied by publisher] (Source: Vaccine)


How The Science Of Wasabi Could Pave The Way For New Pain Meds
Scientists have modeled the stunning structure of the receptor in our bodies that jolts our senses when we eat sushi garnished with spicy wasabi -- and it turns out that this so-called 'wasabi receptor' may hold clues for developing new pain treatments. The receptor, a protein called TRPA1, resides in the cellular membrane of our sensory nerve cells. Not only does it detect certain chemical agents outside of our bodies -- from wasabi to tear gas -- but it also gets triggered by pain-inducing signals within our bodies from itches and inflammation. “The pain system is there to warn us when we need to avoid things that can cause injury, but also to enhance protective mechanisms,” Dr. David Julius, professor and chair of the physiology department at the University of California, San Fran...


Chronic appendicitis: uncommon cause of chronic abdominal pain
(Source: Therapeutic Advances in 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>


010 op: making chronic pain matter--how can qualitative research shape the conversation?
This paper reflects on our experience of designing, running and evaluating participatory qualitative research methods to better understand pain communication. It emerges from Communicating Chronic Pain: Interdisciplinary methods for non-verbal data, a research project funded by the National Centre for Research Methods, which aimed to bridge the gap between experiencing and communicating about pain. Focusing on non-verbal forms of communication instead of personal illness narratives, this project explored pain communication in non-clinical contexts, analysing non-verbal forms of pain expression across multiple social media platforms and by using arts methods as experimental and participatory methodologies to explore pain communication. Involving a mixed group of people living with different...


MeCP2 plays an analgesic role in pain transmission through regulating CREB / miR-132 pathway
Conclusions: Our study shows that MeCP2 plays an analgesic role in both acute pain transduction and chronic pain formation through regulating CREB-miR-132 pathway. This work provides a potential therapeutic target for neural pathologic pain, and also sheds new lights on the abnormal sensory mechanisms associated with autism spectrum orders. (Source: Molecular Pain)


Dying Well Means Dying At Home
"Count no man happy till his end is known." Herodotus This was true in ancient Greece 2500 hundred years ago. It is even more true today -- aggressive end-of-life hospital care, the lack of sufficient palliative care, and unduly restrictive assisted suicide laws make it impossible for most people to die with dignity. There is no worse death than a hospital death. Dying well means dying at home. This requires preparation and preparation requires recognizing that dying is a necessary, and indeed desirable, part of life. The ancient Greeks understood the value of death. Aurora, goddess of the dawn falls deeply in love with a mortal man and successfully prevails upon the gods to grant him immortality. But Aurora carelessly forgets to request also that he be granted the additional gift...


Safety and efficacy of sustained release of basic fibroblast growth factor using gelatin hydrogel in patients with critical limb ischemia
Abstract As a form of therapeutic angiogenesis, we sought to investigate the safety and efficacy of a sustained-release system of basic fibroblast growth factor (bFGF) using biodegradable gelatin hydrogel in patients with critical limb ischemia (CLI). We conducted a phase I–IIa study that analyzed 10 CLI patients following a 200-μg intramuscular injection of bFGF-incorporated gelatin hydrogel microspheres into the ischemic limb. Primary endpoints were safety and transcutaneous oxygen pressure (TcO2) at 4 and 24 weeks after treatment. During the follow-up, there was no death or serious procedure-related adverse event. After 24 weeks, TcO2 (28.4 ± 8.4 vs. 46.2 ± 13.0 mmHg for pretreatment vs after 24 weeks, p &lt; 0.01) showed significant improvement. Regarding second...


Resolution of Chronic Vulvar Pruritus With Replacement of a Neuromodulation Device
We report a case in which a patient experienced chronic vulvar pruritus that was refractory to medical treatments and did not have a pathological diagnosis. A neurological etiology was suspected, and upon replacement of the patient's sacral neuromodulation device, complete resolution of the vulvar symptoms occurred. (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>


Infectious spondylitis in the Balearic Islands: An analysis of 51 cases
Conclusions Diagnosis was delayed in most cases. Previous bacteremia being main predisposing factor and hematogenous origin the main source of infection. S. aureus was the most isolated. Percutaneous puncture together with blood cultures increase etiologic diagnosis. A high percentage of patients had complications or sequelae. (Source: Revista Clinica Espanola)


Discriminating military and civilian traumatic brain injuries
This article is part of a Special Issue entitled ‘Traumatic Brain Injury’. Graphical abstract (Source: Molecular and Cellular Neuroscience)


A Subgroup Analysis Found no Diminished Response to Buprenorphine Transdermal System Treatment for Chronic Low Back Pain Patients Classified with Depression
ConclusionsResults do not support a differential response to BTDS treatment between depressed and nondepressed CLBP patients across a variety of patient‐reported outcomes. These findings raise the question of whether depressed mood actually moderates the effectiveness of treatment in CP patients. (Source: Pain Practice)


Tramadol and the risk of fracture in an elderly female population: a cost utility assessment with comparison to transdermal buprenorphine
Conclusion Transdermal buprenorphine is cost-effective compared to tramadol at a willingness-to-pay threshold of £20,000 per QALY. (Source: The European Journal of Health Economics)


An Approach to Pain Management in End Stage Renal Disease: Considerations for General Management and Intradialytic Symptoms.
Authors: Koncicki HM, Brennan F, Vinen K, Davison SN Abstract The prevalence and severity of symptoms in patients with advanced chronic kidney disease is higher than those of the general population and comparable to those with other chronic and serious medical conditions. Despite the prevalence and severity in this population, symptoms continue to be under-recognized and inadequately managed. The recognition of specific intradialytic pain syndromes such as pain related to arteriovenous access, headaches, muscle cramps or generalized pain by providers may aid in improving patient compliance and quality of life. The approach to pain management in end stage renal disease patients follows that of the general population with specific considerations regarding clearance and potential side...<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>


Short- but Not Long-Term Melatonin Administration Reduces Central Levels of Brain-Derived Neurotrophic Factor in Rats with Inflammatory Pain
Conclusion: The high spinal cord BDNF levels and the low prefrontal cortical BDNF levels observed in rats with acute CFA-induced inflammation following short-term melatonin administration may be related to the pain-modulating and neuroprotective effects of this protein. Long-term melatonin administration did not alter BDNF levels in chronic inflammation.Neuroimmunomodulation (Source: Neuroimmunomodulation)


Peripheral Nerve Stimulation: Advances in the Field
Abstract The prevalence of chronic pain is increasing in the United States. Fortunately, a growing body of evidence continues to enhance our understanding of pain pathways and provide new avenues for clinical treatment of pharmacologic-resistant pain disorders. Specifically, the field of neurostimulation is garnering momentum with peripheral nerve stimulation (PNS) being one of the largest areas of interest over the last decade. PNS potentially offers clinicians an alternative treatment modality when conventional management options fail. The current body of literature is dominated by case series and reports; however, there is an increasing number of prospective clinical trials being conducted in recent years. As applications continue to expand, further evaluation of its utility, e...


Abdominal CT predictors of fibrosis in patients with chronic pancreatitis undergoing surgery
Conclusion Parenchymal calcification(s) independently predict severe fibrosis and are significantly associated with post-operative pain relief in CP. The presence of &gt;10 parenchymal calcifications is a better predictor of severe fibrosis than 1-10 parenchymal calcification(s). Key Points • Parenchymal calcifications in chronic pancreatitis independently predict post-operative pain relief • Intraductal calculi and MPD dilation are not associated with post-operative pain relief • Better patient selection for pancreatic resection surgery in painful chronic pancreatitis (Source: European Radiology)


Characteristics of Trunk Control During Crook-Lying Unilateral Leg Raising in Different Types of Chronic Low Back Pain Patients
Conclusion. This study demonstrated that the characteristics of trunk control during unilateral leg-raising movement were different depending on the types of NS-CLBP patients. These results indicate that patients with NS-CLBP might select compensatory trunk control strategies subconsciously to prevent the manifestation of LBP. These results also suggest the importance of the different characteristics of trunk control during active limb movement in the clinical reasoning process for the management of different types of NS-CLBP patients. Level of Evidence: N/A (Source: Spine)


Distal radioulnar joint instability: trans-osseous flexible stabilization using nylon tape
Conclusion This simple procedure, requiring no hardware removal, is a direct tether passing within the joint. Being strictly within bone, no soft tissues are violated. It provides immediate stability, maintains forearm rotation and allows restored grip strength and may be considered as a new treatment option. (Source: European Orthopaedics and Traumatology)<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>


Thymoma with extensive ossification in a young woman
Conclusion The mechanism of osseous metaplasia is unknown. Several theories have been given. Certain cell mediators would stimulate and influence connective tissue to be replaced by heterotopic bone. Further cases of osseous metaplasia will be necessary to figure out pathogenesis, prognosis and treatments outcomes of these particular types of thymomas. (Source: European Surgery)


Fowler's syndrome of urinary retention: A retrospective study of co‐morbidity
ConclusionsWe found high levels of co‐morbidity with patients having some form of pain (50%), a probable functional disorder (24%), or psychological symptoms (31%). There are several potential explanations for this association including the effect of developing an apparently unexplained distressing condition, confounding effect of opiate use or referral bias. The findings suggest a need for prospective systematic study of comorbidity for this disabling condition. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc. (Source: Neurourology and Urodynamics)


Pain and Personality: Do Individuals with Different Forms of Chronic Pain Exhibit a Mutual Personality?
In conclusion, our study reveals that irrespective of type, chronic pain may be associated with Cluster C personality disorders. Indeed, there has never been empirical evidence in the past to suggest that chronic pain as an overall concept is associated with any particular personality disorders. Therefore, a potential future avenue of chronic pain treatment may lie in targeting particular personality aspects and shift the target of pain‐relieving treatments from sensory and psychologically state focused to psychologically trait focused. (Source: Pain Practice)


Pain and Physical Functioning in Neuropathic Pain: A Systematic Review of Psychometric Properties of Various Outcome Measures
ConclusionAlthough a variety of pain and physical functioning outcome measures have been reported in the literature, few have demonstrate methodologically strong psychometric properties. Thus, future research is required to further investigate the psychometric properties of existing pain and physical functioning outcome measures used for clinical and research purposes. (Source: Pain Practice)


A novel selective and orally bioavailable Nav1.8 channel blocker, PF‐01247324, attenuates nociception and sensory neuron excitability
Conclusions and ImplicationsUsing PF‐01247324, we have confirmed a role for Nav1.8 channels in both inflammatory and neuropathic pain. We have also demonstrated a key role for Nav1.8 channels in action potential upstroke and repetitive firing of rat and human DRG neurons. (Source: British Journal of Pharmacology)<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>


Cellular Supplementation Technologies for Painful Spine Disorders
Publication date: April 2015 Source:PM&amp;R, Volume 7, Issue 4, Supplement Author(s): Michael J. DePalma , Justin J. Gasper Low back pain affects more than 80% of adults. A proportion of these adults develops chronic low back pain (CLBP) and becomes disabled by their condition. CLBP is expensive to diagnose and treat and in terms of associated loss of productivity in the work place setting by affected individuals. Although challenging, the source of CLBP can be identified. Contemporary literature contains several studies that have established prevalence estimates for various structural sources of CLBP. In young adults, the intervertebral disk is a common source of CLBP, once it incurs annular injury that heals incompletely. Effective treatment for painful disks currently is an unmet...


The Role of Physiatry in Regenerative Medicine: The Past, The Present, and Future Challenges
This article will also address the role physiatrists should have in the inevitable growth of regenerative medicine applications. (Source: PMandR)


Lack of evidence for ectopic sprouting of genetically labeled A&#946; touch afferents in inflammatory and neuropathic trigeminal pain
Conclusions: CreER-based labeling prior to injury precluded the issue of phenotypic changes of neurons after injury. Our results suggest that touch allodynia in chronic orofacial pain is unlikely caused by ectopic sprouting of Aβ trigeminal afferents. (Source: Molecular Pain)


Short-term effect on pain and function of neurophysiological education and sensorimotor retraining compared to usual physiotherapy in patients with chronic or recurrent non-specific low back pain, a pilot randomized controlled trial
Conclusions: MMT was found to be feasible and to significantly reduce pain in the short term when compared with UPT. A future RCT with a six-month follow-up would require approximately 170 patients.Trial registrationCurrent Controlled Trials ISRCTN66262199. Registered 8 January 2014. (Source: BMC Musculoskeletal Disorders)


Neuronal changes induced by Varicella Zoster Virus in a rat model of postherpetic neuralgia.
Authors: Guedon JM, Yee MB, Zhang M, Harvey SA, Goins WF, Kinchington PR Abstract A significant fraction of patients with herpes zoster, caused by Varicella Zoster Virus (VZV), experience chronic pain termed postherpetic neuralgia (PHN). VZV-inoculated rats develop prolonged nocifensive behaviors and serve as a model of PHN. We demonstrate that primary rat cultures show a post-entry block for VZV replication, suggesting the rat is not fully permissive. However, footpads of VZV infected animals show reduced peripheral innervation and innervating dorsal root ganglia (DRG) contained VZV DNA and transcripts of candidate immediate early and early genes. The VZV-infected DRG showed changes in host gene expression patterns, with 84 up-regulated and 116 down-regulated genes seen in gene ar...<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>


JRRD Podcast Episodes 37 & 38 Now Online
After a brief hiatus, JRRD At a Glance Podcasts are back! Listen to Episode 37 discussing chronic pain and PTSD, ear prostheses, tinnitus management, and more from JRRD 51-4. Episode 38 discusses gait ability, early opioid effect on PTSD, telerehabilitation, and more from JRRD Volume 51-5. Don't forget to subscribe to the JRRD At a Glance Podcast on iTunes. (Source: Journal of Rehabilitation Research and Development)


Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients
Conclusions This trial indicated that gabapentin treatment had no clinically important reduction in postoperative morphine consumption at 72 hr in patients undergoing THA. Multimodal analgesia may account for the similar primary and secondary outcomes found in the groups. This trial was registered at ClinicalTrials.gov, number: NCT01307202. (Source: Canadian Journal of Anesthesia)


Mediators and Moderators of Chronic Pain Outcomes in an Online Self-Management Program
This study supports the effectiveness of online interventions when CBT and self-management targets pain levels, emotional factors, and wellness-focused coping. The importance of stress as a mediator of pain severity is discussed. The absence of moderators may indicate that the intervention is effective for a wide variety of patients with chronic pain. (Source: The Clinical Journal of Pain)


Effect of Spinal Cord Stimulation on Sensory Characteristics: A Randomized, Blinded Crossover Study
Discussion: The results support existing evidence suggesting that SCS does not change sensory characteristics, which is important information for both patients and clinicians. Changes in pain intensity after deactivation of SCS may be different in short-term and long-term SCS treatment. (Source: The Clinical Journal of Pain)


The Influence of Anxiety Reduction on Clinical Response to Pediatric Chronic Pain Rehabilitation
This study investigates the relationship between anxiety reduction and functional outcomes in children and adolescents receiving intensive interdisciplinary rehabilitation services for chronic pain (CP). Specifically, we evaluated whether: (1) anxiety changes over the course of treatment; (2) anxiety covaries with functional outcomes to rehabilitation; and (3) change in anxiety predicts change in functional outcomes from rehabilitation for CP. Using 3 separate measures assessing anxiety-related constructs, we hypothesized that anxiety would be associated with functioning, both before and following intensive rehabilitation for CP. Further, we hypothesized that a decrease in anxiety-related symptoms following rehabilitation would predict a positive change in functional outcomes. Materials 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>


A prospective, multicenter study assessing the DENTSPLY Implants, OsseoSpeed™ TX, length 6 mm in the posterior maxilla and mandible: a 1‐year follow‐up study
ConclusionOne‐year data indicate that the use of 6‐mm‐long implants is a predictable treatment. This provides a good treatment option in situations with limited bone height in posterior regions. (Source: Clinical Oral Implants Research)


Cannabinoid Hyperemesis Syndrome: A Case Report and Literature Review
As society has seen an increase in rates of cannabis abuse, largely related to an increase in legalization of the substance, a new clinical condition deemed cannabinoid hyperemesis syndrome has been recognized. This syndrome of idiopathic etiology is stimulated from chronic marijuana usage and produces cyclic episodes of nausea, vomiting, and epigastric pain often alleviated with compulsive hot water bathing. (Source: Journal of Oral and Maxillofacial Surgery)


Joint bleeds in von Willebrand disease patients have significant impact on quality of life and joint integrity: a cross‐sectional study
Conclusion: In conclusion, joint bleeds are reported by 23% of moderate and severe VWD patients, mostly start in childhood, are associated with more CFC use, joint pain, lower HR‐QoL and significantly more radiological and self‐reported joint damage. (Source: Haemophilia)


Patient-Reported Outcomes to initiate a provider-patient dialog for the management of hip and knee osteoarthritis
Although many treatment guidelines exist for hip and knee osteoarthritis (OA), uptake in clinical practice is typically low. Valid patient-reported outcome measures (PROs) that can be easily used in the clinic could aid implementation and evaluation of treatment recommendations and the tracking of symptoms and function over time. This project responded to a 2012 Call to Action of the Chronic Osteoarthritis Management Initiative of the United States Bone and Joint Initiative; we aimed to develop a tiered list of recommended PROs that could be feasibly applied in common clinical settings, across four domains of pain, function, fatigue, and sleep. (Source: Seminars in Arthritis and Rheumatism)


Pain and recovery are comparable after either uniportal or multiport video-assisted thoracoscopic lobectomy: an observation study [THORACIC]
CONCLUSIONS Uniportal VATS lobectomy is safe, and there is no appreciable negative impact on the hospital stay or morbidity. Patient-reported pain and morphine use in the first 24 h was low with either technique. Larger prospective studies are needed to quantify any benefit to a particular approach for VATS lobectomy. (Source: European Journal of Cardio-Thoracic 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>


Pain management in cancer survivorship.
This article addresses the central aspects of pain epidemiology, mechanisms and the frequent pain syndromes met in cancer survivors. Pain management strategies are discussed according to the biopsychosocial model and with the rapidly growing number of cancer survivors the establishment of multidisciplinary clinics as a part of comprehensive cancer centers are proposed. PMID: 25855865 [PubMed - as supplied by publisher] (Source: Acta Oncologica)


Cannabinoid Hyperemesis Syndrome: A Case Report and Literature Review
As society has seen an increase in rates of cannabis abuse, largely related to an increase in legalization of the substance, a new clinical condition deemed cannabinoid hyperemesis syndrome has been recognized. This syndrome of idiopathic etiology is stimulated from chronic marijuana usage and produces cyclic episodes of nausea, vomiting, and epigastric pain often alleviated with compulsive hot water bathing. (Source: Journal of Oral and Maxillofacial Surgery)


Pain management programme for Chinese patients: a 10-year outcome review.
CONCLUSIONS: Patients with chronic pain who joined the Comprehensive Outpatient Pain Engagement programme showed significant functional improvement despite the long history of pain. PMID: 25904291 [PubMed - as supplied by publisher] (Source: Hong Kong Med J)


Patient-reported outcomes to initiate a provider–patient dialog for the management of hip and knee osteoarthritis
Although many treatment guidelines exist for hip and knee osteoarthritis (OA), uptake in clinical practice is typically low. Valid patient-reported outcome measures (PROs) that can be easily used in the clinic could aid implementation and evaluation of treatment recommendations, and the tracking of symptoms and function over time. This project responded to a 2012 Call to Action of the Chronic Osteoarthritis Management Initiative of the United States Bone and Joint Initiative; we aimed to develop a tiered list of recommended PROs that could be feasibly applied in common clinical settings, across four domains of pain, function, fatigue, and sleep. (Source: Seminars in Arthritis and Rheumatism)


HealthOS Software to Assist 100M Americans in Pain
The cost of treating chronic pain in adults in the US exceeds $600 billion annually. HealthOS™ is launching a new web-based platform called PainCareOS™, a pain management support tool, at HIMSS 15 in...(PRWeb April 08, 2015)Read the full story at http://www.prweb.com/releases/2015/04/prweb12638684.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>


Role of MicroRNA in Visceral Pain.
Authors: Zhang J, Banerjee B Abstract The long-lasting nociceptive transmission under various visceral pain conditions involves transcriptional and/or translational alter-ation in neurotransmitter and receptor expression as well as modification of neuronal function, morphology and synaptic connections. Although it is largely unknown how such changes in posttranscriptional expression induce visceral pain, recent evi-dence strongly suggests an important role for microRNAs (miRNAs, small non-coding RNAs) in the cellular plasticity underlying chronic visceral pain. MicroRNAs are small noncoding RNA endogenously produced in our body and act as a major regulator of gene expression by either through cleavage or translational repression of the target gene. This regulation is essential for ...


Role of principal ionotropic and metabotropic receptors in visceral pain.
Authors: Kannampalli P, Sengupta JN Abstract Visceral pain is the most common form of pain caused by varied diseases and a major reason for patients to seek medical consultation. It also leads to a significant economic burden due to workdays lost and reduced productivity. Further, long-term use of non-specific medications is also associated with side effects affecting the quality of life. Despite years of extensive re-search and the availability of several therapeutic options, management of patients with chronic visceral pain is often in-adequate, resulting in frustration for both patients and physicians. This is, most likely, because the mechanisms associated with chronic visceral pain are different from those of acute pain. Accumulating evidence from years of research implicates ...


Physical Therapy Equals Surgery for Certain Lower Back Pain, Study Says
Title: Physical Therapy Equals Surgery for Certain Lower Back Pain, Study SaysCategory: Health NewsCreated: 4/7/2015 12:00:00 AMLast Editorial Review: 4/8/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Trigeminal Inflammatory Compression (TIC) injury induces chronic facial pain and susceptibility to anxiety-related behaviors
Publication date: 4 June 2015 Source:Neuroscience, Volume 295 Author(s): D.N. Lyons , T.C. Kniffin , L.P. Zhang , R.J. Danaher , C.S. Miller , J.L. Bocanegra , C.R. Carlson , K.N. Westlund Our laboratory previously developed a novel neuropathic and inflammatory facial pain model for mice referred to as the Trigeminal Inflammatory Compression (TIC) model. Rather than inducing whole nerve ischemia and neuronal loss, this injury induces only slight peripheral nerve demyelination triggering long-term mechanical allodynia and cold hypersensitivity on the ipsilateral whisker pad. The aim of the present study is to further characterize the phenotype of the TIC injury model using specific behavioral assays (i.e. light–dark box, open field exploratory activity, and elevated plus maze) to explor...


The Hippocampus and TNF: Common Links between Chronic Pain and Depression
Publication date: Available online 7 April 2015 Source:Neuroscience &amp; Biobehavioral Reviews Author(s): Victoria Fasick , D.O. Robert N. Spengler , Shabnam Samankan , Nader D. Nader , Tracey A. Ignatowski Major depression and chronic pain are significant health problems that seriously impact the quality of life of affected individuals. These diseases that individually are difficult to treat often co-exist, thereby compounding the patient's disability and impairment as well as the challenge of successful treatment. The development of efficacious treatments for these comorbid disorders requires a more comprehensive understanding of their linked associations through common neuromodulators, such as tumor necrosis factor-α (TNFα), and various neurotransmitters, as well as common neur...<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>


Modulation of cervical facet joint nociception and pain attenuates physical and psychological features of chronic whiplash: a prospective study
Conclusions Physical and psychological features of chronic whiplash associated disorder are dynamically modulated with cervical radiofrequency neurotomy. These findings indicate that peripheral nociception is involved in the manifestations of chronic whiplash associated disorder in this cohort of individuals. (Source: PMandR)


Influence of Knee Pain and Low Back Pain on the Quality of Life in Adults Older Than 50 Years of Age
Conclusions These results suggest that knee pain and LBP are important factors affecting QoL in middle-aged and elderly people and that LBP may be relatively more important than knee pain in elderly people, especially men. Proper management and prevention of these conditions can help to improve QoL. (Source: PMandR)


Tumor necrosis factor-alpha is a potential diagnostic biomarker for chronic neuropathic pain after spinal cord injury
Publication date: 19 May 2015 Source:Neuroscience Letters, Volume 595 Author(s): Jun Xu , Xiaoqiang E , Huiyong Liu , Feng Li , Yanhui Cao , Jun Tian , Jinglong Yan Neuropathic pain (NP) is one of the most common complications after spinal cord injury (SCI), but no protein biomarkers has ever been introduced into clinical diagnosis. Previous studies implicated that toll-like receptor (TLR) 4 played a critical role in the development of NP in animal SCI models. Here, a total of 140 participants were recruited, 70 of them were SCI-NP subject and the rest 70 controls did not show neuropathic symptoms. TLR4 was upregulated significantly in SCI-NP patients compared with SCI-noNP subjects. Furthermore, we measured the concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL...


