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


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)


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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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, 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)


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


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...


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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)


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


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...


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)


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)


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)


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


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...


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


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...


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


Headache, 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)


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


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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)


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


Nigrostriatal dopaminergic depletion 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)


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


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...


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


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)


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


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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)


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


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...


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


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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)


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


Possible 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...


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


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)


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


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)


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


Can 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)


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


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)


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


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...


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


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...


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)...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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)


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)


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 ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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...


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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)


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


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...


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


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)


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


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)


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


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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)


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


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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)


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


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)


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


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)


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


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)


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


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)


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


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)


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


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)


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)


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


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)


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


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)


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


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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)


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


Opioid 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)


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


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)


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


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...


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...


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


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)


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


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)


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


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)


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


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...


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


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)


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


Mp25-01 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)


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


Pd20-08 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)


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


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...


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


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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
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...


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 ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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...


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


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)


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...


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


Successful 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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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)


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


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...


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


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. ...


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)


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


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)


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


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)


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 ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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...


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


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...


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


Effect of 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)


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


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)


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


(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)


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


(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)


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


(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)


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


(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)


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


(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)


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


(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)


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


(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)


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


(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)


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


(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)


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


(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)


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


(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)


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


(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)


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


(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...


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


(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)


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


(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)


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


(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)


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


(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)


(279) Anatomical plasticity in spinal oxytocin fibers after peripheral nerve injury
This study focuses on oxytocin (OXY) induced inhibition after injury. Spinal OXY fibers originating in the hypothalamus terminate in the superficial laminae of the spinal dorsal horn (SDH) where OXY excites inhibitory interneurons that modulate primary afferent activity, thereby producing antinociception. (Source: The Journal of Pain)


(281) Characterization of Toll-like receptor signaling in pain and arthritis in female mice
Toll-like receptor (TLR) 4 mediates the transition from acute to chronic pain in the K/BxN model of arthritis. In this model, male WT mice reliably show tactile allodynia persisting beyond the resolution of visible inflammation. However, Tlr4-/- mice show an attenuation of the late phase of pain. As with many persistent pain conditions, women are more likely to develop RA, and the effects of TLR4 signaling may differ between the sexes. However, females are infrequently studied in pre-clinical models, and sex-specific differences in TLR signaling have not been addressed in the arthritis model. (Source: The Journal of Pain)


(282) The development of mechanical allodynia after spinal cord injury is associated with higher respiratory rate
Chronic neuropathic pain and impaired autonomic signaling are major consequences of spinal cord injury (SCI). Despite the prevalence of these maladaptive conditions, the underlying mechanisms are poorly understood. C low threshold mechanoreceptors (C-LTMRs; CT afferents in human) are unmyelinated cutaneous afferents that were recently shown to normally encode pleasant touch, although under painful conditions, they can signal mechanical allodynia. In rodents, C-LTMRs innervating hairy skin can be selectively identified by their expression of tyrosine hydroxylase (TH). (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>


(283) Correlation between preclinical end points across pain models can help suggest relevant mechanisms
Compound A, a selective, orally bioavailable, NaV1.7 inhibitor, has been evaluated in numerous rodent models of pain where mechanical hypersensitivity, thermal hypersensitivity, mechanical allodynia and spontaneous pain have been measured. These models include the complete Freund’s adjuvant model, the chronic constriction injury model, partial sciatic nerve ligation model, and the streptozotocin induced diabetic neuropathy model. Surprisingly, the relative percent reversal of each of these endpoints is highly correlated across models and doses. (Source: The Journal of Pain)


(284) Voluntary wheel running as a nonreflexive pain measure following nerve injury in mice
Chronic pain represents an immense clinical problem, with over 100 million Americans afflicted and an annual price tag exceeding half a trillion dollars. One of the major hurdles to effective translation of pain research findings is the lack of research that directly translates from animal models into human studies. Studies aligning findings from animal pain models with human physiology are therefore desperately needed. There has recently been some discussion regarding the validity of using only reflex/withdrawal measures of pain in animal studies as these endpoints may not adequately model human clinical pain. (Source: The Journal of Pain)


(286) Autoimmune mechanisms of pain in a mouse model of complex regional pain syndrome
Complex Regional Pain Syndrome (CRPS) is a painful, disabling and often chronic condition with an estimated 50,000 new cases in the US each year. While acute CRPS sometimes improves with early and aggressive physical therapy, CRPS present for a period of one year or more seldom spontaneously resolves, leaving ∼80% of patients severely disabled. Our lack of understanding of the pathophysiological mechanisms supporting this condition prevents the rational design of new therapies. The recent suggestion that CRPS may be supported by autoimmune mechanisms provides an entirely novel framework in which to study CRPS and consider new approaches to treatment. (Source: The Journal of Pain)


(285) Spinal cord-derived neural stem cells restore hyperalgesic responses previously diminished by chemical ablation of NK-1 expressing neurons in the rat spinal cord
Spinal cord injury presents with complex, of often chronic, sensory abnormalities, including numbness, paraesthesias and pain. Understanding the mechanisms underlying any one of these and developing effective therapeutics is complicated by the broad pathological changes resulting from these traumatic injuries. Here we have used a very specific cytological injury in the spinal cord to produce a limited but well-defined sensory deficit, which has then been reversed by implanting stem cells derived from adult spinal cord. (Source: The Journal of Pain)


(291) Pain catastrophizing and cytomegalovirus antibody titers in adults with chronic pain
Chronic pain is physically and psychologically stressful. Individuals with chronic pain who tend to catastrophize often report more intense pain and emotional distress. It has been suggested that catastrophizing might be related to altered immunological responses to stress and pain; however, relatively little is currently understood regarding the relationships among catastrophizing, pain, and stress-related immune function. Latent herpesvirus reactivation, which is reflected by elevated herpesvirus antibody titers, provides a window into immune function/dysregulation. (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>


(290) The effects of chronic stress on cortical responsiveness to suprathreshold heat stimuli: an fMRI study of pain-free volunteers
The overall literature suggests that chronic stress, unrelated to pain, may initiate, exacerbate, or prolong the pain experience. Chronic stress may decrease pain modulation or increase cortical responsiveness to aversive stimuli. Temporal summation (TS) is a measure of centrally-mediated pain sensitivity that presents as an increase in perceived pain intensity despite a static stimulus intensity during repeated pulses of suprathreshold heat. However, subjective ratings of pain intensity are individual-specific and may be influenced by countless physiological, psychological, and environmental factors (such as chronic stress). (Source: The Journal of Pain)


(293) Characterization of serotonin receptor subtype 7 (5-HT7) in pain and depression using novel compounds derived from marine cyanobacteria
Chronic pain and major depressive disorder are widespread conditions in the United States. Interestingly, these conditions often occur comorbidly, with each individual disease amplifying the symptoms of the other. Many medications available on the market today for treating pain or depression target G-protein coupled receptors (GPCRs), implying that this class of receptors may be involved in the treatment of the comorbidity of these conditions. Our lab has sought to characterize a poorly understood GPCR, the serotonin receptor subtype 7 (5-HT7), and the role that it plays in comorbid pain and depression. (Source: The Journal of Pain)


(294) Pain anxiety is associated with pain sensitivity even after controlling for anxiety sensitivity
Pain anxiety has sometimes been characterized as a type of “specific phobia” of pain; however, there is some question in the literature regarding the relationship between pain anxiety and anxiety sensitivity (a general sense of fear about anxiety-related symptoms (e.g., racing heart, sweating). The Pain Anxiety Symptoms Scale (PASS-40) is a 40-item scale that was developed to assess avoidance and fear of pain. Most of the research on this measure has been validation of this scale in chronic pain populations. (Source: The Journal of Pain)


(295) Impulsive decision making and experimental tonic pain
The present study investigated the effects of a laboratory model of persistent pain on an intertemporal choice task to determine whether persistent pain leads to impulsive decision making. Prior studies have observed poorer performance on risky decision-making in chronic pain individuals. We have also demonstrated that healthy individuals exposed to persistent pain tended to choose outcomes that yielded high immediate gains despite higher losses in the future compared to pain-free matched controls. (Source: The Journal of Pain)


(305) The pain and interoception imaging network (PAIN) repository: towards big data approaches to chronic pain
The PAIN repository (painrepository.org) is a newly created NIH (NIDA/NCCAM) funded neuroimaging data repository that aims to accelerate scientific discovery regarding brain mechanisms in pain and provide more rapid benefits to pain patients through the harmonization of efforts and data sharing. The PAIN Repository consists of two components, an Archived Repository and a Standardized Repository. Similar to other ‘open’ imaging repositories, neuroimaging researchers can deposit any dataset of chronic pain patients and healthy controls into the Archived Repository. (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>


(307) An fMRI analysis of cortisol and central sensitization: cortisol-induced neuroplastic alterations contributing to the transition from acute to chronic pain
Glutamate-mediated excitatory postsynaptic potentials (EPSPs) augment synaptic plasticity and amplify centrally mediated pain sensitivity (central sensitization). Upregulation of brain-derived neurotrophic factor (BDNF) during central sensitization may potentiate long-term neuroplastic alterations in pain circuitry, persistent secondary hyperalgesia, and sensitized responses to normally non-painful stimuli. A physiologic stress response and cortisol secretion during an acute pain experience may facilitate central sensitization by increasing glutamate, upregulating N-methyl-D-aspartate receptors, and prolonging calcium uptake. (Source: The Journal of Pain)


(309) Evoked brain response to fearful faces in pediatric complex regional pain syndrome (CRPS)
Complex regional pain syndrome is a chronic neuropathic pain disorder that effects many pediatric pain patients after injury, and pathways and causes have yet to be well understood. Fear of pain in these children has presented as a major challenge, which can vastly limit progress in treatment. We seek to better understand the neural underpinnings of fear processing in pediatric CRPS patients using functional magnetic resonance imaging (fMRI). We measured the evoked brain responses of youth, ages 9-20, at two time points (Time 1: admission to intensive pain rehabilitation; Time 2: two months post-discharge) using an unmasked emotional faces paradigm. (Source: The Journal of Pain)


(314) Gray matter abnormalities in chronic fatigue syndrome
The objective of this study was to re-examine global and regional GM concentrations within a separate CFS cohort. A cross-sectional study design was used, where T1-weighted magnetic resonance imaging (MRI) scans were acquired from 18 women with CFS and 15 age-sex matched controls. (Source: The Journal of Pain)


(315) Default mode network connectivity in chronic fatigue syndrome patients
The objective of this study was to compare DMN connectivity with all other brain regions between Chronic Fatigue Syndrome (CFS) patients and healthy controls. A cross-sectional study design was used, where resting state functional magnetic resonance imaging (rs-fMRI) data were acquired from 18 CFS patients and 17 age matched controls. (Source: The Journal of Pain)


(316) Elucidating brain regions engaged in strategies for real-time fMRI neurofeedback pain modulation
Real-time fMRI (rtfMRI) neurofeedback for pain modulation is still in an early developing phase. Cognitive and attention strategies can be helpful for pain coping, and strategy effectiveness can be enhanced through training. For patients with chronic low back pain, our overall goal is to effectively combine rtfMRI neurofeedback with Cognitive Regulation (CR) and Attention Regulation (AR) strategies. A preliminary step is to elucidate brain regions involved with these strategies to identify targets for feedback control of neural activity. (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>


(317) Increased neurogenic and inflammatory pain in healthy young adults with greater early life stress
Early life stress is a risk factor for chronic pain in adulthood, yet little is known about the underlying mechanisms. The purpose of this experiment was to evaluate whether healthy individuals reporting high levels of early life stress would show enhanced spontaneous pain and neurogenic flare responses to topical capsaicin. Capsaicin temporarily induces localized spontaneous pain and neurogenic inflammation by engaging mechanisms involved in neuropathic and inflammatory pain. A total of 2,625 participants were prescreened for their early life stressful events using the Early Trauma Inventory Self-report-short form (ETISR-SF). (Source: The Journal of Pain)


(318) Chronic stress, prior to pain onset, and persistent centrally-mediated pain sensitivity following an acute episode of delayed-onset muscle soreness
Managing chronic pain is an ongoing challenge for patients and clinicians, and the optimal treatment is prevention. Many patients recover from acute pain with ease, however, a subset of patients develop symptoms that persist beyond normal physiologic healing. Cortisol is an anti-inflammatory hormone that is secreted diurnally to maintain homeostasis. During acute stress, cortisol levels rise exponentially; however, chronic stress precipitates cortisol dysfunction and pervasive, unmodulated inflammation. (Source: The Journal of Pain)


(319) TRPV4-mediated puritus: the role of skin-resident cells
Chronic pruritus is a major clinical issue involving both allergic and non-allergic mechanisms. Although skin-resident cells play critical roles in skin barrier function and immune surveillance, their role in the pathogenesis of chronic pruritus is not completely understood. Here we show that transient receptor potential vanilloid 4 (TRPV4) channel is abundantly expressed by skin-resident cells including K14-positive keratinocytes and CD11b-positive dermal dendritic cells and macrophages. Activation of TRPV4-expressing skin-resident cells is sufficient to induce a robust increase in the discharge rate of nociceptive afferent fibers in mouse skin-nerve preparations and elicit an acute scratching response. (Source: The Journal of Pain)


(320) Neurotrophic factors selectively modulate scratching behavior and sensory neuron responses to pruritogens
Skin biopsies from patients with atopic dermatitis or psoriasis exhibit increased intraepidermal nerve fiber density, increased glial cell line-derived neurotrophic factor (GDNF) and artemin, and increased nerve growth factor (NGF) and its receptor TrkA. Additionally, we have recently demonstrated a selective increase in Ret+ fibers in a mouse model of dry skin itch. These data indicate that neurotrophic factors (NTFs) contribute to the development and maintenance of chronic itch. In our current studies we investigated whether NGF and the GDNF family ligands (GFLs) GDNF, neurturin, and artemin can directly induce or modulate histaminergic and non-histaminergic itch. (Source: The Journal of Pain)


(321) Role of microglia and P2X7 receptors in arthritis pain
Joint pain associated with arthritis is among the most common and debilitating chronic pain conditions. Although joint pathology is an underlying factor, some patients with severe joint degeneration report little to no pain, while others with minor joint pathology experience debilitating and unremitting pain. The discordance between pain severity and peripheral pathology of the arthritic joint suggests joint damage is not necessarily a direct predictor of ensuing chronic pain. Rather, new evidence suggests altered pain processing within the spinal cord as being a key determinant of joint pain. (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>


(324) A novel optogenetic spinal cord stimulator for wireless, bi-directional control of nociceptive circuitry in freely moving mice
Optogenetics has dramatically expanded the tools available for studying peripheral and central circuitry involved in pain. In order to realize the full potential of optogenetics for the study of pain, devices are needed which allow integration of miniaturized light sources that are minimally invasive, provide sufficient light, and allow chronic, free movement of rodents during the study of spontaneous and evoked pain behaviors. Here, we designed a highly flexible, wirelessly-powered, micro-LED spinal implant which allows optogenetic stimulation and inhibition of neurons in the spinal cord during free movement over a relatively large area. (Source: The Journal of Pain)


(325) DREADD activation of dopaminergic and glutamatergic neurons in the periaquaductal gray produces differing analgesic responses
Despite years of study, current treatments do not sufficiently treat chronic pain syndromes. Electrical brain stimulation of the periaqueductal gray (PAG) produces profound antinociception, and shows promise in treating these difficult conditions. However, this treatment can also produce intense anxiety which has limited its use. The goal of this study was to better define the complex neural circuitry in the PAG specifically responsible for the analgesic effect and hypothesized that in targeting specific neural circuits we would be able to produce analgesia without anxiety. (Source: The Journal of Pain)


(329) PARP inhibition attenuates neuroinflammation and oxidative stress in chronic constriction injury induced peripheral neuropathy
Chronic constriction injury mimics trauma induced neuropathy mainly mediated by neuroinflammation, oxidative stress and mitochondrial dysfunction. Poly ADP-ribose polymerase (PARP) inhibition has been associated with these pathways and results in various deficits in peripheral neuropathy. In the present study we investigated the effect of known PARP inhibitors 3-Aminobenzamide (3-AB) and 1,5-isoquinelinediol (ISO) against behavioral and biochemical alteration in chronic constriction injury (CCI) induced neuropathy in rats. (Source: The Journal of Pain)


(337) 24-hour high-frequency heart rate variability in chronic pain patients compared to healthy controls – A meta-analysis
A meta-analysis was conducted to investigate difference in 24-hour vagal nerve activity indexed by high-frequency heart rate variability (HF-HRV) in chronic pain patients compared to healthy controls. An extensive search of the literature revealed 55 studies that reported HRV in chronic pain patients compared to healthy controls. Only studies reporting 24-hour recordings of HF-HRV were included in the present analysis, leaving a total of 8 studies eligible for inclusion. Included studies yielded a total of 12 comparisons that were subjected to meta-analysis. (Source: The Journal of Pain)


(338) Human sensory neurons: cellular excitability, sensitization, and ion channel conductances
Biological differences in sensory processing between human and model organisms may present significant obstacles to translational approaches in treating chronic pain. Such obstacles may include functional differences in target receptor pharmacology and signaling or fundamental differences in neuronal physiology. While cultures of rodent dorsal root ganglion (rDRG) neurons have proven useful for identifying new analgesic targets and elucidating signaling pathways, notable translational failures have recently raised questions about the wisdom of developing drugs for pain relief in rodents for eventual use in humans. (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>


(339) Bidirectional optogenetic control of peripheral pain transmission with fully wireless implantable microLEDs
Chronic pain is a debilitating condition that is poorly managed by current therapeutics due to a lack of efficacy and a multitude of side effects. New approaches to manage chronic pain are desperately needed. Optogenetics affords the opportunity to nonpharmacologically control neuronal activity in pain pathways. Implementation of optogenetics for pain control will require both a light-activatable ion channel and a light source that is small and compatible with biological tissues. Hence, we have developed a fully implantable, wirelessly powered, microscale-LED (mLED) device for targeted light delivery to primary afferent fibers at the level of the sciatic nerve in combination with optogenetics. (Source: The Journal of Pain)


(346) Increasing age is associated with brain deactivation and decreasing pain sensitivity in older females
Sex differences in pain processing in younger adults have been well documented, with women generally reporting a higher prevalence of chronic pain and greater pain intensity than males for comparable pain conditions. Painful conditions increase with increasing age but it is unclear if these sex differences persist into older age. The purpose of this investigation was to examine the effects of sex and age on psychophysical and neurophysiological responses to pain in healthy older adults. Psychophysics: The average stimulus temperature producing mild pain was determined for each subject by delivering a thermal stimulus (in degrees Celsius; baseline=30°C) to the palm of the right hand. (Source: The Journal of Pain)


(349) Sleep disturbance and pain catastrophizing mediate the association between depression and clinical pain severity
Depression and pain have been documented to be highly comorbid, where chronic pain is a risk factor for depression and vice versa. Specifically, depression severity is a predictor of both pain severity and pain interference with daily life. Understanding the mediating factors linking depression with the experience of pain could lead to potential treatment options. We investigated this question in a sample of individuals with Temporomandibular Joint Disorders (TMJD), the most common cause of persistent orofacial pain. (Source: The Journal of Pain)


(348) Gender differences in the relationship between social support and pain in healthy older adults
We examined gender differences in the relationship of SS and several psychological factors with pain in healthy older adults. Participants (N=155; mean age = 66.3 [SD 6.9]; 52% male; 79% White) completed the Interpersonal Support Evaluation List, Beck Depression Inventory, Beck Hopelessness Scale, and Short-Form 36 Health-related Quality of Life questionnaire to measure perceived social support, depressive symptoms, hopelessness, sleep problems, and bodily pain, respectively. (Source: The Journal of Pain)


(353) A direct role of the sympathetic nervous system in chronic pain? An optogenetic approach
Despite various etiologies, common features can be found between different types of chronic pain. Among them, involvement of the sympathetic system has been shown in humans as well as in animal models of chronic pain. Interestingly, we described a robust sprouting of sympathetic fibers in the skin following neuropathy or inflammation in rodent models. These ectopic sympathetic fibers wrap around the peptidergic nociceptive fibers in the upper dermis, a region in which they are normally absent, providing a morphological substrate for autonomic/sensory interactions. (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>


(352) activation of SK channels reduces the dose of NMDA receptor antagonist needed to produce antinociception
N-methyl-D-aspartate receptor (NMDAR) antagonists have been shown to reduce mechanical hypersensitivity in animal models of chronic inflammatory pain. In the majority of clinical studies NMDAR antagonists have shown efficacy in the treatment of chronic pain, however their clinical use has been limited by a very narrow therapeutic window and the inability to adequately manage the adverse effects that can occur at therapeutic doses. Small conductance Ca2+-activated K+ channels (SK) have been shown to modulate NMDAR activity in the brain. (Source: The Journal of Pain)


(355) Zymosan-induced prostatitis induces bladder hypersensitivity via neural cross-talk
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a condition that involves the prostate, bladder, and pelvic floor, and causes symptoms that include frequent and urgent need to urinate, pain or burning when urinating, and pain radiating to the back, abdomen, and/or colorectum. The purpose of the study is to provide evidence of existing pathways in the development of organ cross-sensitization by demonstrating that bladder hypersensitivity develops following the induction of chronic prostatitis. (Source: The Journal of Pain)


356) Voluntary wheel running reverses bladder hypersensitivity and dysfunction resulting from neonatal maternal separation in female mice
Exposure to early life stress serves as a risk factor for developing chronic pelvic pain disorders that have been attributed to altered functioning of the hypothalamic-pituitary-adrenal (HPA) axis, which regulates stress response and influences the perception of pain. Voluntary exercise has been shown to attenuate molecular and behavioral changes associated with a dysfunctional HPA axis; however, the potential therapeutic benefit of exercise on early life stress-induced adult visceral hypersensitivity has not been determined. (Source: The Journal of Pain)


(357) Hypothalamic-pituitary-adrenal axis activation drives cross-sensitization following neonatal vaginal irritation in mice
Experiencing early life stress or injury increases the likelihood of developing chronic pelvic pain syndromes and concomitant dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. This has been well-described in both the gastrointestinal and urinary systems and here we provide additional evidence that reproductive organs are also susceptible to early life insult. To investigate the outcome of neonatal irritation of the vagina (NVI), female mouse pups were administered intravaginal zymosan on postnatal days 8 and 10 and assessed as adults for vaginal hypersensitivity; expression of transient receptor potential ankyrin 1 (TRPA1), vanilloid 1 (TRPV1), and corticotropin-releasing factor receptor 1 (CRF1); serum corticosterone level; mast cell degranulation; and cross-sensitization of...


(360) Pudendal nerve stimulation inhibits visceromotor responses to urinary bladder distension during concurrent treatment with acute or chronic morphine
Bilateral electrical pudendal nerve stimulation (bPNS) anecdotally reduces pain in humans with pain due to interstitial cystitis (IC) and we have reported that it reduces bladder hypersensitivity in rat models. Concomitant medication use can alter responses to neuromodulation and so prior to the development of a clinical trial, the interaction between opioid medication use and acute bPNS was examined. Bladder hypersensitivity was produced by neonatal bladder inflammation in rats pups coupled with a second inflammatory insult as an adult. (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>


(362) Combined serotonin and norepinephrine reuptake inhibition reduces the effects of stress on post-injury pain behaviors in a rat model of burn injury
Even with currently available medications, moderate or severe pain after burn injuries is typical and remains a major clinical challenge. There is an urgent need for improvement in the understanding of mechanisms that mediate pain after thermal burn injury in order to reduce patient suffering and enhance recovery. Previous studies suggest that stress may exaggerate pain processing, reduce sensitivity to pain therapeutics, and increase the probability of developing chronic post-burn pain. However, the potential influence of stress has not been incorporated into animal models of thermal burn injury. (Source: The Journal of Pain)


(367) Intrathecal morphine infusion therapy in management of cancer and chronic pain: present and future in Korea
Intrathecal morphine pump (ITMP) infusion therapy is an efficient treatment for malignant and nonmalignant chronic pain refractory to standard treatment. However, ITMP is characterized by high cost, which is the greatest economic barrier for the initiation of ITMP infusion therapy. According to the revised Korean reimbursement guideline, we investigated the cost effectiveness of intrathecal morphine infusion therapy and conducted survey in patients implanted with an ITMP and those scheduled to be implanted with an ITMP. (Source: The Journal of Pain)


(373) Ultrasound-guided genicular nerve block for persistent knee pain after knee surgery
A 45 year old male with chronic left knee pain initially due to patellar tendonitis underwent two arthroscopic knee surgeries. The second surgery relieved his original left knee pain. However, afterwards he developed a different pain in the same knee which located more anterolateral and was sharper than his previous achy pain. Multiple intraarticular knee injections and a saphenous nerve block did not alleviate the pain during local anesthetic phase. A popliteal fossa sciatic nerve block did provide temporary 100% analgesia but pulsed radiofrequency (pRF) modulation of the sciatic nerve brought no durable benefit. (Source: The Journal of Pain)


(375) Incorporating high frequency repetitive transcranial magnetic stimulation as a routine therapy for migraine headache: a case series
Transcranial magnetic stimulation (TMS) has been developed as a non-invasive therapeutic modality to treat migraine headache. Single-pulse TMS (sTMS) is established as an effective abortive therapy for migraine with aura. Repetitive TMS (rTMS) can work as prophylactic therapy in the management of chronic migraine. This case series investigates the clinical feasibility of utilizing repeated sessions of rTMS as prophylactic and maintenance therapy in patients with refractory migraine headache. A total of 7 patients (age range 31-64 years) meeting the international criteria of migraine with aura (4 patients) or without aura (3 patients) were included. (Source: The Journal of Pain)


(376) The effect of LFTMS on TENS related neuronal functional changes
After peripheral nerve injury fast conducting large myelinated A-beta afferent firing diminished over time, whereas smaller pain transmitting fibers including A-delta and C-fibers firing enhanced. This aberrant afferent neuronal behavior is thought to be one of the main neuronal mechanisms leading to the development of chronic post-traumatic peripheral neuropathic pain (PTP-NP). Recently the use of non-invasive dynamic magnetic flux stimulation has been implicated in treating PTP-NP, a condition currently not being adequately addressed by other means of non-invasive but skin contact required peripheral electrical stimulation such as transcutaneous electrical stimulation (TENS). (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>


(379) Delayed presentation of an epidural abscess with resultant meningitis following an uneventful neurostimulator trial; a case report
We present a case of an epidural abscess and resultant meningitis following a neurostimulator trial. A 67 yo woman with failed back surgery syndrome and bilateral lumbar radicular pain elected to undergo said trial after several years of treatment (surgery, medication management, physical therapy, weight loss, psychological care and interventional procedures) failed to provide her with adequate analgesia. (Source: The Journal of Pain)


(381) Complete relief of pain from arachnoiditis after spinal column stimulation: a case report
We present the case of a 39 year-old female with a history of pseudotumor cerebri requiring ventriculoperitoneal (VP) shunt placement. The shunt was eventually changed to a lumbar peritoneal shunt after an infection and leak occurred. Post-operatively the patient developed persistent headaches and intense, 10/10, low back pain radiating into the legs. (Source: The Journal of Pain)


(385) Targeting KCNQ channels to prevent spinal cord injury-induced chronic pain
Chronic pain is one of the most debilitating problems caused by traumatic injury to the spinal cord (SCI). The molecular mechanisms underlying SCI-induced pain remain uncertain, severely hindering the development of effective therapies. Most research has focused on CNS mechanisms, assuming that central alterations exclusively drive chronic neuropathic pain after SCI. However, we found that contusive SCI results in a chronic increase in spontaneous activity (SA) in primary sensory neurons, and this SA is associated with hypersensitivity of withdrawal reflexes to mechanical and heat test stimuli, and with an operant measure of ongoing pain. (Source: The Journal of Pain)


(384) Targeting KCNQ channels to prevent and ameliorate paclitaxel-induced peripheral neuropathy
Paclitaxel is routinely used to treat breast cancer patients. However, paclitaxel induces toxic effects, among which peripheral sensory neuropathy accompanied by neuropathic pain is particularly severe and is often a limiting factor in treatment. Several pharmacological interventions have been proposed for paclitaxel-induced chronic pain treatment, but none have been shown to be both widely effective and without serious side effects. Recent studies indicated that the development and maintenance of peripheral neuropathy including associated pain is driven by intense, long-lasting excitation of neurons exposed to paclitaxel. (Source: The Journal of Pain)


(395) Patient-reported outcomes of disease impact and change experienced with pregabalin treatment in patients with fibromyalgia and moderate or severe baseline pain
Fibromyalgia is generally associated with widespread chronic pain. In this analysis, we used patient-reported outcomes (Patient Global Impression of Change [PGIC], Fibromyalgia Impact Questionnaire [FIQ]) to evaluate management of fibromyalgia with pregabalin. Data were pooled from five randomized, placebo-controlled clinical trials of pregabalin (8-15 weeks at 300 mg/day, 450 mg/day, or flexible dosing [300-450 mg/day]) in patients with fibromyalgia. Patients were subgrouped by moderate (mean baseline pain scores ≥4- (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>


(398) Flare of CRPS symptoms after lidocaine infusion
Lidocaine infusion has been used for a number of years to treat sympathetically maintained chronic pain conditions including complex regional pain syndrome (CRPS). Therapeutic lidocaine infusion works by desensitizing the pain pathways in both the central and peripheral nervous systems via blocking voltage-dependent sodium channels. Adverse effects for lidocaine infusion are common, ranging from general fatigue, somnolence, periorbital and extremity numbness and tingling to arrhythmias, seizures, confusion, or even death. (Source: The Journal of Pain)


(403) Pregabalin for the treatment of fibromyalgia or painful diabetic peripheral neuropathy: analysis of crossover design studies
The efficacy and safety of pregabalin for fibromyalgia (FM) or painful diabetic peripheral neuropathy (DPN) has been evaluated in multiple crossover studies. Crossover studies have inherent strengths but also methodological issues and risks, such as subject, period, carryover, and sequence effects, and treatment-by-period interactions, which may affect efficacy outcomes. The current work addresses methodological issues specifically associated with crossover studies of pregabalin. Two randomized, double-blind, two-way, placebo-controlled studies in patients with FM (A0081165, A0081275; maximum dose 450mg/day) and two in patients with DPN (A0081268, A0081269; maximum dose 300mg/day) were assessed using data visualization and meta-analytic methods. (Source: The Journal of Pain)


(405) A potential anti-inflammatory effect of low-dose naltrexone in fibromyalgia
Fibromyalgia (FM) is a chronic pain disorder of an uncertain pathophysiology, that predominantly affects females. FM is mainly characterized by widespread pain, increased sensitivity to normal physical stimuli, and fatigue. Changes in neuroimmune function, such as a shift in the microglia towards a pro-inflammatory phenotype, could be involved in the generation and maintenance of FM symptoms. The drug naltrexone has previously been shown to suppress glial activation in animal models. At low doses, naltrexone (LDN) has also been shown to be effective in reducing symptoms of FM in women. (Source: The Journal of Pain)


(406) AYX2 transcription factor decoy produces a long-term resolution of chronic pain following a single intrathecal injection by inhibiting the triumvirate of KLF6, 9 and 15 transcription factors
Chronic pain limits activity and current treatments often contribute to further reduced function, limiting their chronic usage and creating a large unmet medical need. AYX2 is a drug candidate developed specifically to interrupt the maintenance and allow the resolution of chronic pain following a single or limited number of intrathecal administrations. Chronic pain is maintained through well-orchestrated waves of gene regulation across a wide range of gene categories within the dorsal root ganglia – spinal cord network. (Source: The Journal of Pain)


(409) Chromocell's Compounds A: a novel, orally active, selective NaV1.7 inhibitor
Compound A is a novel, orally bioavailable, peripherally restrictive, selective inhibitor of NaV1.7 that is 1000x selective for the inactivated state of the channel over the resting state. Compound A is active in numerous rat and mouse models of pain and itch including the formalin model of induced pain, acetic acid writhing model, complete Freund’s adjuvant model, chronic constriction injury model, partial sciatic nerve ligation model, streptozotocin induced diabetic neuropathy model and histamine and serotonin induced itch models. (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>


(412) Treatment effects of opioids versus NSAIDs prescribed from the emergency department following motor vehicle collision: the impact on pain outcomes at 6 weeks
More than four million Americans present to U.S. Emergency Departments (EDs) each year after motor vehicle collision (MVC). More than 90% of these individuals have acute musculoskeletal pain (MSP), and, while less than 5% have a fracture or require hospital admission, 20-30% transition to chronic MSP. Individuals with acute MSP after MVC are most often discharged with oral non-steroidal anti-inflammatory drugs (NSAIDs) or opioid medications, however optimal medication treatments are poorly defined and the influence of acute medication choices on post-MVC pain trajectory are unknown. (Source: The Journal of Pain)


(421) CR845, a novel peripherally-acting kappa opioid receptor agonist, has low abuse potential compared with pentazocine
This study examined the relative abuse potential of CR845 compared to placebo or pentazocine, a schedule IV opioid analgesic. Recreational polydrug users with experience with opioids and hallucinogenic agents were enrolled in this single-center, randomized, double-blind, active- and placebo-controlled study. Thirty-nine subjects received a single bolus IV dose of the following 4 treatments in random order: CR845 5 mcg/kg (therapeutic dose), CR845 15 mcg/kg (supra-therapeutic dose), placebo, and pentazocine 0.5 mg/kg. (Source: The Journal of Pain)


(420) Implications of Opioid Induced Hyperalgesia (OIH) in lower back pain patients
We examined whether opioid therapy induced psychophysical changes consistent with hyperalgesia in patients with chronic low back pain. This interim analysis included twenty subjects between the ages of 29 and 75 with a primary diagnosis of chronic low back pain (any type) enrolled in an IRB-approved observational study. A lab standard Morphine Milligram Equivalency (MME) conversion was developed and used to compare opioid doses between subjects. (Source: The Journal of Pain)


(427) Negative affect and functional status predict opioid analgesic effects on chronic pain: evidence for endogenous opioid mediation
Negative affect may be associated with opioid analgesic effectiveness. Studies in the acute post-operative pain context consistently report that elevated negative affect is linked to greater opioid analgesic requirements. Virtually no work has examined these issues in the chronic pain context, and possible underlying mechanisms have not previously been explored. We evaluated whether negative affect and functional status are associated with subsequent analgesic responsiveness to morphine, and whether endogenous opioid mechanisms mediate these associations. (Source: The Journal of Pain)


(426) Genetics and drug response: study on the role of genetics in analgesic response variations in chronic pain patients taking hydrocodone
This study included 1219 pain subjects (males 509, females 710) across 30 Clinical research sites in the US. The analgesic effect of the hydrocodone was recorded using the Proove Medication Efficacy Differentiation (MED) Scale (A scale of 1-5 to measure efficacy of a drug). (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>


(428) Opioid poisonings in Washington state Medicaid: trends, dosing, and guidelines
Fatal and non-fatal opioid poisonings (overdoses) have increased as opioid prescriptions and doses have increased. To reduce opioid poisonings, the Washington (WA) State Interagency Guideline on Opioid Dosing for Chronic Non-Cancer Pain was released in March 2007. These opioid guidelines focus on doses above 120 mg/day morphine equivalent dose (MED) in patients on chronic opioid therapy. However, if opioid poisonings occur in individuals who do not have high prescribed doses and who are not chronic opioid users, guidelines may need revision. (Source: The Journal of Pain)


(429) Use of an electronic pain and opioid risk assessment program to promote reporting and benefit treatment among chronic pain patients
Although opioid analgesics are recognized as indispensable for the relief of pain, the detrimental effects of prescription opioids have been shown to outweigh the benefits among some individuals. In accordance with the FDA’s recommendation to implement Risk Evaluation and Mitigation Strategies (REMS) for certain opioid analgesics, an electronic reporting assessment known as the Pain Assessment Interview Network: Clinical Advisory System (painCAS) was developed. PainCAS captures demographic information, pain evaluation, and quality-of-life variables. (Source: The Journal of Pain)


(430) Long-term opioid users with chronic non-cancer pain: differences between patients with and without diagnosed alcohol abuse or dependence
The primary objectives of this study were to compare patient characteristics and opiate overdose, accident, and injury rates among chronic non-cancer pain (CNCP) patients on long-term opioid treatment with and without prior diagnosis of alcohol abuse or dependence (AAD). Using MarketScan claims databases (2006-2012), CNCP patients, aged ≥18, with ≥90 days’ opioid supply after the first pain diagnosis were identified. Continuous enrollment 12 months prior to pain diagnosis (pre-period) and 12 months after opioid start (post-index) was required. (Source: The Journal of Pain)


(431) Trends in opioid dosing among medicaid patients in Washington State
We report here on opioid dosing in the WA Medicaid fee-for-service population for all those adults with a paid claim for an opioid prescription between 4-1-2006 and 12-31-2010 (N=273,200). (Source: The Journal of Pain)


(433) Polypharmacy, opioid use, and chronic widespread pain: a secondary analysis of clinical trial data
Fibromyalgia (FMS), a chronic widespread pain syndrome that has no known etiology, coincides with other life-altering symptoms that include fatigue, mood disturbances, non-restorative sleep and muscle stiffness. Despite multiple medication classes typically used for the treatment of FMS, there few studies assessing the efficacy of polypharmacy on symptoms of pain in this patient population. While analgesic medications, including opioid or opioid-like medications, are commonly prescribed, the use of these medications for FMS has not been fully described, including potential incidence of analgesic overuse. (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>


(432) Predictors of prescription opioid therapy in patients with chronic pain and a history of substance use disorder
This study examined correlates of receipt of prescription opioid therapy in 214 patients with a SUD history receiving care at one Veterans Health Administration (VHA) medical center. Participants had one or more recent chronic non-cancer pain diagnoses documented in their VHA electronic medical records. (Source: The Journal of Pain)


(435) Reducing opioid misuse among chronic pain patients in primary care
This study investigated interventions designed to reduce opioid misuse and improve provider confidence in managing patients with chronic noncancer pain through the use of risk assessment, specialty support, and summary reports. Fifty-six PCPs and 253 chronic pain patients were recruited into the study. Patients were randomized to receive either comprehensive, team-based pain services (experimental group) or standard of care. (Source: The Journal of Pain)


(437) Efficacy and tolerability of BEMA buprenorphine in opioid-experienced patients with moderate-to-severe chronic low back pain: primary results from a phase 3, enriched-enrollment, randomized withdrawal study
BEMA®, BioErodible MucoAdhesive Buprenorphine, a buccal film form of buprenorphine, was evaluated for the management of chronic pain in a multicenter, double-blind, placebo-controlled, enriched-enrollment, randomized withdrawal study in opioid-experienced patients with moderate-to-severe chronic low back pain (CLBP) requiring around-the-clock opioid analgesia. Eligible patients (30 mg to ≤160 mg/day morphine sulfate equivalent [MSE]) had their opioid doses tapered to ≤30 mg MSE, and then underwent open-label titration to a dose of buprenorphine buccal film (range, 150-900 ug q12h) that provided adequate analgesia and was generally well tolerated for 14 days. (Source: The Journal of Pain)


(438) A 24-week extension of an open-label, long-term safety study evaluating the safety and effectiveness of once-daily, single-entity, hydrocodone in patients with chronic nonmalignant and non-neuropathic pain
HYD is a once-daily, single-entity hydrocodone bitartrate tablet formulated with abuse-deterrent properties that is under development for treatment of moderate-to-severe chronic pain. This 24-week extension of a long-term, open-label study with a 12-month maintenance period characterized the safety, effectiveness, and impact on quality of life (QoL) measures of HYD (20, 40, 60, 80, 120 mg/day) treatment in patients with moderate-to-severe chronic non-malignant and non-neuropathic pain. Evaluations included adverse events (AEs), aberrant drug behaviors, audiologic and clinical laboratory assessments, ECGs, average daily pain scores, the Brief Pain Inventory, the Short Form-36, and the MOS-Sleep-revised. (Source: The Journal of Pain)


(439) Efficacy and tolerability of BEMA buprenorphine in opioid-naive patients with moderate-to-severe chronic low back pain: primary results from a phase 3, enriched-enrollment, randomized withdrawal study
BEMA®, BioErodible MucoAdhesive Buprenorphine, a buccal film form of buprenorphine, was evaluated for the management of chronic pain in a multicenter, double-blind, placebo-controlled, enriched-enrollment, randomized withdrawal study in opioid-naive patients with moderate-to-severe chronic low back pain (CLBP) requiring around-the-clock analgesia. Patients were titrated to a dose of buprenorphine buccal film (range, 150–450 ug q12h) that was generally well tolerated and provided adequate analgesia for ≥14 days. (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>


(440) State of Washington opoioid prescription guidelines for the management of chronic non-cancer pain
Increased opioid prescription abuse, rising medication costs, and a perceived need to provide practitioners with guidance in opioid prescribing has prompted the Washington State Legislature to establish new standards of practice concerning the management of chronic non-cancer pain. Clinicians are now required to conduct a detailed physical examination and health history prior to treatment. The patient’s health record should document one or more indications for the use of pain medication in order to draft a treatment plan. (Source: The Journal of Pain)


(441) Healthcare utilization and cost differences in chronic non-cancer pain (CNCP) patients treated long-term with long-acting (LAOs), short-acting (SAOs), both, or with opioid therapy
A retrospective, cohort analysis comparing 12-month chronic-pain (CP)-related healthcare utilization and costs among adult CNCP patients initiating different long term opioid treatments - monotherapy LAOs, monotherapy SAOs, both (LAOs with SAOs), and opioid switchers - was conducted. Using MarketScan® claims databases (2006-2012) CNCP patients with ≥90 days’ opioid supply after pain diagnosis, continuous enrollment 12 months prior to pain diagnosis (pre-period) and 12 months after opioid start (post-index) were identified. (Source: The Journal of Pain)


(442) Associations between opioid use and pain-related interference in functioning among returning combat veterans
While the effectiveness of opioid analgesics for the treatment of malignant pain and acute pain states is widely recognized, the efficacy of long-term opioid use for the management of chronic, non-cancer pain remains equivocal. Debate persists about the long-term efficacy of opioids for pain, as well as their safety given potential adverse side effects. The present study compared pain outcomes among Veterans prescribed opioid analgesics to those prescribed non-opioid analgesic medications. Participants (N = 135) were personnel who had been deployed during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. (Source: The Journal of Pain)


(443) Low risk of diversion in a randomized, double-blind, placebo-controlled study of extended-release hydrocodone tablets formulated with abuse-deterrence technology for the treatment chronic low back pain
Emergency department visits and deaths related to prescription opioid misuse have increased. A single-agent (i.e., acetaminophen and ibuprofen free) hydrocodone extended-release (ER) tablet that uses CIMA® Abuse-Deterrence Technology was developed to maintain extended release properties despite misuse or manipulation for abuse by crushing or by alcohol extraction. Several abuse characteristics of this hydrocodone ER formulation were assessed in a 12-week, phase 3, randomized, double-blind, placebo-controlled, randomized-withdrawal study. (Source: The Journal of Pain)


(445) Efficacy and safety of oxycodone DETERx: results of a randomized, double-blind, placebo-controlled phase III study
Oxycodone DETERx (DETERx) is an extended-release (ER), microsphere-in-capsule, abuse-deterrent analgesic formulation designed to retain its ER properties following common tampering methods such as crushing, chewing, and preparation for intravenous (IV) injection. In a multicenter, double-blind, enriched enrollment, randomized withdrawal study, safety, tolerability, and efficacy of DETERx were compared with placebo in opioid-experienced and -naïve subjects with moderate-to-severe chronic low back pain (CLBP), requiring continuous around-the-clock (ATC) opioid 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>


(444) Treatment with naloxegol versus placebo: pain assessment in patients with noncancer pain and opioid-induced constipation
Opioid-induced constipation (OIC) is a deleterious consequence of opioid treatment in patients with chronic pain. Naloxegol is a peripherally acting mu-opioid receptor antagonist with negligible CNS penetration and is FDA-approved for the treatment of OIC in adults with chronic noncancer pain. Two phase 3 randomized, double-blind, 12-week studies investigated the effects of daily oral administration of naloxegol 12.5 or 25 mg vs placebo on pain and opioid use in outpatients with OIC and noncancer pain. (Source: The Journal of Pain)