Immediate and sustained effects of 5-day transcranial direct current stimulation of the motor cortex in phantom limb pain
The study explores the analgesic effects of transcranial Direct Current Stimulation (tDCS) over the motor cortex on post-amputation Phantom Limb Pain (PLP). Eight subjects with unilateral lower or upper limb amputation and chronic PLP were enrolled in a cross-over, double-blind, sham-controlled treatment program. For five consecutive days, anodal (active or sham) tDCS was applied over the motor cortex for 15 minutes at an intensity of 1.5 mA. The 5-day treatment with active, but not sham, tDCS induces a sustained decrease in background PLP and in the frequency of PLP paroxysms, which lasted for one week after the end of treatment. (Source: The Journal of Pain)


Psychometric Properties of the Pain Stages of Change Questionnaire: New Insights on the Measurement of Readiness to Change in Adolescents, Mothers and Fathers
There is increasing interest in the measurement of “readiness to change,” or willingness to engage in a self-management approach to pain coping, as a predictor of treatment response in pediatric pain populations. The primary aim of the present study was to provide cross-validation of the Pain Stages of Change Questionnaire (PSOCQ)-Adolescent and Parent versions in a new, independent pediatric chronic pain sample by examining aspects of reliability, validity, and generalizability of the factor structures identified in the initial validation study. (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>


Presence of decreased Intraepidermal Nerve Fiber Density consistent with Small Fiber Neuropathy in Patients with Central Post-Stroke Pain (P1.050)
CONCLUSIONS: We have demonstrated evidence of decreased ENFD in a small series of patients with CPSP. These findings do not imply causality; however, they do bring up several important questions for further consideration. Does the central nervous system injury associated with stroke result in small fiber neuropathy in certain patients? Are patients with asymptomatic, previously undiagnosed small fiber neuropathy at increased risk for developing CPSP following a stroke? Do these findings have any implication for treatment? Further studies including prospective analyses are necessary to better understand these findings for both diagnostic and treatment purposes. Study Supported by:Disclosure: Dr. Yushvayev-Cavalier has nothing to disclose. Dr. Amory has nothing to disclose. Dr. Bernardini ha...


Gastrointestinal manifestations of postural orthostatic tachycardia syndrome (P1.280)
CONCLUSIONS: Subjective GI disturbance is common in patients with POTS, and these symptoms are not necessarily related to primary GI pathology. Symptoms are frequent and prolonged, likely decreasing quality of life. Given the importance of autonomic input to normal GI function, the same autonomic impairment that leads to postural tachycardia may also affect the enteric nervous system, leading to gastroparesis, abnormal gut motility, and esophageal reflux. Further studies correlating subjective symptoms with objective abnormalities of GI autonomics are needed.Disclosure: Dr. Morgenshtern has nothing to disclose. Dr. Culbertson has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Deb has nothing to disclose. Dr. Hohler has nothing to disclose. (Source: Neurology)


Herpes Simplex Virus Type 1 Dorsal Root Ganglionitis in a 34 Year Old Male With Occipital Neuralgia Refractory to Medical and Radiofrequency Ablation Therapies: A Clinicopathological Report and Literature Review (P1.293)
CONCLUSIONS: These observations indicate that active HSV-1 infection can cause ganglionitis in human cervical DRG and suggest that HSV-1 infection may have played a role in the pathogenesis of the occipital headaches of this patient. Histopathological images and brief literature review of HSV-1 reactivation will be presented.Disclosure: Dr. Rathore has nothing to disclose. Dr. Slavin has nothing to disclose. Dr. Rathore has nothing to disclose. Dr. Rakic has nothing to disclose. Dr. Valyi-Nagy has nothing to disclose. (Source: Neurology)


Clinical Benefit Of Incobotulinumtoxin-A For The Treatment Of Chronic Migraine (P1.297)
CONCLUSIONS: IncobotulinumtoxinA has proved to be a useful drug for the treatment of chronic migraine in the assessed patients. Study Supported by: NO SUPPORTEDDisclosure: Dr. Lopez has nothing to disclose. Dr. Lopez Garcia has nothing to disclose. Dr. SANTOS LASAOSA has nothing to disclose. Dr. BELLOSTA DIAGO has nothing to disclose. (Source: Neurology)


Efficacy and Safety of OnabotulinumtoxinA in a Long-Term, Open-Label Study for the Prophylaxis of Headaches in Adult Chronic Migraine Patients: An Interim Analysis of the COMPEL Study (P1.306)
Conclusions: Consistent with previously published findings, interim data from COMPEL supports the efficacy and safety of onabotulinumtoxinA for headache prophylaxis in CM, up to 24 weeks. Study Supported by: Allergan, Inc.Disclosure: Dr. Blumenfeld has received personal compensation with Allergan, Zogenix, Inc., Depomed, Inc., Forest Laboratories, and Keller Labs as a speaker, advisory board member and/or consultant. Dr. Stark has received personal compensation for activities with Allergan, Inc., Merck Sharp & Dohme Ltd., Invivo, and Pfizer Inc. Dr. Reppine has received personal compensation for activities with Allergan, Inc. as an employee. Dr. Halstead has received personal compensation for activities with Allergan, Inc. as an employee. Dr. Holdbrook has received personal compensatio...<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>


Primary Headaches as a Cause of Non-traumatic Ecchymosis: a 120-Year Systematic Review and Pooled Analysis of Published Case Studies (P1.307)
CONCLUSIONS: Our results suggest that non-traumatic ecchymoses can be a feature of primary headache disorders. Future studies would benefit from a systematic characterization of ecchymosis in relation to headaches.Disclosure: Dr. Peretz has nothing to disclose. Dr. Woldeamanuel has nothing to disclose. Dr. Cowan has received personal compensation for activities with Allergan, Inc., MAP Pharmaceuticals, Nautilus Neurosciences, and Nupathe. (Source: Neurology)


Sexual Function In Female Patients With Migraine (P1.316)
CONCLUSIONS: Patients with chronic migraine and comorbid psychiatric disorders experience problems in several aspects of sexuality compared with epizodic migraine and controls. Pain severity is a significant predictor of sexuality in patients with migraine. It is important to detect and treat these comorbid conditions earlier to increase the life quality and treatment success in migraine. Study Supported by: NoneDisclosure: Dr. Uluduz has nothing to disclose. Dr. Ayan has nothing to disclose. Dr. Ertem has nothing to disclose. Dr. Uygunoglu has nothing to disclose. Dr. Goksan has nothing to disclose. Dr. Saip has nothing to disclose. Dr. Siva has nothing to disclose. (Source: Neurology)


Botox (onabotulinumtoxinA) for treatment of post traumatic chronic migraine headaches (PTCMH) in veterans (P1.318)
CONCLUSION: In conclusion, with proper administration of Botox, veterans who suffer from TBI and have failed conventional treatment showed significant improvement in ADL, migraine severity, frequency, and duration of PTCMH.Disclosure: Dr. Roka has nothing to disclose. Dr. zachariah has nothing to disclose. Dr. Badiali has nothing to disclose. Dr. Zachariah has nothing to disclose. (Source: Neurology)


Survey of Non-motors symptoms in patients with Spinocerebellar ataxia type 10 (P2.134)
CONCLUSIONS: Except for daytime sleepiness, all other NMS were more prevalent among SCA3 cases, confirming SCA10 as a more pure form of SCA.Disclosure: Dr. Moro has nothing to disclose. Dr. Moscovich has received personal compensation for activities with Roche and Medtronic. Dr. Munhoz has nothing to disclose. Dr. Arruda has nothing to disclose. Dr. Raskin has nothing to disclose. Dr. Ashizawa has received royalty payments from Baylor College of Medicine. Dr. Teive has nothing to disclose. (Source: Neurology)


Not everything that worsens on standing is intracranial hypotension! (P3.045)
Conclusion: Here we report a rare case of coexisting PDPH and pneumocephalus after epidural steroid injection. The lack of MRI brain findings for intracranial hypotension was unexpected, but not surprising as studies have shown up to 20-30[percnt] of patients with intracranial hypotension would have a normal cranial MRI. Since orthostatic headache is not reliable to rule out pneumocephalus, especially in patient with coexisting PDPH, we believe early brain imaging might be indicated in patients with orthostatic headache that is refractory of conventional therapy.Disclosure: Dr. Limaye has nothing to disclose. Dr. Mahuwala has nothing to disclose. Dr. Lee has nothing to disclose. (Source: Neurology)<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 Volume Suboccipital Nerve Injections for Chronic Cluster Headache with Long Term Efficacy Data (P3.054)
CONCLUSIONS: HVSON appears effective in the treatment of CCH and shows consistent response over long-term usage. Some patients achieved surprisingly long duration of CH freedom and a definite preventive response was noted.Disclosure: Dr. Rozen has nothing to disclose. (Source: Neurology)


Cluster Headache - A Nationwide Study of 387 Cases (P3.062)
Conclusions: As expected, most sufferers were men, but with a male/female ratio smaller than previously reported. The proportion of chronic CH was higher than previously described. Some patients did not have strictly unilateral pain, and this possibility has recently been recognized, although not to the frequency found in our study. Delayed diagnosis was the norm, suggesting that continuous medical education on cluster headaches is necessary in order to relieve the incredible burden of these sufferers.Disclosure: Dr. Nobre De M Costa has nothing to disclose. (Source: Neurology)


An Unusual Case of Post-Traumatic Headache Complicated by Intracranial Hypotension (P3.065)
CONCLUSIONS: In this case, a young healthy man who presented with a seemingly straightforward case of post-traumatic headache developed intracranial hypotension resulting in an acquired Chiari malformation and myelopathy with syringomyelia. This unusual presentation of post-traumatic headache highlights the varying presentations and the potential sequelae of intracranial hypotension. As is made evident by this report, CSF leakage is not a benign condition. Potential sequelae including syrinx formation can cause profound debilitation and prove to be quite challenging to treat. The delayed onset of upper motor neuron symptoms along with initially normal Head CT findings, beg the question of whether or not a post-traumatic headache warrants earlier MR imaging, especially if there if there is ...


Pain control is an independent predictor of self-reported mental health among patients with chronic neurological conditions. (P3.297)
CONCLUSIONS: Pain level independently and negatively impacts self-perceived mental health among patients with neurological conditions, many of which are not typically associated with pain. Further research is warranted to validate these findings and systematically assess pain and mental health in neurological practices.Disclosure: Dr. Moura has nothing to disclose. Dr. Schwamm has nothing to disclose. Dr. Schwamm has received research support from Genentech. (Source: Neurology)


Antiretroviral Central Nervous System Penetration Does Not Reduce Chronic Pain in People Living with HIV (P3.298)
Conclusions: CPE score does not correlate with chronic pain rates in PLWH. CPE score may affect depression, though additional studies are necessary. Given the substantial morbidity associated with chronic pain in PLWH, future studies should investigate preventable and treatable factors.Disclosure: Dr. Robbins has nothing to disclose. Dr. Chaiklang has nothing to disclose. Dr. Supparatpinyo has nothing to disclose. (Source: Neurology)<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 Prevalence in the Elderly (P3.300)
CONCLUSION: The majority of elderly adults experience pain. The legs, feet and back appear to be the sites of both the most frequent and most intense pain. Study Supported by: National Institute on Aging; P01 AG03949Disclosure: Allergan, Inc, Dr. Wang has nothing to disclose. Dr. Katz has received research support from Bristol-Myers Squibb. Dr. Derby has nothing to disclose. Dr. Zimmerman has received research support from Merck Sharp & Dohme Ltd. and Bristol-Myers Squibb Company. Dr. Lipton has received personal compensation for activities with Allergan, Inc., American Headache Society, Autonomic Technologies, Boston Scientific Corp., Bristol-Myers Squibb, CogniMed Inc., Colucid Pharmaceuticals, Eli Lilly & Company, eNeura Therape (Source: Neurology)


Provocative Infrared Telethermography in Knee Osteoarthritis: The Role of the Sympathetic Nervous System in Pain (P3.305)
CONCLUSION: Traditional theory would predict that with provocation, the affected knee would become warmer due to increased local inflammation and resultant vasodilation. However, this pilot suggests that the opposite occurs, with both knees becoming significantly cooler. This suggests a centrally-mediated response, most likely sympathetic-mediated vasoconstriction.Disclosure: Dr. Gerson has nothing to disclose. Dr. Saracoglu has received research support from Forest Laboratories. Dr. Connolly has received research support from Forest Pharmaceuticals. Dr. Kirsling has nothing to disclose. Dr. Harden received personal compensation for activities with GlaxoSmithKline, Johnson & Johnson, and King Pharmaceuticals. (Source: Neurology)


Prevalence of B12 Deficiency in Patients Presenting with Non-Specific Pain and Other Sensory Symptoms: A Clinical Observational Study (P3.307)
CONCLUSIONS:There is a high prevalence of Vit B12 deficiency in patients presenting with ill-defined chronic pain and other non-specific sensory symptoms. Vit B12 is a correctable nutritional deficiency and such may be the initial manifestation. This has to be treated to prevent progression to neuropathy, myelopathy and dementia.Disclosure: Dr. Ummer has nothing to disclose. Dr. Noone has nothing to disclose. (Source: Neurology)


Comparison of patients with chronic non-cancer pain taking and not taking chronic opioid therapy (P3.313)
CONCLUSIONS: Patients prescribed chronic opioid therapy for CNCP report worse overall health compared to patients not taking opioids. Novel non-opioid strategies should be studied, which could lead to better care for patients with CNCP.Disclosure: Dr. Przekop has nothing to disclose. Dr. Przekop has nothing to disclose. Dr. Haviland has nothing to disclose. (Source: Neurology)


Differential Effects of Pain and Weakness on Function in Chiari Malformation And Syrinx; A Longitudinal Study (P3.314)
CONCLUSIONS: The favorable course in operated and observed patients indicates that criteria for recommending surgery or observation were appropriate and that surgical intervention halted progression. Typically, motor deficits are emphasized in disability evaluations. Our data reveals a significant impact of chronic pain on functional ability. Adequate treatment of pain should result in better function.Disclosure: Dr. Cantor has nothing to disclose. Dr. Spencer has nothing to disclose. Dr. Mack has nothing to disclose. Dr. Heiss has nothing to disclose. (Source: Neurology)<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 Rare Presentation of Neuro-Behcet's Disease (NBD) (P4.062)
CONCLUSIONS: We present a rare manifestation of BD in which our patient had rapidly progressive spinal cord lesions. High dose steroids are the initial choice in management, but the optimal management for chronic NBD has yet to be determined. Immunosuppresion is thought to be the best treatment guided by the severity of systemic symptoms. Spinal involvement has a less favorable response to therapy, highlighting the importance of early recognition and aggressive treatment.Disclosure: Dr. Harris has nothing to disclose. Dr. Shah has nothing to disclose. Dr. Urtecho has nothing to disclose. Dr. Bell has nothing to disclose. (Source: Neurology)


Pain Comorbidities of Episodic and Chronic Migraine: Results from the CaMEO (Chronic Migraine Epidemiology & Outcomes) Study (P5.042)
CONCLUSIONS: Pain comorbidities at non-cephalic locations are common with migraine. Non-cephalic pain increases in prevalence, number of affected sites and intensity of pain from EM to non-daily CM to daily CM. These findings support the hypothesis that propensity to extra-cephalic pain is higher in persons with CM than in persons with EM, possibly reflecting genetic differences in pain susceptibility or modifications in pain processing produced by enduring pain. Study Supported by: Allergan, Inc.Disclosure: Dr. Scher has received personal compensation for activities with Allergan, Inc. as an advisory board member. Dr. Lipton has received personal compensation for activities with Allergan, Inc., American Headache Society, Autonomic Technologies, Boston Scientific Corp., Bristol-Myers Squib...


A Promising Marker to Detect Chronic Pain Syndrome (P5.055)
CONCLUSIONS: Chronic pain is a complex problem, often without a definite etiology. TS-HDS is associated with a painful presentation and subtle clinical exam findings. Our results indicate that TS-HDS may be associated with CPS whether or not the subject has biopsy proven SFN. TS-HDS could provide diagnostic evidence of chronic pain; larger studies are needed to confirm the results of this study.Disclosure: Dr. Strong has nothing to disclose. Dr. Kafaie has nothing to disclose. (Source: Neurology)


Neuromyelitis optica's related optic neuritis can be distinguished by optic nerve enhancement characteristics and resistance to steroids (P5.270)
Conclusion: Performing optic nerve MRI at onset and following visual acuity after a steroid challenge may help to discriminate NMO-SD after an acute ON.Disclosure: Dr. Buch has nothing to disclose. Dr. Savatovsky has received personal compensation for activities with Bayer Pharmaceuticals Corporation, Philips Healthcare, and GE Healthcare. Dr. Deschamps has nothing to disclose. Dr. Gout has received personal compensation for activities with Allergan, Inc., Almirall, Bayer-Schering, Biogen Idec, Genzyme, Novartis, Merck Serono, Sanofi, and Teva. (Source: Neurology)


Neuropathic Pain Treatments and Quality of Life Results in Leprosy Patients (P6.313)
CONCLUSION: This study highlights the superiority of Group 1 compared to Group 2 when analyzing the results. Although Group 1 was statistically superior to Group 2, the Limitations by Emotional Aspects criteria showed no statistical difference in both. One might speculate as hypothesis for this finding, aspects that go beyond pharmacotherapy, such as the impact of stigma related to the presence of cutaneous manifestations.Disclosure: Dr. Dornas has nothing to disclose. Dr. Nascimento has nothing to disclose. Dr. Pupe has nothing to disclose. Dr. Araujo has nothing to disclose. Dr. Davidovich has nothing to disclose. Dr. Vianna has nothing to disclose. Dr. Coutinho has nothing to disclose. Dr. Bittar has nothing to disclose. (Source: Neurology)<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>


Did Charcot have vascular parkinsonism? (P6.328)
CONCLUSIONS:Professor Charcot probably had VP in the last years of your life, associated to others vascular problems (angina pectoris, probable cerebrovascular disease, and finally myocardial infarct). Study Supported by: Disclosure: Dr. Teive has nothing to disclose. Dr. Germiniani has nothing to disclose. Dr. Munhoz has nothing to disclose. (Source: Neurology)


Deep Brain Stimulation: the past, the present, and the future (P6.330)
CONCLUSIONS: FDA has currently approved use of deep brain stimulation for treatment of essential tremor, Parkinson&rsquo;s disease, dystonia and Obsessive-Compulsive Disorder where it has acquired great achievement. The future of DBS is encouraging with a great potential to treat a wide array of diseases. Study Supported: NoneDisclosure: Dr. Davis has nothing to disclose. (Source: Neurology)


An 8 Year Old Girl with Chronic Inflammatory Optic Neuritis (CRION): the Youngest Reported Case to Date (P7.015)
CONCLUSIONS: To our knowledge, this is the youngest reported case of CRION, a rare but progressively disabling demyelinating disease requiring further study in both pediatric and adult populations.Disclosure: Dr. Rossman has nothing to disclose. Dr. Rensel has nothing to disclose. (Source: Neurology)


Clinical Features of HNPP Patients With the 17p11.2 Deletion (P7.080)
Conclusion.The clinical presentation of the HNPP is highly variable and pain is not a manifestation that excludes the disease.Disclosure: Dr. Oliveira has nothing to disclose. Dr. Pereira has nothing to disclose. Dr. Marques has nothing to disclose. Dr. Barreira has nothing to disclose. Dr. Marques has nothing to disclose. (Source: Neurology)


Pain and Sleep Disturbance in the Elderly: Evaluation the Role of Stress and Depression (P7.310)
Conclusions: Pain is significantly associated with sleep disturbance in older adults but effects may be confounded or mediated by the effects of perceived stress and depression.Disclosure: Dr. eslami has nothing to disclose. Dr. Zimmerman has received research support from Merck Sharp & Dohme Ltd. and Bristol-Myers Squibb Company. Dr. Grewal has nothing to disclose. Dr. Katz has received research support from Bristol-Myers Squibb. Dr. Lipton has received personal compensation for activities with Allergan, Inc., American Headache Society, Autonomic Technologies, Boston Scientific Corp., Bristol-Myers Squibb, CogniMed Inc., Colucid Pharmaceuticals, Eli Lilly & Company, eNeura Therape (Source: Neurology)<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>


Clinically Moderate to Severe Insomnia without Excessive Daytime Sleepiness in Diabetic Patients with Chronic Neuropathic Limb Pain (P7.315)
CONCLUSIONS: Our results indicate that insomnia in random diabetic patients is more prevalent than excessive daytime sleepiness. Older patients with chronic pain have a poorer quality of sleep. Excessive daytime sleepiness in our diabetic patients may be due to life style and not due to diabetes per se.Disclosure: Dr. Rakusa has received personal compensation for activities with Pfizer Inc. as a speaker. Dr. Rakusa has nothing to disclose. Dr. Cokolic has nothing to disclose. (Source: Neurology)


Alterations in Brain Gray Matter Volume are Associated with Reduced Evoked-Pain Connectivity following Acute Pregabalin Administration (S10.003)
CONCLUSIONS: We find that short-term administration of PGB alters brain structure and evoked pain connectivity. Moreover, decreases in GMV and evoked-pain connectivity during PGB treatment were associated with reduced clinical pain, suggesting short-term structural changes may be related to the efficacy of this compound. It is unknown if these effects are generalizable to other chronic pain states. Study Supported by: Pfizer, Inc.Disclosure: Dr. Puiu has nothing to disclose. Dr. Kairys has nothing to disclose. Dr. Pauer has received personal compensation for activities with Pfizer Inc. as an employee. Dr. Schmidt-Wilcke has nothing to disclose. Dr. Ichesco has nothing to disclose. Dr. Hampson has nothing to disclose. Dr. Napadow has nothing to disclose. Dr. Clauw has received personal comp...


Chronic Regional Pain Syndrome: A Preliminary report on molecular mechanisms and structural correlates (S10.005)
CONCLUSIONS: We conclude that gene expression changes in peripheral nerve may contribute to pain perpetuation following nerve injury and further study is needed. Study supported by: Clinical Research Institute at Rambam.Disclosure: Dr. Murinson has nothing to disclose. Dr. Ghersin has nothing to disclose. Dr. Peled has nothing to disclose. (Source: Neurology)


Efficacy of SPG Stimulation in relieving Acute Cluster Pain: Results from >5000 attacks treated during Long-Term Follow-Up of the Pathway CH-1 Study (S23.005)
CONCLUSIONS: Two-thirds of the more than 5000 cluster attacks evaluated during the LTFU period are effectively treated with SPG stimulation therapy. The ATI neurostimulator is safe and effective for the treatment of cluster headache. Study Supported by: Autonomic Technologies, Inc.Disclosure: Dr. Lainez has nothing to disclose. Dr. Jensen has nothing to disclose. Dr. May has received personal compensation for activities with Autonomic Technologies as a consultant. Dr. Gaul has received personal compensation for activities with Merck Sharp & Dohme Ltd., Berlin Chemie, Medtronic Inc., and Boehringer Ingelheim Pharmaceuticals Inc. as a consultant. Dr. Goodman has received personal compensation for activities with Autonomic Technologies as an employee. Dr. Caparso has nothing to disclose. ...


Botulinum Toxin Type A and Rat Trigeminal Regions: The Search for Mechanism of Antinociceptive Action in Migraine and Other Headaches (S51.002)
CONCLUSIONS:Antinociceptive activity of BoNT/A in trigeminal region might be associated with prevention of CGRP release from dural nerve endings but involves endogenous opioid system as well. Study Supported by: Croatian Ministry of Science, Education and SportDisclosure: Dr. Lackovic has nothing to disclose. (Source: Neurology)<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 Headache Diagnoses in Pregnancy: A 5 Year Registry Study (S51.004)
Conclusions: Among pregnant women receiving inpatient neurologic consultation for headache, over one-third have a secondary disorder. Vigilance for secondary headache in pregnancy should be heightened, especially when previous headache is lacking and hypertension or fever are present. Clinical features may not adequately distinguish primary versus secondary headache, and a low neuroimaging threshold may be justified.Disclosure: Dr. Robbins has received personal compensation for activities with MedLink and Prova Education. Dr. Robbins has received personal compensation in an editorial capacity for Current Pain and Headache Reports. Dr. Farmakidis has nothing to disclose. Dr. Dayal has nothing to disclose. Dr. Lipton has received personal compensation for activities with Allergan, Inc., Ame...