(447) Efficacy and safety of hydrocodone extended-release tablets formulated with an abuse-deterrence technology platform for the treatment of moderate to severe pain in patients with chronic low back pain
The development of abuse-deterrent opioids is a high public priority. This phase 3 study assessed the efficacy and safety of a hydrocodone extended-release (ER) tablet formulated with CIMA® Abuse-Deterrence Technology (ADT) in patients aged 18–80 years with a ≥3-month history of moderate to severe chronic low back pain. Patients identified their analgesic dose of ER hydrocodone (i.e., stable pain relief without unacceptable adverse events [AEs]) during an open-label titration period and were randomized to receive hydrocodone ER every 12 hours at the identified analgesic dose (30–90 mg) or matching placebo during a 12-week, double-blind, placebo-controlled, randomized-withdrawal treatment period. (Source: The Journal of Pain)


(446) Evaluation of once-daily hydrocodone in patient subgroups
Chronic pain patients are a heterogeneous group with diverse demographic characteristics and medical conditions. This post-hoc analysis evaluated the treatment effectiveness and tolerability of single-entity, once-daily hydrocodone (HYD) formulated with abuse-deterrent properties in patient subgroups. The data were from an open-label, long-term study in chronic pain patients, designed to reflect pain practice in community settings. Adjustment of HYD dosage, short-acting opioid and nonopioid analgesics were allowed during study. (Source: The Journal of Pain)


(448) Safety and effectiveness of once-daily hydrocodone in patients switching from an oral morphine regimen
Opioid rotation is a strategy often used for individuals with chronic pain due to loss of effectiveness of current opioids or unacceptable side effects. This post-hoc analysis evaluated the efficacy and safety of once-daily hydrocodone (HYD) in individuals rotating from oral morphine to HYD during an open-label, long-term study with a 12-month maintenance-period. HYD is a single-entity hydrocodone bitartrate tablet formulated with abuse-deterrent properties. Evaluations of effectiveness included average daily pain scores (0-10 numerical rating scale), Brief Pain Inventory pain interference subscale, and Treatment Satisfaction Questionnaire. (Source: The Journal of Pain)


(453) Ganglion impar block for chronic vulvar pain syndrome
Although chronic vulvar pain syndrome or vulvodynia is not rare, it has no known effective treatment. Vulvodynia may be a common pathway in or the ultimate outcome of several pathological processes; therefore, given the heterogeneous etiology of the disorder, one management strategy may not be adequate for all women with vulvar pain. Although the role of the sympathetic nervous system (SNS) in neuropathic pain is a controversial issue, selective sympathetic nerve blocks have been a standard treatment for chronic pain. (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>


(460) Cauda Equina Syndrome secondary to a chalk-like precipitate around an intrathecal catheter: a case report
Extramedullary intrathecal inflammatory mass formation is a rare but well documented complication of opioid administration via implanted drug delivery systems. However, we present a rare case of a chalk-like substance formed around an intrathecal catheter tip in a patient with a pain pump system causing cauda equina syndrome. Pt is a 36y/o male, w/ Klinefelter's syndrome s/p bilateral orchiectomy, subsequently developed chronic bilateral phantom testicular pain. Pain was sharp and unbearable. Several multiple interventions attempted including spermatocord blocks, radiofrequency ablations, and spinal cord stimulator system trial without any significant relief. (Source: The Journal of Pain)


(462) Placebo effects in analgesic medication trials in two chronic pain models: gender and pain disorder moderators
Placebo effects in analgesic medication trials for chronic pain are the economic bane of clinical research, yet little is known regarding factors that may influence the magnitude of these effects. Further, most placebo studies rely entirely on subjective self-report of pain and function. As part of trials of milnacipran in knee osteoarthritis (KOA; n=42) and long acting hydromorphone in low back pain (LBP; n=36), a 10 to 14 day single blind placebo lead-in was conducted. Subjects were informed they may receive active agents or placebo at any time during the trial but all subjects received placebo during the lead-in period. (Source: The Journal of Pain)


(464) Efficacy and safety of onabotulinumtoxinA for the prophylaxis of headaches in adult chronic migraine patients: an interim analysis of the prospective, long-term, multicenter, open-label study, COMPEL
Chronic migraine (CM) is a painful, debilitating disorder with few effective treatments, which are often further limited by side effects. OnabotulinumtoxinA is approved for CM headache prophylaxis and has demonstrated a favorable safety and efficacy profile; however, data are limited to 56 weeks. The longer-term efficacy and safety of onabotulinumtoxinA for CM is being investigated in COMPEL, a multicenter, open-label study in adult CM patients treated with 155U onabotulinumtoxinA every 12 weeks (NCT01516892). (Source: The Journal of Pain)


(466) Analysis of opioid-mediated analgesia in studies with methylnaltrexone for opioid-induced constipation in patients with chronic noncancer pain
Subcutaneous methylnaltrexone is efficacious and well tolerated for opioid-induced constipation (OIC). Although methylnaltrexone is a peripherally acting mu-opioid receptor antagonist, the current analysis examined potential effects of methylnaltrexone on centrally mediated opioid analgesia. Changes in pain intensity scores and opioid use in adults with chronic, noncancer pain (CNCP) were evaluated in a phase 3, randomized, double-blind, placebo-controlled trial (RCT) and an open-label safety study. (Source: The Journal of Pain)


(467) Complete relief of chronic abdominal pain after rapid detoxification of oral and intravenous opiates: a case report
We present the case of a 27 year-old female that had chronic abdominal pain since 2010 from autoimmune hepatitis, primary sclerosing cholangitis and gastroparesis. (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>


(470) Effect of environmental enrichment, associate or not to physical activity, on nociceptive and motor functions in an animal model of Fibromyalgia
This study proposes the investigation of environmental enrichment (EE), a technique based on physical, sensory and cognitive stimulation, and physical activity (PA) as strategies for fibromyalgia prevention. (Source: The Journal of Pain)


(471) Raising awareness of evidence-based physical activity programs in the community
Community resources such as evidence-based physical activity (PA) and self-management education (SME) programs, with their documented health benefits, can complement clinical care for patients with arthritis or other conditions with chronic pain. These clinical-community linkages can be strengthened by Physical Therapists (PTs) awareness of and recommending these resources to their patients. An online survey conducted with 841 PTs (response rate 11.6%) revealed that PTs are willing to recommend arthritis-appropriate evidence-based programs in the community, both during therapy and at discharge. (Source: The Journal of Pain)


(472) Adolescents' change in functional abilities after completion of an intensive chronic pain rehabilitation program using subjective measures
The purpose of this research was to evaluate subjective measures of functional improvement within a pediatric chronic pain rehabilitation setting. Information was gathered retrospectively to observe progress made from admission to discharge during a 3 week intensive multidisciplinary program. The structure of the program offers three hours of physical and occupational therapy in group and individual sessions daily, primarily focusing on therapeutic activities that will promote return to age appropriate functional level. (Source: The Journal of Pain)


(476) The use of a commonly-used digital monitoring device as a post treatment activity measure to encourage function after structured opioid tapering, a case report.
Opioid tapering has seen increased attention given that chronic opioid therapy can lead to a problematic treatment course and poor outcomes. Improvement in activity is a critical goal in this context, yet the measure of function during and after tapering has received scant attention. Technological advances now permit reliable monitoring of physical activity, where inexpensive digital interactive devices provide real-time incentives to increase movement and employ quota-based activity principles. (Source: The Journal of Pain)


(477) Duration of analgesia induced by a 15 or 30-minute application of acupuncture-like TENS on a population of patients suffering from chronic non-specific low back pain
Electrotherapy can be used as an add-on modality for patients with chronic low back pain (CLBP), where it can temporarily alleviate painful symptoms. Acupuncture-like TENS (AL-TENS) has been shown to alleviate clinical pain, but no study has yet investigated the duration and magnitude of analgesia induced by AL-TENS on population suffering from CLPB. We initially hypothesize that a 30-minutes application would induce a greater duration and magnitude of AL-TENS analgesia than a 15-minute application. (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>


(480) Disparities in gender and weight bias toward chronic low back pain patients
Research consistently demonstrates the presence of anti-fat bias in medical and health settings. Such bias may be particularly salient for female patients, as research finds a stronger weight bias against women across various contexts. The current study examined the relationship between patient gender, patient weight, and participants’ perceptions of patient pain intensity/interference, etiology (psychological influence, lifestyle factors), exaggeration, and treatment recommendation. Participants (college students; n = 87) viewed videos of female and male chronic low back pain patients in four weight categories performing a standard physical activity; level of pain behavior was standardized across videos. (Source: The Journal of Pain)


(481) Catastrophizing, pain self-efficacy, mindfulness, and acceptance: relationships and changes among individuals receiving CBT, MBSR, or usual care for chronic back pain
We examined, in an RCT comparing group CBT (n=112), MBSR (n=116), and usual care (UC; n=113) for chronic back pain: (1) baseline relationships among the Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire (PSEQ), Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), and Five Facet Mindfulness Questionnaire-short form (FFMQ-SF); and (2) pre- to post-treatment changes in these measures. (Source: The Journal of Pain)


(484) Physical activity and IL-6 related to capsaicin pain in healthy individuals
We examined the association between self-reported physical activity level (over a typical week), using the Godin Leisure-Time Exercise Questionnaire, IL-6 reactivity and response to capsaicin pain under saline and naloxone conditions. (Source: The Journal of Pain)


(486) Pain acceptance predicts indicators of distress, well-being and functioning in spinal cord injury
Chronic pain acceptance has been shown to relate to positive adaptation to chronic pain in a number of pain conditions, but very little is known about pain acceptance in individuals with spinal cord injury (SCI). The aim of this study was to examine whether pain acceptance predicts depressive symptoms as well as indicators of well-being and functioning in SCI. Thirty-one participants with chronic pain and SCI were recruited from two Midwestern medical centers as part of an ongoing study. Participants completed baseline self-report measures, including measures of chronic pain acceptance (Chronic Pain Acceptance Questionnaire; CPAQ) and pain intensity, and up to 7 days of online daily diaries that included measures of depressive symptoms, positive affect, pain interference, independence, and...


(489) Reducing disparities with literacy-adapted psychosocial treatments for chronic pain: initial exploration of feasibiity/acceptability
Cognitive behavioral therapy (CBT) has been found to be both efficacious and effective for treating chronic pain. Nevertheless, CBT and other psychosocial treatments remain underutilized, particularly among disadvantaged populations. Recent efforts have sought to increase the accessibility of psychosocial treatments by reducing literacy and cognitive load barriers. To investigate the value of these efforts, we compared patients currently enrolled in an ongoing trial (N = 64) who participated in one of two literacy–adapted 10-week psychosocial treatments. (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>


(491) Exploring the role of pain-related fear and catastrophizing in response to a virtual reality gaming intervention for chronic low back pain
Virtual reality gaming (VRG) has been successfully utilized in acute pain intervention; however, few studies have examined the application of VRG to chronic pain. Pain-related fear and catastrophizing have been associated with negative pain/functional outcomes as well as poorer treatment response across a number of chronic pain conditions. The current study examined the relationship between pain-related fear, catastrophizing, and responses to a VRG platform intended to facilitate graded exposure to avoided physical activity among 30 individuals with chronic low back pain (CLBP; 15 female) characterized by high disability and pain-related fear. (Source: The Journal of Pain)


(490) Development and preliminary evaluation of an integrated cognitive-behavior treatment for patients with Hepatitis C virus who have comorbid chronic pain and substance use disorder
Individuals with the hepatitis C virus (HCV) have high rates of chronic pain and substance use disorders (SUDs). Limited data are available on methods of treating patients with co-occurring chronic pain and SUD. We adapted an 8-session cognitive-behavior treatment (CBT) for chronic pain to include relapse prevention for SUD and recommendations for improving HCV-related health among HCV-positive patients with chronic pain and current or past SUD. Traditional CBTs for pain and relapse prevention were modified based on cross-sectional assessments of biopsychosocial factors associated with chronic pain in patients with HCV, focus groups, and preliminary testing. (Source: The Journal of Pain)


(492) Anger mediates the relationship between trauma and pain catastrophizing in chronic pain
This study explored the relationships between traumatic etiology of pain, anger, and Pain Catastrophizing Scale (PCS) scores. (Source: The Journal of Pain)


(494) Identifying and categorizing patient-generated pain treatment goals
We describe a procedure for soliciting and categorizing behavioral treatment goals among 142 adults receiving cognitive behavioral therapy for chronic low back pain (mean age=54.5; 81.7% male; 83.1% Caucasian; mean pain duration = 145.3 months; mean numeric pain intensity rating = 6.3/10). (Source: The Journal of Pain)


(495) Pain self-management in HIV-infected individuals with chronic pain: a qualitative study
Chronic pain in individuals with HIV is a common, impairing condition. Behavioral interventions for chronic pain specifically tailored to this population have yet to be developed. We assert that understanding self-management strategies already used by persons living with these conditions is an essential first step, and is the objective of this investigation. We conducted a thematic analysis of qualitative data from 25 in-depth interviews with individuals with HIV and chronic pain. The primary pain self-management strategies articulated by participants were: physical activity; cognitive and spiritual strategies; spending time with family and friends and social support; avoidance of physical/social activity; medication-centric pain management; and substance use. (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>


(498) The effects of daily fluctuations in interpersonal stress on mood: the moderating role of depression in chronic pain
Depression among individuals with chronic pain contributes to poorer adaptation, including increased pain and emotional reactivity to stress. Few studies, however, have evaluated whether co-morbid depressive symptoms moderate stress-related changes in daily positive and negative affect in the context of managing a chronic pain condition. Examine the moderating role of depressive symptoms on the link between daily interpersonal stress and positive and negative affect in individuals with chronic pain. (Source: The Journal of Pain)


(499) Provider perspectives on the potential utility of technology-based tools in the treatment of chronic pain
Although there is a recognized need for behavioral approaches in the treatment of chronic pain, a number of systemic barriers, such as limited payer reimbursement, have hindered their widespread implementation. Technology-based tools are a promising means to help address this need, yet sustaining user engagement with e-Health tools remains a persistent challenge, and there is a need for research to identify new ways of increasing patients' uptake of and engagement with these tools. A pilot study was conducted to explore the perspectives of pain specialty providers regarding how to optimize pain patients' engagement with technology-based behavioral interventions and promote broader implementation of such tools in chronic pain care. (Source: The Journal of Pain)


(500) The role of perceived injustice in chronic pain in a clinical pediatric sample
Upwards of 35% of children and adolescents experience chronic pain. Expectations and beliefs about the self and the environment may play a critical role in the pain experience. The idea that the world is a just and fair place is a commonly held belief among the general population; when that belief is violated, feelings of injustice can emerge. In adults with chronic pain, recent research found that perceived injustice augmented the relationship between pain intensity and depressive symptoms and, thus, may be a possible focus for intervention efforts. (Source: The Journal of Pain)


(501) Pain-related fear is associated with pain and functional outcomes in a level-I trauma sample
Pain-related fear – the belief that one’s pain is indicative of harm or (re)injury and should therefore be avoided – is associated with negative pain and disability outcomes among individuals with acute and chronic pain. To date, research on the predictive power of this construct has focused on individuals with chronic pain from benign musculoskeletal conditions. However, research suggests that patients with traumatic injuries may endorse beliefs closely associated with pain-related fear. The current study examined the relationships between pain-related fear, pain catastrophizing (a highly negative orientation toward pain closely associated with pain-related fear), and relevant measures of function in a sample of individuals admitted to a Level-I trauma center. (Source: The Journal o...


(505) A case study of response to group CBT or a potent pain education group for minority patients with chronic pain
Chronic pain is a large and growing problem facing U.S. health care in the 21st century. Current practice relies on biomedical interventions (e.g., medication/surgery), which may have severe side effects and discouraging outcomes. Psychosocial interventions are low-cost and effective with few side effects. However, uncertainty about when to use an intervention or how it may look in vivo presents difficulty to clinicians when selecting a treatment approach. In response, this poster presents a case study (n = 13) of two groups drawn from a clinical trial evaluating two novel psychosocial group treatments: Cognitive-Behavioral Therapy for chronic pain (CBT) and a potency-enhanced pain education (EDU). (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>


(506) Does personality type influence attentional bias in individuals with chronic back pain?
Theories of attention and pain predict that individuals with chronic pain will display attentional biases towards pain related information. Eysenck, however, suggested that individuals differ in their attentional biases for threat (e.g. disability and pain) as an interactive function of trait anxiety and defensiveness. Weinberger et al. suggested four personality types1 based on measures of defensiveness and trait anxiety; repressors (low anxiety/high defensiveness), low-anxious (low anxiety/defensiveness), high-anxious (high anxiety/low defensiveness) and defensive high-anxious (high anxiety/defensiveness). (Source: The Journal of Pain)


(507) Positive affect is associated with outcomes of psychosocial interventions for persons with chronic pain and disability
Positive affect has been linked to better quality of life in persons undergoing physical rehabilitation, and has been shown to buffer the negative impact of physical injury on functioning and chronic pain. However, little is known regarding the associations between changes in positive affect and improvements in other pain-related outcomes following psychosocial chronic pain interventions. To better understand the role that positive affect may play in pain treatment, we examined the associations between changes in positive affect and pain-related outcomes in a randomized controlled trial evaluating telephone-delivered cognitive-behavioral therapy versus telephone-delivered pain education for individuals with chronic pain and disability. (Source: The Journal of Pain)


(510) The effects of anxiety attachment on pain catastrophizing, recognition of emotionally ambiguous facial expression, and interpersonal problems in patients with chronic pain: Preliminary study
According to the communal coping model, pain catastrophizing is used as a means to obtain others’ support, sympathy, or attention in interpersonal situations. Previous studies have demonstrated that pain catastrophizing affects the recognition of emotional facial expressions and interpersonal problems. Recently, it has been proposed from the developmental perspective that an internal working model (i.e., attachment) formed during childhood may continue until adulthood and affect pain catastrophizing. (Source: The Journal of Pain)


(511) The role of alexithymia in pain catastrophizing and functioning among chronic pain patients in an interdisciplinary chronic pain program
Patients with disabling chronic pain display higher rates of alexithymia (the inability to process and express emotions), and pain catastrophizing, than the general population. Additionally, previous research suggests that alexithymia is predictive of poor functioning and pain catastrophizing; however, there is a paucity of research examining the contribution of alexithymia to functioning and catastrophizing over and above the effects of anxiety and depression symptoms. Using 1,073 (698 female) chronic pain patients presenting to the Cleveland Clinic Chronic Pain Rehabilitation Program (CPRP) between January 2011 and September 2014, this investigation examined characteristics of alexithymic patients and attempted to elucidate the relations between alexithymia, functioning, and catastrophiz...