CB1 receptors modulate affective behaviour induced by neuropathic pain.
Authors: Rácz I, Nent E, Erxlebe E, Zimmer A Abstract Patients suffering from chronic pain are often also diagnosed with a psychiatric condition, in particular generalized anxiety and major depression. The underlying pathomechanisms contributing to this comorbidity, however, are not entirely clear. In this manuscript we have focussed on the potential role of the cannabinoid receptor CB1, because it is known to modulate neuronal circuits contributing to chronic pain states and affective behaviours. For this purpose we analysed the consequences of a partial sciatic nerve ligation on anxiety- and depression related behaviours in mice lacking CB1 receptors. Our results show that the development of mechanical hypersensitivity was similar in CB1 deficient mice and wild type controls. Ho...


Physiotherapy may work just as well as surgery for chronic back pain
Physiotherapy regime was just as effective as surgery at controlling the pain of lumbar spinal stenosis - the leading cause of back pain among older people - University of Pittsburg researchers found. (Source: the Mail online | Health)


An Ancient Fix For Backache
Too many doctors refuse to think outside the narrow confines of the mainstream medical establishment – especially when it comes to chronic back pain. Back pain is one of the most common reasons Americans go to the doctor, which explains why it&#8217;s also one of America&#8217;s biggest businesses. But I never cease to be astounded when patients come to my wellness clinic with back pain and tell me they&#8217;ve already had a barrage of dangerous Big Pharma prescriptions pushed at them. These drugs include highly addictive opiates like Vicodin, Percocet and OxyContin. Meanwhile, big bucks are also made when doctors push pointless and potentially dangerous surgeries. The latest, highly lucrative trend in back pain is a procedure called &#8220;spinal fusion,&#8221; in which where two segme...


Cognitive behavioral therapy in patients with sickle cell disease.
CONCLUSIONS: CBT shows promise for individuals with chronic conditions such as SCD, but more investigation into its efficacy is needed with larger sample sizes over longer periods of time. PMID: 25842524 [PubMed - in process] (Source: Creative 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>


Total Pancreactectomy with Islet Autotransplant Failure: Now What?
Abstract Total pancreatectomy with islet cell autotransplant (TPIAT) is a definitive therapeutic approach to pain management for patients with chronic pancreatitis that is non-responsive to maximum medical management. Total pancreatectomy (TP) results in brittle diabetes unless islet cell autotransplant (IAT) is concomitantly performed. Even with IAT, about 30 % of patients will require long-term basal-bolus insulin therapy due to significant endocrine insufficiency. The focus of this review is on the utility of whole organ pancreas transplantation toward improving quality of life, and decreasing the risk of mortality and overall cost of care for the subset of patients who experience endocrine and exocrine deficiency after pancreatic resection. (Source: Current Transplantation Re...


Polysomnographic Characteristics in Nonmalignant Chronic Pain Populations: A Review of Controlled Studies
Sleep and pain are critical homeostatic systems that interact in a bidirectional manner. Complaints of sleep disturbance are ubiquitous among patients with chronic pain disorders, and conversely, patients with persistent insomnia symptoms commonly report suffering from chronic pain. Sleep deprivation paradigms demonstrate that partial or complete sleep loss induce hyperalgesia, possibly due to shared mechanistic pathways including neuroanatomic and molecular substrates. Further, chronic pain conditions and sleep disturbances are intertwined through comorbidities, which together cause detrimental psychological and physical consequences. (Source: Sleep Medicine Reviews)


Discriminating military and civilian traumatic brain injury
This article is part of a Special Issue entitled ‘Traumatic Brain Injury’. Graphical abstract (Source: Molecular and Cellular Neuroscience)


Effectiveness of physical and rehabilitation techniques in reducing pain in chronic trapezius myalgia: a systematic review and meta-analysis
Neck pain is highly prevalent in the general population. Chronic trapezius myalgia (CTM) is a common cause of neck pain. (Source: International Journal of Osteopathic Medicine)


Trunk Motor Control Deficits in Acute and Subacute Low Back Pain are Not Associated with Pain or Fear of Movement
A subgroup of patients with acute/sub-acute low back pain (LBP) presenting with trunk movement control deficits, pain provocation with segmental testing, and segmental hypermobility have been clinically identified as having movement coordination impairments (MCI) of the trunk. It is hypothesized that these patients have proprioceptive, postural and movement control impairments of the trunk associated with LBP. While, trunk control impairments have been identified in patients with chronic LBP, they have not been investigated in this subgroup or closer to symptom onset. (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>


mTOR and Erk1/2 Signaling in the Cerebrospinal Fluid-Contacting Nucleus is Involved in Neuropathic Pain.
Authors: Li G, Lu X, Zhang S, Zhou Q, Zhang L Abstract The cerebrospinal fluid-contacting nucleus (CSF-CN) has been demonstrated to be involved in neuropathic pain, but the underlying molecular mechanisms remain unclear. Previous work has shown that mTOR and ERK1/2 are important signaling pathways regulating neuropathic pain. However, studies on the interactions between these major pathways in neuropathic pain are very rare. Therefore, the purpose of this study is to determine whether mTOR and ERK1/2 exist in the CSF-CN and elucidate their alterations in neuropathic pain, especially, the crosstalk between them. Our results showed that mTOR and ERK1/2 were distributed in the CSF-CN, and their expression levels were increased in chronic constriction injury (CCI)-induced neuropathic p...


Resolution of Crohn's disease and complex regional pain syndrome following treatment of paratuberculosis.
Authors: Kuenstner JT, Chamberlin W, Naser SA, Collins MT, Dow CT, Aitken JM, Weg S, Telega G, John K, Haas D, Eckstein TM, Kali M, Welch C, Petrie T Abstract A cohort of family members with various chronic diseases including Crohn's disease, asthma, complex regional pain syndrome, hypothyroidism, type 1 diabetes mellitus, and lymphangiomatosis and/or evidence of infection by Mycobacterium avium subsp. paratuberculosis (MAP) are described in this series of case reports. MAP was cultured from the blood of three members affected by the first five diseases and there was accompanying elevated anti-MAP IgG in two members. The patient affected by the sixth disease has a markedly elevated anti-MAP titer. The two patients affected by the first four diseases have been treated with a combina...


Increased expression of HCN2 channel protein in L4 dorsal root ganglion neurons following axotomy of L5- and inflammation of L4-spinal nerves in rats
Publication date: 4 June 2015 Source:Neuroscience, Volume 295 Author(s): T. Smith , M. Al Otaibi , J. Sathish , L. Djouhri A hallmark of peripheral neuropathic pain (PNP) is chronic spontaneous pain and/or hypersensitivity to normally painful stimuli (hyperalgesia) or normally nonpainful stimuli (allodynia).This pain results partly from abnormal hyperexcitability of dorsal root ganglion (DRG) neurons. We have previously shown, using a modified version of the lumbar 5 (L5)-spinal nerve ligation model of PNP (mSNA model involving L5-spinal nerve axotomy plus loose ligation of the lumbar 4 (L4)-spinal nerve with neuroinflammation-inducing chromic-gut), that L4 DRG neurons exhibit increased spontaneous activity, the key characteristic of neuronal hyperexcitability. The underlying ionic and m...


Effects of chronic doxepin and amitriptyline administration in naïve mice and in neuropathic pain mice model
Publication date: 21 May 2015 Source:Neuroscience, Volume 294 Author(s): J. Mika , A.M. Jurga , J. Starnowska , M. Wasylewski , E. Rojewska , W. Makuch , K. Kwiatkowski , N. Malek , B. Przewlocka Neuropathic pain is a severe clinical problem, often appearing as a co-symptom of many diseases or manifesting as a result of damage to the nervous system. Many drugs and agents are currently used for the treatment of neuropathic pain, such as tricyclic antidepressants (TCAs). The aims of this paper were to test the effects of two classic TCAs, doxepin and amitriptyline, in naïve animals and in a model of neuropathic pain and to determine the role of cytokine activation in the effects of these drugs. All experiments were carried out with Albino-Swiss mice using behavioral tests (von Frey test a...


Opioids for chronic noncancer pain: A position paper of the American Academy of Neurology
(Source: Neurology)<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 and the adaptive significance of positive emotions.
The February–March 2014 special issue of the American Psychologist featured articles summarizing select contributions from the field of psychology to the assessment and treatment of chronic pain. The articles examined a range of psychosocial and family factors that influence individual adjustment and contribute to disparities in pain care. The reviews also considered the psychological correlates and neurophysiological mechanisms of specific pain treatments, including cognitive–behavioral therapy, hypnosis, acceptance and commitment therapy, mindfulness, and meditation. Although a number of articles emphasized the role that negative states of mind play in pain outcomes, positive emotions were given only brief mention. Here, we provide a rationale for the inclusion of positive emotions i...


Salivary cortisol responses to household tasks among couples with unexplained chronic fatigue.
This study examined salivary cortisol levels in couples in which one member had unexplained chronic fatigue (CF). The couples completed questionnaires and seven household activities in a laboratory setting and provided salivary cortisol samples prior to and immediately after the activities, as well as again after completing additional questionnaires and debriefing. The couples rated their interactions as similar to those at home, suggesting ecological validity, and patients with CF experienced the activities as involving more exertion than did their partners. The multilevel model results indicated that patients with CF had overall lower cortisol levels and flatter slopes across repeated measurements than did their significant others. Patients’ and significant others’ cortisol concentra...


Teriparatide and Bone Turnover and Formation in a Hemodialysis Patient With Low-Turnover Bone Disease: A Case Report
We report on a patient with stage 5 CKD treated with dialysis who presented to our clinic with multiple fractures, including bilateral nondisplaced pelvic fractures resulting in chronic pain and interfering with the patient’s ability to work. Bone histomorphometry demonstrated low-turnover bone disease, and he was treated with 20μg of teriparatide (subcutaneous injection) every morning for 24 months. Within 6 months of initiating therapy, the patient’s pain resolved and he was able to resume work. Serum calcium and phosphate levels remained within reference ranges throughout his treatment, and he sustained no further fractures. During 24 months of treatment, bone mineral density was maintained at the lumbar spine, and there was an increase of 4% at the femoral neck and total hip. A se...


Do Sleep Complaints Predict Persistent Fatigue in Older Adults?
ConclusionThe results indicate greater risk of PSF in older adults with difficulty staying asleep and those who use sleep‐promoting medications. These findings underscore the significance of sleep problems and present potential targets for interventional studies that aim to improve fatigue in older adults. (Source: Journal of the American Geriatrics Society)


Dislodged Pacer Lead Causing Ventricular Tachycardia
A 68-year-old woman with history of congestive heart failure, chronic obstructive pulmonary disease, type II diabetes, and hypertension, presented to the Emergency Department with acute onset of shortness of breath. She had been discharged from the hospital 2 days prior after pacemaker placement for a tachycardia/bradycardia syndrome. She did well postoperatively, but stated the shortness of breath started 12 h prior to presentation and progressively worsened. She denied chest pain, cough, fevers, palpitations, or syncope. (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>


Is Pain a Public Health Crisis?
(MedPage Today) -- Federal advisory group wants to frame chronic pain as public health problem. (Source: MedPage Today Psychiatry)


Fibromyalgia and chronic fatigue: the underlying biology and related theoretical issues.
Authors: Romano GF, Tomassi S, Russell A, Mondelli V, Pariante CM Abstract There is an increasing interest in understanding the biological mechanism underpinning fibromyalgia (FM) and chronic fatigue syndrome (CFS). Despite the presence of mixed findings in this area, a few biological systems have been consistently involved, and the increasing number of studies in the field is encouraging. This chapter will focus on inflammatory and oxidative stress pathways and on the neuroendocrine system, which have been more commonly examined. Chronic inflammation, together with raised levels of oxidative stress and mitochondrial dysfunction, has been increasingly associated with the manifestation of symptoms such as pain, fatigue, impaired memory, and depression, which largely characterise at ...


Latent sensitization: a model for stress-sensitive chronic pain.
Authors: Marvizon JC, Walwyn W, Minasyan A, Chen W, Taylor BK Abstract Latent sensitization is a rodent model of chronic pain that reproduces both its episodic nature and its sensitivity to stress. It is triggered by a wide variety of injuries ranging from injection of inflammatory agents to nerve damage. It follows a characteristic time course in which a hyperalgesic phase is followed by a phase of remission. The hyperalgesic phase lasts between a few days to several months, depending on the triggering injury. Injection of μ-opioid receptor inverse agonists (e.g., naloxone or naltrexone) during the remission phase induces reinstatement of hyperalgesia. This indicates that the remission phase does not represent a return to the normal state, but rather an altered state in which hyp...


Anterior cervical arthrodesis using a vertebral body autograft
Discussion The use of autograft bone of the vertebral body itself reduces comorbidities associated with the use of the iliac crest of the patient. Our results using the technique described are comparable to those in the literature, with a fusion rate of 98% and a mean of 62min duration of the procedure. (Source: Revista Espanola de Cirugia Ortopedica y Traumatologia)


Electrophysiological characterization of activation state-dependent Cav2 channel antagonist TROX-1 in spinal nerve injured rats
This study confirms the pathological state-dependent actions of TROX-1 through a likely spinal mechanism and reveals a modality selective change in calcium channel function following nerve injury. (Source: Neuroscience)<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>


Methadone for Pain: What to Do When the Oral Route Is Not Available
Methadone has an important role in the management of severe chronic pain, whether from cancer or other causes. Patents taking methadone for pain in situations such as advanced cancer or end-stage renal failure have often exhausted all other available opioids and appropriate adjuvant analgesics.1 Methadone is available in different forms around the world, including liquid (with and without preservative) and tablets. As people approach end of life, it is expected that they will stop eating. Many patients experience a period of time before death when they are unable to take oral medications. (Source: Journal of Pain and Symptom Management)


Afferent inhibition and cortical silent periods in shoulder primary motor cortex and effect of a suprascapular nerve block in people experiencing chronic shoulder pain
Chronic shoulder and upper limb pain is a highly prevalent and recalcitrant condition affecting health-related quality of life in many patient populations (Pope et al., 1997; Hill et al., 2010; Gill et al., 2013). There is emerging evidence that painful musculoskeletal disorders of the upper limb are accompanied by aberrant cortical neurophysiology(Alexander, 2007; Berth et al., 2009; Berth et al., 2010; Schabrun et al., 2014). It is unclear whether this aberrant neurophysiology normalises in response to interventions targeting upper limb pain. (Source: Clinical Neurophysiology)


Afferent inhibition and cortical silent periods in shoulder primary motor cortex and effect of a suprascapular nerve block in people experiencing chronic shoulder pain.
CONCLUSIONS: SAI and the CSP were present and demonstrated robust interaction in controls, which was aberrant in patients. The SSNB transiently restored SAI but had no effect on the CSP; however CSP modulation by SAI was further attenuated 1week post injection. SIGNIFICANCE: The current findings improve understanding of the neurophysiology of the shoulder motor cortex and its modulation by chronic pain. The effect of SSNB in shoulder pain patients should be interpreted with caution until proven in a larger population. Interventions that target intracortical inhibition might increase efficacy in people with chronic shoulder pain. PMID: 25900020 [PubMed - as supplied by publisher] (Source: Clinical Neurophysiology)


Auricular therapy for chronic pain management in adults: A synthesis of evidence.
CONCLUSIONS: AT may positively control pain intensity for patients with chronic pain. However, due to the significant heterogeneity and methodological flaws identified in the analyzed trials, the current evidence on AT for chronic pain management is still uncertain. More rigorously designed large-scale randomized controlled trials are required to evaluate the efficacy of AT for patients with chronic pain. PMID: 25921554 [PubMed - as supplied by publisher] (Source: Complementary Therapies in Clinical Practice)


Friday Feedback: Opioids for Chronic Pain
(MedPage Today) -- Guidelines discourage it, but clinicians find value for carefully selected and monitored patients. (Source: MedPage Today Psychiatry)<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 concepts on functional chronic pelvic and perineal pain: pathophysiology and multidisciplinary management.
Authors: Ploteau S, Labat JJ, Riant T, Levesque A, Robert R, Nizard J Abstract The management of chronic pelvic and perineal pain has been improved by a better understanding of the mechanisms of this pain and an optimized integrated multidisciplinary approach to the patient. The concept of organic lesions responsible for a persistent nociceptive factor has gradually been replaced by that of dysregulation of nociceptive messages derived from the pelvis and perineum. In this setting, painful diseases identified by organ specialists are usually also involved and share several common denominators (triggering factors, predisposing clinical context). These diseases include painful bladder syndrome, irritable bowel syndrome, vulvodynia, and chronic pelvic pain syndrome. The painful sympto...


Fibromyalgia, milnacipran and experimental pain modulation: study protocol for a double blind randomized controlled trial
DiscussionThis method would allow clinicians to take a pro-active attitude by performing a rapid psychophysical test before starting milnacipran treatment and would avoid unnecessary prescription while preventing therapeutic failure in patients who often face this recurrent problem.Trial registrationClinicalTrials.gov NCT01747044. (Source: Trials)


Managing Comorbidities in Patients with Chronic Heart Failure: First, Do No Harm
Abstract Heart failure (HF) affects approximately 5.1 million adults in the USA, with expectations of a rise to nearly 8 million adults by 2030. Patients with HF are at increased risk for morbidity/mortality, and comorbidities can further complicate care for these patients. Diabetes mellitus, chronic pain, arrhythmias, and depression are diagnoses that often coexist with HF. Medications commonly used to treat these comorbidities may induce or worsen HF symptoms, so determining appropriate drug therapy is important. Healthcare providers must understand the relationship between these medications and HF in order to improve prescribing practices to increase patient safety and reduce morbidity and mortality. This manuscript discusses the association between certain medications used to ...


Racial Differences in Chronic Pain and Quality of Life among Adolescents and Young Adults with Moderate or Severe Hemophilia
Conclusions Targeted efforts to prevent and manage chronic pain among non-white AYAs with moderate or severe hemophilia are necessary. After accounting for demographic and clinical differences, there were no racial differences in adherence to recommended clotting factor treatment regimens; however, non-whites were more than five times more likely to report high levels of chronic pain, which predicted worse overall physical QoL, bodily pain, physical and social functioning, and greater role limitations due to physical health. (Source: Journal of Racial and Ethnic Health Disparities)


Gastrointestinal cryptococcoma – Immune reconstitution inflammatory syndrome or cryptococcal relapse in a patient with AIDS?
We present the case of an HIV-infected patient on ART, with a history of cryptococcal meningitis who presented with subacute, worsening abdominal pain during immune recovery. This evolved into chronic abdominal pain, with thickened bowel, and abdominal lymphadenopathy, while receiving empiric tuberculosis treatment. At 6-months, he developed intestinal perforation due to a histologically confirmed cryptococcoma. (Source: Medical Mycology Case Reports)<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>


Metformin and caloric restriction induce an AMPK-dependent restoration of mitochondrial dysfunction in fibroblasts from Fibromyalgia patients
Publication date: July 2015 Source:Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease, Volume 1852, Issue 7 Author(s): Elísabet Alcocer-Gómez , Juan Garrido-Maraver , Pedro Bullón , Fabiola Marín-Aguilar , David Cotán , Angel M. Carrión , José Miguel Alvarez-Suarez , Francesca Giampieri , José Antonio Sánchez-Alcazar , Maurizio Battino , Mario D. Cordero Impaired AMPK is associated with a wide spectrum of clinical and pathological conditions, ranging from obesity, altered responses to exercise or metabolic syndrome, to inflammation, disturbed mitochondrial biogenesis and defective response to energy stress. Fibromyalgia (FM) is a world-wide diffused musculoskeletal chronic pain condition that affects up to 5% of the general population and comprises all the above me...


Deconstructing Chronic Low Back Pain in the Older Adult: Shifting the Paradigm from the Spine to the Person
(Source: Pain Medicine)


Deficits in foot skin sensation are related to alterations in balance control in chronic low back patients experiencing clinical signs of lumbar nerve root impingement
Chronic low back pain (LBP) is a debilitating musculoskeletal disorder, affecting nearly 80% of adults at some point in their lifetime [1]. A subset of LBP patients suffer from associated lumbosacral radiculopathy, or sciatica. LBP-associated radiculopathy (LBP-R) is characterized by pain, tingling or numbness radiating down the affected leg, and is the most commonly occurring form of neuropathic pain [2]. Chronic compression of the affected lumbar nerve root and the resulting inflammation can compromise motor signals and sensation to the lower leg and foot, within the respective myotome and dermatome [3]. (Source: Gait and Posture)


Trauma symptoms, temperament traits, social support and the intensity of pain in a Polish sample of patients suffering from chronic pain
Publication date: September 2015 Source:Personality and Individual Differences, Volume 83 Author(s): Marcin Rzeszutek , Włodzimierz Oniszczenko , Katarzyna Schier , Edyta Biernat-Kałuża , Robert Gasik The aim of the current study was to investigate the relationship between the intensity of pain, treated as the explained variable, and the level of trauma symptoms, as appear in posttraumatic stress disorder (PTSD), temperament traits postulated by the Regulative Theory of Temperament and aspects of social support among patients suffering from chronic pain (arthritis and low-back pain). To assess the intensity of pain among participants we used the Numerical Rating Scale (NRS-11). The level of trauma symptoms was assessed with the PTSD Factorial Version inventory (PTSD-F). Temperament wa...


An Open Multicenter Comparative Randomised Clinical Study on Chitosan
In conclusion this open multicenter comparative prospective randomized clinical study has provided compelling evidence that the next generation chitosan wound dressing can enhance wound progression towards healing by facilitating wound re‐epithelialisation and reducing the patients pain level. Furthermore the dressing was shown to be clinically safe and effective in the management of chronic wounds. This article is protected by copyright. All rights reserved. (Source: Wound Repair and Regeneration)<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>


Stercoral Perforation of the Colon: A Potentially Fatal Complication of Opioid-Induced Constipation
Stercoral perforation of the colon is a rare complication of constipation, and there have only been a few reported cases of stercoral perforation of the colon secondary to opioid-induced constipation. This paper describes such a case in a cancer survivor with chronic cancer-related pain, and reviews the medical / surgical literature on stercoral perforation of the colon. (Source: Journal of Pain and Symptom Management)


Vagus nerve stimulation for partial seizures.
CONCLUSIONS: VNS for partial seizures appears to be an effective and well tolerated treatment in 439 included participants from five trials. Results of the overall efficacy analysis show that VNS stimulation using the high stimulation paradigm was significantly better than low stimulation in reducing frequency of seizures. Results for the outcome "withdrawal of allocated treatment" suggest that VNS is well tolerated as withdrawals were rare. No significant difference was found in withdrawal rates between the high and low stimulation groups, however limited information was available from the evidence included in this review so important differences between high and low stimulation cannot be excluded . Adverse effects associated with implantation and stimulation were primarily hoarseness, co...


Calciphylaxis: from the disease to the diseased.
Authors: Oliveira TM, Frazão JM Abstract Calciphylaxis, or calcific uremic arteriolopathy, is a vascular ossification-calcification disease involving cutaneous or visceral arterioles, with ischemic damage of the surrounding tissues, usually in the setting of chronic kidney disease. Pathogenesis is still unclear and probably comprises the participation of vascular smooth muscle cells, endothelial cells and macrophages surrounded by a uremic and/or pro-calcifying environment. According to the original concept of calcific uremic arteriolopathy coined by Hans Selye, risk factors may be divided into sensitizers and challengers and their knowledge is useful in clinical practice to pre-emptively identify both uremic and non-uremic 'at risk' patients and guide treatment. Systemic calcific...


Stercoral Perforation of the Colon: A Potentially Fatal Complication of Opioid-Induced Constipation
This article describes such a case in a cancer survivor with chronic cancer-related pain and reviews the medical/surgical literature on stercoral perforation of the colon. (Source: Journal of Pain and Symptom Management)


Acute Stanford type B aortic dissection occurred simultaneously with acute myocardial infarction
We report a case of a 61-year-old male patient who was referred to our emergency department with abrupt onset of severe chest pain lasting for the past 5hours. He had uncontrolled hypertension for 20years and chronic smoking for 30years. On admission, the physical examination revealed markedly elevated blood pressure of 180/110mmHg, regular pulse rate of 90 beats/min and O2 saturation of 96% in the room air. No significant heart murmur was heard, and lungs were clear. (Source: International Journal of Cardiology)<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 lonely life–A qualitative study of immigrant women on long-term sick leave in Norway
This study focuses on the everyday life of immigrant women with chronic pain on long-term sick leave in Norway. Research has shown that rehabilitation of immigrant women with chronic pain might be challenging both due to their lack of linguistic competence, due to lack of sufficient confidence/trust in their employers and in health personnel and lack of knowledge/skills among health care personnel in meeting immigrants’ special needs. (Source: International Journal of Nursing Studies)


Musculoskeletal disorders in Norway: prevalence of chronicity and use of primary and specialist health care services
Conclusion: Chronic musculoskeletal disorders were common in the general population, with higher prevalence among women compared to men, and increasing prevalence with age. Musculoskeletal disorders had considerable impact on the use of primary and specialist health services in Norway. The use of register data on health service utilization may be a useful source for monitoring population trends, and for estimating the burden in terms of health and health service use. (Source: BMC Musculoskeletal Disorders)


What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma?
Morton's neuroma (MN) is a common condition affecting the common digital nerve and its branches most frequently in the third plantar webspace [1]. Theories for its pathogenesis include chronic repetitive trauma, ischemia, entrapment, and intermetatarsal bursitis. It has a predilection for middle aged women [2]. Ultrasound studies describe it as an ovoid, hypo-echoic mass oriented parallel to the long axis of the metatarsals [3]. Patients complain of pain in the affected webspace, mainly on weight-bearing, as well as burning and paraesthesia [4]. (Source: Foot and Ankle Surgery)


Glucosamine and chondroitin for knee osteoarthritis: a double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens
Conclusions Allocation to the glucosamine&ndash;chondroitin combination resulted in a statistically significant reduction in JSN at 2&nbsp;years. While all allocation groups demonstrated reduced knee pain over the study period, none of the treatment allocation groups demonstrated significant symptomatic benefit above placebo. Trial Registration ClinicalTrials.gov identifier: NCT00513422; http://www.clinicaltrials.gov (Source: Annals of the Rheumatic Diseases)


Transcriptomic signatures in whole blood of patients who acquire a chronic inflammatory response syndrome (CIRS) following an exposure to the marine toxin ciguatoxin
Conclusions: Disruptions of innate and adaptive immune mechanisms were recorded at both the genomic and proteomic level. A disruption in the HLA-T cell receptor axis could indicate HLA haplotype sensitivity for this chronic syndrome, as noted in many autoimmune conditions. Taken together, these indicators of illness provide additional insights into pathophysiology and potential therapies. (Source: BMC Medical Genomics)<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 lonely life—A qualitative study of immigrant women on long-term sick leave in Norway
This study focuses on the everyday life of immigrant women with chronic pain on long-term sick leave in Norway. Research has shown that rehabilitation of immigrant women with chronic pain might be challenging both due to their lack of linguistic competence, due to lack of sufficient confidence/trust in their employers and in health personnel and lack of knowledge/skills among health care personnel in meeting immigrants’ special needs. (Source: International Journal of Nursing Studies)


Treating the Root Cause of IBS: Small Intestine Bacterial Overgrowth
Rosie is a 30-year-old banker with very long work hours who came to see me with symptoms of gas, bloating and constipation. She had stomach cramps after eating, stubborn acne and a weight gain of 10 pounds in the last couple years despite a good diet and exercising regularly. A visit to a gastroenterologist had yielded the diagnosis of irritable bowel syndrome (IBS) after testing that included an endoscopy, a colonoscopy, blood work, and an MRI -- all of which were essentially normal. Rosie's doctor prescribed Amitiza, a drug typically given for constipation, which caused her nausea and abdominal pain. She stopped taking it after a few days. Rosie expressed her frustration to me: How could everything show up normal on tests? Was this all in her head? She didn't want to take medications tha...


Opioid Misuse In Chronic Pain Patients Is Around 25%, New Study Shows
Various studies on problematic opioid use in chronic pain patients have been conducted over the years, but many of them have failed to clearly define misuse, abuse and addiction. One group of researchers&nbsp;believe they've uncovered an updated review of this topic with definitions of their own. (Source: Forbes.com Healthcare News)


The Collective Sigh: Don't Believe the Hype!
I write about all sorts of things that come up in my coaching -- love, relationships, time management, character traits... but today I want to I want address a subject that is possibly THE most important concern (or should be) for me, my family, my clients and community: Health. The state of your body during your time on the planet. How you look and feel every single day. A few weeks ago I attended the book release of a dear friend and colleague of mine, Dr. Mark Hyman. An internationally recognized leader in the field of Functional Medicine, it has been Mark's mission to educate people on the state of health in this country and advocate for better practices both personal and societal. His message carries gravitas: that we are currently suffering at the hands of a food system that do...


Predicting chronic pain in whiplash injuries
While most people recover from whiplash injuries within a few months, about 25 percent have long-term pain and disability for many months or years. Using special MRI imaging, scientists identified, within the first one and two weeks of the injury, which patients will develop chronic pain and disability. This is the earliest these patients have been identified and will enable faster treatment. The imaging revealed large amounts of fat infiltrating the patients' neck muscles, indicating rapid atrophy. (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>


Chronic Pain in Multiple Sclerosis Patients: Utility of Sensory Quantitative Testing in Patients with Fibromyalgia Comorbidity
Conclusion: Thermal and discomfort thresholds were lower in patients than controls and were the lowest in PFM+. Their more severely impaired thermal threshold supports a neurophysiological basis of such association.Eur Neurol 2015;73:257-263 (Source: European Neurology)


Paracetamol 'not effective' for lower back pain or arthritis
Conclusion This systematic review and meta-analysis suggests paracetamol may not be effective for some people with lower back pain and of limited help to people with osteoarthritis of the hip and knee. Strengths of the study include: the systematic review only contained the &quot;gold standard&quot; type of trials – RCTs existing published RCTs comparing paracetamol with a placebo were likely to have been identified, as a large number of databases were searched from the beginning of their records up to December 2014. There were also two independent reviewers, which reduces the risk of any slipping through the net they also searched for unpublished studies, reducing the risk of publication bias in their results (trials are less likely to be published if their results do not show ...


Clues to 'Brain Fog' in Chronic Fatigue Patients Found in Spinal Fluid
Title: Clues to 'Brain Fog' in Chronic Fatigue Patients Found in Spinal FluidCategory: Health NewsCreated: 3/31/2015 12:00:00 AMLast Editorial Review: 4/1/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Study Casts Doubt on Acetaminophen for Low Back Pain, Arthritis
Title: Study Casts Doubt on Acetaminophen for Low Back Pain, ArthritisCategory: Health NewsCreated: 3/31/2015 12:00:00 AMLast Editorial Review: 4/1/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Risk Assessment of Magnetic Resonance Imaging in Chronically Implanted Paddle Electrodes for Cortical Stimulation
Conclusion: MRI under the conditions described here seems to be safe with the implants used in this study. In particular, the induced temperature is much lower with paddle compared to conventional leads due to the different electrode design. The induced voltage does not carry any risks. However, these findings cannot automatically be transferred to other implants or other scanning conditions, and further studies are needed. The biomedical companies should be encouraged to develop MR-conditional paddle leads. Also, further research is necessary to study the mechanism of action of cortical stimulation in the future.Stereotact Funct Neurosurg 2015;93:182-189 (Source: Stereotactic and Functional Neurosurgery)<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>


Subdiaphragmatic Gallstone Mimicking Hepatic Malignancy on FDG PET/CT
Abstract: A 70-year-old man underwent an FDG PET/CT for a possible primary liver malignancy or metastasis found on an abdominal MRI obtained as part of a workup for intermittent abdominal pain. The MRI showed an enhancing lesion at the dome of the right lobe of the liver. The lesion was FDG avid with a discrete central calcification. In conjunction with the patient’s history of laparoscopic cholecystectomy 1 year prior, the findings were consistent with inflammation around a migrated subdiaphragmatic gallstone. One month after the scan, a CT-guided percutaneous biopsy of this lesion revealed chronic inflammatory cells with no evidence of malignancy. (Source: Clinical Nuclear Medicine)


Bioabsorbable Hernia Plugs in Laparoscopic Inguinal Herniorraphy: Short-term and Long-term Results
Conclusions: Bioabsorbable plug combined with a synthetic mesh is safe and effective for use during LIHR. The technique offers an acceptable incidence of chronic pain and recurrence. (Source: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques)


Elbow Magnetic Resonance Imaging: Imaging Anatomy and Evaluation
Abstract: The elbow is a complex joint. Magnetic resonance imaging (MRI) is often the imaging modality of choice in the workup of elbow pain, especially in sports injuries and younger patients who often have either a history of a chronic repetitive strain such as the throwing athlete or a distinct traumatic injury. Traumatic injuries and alternative musculoskeletal pathologies can affect the ligaments, musculotendinous, cartilaginous, and osseous structures of the elbow as well as the 3 main nerves to the upper limb, and these structures are best assessed with MRI. Knowledge of the complex anatomy of the elbow joint as well as patterns of injury and disease is important for the radiologist to make an accurate diagnosis in the setting of elbow pain. This chapter will outline elbow anatomy, ...


Longitudinal Associations Between Depression, Anxiety, Pain, and Pain-Related Disability in Chronic Pain Patients
Conclusions: Among adult patients with chronic pain treated at specialty pain clinics, high levels of depression and anxiety may worsen pain and pain-related disability. (Source: Psychosomatic Medicine)


Medial Abrasion Syndrome: A Neglected Cause of Knee Pain in Middle and Old Age
Abstract: Knee pain is a prevailing health problem of middle and old age. Medial plica-related medial abrasion syndrome (MAS), although a well-known cause of knee pain in younger individuals, has rarely been investigated in older individuals. This prospective study was conducted to investigate the prevalence and clinical manifestations of this syndrome as a cause of knee pain in middle and old age. The outcomes of arthroscopic treatment for this syndrome were also evaluated. A total of 232 knees of 169 patients >40 years of age (41–82, median: 63 years old) suffering from chronic knee pain were analyzed. The clinical diagnosis, predisposing factors, presenting symptoms, and physical signs were investigated. The sensitivity and specificity of each parameter of the clinical presentation 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>


Scapulothoracic Bursitis in a Patient With Quadriparesis: A Case Report
Abstract: Scapulothoracic bursitis is a rare disease and presents as pain or swelling around the bursa of the scapulothoracic articulation. It has been reported to be related to chronic repetitive mechanical stress of the periscapular tissue, trauma, overuse, and focal muscle weakness. The authors experienced an atypical case of scapulothoracic bursitis with shoulder and periscapular pain after quadriparesis. This case implies that muscular atrophy around the scapula and chest wall from quadriparesis may contribute to the development of scapulothoracic bursitis with shoulder and periscapular pain. In addition, clinician should be alert to it as a possible cause when a patient with quadriparesis complains of shoulder and periscapular pain and consider proper diagnostic options such as ultra...


Cannabinoid Hyperemesis Syndrome
Legalization of marijuana use will increase the number of people who will become long-term users. A prior medical record review study in Australia, in 2004, identified 19 chronic marijuana users who entered the emergency department with recurrent vomiting associated with abdominal pain. Routine treatment of the nausea and vomiting, associated with the chronic marijuana abuse, with antiemetics is ineffective in patients with cannabinoid hyperemesis syndrome. Narcotics do not relieve the abdominal pain but may cause worsening rebound pain. The best treatment of cannabinoid hyperemesis syndrome was found to be abstinence from the recreational use of marijuana. It is important for advanced practice nurses to place cannabinoid hyperemesis syndrome in their differentials of patients presenting t...


Predicting chronic pain in whiplash injuries
(Northwestern University) While most people recover from whiplash injuries within a few months, about 25 percent have long-term pain and disability for many months or years. Using special MRI imaging, scientists identified, within the first one and two weeks of the injury, which patients will develop chronic pain and disability. This is the earliest these patients have been identified and will enable faster treatment. The imaging revealed large amounts of fat infiltrating the patients' neck muscles, indicating rapid atrophy. (Source: EurekAlert! - Medicine and Health)


Establishment of a New Pain Catastrophizing Baseline After Pediatric Major Surgery?
I'm writing to commend Rabbitts et al1 on an excellent article—one of the best yet—and to raise an issue that came to mind as I read their paper, one that may be relevant to future research in risk factor identification for pediatric acute and chronic postsurgical pain. The authors evaluated children over a 1-week interval before surgery, examining a number of important and heretofore novel risk factors (eg, parental pain catastrophizing, daily child electronic pain and sleep diaries, sleep actigraphy, pain catastrophizing, state and trait anxiety) and their relationships to child pain intensity and health-related quality of life outcomes 2 weeks after surgery. (Source: The Journal of Pain)


Pain experience of adults with intellectual disabilities – caregiver reports
ConclusionsThe results support the use of the NCAPC as a scale to evaluate CP in adults with IDD. The findings reiterate the reliability of caregivers as proxy observers and the importance of involving them in identifying pain behaviours of their protégées. Our findings reiterate the need for an immediate action for appropriate pain management protocols for adult with IDD. (Source: Journal of Intellectual Disability 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>


Validity of three rating scales for measuring pain intensity in youths with physical disabilities
ConclusionsThe findings support the validity of the NRS‐11 for assessing pain intensity in youths with physical disabilities between the ages of 8 and 20 years. (Source: European Journal of Pain)


Spinal antinociceptive effects of the novel NOP receptor agonist PWT2‐nociceptin/orphanin FQ in mice and monkeys
Conclusions and ImplicationsThe present study has demonstrated that PWT2‐N/OFQ mimicked the antinociceptive effects of the natural peptide in rodents and non‐human primates acting as a potent and longer lasting NOP selective agonist. More generally PWT derivatives of biologically active peptides can be viewed as inovative pharmacological tools for investigating those conditions/states in which selective and prolonged receptor stimulation promotes beneficial effects. (Source: British Journal of Pharmacology)


Predicting a clinically important outcome in patients with low back pain following McKenzie therapy or spinal manipulation: a stratified analysis in a randomized controlled trial
Conclusions: We did not find any baseline variables which were statistically significant effect modifiers in predicting different response to either McKenzie treatment or spinal manipulation when compared to each other. However, we did identify nerve root involvement and peripheralization to produce differences in response to McKenzie treatment compared to manipulation that appear to be clinically important. These findings need testing in larger studies.Trial registrationClinicaltrials.gov: NCT00939107 (Source: BMC Musculoskeletal Disorders)


Congenital Left Paraduodenal Hernia Causing Chronic Abdominal Pain and Abdominal Catastrophe
Paraduodenal hernias are the most common type of congenital internal hernia. Because of its overall rare incidence, this entity is often overlooked during initial assessment of the patient. Lack of specific diagnostic criteria also makes diagnosis exceedingly difficult, and the resulting diagnostic delays can lead to tragic outcomes for patients. Despite these perceived barriers to timely diagnosis, there may be specific radiographic findings that, when combined with the appropriate constellation of clinical symptoms, would aid in diagnosis. This patient first presented at 8 years of age with vague symptoms of postprandial emesis, chronic abdominal pain, nausea, and syncope. Over the span of 6 years he was evaluated 2 to 3 times a year with similar complaints, all of which quickly resolved...


Neuropathic Pain: Principles of Diagnosis and Treatment
Neuropathic pain is caused by disease or injury of the nervous system and includes various chronic conditions that, together, affect up to 8% of the population. A substantial body of neuropathic pain research points to several important contributory mechanisms including aberrant ectopic activity in nociceptive nerves, peripheral and central sensitization, impaired inhibitory modulation, and pathological activation of microglia. Clinical evaluation of neuropathic pain requires a thorough history and physical examination to identify characteristic signs and symptoms. (Source: Mayo Clinic Proceedings)<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>


Electrophysiological Characterisation of Activation State Dependent Cav2 Channel Antagonist TROX-1 in Spinal Nerve Injured Rats
This study confirms the pathological state dependent actions of TROX-1 through a likely spinal mechanism and reveals a modality selective change in calcium channel function following nerve injury. (Source: Neuroscience)


Agreement between definitions of pharmaceutical opioid use disorders and dependence in people taking opioids for chronic non-cancer pain (POINT): a cohort study
We examined agreement between classification systems, and tested the unidimensionality of the syndrome with confirmatory factor analysis. Findings We included 1422 participants (median time of pain disorder 10 years [IQR 5–20]; median length of strong opioid prescription 4 years [IQR 1·5–10·0]; mean age 58 years). Similar proportions of individuals met lifetime criteria for dependence with DSM-IV (127; 8·9%), ICD-10 (121; 8·5%), and ICD-11 (141; 9·9%). Criteria in DSM-5 classified 127 (8·9%) participants with moderate or severe use disorder. There was excellent agreement between ICD-10, ICD-11 and DSM-IV dependence (κ&gt;0·90). However, there was only fair to moderate agreement between ICD-10 and DSM-IV dependence diagnoses, and DSM-5 use disorder (mild, moderate, or sever...


Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of migraine in adults.
CONCLUSIONS: Since the last version of this review, the new included studies have not added high quality evidence to support the use of SSRIs or venlafaxine as preventive drugs for migraine. There is no evidence to consider SSRIs or venlafaxine as more effective than placebo or amitriptyline in reducing migraine frequency, intensity, and duration over two to three months of treatment. No reliable information is available at longer-term follow-up. Our conclusion is that the use of SSRIs and SNRIs for migraine prophylaxis is not supported by evidence. PMID: 25829028 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Electroacupuncture inhibits chronification of the acute pain of knee osteoarthritis: study protocol for a randomized controlled trial
Background: Previous studies have shown that electroacupuncture (EA) has a significant effect on acute pain, but it has not solved the clinical problem of the chronification of acute pain. Diffuse noxious inhibitory controls (DNIC) function as a reliable indicator to predict the risk of chronic pain events. DNIC function in knee osteoarthritis (KOA) patients has been demonstrated to gradually decrease during the development of chronic pain. The purpose of this study is to conduct a randomized, controlled clinical trial to determine if EA can repair impaired DNIC function and thus prevent chronification of the acute pain of KOA.Methods/DesignThis is a multicenter, single blind, randomized, controlled, three-arm, large-scale clinical trial. A total of 450 KOA patients will be randomly assign...


Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial
Conclusions Compared with TAU, pharmacist-led interventions for chronic pain appear more costly and provide similar QALYs. However, these estimates are imprecise due to the small size of the pilot trial. The EVSI indicates that a larger trial is necessary to obtain more precise estimates of differences in mean effects and costs between treatment groups. Trial registration number ISRCTN06131530. (Source: BMJ Open)<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>


Prevention of oxaliplatin-induced peripheral neuropathy by a polyamine-reduced diet--NEUROXAPOL: protocol of a prospective, randomised, controlled, single-blind and monocentric trial
Introduction Oxaliplatin remains the most widely used chemotherapeutic agent for treating advanced colorectal cancer but its efficacy is hampered by dose-limiting neurotoxicity manifested by a painful polyneuropathy. Oxaliplatin-induced peripheral neuropathy (OIPN) is characterised by acute and transient cold hyperaesthesia in the hours and days following oxaliplatin infusion (&gt;90% of patients), but also by retarded chronic neuropathy due to the repetition of chemotherapy cycles (30&ndash;50% of patients). OIPN impairs the health-related quality of life (HRQOL) of patients and no preventive or curative strategies have as yet proven effective. A polyamine-reduced diet (PRD) has recently demonstrated its efficacy to prevent OIPN in animals without adverse effects. Methods and analysis Th...


Rare case of giant cystic adenomyoma mimicking a uterine malformation, diagnosed and treated by hysteroscopy
We describe a case of giant cystic uterine adenomyoma that was diagnosed and treated by hysteroscopy. In a 27‐year‐old woman with menometrorrhagia, severe dysmenorrhea, and chronic pelvic pain, pelvic ultrasonography revealed an enlarged uterine cavity filled with homogeneous low echogenic fluid content. A large cornual hematometra of 8.0 cm in diameter in a bicornuate uterus was suspected, and this hypothesis was also supported by magnetic resonance imaging findings. On the contrary, hysteroscopy revealed a bilocular huge cystic lesion of the posterior uterine wall that was removed by means of monopolar loop resection. The operative finding and the histopathologic examination confirmed the diagnosis of cystic adenomyoma of the uterus. Hysteroscopy may represent a valid tool for diag...


Preparing Family Medicine Residents for Managing Chronic Pain (Laura Hempstead DO)
Care of the patient with chronic pain can be emotionally difficult for both resident and faculty. We will describe how we implemented evidence-based practices in our family medicine resident clinic both to improve the quality of care delivered to our patients with chronic pain and to help our residents feel more confident in their ability to care for this patient population. We will review lessons learned and recommendations for other programs who may wish to integrate these tools into their clinic flow. We will also present data from our research study showing the implementation of these strategies increased perceived comfort with managing patients with chronic pain amongst family medicine residents. (Source: Family Medicine Digital Resources Library (FMDRL) Recently Uploaded)


Ventricular tachycardic storm with a chronic total coronary artery occlusion treated with percutaneous coronary intervention.
Authors: Mixon TA Abstract A 66-year-old man with a history of coronary artery disease was evaluated due to ventricular tachycardic (VT) storm. The patient continued to have frequent recurrences of VT despite treatment with amiodarone and lidocaine. Since the ventricular arrhythmia could be related to myocardial ischemia related to a chronic total occlusion (CTO) of the right coronary artery, the patient underwent successful percutaneous coronary intervention of the CTO, followed by implantable cardioverter defibrillator implantation. He had no further episodes of VT during his hospital stay. After 9 months of follow-up, he had no further chest pain or clinically apparent recurrent ischemia. Interrogation of his defibrillator has shown brief nonsustained episodes of ventricular tac...