(514) The relative utility of pacing and committed action for predicting adjustment to chronic pain
Pacing is defined as doing a work by diving it into pieces, or slowly or with taking breaks and controlling the pace. Pacing has not shown a consistently positive impact on adjustment to chronic pain. Recently, a psychological flexibility model of acceptance and commitment therapy was proposed as theoretical framework for supplementing such variations. Among the elements of the model, committed action indicates acting flexibly and continuing or stopping the action according to the person’s value or goal. (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>


(515) A cross-sectional survey of pain-related experiences and knowledge in emerging adults
Chronic pain is a common phenomenon in the U.S., known to occur across the lifespan (Institute of Medicine, 2011). Much remains to be learned, however, about the distribution of pain conditions in emerging adults or the knowledge that they have about pain. Greater knowledge about pain and its management can be effective for improving pain outcomes, even among at-risk individuals (Thorn et al., 2011). To improve this knowledge, we surveyed 200 emerging adults at a large public university in the geographic south about their chronic pain conditions (if present) and knowledge about pain and its management. (Source: The Journal of Pain)


(516) Improving coping skills and functional biomechanics in teens with Juvenile Fibromyalgia: the Fibromyalgia Integrative Training Program for Teens (FIT Teens)
Juvenile Fibromyalgia (JFM) is a chronic widespread musculoskeletal pain condition often accompanied by fatigue, coping difficulties, and physical activity (PA) avoidance. Symptom management is challenging given pain and associated fears of movement dissuade adherence to prescribed regular physical exercise. Poor body mechanics and decreased strength are purported to exacerbate the PA deficit in this population. Although effective in improving psychological coping, cognitive behavioral therapy (CBT) alone does not consistently improve long-term PA in adolescents with JFM. (Source: The Journal of Pain)


(517) Effect of Cognitive-Behavioral Therapy on brain connectivity supporting hyperalgesia in fibromyalgia patients
Fibromyalgia (FM) is a chronic, common pain disorder and a primary cause of disability. Cognitive-behavioral therapy (CBT) is one of the few effective long-term interventions that fosters improvement in pain outcomes via reductions in pain-related catastrophizing. Our aim was to assess CBT’s effects on brain circuitry underlying hyperalgesia in FM and explore the sequential mediational relationships between treatment-associated changes in catastrophizing and changes in the brain circuitry underlying clinical pain and hyperalgesia. (Source: The Journal of Pain)


(518) Facilitators and barriers to peer support for chronic pain self-management in veterans
This study pilot tested a 4-month peer support intervention for veterans with chronic pain (10 peers, 20 patients). Post-intervention qualitative interviews explored facilitators and barriers to peer support for veterans. Thematic analysis revealed the following results. Facilitators: 1) Shared veteran status, which provided important common ground. (Source: The Journal of Pain)


(520) Immediate benefits of a multidisciplinary educational program for fibromyalgia on patients’ pain related self-efficacy and health locus of control
Patients who suffer from fibromyalgia (FMS), a chronic biopsychosocial pain syndrome, and are uneducated about their condition have increased risk for poor outcomes. No studies have looked at the impact of brief intervention on self-efficacy and locus of control specific self-management constructs. We evaluated the effect of an intensive, brief, multidisciplinary educational program on these constructs in managing FMS. Patients and family actively participated in a 3.5 hour program involving discussion about clinical, pathophysiologic, and therapeutic aspects of FMS; exercise instruction, orientation on the cognitive behavioral model of pain and stress, review of psychosocial contributors to chronic pain, family education, and introduction to relaxation techniques. (Source: The Journal 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>


(519) Can a pediatric pain rehabilitation program achieve and maintain important health outcomes?
The impact of chronic pain can be devastating for adolescent development with school disruption, cessation of age-appropriate activities, as well as detrimental effects on mood. Pain rehabilitation efforts are in their infancy, but may be particularly effective in restoring functional status and improving adjustment for these patients. The present study examined school attendance, depressive symptoms, functional status, and use of opioids in a sample of 68 adolescents with chronic pain admitted to a 3-week structured inter-disciplinary pain rehabilitation program and at 3-month follow-up. (Source: The Journal of Pain)


(522) The effect of psychiatric comorbidities on treatment outcomes of veterans participating in an interdisciplinary chronic pain rehabilitation program
This study examined the effects of psychiatric comorbidities on veterans’ response to an interdisciplinary outpatient chronic pain rehabilitation program (OCPRP). One hundred patients who completed a VA OCPRP were randomly selected. (Source: The Journal of Pain)


(521) A multilevel path model analysis of the relations between sleep, pain, and pain catastrophizing in chronic pain rehabilitation program patients
This study found that, in patients with temporomandibular disorder, pain catastrophizing was associated with greater sleep impairments and that pain catastrophizing indirectly contributed to pain severity through its association with sleep disturbance. (Source: The Journal of Pain)


(523) Validity and predictors of patients’ global impression of change ratings following Acceptance and Commitment Therapy for chronic pain
Consensus guidelines outline patients’ global impression of change (PGIC) as an important indicator of meaningful change in treatments for chronic pain. Researchers have typically used a single PGIC item that asks patients to identify their overall improvement. However, limited research has examined the validity of this item despite its wide adoption in clinical trials. Presently, it is not clear which aspects of patients’ treatment experience are captured by this item. It is also unclear whether this general item reflects patients’ impression of change in specific outcome domains, such as pain, function, and mood, or some combination of these. (Source: The Journal of Pain)


(525) Efficacy and prediction of pain, mood, and function outcomes upon completion of an interdisciplinary chronic pain rehabilitation program.
Chronic pain renders many individuals incapacitated and increases the risk of opioid dependence throughout the lifetime course of treatment. The efficacy of an intensive non-opioid interdisciplinary chronic pain rehabilitation program (CPRP) was previously established in headache patients1 and was expanded to include a broader range of primary pain conditions in this study. Assessments of pain intensity (0-10), Depression Anxiety Stress Scale (DASS) and Perceived Stress Scale (PSS) scores (measuring mood), Pain Disability Index scores (PDI; measuring function), and coping styles, utilizing the brief COPE questionnaire were compared in 133 patients at admission versus discharge. (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>


(526) Exposure treatment of pain-related fear for children with chronic pain
Pain-related fear has been identified as an important factor that increases the likelihood of poor outcomes among individuals who experience pain. The primary objective of this study is to implement graded in-vivo exposure in children with chronic pain and examine clinically meaningful changes in our primary outcome, fear of pain, and secondary outcomes, disability and pain. Treatment is a 12-session individualized outpatient program delivered 1-2 times per week. Using a rigorous small sample randomized baseline design (baseline ranging from 7 to 21 days) we collected data at baseline, end of treatment, and 3-month follow-up. (Source: The Journal of Pain)


(530) Functional, emotional, and pain outcomes of patients with Complex Regional Pain Syndrome treated in a comprehensive interdisciplinary pain management program
This study investigated whether CRPS can be effectively treated in a comprehensive interdisciplinary pain management program. This is a retrospective chart review of 49 patients (67% female) aged 18-89 (M=39.57) years who fulfilled CRPS Budapest Criteria and completed a 4-week interdisciplinary pain management program between 2008 and 2013. Changes in physical functioning, perceived disability, emotional functioning, coping, and pain were assessed between initial visit and program completion using the following measures: Pain Disability Index (PDI), Six minute walk test (6MWT), two minute sit-to-stand (2MSTS), Numerical Rating Scale (NRS), Center for Epidemiologic Studies Depression Scale (CESD-10), Pain Anxiety Symptoms Scale (PASS-20), Chronic Pain Acceptance Questionnaire (CPAQ), and Co...


(532) Implications of pain interference on restoration of physical function for people with chronic pain
The Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) item bank and Pain Interference (PI) item bank in the chronic pain population are conceptually similar domains. We leveraged the learning health care system platform Collaborative Health Outcomes Information Registry (CHOIR) at our institution to characterize their relationships. As part of routine clinical care, patients seen at an academic medical center were enrolled in CHOIR and their PF and PI assessed using computer adaptive testing algorithm. (Source: The Journal of Pain)


(533) Functional restoration in a military chronic pain population: first year outcomes from the SAMMC Functional Restoration Program
Historically, management of loss of function due to chronic pain in the military has focused on interventional and medical treatment modalities. Recent attention has been given to interdisciplinary care for Service Members with chronic pain conditions. Functional Restoration Programs (FRPs) have been shown to be effective in the civilian sector but until recently have not been employed in military medicine. The San Antonio Military Medical Center (SAMMC) FRP is a 3 week, 8 hour per day program aimed at restoring physical and psychological function to Service Members who have been injured during their military careers. (Source: The Journal of Pain)


(534) A novel strategy to improve opioid prescribing safety in chronic pain patients: evaluation by addiction psychiatry fellow rotators
The goal of the evaluation was to assist pain providers with safe opioid prescribing. 95% of the consultations were requested by the pain fellows and NPs. Seven addiction Psychiatry fellows evaluated opioid prescribing risk in chronic pain patients at the Pain Clinic, Beth Israel Medical Center, an academic center. This one time evaluation was performed as part of their training in a once a week ½ a day session. The Chief of the Pain Division and the Director of the Addiction Psychiatry Fellowship supervised the evaluations. (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>


(535) Functional disability, anxiety, and depression in chronic pediatric headache patients
Chronic pediatric headache is becoming an increasingly prevalent pain condition in children and adolescents in the United States. It is often associated with impairment in daily functioning, including school attendance and activity limitations.1 Few studies have examined the relationship between anxiety, depression and functional disability in chronic headache patients. In pediatric patients with abdominal pain, depression predicted functional disability.2 In adults, depression and comorbid anxiety were found to be the strongest predictors of dysfunction. (Source: The Journal of Pain)


(541) Factors and mechanisms of dance/movement therapy for resilience-building in people living with chronic pain
Psychological resilience is a highly applicable concept for chronic pain management. Researchers have identified resilience-promotive-factors, such as positive emotions, self-esteem, self-efficacy, social support, hope, finding meaning, reflective skills, creativity, humor and spirituality etc. Dance/Movement Therapy (DMT) is the psychotherapeutic use of creative and expressive movement through which individuals connect to their body and mind, and process feelings and thoughts that are often inaccessible with verbal therapy alone. (Source: The Journal of Pain)


(546) “I Dare to Hope”: case report of a pain and spirituality group
Individuals with chronic pain express their pain as life-limiting. Researchers have identified spirituality as an active coping process that can affect various health outcomes. Despite this, spirituality has not been included as an active treatment component within psychotherapy groups for this population. The goal of this group was 1) to trial the feasibility of co-leading a CBT and spirituality group and 2) to help patients with chronic pain reconcile their losses, decrease their suffering, and increase an awareness of the self. (Source: The Journal of Pain)


(548) Prolotherapy treatment for Dequervain's Tenosynovitis and Intersection Syndrome
A 62-year-old female laboratory assistant presented to our clinic with chronic pain of the radial and dorsal aspect of the wrist. The pain was aggravated with an increased use of her hands, and improved with ice and anti-inflammatories. On examination, the patient demonstrated a positive Finkelstein’s test and tenderness over the radial styloid process. A musculoskeletal ultrasound evaluation performed in clinic revealed edema in the 1st dorsal compartment around the flexor pollicis longus and extensor pollicis brevis, confirming the suspicion for a diagnosis of Dequervain’s Tenosynovitis with Intersection Syndrome. (Source: The Journal of Pain)


(550) Feldenkrais method-based exercise improves quality of life in individuals with Parkinson's disease: a controlled, randomized clinical trial
This study intended to assess changes in QoL and depression in older adults with Parkinson's disease through use of the Feldenkrais method-based exercise. The study was a controlled, blinded and randomized clinical trial. The study was performed at the University Hospital of the Federal University of Sergipe in Aracaju, Sergipe, Brazil. (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>


(551) Non-drug pain strategies used by heart failure patients with chronic pain
Chronic non-cardiac pain is reported by 76% of people with chronic heart failure. Severe pain intensity is reported by 38.9%. Non-steroidal anti-inflammatory drugs increase risk for cardiovascular adverse events and therefore should not be used to treat pain in people with heart disease. Little is known about non-drug pain self-treatments used by chronic heart failure patients to treat their chronic pain. The purpose of the current research was to describe non-drug chronic pain treatments used by patients hospitalized for chronic heart failure. (Source: The Journal of Pain)


Psychological Treatments for Chronic Pain in East and Southeast Asia: A Systematic Review
Conclusion The current available literature on psychological treatments for chronic pain in East and Southeast Asia is generally small in scale, mostly preliminary and lags behind on some developments occurring in North America and Europe. Further development of treatment methods and research designs is warranted. (Source: International Journal of Behavioral Medicine)


Development and statistical optimization of nefopam hydrochloride loaded nanospheres for neuropathic pain using Box-Behnken design
Publication date: Available online 25 March 2015 Source:Saudi Pharmaceutical Journal Author(s): S. Sukhbir , S. Yashpal , A. Sandeep Nefopam hydrochloride (NFH) is a non-opioid centrally acting analgesic drug used to treat chronic condition like neuropathic pain. In current research, sustained release nefopam hydrochloride loaded nanospheres (NFH-NS) were auspiciously synthesized using binary mixture of eudragit RL 100 and RS 100 with sorbitan monooleate as surfactant by quasi solvent diffusion technique and optimized by 35 Box-Behnken designs to evaluate the effects of process and formulation variables. Fourier transforms infrared spectroscopy (FTIR), differential scanning colorimetric (DSC) and x-ray diffraction (XRD) affirmed absence of drug-polymer incompatibility and confirmed forma...


Home-use servo-ventilation therapy in chronic pain patients with central sleep apnea: initial and 3-month follow-up
Conclusions Initial and home use of ASV for 3 months resulted in significantly lower AHI, CAI, and OAI. This reduction attests to the efficacy of ASV treatment in chronic pain patients on high doses of opioids. (Source: Sleep and Breathing)


BK channel in microglia as a potent therapeutic molecular target for neuropathic pain
Conclusion These findings suggest that potent analgesic effects of S-ketamine arise from the inhibition of microglial BK channels, in addition to neuronal NMDA receptors. Thus, BK channels in microglia are a potential target for the treating of neuropathic pain. (Source: Journal of Oral Biosciences)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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)


Dysfunction of Cortical Dendritic Integration in Neuropathic Pain Reversed by Serotoninergic Neuromodulation
Publication date: Available online 26 March 2015 Source:Neuron Author(s): Mirko Santello , Thomas Nevian Neuropathic pain is caused by long-term modifications of neuronal function in the peripheral nervous system, the spinal cord, and supraspinal areas. Although functional changes in the forebrain are thought to contribute to the development of persistent pain, their significance and precise subcellular nature remain unexplored. Using somatic and dendritic whole-cell patch-clamp recordings from neurons in the anterior cingulate cortex, we discovered that sciatic nerve injury caused an activity-dependent dysfunction of hyperpolarization-activated cyclic nucleotide-regulated (HCN) channels in the dendrites of layer 5 pyramidal neurons resulting in enhanced integration of excitatory postsyn...


Chronic Giant Post-traumatic Pseudoaneurysm of the Right Ventricular Outflow Tract Associated with Penetrating Ventricular Septal Fistula
A 28-year-old man was referred to our institution with symptoms of chest pain. After physical examination, a 2-cm length scar on the left chest and a soft systolic murmur over the left sternal border were incidentally found. He had no prior history of endocarditis or cardiac surgery for congenital heart diseases. A history of chest trauma, penetration by sharp glass seven years ago, was noted. After trauma, he was immediately taken to a small district hospital and underwent a debridement and suture. (Source: International Journal of Cardiology)


Purpura in the Duodenum
Question: A 71-year-old white man was admitted with a chronic watery diarrhea (>10 bowel movements per day; lasting 8 weeks) and a severe weight loss (5 kg in the last 2 weeks). He denied any other symptoms, namely abdominal pain, visible blood loss, vomiting, or fever. On physical examination, the most remarkable finding was the presence of multiple, diffuse, small, palpable purpuric lesions in both legs with coalescing lesions (FigureA). No peripheral edema was noted. Laboratory demonstrated a mild normocytic anemia (hemoglobin, 9.4 g/dL), slightly elevated coagulation tests (International Normalized Ratio, 1.3), elevated erythrocyte sedimentation rate (ESR; 68 mm/h), and a low serum albumin level (2.2 g/dL). (Source: Gastroenterology)


Patient-Reported Outcomes as Diagnostic Tools and Clues in Chronic Wounds: Considerations for Practice
Conclusion Patient-reported outcomes are mandatory for the diagnostic work-up of chronic wounds. They also provide essential information in the course of disease, can be diagnostic clues for non-adherence and treatment failures and reflect patient orientation in treatment. Measurement of many PRO parameters in wound disease, such as health-related quality of life and pain, is facilitated by validated instruments, which are recommended for practice. (Source: Wound 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>


Neuropsychiatric and cardiometabolic comorbidities in patients with previously diagnosed Cushing's disease: a longitudinal observational study
Introduction Only few studies have systematically investigated neuropsychiatric aspects in patients with Cushing's disease (CD). Pain syndromes have been described in patients with pituitary adenomas, but so far no systematical investigation has been conducted in patients with CD. Additionally, CD has an association with cardiometabolic comorbidities which ultimately leads to increased morbidity and mortality. Long-term treatment of the hypercortisolic state cannot prevent the persistence of an unfavourable cardiometabolic risk profile. Finally, chronic hypercortisolism is known to impact the health-related quality of life (HRQoL). We aim to systematically investigate the neuropsychiatric and cardiometabolic comorbidities, as well as assess the HRQoL, in patients with previously diagnosed ...


Home-use servo-ventilation therapy in chronic pain patients with central sleep apnea: initial and 3-month follow-up.
CONCLUSIONS: Initial and home use of ASV for 3 months resulted in significantly lower AHI, CAI, and OAI. This reduction attests to the efficacy of ASV treatment in chronic pain patients on high doses of opioids. PMID: 25813356 [PubMed - as supplied by publisher] (Source: Sleep and Breathing)


Single-incision Laparoscopic Cholecystectomy with an Additional Needle Grasper: A Novel Technique.
CONCLUSIONS: SILCAN is a safe and feasible alternative to SILC which does not compromise the qualities of CLC. It is less technically challenging, and postoperative pain and cosmesis are comparable to those of conventional SILC. PMID: 25797875 [PubMed - in process] (Source: Journal of Nippon Medical School)


Obesity, Smoking, Drinking, Depression: All Linked to Low Back Pain
Title: Obesity, Smoking, Drinking, Depression: All Linked to Low Back PainCategory: Health NewsCreated: 3/25/2015 12:00:00 AMLast Editorial Review: 3/26/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


[18F]-fluorodeoxyglucose positron emission tomography of the cat brain: a feasibility study to investigate osteoarthritis-associated pain
This study indicates that 18FDG-PET brain imaging in cats is feasible in investigating CNS changes related to chronic pain. The results also suggest that OA is associated with sustained nociceptive inputs and increased activity of the descending modulatory pathways. (Source: The Veterinary 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>


Altered nociception in mice with genetically induced hypoglutamatergic tone
Publication date: 7 May 2015 Source:Neuroscience, Volume 293 Author(s): V. Kayser , F. Viguier , M. Melfort , S. Bourgoin , M. Hamon , J. Masson Extensive pharmacological evidence supports the idea that glutamate plays a key role in both acute and chronic pain. In the present study, we investigated the implication of the excitatory amino acid in physiological nociception by using mutant mice deficient in phosphate-activated glutaminase type 1 (GLS1), the enzyme that synthesizes glutamate in central glutamatergic neurons. Because homozygous GLS1−/− mutants die shortly after birth, assays for assessing mechanical, thermal and chemical (formalin) nociception were performed on heterozygous GLS1+/− mutants, which present a clear-cut decrease in glutamate synthesis in central neurons. As...


Intracranial hemorrhage after tooth extraction in a patient with chronic disseminated intravascular coagulation
Publication date: Available online 9 March 2015 Source:Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Author(s): Takuya Naganawa , Kosuke Sakuma , Abhishek Kumar , Satoshi Fukuzawa , Toshihiro Okamoto , Tomohiro Ando Disseminated intravascular coagulation (DIC) is a condition causing severe bleeding, which requires hemostatic measures be taken after surgical treatment. However, there is no clear method to assess coagulation and bleeding after surgical treatment. Here, we describe a rare case of intracranial hemorrhage after tooth extraction in a patient with chronic DIC associated with aortic dissection. A 76-year-old Japanese male reported spontaneous pain in the upper front teeth region. Tooth extraction was performed based on a diagnosis of severe periodontitis. Fo...


Functional gastrointestinal disorders are associated with the joint hypermobility syndrome in secondary care: a case–control study
Conclusions & InferencesJHS is significantly associated with FGID, and this subgroup of patients have increased comorbidity and decreased QOL. Further research is required to understand the pathophysiological basis of this association. The prevalence of joint hypermobility syndrome (JHS) in patients with Functional gastrointestinal disorders (FGID) has not been studied prospectively. In patients presenting to secondary care GI clinics, JHS is more common in patients with FGID in comparison to those with organic GI disorders; JHS is most‐significantly associated with functional gastroduodenal disorders, specifically postprandial distress syndrome. Patients with overlapping JHS and FGID have a phenotype characterized by increased chronic pain, somatic sensitivity, autonomic symptoms, ...


Involvement of phosphatase and tensin homolog deleted from chromosome 10 in rodent model of neuropathic pain
Conclusions: These findings demonstrate that PTEN plays a key, beneficial role in a rodent model of neuropathic pain. (Source: Journal of Neuroinflammation)


Gastrointestinal and nutritional issues in joint hypermobility syndrome/ehlers–danlos syndrome, hypermobility type
Gastrointestinal involvement is a well known complication of Ehlers–Danlos syndromes (EDSs), mainly in form of abdominal emergencies due to intestinal/abdominal vessels rupture in vascular EDS. In the last decade, a growing number of works investigated the relationship between a wide spectrum of chronic gastrointestinal complaints and various EDS forms, among which the hypermobility type (a.k.a. joint hypermobility syndrome; JHS/EDS‐HT) was the most studied. The emerging findings depict a major role for gastrointestinal involvement in the health status and, consequently, management of JHS/EDS‐HT patients. Nevertheless, fragmentation of knowledge limits its impact on practice within the boundaries of highly specialized clinics. In this paper, literature review on gastrointestinal mani...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Anxiolytic-like effects of translocator protein (TSPO) ligand ZBD-2 in an animal model of chronic pain
The activation of Translocator protein (18 kDa) (TSPO) has been demonstrated to mediate rapid anxiolytic efficacy in stress response and stress-related disorders. This protein is involved in the synthesis of endogenous neurosteroids that promote γ-aminobutyric acid (GABA)-mediated neurotransmission in the central neural system. However, little is known about the functions and the underlying mechanisms of TSPO in chronic pain-induced anxiety-like behaviors. The novel TSPO ligand N-benzyl-N-ethyl-2-(7,8-dihydro-7-benzyl-8-oxo-2-phenyl-9H-purin-9-yl) acetamide (ZBD-2) was used in the present study. We found that ZBD-2 (0.15 or 1.5 mg/kg) significantly attenuated anxiety-like behaviors in mice with chronic inflammatory pain induced by hindpaw injection of complete Freund’s adjuvant (CFA)....


WITHDRAWN: Interventions for treating chronic pelvic pain in women.
CONCLUSIONS: The range of proven effective interventions for chronic pelvic pain remains limited and recommendations are based largely on single studies. Given the prevalence and healthcare costs associated with chronic pelvic pain in women, randomised controlled trials of other medical, surgical and psychological interventions are urgently required.Chronic pelvic pain is common in women in the reproductive and older age groups and it causes disability and distress that result in significant costs to health services. The pathogenesis of chronic pelvic pain is poorly understood. Often investigation by laparoscopy reveals no obvious cause for the pain. There are several possible explanations for chronic pelvic pain including undetected irritable bowel syndrome, and central sensitisation of t...


A Rational Cannabis Policy: The Pain Medicine News Report
(MedPage Today) -- A stepped-care program, and a new direction for chronic noncancer pain. (Source: MedPage Today Primary Care)


Medical utilization and costs with chronic pain in COPD
Roberts MH, Mapel DW, Thomson HN (Source: ClinicoEconomics and Outcomes Research)


Take a multidisciplinary approach when managing chronic noncancer pain in paediatric patients
Abstract Optimal management of chronic noncancer pain in paediatric patients requires a multidisciplinary approach, with medications forming an important part of therapy. There is limited clinical evidence to support the use of specific medications in children with chronic pain, with most drugs being used off-label. (Source: Drugs and Therapy Perspectives)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Controlled Trial Comparing Transforaminal Lumbar Interbody Fusion and Uninstrumented Posterolateral Fusion in the Degenerative Lumbar Spine
Conclusions The results of the current study support the use of TLIF rather than uninstrumented PLF in the surgical treatment of the degenerative lumbar spine. The less optimal outcome after uninstrumented PLF may be explained by the much higher reoperation rate.[...]Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents  |  Abstract  |  open access Full text (Source: Global Spine Journal)


Modulation of cervical facet joint nociception and pain attenuates physical and psychological features of chronic whiplash: a prospective study
To investigate changes in clinical (physical and psychological) features of individuals with chronic whiplash associated disorder who had previously underwent cervical radiofrequency neurotomy at the time point when the effects of radiofrequency neurotomy had dissipated and pain returned. (Source: PM and R)


Chronic Obstructive Pulmonary Disease and sexual functioning among Women in Egypt
Conclusion Significant dysfunction in sexual life as attributed to symptoms of breathing difficulties and difficult sexual positions were found in a majority of the studied Egyptian female group with Chronic Obstructive Pulmonary Disease. Comparatively the healthy women group demonstrated significantly less sexual dysfunction. (Source: Egyptian Journal of Chest Diseases and Tuberculosis)


Patient–professional partnerships and chronic back pain self‐management: a qualitative systematic review and synthesis
Abstract Chronic back pain is common, and its self‐management may be a lifelong task for many patients. While health professionals can provide a service or support for pain, only patients can actually experience it. It is likely that optimum self‐management of chronic back pain may only be achieved when patients and professionals develop effective partnerships which integrate their complementary knowledge and skills. However, at present, there is no evidence to explain how such partnerships can influence patients' self‐management ability. This review aimed to explore the influence of patient–professional partnerships on patients' ability to self‐manage chronic back pain, and to identify key factors within these partnerships that may influence self‐management. A systematic revie...


Evaluation of Analgesic Effects of Ketamine through Sub-Dissociative Dosing in the Emergency Department
Effectively managing pain is known to be problematic in the emergency department (ED) with up to 43% of patients suffering from oligoanalgesia [1-3]. Opioids alone are commonly inadequate at controlling acute and acute on chronic pain in the ED [4-6]. Furthermore, utilizing higher doses or more potent opioids may be challenging in some patients due to the risk of adverse effects such as somnolence, respiratory and hemodynamic depression, nausea, and vomiting [7-12]. (See Table 1.) (Source: The American 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>


The ventral portion of the anterior pretectal nucleus controls descending mechanisms that initiate neuropathic pain in rats.
This study examines whether the cell lesion by injecting N-methyl-D-aspartate into the dAPtN or vAPtN changes the withdrawal threshold of a rat hind paw during different phases of the tactile hypersensitivity induced by a chronic constriction injury (CCI) of the contralateral sciatic nerve. The number of Fos immunoreactive cells in the APtN was also evaluated. The rats whose vAPtN was lesioned 2 days before CCI had more intense tactile hypersensitivity 2 days after CCI than that of the control, but the groups were not different 7 days after the CCI. The rats whose vAPtN was lesioned 5 days after CCI had WTs that did not significantly differ 7 days after the CCI. The tactile hypersensitivity of the rats whose dAPtN was lesioned 2 days before or 5 days after CCI was not different from that o...


Developing a nurse-led clinic using transformational leadership.
This article explores the effects of transformational leadership in bringing about service-led improvements in health care, using the example of setting up a nurse-led acupuncture clinic to optimise the care of patients with chronic pain. Transformational leadership was used throughout the project - from the initial local planning, training and development, through to liaising with the appropriate staff and deciding on an evaluation strategy. Transformational leadership proved to be an effective way to engage and empower nurses and other members of the chronic pain team to enable them to achieve the project aims. PMID: 25804177 [PubMed - in process] (Source: Nursing Standard)


Evaluation of analgesic effects of ketamine through sub-dissociative dosing in the ED
Effectively managing pain is known to be problematic in the emergency department (ED) with up to 43% of patients with oligoanalgesia [1–3]. Opioids alone are commonly inadequate at controlling acute and acute on chronic pain in the ED [4–6]. Furthermore, using higher doses or more potent opioids may be challenging in some patients because of the risk of adverse effects such as somnolence, respiratory and hemodynamic depression, nausea, and vomiting [7–12]. (Source: The American Journal of Emergency Medicine)


Skin innervation: important roles during normal and pathological cutaneous repair.
Authors: Betty L, Aurore D, Dorothée G, Laurent M, Claire D, Alexis D Abstract The skin is a highly sensitive organ. It is densely innervated with different types of sensory nerve endings, which discriminate between pain, temperature and touch. Autonomic nerve fibres which completely derive from sympathetic (cholinergic) neurons are also present. During all the phases of skin wound healing (inflammatory, proliferative and remodelling phases), neuromediators are involved. Several clinical observations indicate that damage to the peripheral nervous system influences wound healing, resulting in chronic wounds within the affected area. Patients with cutaneous sensory defects due to lepromatous leprosy, spinal cord injury and diabetic neuropathy develop ulcers that fail to heal. In add...


Pfizer, Lilly to Resume Phase 3 Chronic Pain Program
Pfizer expects to receive a $200 million upfront payment from Lilly in accordance with their collaboration agreement (Source: PharmaManufacturing.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>


Wandering spleen with volvulus of pancreas
Abstract Abnormal location of the spleen, which is called wandering spleen, results from laxity or absence of the splenic pedicle. In the presence of an elongated splenic pedicle, torsion of the spleen or neighboring organs may occur, which results in acute or chronic abdominal pain. In this case report, we present imaging findings of a wandering spleen that manifested with volvulus of the pancreas. (Source: Journal of Medical Ultrasonics)


Spinal surgery diminishes low back pain, improves sexual function
Chronic low back pain can limit everyday activities, including sex. 70 percent of patients consider sexual activity "relevant" to their life quality, and patients who receive surgical treatment for spinal spondylolisthesis (DS) and spinal stenosis (SS) -- common degenerative conditions most often occurring in older adults -- were twice as likely to report no pain during sex. (Source: ScienceDaily Headlines)


Creating a gold standard surgical device: scientific discoveries leading to TVT and beyond
Conclusions The lecture concluded with advice to younger members. Without new paradigms, there are no randomized controlled trials, no meta-analyses, Cochrane. Indeed, no progress. Be open to new concepts. Read Kuhn’s “The Structure of Scientific Revolutions” to understand the discovery process. Examine the relationship among symptoms, ATFP, cardinal, uterosacral ligaments, and the perineal body. This is the next paradigm. Don’t disregard anomalies. Pursue them. They are the pathway to discovery. Innovation is born from challenge, not conformity. Persist, even when meeting resistance. Resistance is a sign that your discovery is important. (Source: International Urogynecology Journal)


Spinal surgery diminishes low back pain, improves sexual function
(American Academy of Orthopaedic Surgeons) Chronic low back pain can limit everyday activities, including sex. (Source: EurekAlert! - Medicine and Health)


Deep vein thrombosis: remember the mechanical causes
A 32-year-old woman presented to the emergency department with acute-onset left leg pain. Duplex ultrasound scan demonstrated an iliofemoral deep vein thrombosis (DVT). CT venogram confirmed the presence of a left-sided iliofemoral DVT and demonstrated May&ndash;Thurner syndrome (MTS; figure 1). She underwent thrombectomy and stenting and has made good recovery with no further thrombotic episodes (figure 2). MTS is a condition whereby the left common iliac vein is compressed against the lumbar vertebrae by the right common iliac artery. Chronic arterial pulsation causes intimal hyperplasia, increasing the risk of venous stasis and iliofemoral DVT. Believed to be present in around 22% of the population, it is only reported in 2%&ndash;3% of patients presenting with a lower extremity DVT.1 M...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Laparoscopic transabdominal preperitoneal approach for recurrent inguinal hernia: A randomized trial
Conclusion: In recurrent inguinal hernia, the laparoscopic and open posterior approaches are equally effective in term of operative outcome. The open preperitoneal hernia repair is inexpensive, has a low recurrence rate. Postoperative recovery is short and postoperative pain is minimal. This approach gives results far superior to those of the commonly used anterior approach. However, while laparoscopic hernia repair requires a lengthy learning curve and is difficult to learn and perform, it has advantages of less post-operative pain, early recovery with minimal hospital stay, low post-operative complications and recurrence. Trial Registration ACTRN12613001050741 (Source: Journal of Minimal Access Surgery)


Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial
ConclusionsThese results indicate that compression at MTrPs is effective to treat acute low back pain compared with compression at non‐MTrPs and superficial massage. (Source: European Journal of Pain)


Involvement of neuronal TGF‐β activated kinase 1 in the development of tolerance to morphine‐induced antinociception in rat spinal cord
Conclusions and ImplicationsTAK1 played a pivotal role in the development of morphine‐induced antinociceptive tolerance. Modulation of TAK1 activation by the selective inhibitor OZ in the lumbar spinal cord may prove to be an attractive adjuvant therapy to attenuate such tolerance. (Source: British Journal of Pharmacology)


Evidence for distorted mental representation of the hand in osteoarthritis
Conclusion. These results suggest that hand OA is associated with a distorted mental representation of the painful hand and are consistent with the idea that the pain relief offered by multisensory illusions may work via normalization of this distortion. (Source: Rheumatology)


Health-related quality of life among prescription opioid-dependent patients: Results from a multi-site study.
CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The growing focus on wellness underscores the importance of measuring quality of life in addition to substance use outcomes. Routine assessment of health-related quality of life can add an important dimension to overall evaluation of patients' treatment response. (Am J Addict 2014;XX:1 -7). PMID: 25808055 [PubMed - as supplied by publisher] (Source: American Journal on Addictions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Neurobiological studies of chronic pain and analgesia: Rationale and refinements.
Authors: Fairbanks CA, Goracke-Postle CJ Abstract Chronic pain is a complex condition for which the need for specialized research and therapies has been recognized internationally. This review summarizes the context for the international call for expansion of pain research to improve our understanding of the mechanisms underlying pain in order to achieve improvements in pain management. The methods for conducting sensory assessment in animal models are discussed and the development of animal models of chronic pain is specifically reviewed, with an emphasis on ongoing refinements to more closely mimic a variety of human pain conditions. Pharmacological correspondence between pre-clinical pain models and the human clinical experience are noted. A discussion of the 3Rs Framework (Repl...


High-Frequency SCS Raises Bar on Chronic Pain ReliefHigh-Frequency SCS Raises Bar on Chronic Pain Relief
Randomized trial results show double the pain relief and remission with an investigational high-frequency spinal cord stimulation device of those with conventional, lower-frequency SCS. Medscape Medical News (Source: Medscape Neurology and Neurosurgery Headlines)


Clinical examination findings as prognostic factors in low back pain: a systematic review of the literature
Conclusions: For most clinical tests in LBP there is not consistent evidence for an association with outcome. Centralization and non-organic signs are exceptions from that. None of the other clinical tests have been investigated in confirmatory studies and study quality is generally low. There is a need for hypothesis testing studies designed specifically to investigate the prognostic value of the clinical tests, and a need for standardization of the performance and interpretation of tests. (Source: Chiropractic and Osteopathy)


Cognitive, Psychophysical, and Neural Correlates of Vulvar Pain in Primary and Secondary Provoked Vestibulodynia: A Pilot Study
ConclusionsFindings are limited by sample size and liberal alpha values; however, future research is certainly warranted based on the preliminary findings of this study suggesting both similarities and differences between PVD1 and PVD2. Overall, women with PVD1 seem to fare worse on several pain‐related and psychosocial variables compared with women with PVD2. Sutton K, Pukall C, Wild C, Johnsrude I, and Chamberlain S. Cognitive, psychophysical, and neural correlates of vulvar pain in primary and secondary provoked vestibulodynia: A pilot study. J Sex Med **;**:**–**. (Source: The Journal of Sexual 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>


Measures Used to Assess Chronic Pelvic Pain in Randomized Controlled Clinical Trials: A Systematic Review
ConclusionWe believe the authors of clinical studies should report their results in a comprehensive way including in the outcomes of the measurement of one‐dimensional and multidimensional pain characteristics. (Source: Journal of Evaluation in Clinical Practice)


Deep Brain Stimulation of the Subthalamic Nucleus Taking the Ouch Out of Parkinson Disease
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...


Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents.
CONCLUSIONS: Psychological therapies delivered remotely, primarily via the Internet, confer benefit in reducing the intensity or severity of pain after treatment across conditions. There is considerable uncertainty around these estimates of effect and only eight studies with 371 children contribute to the conclusions. Future studies are likely to change the conclusions reported here. All included trials used either behavioural or cognitive behavioural therapies for children with chronic pain, therefore we cannot generalise our findings to other therapies. However, satisfaction with these treatments was generally positive. Larger trials are needed to increase our confidence in all conclusions regarding the efficacy of remotely delivered psychological therapies. Implications for practice and...


Development and Validation of the Athlete Fear Avoidance Questionnaire.
CONCLUSIONS:   We developed a questionnaire with good internal and external validity. The AFAQ is a scale that measures sport-injury-related fear avoidance in athletes and could be used to identify potential negative psychological barriers to rehabilitation. PMID: 25793458 [PubMed - as supplied by publisher] (Source: Journal of Athletic Training)


Colorado school confiscates student's life-saving medicine thanks to draconian prohibition laws
(NaturalNews) Twenty-three states and the District of Columbia currently recognize the vast therapeutic potential of the cannabis plant, which millions of people across the country rely on for safe relief from chronic pain, neurological disease, seizures, paralysis, sleeping disorders... (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>


Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis
Conclusion: The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials. (Source: BioMed Central)


A study to evaluate the safety of platelet-derived growth factor for treatment of osteochondral defects of the talus
Conclusion This new procedure may offer a promising alternative for the treatment of osteochondral defects. Further high-quality studies are needed to confirm these results and to analyse the long-term effects of the procedure. The clinical relevance of this study is that the procedure may provide a less invasive option with improved bone healing compared to standard techniques . Level of evidence IV. (Source: Knee Surgery, Sports Traumatology, Arthroscopy)


Cannabinoids for the Treatment of Chronic Non-Cancer Pain: An Updated Systematic Review of Randomized Controlled Trials
Abstract An updated systematic review of randomized controlled trials examining cannabinoids in the treatment of chronic non-cancer pain was conducted according to PRISMA guidelines for systematic reviews reporting on health care outcomes. Eleven trials published since our last review met inclusion criteria. The quality of the trials was excellent. Seven of the trials demonstrated a significant analgesic effect. Several trials also demonstrated improvement in secondary outcomes (e.g., sleep, muscle stiffness and spasticity). Adverse effects most frequently reported such as fatigue and dizziness were mild to moderate in severity and generally well tolerated. This review adds further support that currently available cannabinoids are safe, modestly effective analgesics that provide a...


17 Surprising Reasons You're Stressed Out
By Amanda MacMillan You're probably all too aware of the major sources of stress in your life -- money, your terrible commute, the construction workers who start jackhammering at 5 a.m. But stress and anxiety don't have to just come from obvious or even negative sources. "There are plenty of chronic strains and low-grade challenges that don't necessarily overwhelm you in the moment, but almost take more of a toll in the long run," says Scott Schieman, Ph.D., professor of sociology at the University of Toronto. These are some of unexpected reasons why you might feel anxious or agitated. By recognizing them for what they are, says Schieman, you can better prepare to cope. 1. Your Significant Other Even if you have a blissfully happy relationship with your live-in partner or spouse, you're ...


Why Loneliness Is A Growing Public Health Concern -- And What We Can Do About It
Our time has been called the "age of loneliness." It's estimated that one in five Americans suffers from persistent loneliness, and while we're more connected than ever before, social media may actually be exacerbating the problem. A new wave of research is shedding light on some of the causes and consequences of chronic loneliness, a condition that significantly raises the risk of a number of physical and psychological health problems, including heart disease and depression. For a condition that has such an enormous impact on our health and well-being, loneliness has been relatively neglected by psychologists -- but that's beginning to change. In a special section of the March 2015 issue of the journal Perspectives on Psychological Science, psychologists took stock of some of the po...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Evaluation of pain, jaw movements, and psychosocial factors in elderly individuals with temporomandibular disorder under laser phototherapy
Abstract Few studies have been carried out on the application of laser phototherapy (LPT) for treating painful temporomandibular disorder (TMD) in elderly population that is growing worldwide. The aim of the present study was to evaluate the pain, jaw movements, and psychosocial factors in ten elderly patients with painful TMD before and after LPT. All patients were evaluated before and after LPT by using the Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD) axes I and II. For pain assessment, a visual analogue scale (VAS) was used. The LPT was carried out with an GaAlAs diode laser (780 nm; spot size 0.04 cm2) in punctual and contact mode. Two settings of irradiations were applied as follows: in patients presenting myofascial pain, 10 mW, 5 J/cm2, 20 s,...


Gynaecological causes of abdominal pain
This article addresses causes of abdominal pain in pregnancy such as miscarriage, ectopic pregnancy, fibroids and urinary tract infection. In the non-pregnant female, cyclical causes of pain include primary dysmenorrhoea, endometriosis and mittelschmerz; and non-cyclical causes include pelvic inflammatory disease, ovarian cyst accidents and adhesions. An ovarian cyst accident occurs when an ovarian cyst undergoes torsion, bleeds internally or ruptures. Timely diagnosis is prudent in order to avoid ovarian infarction and hence loss of ovarian tissue, especially in a young woman. Pelvic inflammatory disease is the reason for 1 in 60 visits to GPs by women under 45 years. It has long-term consequences which include chronic pelvic pain and infertility making timely management crucial. In the U...


Prevalence and Experience of Chronic Pain in Suburban Drug Injectors
The relationship between chronic pain and addictive disorders has received increasing attention as both the use and the abuse of pharmaceutical opioids have increased. While rates of addiction among those with chronic pain seem to be no different than those in the general population (Weaver and Schnoll, 2002), it also appears that chronic pain may be more prevalent in those with substance abuse history (Jamison et al., 2000; Rosenblum et al., 2003; Warner, 2012). The relationship between pain and addiction is remarkably complex, but most research has focused on clinical populations seeking treatment for pain (Cicero et al., 2008; Krashin et al., 2012; Sehgal et al., 2012). (Source: Drug and Alcohol Dependence)


Colonic sarcoidosis: Unusual onset of a systemic disease.
Authors: Erra P, Crusco S, Nugnes L, Pollio AM, Di Pilla G, Biondi G, Vigliardi G Abstract Sarcoidosis is a multisystem chronic inflammatory condition of unknown etiology that has the potential to involve every tissue in the body. Sarcoidosis in the gastrointestinal system, and particularly the colon, is very rare. Here, we report the case of a 57-year-old man with no previous diagnosis of sarcoidosis who presented with new onset of abdominal pain and constipation. A colonoscopy revealed that the abdominal pain was caused by an obstructing lesion in the cecum-ascending colon and lacked a clear histologic diagnosis. Radiologic investigation revealed concentric wall thickening of the cecum-ascending colon with multiple satellite lymphadenopathies, highly suggestive of a malignancy. T...


The gender health gap in China: A decomposition analysis.
Authors: Zhang H, Bago d'Uva T, van Doorslaer E Abstract Around the world, and in spite of their higher life expectancy, women tend to report worse health than men until old age. Explanations for this gender gap in self-perceived health may be different in China than in other countries due to the traditional phenomenon of son preference. We examine several possible reasons for the gap using the Chinese SAGE data. We first rule out differential reporting by gender as a possible explanation, exploiting information on anchoring vignettes in eight domains of health functioning. Decomposing the gap in general self-assessed health, we find that about 31% can be explained by socio-demographic factors, most of all by discrimination against women in education in the 20th century. A more 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>


Opioids for nonmalignant chronic pain.
Authors: Woodbury A PMID: 25785871 [PubMed] (Source: Pain Physician)


Effectiveness of Electromyographic Biofeedback, Mirror Therapy, and Tactile Stimulation in Decreasing Chronic Residual Limb Pain and Phantom Limb Pain for a Patient with a Shoulder Disarticulation: A Case Report
Discussion: This case is clinically relevant to the field of physical therapy in terms of decreasing chronic residual limb pain, PLP, and improving muscular control with use of mirror therapy, biofeedback, and tactile stimulation. (Source: JPO Journal of Prosthetics and Orthotics)


Analysis of the physical aspects of quality of life of kidney recipients
CONCLUSION The kidney transplant generated improvement in all physical aspects of QOL. The factors that showed stronger correlation with the Overall QOL before the transplant were the capacity to work and pain. After the transplant, the perception of need for treatment was the factor that showed stronger correlation with the Overall QOL. OBJETIVO Identificar los principales factores de dominio físico modificados luego de trasplante renal y analizar la influencia de dichos aspectos en la percepción de la calidad de vida (CV) general. MÉTODO Estudio longitudinal, desarrollado con 63 pacientes renales crónicos, evaluados antes y después de trasplante renal, utilizando la escala de calidad de vida propuesta por la Organización Mundial de la Salud. RESULTADOS Se observó una mejora signif...


Fibromyalgia and nutrition: what news?
Authors: Rossi A, Di Lollo AC, Guzzo MP, Giacomelli C, Atzeni F, Bazzichi L, Di Franco M Abstract Fibromyalgia syndrome (FM) is a chronic, generalised pain condition usually accompanied by several associated symptoms, such as fatigue, sleep disturbance, headache, irritable bowel syndrome and mood disorders. Different medical treatments are used to treat fibromyalgia and the recent guidelines suggest that the optimal treatment consists in a multidisciplinary approach with a combination of pharmacological and non-pharmacological treatment modalities. Among non-pharmacological treatment, nutrition is a promising tool for FM patients. The aim of this review is to update the present knowledge about fibromyalgia and nutrition by means of a systematic search performed on Medline from Janu...