Preservation of Beta Cell Function after Pancreatic Islet Autotransplantation: University of Chicago Experience.
Authors: Savari O, Golab K, Wang LJ, Schenck L, Grose R, Tibudan M, Ramachandran S, Chon WJ, Posner MC, Millis JM, Matthews JB, Gelrud A, Witkowski P Abstract The aim of the study was to assess the rate of insulin independence in patients after total pancreatectomy (TP) and islet autotransplantation in our center. TP followed by islet autotransplantation was performed in 10 patients. Severe unrelenting pain associated with chronic pancreatitis was the major indication for surgery. Islets were isolated using the modified Ricordi method and infused through the portal vein. Exogenous insulin therapy was implemented for at least two months posttransplant to support islet engraftment and was subsequently weaned off, if possible. Median follow-up was 26 months (range, 2 to 60 months). Me...<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>


Pd45-09 scrotox: salvage peri-spermatic cord botulinum-a toxin injections for patients with refractory chronic scrotal content pain after microsurgical denervation of the spermatic cord.
Botulinum-A toxin (Botox) has been shown to modulate the release of neuropeptides leading to inhibition of neurogenic inflammation and chronic pain. This provides an antinociceptive effect. Chronic scrotal content pain is a difficult condition to treat. Microsurgical denervation of the spermatic cord (MDSC) is one surgical treatment option with success rates published in the 60-85% range. However, patients who fail MDSC have limited options. Our goal was to assess the use of peri-spermatic cord Botox injections (Scrotox) to provide prolonged pain relief in men with refractory chronic scrotal content pain after MDSC. (Source: The Journal of Urology)


Pd45-05 the role of testosterone supplemental therapy in opioid-induced hypogonadism: a collaborative, prospective analysis
The objective of this study is to identify the effect of testosterone supplemental therapy (TST) in men with chronic pain undergoing opiate therapy. We hypothesize that treatment of opiate-induced hypogonadism can reduce opiate requirement in men suffering from chronic pain. (Source: The Journal of Urology)


Pd40-04 salvage ultrasound guided targeted microcryoablation of the peri-spermatic cord for persistent chronic scrotal content pain after microsurgical denervation of the spermatic cord
Chronic scrotal content pain is a difficult condition to treat. Microsurgical denervation of the spermatic cord (MDSC) is one surgical treatment option with success rates published in the 60-85% range. However, patients who fail MDSC have limited options. Our goal was to assess the use of Ultrasound guided targeted microcryoablation (UTM) of the peri-spermatic cord as a salvage treatment option for patients who fail MDSC. (Source: The Journal of Urology)


Pd40-03 targeted robotic assisted microsurgical denervation of the spermatic cord for the treatment of chronic scrotal content pain: single center, large series review.
Microsurgical denervation of the spermatic cord (MDSC) is a treatment option for chronic scrotal content pain that is unresponsive to conservative treatments. A recent study has shown specific nerve fiber abnormalities (Wallerian degeneration) in the cord as a potential cause for this pain. Our goal was to assess outcomes of a more targeted technique in ablating only these abnormal nerves when performing MDSC: targeted robotic assisted microsurgical denervation of the spermatic cord (RMDSC). (Source: The Journal of Urology)


Mp25-14 the treatment of chronic orchalgia with tmr: substantial pain reduction with durable results
Chronic orchalgia is a common urological complaint with treatments ranging from medication to denervation and orchiectomy. Here we report our five year experience in the treatment of chronic orchalgia with Therapeutic Magnetic Resonance (TMRTM), an FDA approved device for the treatment of pain. With TMRTM, an electric current is applied for 10-20 minutes directly to the skin overlying the spermatic cord via two metal probes positioned on opposite sides of the scrotum, reportedly altering nerve cell ion conduction and the sensation of pain. (Source: The Journal of 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>


Mp25-06 models of lower urinary tract symptoms in the presence and absence of pain
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a debilitating condition characterized mainly by pelvic pain. In addition, many patients report voiding complaints and lower urinary tract symptoms (LUTS). While the mechanism behind these voiding complaints is not well understood, it is possible that inflammation induces fibrosis within the prostate, as has been hypothesized to occur in benign prostatic hyperplasia (BPH). To better understand this process, we developed two transient infection-induced prostatitis murine models where LUTS can be studied in the presence or absence of chronic pain. (Source: The Journal of Urology)


Mp25-05 enhanced bladder pain sensitivity due to the prostate-to-bladder afferent cross sensitization in a rat model of prostatitis
In chronic pelvic pain syndrome/chronic prostatitis (CPPS/CP), patients suffer from pelvic pain derived not only from the prostate, but also from the lower urinary tract (LUT). However, the mechanisms remain unclear; therefore, we investigated whether prostatic inflammation induced enhanced pain sensitivity in the LUT and bladder overactivity using a rat model of prostatitis. (Source: The Journal of Urology)


Mp25-02 testosterone replacement therapy for hypogonadal patients with chronic prostatitis / chronic pelvic pain syndrome
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects about 10-15% of male population and dramatically diminishes quality of life (QOL). It has been shown that patients with CP/CPPS have a lower serum testosterone level compared to controls. The aim of this study was to evaluate the effect of testosterone replacement therapy (TRT) on symptoms of CP/CPPS in patients with hypogonadism. (Source: The Journal of Urology)


Mp25-01 relationship between testosterone and prostatitis-like symptoms assessed by the national institutes of health chronic prostatitis symptom index
Recently, it has been reported that chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is related to decreased vascular endothelial dysfunction and cardiovascular disease. Testosterone has been suggested to play a role in vascular endothelial dysfunction and cardiovascular disease. Considering the relationship of testosterone and CP/CPPS with endothelial dysfunction and cardiovascular disease, there may also be a relationship between testosterone and CP/CPPS. Therefore, we evaluate their relationship. (Source: The Journal of Urology)


Mp27-04 a psychometric analysis of pain and urinary symptoms in patients with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome: findings from mapp research network
Approaches are needed to better characterize the course of interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), conditions which are collectively referred to as urologic chronic pelvic pain syndromes (UCPPS). As part of a prospective observational study within the Multi-Disciplinary Assessment of Pelvic Pain (MAPP) Research Network, patients diagnosed with IC/BPS and CP/CPPS completed a battery of questionnaires. The purpose of this research was to examine the number of factors among a large set questionnaire items, which helps to understand the symptom structure of pelvic pain, as well as to create simple indices to characterize changes in symptoms. (Source: The Journal of 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>


Pd8-09 painful bladder filling and painful urgency are distinct characteristics in men and women with urologic chronic pelvic pain syndromes (ucpps) – a mapp research network study
“Painful filling” (i.e. pain that gets worse with bladder filling), and “painful urgency” (the urge to urinate due to pain, pressure, or discomfort instead of fear of leakage) have been described in women with interstitial cystitis (IC/BPS). However, only 56% to 87% of IC/BPS patients reported these characteristics. In men with chronic prostatitis (CP/CPPS), we have only limited, mostly anecdotal, information on the prevalence of painful filling and painful urgency. Thus, the clinical significance of painful filling and painful urgency is not well understood in either women or men. (Source: The Journal of Urology)


Pd20-11 endoscopic injection of triamcinolone – a simple, minimally invasive, and effective therapy for hunner's lesions
Gross inflammatory bladder wall changes, termed “Hunner's lesions,” (HL) may be identified in 5-10% of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) patients. Chronic inflammatory events result in severe pain with bladder filling and limitations of bladder capacity. These lesions are also associated with bladder wall scarring and further limitations of capacity and compliance. Although fulguration of HL is recommended therapy, concern has been raised that these procedures, while improving pain, may be associated with increased bladder wall scarring. (Source: The Journal of Urology)


Pd20-09 altered microbiome in chronic pelvic pain patients
Chronic pelvic pain afflicts millions of patients in the U.S., yet underlying disease mechanisms remain unclear. We recently reported that E. coli strains exhibit diverse pain phenotypes in a murine urinary tract infection model that were subject to modulation via the GI tract, including a chronic pelvic pain phenotype reminiscent of interstitial cystitis/bladder pain syndrome (IC). Thus, we hypothesized that flora of the GI and/or reproductive tracts modulate IC symptoms and characterized the IC microbiome. (Source: The Journal of Urology)


Pd20-08 the impact of comorbid chronic pain syndromes on sexual activity and dyspareunia after pelvic organ prolapse repair
Some have suggested that women with coexisting chronic pain syndromes (CPS) have increased risk of dyspareunia after pelvic organ prolapse repair (POP), particularly with transvaginal mesh. We compared sexual activity and dyspareunia in women with and without a comorbid chronic pain syndrome after POP repair via an abdominal or transvaginal approach. (Source: The Journal of Urology)


Pd20-07 alterations in connectivity on fmri with provocation of lower urinary tract symptoms in urologic chronic pelvic pain syndromes
Urologic chronic pelvic pain syndromes (UCPPS) have refractory bladder or pelvic pain as their dominant symptom, which has been attributed to changes in the central nervous system caused by a chronic barrage of noxious stimuli. To ascertain whether altered brain function is associated with UCPPS, we developed a novel challenge protocol that induces bladder distention in study participants to reproduce pain symptoms. (Source: The Journal of 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>


Pd20-06 comparative pilot study of implantation techniques for pudendal neuromodulation: technical and clinical outcome in first 20 patients with chronic pelvic pain
Neurostimulation of the pudendal nerve (PN) is considered for patients who have failed sacral neuromodulation. Previous techniques for PN localisation are described to be uncomplicated and promise to achieve accuracy in electrode placement. However, in clinical use they appear challenging. We developed a puncture technique using fixed anatomical landmarks for a fast and reproducible localisation of the PN. (Source: The Journal of Urology)


Pd20-01 tanezumab reduces pain in women with interstitial cystitis/bladder pain syndrome
Elevated nerve growth factor (NGF) levels have been reported in patients with both interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). NGF is a key modulator of pain perception. Tanezumab (TNZ), a humanized monoclonal antibody binds NGF and inhibits NGF signaling. Three clinical trials of TNZ therapy were conducted in patients with urologic chronic pelvic pain syndromes (UCPPS), including both IC/BPS (studies 1010 [published] and 1035 [not published]) and CP/CPPS (study 1019 [published]). (Source: The Journal of Urology)


Risk factors for delayed healing in venous leg ulcers: a review of the literature
ConclusionThe findings from this review can assist health professionals to identify prognostic indicators or risk factors significantly associated with delayed healing in venous leg ulcers. This will facilitate realistic outcome planning and inform implementation of appropriate early strategies to promote healing. (Source: International Journal of Clinical Practice)


Deconstructing Chronic Low Back Pain in the Older Adult—Step by Step Evidence and Expert‐Based Recommendations for Evaluation and Treatment: Part I: Hip Osteoarthritis
ConclusionsHip OA is common and should be evaluated routinely in the older adult with CLBP so that appropriately targeted treatment can be designed. (Source: Pain Medicine)


Evolutionary dynamics of metazoan TRP channels.
Authors: Kadowaki T Abstract Transient receptor potential (TRP) channels are unusual among cation channels because of their diverse cation selectivities and activation mechanisms. TRP channels thus play major roles in various sensory perceptions by functioning as multimodal signal integrators. Some TRP subfamily members are also implicated in acute and chronic pain and inflammation. So far, most TRP channel studies have been targeted to human and model organisms within a limited evolutionary context. Classification of TRP channels in various animal genomes has revealed extensive gene gain and loss events across animal species. Furthermore, the chemical activation profiles of some orthologous TRP channels were different between species such as human and mouse. Amino acid substitutio...<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' recall of diagnostic and treatment information improves with use of the Pain Explanation and Treatment Diagram in an outpatient chronic pain clinic.
Authors: Finestone HM, Yanni MM, Dalzell CJ PMID: 25831077 [PubMed - as supplied by publisher] (Source: Pain Research and Management)


What Ecologic Analyses Cannot Tell Us About Medical Marijuana Legalization and Opioid Pain Medication Mortality—Reply
In Reply We agree with Finney et al that large, prospective studies of the effects of medical cannabis in individuals with chronic pain are warranted. However, we believe that results from studies of state-level data can also be informative. (Source: JAMA Internal Medicine)


Chronic pain and the adaptive significance of positive emotions.
Authors: Ong AD, Zautra AJ, Reid MC Abstract The February-March 2014 special issue of the American Psychologist featured articles summarizing select contributions from the field of psychology to the assessment and treatment of chronic pain. The articles examined a range of psychosocial and family factors that influence individual adjustment and contribute to disparities in pain care. The reviews also considered the psychological correlates and neurophysiological mechanisms of specific pain treatments, including cognitive-behavioral therapy, hypnosis, acceptance and commitment therapy, mindfulness, and meditation. Although a number of articles emphasized the role that negative states of mind play in pain outcomes, positive emotions were given only brief mention. Here, we provide a r...


Morphine potentiates LPS‐induced autophagy initiation but inhibits autophagosomal maturation through distinct TLR4 dependent and independent pathways
ConclusionThese observations imply that although morphine treatment facilitates LPS‐induced autophagy, it inhibits autophagolysosomal fusion leading to decreased bacterial clearance and increased bacterial load. These observations support the increased susceptibility to infection and the prevalence of persistent infection in the drug abuse population.This article is protected by copyright. All rights reserved. (Source: Acta Physiologica)


A randomized controlled trial of auricular acupressure in heart rate variability and quality of life for hypertension.
CONCLUSION: Acupressure can be applied at the acupoints of shenmen, sympathesis, kidney, liver, heart, and subcortex to improve physical pain and mental health of QoL for hypertensive patients. Auricular acupressure is acceptable and feasible although it does not support physiological benefits. Further studies are warranted to assure the effects of using auricular acupressure as an adjunctive care for patients with hypertension. PMID: 25847557 [PubMed - in process] (Source: Complementary Therapies in 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>


Clinical effectiveness of osteopathic treatment in chronic migraine: 3-Armed randomized controlled trial.
CONCLUSIONS: These findings suggest that OMT may be considered a valid procedure for the management of migraineurs. The present trial was registered on www.ClinicalTrials.gov (identifier: NCT01851148). PMID: 25847552 [PubMed - in process] (Source: Complementary Therapies in Medicine)


Electroacupuncture down-regulates the expressions of colonic NGF and NGFR in visceral hypersensitivity rats
Conclusion The EA could up-regulate the pain threshold of visceral hypersensitivity rats, and down-regulate the expressions of colonic NGF and NGFR. The regulation of the expressions of colonic NGF and NGFR would be one of the peripheral mechanisms of EA in treating chronic visceral hypersensitivity. (Source: Journal of Acupuncture and Tuina Science)


Effect of ginger-partitioned moxibustion on immunocytokines in patients with chronic nonbacterial prostatitis
Conclusion Ginger-partitioned moxibustion can improve clinical symptoms of CNP patients by improving their immune function. (Source: Journal of Acupuncture and Tuina Science)


Cellular Supplementation Technologies for Painful Spine Disorders
Low back pain affects more than 80% of adults. A proportion of these adults develops chronic low back pain (CLBP) and becomes disabled by their condition. CLBP is expensive to diagnose and treat and in terms of associated loss of productivity in the work place setting by affected individuals. Although challenging, the source of CLBP can be identified. Contemporary literature contains several studies that have established prevalence estimates for various structural sources of CLBP. In young adults, the intervertebral disk is a common source of CLBP, once it incurs annular injury that heals incompletely. (Source: PM and R)


The Role of Physiatry in Regenerative Medicine: The Past, The Present, and Future Challenges
Historically, the foundation of physical medicine and rehabilitation training has provided the capabilities to optimize nonoperative treatments of a variety of musculoskeletal conditions, including acute and chronic muscle, tendon, ligament, and cartilage disorders. Such treatments include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), therapeutic modalities (eg, thermal and manual therapies), and corticosteroid injections in conjunction with specific rehabilitation exercises. Although NSAIDs, modalities, and corticosteroids may be helpful for short-term pain reduction and early recovery of function, they do not typically reverse the structural changes associated with degenerative conditions and may contribute to worse long-term outcomes by potentially interfering with tissue 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>


Assessment of Vitamin D status In Patients of Chronic Low Back Pain of Unknown Etiology
This study was conducted to assess the contribution of vitamin D levels and other biochemical factors to chronic low back pain in such cases. All patients attending the orthopedics OPD for low back pain in whom a precise anatomical cause could not be localized, were prospectively enrolled in this study. We measured serum levels of glucose, calcium, phosphorus, uric acid, rheumatoid factor, C reactive protein, alkaline phosphatase, total protein, albumin and 25 (OH) D concentrations in 200 cases and 200 control samples. The patients showed significantly lower vitamin D levels compared to controls with p value &lt; 0.0001. The maximum number of low back pain patients were in the age group of 31–50 years (42 %).The average BMI was 23.27 ± 5.17 kg/sq m, 73 % of total patient populat...


Are Physicians Safely Prescribing Opioids for Chronic Noncancer Pain? A Systematic Review of Current Evidence
ConclusionsSubstantial practice and knowledge gaps were identified, including the use of pain scales and prescription of transdermal fentanyl in opioid‐naïve patients, which have important implications for patient's safety. Guidelines more practical to physicians’ settings and further education of physicians are warranted. (Source: Pain Practice)


Thermal imaging evaluation of paravertebral block for mastectomy in high risk patient: case report
Abstract Thoracic paravertebral block is the technique of injecting local anesthetic adjacent to the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramina. It is effective in treating acute and chronic pain of unilateral origin from the chest and abdomen. This technique causes pain relief with pulmonary function preservation and great hemodynamic stability. 66 year old woman (156 cm, 80 kg, BMI 32) with chronic right heart failure, hypertension and obesity, on chronic oxygen therapy was presented for elective mastectomy due to breast cancer. She suffered from severe COPD and also bullous emphysema. FVC 1.59 l; FEV1 0.55 l; FEV1%FVC 34.6. The paravertebral block was performed using the multi-shot percutaneous technique with additional ...


The Diagnostic View: Assess Your Rheumatology Knowledge
Radiograph, MR images of a 55-year-old man with chronic back pain (Source: The Rheumatologist)


[Can ICF Core Sets be Helpful in Preparing a Social-medical Expert Report Due to Incapacity to Work? - A First Proposal].
The objective of this investigation is to determine whether the ICF Core Sets and other international approaches, such as the EUMASS Core Sets or ICF Core Set for vocational rehabilitation cover the content of the social-medical expert reports as well as to propose an approach how the ICF can be economically used by the social medicine practitioner when writing a social-medical expert report. METHOD: A retrospective quantitative study design was used to translate a total of 294 social-medical expert reports from patients with low back pain (LBP) or chronic widespread pain (CWP) into the language of the ICF (linking) by 2 independent health professionals and compare the results with the ICF Core Sets for specific health conditions and other international approaches. RESULTS: The con...<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 17-year-old girl with chronic intermittent abdominal pain.
Authors: Mungan NÖ, Yilmaz BS, Nazoglu S, Yildizdas D, Hergüner Ö, Turgut M, Öktem M PMID: 25875978 [PubMed - in process] (Source: Pediatric Annals)


Common Questions About the Diagnosis and Management of Fibromyalgia.
Authors: Kodner C Abstract Fibromyalgia has a distinct pathophysiology involving central amplification of peripheral sensory signals. Core symptoms are chronic widespread pain, fatigue, and sleep disturbance. Most patients with fibromyalgia have muscle pain and tenderness, forgetfulness or problems concentrating, and significant functional limitations. Fibromyalgia is diagnosed using an updated set of clinical criteria that no longer depend on tender point examination; laboratory testing may rule out other disorders that commonly present with fatigue, such as anemia and thyroid disease. Patients with fibromyalgia should be evaluated for comorbid functional pain syndromes and mood disorders. Management of fibromyalgia should include patient education, symptom relief, and regular aer...


Are Depressive Symptomatology, Self‐Efficacy, and Perceived Social Support Related to Disability and Quality of Life in Patients With Chronic Migraine Associated to Medication Overuse? Data From a Cross‐Sectional Study
ConclusionsAdding information on psychosocial variables to headache features improved our ability to understand disability and QoL of CM‐MO patients. We deem that the inclusion of psychosocial variables in standard evaluation protocols may contribute to the global assessment of CM‐MO patients, and eventually to their success in reducing the personal and social impact of this condition. Future longitudinal studies are needed to confirm this hypothesis. (Source: Headache: The Journal of Head and Face Pain)


L5 pedicle subtraction osteotomy for high-grade isthmic spondylolisthesis.
This report is the first documented successful pedicle subtraction osteotomy in the treatment of high-grade spondylolisthesis. This report indicates that certain patient populations may be amenable to pedicle subtraction osteotomy as a treatment option for pathology involving high-grade isthmic spondylolisthesis [Orthopedics. 2015; 38(4):e347-e351.]. PMID: 25901631 [PubMed - in process] (Source: Orthopedics)


[Regional anaesthesia in injuries of the upper extremity].
Authors: Döffert J, Steinfeldt T Abstract Regional anaesthesia has significant advantages compared to general anaesthesia with an opiate-based postoperative analgesia in injuries of the upper extremity. Severe pain may be considered a risk factor for the development of chronic postoperative pain syndromes in adults and children. Depending on the anticipated postoperative pain level, a catheter procedure should be used. Fractures of the upper extremity are common and may also be associated with seemingly minor injuries with a high postoperative pain level. Nerve damage can be caused mainly by traumatic fractures, or iatrogenically during surgical procedures. Reduced possible neurological evaluability should not prevent the excellent pain control which regional anesthesia can provid...<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 Management in Nursing Practice Wright Shelagh Pain Management in Nursing Practice 336pp £24.99 Sage 9781446282007 1446282007 [Formula: see text].
Authors: Abstract DIFFERENT PAIN models and concepts of pain are clearly explained in this text. It also focuses on communication in pain management and assessment of pain. Dedicated chapters on acute, chronic and cancer pain help the reader to identify the different contexts in which pain may occur, and the circumstances which need to be considered as part of holistic assessment and management. PMID: 25924746 [PubMed - in process] (Source: Nursing Older People)


Combined volar and dorsal plating for complex comminuted distal radial fractures.
CONCLUSION: Combined volar and dorsal plating enables early mobilisation and good outcome for certain complex comminuted distal radial fractures. PMID: 25920637 [PubMed - in process] (Source: Journal of Orthopaedic Surgery)


Arthroscopic resection of humeroradial synovial plica for persistent lateral elbow pain.
CONCLUSION: A humeroradial synovial plica is one of the causes of chronic lateral elbow pain. Arthroscopic resection of the synovial plica followed by intensive physiotherapy achieved good outcome. PMID: 25920635 [PubMed - in process] (Source: Journal of Orthopaedic Surgery)


Spontaneous rupture and massive hemoperitoneum from uterine leiomyomas and adenomyosis in a nongravid and unscarred uterus
Uterine leiomyomas (fibroids or myomas) are benign monoclonal tumors arising from the smooth muscle cells of the myometrium [1]. The symptoms attributed to myomas include heavy or prolonged menstrual bleeding, pelvic pressure and pain, and reproductive dysfunction. Acute or chronic pelvic pain may be a result of mass bulk-related symptoms, dysmenorrhea, dyspareunia, or degeneration or torsion of the myoma [2]. Adenomyosis refers to a disorder in which endometrial glands and stroma are present within the uterine musculature (uterine adenomyomatosis). (Source: Taiwanese Journal of Obstetrics and Gynecology)


Intrathecal Clonidine via Lumbar Puncture Decreases Blood Pressure in Patients With Poorly Controlled Hypertension
ConclusionsThis is the first clinical study in subjects with hypertension that demonstrates significant and profound acute reductions in blood pressure after a single dose of intrathecal clonidine. Future placebo‐controlled, dose‐escalating studies are warranted to assess the long‐term effects of intrathecal clonidine infusion via an implantable drug pump in patients with treatment‐resistant hypertension at risk of stroke or myocardial infarction. (Source: Neuromodulation: Technology at the Neural Interface)<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 Centrally Mediated Symptoms on Postoperative Pain in Osteoarthritis Patients Undergoing Total Knee Arthroplasty: A Prospective Observational Evaluation
ConclusionsOA patients with high levels of comorbid centrally mediated symptoms showed severe pain and increased analgesic requirements after TKA in the early postoperative period. Moreover, these patients seemed to be at higher risk of persistent pain, and a high CSI score was predictive of low patient satisfaction in terms of pain relief after surgery. (Source: Pain Practice)


Effect of low frequency transcutaneous magnetic stimulation on sensory and motor transmission
Peripheral nerve injury diminishes fast conducting large myelinated afferent fibers transmission but enhances smaller pain transmitting fibers firing. This aberrant afferent neuronal behavior contributes to development of chronic post‐traumatic peripheral neuropathic pain (PTP‐NP). Non‐invasive dynamic magnetic flux stimulation has been implicated in treating PTP‐NP, a condition currently not adequately addressed by other therapies including transcutaneous electrical nerve stimulation (TENS). The current study assessed the effect of low frequency transcutaneous magnetic stimulation (LFTMS) on peripheral sensory thresholds, nerve conduction properties, and TENS induced fast afferent slowing effect as measured by motor and sensory conduction studies in the ulnar nerve. Results indica...


Sacred Sisterhood of Healers!
I don't know how many people learn about the revolutionary Dorothea Dix in school any more, but for people involved with mental health advocacy, she is a shining light and one of the great women of history. It is poignant for me that I will be spending the last three days of Women's History Month with the modern-day Dorothea Dix, Elyn Saks of the USC Gould School of Law. We will be immersed in collaboration and study at the Saks Institute for Mental Health Law, Policy and Ethics, where Elyn is changing history and shattering expectations with her life and work. These two shining stars carry on a tradition of advocacy that unites them across the centuries. When I stop and think about this incredible legacy, it draws my attention and awareness to how many modern day female leaders have revo...


You Are A Good Daughter
When I first began talking to people about my journey with my mother's Alzheimer's -- which I tentatively began to do a couple of years ago -- one of the things I heard the most often was: "Your mother is very lucky to have such a good daughter." At first, I felt like an imposter. "I'm really not," I wanted to reply. "I'm so imperfect. I was a challenging teenager. I was so angry at my mother for so long and for so much. I've stayed living in Los Angeles instead of moving back to Massachusetts to take care of her full-time. I could have done less. I could be doing more. Sometimes I don't want to talk to her on the phone because it hurts. I've been selfish. I am selfish. I'm not a good daughter. I'm not good enough." Rebellious teenage me When my mother was two years into her illness,...