A randomised controlled trial comparing duloxetine and acetyl L-carnitine in fibromyalgic patients: preliminary data.
CONCLUSIONS: Although they need to be confirmed by further studies, these preliminary findings confirm the efficacy of duloxetine, and suggest that acetyl L-carnitine is also efficacious in improving depressive symptoms, pain, and the quality of life of FMS patients. PMID: 25786048 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Rheumatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Relationship between sympathetic activity and pain intensity in fibromyalgia.
CONCLUSIONS: These findings raise the theoretical possibility that in FM patients the use of anti-adrenergic agents might lessen chronic pain intensity by reducing the underlying excessive sympathetic activity. PMID: 25786044 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Rheumatology)


The rs3771863 single nucleotide polymorphism of the TACR1 gene is associated to a lower risk of sicca syndrome in fibromyalgia patients.
CONCLUSIONS: Our findings indicate a role of the TACR1 gene in the development of sicca syndrome in subjects affected with FM. PMID: 25786041 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Rheumatology)


Urological chronic pelvic pain syndrome flares and their impact: qualitative analysis in the MAPP network
Conclusions Given their negative impact, future research should focus on approaches to prevent flares, and to reduce their frequency, severity, and/or duration. Patients’ quality of life may also be improved by providing them with a sense of control over their symptoms through ready access to flare medications/therapy, and by engaging them socially. (Source: International Urogynecology Journal)


A comparison of the attitudes toward chronic low back pain in Saudi, Australian and Brazilian physical therapy students
Conclusion This is the first study to translate HC-PAIRS into Arabic language. Compared with Brazilian and Australian students, Saudi physical therapy students agreed more strongly with the notion that chronic LBP leads to impairment and disability. (Source: Journal of Taibah University Medical Sciences)


Sensing the body in chronic pain: A review of psychophysical studies implicating altered body representation
Publication date: Available online 14 March 2015 Source:Neuroscience &amp; Biobehavioral Reviews Author(s): A. Tsay , T.J. Allen , U. Proske , M. Giummarra There is growing evidence that chronic pain conditions can have an associated central pathology, involving both cortical reorganisation and an incongruence between expected and actual sensory–motor feedback. While such findings are primarily driven by the recent proliferation of neuroimaging studies, the psychophysical tasks that complement those investigations have received little attention. In this review, we discuss the literature that involves the subjective appraisal of body representation in patients with chronic pain. We do so by examining three broad sensory systems that form the foundations of the sense of physical self...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Interpretation of Urine Drug Testing Results in Patients Using Transdermal Buprenorphine Preparations for the Treatment of Chronic Noncancer Pain
ConclusionsThese data suggest that currently available urine drug tests for buprenorphine, including the more expensive LC‐MS/MS based assays, may not be sufficiently sensitive to detect the metabolites from transdermal buprenorphine patients. This study highlights the need to evaluate the value and sensitivity of urine drug tests given the wide range of buprenorphine dosing in clinical practice. These results underscore the need for additional cost benefit analyses comparing different confirmatory drug testing techniques including many commercially available drug testing options.© 2014 Wiley Periodicals, Inc. (Source: Pain Medicine)


Mixed Experiences and Perceptions of Psychological Treatment for Chronic Pain in Singapore: Skepticism, Ambivalence, Satisfaction, and Potential
ConclusionEducation for both patients and health professionals unfamiliar with psychological treatments for pain may improve access to these treatments. (Source: Pain Medicine)


Associations between Pain, Current Tobacco Smoking, Depression, and Fibromyalgia Status Among Treatment‐Seeking Chronic Pain Patients
ConclusionsCurrent smoking and positive fibromyalgia status were associated with greater pain and impairment among chronic pain patients, possibly as a function of depression. Although FM+ smokers report the most negative clinical symptomatology (i.e., high pain, greater interference) smoking does not appear to have a unique association with pain or functioning in FM+ patients, rather the effect is additive. The 38.7% smoking rate in FM+ patients is high, suggesting FM+ smokers present a significant clinical challenge. (Source: Pain Medicine)


Basal Pain Sensitivity does not Predict the Outcome of Multidisciplinary Chronic Pain Treatment
This study investigated if basal pain sensitivity predicted the outcome of a 4‐week outpatient multidisciplinary pain management program. DesignCohort study. SettingChronic pain outpatient clinic at the Department of Anesthesiology, Intensive Care Medicine and Pain Therapy of the University of Münster. MethodsBasal pain sensitivity was measured at treatment onset, using comprehensive experimental pain testing (thermal, pressure, and pinprick pain) and the pain sensitivity questionnaire. Primary (clinical pain intensity) and secondary (depression, anxiety, pain‐related disability) outcome parameters were assessed at treatment start, at discharge and 6 months later. SubjectsSixty five adult chronic pain patients with mixed pain diagnoses. ResultsThere were significant improvements in cl...


Pain Relief due to Transsacrococcygeal Ganglion Impar Block in Chronic Coccygodynia: A Pilot Study
ConclusionsGanglion impar block appears to be effective in patients who have coccygodynia resistant to conservative therapy, with high success rates and prolonged duration of effect. Controlled studies are required to reveal the mechanism of this effect. (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>


Opioid‐Induced Constipation Among Patients with Chronic Noncancer Pain in the United States,Canada,Germany, and the United Kingdom: Laxative Use, Response, and Symptom Burden Over Time
ConclusionsOIC among noncancer pain patients is a persistent and significant condition with varying utilization and response to laxatives thus increasing the ongoing burden of chronic pain.© 2014 Wiley Periodicals, Inc. (Source: Pain Medicine)


Dynamic Pain Phenotypes are Associated with Spinal Cord Stimulation‐Induced Reduction in Pain: A Repeated Measures Observational Pilot Study
ConclusionsThese findings suggest a potentially important role for dynamic pain assessment in individuals undergoing SCS, and hint at potential mechanisms through which SCS may impart its benefit. (Source: Pain Medicine)


Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study
Conclusions Mesh repair halved long-term risk of recurrence after repair for small ventral hernias without increased risk of chronic pain. (Source: The American Journal of Surgery)


N-acetyl-cysteine, a drug that enhances the endogenous activation of group-II metabotropic glutamate receptors, inhibits nociceptive transmission in humans
Conclusions: Our findings show for the first time that NAC inhibits nociceptive transmission in humans, and does the same in mice by activating mGlu2/3 receptors. These data lay the groundwork for investigating the therapeutic potential of NAC in patients with chronic pain. (Source: Molecular Pain)


Initial healthcare and coping preferences are associated with outcome 1 year after whiplash trauma: a multicentre 1-year follow-up study
Conclusions A simple nine-item measure of coping preferences is associated with the development of chronic neck pain and reduced capability to work following whiplash trauma and may be used to identify individuals at risk of poor recovery. (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>


A multi-centre randomized controlled trial comparing arthroscopic osteochondroplasty and lavage with arthroscopic lavage alone on patient important outcomes and quality of life in the treatment of young adult (18&#8211;50) Femoroacetabular impingement
DiscussionSymptomatic FAI is associated with chronic hip pain, functional limitations, and secondary osteoarthritis. Therefore, optimizing treatment has the potential to improve the lives millions of young, active persons who are diagnosed with this condition. Few orthopaedic surgical trials have similar potential to shift the paradigm of care dramatically towards (or away) from surgical bony and soft tissue interventions.Trial registrationThe FIRST trial is registered with clinicaltrials.gov (NCT01623843). (Source: BMC Musculoskeletal Disorders)


Stepped-Care Approach to Chronic Pain Improves FunctionStepped-Care Approach to Chronic Pain Improves Function
A two-step program combining analgesics, self-management strategies, and cognitive-behavioral therapy yields lasting improvement in chronic pain and function in a trial of US veterans. Medscape Medical News (Source: Medscape Medical News Headlines)


The German PASS-20 in Patients with Low Back Pain: New Aspects of Convergent, Divergent, and Criterion-Related Validity
Conclusions The results for the German PASS-20 support the original factor structure and provide evidence of satisfactory psychometric characteristics and usefulness in patients with low back pain. (Source: International Journal of Behavioral Medicine)


Here to Stay -- Living With Sickle Cell Disease
My name is Noah Alexander Williams and I am living with sickle cell anemia disease. Sickle cell isn't really a widely talked-about disease but it's so real and epic that it should be. Sickle cell anemia disease is a grasping chronic sickness that doesn't let go. Unfortunately I have it and have had it since I was born. I don't know life without sickle cell disease and therefore I don't know life without pain -- the daily aches, the crucial crises that come out of nowhere. Sickle cell is never predictable. Of course this disease has impacted my life beyond words. I've learned to cope with it. Just to be clear, sickle cell is a genetic trait. Sickle cell disease is a severe illness that occurs in people who inherit the sickle cell gene from both parents. When I was a few months old, my pe...


Physical Activity and Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Purpose: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent urologic disorder among men, but its etiology is still poorly understood. Our objective was to examine the relation between physical activity and incidence of CP/CPPS in a large cohort of male health professionals. Methods: We conducted a prospective cohort study among men in the Health Professionals Follow-up Study followed from 1986 to 2008. The study population included 20,918 men who completed all CP/CPPS questions on the 2008 questionnaire. Leisure-time physical activity, including type and intensity of activity, was measured by questionnaire in 1986. A National Institute of Health Chronic Prostatitis Symptom Index pain score was calculated on the basis of the responses on the 2008 questionnaire. Partic...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Profile of circulating microRNAs in fibromyalgia and their relation to symptom severity: an exploratory study
Abstract Fibromyalgia (FM) is characterized by generalized chronic pain and reduced pain thresholds. Disturbed neuroendocrine function and impairment of growth hormone/insulin-like growth factor-1 is common. However, the pathophysiology of FM is not clear. MicroRNAs are important regulatory factors reflecting interface of genes and environment. Our aim was to identify characteristic microRNAs in FM and relations of specific microRNAs with characteristic symptoms. A total of 374 circulating microRNAs were measured in women with FM (n = 20; median 52.5 years) and healthy women (n = 20; 52.5 years) by quantitative PCR. Pain thresholds were examined by algometry. Pain [fibromyalgia impact questionnaire (FIQ) pain] levels were rated (0–100 mm) using FIQ. Fatigue (FIQ fati...


Ulnar Collateral Ligament Injuries of the Thumb: A Comprehensive Review.
Authors: Avery DM, Caggiano NM, Matullo KS Abstract Injuries to the thumb ulnar collateral ligament (UCL) are common. Failure to address the ensuing laxity of the metacarpophalangeal joint can lead to compromised grip and pinch, pain, and ultimately osteoarthritis. Instability to valgus stress with the lack of a firm end point is a strong indicator of complete rupture of the UCL. Nonoperative treatment is reserved for incomplete ruptures of the thumb UCL. Operative intervention is typically performed for complete ruptures. Repair of acute ruptures and reconstruction for chronic injuries yield excellent results. Complications are rare and most patients show preservation of motion, key pinch, and grip strength. PMID: 25771322 [PubMed - as supplied by publisher] (Source: The Ortho...


Relative benefit-risk comparing diclofenac to other traditional non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors in patients with osteoarthritis or rheumatoid arthritis: a network meta-analysis
Conclusions: The benefit-risk profile of diclofenac was comparable to other treatments used for pain relief in OA and RA; benefits and risks vary in individuals and need consideration when making treatment decisions. (Source: Arthritis Research and Therapy)


Pericarditis
Publication date: April 2015 Source:Hospital Medicine Clinics, Volume 4, Issue 2 Author(s): Florian Foerg , Zechariah GardnerTeaser Pericarditis is acute or chronic inflammation of the pericardium. Pericarditis is a common cause of chest pain and its recognition has important clinical implications. Viral pathogens are thought to be the leading cause of pericarditis. Complications of acute pericarditis include cardiac tamponade, recurrent or chronic pericarditis, and constrictive or constrictive-effusive pericarditis. Subspecialty consultation should be considered when the diagnosis remains uncertain following initial evaluation or based on a failure to respond to treatment. Surgery may be required for recurrent symptomatic effusions or recurrent pericardial tamponade. The causes, differe...


Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life
This study examined 250 Veterans Affairs primary care patients with moderate to severe chronic musculoskeletal pain who participated in a randomized controlled pain treatment trial. Baseline data were analyzed to examine the independent associations of PTSD and major depression with multiple domains of pain, psychological status, quality of life, and disability. PTSD was strongly associated with these variables and in multivariate models, PTSD and major depression each had strong independent associations with these domains. PTSD demonstrated similar relationships as major depression with psychological, quality of life, and disability outcomes and significant but somewhat smaller associations with pain. Because PTSD and major depression have independent negative associations with pain, psyc...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Honeycomb-Like Structure in Chronic Total Occlusion Demonstrated by Frequency-Domain Optical Coherence Tomography
A 68year-old male with a history of hypertension and current smoking was admitted due to exertional chest pain. Coronary angiography (CAG) showed a chronic total occlusion (CTO) in the left circumflex artery with collateral supply from the right coronary artery (Fig. 1). PCI was performed in this lesion as patient has normal left ventricular function. After crossing the lesion with guide wire (Gaia 2nd) and micro catheter, frequency-domain optical coherence tomography (FD-OCT) (ILUMIEN™ OCT Imaging System, St Jude Medical, Inc, St Paul, Minnesota) was performed. (Source: International Journal of Cardiology)


Pain Management in Military Trauma
This article reviews current initiatives used in current conflict situations, as well as those in continued care following initial stabilization. (Source: Critical Care Nursing Clinics of North America)


Physical activity and health-related quality of life in chronic low back pain patients: a cross-sectional study
Background: The aim of the present study was to identify the relationship of physical activity (PA) and Health-Related Quality of Life (HRQoL) in patients suffering from low back pain (LBP). Methods: The present evaluation was conducted as a cross-sectional study based on baseline data of an randomized controlled trial on the effectiveness of an intervention promoting PA. Patients answered a questionnaire on domain specific PA (GPAQ) and HRQoL (EQ-5D-5 L). Furthermore, sociodemographic and indication-specific variables as well as work-related aspects were assessed. Associations of PA and HRQoL were estimated by means of regression analysis: one regression model only included domain specific PA (model 1) and a second regression model additionally included further variables (model 2). Resul...


Synthesis of a Series of Novel 3,9-Disubstituted Phenanthrenes as Analogues of Known N-Methyl-d-aspartate Receptor Allosteric Modulators
SynthesisDOI: 10.1055/s-0034-13801149-Substituted phenanthrene-3-carboxylic acids have been reported to have allosteric modulatory activity at the N-methyl-d-aspartate (NMDA) receptor. This receptor is activated by the excitatory neurotransmitter l-glutamate and has been implicated in a range of neurological disorders such as schizophrenia, epilepsy and chronic pain, and in neurodegenerative disorders such as Alzheimer’s disease. Herein, the convenient synthesis of a wide range of novel 3,9-disubstituted phenanthrene derivatives starting from a few common intermediates is described. These new phenanthrene derivatives will help to clarify the structural requirements for allosteric modulation of the NMDA receptor.[...]© Georg Thieme Verlag Stuttgart · New YorkArticle in Thieme eJournals...


Effect of orally administered gabapentin on chronic lameness in horses
Gabapentin has been used to treat chronic pain in people and small animals. To date, no study has reported its use in horses for the treatment of chronic painful conditions. The clinical effectiveness of gabapentin as an analgesic in horses with chronic lameness was evaluated in a double-blinded crossover study. Six horses with chronic lameness referable to musculoskeletal pathology were randomly assigned to one of three treatments: 5 and 10 mg/kg bwt of gabapentin, and placebo administered orally three times daily for fourteen days. (Source: Journal of Equine Veterinary 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>


Focus points in prevention actions against legal substances' abuse.
CONCLUSION: Risky alcohol drinking and smoking are still major public health problems in Slovenia and are associated with known demographic risk factors but also with some symptoms of somatoform disorders. These findings should be incorporated into the guidelines for family physicians as the important focus points for screening and intervening against legal substances' abuse in their patients. PMID: 25787211 [PubMed - as supplied by publisher] (Source: Wiener Klinische Wochenschrift)


Endoscopic or surgical intervention for painful obstructive chronic pancreatitis.
CONCLUSIONS: For patients with obstructive chronic pancreatitis and dilated pancreatic duct, this review shows that surgery is superior to endoscopy in terms of pain relief. Morbidity and mortality seem not to differ between the two intervention modalities, but the small trials identified do not provide sufficient power to detect the small differences expected in this outcome.Regarding the comparison of surgical intervention versus conservative treatment, this review has shown that surgical intervention in an early stage of chronic pancreatitis is a promising approach in terms of pain relief and pancreatic function. Other trials need to confirm these results because of the methodological limitations and limited number of participants assessed in the present evidence. PMID: 25790326 [Pu...


"How to conquer a mountain with multiple sclerosis". How a climbing expedition to Machu Picchu affects the way people with multiple sclerosis experience their body and identity: a phenomenological analysis.
CONCLUSION: Participating in Machu Picchu expedition appeared to have a deep and profound effect on body awareness and identity. Participants experienced their body once again as theirs, owning it and above all, allowing it to be a source of strength, joy and meaningfulness. While MS determined their lives prior to the journey, they now could look at MS as a part of what they are, without totally being absorbed in it. So being a patient with MS before, resulted in merely having MS after the climb. Implications for Rehabilitation Patients experience illness as a disruption of their previous life. A phenomenological approach deals with the lived experience and the concept of body awareness, the meaningful experience of living in the world through the body. This approach complements biomedica...


Caring for Tube-Fed Children: A Review of Management, Tube Weaning, and Emotional Considerations.
Authors: Edwards S, Davis AM, Bruce A, Mousa H, Lyman B, Cocjin J, Dean K, Ernst L, Almadhoun O, Hyman P Abstract Enteral nutrition is the practice of delivering nutrition to the gut either orally or through a tube or other device. Many children are reliant on enteral feedings to either supplement their nutrition or as a complete source of their nutrition. Managing children on tube feedings requires a team of providers to work through such dilemmas as feeding schedules, weaning from tube feeding, sensory implications of tube feeding, treatment of pain or nausea associated with eating, oral-motor issues, and behavioral issues in the child and family. The purpose of the current review is to summarize the multidisciplinary aspects of enteral feeding. The multidisciplinary team consist...


A novel analgesic approach to optogenetically and specifically inhibit pain transmission using TRPV1 promoter.
In conclusion, we have established a novel analgesic approach that can noninvasively and selectively inhibit pain transmission using an acute and controllable optogenetics method. This study may shed light on the application of a novel optogenetic strategy for the treatment of pain. PMID: 25797803 [PubMed - as supplied by publisher] (Source: Brain 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>


Effect of PO Administered Gabapentin on Chronic Lameness in Horses
Gabapentin has been used to treat chronic pain in people and small animals. To date, no study has reported its use in horses for the treatment of chronic painful conditions. The clinical effectiveness of gabapentin as an analgesic in horses with chronic lameness was evaluated in a double-blinded crossover study. Six horses with chronic lameness referable to musculoskeletal pathology were randomly assigned to one of three treatments: 5 and 10 mg/kg body weight of gabapentin, and placebo administered PO three times daily for 14 days. (Source: Journal of Equine Veterinary Science)


Clinical Outcomes of Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears without Osteoarthritis in the Glenohumeral Joint
Chronic rotator cuff tears are challenging to repair completely because of the development of tendon retraction with inelasticity, muscle atrophy, and fatty infiltration. Main symptoms of rotator cuff tears including pain due to subacromial impingement, muscle weakness in the shoulder joint and, as a result, limitation of arm elevation result from a loss of the superior stability of the glenohumeral joint due to dysfunction of the rotator cuff muscles. A recent anatomical study has shown that the superior shoulder capsule is attached to a substantial area (30% to 61%) of the greater tuberosity, suggesting that the superior shoulder capsule is an important component of the glenohumeral joint. (Source: Journal of Shoulder and Elbow Surgery)


Early Scans for Back Pain May Do Little to Help Seniors
Title: Early Scans for Back Pain May Do Little to Help SeniorsCategory: Health NewsCreated: 3/17/2015 12:00:00 AMLast Editorial Review: 3/18/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Patterns and Predictors of Service Use Among Women Who Have Separated from an Abusive Partner
Abstract Using baseline data from a survey of 309 Canadian women recently separated from an abusive partner, we investigated patterns of access to health, social, legal, and violence-specific services and whether abuse history and social and health variables predict service use. We compared rates of service use to population rates, and used logistic regression to identify determinants of use. Service use rates were substantially higher than population estimates in every category, particularly in general and mental health sectors. Although women were confident in their ability to access services, they reported substantial unmet need, difficulty accessing services, and multiple barriers. The strongest unique predictors of use varied across service type. Health variables (high disabi...


Portal vein thrombosis associated with psoriasis: a case report
Conclusion: This case highlights the importance of having clinical awareness of occurrence of thrombosis in patients with psoriasis. Typical symptoms favoring thrombosis should prompt thorough investigation to exclude this rare yet possible complication in patients with psoriasis, including that of portal vein thrombosis. Prophylaxis with anticoagulation still lacks strength of evidence to be justified in psoriasis. The exact pathogenesis of venous thromboembolism in psoriasis is still unexplained and further studies are needed to clarify the causal association. (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>


Sleep quality in patients with ankylosing spondylitis
Conclusion In the current study, we found that the sleep disturbances were significantly higher in patients with AS in comparison to controls. Patients with active disease had worse sleep quality. In addition, disease activity was correlated with the scores of most of the PSQI subscales. Sleep quality assessment should be a tool for evaluating patients with AS. (Source: Revista Brasileira de Reumatologia)


Sports hernias: experience in a sports medicine center
Conclusions Our series reflects the multidisciplinary approach performed in a sports medicine center in which patients are initially evaluated by orthopedic surgeons in order to discard the most common causes of “pubalgia”. “Sports hernias” are often associated with adductor muscle strains and other injuries of the groin allowing speculate that these respond to a common mechanism of production. We believe that, considering the difficulty to design randomized trials, only a high coincidence among the diagnostic and therapeutic instances can ensure a rational health care. (Source: Hernia)


Therapeutic efficacy of Lofnac Gel via phonophoresis in the management of chronic nonspecific low back pain: A randomised controlled trial
Conclusion Exercise combined with Lofnac phonophoresis was more effective in the management of patients with chronic low back pain than exercise and ultrasound alone. (Source: Hong Kong Physiotherapy Journal)


Development and characterisation of novel fentanyl-delta opioid receptor antagonist based bivalent ligands
Conclusions The addition of a linker between fentanyl and Dmt-Tic did not alter the ability to bind to MOP and DOP, however a substantial loss in MOP functional activity was apparent. This highlights the difficulty in multifunctional opioid development. (Source: British Journal of Anaesthesia)


Chronic pain in adults.
Authors: Ponomarenko-Jones R Abstract I was unaware of the full range of treatments available for individuals experiencing chronic pain before reading this CPD article. Many patients on the gynaecology ward where I work are admitted because of chronic pain. PMID: 25783283 [PubMed - in process] (Source: Nursing Standard)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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.
Authors: Abstract Essential facts Chronic pain is pain that persists or recurs for more than three months. It may be related to a condition, or may be pain from an injury or operation that continues after healing would usually take place. According to guidance from the Scottish Intercollegiate Guidelines Network (SIGN), around 18 per cent of Europe's population are currently affected by moderate to severe chronic pain. It has a considerable effect on quality of life, and can cause significant suffering and disability. PMID: 25783253 [PubMed - in process] (Source: Nursing Standard)


Spider venom proteins could be used to relieve pain thanks to their nerve-blocking action.
Authors: Abstract Spider venom could be used to treat chronic pain, say researchers in Australia who employed an innovative screening approach to isolate the protein molecules from spider venoms. PMID: 25783252 [PubMed - in process] (Source: Nursing Standard)


Therapeutic value of spinal cord stimulation in irritable bowel syndrome - a randomized cross-over pilot study.
Authors: Lind G, Winter J, Linderoth B, Hellstrom PM Abstract 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 26-56 years) were recruited. A SCS system with a 4-polar electrode was implanted at the T5-T8 level. After a two-week run-in, a randomized, crossover design SCS during 6 weeks was compared to no stimulation, with an ensuing stimulation period for 12 weeks; total study period 28 weeks. Patients recorded pain level, pain a...


Management of patients with psoriatic arthritis
Abstract: Psoriatic arthritis is a chronic inflammatory arthritis condition. If left untreated, patients with psoriatic arthritis may suffer pain, reduced quality of life, joint damage, and disability. Understanding clinical presentation and comorbidities of the disease, as well as current guidelines for treatment, allows the nurse practitioner to provide comprehensive care for patients. (Source: The Nurse Practitioner)


P2Y2 receptor antagonists as anti‐allodynic agents in acute and sub‐chronic trigeminal sensitization: Role of satellite glial cells
Trigeminal (TG) pain often lacks a satisfactory pharmacological control. A better understanding of the molecular cross‐talk between TG neurons and surrounding satellite glial cells (SGCs) could help identifying innovative targets for the development of more effective analgesics. We have previously demonstrated that neuronal pro‐algogenic mediators upregulate G protein‐coupled nucleotide P2Y receptors (P2YRs) expressed by TG SGCs in vitro. Here, we have identified the specific P2YR subtypes involved (i.e., the ADP‐sensitive P2Y1R and the UTP‐responsive P2Y2R subtypes), and demonstrated the contribution of neuron‐derived prostaglandins to their upregulation. Next, we have translated these data to an in vivo model of TG pain (namely, rats injected with Complete Freund's adjuvant i...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Evidence of a role for GTP cyclohydrolase‐1 in visceral pain
Conclusions & InferencesThe data generated indicate that GCH‐1 plays a role in visceral pain processing that requires more detailed investigation. In the present study, we demonstrate that pretreatment with the GCH‐1 inhibitor DAHP reduces visceral pain behavior in a rodent model of acute inflammatory visceral pain. Additionally in human studies we demonstrate that the presence of the pain protective GCH‐1 haplotype is associated with lower depression scores and increased pain thresholds following repeat esophageal pain testing in subjects who develop central sensitization to esophageal acidification. Our data indicate that GCH‐1 plays an important role in visceral pain processing that requires more detailed investigation. (Source: Neurogastroenterology and Motility)


Characteristics and Diagnostic Yield of Pediatric Colonoscopy in Taiwan
Conclusion Lower gastrointestinal bleeding is the most common indication for pediatric colonoscopy. Pediatric colonoscopy is most effective in diagnosing pediatric lower gastrointestinal bleeding and chronic diarrhea. (Source: Pediatrics and Neonatology)


Tramadol‐induced mania in a patient with depression
It is not unusual for patients with co‐occurring chronic pain and depression to receive concurrent administration of an antidepressant (e.g., a tricyclic antidepressant [TCA], selective serotonin reuptake inhibitor [SSRI], or serotonin‐norepinephrine reuptake inhibitor [SNRI]) and tramadol, which is sometimes preferred in place of more potent analgesics. However, tramadol also can have an inhibitory effect on serotonin and norepinephrine uptake, and concurrent administration of an antidepressant and tramadol could result in undesirable side effects associated with increased serotonin and norepinephrine neurotransmission. (Source: The Brown University Psychopharmacology Update)


Is magnesium sulfate effective for pain in chronic postherpetic neuralgia patients comparing with ketamine infusion therapy?
Postherpetic neuralgia (PHN) is a frequent debilitating complication and one of the most intractable pain disorders, particularly in elderly patients. Although tricyclic antidepressants, topical capsaicin, gabapentin, and oxycodone are effective for alleviating PHN, many patients remain refractory to current therapies. Here, the analgesic effects of ketamine or magnesium for PHN were assessed in an open prospective study. (Source: Journal of Clinical Anesthesia)


C2 nerve field stimulation for the treatment of Fibromyalgia: A prospective, double-blind, randomized, controlled cross-over study
Fibromyalgia is a condition characterized by widespread chronic pain. Due to the high prevalence and high costs, it has a substantial burden on society. Treatment results are diverse and only help a small subset of patients. C2 nerve field stimulation, aka occipital nerve stimulation, is helpful and a minimally invasive treatment for primary headache syndromes. Small C2 pilot studies seem to be beneficial in fibromyalgia. (Source: BRAIN STIMULATION: Basic, Translational, and Clinical Research in Neuromodulation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cervical joint position sense in neck pain - Immediate effects of muscle vibration versus mental training interventions.
CONCLUSION: Although motor imagery and action observation did not modulate proprioceptive, afferent input, they nevertheless improved cervical joint position sense acuity. This indicates that, against the common opinion, changes in proprioceptive input are not prerequisite to improve joint repositioning performance. However, the short--term applications of these cognitive treatments had no effect on pressure pain thresholds, whereas vibration reduced pressure pain thresholds. This implies different underlying mechanisms after vibration and mental training. CLINICAL REHABILITATION IMPACT: Mental interventions were effective in improving cervical joint position sense and are easy to integrate in rehabilitation regimes. Neck muscle vibration is effective in improving cervical joint positi...


Chronic low back pain and disability in Brazilian jiu-jitsu athletes
To identify the prevalence of chronic low back pain (CLBP) and functional disability in Brazilian jiu-jitsu athletes. (Source: Physical Therapy in Sport)


[How to relieve a dyspneic patient at the end of life?]
Authors: Voisin-Saltiel S Abstract Dyspnea is a very common symptom that particularly worries the patient and his relatives. In terminally ill patients, there is no correlation between dyspnea and hypoxaemia. Although a specific cause may require an appropriate treatment, most of the time the treatment is symptomatic. This approach is based on oral or parenteral administration of opioids but with a narrower safety margin than in chronic pain patients. The use of an anxiolytic is indicated in stressful circumstances or when opioids fail. Oxygen administration should be discussed on an individual basis and not conditioned to the achievement of full arterial blood saturation. The airstream effect may improve patient's condition as well as oxygen itself. Facial masks impair communicati...


5 Ways Positive Thinking Can Transform Your Health
Our emotional world has a remarkable power to determine not only our mental health, but also how our physical well-being. "Positive characteristics, such as optimism, vitality, meaning, and subjective life satisfaction are immensely important in their own right," psychologist Dr. Scott Barry Kaufman wrote in a recent Scientific American blog on optimism and heart health. "The related fields of positive psychology and health psychology focus on rigorous scientific investigations of how people adapt to life’s inevitable challenges, and how that is related (or even leads to) a better quality of life." And a growing body of research in psychology, medicine and public health is demonstrating the health benefit of positive emotions and their effect on physical health. When past studies have...


Abuse-Deterrent Opioids: What Role Do They Play In Prescription Opioid Addiction?
The rise in&nbsp;opioid-related deaths&nbsp;has many in the medical community outraged over practitioners prescribing opioids for chronic pain. Some, mainly those in pain management, believe this practice is justified. Others claim there are better alternatives. Pharmaceutical companies, on the other hand, are taking a&nbsp;shot at the opioid epidemic by promoting opioids with&nbsp;abuse-deterrent properties. (Source: Forbes.com Healthcare News)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Drink won't banish your pain, Jennifer. But mindfulness just might
Living with chronic pain can feel like an endless struggle. This feeling of hopelessness leads some to cling to the wrong things to dull the pain, writes DR MARK ABRAHAMS. (Source: the Mail online | Health)


Identifying relationships between symptom clusters and quality of life in adults with chronic mixed venous and arterial leg ulcers
The objective of this study was to identify symptom clusters and their effect on quality of life (QOL) of adults with chronic leg ulcers of mixed venous and arterial aetiology. A secondary analysis of data from four existing prospective longitudinal studies conducted by a wound healing research group in Australia was undertaken. A total of 110 patients who met the inclusion criteria were selected for this study. Exploratory factor analysis (EFA) was used to identify symptom clusters and correlational analyses to examine relationships between the identified symptom clusters and QOL. The EFA identified two distinct symptom clusters: a ‘systemic symptom cluster’ consisting of pain, fatigue and depressive symptoms; and a ‘localised‐leg symptom cluster’ including pain, fatigue, oedema...


C2 nerve field stimulation for the treatment of Fibromyalgia: A prospective, double-blind, randomized, controlled cross-over study
Conclusion Subcutaneous C2 nerve field stimulation seems to offer a safe and effective treatment option for selected medically intractable patients with fibromyalgia. (Source: Brain Stimulation)


The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: A randomized controlled trial.
CONCLUSION: A regular stretching exercise program performed for four weeks can decrease neck and shoulder pain and improve neck function and quality of life for office workers who have chronic moderate-to-severe neck or shoulder pain. PMID: 25780258 [PubMed - as supplied by publisher] (Source: Clinical Rehabilitation)


Pulsed radiofrequency treatment for chronic hip pain
Chye CL, Liang CL, Lu K, Chen YW, Liliang PC (Source: Clinical Interventions in Aging)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Mental imagery-induced attention modulates pain perception and cortical excitability
Conclusions: Mental imagery has a minor effect on pain modulation in healthy subjects. Its effects appear to differ compared with in chronic pain, leading to a small decrease in pain threshold. Assessments of cortical excitability confirmed that these effects are related to the modulation of pain-related cortical circuits. These exploratory findings suggest that neuronal plasticity is influenced by pain and that the mental imagery effects on pain depend on the state of central sensitization. (Source: BMC Neuroscience)


Transnasal Sphenopalatine Ganglion Block for the Treatment of Postdural Puncture Headache in the Emergency Department
Postdural puncture headache (PDPH), also known as spinal headache, is a common complication associated with neuraxial anesthesia and diagnostic lumbar puncture. Autologous epidural blood patch (AEBP) is considered the definitive treatment for PDPH with efficacy over 75%, but it is an invasive procedure that carries the same risks as other epidural procedures, including dural puncture, infection, and neurologic complications.[1,2,3] Transnasal sphenopalatine ganglion block (SPGB) has been used traditionally used to treat chronic conditions such as migraine, cluster headache, trigeminal neuralgia, and atypical facial pain, [4], and has also been used with good results in a recent case series to treat acute PDPH headache in obstetric patients. (Source: The American Journal of Emergency Medici...


Low-dose hydrocortisone replacement improves wellbeing and pain tolerance in chronic pain patients with opioid-induced hypocortisolemic responses. A pilot randomized, placebo-controlled trial
Chronic pain is experienced by 20% of the population (Reid et al., 2011). The long-term use of opioid analgesia is becoming increasingly common, particularly in sufferers of chronic non-cancer pain (CNCP) (Manchikanti et al., 2012). This increase in opioid consumption is accompanied by considerable risks; common side effects include constipation, nausea, sedation and physical dependence, while more serious complications include hyperalgesia, immunosuppression, respiratory depression, overdosage death, and neuroendocrine dysfunction (Benyamin et al., 2008, Baldini et al., 2012). (Source: Psychoneuroendocrinology)


[Does treatment of patients with chronic back pain and proven Modic type 1 alterations using vertebroplasty make sense?]
Authors: Weber MA PMID: 25773114 [PubMed - as supplied by publisher] (Source: Der Radiologe)


Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED
Postdural puncture headache (PDPH), also known as spinal headache, is a common complication associated with neuraxial anesthesia and diagnostic lumbar puncture. Autologous epidural blood patch is considered the definitive treatment for PDPH with efficacy greater than 75%; but it is an invasive procedure that carries the same risks as other epidural procedures, including dural puncture, infection, and neurologic complications [1–3]. Transnasal sphenopalatine ganglion block (SPGB) has been traditionally used to treat chronic conditions such as migraine, cluster headache, trigeminal neuralgia, and atypical facial pain [4], and has also been used with good results in a recent case series to treat acute PDPH headache in obstetric patients [5]. (Source: The American Journal of Emergency Medici...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Diagnosis and treatment of temporomandibular disorders.
Authors: Gauer RL, Semidey MJ Abstract Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, and surrounding musculature and osseous components. TMD affects up to 15% of adults, with a peak incidence at 20 to 40 years of age. TMD is classified as intra-articular or extra-articular. Common symptoms include jaw pain or dysfunction, earache, headache, and facial pain. The etiology of TMD is multifactorial and includes biologic, environmental, social, emotional, and cognitive triggers. Diagnosis is most often based on history and physical examination. Diagnostic imaging may be beneficial when malocclusion or intra-articular abnormalities are suspected. Most patients improve with a combi...


Bullying, abuse and family conflict as risk factors for chronic pain among Dutch adolescents - Voerman JS, Vogel I, de Waart F, Westendorp T, Timman R, Busschbach JJ, van de Looij-Jansen P, de Klerk C.
PURPOSE: Psychosocial stress seems to serve as an important risk factor for the occurrence of pain. The present study aims to examine if early adversities, e.g. bullying, abuse and family conflict are risk factors for chronic pain in adolescents. The secon... (Source: SafetyLit: All (Unduplicated))


Prospective multicenter observational trial on the safety and efficacy of LEVORAG ® Emulgel in the treatment of acute and chronic anal fissure
Conclusions Treatment with THD Levorag® Emulgel proved to be effective for the reepithelization of AF and the reduction of pain in the short term in about 80 % of patients. (Source: Techniques in Coloproctology)


Cervical Spine Dysfunctions in Patients With Chronic Subjective Tinnitus
Conclusions: Although a higher prevalence of neck dysfunction was found in the CST group, neck dysfunction is often in non-CST patients. (Source: Otology and Neurotology)


ERK1/2: Function, signaling and implication in pain and pain-related anxio-depressive disorders
Publication date: 3 July 2015 Source:Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 60 Author(s): Gisela Borges , Esther Berrocoso , Juan Antonio Mico , Fani Neto Despite the increasing knowledge regarding pain modulation, the understanding of the mechanisms behind a complex and pathologic chronic pain condition is still insufficient. These knowledge gaps might result in ineffective therapeutic approaches to relieve painful sensations. As a result, severe untreated chronic pain frequently triggers the onset of new disorders such as depression and/or anxiety, and therefore, both the diagnosis and treatment of patients suffering from chronic pain become seriously compromised, prompting a self-perpetuating cycle of symptomatology. The extracellular signal-regulated k...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The use of porcine small intestine submucosa implants might be associated with a high recurrence rate following laparoscopic herniorrhaphy
Conclusion Our data suggest that the use of SIS mesh in endoscopic TEP herniorrhaphy might be associated with a high recurrence rate. The second look laparoscopy in these recurrent cases revealed slow and inadequate integration of host tissue. More evidence is still required to further evaluate the efficacy of SIS mesh in endoscopic TEP herniorrhaphy. (Source: Journal of the Formosan Medical Association)


Catechol- O -methyltransferase (COMT) gene polymorphisms are associated with baseline disability but not long-term treatment outcome in patients with chronic low back pain
Conclusions Results suggest that genetic factors are partly responsible for the variation in disability levels in patients presenting with chronic LBP being considered for surgery; in contrast, genetics has no influence on the long-term outcome of treatment. (Source: European Spine Journal)


Clinical decision rule for primary care patient with acute low back pain at risk of developing chronic pain
Primary care clinicians need to identify candidates for early interventions to prevent patients with acute pain from developing chronic pain. (Source: The Spine Journal)


Lateral Antebrachial Cutaneous Nerve Entrapment After Shoulder Arthroscopy: A Case Report
The lateral antebrachial cutaneous nerve (LABCN) is a distal sensory branch of the musculocutaneous nerve. It innervates the radial aspect of the forearm. There have been reported cases of LABCN injury from trauma and chronic compression. There has also been a reported case of musculocutaneous nerve injury after a biceps tenodesis. This is a case report of a LABCN injury and forearm pain following a biceps tenodesis. Using a multifaceted diagnostic approach of electrodiagnostics and MR neurography, the site of compression was appropriately localized. (Source: PM and R)


Utilization and Patients’ Perceptions of the Effectiveness of Pain Treatments in Multiple Sclerosis: A Cross-sectional Survey
Although chronic pain is common among persons with multiple sclerosis (MS), little is known about the utilization and patients’ perception of the effectiveness of pain treatments in MS. (Source: Disability and Health 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>


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. PMID: 25772701 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)


Utilization and patients' perceptions of the effectiveness of pain treatments in multiple sclerosis: A cross-sectional survey
Although chronic pain is common among persons with multiple sclerosis (MS), little is known about the utilization and patients' perception of the effectiveness of pain treatments in MS. (Source: Disability and Health Journal)


Item Response Theory Analysis of the Modified Roland-Morris Disability Questionnaire in a Population-Based Study
Study Design. This is a secondary analysis of a cross-sectional population-based survey. Objective. Shorten the modified 23-item Roland (mRoland) scale using item response theory (IRT) methods and describe where in the functional disability range each scale is the most precise. Summary of Background Data. The Roland-Morris Disability Questionnaire is recommended for a functional disability outcome measure in patients with low back pain (LBP). One commonly used version is the Roland. It is unknown where in the functional disability range the Roland measures. Methods. One candidate individual with LBP in randomly selected households was interviewed, identifying 694 adults with chronic LBP. To justify the use of a unidimensional 2-parameter logistic IRT model, we performed both exploratory an...


Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double‐blind, and placebo‐controlled study
ConclusionsOur results suggest that GON blockade with bupivacaine was superior to placebo and was found to be effective, safe, and cost‐effective for the treatment of CM. According to our knowledge, this is the first randomized, multicentre, double‐blind, and placebo‐controlled study in the literature in this field of work. (Source: Acta Neurologica Scandinavica)


Lateral Antebrachial Cutaneous Nerve Entrapment After Shoulder Arthroscopy: A Case Report
Publication date: Available online 13 March 2015 Source:PM&amp;R Author(s): Herbie Yung , Gerritt M. Lagemann , Albert Lin , Steven L. Orebaugh , Megan H. Cortazzo The lateral antebrachial cutaneous nerve (LABCN) is a distal sensory branch of the musculocutaneous nerve. It innervates the radial aspect of the forearm. There have been reported cases of LABCN injury from trauma and chronic compression. There has also been a reported case of musculocutaneous nerve injury after a biceps tenodesis. This is a case report of a LABCN injury and forearm pain following a biceps tenodesis. Using a multifaceted diagnostic approach of electrodiagnostics and MR neurography, the site of compression was appropriately localized. The patient ultimately achieved relief after a surgical decompression. (S...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Influence of Knee Pain and Low Back Pain on the Quality of Life in Adults Over Age Fifty
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)


Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective
Publication date: Available online 24 February 2015 Source:PM&amp;R Author(s): Jay P. Shah , Nikki Thaker , Juliana Heimur , Jacqueline V. Aredo , Siddhartha Sikdar , Lynn H. Gerber The intent of this paper is to discuss the evolving role of the myofascial trigger point (MTrP) in myofascial pain syndrome (MPS) from both a historical and scientific perspective. MTrPs are hard, discrete, palpable nodules in a taut band of skeletal muscle that may be spontaneously painful (i.e. active), or painful only on compression (i.e. latent). MPS is a term used to describe a pain condition which can be acute or, more commonly, chronic and involves the muscle and its surrounding connective tissue (e.g. fascia). According to Travell and Simons, MTrPs are central to the syndrome—but are they necess...


A Review of the Clinical Value of Isolated Lumbar Extension Resistance Training for Chronic Low Back Pain
Conclusions These findings highlight ILEX resistance training as effective for significant and meaningful improvements in perceived pain, disability, and GPOs for CLBP participants. Further research should elucidate comparisons between ILEX resistance training and other specific exercise approaches and should clarify whether lumbar extensor conditioning is the mechanism responsible for the improvements reported. (Source: PMandR)


TRPV1, CGRP and SP in scalp arteries of patients suffering from chronic migraine. Some like it hot! Chronic migraine increases TRPV1 receptors in the scalp
The transient receptor potential vanilloid type-1 receptor (TRPV1) is a non-selective, ligand-gated cation channel expressed in small sensory neurons.1 It responds to noxious heat, protons and capsaicin and it is preferentially expressed in small sensory neurons.2 3 Trigeminal nociceptive neurons contain glutamate, substance P (SP) and calcitonin gene-related peptide (CGRP). TRPV1 receptors evoke CGRP release; inhibition prevents and reverses central sensitisation. BoNT/A has analgesic effects on capsaicin-evoked pain. It is effective in chronic migraine treatment.4 BoNT/A decreases TRPV1-positive neurons in the rat trigeminal ganglion.5 What then is the role in periarterial neurovascular scalp structures in migraine?6 Del Fiacco et al7 did a quantitative study of TRPV1-like, CGRP-like and...


TRPV1, CGRP and SP in scalp arteries of patients suffering from chronic migraine
Conclusions This study yields the first evidence for the existence of a TRPV1-LI innervation in human scalp arteries and provides the first quantitative assessment of the TRPV1-LI, CGRP-LI and SP-LI innervation of those vessels. The increase of TRPV1-LI periarterial nociceptive fibres of scalp arteries may represent, at least in some participants, a structural condition favouring CM (and possibly migraine), for example, by causing a higher sensitivity to algogenic agents. (Source: Journal of Neurology, Neurosurgery and 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>


Neonatal handling (resilience) attenuates water-avoidance stress induced enhancement of chronic mechanical hyperalgesia in the rat
Publication date: 30 March 2015 Source:Neuroscience Letters, Volume 591 Author(s): Pedro Alvarez , Jon D. Levine , Paul G. Green Chronic stress is well known to exacerbate pain. We tested the hypothesis that neonatal handling, which induces resilience to the negative impact of stress by increasing the quality and quantity of maternal care, attenuates the mechanical hyperalgesia produced by water-avoidance stress in the adult rat. Neonatal male rats underwent the handling protocol on postnatal days 2–9, weaned at 21 days and tested for muscle mechanical nociceptive threshold at postnatal days 50–75. Decrease in mechanical nociceptive threshold in skeletal muscle in adult rats, produced by exposure to water-avoidance stress, was significantly attenuated by neonatal handling. Neonatal h...