Postoperative Pain Control.
Authors: Lovich-Sapola J, Smith CE, Brandt CP Abstract Prevention and control of postoperative pain are essential. Inadequate treatment of postoperative pain continues to be a major problem after many surgeries and leads to worse outcomes, including chronic postsurgical pain. Optimal management of postoperative pain requires an understanding of the pathophysiology of pain, methods available to reduce pain, invasiveness of the procedure, and patient factors associated with increased pain, such as anxiety, depression, catastrophizing, and neuroticism. Use of a procedure-specific, multimodal perioperative pain management provides a rational basis for enhanced postoperative pain control, optimization of analgesia, decrease in adverse effects, and improved patient satisfaction. PMID...<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>


Methadone therapy in underserved urban community: QTc prolongation and life‐threatening ventricular arrhythmias
This article is protected by copyright. All rights reserved. (Source: Cardiovascular Therapeutics)


Successful Use of High-Frequency Spinal Cord Stimulation Following Traditional Treatment Failure
Conclusions: HFSCS at the frequency of 1 kHz offers a new tool for treatment of chronic pain in patients with traditional stimulation settings. Furthermore, most standard SCS batteries are capable of delivering stimulation in this frequency range.Stereotact Funct Neurosurg 2015;93:190-193 (Source: Stereotactic and Functional Neurosurgery)


Further Evidence for a Pain Pathway Involving the Cingulate Gyrus: A Case of Chronic Cluster Headache Cured by Glioblastoma
This report suggests that the cingulate gyri could be a potential target for neuromodulation in patients with medically refractory chronic CH.Stereotact Funct Neurosurg 2015;93:194-198 (Source: Stereotactic and Functional Neurosurgery)


Four proven natural remedies for chronic inflammation
(NaturalNews) At the root of any serious disease lies chronic inflammation. Normally a beneficial response by the body to heal itself, it becomes problematic when this process is initiated 24-7. Symptoms are expressed in a wide variety of ways, most notably through pain.This has... (Source: NaturalNews.com)


Neglected Monteggia fracture dislocations in children: a systematic review
This article aims to study, in a systematic manner, the surgical management and complications of treatment of chronic radial head dislocations. After screening of relevant abstracts, a total of 28 studies were included in the systematic review. A narrative synthesis of various treatment modalities has been discussed. This article concludes that open reduction should be attempted unless dysmorphism of the radial head restricts it. Open reduction with ulnar osteotomy with or without annular ligament reconstruction is the most commonly performed procedure and is expected to result in reduced pain and elbow deformity. (Source: Journal of Pediatric Orthopaedics B)<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 Impact of Chronic Opioid Use on Colonoscopy Outcomes
Conclusion Patients on chronic opioids represent a high-risk population with longer procedural times and more discomfort, despite higher dosages of sedative agents. Prospective studies are required to define the risks and benefits of more costly alternative sedation strategies for patients on chronic opioids. (Source: Digestive Diseases and Sciences)


Chronic Migraine Is Associated With Reduced Corneal Nerve Fiber Density and Symptoms of Dry Eye
ConclusionsWe found that in the sample used in this study, the presence of structural changes in nociceptive corneal axons lends further support to the hypothesis that the trigeminal system plays a critical role in the pathogenesis of migraine. In vivo corneal confocal microscopy holds promise as a biomarker for future migraine research as well as for studies examining alterations of corneal innervation. Dry eye symptoms appear to be extremely prevalent in this population. The interrelationships between migraine, corneal nerve architecture, and dry eye will be the subject of future investigations. (Source: Headache: The Journal of Head and Face Pain)


Long‐Term Efficacy of a Double‐Blind, Placebo‐Controlled, Randomized Study for Repetitive Sphenopalatine Blockade With Bupivacaine vs Saline With the Tx360® Device for Treatment of Chronic Migraine
ConclusionsData from this exploratory pilot study suggest that there may be long‐term clinical benefits with the use of repetitive SPG blockades with bupivacaine delivered with the simple to use Tx360® device. These include a sustained reduction of headache days and improvement in several important quality of life assessments. The SPG blockades were not associated with any significant or lasting adverse events. Further research on SPG blockade is warranted. (Source: Headache: The Journal of Head and Face Pain)


Constipation in pregnancy
Key content Constipation affects up to 38% of pregnancies. Rising progesterone levels in pregnancy contribute to slow gut motility. The standard clinical measures of chronic constipation are the Rome III criteria, which are based on frequency and difficulty in the passage of stool. Secondary constipation is due to primary disease of the colon (anal fissure, stricture and neoplasia), metabolic disturbances (hypothyroidism and hypercalcaemia) and neurological disorders. Severe constipation may result in faecal impaction, retention of urine, pain or abdominal discomfort, rectal bleeding and/or rectal prolapse. A treatment algorithm using laxatives that are effective, safe and non‐teratogenic will be discussed. Learning objectives To understand the prevalence and pathophysiology of t...


Staying Healthy From Fibromyalgia Is Ongoing Hard Work
In conclusion, remaining healthy requires ongoing hard work to maintain the body, as well as profound changes in everyday life. At the same time, the narratives show continuity in the informants&rsquo; self-presentation as hard-working women. (Source: Qualitative Health 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>


The Mediating Role of Acceptance in Multidisciplinary Cognitive Behavioral Therapy for Chronic Pain
Cognitive Behavioral Therapy (CBT) is the most frequently delivered psychological intervention for adults with chronic pain. The treatment yields modest effect sizes and the mechanisms of action remain understudied and unclear. Efforts are needed to identify treatment mediators that could be used to refine CBT and improve outcomes. The primary aim of this study is to investigate whether pain-related acceptance, from the psychological flexibility model, mediates changes in outcome over time in a CBT-based treatment program. (Source: The Journal of Pain)


Cervical 10 kHz spinal cord stimulation in the management of chronic, medically refractory migraine: A prospective, open‐label, exploratory study
ConclusionParesthesia‐free cervical HF10 SCS may be a safe and effective therapeutic option for chronic migraineurs refractory to conventional treatments. (Source: European Journal of Pain)


Childhood Cancer Prevalence and Morbidity
Conclusions: The estimated prevalence of survivors of childhood cancer is increasing, as is the estimated prevalence of morbidity in those &ge;5 years after diagnosis. Impact: Efforts to understand how to effectively decrease morbidity burden and incorporate effective care coordination and rehabilitation models to optimize longevity and well-being in this population should be a priority. Cancer Epidemiol Biomarkers Prev; 24(4); 653&ndash;63. &copy;2015 AACR. (Source: Cancer Epidemiology Biomarkers and Prevention)


Pain following blood donation: a questionnaire study of long‐term morbidity (LTM) in blood donors
DiscussionAlthough a rare complication, nerve injury after blood donation may lead to long‐term morbidity and may become chronic in a small proportion of donors. The most common symptoms are pain, and we estimate that neuropathic pain can be the underlying cause. (Source: Vox Sanguinis)


Prevalence and Risk Factors of Urinary Incontinence in Chinese Women: A Population-Based Study
To estimate the current prevalence rate of urinary incontinence (UI) and to identify risk factors in Chinese women, we conducted a population-based survey in 3058 women in Beijing, China, in 2009. The prevalence rate of UI was estimated to be 22.1%, with stress UI (12.9%) being more prevalent than urgency UI (1.7%) and mixed UI (7.5%). The prevalence rates of UI, urgency UI, and mixed UI increased with age, with the highest recorded in participants aged &ge;70 years. However, stress UI was most commonly seen in participants aged 50 to 69 years. Risk factors for UI included aging, lower education background, older age of menarche, menstrual disorder, pregnancy history, episiotomy, chronic pelvic pain, gynecological disease, other chronic diseases, constipation, fecal incontinence, lower dai...<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 Efficacy of a Double-Blind, Placebo-Controlled, Randomized Study for Repetitive Sphenopalatine Blockade With Bupivacaine vs Saline With the Tx360(®) Device for Treatment of Chronic Migraine.
CONCLUSIONS: Data from this exploratory pilot study suggest that there may be long-term clinical benefits with the use of repetitive SPG blockades with bupivacaine delivered with the simple to use Tx360(®) device. These include a sustained reduction of headache days and improvement in several important quality of life assessments. The SPG blockades were not associated with any significant or lasting adverse events. Further research on SPG blockade is warranted. PMID: 25828648 [PubMed - as supplied by publisher] (Source: Headache)


Clomiphene Citrate as a Preventive Treatment for Intractable Chronic Cluster Headache: A Second Reported Case With Long-Term Follow-Up.
DISCUSSION: This is the second reported case of the effective use of clomiphene citrate for the preventive treatment of medicinal refractory chronic cluster headache. This is the first case to report long-term follow-up of this neurohormonal treatment. Clomiphene citrate appears to be safe for extended use in chronic cluster headache even in an elderly sufferer and has a minimal side effect profile. The mechanism of action of how clomiphene prevents cluster headache may involve both its ability to enhance testosterone production and its ability to bind to hypothalamic estrogen receptors. Clomiphene citrate should join the list of alternative cluster headache prophylactic treatments to be considered by headache specialists when conventional cluster headache preventives are ineffective. ...


The Mediating Role of Acceptance in Multidisciplinary Cognitive-Behavioral Therapy for Chronic Pain
Cognitive-behavioral therapy (CBT) is the most frequently delivered psychological intervention for adults with chronic pain. The treatment yields modest effect sizes, and the mechanisms of action remain understudied and unclear. Efforts are needed to identify treatment mediators that could be used to refine CBT and improve outcomes. The primary aim of this study was to investigate whether pain-related acceptance, from the psychological flexibility model, mediates changes in outcome over time in a CBT-based treatment program. (Source: The Journal of Pain)


Intranasal SPG Block Reduces Chronic Migraine PainIntranasal SPG Block Reduces Chronic Migraine Pain
The first randomized controlled trial of its kind shows benefits in long-term treatment with the intranasal SPG block. Medscape Medical News (Source: Medscape Medical News Headlines)


Rate of opioid misuse is around 25 percent, addiction rate 10 percent, reports study
New estimates suggest that 20 to 30 percent of opioid analgesic drugs prescribed for chronic pain are misused, while the rate of opioid addiction is approximately 10 percent. "On average, misuse was documented in approximately one out of four or five patients and addiction in approximately one out of ten or eleven patients," who were prescribed opioids as part of their treatment for chronic pain, write researchers. They note extremely wide variation in reported rates of misuse, abuse, and addiction and raise questions about the benefits of widespread opioid use for chronic pain, given the harmful consequences. (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>


Regional Anesthesia for Breast Surgery: Techniques and Benefits
Abstract Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. While much data have supported the efficacy of paravertebral blocks, they are not without risks. More recently, pectoral blocks have shown promise for this population, whereas wound infiltration has demonstrated mixed results. In this review, regional anesthesia techniques, the associated anatomy and the evidence for their utility are reviewed. Additionally, the advantages of regional anesthesia beyond postoperative pain control are discussed. (Source: Current Anesthesiology Reports)


Peripheral Nerve Blockade for Total Knee Arthroplasty: An Evidence-Based Review
Abstract Total knee arthroplasty (TKA) is associated with significant postoperative pain. Optimization of postoperative analgesia can improve rehabilitation and functional recovery. There is much debate regarding the best peripheral nerve blocks for optimization of postoperative analgesic and functional outcomes following TKA. Continuous femoral nerve block provides excellent postoperative analgesia. In comparison, adductor canal block may provide relative preservation of quadriceps motor weakness, however, its effect on analgesia, mobilization, long-term functional outcomes, and inpatient falls remains unclear. Sciatic nerve block provides effective analgesia in addition to continuous femoral nerve block, and its clinical benefit may be greatest in patients with opioid tolerance ...


Work modification as a treatment for low-back pain
Work modification is considered as an essential element in enhancing return to work (RTW) among persons with musculoskeletal problems (1) although systematic reviews have called for more studies (2) and pointed out that the net gain in sickness absence days has been only modest and economic effects uncertain (3). Loisel and his co-workers (4) showed for the first time that an occupational intervention – and especially an occupational intervention combined with a clinical intervention – was associated with a faster RTW compared with clinical intervention alone or usual care. The developed Sherbrooke model has been tested with a randomized controlled trial (RCT) in the Netherlands. Workers sick-listed for 2–6 weeks due to low-back pain (LBP) were first randomized into a workplace interven...


Endometriosis and mild bleeding disorders
Endometriosis is a benign inflammatory disease defined by the presence of endometrial glands and stroma in areas outside the uterus. It is estimated to affect 5%–15% of women of reproductive age and is even more prevalent among women with chronic pelvic pain and infertility. Endometriotic implants may be located anywhere within the pelvis, including the ovaries, ovarian fossa, pelvic peritoneum, rectovaginal septum, uterosacral ligaments, and cul-de sac. In some cases, ovarian endometriotic cysts (endometriomas) may be observed by ultrasound imaging. (Source: Fertility and Sterility)


Rate of opioid misuse is around 25 percent, addiction rate 10 percent, reports study in Pain
(Wolters Kluwer Health) New estimates suggest that 20 to 30 percent of opioid analgesic drugs prescribed for chronic pain are misused, while the rate of opioid addiction is approximately 10 percent, reports a study in the April issue of Pain, the official journal of the International Association for the Study of Pain. The journal is published by Wolters Kluwer. (Source: EurekAlert! - Medicine 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>


When Do Feet Have Arches?
Discussion Pes planus or flat foot is a common presentation in children and is defined as the absent or diminished longitudinal medial foot arch. Parents usually become more concerned if the child appears to have problems with walking, tripping or falling, problems with alignment (i.e. feet turning outward or inward) or if there is perceived discomfort. Some parents of older children will become concerned when they notice excessive or abnormal shoe wear. The differential diagnosis in rare cases also includes rheumatologic, neurologic, neoplastic and genetic syndromes such as Ehler-Danlos and Marfan syndrome. The differential diagnosis of leg pain can be found here, and the differential diagnosis for intoeing and outtoeing can be found here. A history of chronic pain and/or rheumatological...


Contributing factors to Star Excursion Balance Test performance in individuals with chronic ankle instability
Ankle sprains are common in physically active populations. The incidence of ankle sprains in military and select athletic cohorts can be up to twenty-seven times greater than reported in the general population[1]. Approximately 30% of individuals who suffer an initial lateral ankle sprain develop chronic ankle instability (CAI)[2]. CAI is a condition defined as a history of at least one ankle sprain resulting in one or more recurrent sprains combined with feelings of joint instability and occasionally pain[3]. (Source: Gait and Posture)


Subtalar Dislocations
Subtalar dislocations make up 1-2% of all dislocations, about 75% of them being medial dislocations. Treatment consists of early reduction under adequate sedation. In cases of soft tissue interposition or locked dislocations, open reduction is warranted. More than 60% of subtalar dislocations are associated with additional fractures, therefore a postreduction CT is recommended. Complications include avascular necrosis of the talus, infection, posttraumatic arthritis, chronic subtalar instability, and complex regional pain syndrome with delayed reduction. The prognosis of purely ligamentous injuries is excellent after early reduction. Negative prognostic factors include lateral and open dislocations, total talar dislocations, and associated fractures. (Source: Foot and Ankle Clinics)


Painting pain: An interpretative phenomenological analysis of representations of living with chronic pain.
Conclusion: The images and accounts provide a powerful insight into the internal world of the pain sufferer and the subjective experience of chronic pain. We link this work to other attempts to represent patients’ pain and point to the particular contribution our work makes. We make some suggestions for subsequent research following on from what is presented here and we also argue that the methodology outlined in the article offers considerable potential for research on other health conditions. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (Source: Health Psychology)


A review of behaviour change theories and techniques used in group based self-management programmes for chronic low back pain and arthritis
Medical Research Council (MRC) guidelines recommend applying theory within complex interventions to explain how behaviour change occurs. Guidelines endorse self-management of chronic low back pain (CLBP) and osteoarthritis (OA), but evidence for its effectiveness is weak. (Source: Manual 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>


Family Beliefs and Interventions in Pediatric Pain Management
This article provides an overview of acute and chronic pain, the impact of parent factors on pediatric pain, parental assessments of parent functioning, and parent-based interventions for pediatric pain management. Case examples are used to illustrate the treatments presented. (Source: Child and Adolescent Psychiatric Clinics of North America)


(+)-borneol alleviates mechanical hyperalgesia in models of chronic inflammatory and neuropathic pain in mice.
Authors: Jiang J, Shen YY, Li J, Lin YH, Luo CX, Zhu DY Abstract Chronic pain is a major public health problem categorized as inflammatory or neuropathic, each involving impaired GABAergic control in the spinal cord of mammals. (+)-Borneol, a bicyclic monoterpene present in the essential oil of plants, is used for analgesia and anaesthesia in traditional Chinese medicine. It has been reported that (+)-borneol directly potentiates GABA activity at recombinant human GABAA receptors. Although borneol has antinociceptive effect on acute pain models, little is known about its effect on chronic pain and its mechanism. Here we report that (+)-borneol has remarkable anti-hyperalgesic effects on neuropathic and inflammatory pain in animal models. Neuropathic hypersensitivity was induced by ...


Targeting P2X7 receptor for the treatment of central post-stroke pain in a rodent model.
Authors: Kuan YH, Shih HC, Tang SC, Jeng JS, Shyu BC Abstract Stroke is a leading cause of death and disability in industrialized countries. Approximately 8-14% of stroke survivors suffer from central post-stroke pain (CPSP) when hemorrhagic stroke occurs in lateral thalamic regions, which severely affects their quality of life. Because the mechanisms of CPSP are not well understood, effective treatments have not been developed. In the present study, we tested the hypothesis that persistent CPSP is caused by P2X7 receptor activation after brain tissue damage and subsequent elevations in inflammatory cytokines. A thalamic hemorrhagic rat model was used, characterized by thermal and mechanical allodynia that develops in the subacute to chronic phases upon CPSP onset. We found a signi...


Trigeminal neuralgia induced by cobra venom in the rat leads to deficits in abilities of spatial learning and memory - Wu Z, Qian XY, An JX, Liu CC, Tian M, Cope DK, Williams JP.
BACKGROUND: Patients with chronic pain usually suffer from cognitive impairment, with memory deterioration being the most common deficit that affects daily functioning and quality of life. The causes for this impairment are not clear despite intensive clin... (Source: SafetyLit: All (Unduplicated))


Emerging Behavioral Treatments for Migraine
Abstract Although the efficacy of behavioral interventions for migraine (e.g., relaxation training, stress management, cognitive-behavioral therapy, biofeedback) is well established, other behavioral interventions that have shown efficacy for other conditions are being adapted to treat migraine. This paper reviews the literature to date on acceptance and commitment therapy (ACT), mindfulness-based interventions, and behavioral interventions for common migraine comorbidities. ACT and mindfulness interventions prioritize the outcome of improved functioning above headache reduction and have demonstrated efficacy for chronic pain broadly. These emerging behavioral therapies show considerable promise for improving outcomes of migraine patients, particularly in reducing headache-relate...<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 Chronic Illness Acceptance Questionnaire: Confirmatory Factor Analysis and Prediction of Perceived Disability in an Online Chronic Illness Support Group Sample
In this study, a measure of Acceptance commonly utilized in chronic pain populations (Chronic Pain Acceptance Questionnaire) was adapted for application with patients with heterogeneous and often co-morbid chronic illness diagnoses. The online chronic illness support group sample participants (N=413) ranged in age from 20–84 years [Mean age=53.18 (12.39)] and were diagnosed with 1–7 (M=2.36; SD=1.39) chronic illnesses. The Chronic Illness Acceptance Questionnaire (CIAQ) showed adequate-to-good fit to the data. For the two factor CFA model, the RMSEA=0.078 (90% CI=0.071–0.085). The items of the two parallel measures appear to tap similar acceptance dimensions or subscales – Willingness and Activity Engagement. Additionally, the two CIAQ subscales significantly predicted illness-rela...


A novel method for assessing bladder‐related pain reveals the involvement of nerve growth factor in pain associated with cyclophosphamide‐induced chronic cystitis in mice
ConclusionsThe blunt probe method is useful for evaluating bladder pain signalling in mice, and revealed the involvement of an NGF‐sensitive pain pathway in chronic cystitis pain. This assessment method may be useful for studying the pathophysiology of bladder pain and for developing therapeutic strategies for non‐ulcerative IC/PBS in patients. (Source: European Journal of Pain)


Neuroplasticity Underlying the Comorbidity of Pain and Depression.
Authors: Doan L, Manders T, Wang J Abstract Acute pain induces depressed mood, and chronic pain is known to cause depression. Depression, meanwhile, can also adversely affect pain behaviors ranging from symptomology to treatment response. Pain and depression independently induce long-term plasticity in the central nervous system (CNS). Comorbid conditions, however, have distinct patterns of neural activation. We performed a review of the changes in neural circuitry and molecular signaling pathways that may underlie this complex relationship between pain and depression. We also discussed some of the current and future therapies that are based on this understanding of the CNS plasticity that occurs with pain and depression. PMID: 25810926 [PubMed - as supplied by publisher] (Sour...


What is a cystocele?
Sourced from The Hysterectomy Association: Hysterectomy Association - Hysterectomy Association - hysterectomy, menopause and hormone replacement therapy (hrt) information and support for women. A cystocele (pronounced sis-toe-seel) is also called an anterior prolapse, dropped or prolapsed bladder. It often occurs because the wall between the vagina and bladder has been torn or weakened during childbirth allowing the bladder to bulge or drop into the vaginal vault. Other less common causes can be severe obesity, straining regularly because of chronic constipation, violent coughing or even lifting heavy things incorrectly. As with all types of prolapse, the effects can range from mild to severe and may need treatment or not, depending on whether or not it is affecting a woman&#8217;s qualit...


Giant sigmoid diverticulum: A case report
Sigmoid colon diverticulosis is commonly seen in both the surgical outpatient and emergency departments. Rarely, these sigmoid diverticulum, which usually range from 2–3mm to 2cm in size, can enlarge to more than 10 times. This is due to a ball-valve type mechanism that traps colonic gas inside the sigmoid diverticulum causing it to gradually enlarge. Patients with a giant sigmoid diverticulum (GSD) must be investigated thoroughly as 2 per cent of patients will present with a colonic carcinoma either within or distal to the GSD. Clinical symptoms of a GSD can range from chronic abdominal pain, altered bowel habits, abdominal distention, weight loss, bleeding, perforation, fistula formation, or bowel obstruction. CT and plain abdominal x-ray is the investigation of choice for its diagnosi...<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>


Coordination of Care Matters Most to Patients With Chronic Pain Coordination of Care Matters Most to Patients With Chronic Pain
A survey shows patients rank coordination of chronic pain management above the relationship with their healthcare provider, and outcomes correlate with the quality of coordination. Medscape Medical News (Source: Medscape Neurology and Neurosurgery Headlines)


Abstract P77: Selective Neurectomies for Chronic Postoperative Neurogenic Pain
No abstract available (Source: Plastic and Reconstructive Surgery)


Effect of topical anesthesia in patients with persistent dentoalveolar pain disorders: a quantitative sensory testing evaluation
PDAP (persistent dentoalveolar pain disorder) is a chronic neuropathic condition that is characterized by a continuous and severe pain located in the dentoalveolar region innervated by the trigeminal nerve that is not caused by any other disease and is identified through clinical and image examination.1–4 PDAP occurs in 3-6% of patients who receive dentistry management. Traumatic injury, periodontal surgery, endodontic therapy, apicectomy, tooth extraction or the slightest trauma during tooth preparation or inferior alveolar nerve block that damage nerve fibers may disrupt peripheral afferent nerve impulses. (Source: Archives of Oral Biology)


Migraine and body mass index categories: a systematic review and meta-analysis of observational studies
Conclusions The meta-analysis of the available observational studies suggested an association between migraine and obesity likely mediated by gender and migraine frequency. Further studies taking into account gender, migraine type, frequency, activity, and duration could provide more robust evidence. (Source: The Journal of Headache and Pain)


Effect of topical anaesthesia in patients with persistent dentoalveolar pain disorders: A quantitative sensory testing evaluation
PDAP (persistent dentoalveolar pain disorder) is a chronic neuropathic condition that is characterized by a continuous and severe pain located in the dentoalveolar region innervated by the trigeminal nerve that is not caused by any other disease and is identified through clinical and image examination.1–4 PDAP occurs in 3–6% of patients who receive dentistry management. Traumatic injury, periodontal surgery, endodontic therapy, apicectomy, tooth extraction or the slightest trauma during tooth preparation or inferior alveolar nerve block that damage nerve fibres may disrupt peripheral afferent nerve impulses. (Source: Archives of Oral Biology)<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>


Increased Cerebral Cannabinoid-1 Receptor Availability Is a Stable Feature of Functional Dyspepsia: A [18F]MK-9470 PET Study
Conclusions: Although these findings need replication in larger samples, they suggest that the abnormal brain activity in several of these regions, previously demonstrated in FD, may be due to a sustained endocannabinoid system dysfunction, identifying it as a potential novel target for treatment and warranting further studies to elucidate whether it is also a feature of other FGIDs or FSSs.Psychother Psychosom 2015;84:149-158 (Source: Psychotherapy and Psychosomatics)


Understanding and treating painful diabetic neuropathy: time for a paradigm shift
This article is protected by copyright. All rights reserved. (Source: Diabetic Medicine)


Crossing your fingers may help reduce pain
Conclusion This study investigated pain using a thermal grill trick, which applies hot and cold in different combinations to the index, middle and ring fingers to induce a phantom burning sensation. This showed that crossing your fingers may confuse the way your brain processes feelings of hot and cold, and in some cases stopped the phantom pain. The biggest limitation of this study is that it looked at phantom pain using the thermal grill trick, rather than actual pain. Phantom pain may be different from &quot;normal&quot; pain, so the results may not relate to a regular pain situation. We shouldn't get too hung up on the crossed finger idea, though. The concept behind it is more interesting. The study tentatively showed that pain might be influenced by how our bodies are organised in ...


Antidepressant Drugs for Prevention of Acute and Chronic Postsurgical Pain: Early Evidence and Recommended Future Directions
No abstract available (Source: Survey of Anesthesiology)


(105) The influence of familial pain models and ethnicity on the rating of experienced and imagined painful events
Numerous studies have indicated racial/ethnic differences in both clinical and experimental pain. Similarly, the presence of a parental pain model is associated with altered pain behavior, greater frequency of pain complaints, and greater likelihood of developing chronic pain. However, to our knowledge, the potential interaction of race/ethnicity and presence of parental pain models on the evaluation of experienced and imagined painful events has not been examined, nor whether the presence of a same-sex parental pain model might have different effects than a parental pain model of either sex. (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>


(111) An evidence-informed approach to the identification and assessment of chronic pain in children with cerebral palsy
Chronic pain is common for children with disabilities, most notably cerebral palsy (CP). Due to the complex heterogeneity of the disability, chronic pain is often unrecognized and thereby undertreated. Through an integrated knowledge translation strategy, a need for a Chronic Pain Assessment Toolbox for Children with Disabilities was recognized, to assist clinicians in the identification and assessment of chronic pain in a population for which very little support exists. A structured review of clinical practice guideline clearinghouses and scientific databases (Medline, CINAHL, Embase) retrieved 1,243 documents, from which 3 guidelines met eligibility criteria: (i) available in English; (ii) recommendations for ages 1-18 years; (iii) published between 2001- 2013. (Source: The Journal of Pa...


(115) Validity and reliability of the Patient-Reported Outcomes Measurement Information System (PROMIS) for pain interference and quality of life in women with fibromyalgia
The Patient-Reported Outcomes Measurement Information System (PROMIS) is a system of measurement tools developed to standardize reporting of patient-centered health related outcomes in various domains across a spectrum of chronic conditions. The purpose of this study was to determine validity and reliability of the PROMIS measurement tools for pain interference and quality of life in women with fibromyalgia. The current study is part of a larger randomized control trial evaluating the effect of TENS on movement pain in women with fibromyalgia. (Source: The Journal of Pain)


(116) Assessment of anxiety as mediator of the relationship between sleep disturbance and pain catastrophizing in chronic pain
One of the most commonly reported issues of chronic pain sufferers is sleep disturbance, which causes decreases in productivity and quality of life for 70-88% of the chronic pain population.3 These patients also often suffer from anxiety and pain catastrophizing (PC), a negative emotional and cognitive state regarding actual or anticipated pain; however, it is unclear how these psychological conditions contribute to their disrupted sleep. Thus, we conducted the largest known retrospective review of sleep disturbance, anxiety, and PC scores using the Stanford-NIH Collaborative Health Outcomes Measurement Information Registry (CHOIR),1 including measures from the Patient Reported Outcomes Measurement Information System (PROMIS). (Source: The Journal of Pain)


(118) Differentiating among veterans who evidence clinically meaningful improvement in pain and those who don’t: a longitudinal analysis
We examined two waves of survey data from a cohort of recently returning veterans to identify demographic and clinical variables that differentiate those who evidence clinically meaningful improvement in pain intensity from those who don’t. (Source: The Journal of Pain)


(120) Toward clinical decision support for chronic pain: integrating patient reported outcomes in an electronic health record
This study describes the technical design and implementation of a novel system for integrating PROs with an EHR to provide pain-related clinical decision support. (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>


(121) Individual predictors of physical function and pain interference in chronic pain syndromes
There has been an effort to determine how the impact of chronic pain on daily life and well-being is altered by other factors. Through Stanford’s Collaborative Health Outcomes Information Registry (CHOIR) patients use the NIH Patient Reported Outcomes Measurement Information System (PROMIS) measures to inform doctors of the impact that chronic pain has on their life – biologically, socially and physiologically. In this retrospective analysis, we analyzed CHOIR data to determine individual predictors of physical function and pain interference in the chronic pain population. (Source: The Journal of Pain)


(122) Differentiating mild versus clinically meaningful chronic pain among recent service veterans
The Institute of Medicine reported that over 100 million Americans suffer from pain. Some have criticized this estimate as failing to distinguish clinically meaningful chronic pain from pain that is mild in severity with minimal functional interference. The present investigation utilized a cohort of returning service veterans and applied stringent chronicity and severity definitions to identify demographic and clinical variables differentiating those with mild versus clinically meaningful chronic pain. (Source: The Journal of Pain)


(123) Differing responses to functional tests among LBP and KOA populations
This study aimed to use true, quantitative functional testing to assess elements of daily living in both models, and correlate this with pain before and after these functional tests. 48 subjects with KOA and 50 subjects with CLBP completed a six minute treadmill walk, timed stair climb, finger-to-floor forward bend, and a one minute sit-to-stand test. (Source: The Journal of Pain)


(131) Transitions among chronic pain and fibromyalgia patients: results from a two-year observational fibromyalgia study in the United States
This study followed a cohort of 226 subjects recruited online to assess transitions into and out of FM over 2 years. At enrollment (Year 1) subjects completed a brief online questionnaire to screen for CWP (bilateral pain, above/below waist lasting ≥1 week) based on the 4 pain questions of the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFESSQ), site visit for physician evaluation of FM, and another online questionnaire with several validated patient-reported outcome instruments. (Source: The Journal of Pain)


(133) Adrenocorticotropin hormone as a biomarker of uncontrolled severe, chronic pain
Adrenocorticotropin (ACTH) is the major pituitary stress hormone that stimulates adrenal hormones to be secreted into the serum in an effort to eliminate or heal injured tissue that may cause pain. When pain occurs, signals are transmitted to the thalamus which stimulates the corticotropin releasing hormone in the hypothalamus to cause the pituitary to hyper-secrete ACTH into the serum. Given this physiologic mechanism, ACTH should be elevated in uncontrolled pain, and, if pain is uncontrolled for an extensive time period, pituitary reserve and production of ACTH may not be able to meet the stress demand of pain, and it, therefore, will drop in the serum. (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>


(132) Use of a depression biomarker panel to diagnose depression in chronic pain patients
In this study we determined MDDScores and investigated the depression related alterations in biomarker expression in a series of CIP patients. The CIP group consisted of 35 patients with documented centralized intractable pain. (Source: The Journal of Pain)


(134) Pituitary-adrenal failure in severe, chronic pain patients
Hormone testing is a new entry into pain management. Recent technological and logistical advances now make it possible to obtain immediate access to hormone profile testing so that complete hormone information is available to outpatient pain care. As a result, profound hormone abnormalities are now being identified in pain patients. Reported here are 61 chronic pain patients who were referred for evaluation and treatment after failing standard pain therapies. All described their pain as constant, uncontrolled, and with flares that were “excruciating and unbearable.” Patients were weak, fatigued, and bed or house-bound. (Source: The Journal of Pain)


(135) Cytochrome P450 defects in pain treatment failures
A long-time question in pain treatment is why patients with similar, painful injuries or conditions may require great differences in dosages of opioids and other drugs. Cytochrome P450 enzymes are principally found in the liver and intestine and they metabolize almost 75% of pharmaceuticals used in pain treatment. Cytochrome P450 (CYP450) enzyme testing capability is now widely accessible to pain practitioners. Reported here is a series of 101 severe, chronic pain patients who had failed standard pain treatments including a minimal daily dosage of 100 mg equivalence of morphine. (Source: The Journal of Pain)


(137) Association of multiple cytochrome P450 defects and opioid malabsorption
Cytochrome P450 (CYP450) enzyme testing has recently entered pain care. One of the main uses of CYP450 testing is to evaluate chronic pain patients who fail standard pain treatments. A surprising finding has been that some patients who have failed standard treatments have multiple CYP450 defects. The CYP450 enzymes that are involved in opioid metabolism are primarily found in the liver and intestine. Those in the intestine facilitate transport of opioids from the intestinal lumen into the serum. (Source: The Journal of Pain)


(138) Modelling oral fluid test results for hydrocodone: assisting with assessment of dose compliance
Oral fluid testing to assist in the assessment of dose compliance for chronic pain patients is growing (1,2). This work reports a retrospective approach to determine the important parameters for assisting a clinician with assessing whether a patient is compliant or not with his or her prescribed dose of hydrocodone via oral fluid testing results. Data from patients who were both prescribed hydrocodone and tested positive (reporting cutoff < X < ULOL) by LC/MSMS were used to determine a “normal” representation of expected results. (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>


(140) Chronic pain and the risk of death: findings from the 1999-2004 NHANES Mortality Follow-up Study
Chronic widespread pain (CWP) is associated with decreased physical activity and limitations in physical function, well-established risk factors for mortality. We sought to (1) determine whether chronic pain is associated with mortality in the general population of the United States and (2) assess the role that physical function plays in the chronic pain-mortality relationship. Data from the 1999-2004 National Health and Nutrition Examination Survey were analyzed. A total of 15,311 adults ages >=20 years were interviewed and followed over 7.7 years (total number of deaths=1,318). (Source: The Journal of Pain)


(142) Correlates of pain among high-risk patients on methadone maintenance treatment
The complex epidemiology of concurrent pain and drug dependency among many patients treated with methadone remains poorly understood. Recent guidelines published by the American Pain Society have called for increased research on the use and safety of methadone among chronic pain patients. To help inform pain management strategies among high-risk methadone-maintained patients, this study explored the prevalence and correlates of pain among a prospective cohort of people who have used illicit drugs in Vancouver, Canada, who reported active enrollment in methadone maintenance treatment (MMT) between 2011 and 2013. (Source: The Journal of Pain)


(144) Chronic pain and prescription opioid use in rural bariatric surgery patients
An estimated 100 million Americans experience chronic pain. Obesity is a risk factor for chronic pain and is also a major contributor to morbidity. Previous research has shown that for every point increase in BMI, there is an associated increase in the number of pain origins reported by patients. These pain origins are not limited to lower limb pain, but all types of pain measured. Bariatric surgery and the weight loss associated with the surgery have been associated with reductions in pain severity and disability, particularly knee and back pain. (Source: The Journal of Pain)


(146) Pain comorbidity and the transition from episodic to chronic migraine: results from the CaMEO (Chronic Migraine Epidemiology & Outcomes) study
Several pain disorders are comorbid with migraine, especially chronic migraine (CM). Herein, we examine the influence of extra-cephalic pain on the progression of episodic migraine (EM) to CM and on the persistence of CM over a 3-month period. Participants were recruited from a US web-panel using quota sampling, and completed web-based questionnaires at baseline and 3 months. Respondents who met ICHD-3 beta criteria for migraine were classified into EM ( (Source: The Journal of Pain)


(150) Prevalance of chronic pain and associated risk factors: intake data from a rehabilitation center in Kuwait
This study looks at intake data from 2,101 patients treated at a private rehabilitation center in Kuwait. Most of the subjects were female (55.4%) and ranged in age between 18 and 88 (average age 41). Sixty nine percent were Kuwaiti citizens and 57.9% were employed. (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>


(153) Chronic pain management in the acute care setting
Chronic pain is a major problem and its management can be difficult under the best of circumstances. When an individual has suffered with chronic pain for a period of time, sometimes years, they utilize many methods for relieving their discomfort, or at least holding it at bay, through both pharmacological and non-pharmacological therapies. When these individuals enter the acute care setting, whether planned or unplanned, their normal chronic pain management regimen may become disrupted and difficult to continue, potentially leading to the exacerbation of their chronic pain symptoms or an inability to adequately meet their current pain relief needs. (Source: The Journal of Pain)


(155) Can thoracotomy patients be “immune” to developing chronic pain? Examination of the role of immune and inflammatory markers in the post-surgical trajectory
Recent evidence reveals that approximately 60% of patients who undergo thoracotomy for lung cancer report chronic pain lasting up to 5 years. However, little evidence exists regarding what factors may protect or place one at-risk for developing chronic post-thoracotomy pain. As part of a larger prospective, longitudinal project, this study identified patterns of immune changes and inflammatory markers and examined associations with temporal patterns of and risk for transition to post-thoracotomy chronic pain. (Source: The Journal of Pain)


(158) Sex moderates the relationship between positive affect and pain severity among knee osteoarthritis patients
Research suggests that women show increased risk for chronic pain disorders, and greater sensitivity to pain, relative to men. Psychological factors, such as positive affect (PA) and negative affect (NA) also show marked effects on pain, with NA largely associated with enhanced pain, and PA having pain-reducing effects. Evidence suggests that affect may modulate pain severity differentially between sexes. However, few studies have directly tested for sex-specific relationships between affect and pain in clinical samples of patients with chronic pain. (Source: The Journal of Pain)


(160) Extracting unstructured data from electronic health records (EHR) to enhance opioid risk assessment in patients with chronic non-cancer pain
Clinical guidelines for the use of opioids in chronic non-cancer pain recommend assessing risk for aberrant drug-related behaviors (ADRBs) prior to initiating opioid therapy. Despite recent drastic increases in prescription opioid misuse and abuse, the use of screening tools in assessing risk of ADRB by clinicians continues to be underutilized. We hypothesized that Natural Language Processing (NLP) techniques may support clinicians in risk assessment of patients considered for opioid therapy. Using a retrospective cohort of 3,672 chronic non-cancer pain patients with at least one Opioid Agreement (OA) between 1/1/2007 and 12/31/2012, we examined the availability of EHR structured and unstructured data to populate three ADRB risk tools, which varied in length, complexity and assessed patien...


(163) Sub-clinical range of pain catastrophizing moderates the effect of pain intensity on opioid prescription
Pain catastrophizing (PC) can predict pain severity, duration, and opioid craving, but its associations with opioid prescription are inconsistent. We aimed to elucidate the association between PC, opioid prescription, and average VAS pain in chronic pain patients. PC data were obtained from the Pain Catastrophizing Scale (PCS) along with VAS from within the Collaborative Health Outcomes Information Registry (CHOIR) for 636 patients. Opioid prescription data were obtained via retrospective chart review. (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>


(167) Contributions of physical function and satisfaction with social roles in chronic pain: a Stanford-NIH CHOIR study
Chronic pain contributes to a variety of emotional difficulties, including increased rates of depression and greater feelings and expression of anger. Individuals with chronic pain who exhibit more severe depression or anger tend to show difficulties with functioning in many domains, including poorer interpersonal functioning and greater physical disability. The current study sought to characterize the process by which pain influences both anger and depression through decreased physical and social functioning. (Source: The Journal of Pain)


(169) Development of the Sensory Hypersensitivity Scale (SHS): a self-report tool for assessing sensitivity to sensory stimuli
Sensory hypersensitivity is one manifestation of the central sensitization that may underlie conditions such as fibromyalgia and chronic fatigue syndrome. We conducted four 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 and demonstrated an overall internal reliability (Cronbach’s alpha) of 0.81, suggesting the tool can be used as a cross-modality assessment of sensitivity. (Source: The Journal of Pain)


(170) Physical and psychological correlates of fatigue and physical function: a Stanford-NIH CHOIR study
Fatigue is a multidimensional construct that has significant implications for physical function in chronic non-cancer pain populations but remains relatively understudied. The current study characterized the independent contributions of self-reported ratings of pain intensity, sleep disturbance, depression, and fatigue to ratings of physical function and pain-related interference in a diverse sample of treatment-seeking individuals with chronic pain. These relationships were examined as a path modeling analysis of self-report scores obtained from 2,487 individuals with chronic pain from a tertiary care outpatient pain clinic, administered through Stanford University’s Collaborative Health Outcomes Information Registry (CHOIR). (Source: The Journal of Pain)


(171) Cognitive-motivational influences on health behavior change in chronic pain
Behavioral therapy for pain offers an effective adjunct to biomedical interventions. However, treatment non-adherence and dropout is common. Assessment of the influences on health behavior change in chronic pain may help identify those at risk for treatment dropout and can themselves serve as targets of intervention to increase motivation for behavioral engagement. Eighty-six adults with chronic musculoskeletal pain were given a newly created self-report measure [The Behavioral Engagement Test for Chronic Pain (BET-CP)] to assess the cognitive-motivational influences on health behavior change in chronic pain. (Source: The Journal of Pain)


(173) Executive function and suicidal risk in complex regional pain syndrome: preliminary study
Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by extremely severe pain, swelling, and changes in the skin, and causes psychological sequelae such as depression, anxiety, and deteriorated quality of life. CRPS patients’ risk for suicide has been reported to be considerably higher than that not only of general populations but also of other chronic pain populations. Considering that conceiving, planning, and committing suicide is closely related to the decline of executive function that regulates cognitive flexibility, planning and organizing, and response inhibition ability, this preliminary study aimed to examine the relationship between CRPS patients’ executive function and their risk for suicide. (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>


(172) Perceived injustice as a risk factor in Chronic Disabling Occupational Musculoskeletal Disorder (CDOMD) population: its association with psychosocial distress and sedatives use
Perceived injustice refers to perception of undeserved loss or suffering as a consequence of injury or negligence. Previous studies have found that perceived injustice plays a role in the trajectory of recovery following musculoskeletal injury. High levels of perceived injustice are associated with persistent pain, greater disability, severe depression, and being less likely to return to work after injury. Perceived injustice has not been studied in Chronic Disabling Occupational Musculoskeletal Disorder (CDOMD), a subgroup of chronic musculoskeletal disorder in which occupational injury is the leading cause. (Source: The Journal of Pain)


(174) Risky business: an actuarial approach to predicting opioid misuse in a chronic-pain population
In the medical management of chronic pain, long-term opioid treatment has been a controversial topic. Much of the concern regarding this approach has been due to the risk of misuse by the patient, addiction, and even death. There have been calls in the literature for assessing risk of opioid misuse before treating a patient with opioids (Robinson et al., Clinical Journal of Pain, 2001), a task that is often assigned to a health psychologist. In recent years, strides have been made in developing measures that assist a psychologist in identifying individuals at risk for opioid misuse (Butler et al., Pain, 2004; Adams et al., Journal of Pain and Symptom Management, 2004; Moore et al., Pain Medicine, 2009); these measures have not, however, led to a “gold standard.” The current article exp...


(175) Examination of pain drawing utility, responsiveness, and one-year outcomes prediction in a chronic disabling occupational spinal disorder (CDOSD) population
Pain drawings are a common tool for pain assessment. They are brief to administer and score, are non-verbal, and provide a graphic representation of multidimensional pain experience. Previous studies show that pain drawings are associated with patient-reported disability, pain severity, physical symptoms, return to work, and personality factors when rated for non-organic pain (pain for which no biological cause is delineated); however, no studies have been done in a chronic disabling occupational spinal disorder (CDOSD) population. (Source: The Journal of Pain)


(176) Opioid craving among chronic pain patients prescribed long-term opioid therapy: a within-person analysis
Recent research indicates that opioid craving is one of the strongest determinants of prescription opioid misuse among patients with chronic pain prescribed long-term opioid therapy. To date, however, little is known on how craving unfolds in everyday life, and on the factors that are associated with opioid craving among patients with pain. In this longitudinal diary study, patients with chronic pain prescribed long-term opioid therapy were asked to provide, once a day for a period of 14 days, self-reports of pain intensity and opioid craving. (Source: The Journal of Pain)


(177) Pain interference mediates the relationship between pain and happiness
Research has extensively explored the relationship between chronic pain and depression; however, less is known about the relationship between chronic pain and happiness. Our first objective was to explore differences in self-reported happiness in individuals with chronic pain versus individuals without. Our second objective was to understand the relationship between pain and happiness, taking into account various factors. We recruited and enrolled 5 groups of participants: healthy volunteers, individuals recovered from low back pain, two groups of patients with current low back pain (one group on opioids and one group opioid-naïve), and individuals in a methadone maintenance treatment program. (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>


(178) MMPI-2 validity scale code-types in chronic headache and orofacial pain
The MMPI-2 has been widely used to classify chronic pain patients into clinically meaningful code-types based on cluster analysis of its clinical scales. These code-types have often been used to assess a patient’s psychological status, to design treatment interventions and to predict treatment outcome. A major strength of the MMPI-2 is its validity scales designed to measure test-taking approaches that may impact MMPI-2 test validity. The primary validity scales are: L (Lie Scale), F (False Item Scale) and K (Defensiveness Scale). (Source: The Journal of Pain)


(180) Quantitative sensory testing: a population based study of adolescents with and without chronic pain
Quantitative sensory testing (QST) has emerged as a modality for examining responses to somatosensory stimuli. However, little data is available in pediatric populations to understand whether youth demonstrate a differential response to QST when they have chronic pain. Data on QST may extend our understanding of the pathophysiology underlying the persistence of pediatric pain. Using a population-based sample, this study compared QST values in adolescents with and without chronic pain. We hypothesized that adolescents with chronic pain would have altered QST compared to adolescents without chronic pain. (Source: The Journal of Pain)


(182) Central inhibition and excitability measures are independent of each other
Central pain modulation consists of a balance between central inhibition and central excitability. Central inhibition is commonly assessed using conditioned pain modulation (CPM) while central excitability is commonly assessed using temporal summation of pain (TS). Clinically, people with chronic pain have exhibited higher clinical pain ratings with either reduced CPM or higher TS. However it is unclear if CPM and TS are related or independent measures. Pain-free adults (n=93, 44F, 49M; 18-49 yr) were assessed for pressure TS by applying pressure to the dorsal forearm (custom apparatus, 1 cm2 tip, individualized pressure) for 30 sec at 0.5 Hz. (Source: The Journal of Pain)


(183) Ethnic differences in pain facilitation across the adult lifespan
The risk of developing chronic pain conditions generally increases with age, and this appears to be particularly relevant for older African Americans (AAs). One explanation for increased pain in older populations of AAs has been that minority aging is associated with greater sensitivity to painful stimuli. However, reviews have reported an increase, a decrease, or stability of pain thresholds associated with aging, as well as a lack of consistent pain threshold differences between AAs and non-Hispanic Whites (NHWs). (Source: The Journal of Pain)


(185) Reducing the respondent burden of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): an approach using curtailment and stochastic curtailment
The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), an empirically derived self-report questionnaire, is widely used in clinical practice to screen patients with chronic pain for potential aberrant medication-related behaviors. Some patients might be reluctant to take the SOAPP-R due to its length of 24 items; therefore, shorter versions are needed. Two methods to reduce respondent burden, curtailment and stochastic curtailment, have been shown to lower average test lengths in computer-based administration of other instruments. (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>


(187) Use of a risk-stratification tool in identification of potential adrenal suppression preceding steroid injection therapy in chronic pain patients
Patients who present for steroid injections are not adequately screened for potential hypothalamic-pituitary-adrenal (HPA) axis suppression from previous steroid exposure. Chronic pain patients often have multiple providers leading to the risk of redundant or contradictory treatments. Patients often receive oral or inhaled steroids, or joint/peri-spinal injections that are not reported by the patient or recorded in the available medical records. Yet, HPA suppression has been reported with a single intra-articular injection. (Source: The Journal of Pain)


(195) Bertolotti’s syndrome: a lesser known cause of chronic low back pain
We report a 43-year-old male, diagnosed with rectal adenocarcinoma complicated by metastasis to the lungs, liver, and bone. (Source: The Journal of Pain)


(196) Implications for assessments with the treatment as usual condition within comparative effectiveness research with an underserved population
Addressing health disparities has become a major focus in research, policy, and practice especially for a patient population burdened with additional psychosocial factors that may negatively impact health outcomes. As with pain management, communities with limited resources may not be equipped to fulfill the pain management needs of their patients. In an ongoing randomized-comparative effectiveness trial of behavioral health interventions for chronic pain, participants in the treatment as usual (TAU) comparison groups are assessed alongside participants who have been randomized to either a cognitive-behavioral coping skills or pain education group. (Source: The Journal of Pain)


(197) The experiences of people living with chronic pain while receiving opioids to manage their pain in the primary care setting
The purpose of this qualitative study is to examine the narratives of people who experience chronic pain and receive opioids for the treatment of chronic pain through a primary care clinic. The purposefully selected sample was composed of 12 patients who experienced pain for more than 6 months, were receiving opioids for the treatment of pain in a primary care clinic in the Midwest metropolitan area, and were willing to tell the story of their experiences. Participants were asked to describe their healthcare experiences living with chronic pain and receiving opioids for their pain. (Source: The Journal of Pain)


(202) Explaining group differences in clinical pain among knee osteoarthritis patients: a moderated mediation model involving pain catastrophizing and sleep disturbance
Pain catastrophizing and sleep disturbance are important factors prevalent in the chronic pain experience, and may help better understand the underlying processes through which these factors exert effects, due to their strong associations with pain. In the present study we examine pain catastrophizing as a mediator in the relationship between group status and clinical pain in older individuals diagnosed with chronic knee osteoarthritis (K-OA). We used a bootstrapped conditional process model to test whether this specific mediation, including both the direct and indirect effects, is also moderated by sleep disturbance. (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>


(203) The role of diet in the etiology and severity of rheumatoid arthritis: a prospective analysis of the NHANES I Epidemiological Follow-up Study (NHEFS) cohort
Rheumatoid arthritis (RA) is a chronic, disabling disease that affects approximately 1.3 million US adults. Due to their anti-inflammatory properties, fruit and vegetable (F&V) consumption could mitigate the risk of developing RA. Evidence from European studies supports this hypothesis; however, it has not been tested in a representative US sample. The current prospective cohort study included data from 6,707 participants in the NHANES I Epidemiological Follow-up Study (NHEFS) to examine dietary risk factors for RA. (Source: The Journal of Pain)


(211) Modulation of experimental and clinical pain by distraction in fibromyalgia patients and controls
In this study, 53 patients with FM and 17 control subjects without FM underwent quantitative sensory testing (QST), including an exposure to a sustained, moderately-painful mechanical stimulus under conditions of distraction (subjects trained to use visual imagery) and pain-focused attention. (Source: The Journal of Pain)


(212) Sleep disturbance in chronic low back pain: an age- and gender-matched case-control study
Sleep disturbance is often reported by individuals with chronic low back pain (cLBP). However, studies have only begun to comprehensively investigate sleep quality in this population. This ongoing study seeks to examine both subjective and objective measures of sleep among cLBP participants, and compare them to age- and gender-matched controls. Thus far, a total of 30 participants (15 cLBP, 15 matched controls) aged 45-88 years have completed the Insomnia Severity Index, the Center for Epidemiological Studies – Depression Scale, and seven consecutive nights of actigraphic measurement in the home environment. (Source: The Journal of Pain)


(215) Pre-pregnancy and first trimester menstrual and pain characteristics of pregnant women
Chronic vulvar pain is common among reproductive-aged women and potentially associated with hormonal triggers yet little is known about fertility and pregnancy in these women, thus limiting clinical guidance on pregnancy. A national sample of pregnant women was followed prospectively to establish a cohort of 169 (93 with no history of chronic vulvar pain, 76 with vulvodynia). Surveys inquiring about reproductive characteristics and pain were completed each trimester of pregnancy. In the 3 months prior to pregnancy we found that menstrual characteristics (regularity, length, flow) did not differ between those with or without vulvodynia. (Source: The Journal of Pain)


(217) Daily peer victimization experiences of adolescents with and without chronic pain: preliminary results of a prospective diary study
This study utilizes a novel prospective diary methodology to assess peer victimization among youth with chronic pain. We compared daily peer victimization experiences over 7 days of youth with chronic pain to a healthy comparison group, and examined associations among peer victimization and daily pain intensity, activity limitations, mood, and sleep quality. (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>


(218) The lived experience of pain in adolescents diagnosed with cystic fibrosis
Cystic Fibrosis (CF) is the most common life-shortening inherited disease in Caucasians. It is characterized by a genetic defect leading to excessively viscous mucus. Individuals with CF develop chronic sinus and chest infections as well as problems with malnutrition. Pain (headache, chest, back, GI, musculoskeletal) in CF, has been well documented. Quantitative studies of pain self-reports in adolescents with CF show that pain negatively impacts quality of life, but little is known about the lived experience of pain in adolescents with CF. (Source: The Journal of Pain)


(220) Central pain processing measures are associated with movement-evoked pain report among older adults with chronic axial low back pain
Research has elucidated age-related neuroplastic changes in pain sensitivity and central pain processing. However, the association of such changes to musculoskeletal pain conditions is less understood, as research has been predominantly performed in asymptomatic individuals. We employed a comprehensive experimental pain battery to compare correlates of pain sensitivity and central pain processing among younger (18-39 years; n=20), middle-aged (40-56 years; n=20) and older (57-76 years; n=20) adults with chronic axial low back pain (CLBP). (Source: The Journal of Pain)


(223) Identifying central sensitization in adults with sickle cell disease: differences in clinical features and psychobehavioral factors
Central sensitization (CS) has been identified as a leading culprit responsible for maintaining pain in several chronic pain conditions. 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 identified and categorized SCD patients based on QST into a high or low CS phenotype and examined clinical pain, vaso-occlusive crises, psychosocial factors, and sleep continuity (i.e. (Source: The Journal of Pain)


(225) Differences in Mexican Americans’ prevalence of chronic pain and co-occurring analgesic medication and substance use relative to Non-Hispanic White and Black Americans: Results from NHANES 1999-2004
Little is known about the pain experience of the burgeoning Mexican American (MA) population. Using data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES), prevalence of chronic pain (>3 months), analgesic medication use, and substance use were examined among MA, Non-Hispanic White (NHW), and Non-Hispanic Black (NHB) respondents. Logistic and linear regression models adjusted for age, sex, and sampling design examined racial/ethnic differences in: 1) chronic pain prevalence among all respondents (n=14,036), 2) location and number of pain sites among respondents with chronic pain (n=2,005), and 3) analgesic medication and substance use among respondents with chronic pain. (Source: The Journal of Pain)


(226) How do women deal with dysmenorrhea?
Approximately 25-90% of women of reproductive age experience dysmenorrhea characterized by pelvic pain occurring before or during menstruation. As the leading cause of absence from school and work among women, dysmenorrhea poses a great socioeconomic burden on society. Dysmenorrhea commonly co-occurs with other chronic pain conditions (e.g., irritable bowel syndrome, fibromyalgia). Not only can it exacerbate existing pain conditions, it can even increase a woman’s risk of developing other pain conditions later in life. (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>


(227) Evaluating musculoskeletal pain pathogenesis in the aftermath of motor vehicle collision in a multi-dimensional context
In this study we evaluated how trajectories of pain symptoms, depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and somatic symptoms (often termed “post-concussive” (PC)) cluster over time after motor vehicle collision (MVC) in a large cohort of adult European Americans who presented to the ED within 24 hours of MVC. (Source: The Journal of Pain)


(231) Temporal role of yeast infections prior to the onset of vulvodynia and after pain development
Vulvovaginal yeast infection has been hypothesized to trigger unexplained chronic vulvar pain (vulvodynia). Yet most studies have failed to describe its temporal role as occurring before or after vulvodynia onset, which if different, may delineate the biological mechanism(s). Using a population-based clinically-confirmed case-control study, we estimated risks of having a history of yeast infection (categorized as: none, 1-4, 5-10, 11-20, 21+) before and after vulvodynia onset for 170 cases who reported age of vulvar pain onset (reference age) and 171 vulvar pain-free controls whose reference age was set to that of a case. (Source: The Journal of Pain)


(233) Temporal summation testing provides evidence for increased pain sensitivity and central sensitization in sickle cell anemia
In this study, 30 SCA adults and 30 age and sex matched normal volunteers (NVs) underwent thermal windup and mechanical pinprick summation testing. Pain was reported on a 0-20 scale. For random thermal windup (slow temporal summation), SCA adults reported higher pain scores than NVs at the lowest testing temperature (mean 1.3±1.9 vs. (Source: The Journal of Pain)


(234) Chronic opioid therapy is more strongly associated with central sensitization in sickle cell disease than clinical pain
Central nervous system sensitization (CS) is common to a number of chronic pain conditions. Adult patients with sickle cell disease (SCD) often have chronic pain. Both animal and human evidence suggests that central sensitization is a factor in its development or maintenance. Patients with SCD are often treated with opioids, which can produce paradoxical pain facilitation through central mechanisms. This analysis examined the relationship of chronic opioid therapy (COT, those prescribed daily long-acting opioids) to central sensitization with SCD. (Source: The Journal of Pain)


(235) Regional cerebral blood flow abnormalities in patients with chronic fatigue after a fatiguing task using arterial spin labeling
Chronic fatigue syndrome (CFS) has been associated with activation of nociceptors, the HPA-axis, and pain pathways. Unfortunately, little is known about the underlying neural mechanisms of CFS. Compared to other imaging modalities, arterial spin labeling (ASL) can quantify changes in regional cerebral blood flow (rCBF) over time. For this study, we acquired ASL data from 32 women, 16 with CFS, and 16 age-matched healthy controls (HC), to investigate the relationship between fatigue and temporal changes in rCBF. (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>


(236) Resting regional cerebral blood flow abnormalities of fronto-parietal brain areas in patients with chronic fatigue using arterial spin labeling
Chronic fatigue syndrome (CFS) has been associated with activation of metaboreceptors, the HPA-axis, and pain pathways. Little is known about the underlying neural mechanisms of CFS but hypoperfusion of fatigue related brain areas has been suggested. Compared to other imaging modalities, arterial spin labeling (ASL) can quantify changes in regional cerebral blood flow (rCBF). The purpose of this study was to measure cerebral blood flow in CFS patients at rest and compare them to and healthy controls (HC). (Source: The Journal of Pain)


(237) The integration of healthcare provider and patient education with a standardized chronic pain assessment
Pain is among the most common reasons that patients seek medical attention in the United States, and significant educational and procedural gaps continue to exist with respect to pain assessment, treatment planning, management, and follow-up. Healthcare provider education about chronic pain and its treatment is often lacking, with the burden of patient education being the responsibility of healthcare providers, and it can be difficult to have pertinent educational materials readily available for patient distribution that is valuable based on the specific medical circumstances. (Source: The Journal of Pain)


(238) Estimates of national healthcare expenditures associated with pediatric chronic pain
Pediatric chronic pain, with estimated prevalence rates of 15-25%, is increasingly being recognized as a major cause of morbidity in children, and data are emerging on the associated economic costs to families. However associated national healthcare expenditures are unknown. The primary objective of this study was to assess the impact of pediatric chronic pain on national healthcare expenditures in comparison to healthcare expenditures for other common childhood conditions including asthma, attention deficit hyperactivity disorder (ADHD), and obesity. (Source: The Journal of Pain)


(240) Poor, scared, and hurting: the experiences of Black elders managing chronic pain
Pain is a challenging stressor that can affect every facet of a person’s life and significantly diminish their quality of life. Those at greatest risk for diminished quality of life secondary to pain are older adults. Older adults have an increased likelihood to have chronic end-stage diseases that cause moderate to severe pain. Unfortunately, the management of pain amongst the older adult population has been consistently poor. Of particular concern within the older adult and chronically ill populations are Black Americans. (Source: The Journal of Pain)


(242) Prescriber attitudes regarding treating patients with extended release/long acting opioids
Provider attitudes and beliefs may influence how they perceive and treat people with chronic pain. As part of the PainEDU REMS (Risk Evaluation and Mitigation Strategy) Education Program for extended-release and long-acting (ER/LA) opioid analgesics, we evaluated factors that contributed to provider’s decision- making when it came to decisions about managing pain with ER/LA opioids. Healthcare providers (N=825 to date) were asked a series multiple choice questions while completing the course that evaluated: 1) common challenges associated with treating chronic pain patients, 2) challenges with treating patients with chronic opioids, 3) factors that influence the prescribing chronic opioid therapy, 4) view of family involvement when caring for patients with chronic pain, 5) concerns about...<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>


(245) Establishment of a controlled substance advisory review consult process for patients on chronic opioid therapy
In a system where primary care providers prescribe the majority of opioids for chronic pain, there can be significant benefit in terms of continuity of care. However, there are also outsized challenges posed by the subset of patients who struggle with aberrant behaviors. To help providers address these challenges, the William S. Middleton Memorial Veterans Hospital established an Opioid Pain Care Agreement in May 2012 for all patients who are starting chronic opioid therapy. This was superseded in May 2014 by the nationally mandated VA Consent for Long Term Opioid Therapy for Pain. (Source: The Journal of Pain)


(246) Racial and ethnic disparities in pain care at a statewide federally qualified health center
To date most research on racial/ethnic disparities in chronic nonmalignant pain management has evaluated care in settings such as emergency departments, academic primary care, and post-operative settings. However, community health centers, organizations with a specific mission to provide culturally appropriate care and reduce disparities, have not been examined in this context. We hypothesized that there will be less evidence for pain care disparities in such settings. We retrospectively examined the extent to which racial/ethnic disparities occur in pain care at a statewide, Federally Qualified Health Center in Connecticut for the years 2011-2014. (Source: The Journal of Pain)


(247) Attitudes and beliefs about pain management among providers treating an economically-disadvantaged primary care population
Chronic pain is common in economically-disadvantaged, community-dwelling populations. Although most pain care is provided by primary care practitioners, little is known about their attitudes and beliefs towards pain management. We evaluated baseline data from 55 physicians, 4 nurse practitioners and 1 physician assistant participating in a study of a decision support tool for pain management in six Federally Qualified Health Centers in New York State. The sample had a mean (SD) age of 39.3 (11.0) years, 62.0% were women, and had a mean (SD) of 8.8 (9.7) years in practice. (Source: The Journal of Pain)


(248) Technology use in low income chronic pain patients
Many future advances in chronic pain management are reliant on innovations in technology. These innovations are often proposed as ways to reduce the gap in access to behavioral pain management services. As part of an ongoing comparative efficacy trial of chronic pain management groups, participants were asked questions about their ownership and use of electronics that are often used in providing behavioral healthcare. The participants are primarily low income and many live in rural locations in Alabama, thus primary targets for innovative delivery of behavioral health services. (Source: The Journal of Pain)


(251) Opioids and microglia: a murine-derived microglia stable cell line study
The development of opioid hyperalgesia following long-term opioid use is a critical impediment in treating chronic pain. Activated microglia has been identified as a critical mediator in the development of opioid hyperalgesia. The mechanism by which opioids activate microglia remains unknown. To explore this question, we used a stable cell line of mouse-derived microglial cells, which allowed us to isolate the direct effect of opioids on microglia in the absence of neurons. The BV-2 microglial cell line, derived from mouse microglial cells, was cultured in vitro. (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>


(252) Broad and highly organized changes in DNA methylation in prefrontal cortex and T cells in a model of chronic neuropathic pain in rats
In this study, neuropathic pain (or sham surgery controls) was induced in rats using the spared nerve injury (SNI). (Source: The Journal of Pain)


(254) Gene expression factor analysis differentiates pathways linked to pain, fatigue, and depression in a diverse patient sample
Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FMS) are complex and often debilitating disorders with a range of co-morbidities. Previous research using quantitative mRNA leukocyte gene expression has demonstrated CFS and FMS showed markedly different expression in a large number of individual genes in response to a moderate exercise task compared to healthy people, but differences at resting baseline were few. The major goal of this exploratory study was to examine if we could group baseline expression of genes into meaningful biological factors and if these factors were associated pain and/or depression, which is a common mood co-morbidity in CFS and FMS. (Source: The Journal of Pain)


(255) Induction of a M2 phenotype in human macrophages via CD163 gene induction using nanotechnology
Major surgeries are associated with a higher risk of developing chronic postoperative pain (CPS). We hypothesize that a more efficient wound healing process will reduce the risk of developing CPS following major surgeries. Alternatively activated macrophages (M2) are essential in the promotion of wound healing and the resolution of inflammation via CD163. We propose to use nanotechnology for CD163 gene induction in human macrophages. We used THP-1 human macrophages stimulated with lipopolysaccharide (LPS, 1 μg/ml) or interleukin (IL)-6 (50 ng/ml). (Source: The Journal of Pain)


(257) microRNA 320a is a potential mediator of chronic widespread hyperalgesia development after stress exposure
In a well-explicated animal model, widespread hyperalgesia (WH) induced by unpredictable sound stress (USS) has been shown to be mediated by increased glucocorticoid and catecholamine levels acting at the level of the peripheral nerve.1 A recent study found that circulating levels of miRNA 320a are associated with fibromyalgia,2 and in silico analyses suggest that miR-320a targets multiple transcripts associated with glucocorticoid synthesis/regulation. Based on these data, we evaluated whether (1) circulating miR-320a levels predict chronic widespread pain (CWP) and fibromyalgia development after motor vehicle collision (MVC) stress exposure in humans, (2) miR-320a is expressed in tissues relevant to identified mechanisms mediating WH induced by induced by USS (3) miR-320a regulates gluco...


(259) Exercise attenuates LPS-induced musculoskeletal hyperalgesia in mice by preventing excessive macrophage activation
Exercise is an effective method for alleviating pain symptoms in people with chronic musculoskeletal pain conditions. Macrophages are plastic mononuclear phagocytes that change their phenotype in response to the immunological microenvironment of the tissue, and release cytokines based on their phenotype. M1 macrophages release proinflammatory cytokines that promote tissue damage and hyperalgesia, whereas M2 macrophages release anti-inflammatory cytokines that promote wound healing and analgesia. (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>


(260) Vitamin D deficiency is associated with worse overall pain outcomes over time among African Americans experiencing motor vehicle collision
More than four million Americans present to the emergency department (ED) each year for evaluation after MVC. More than 90% of these individuals are discharged to home; evidence suggests that chronic musculoskeletal pain is common in this population and that rates of chronic pain development are increased in African Americans (AAs). Biological mechanisms responsible for elevated risk in AAs remain poorly understood. Vitamin D deficiency (VDD, defined as 25[OH]D plasma levels (Source: The Journal of Pain)


(261) Reduction of cytokine levels in human macrophages over-expressing CD163
Extended levels of inflammation after major surgeries contribute to the development of chronic pain. In normal wound healing, inflammatory macrophages (M1 phenotype) transition to antiinflammatory macrophages (M2 phenotype). CD163 is highly expressed in M2 macrophages, whereby CD163 seems to play a major role in the induction of M2 macrophages. We hypothesize that the genetic overexpression of CD163 in M1 macrophages will induce an earlier and efficient M2 phenotypic shift. THP-1 macrophages were stimulated with lipopolysaccharide (LPS, 1μg/mL) or interleukin-6 (IL-6, 50ng/mL) in the presence or absence of either CD163 plasmid or an empty plasmid, both conjugated with the nanoparticle polyethylenimine grafted with a mannose receptor ligand (mPEI). (Source: The Journal of Pain)


(262) Persistent changes in pain behaviors and K channel physiology in rats chronically exposed to gulf war neurotoxicants
Following their return from deployment, Gulf War (GW) veterans reported widespread joint and muscle pain at rates that far exceeded those of soldiers returning from other conflicts. The Research Advisory Committee on Gulf War Veterans’ Illnesses (GWI) identified neuroactive insecticides, repellants and nerve agent prophylactics used during the war that might have contributed to the development of GWI. In our previous work, we identified a distinction between membrane nociceptor proteins affected by acute exposure to neurotoxicants (Nav1.8) and those affected by chronic exposure (Nav1.9, Kv7). (Source: The Journal of Pain)


(264) AMPA glutamate receptors containing the GluA4 subunit are expressed in epidermal keratinocytes and may be involved in chronic itch and painful peripheral neuropathies
Epidermal keratinocytes express numerous neurosignaling molecules that were only thought to regulate cell differentiation prior to the discovery of extensive intraepidermal innervation by c- and Aδ-fibers implicated in thermal, pain, and itch sensation. Immunocytochemical and pharmacological evidence indicates that excitatory and inhibitory mechanisms are expressed in differentially stratified epidermal patterns indicating that they may transduce or modulate tactile stimuli including those implicated in pain. (Source: The Journal of Pain)


(266) TLR2 activation induces NGF gene and protein expression via NF-κB in human intervertebral disc cells
Intervertebral disc degeneration is a leading cause of chronic low back pain (LBP), but how degeneration contributes to LBP is poorly understood. Nerve growth factor (NGF) is upregulated in disc degeneration. The presence of NGF may promote disc innervation, neuronal sensitization and low back pain, making NGF a possible therapeutic target. However, the mechanisms underlying the dysregulation of NGF during degeneration are poorly understood. During disc degeneration proteoglycans and other extra-cellular matrix (ECM) proteins are degraded and fragmented. (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>


(268) Female-specific effects of a serotonin 2A receptor genetic variant on TMD pain and psychological phenotypes
Temporomandibular disorders (TMD) represent a major source of chronic orofacial pain, but their etiology is not well understood. In order to identify genetic risk factors for chronic TMD, we have examined genetic polymorphisms in two large candidate gene association studies that used case-control designs. The discovery cohort, the UNC-TMD study, included 200 chronic TMD cases and 198 pain-free controls, all of which were white females. For replication we used the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study; association analyses included 166 chronic TMD cases and 1442 healthy controls, of both sexes and varied racial backgrounds. (Source: The Journal of Pain)


(271) Behavioral and physiological effects of poor diet in mice
Obesity rates in the United States are climbing rapidly, and obesity is often comorbid with chronic pain. In many instances, obesity is a result of poor diet choices. Therefore, we utilized a cafeteria diet (CAF) and a total western diet (TWD) in separate experiments to investigate the functional and physiological consequences of poor diet in mice. The CAF was used to model human-like nutrient intake from junk foods. During ten weeks on the CAF, the mice had elevated mechanical and thermal thresholds when compared to regular diet-fed controls. (Source: The Journal of Pain)


(272) Behavioral and physiological effects of a newly-developed Sub-optimal American Diet (SAD) in rats
Approximately two thirds of the United States population is considered overweight or obese. Chronic pain and inflammation have been shown to be highly comorbid with obesity. Our previous work has shown that a cafeteria diet including typical “junk foods” and a commercially available “total western diet” caused both physiological and behavioral changes in mice. These animals showed higher levels of pro-inflammatory cytokines, higher mechanical and thermal thresholds, and a prolonged recovery period after induction of chronic inflammatory pain with Complete Freund’s Adjuvant. (Source: The Journal of Pain)


(278) GLYX-13, an N-methyl-D-aspartate functional glycine site partial agonist, is efficacious in rat surgical models of neuropathic pain
GLYX-13 is an amidated tetrapeptide (Thre-Pro-Pro-Thre-NH2) that has been shown to be a robust cognitive enhancer and antidepressant. Currently GLYX-13 is entering Phase III clinical trials for major depressive disorder. GLYX-13 was evaluated in two rat surgical models of the neuropathic pain: Chung (spinal nerve ligation) and Bennett (chronic nerve constriction). Pain responses were measured using Von Frey filaments and the Dixon up-down method. At its optimal dose level (5mg/kg, IV), GLYX-13 produced a robust analgesic effect (compared to saline vehicle) in these models 1 hr, 24 hr and 1 week following a single dose without any adverse effects. (Source: The Journal of Pain)