Transition from acute to chronic pain
(Source: Continuing Education in Anaesthesia, Critical Care and Pain)


Psychological functioning of people living with chronic pain: A meta-analytic review.
CONCLUSIONS: This study demonstrates, for the first time, that individuals with CP are more likely to experience physically focussed psychological problems than other psychological problems and that, unlike self-efficacy, fear of pain is intrinsically tied to the CP experience. This challenges the prevailing view that, for individuals with CP, problems with depression are either equal to, or greater than, problems with anxiety, thereby providing important information to guide therapeutic targets. PRACTITIONER POINTS: Positive clinical implications This is the first time that the CP literature has been synthesized from a general perspective to examine psychological functioning in the presence of CP and provide practical recommendations for assessment and therapy. Individuals with CP wer...


Metformin and caloric restriction induce an AMPK-dependent restoration of mitochondrial dysfunction in fibroblasts from Fibromyalgia patients.
Authors: Alcocer-Gómez E, Garrido-Maraver J, Bullón P, Marín-Aguilar F, Cotán D, Carrión AM, Alvarez-Suarez JM, Giampieri F, Sánchez-Alcazar JA, Battino M, Cordero MD Abstract 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 mentioned pathophysiological states. Here, we tested the involvement of AMPK activation in fibroblasts derived from FM patients. AMPK was not phosphorylated in fibroblasts from FM patients and w...


PP-135 Treatment of Significantly Tortuous Abdominal and Iliac Aneurysm with Stent and Vascular Plaque
A 68-year-old man was admitted to our clinic with abdominal pain. In his medical history, he has had chronic atrial fibrillation for 5 years and aortic valve replacement were applied 4 years ago. On physical examination, arterial blood pressure was 120/70 mmHg and peripheral pulses were weak in both lower limbs. The abdominal aortic aneurysm was detected on examination. Electrocardiography and transthoracic echocardiography were in normal limits. In abdominal computed tomography angiography, a aortic aneurysm, 2.5 cm below the left renal artery orifice extending to the aortic bifurcation, approximately 49x54 mm in the widest part at the infrarenal region, about 100 degrees angulation between normal aorta and aneurysmal section was detected. (Source: The American 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>


Comparison of diagnostic performance between single- and multiphasic contrast-enhanced abdominopelvic computed tomography in patients admitted to the emergency department with abdominal pain: potential radiation dose reduction
Conclusions There is no difference between HVP-CT alone and multiphasic CT for the diagnosis of causes of abdominal pain in patients admitted to the ED without prior chronic disease or neoplasia. Key Points • There was no difference in diagnostic performance of HVP CT and multiphasic CT. • The diagnostic confidence level was improved after review of the LAP images. • HVP CT can achieve diagnostic performance similar to that of multiphasic CT, while minimizing radiation. (Source: European Radiology)


Pfizer pain drug Lyrica fails study in adolescents with fibromyalgia
(Reuters) - Pfizer Inc's pain drug, Lyrica, failed a post-marketing study testing the treatment in adolescents with fibromyalgia, a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. (Source: Reuters: Health)


Preoperative Psychological Findings in Adolescents Undergoing Hip Preservation Surgery
Conclusions: Preoperative evaluation identified patients who reported at-risk or clinically significant symptoms of anxiety and/or depression, with up to one third of patients reporting maladaptive behavior that may significantly influence their postoperative outcomes. Preoperative psychological evaluation, with appropriate intervention and follow-up, if needed, should be considered before surgery selection as mental health conditions may be undiagnosed and will likely influence functional outcomes. (Source: Journal of Pediatric Orthopaedics)


Analgesic and anti-inflammatory activities of Citrus aurantium L. blossoms essential oil (neroli): involvement of the nitric oxide/cyclic-guanosine monophosphate pathway
Abstract The analgesic and anti-inflammatory properties of Citrus aurantium L. blossoms essential oil (neroli) were investigated in mice and rats. The analgesic activity of neroli was assessed by acetic acid-induced writhing and Eddy’s hot plate methods, while acute and chronic anti-inflammatory effects were investigated by inflammatory paw edema in rat and the cotton pellet-induced granuloma tissue model, respectively. Mechanistic studies were conducted using L-nitro arginine methyl ester (L-NAME), an inhibitor of NO synthase. Neroli significantly decreased the number of acetic acid-induced writhes in mice compared to animals that received vehicle only. Also, it exhibited a central analgesic effect, as evidenced by a significant increase in reaction time in the hot plate method...


Impact of Race and Diagnostic Label on Older Adults' Emotions, Illness Beliefs, and Willingness to Help a Family Member With Osteoarthritis
Discussion: The diagnostic label of OA had little effect on these older adults, but racial differences indicate that cultural values regarding family caregiving are important in arthritis care. (Source: Journal of Applied Gerontology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Toll-like Receptor 4 and Comorbid Pain in Interstitial Cystitis/Bladder Pain Syndrome: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network Study
Conclusions TLR-4 inflammatory responses in PBMCs are a marker of widespread pain in IC/BPS, and should be explored in other conditions characterized by medically unexplained pain. (Source: Brain, Behavior, and Immunity)


Effects of β2 agonists on post‐thoracotomy pain incidence
ConclusionsThese data suggest a possible influence of chronic β2‐agonist treatments on neuropathic pain secondary to thoracotomy. This apparent preventive effect of β2‐agonist treatments should warrant controlled clinical trials. (Source: European Journal of Pain)


Differences in Cervical Multifidus Muscle Thickness During Isometric Contraction of Shoulder Muscles: A Comparison Between Patients With Chronic Neck Pain and Healthy Controls
The purposes of this study were to (1) measure the thickness of cervical multifidus muscle (CMM) in different maximal voluntary contraction percentages of isometric contraction of shoulder muscles, (2) evaluate the differences of the CMM thickness in different directions of the shoulder movement, and (3) compare the changes in the CMM thickness of participants with neck pain and also of healthy individuals. (Source: Journal of Manipulative and Physiological Therapeutics)


An evaluation of the lower extremity muscle strength of patients with chronic venous insufficiency.
CONCLUSION: Impaired lower extremity muscle strength was observed in chronic venous insufficiency patients. Although the current study was consistent with literature in respect of impaired calf muscle strength, this finding was also seen in the thigh muscles. Furthermore, we concluded that if venous insufficiency becomes more severe, impaired calf muscle strength becomes more evident. PMID: 25769839 [PubMed - as supplied by publisher] (Source: Phlebology)


Sleep disturbances predict long-term changes in low back pain among Finnish firefighters: 13-year follow-up study
Conclusions This is the first prospective study to show that low back symptoms are common and persistent among firefighters and that sleep disturbances strongly predict membership of a radiating pain trajectory. Occupational health and safety personnel, as well as the firefighters themselves, should recognize sleep problems early enough in order to prevent back pain and its development into chronic pain. (Source: International Archives of Occupational and Environmental 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>


Brain processes ongoing pain more emotionally
A momentary lapse of concentration is all it takes for a finger to become trapped or sprain an ankle -- and it hurts. Pain is the body's protective mechanism and a complex neurological phenomenon. Moreover, ongoing pain in the sense of chronic pain can be a disease, clinicians say. Scientists have now demonstrated that already during a few minutes of ongoing pain, the underlying brain activity changes by shifting from sensory to emotional processes. (Source: ScienceDaily Headlines)


Diagnosis and Management of Intra-articular Causes of Pain After Total Knee Arthroplasty.
Authors: Potty AG, Tzeng TH, Sams JD, Lovell ME, Mihalko WM, Thompson KM, Parke J, Manning BT, Dennis DA, Goodman SB, Saleh KJ Abstract Total knee arthroplasty (TKA) is an effective procedure for decreasing pain, improving functional capability, and increasing the overall quality of life for thousands of people with chronic knee osteoarthritis. Although patient outcomes and satisfaction remain high, a substantial percentage of patients report residual pain after TKA. Sources of postoperative pain include intra- and extra-articular etiologies as well as factors unrelated to the implants themselves. A patient-centered approach to the painful TKA may aid clinicians in diagnosing and treating patients with intra-articular causes of pain after TKA. A thorough understanding of the mechan...


The Overlap between Fibromyalgia Syndrome and Myotonia Congenita.
CONCLUSIONS: These two cases are the first report of an overlap of CWP between FMS and MC. PMID: 25749817 [PubMed - as supplied by publisher] (Source: Journal of Clinical Neurology)


Low-Level Laser Therapy at 635 nm for Treatment of Chronic Plantar Fasciitis: A Placebo-Controlled, Randomized Study
Publication date: Available online 10 March 2015 Source:The Journal of Foot and Ankle Surgery Author(s): David M. Macias , Michael J. Coughlin , Kerry Zang , Faustin R. Stevens , James R. Jastifer , Jesse F. Doty Plantar fasciitis affects nearly 1 million persons in the United States at any one time. Conservative therapies have been reported to successfully treat 90% of plantar fasciitis cases; however, for the remaining cases, only invasive therapeutic solutions remain. This investigation studied newly emerging technology, low-level laser therapy. From September 2011 to June 2013, 69 subjects were enrolled in a placebo-controlled, randomized, double-blind, multicenter study that evaluated the clinical utility of low-level laser therapy for the treatment of unilateral chronic fasciitis. ...


Paclitaxel induces acute pain via directly activating toll like receptor 4
In this study, we found that paclitaxel causes acute pain in rodents in a dose-dependent manner. The paclitaxel-induced acute pain occurs within 2 hrs after a single intravenous injection of paclitaxel. This is accompanied by low levels of paclitaxel penetrating into the cerebral spinal fluid and spinal dorsal horn. We demonstrated that a intrathecal injection of paclitaxel induces mechanical allodynia in a dose-dependent manner. Paclitaxel causes activation of toll like receptor 4 (TLR4) in the spinal dorsal horn and dorsal root ganglions. Through activating TLR4, paclitaxel increases glutamatergic synaptic activities and reduces glial glutamate transporter activities in the dorsal horn. Activations of TLR4 are necessary in the genesis of paclitaxel-induced acute pain. The cellular and m...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Specific Management of Post-Chikungunya Rheumatic Disorders: A Retrospective Study of 159 Cases in Reunion Island from 2006-2012
Conclusion Rheumatologists in Reunion Island managed CHIK rheumatic disorders in a pragmatic manner following the outbreak in 2006. This retrospective study describes the common mechanical and inflammatory pCHIK disorders. We provide a diagnostic and therapeutic algorithm to help physicians deal with chronic patients, and to limit both functional and economic impacts. The therapeutic indication of MTX in pCHIK CIR could be approved in future efficacy trials. (Source: PLoS Neglected Tropical Diseases)


Interleukin-10 levels in rat models of nerve damage and neuropathic pain
The objective of the present study was to assess the levels of IL-10 in rat’s dorsal root ganglion (DRG) and the sciatic nerve following four different forms of sciatic nerve injury. The models used to induce the injury included two models of partial nerve injury: partial sciatic ligation (PSL) and chronic constriction injury (CCI), a model of complete sciatic transection (CST) and a model of perineural inflammation with minimal nerve damage (neuritis). Withdrawal responses for mechanical stimulus and withdrawal latency for thermal stimulation were used to measure mechanical and thermal hyperalgesia, respectively, and duration of the nociceptive withdrawal reflex to mechanical stimulus was used to measure mechanical hyperalgesia. The affected and contra-lateral nerves and the affected si...


A quantitative non-invasive assessment of femoroacetabular impingement with CT-based dynamic simulation - cadaveric validation study
Conclusions: The use of this dynamic simulation software to determine the presence of motion limiting deformities of the femoroacetabular is validated. The simulation software is able to non-invasively detect a reduction in achievable ROM, caused by a cam type deformity. (Source: BMC Musculoskeletal Disorders)


Swiss ball enhances lumbar multifidus activity in chronic low back pain: A letter to the editor
A recent paper in your journal (Scott, Vaughan et al. 2015) reports the findings of a cross-sectional study which examined the effects of stable and unstable sitting surfaces on people with and without chronic low back pain (CLBP). The authors conclude that sitting on an unstable surface (Swiss ball) results in greater lumbar multifidus (LM) activity than sitting on a stable surface. Based on this, it is stated that unstable sitting should be used in spinal rehabilitation where the “main objective is to restore spinal segmental stability” or for the prevention of spinal pain. (Source: Physical Therapy in Sport)


Incidental Discovery of a Chronically Thrombosed Abdominal Aortic Aneurysm: Case Report and Literature Review
We present a patient with a completely thrombosed abdominal aortic aneurysm found incidentally on imaging for evaluation of unrelated abdominal pain. The patient was asymptomatic with regards to the aneurysm due to extensive collateralization of the intercostal and lumbar arteries to the bilateral hypogastric and internal mammary arteries to the common femoral arteries bilaterally. Follow-up imaging after ten months showed no aneurysmal change. (Source: Annals of Vascular 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>


Outcome After Arthroscopic Decompression of Inferior Labral Cysts Combined With Labral Repair
To analyze the clinical and radiologic outcomes of arthroscopic cyst decompression and labral repair in patients with inferior paralabral cysts with chronic shoulder pain. (Source: Arthroscopy - Journal of Arthroscopic and Related Surgery)


Toll-like Receptor 4 and comorbid pain in Interstitial Cystitis/Bladder Pain Syndrome: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain research network study.
CONCLUSIONS: TLR-4 inflammatory responses in PBMCs are a marker of widespread pain in IC/BPS, and should be explored in other conditions characterized by medically unexplained pain. PMID: 25771510 [PubMed - as supplied by publisher] (Source: Brain, Behavior, and Immunity)


Treatment changes following aberrant urine drug test results for patients prescribed chronic opioid therapy.
DISCUSSION: Current methods for optimizing treatment after obtaining aberrant UDT results should be enhanced. To improve the utility of UDT to reduce prescription opioid misuse, additional interventions and support for clinicians need to be developed and tested. PMID: 25750164 [PubMed - in process] (Source: Journal of Opioid Management)


Choosing the right laboratory: A review of clinical and forensic toxicology services for urine drug testing in pain management.
Authors: Reisfield GM, Goldberger BA, Bertholf RL Abstract Urine drug testing (UDT) services are provided by a variety of clinical, forensic, and reference/specialty laboratories. These UDT services differ based on the principal activity of the laboratory. Clinical laboratories provide testing primarily focused on medical care (eg, emergency care, inpatients, and outpatient clinics), whereas forensic laboratories perform toxicology tests related to postmortem and criminal investigations, and drug-free workplace programs. Some laboratories now provide UDT specifically designed for monitoring patients on chronic opioid therapy. Accreditation programs for clinical laboratories have existed for nearly half a century, and a federal certification program for drug-testing laboratories was...


Using urine drug testing to support healthy boundaries in clinical care.
This article will examine risk management in general, and urine drug testing (UDT) in particular, as core constituents in an effective, comprehensive risk management strategy. The article will explore UDT as a tool to help practitioners and patients make better choices in the clinical management of chronic pain. How one makes these difficult clinical decisions based on UDT results as well common barriers encountered in conducting patient-centered UDT will also be examined. PMID: 25750160 [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>


After pain rehabilitation therapy, Mexico City pre-teen swaps wheelchair for skis
When Lucia Burillo Rojas arrived in Boston last fall, the 11-year-old from Mexico City could hardly stand up from her wheelchair. “It was very hard,” says her mother Sandra, who had traveled with her daughter, hoping that doctors at Boston Children’s Hospital could help relieve Lucia’s constant pain. &nbsp; Sandra was desperate. Lucia had been a very active child who played soccer and tennis, and loved to dance, ski and ice skate. Then she was hit with a common hand, foot and mouth virus in September. The virus resolved, but not without devastating complications. “She started with bad migraines, sensitivity to light, dizziness, vertigo and extreme neck and back pain that made it really hard for her to walk or move. Even touching her skin hurt,” recalls Sandra. Lucia wasn’t ab...


British Scientists Spot Brain's Pain Center
Title: British Scientists Spot Brain's Pain CenterCategory: Health NewsCreated: 3/9/2015 12:00:00 AMLast Editorial Review: 3/10/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Feasibility of an electrostimulation system treatment for wound healing: a case series of patients with chronic ulcers in Barbados
Abstract Major advances have been made in the development of new therapies for chronic wounds. Fenzian™, an electrostimulation system (ES), has been clinically used for a variety of conditions. The ES was recently tested in the Barbadian population for tolerability and acceptability by asthma patients, with encouraging results. Barbados has an estimated 170 people with diabetes having some form of lower‐extremity amputation annually. Here, we describe a case series of 21 chronic ulcer patients with diabetes recruited as inpatients (n = 10) and outpatients (n = 11) in a pilot study to evaluate the feasibility and acceptability of ES in the Barbadian population. Results showed statistically significant improvement among those in the inpatient‐ versus outpatient‐recruited group for wo...


Sex differences in depression-like behavior after nerve injury are associated with differential changes in brain-derived neurotrophic factor levels in mice subjected to early life stress
Publication date: 10 April 2015 Source:Neuroscience Letters, Volume 592 Author(s): Takashi Nishinaka , Megumi Kinoshita , Kazuo Nakamoto , Shogo Tokuyama We recently demonstrated that exposure to early life stress exacerbates nerve injury-induced thermal and mechanical hypersensitivity in adult male and female mice. Accumulating evidence suggests that chronic pain causes emotional dysfunction, such as anxiety and depression. In the present study, we investigated the impact of early life stress on depression-like behavior after nerve injury in mice. In addition, we examined the expression of brain-derived neurotrophic factor (BDNF), which is known to be involved in the pathogenesis of depression. Early life stress was induced by maternal separation between 2 and 3 weeks of age combined wi...


Low serum vitamin D levels are not associated with increased postoperative pain and opioid requirements: a historical cohort study
Conclusion We did not find any association between preoperative vitamin D levels and postoperative pain scores/opioid consumption in morbidly obese patients undergoing bariatric surgery. (Source: Canadian Journal of Anesthesia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain
This article reviews the main pharmacologic candidates for the treatment of CPSP, discusses the future of preventive analgesia, and considers novel strategies to help treat acute post-operative pain and lessen the risk that it becomes chronic. In addition, this article highlights important areas of focus for clinical practice including: multimodal management of CPSP patients, psychological modifiers of the pain experience, and the development of a Transitional Pain Service specifically designed to manage patients at high risk of developing chronic post-surgical pain. (Source: Drugs)


Active Vitamin D (1,25 Dihydroxyvitamin D) Is Associated With Chronic Pain in Older Australian Men: The Concord Health and Ageing in Men Project
Conclusions. Low serum 1,25D concentrations are associated with chronic pain in older men. This raises the question whether vitamin D metabolites may influence pain states, mediated through different biological mechanisms and pathways. (Source: Journals of Gerontology Series A: Biological Sciences and Medical Sciences)


Preventing Prescription Opioid Abuse—Reply
In Reply We agree with Drs Ballantyne and Kolodny that opioid analgesics are not the most effective treatment option for certain types of chronic pain. This recognition, combined with the public health risks associated with opioid analgesics, prompted revisions to the indications for ER/LA opioid analgesics in 2013. (Source: JAMA)


When Indomethacin Fails: Additional Treatment Options for “Indomethacin Responsive Headaches”
Abstract Indomethacin has been used for the treatment of headache disorders since the 1960’s, shortly after it was introduced as a treatment for pain and joint swelling in rheumatologic conditions. A subgroup of primary headache disorders, often refractory to other pharmacologic treatment such as triptans and the usual non-steroidal anti-inflammatories, was noted to be exquisitely and absolutely responsive to the analgesic effects of indomethacin. These disorders have been better characterized over the past decade and classified into primary headache disorders of paroxysmal hemicrania (PH) and hemicrania continua (HC). Since the current ICHD-3 beta requires response to indomethacin as a diagnostic criterion, studies on alternative treatments in HC and PH generally occur in pati...


Gonadotrophin‐releasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis: a multi‐center randomized trial
ConclusionBoth therapies seemed equally efficacious in preventing endometriosis‐related chronic pelvic pain recurrence in the first nine months of follow‐up.This article is protected by copyright. All rights reserved. (Source: Acta Obstetricia et Gynecologica 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>


Dry Needling Alters Trigger Points in the Upper Trapezius Muscle and Reduces Pain in Subjects With Chronic Myofascial Pain
Conclusions Dry needling reduces pain and changes MTrP status. Change in trigger point status is associated with a statistically and clinically significant reduction in pain. Reduction of pain is associated with improved mood, function, and level of disability. (Source: PMandR)


Extracorporeal shock wave lithotripsy treatment of pancreatic stones complicated with advanced stage autoimmune pancreatitis
Conclusions: Different approaches are needed for the treatment of pancreatic calculi in chronic stage AIP and ordinary CP. Specifically, it appears that intensive ESWL therapy can be avoided or delayed in AIP if the patient displays: (1) advanced age, (2) little or no chronic pain or pancreatitis, and (3) pancreatic duct stenosis proximal to pancreatic stones. In such cases, the benefit of ESWL treatment may be outweighed by the risks involved in this procedure. (Source: BMC Gastroenterology)


Study protocol for a randomised, double-blinded, placebo-controlled, clinical trial of S-ketamine for pain treatment in patients with chronic pancreatitis (RESET trial)
Introduction Chronic pancreatitis (CP) is an inflammatory disease that causes irreversible damage to pancreatic tissue. Pain is its most prominent symptom. In the absence of pathology suitable for endoscopic or surgical interventions, pain treatment usually includes opioids. However, opioids often have limited efficacy. Moreover, side effects are common and bothersome. Hence, novel approaches to control pain associated with CP are highly desirable. Sensitisation of the central nervous system is reported to play a key role in pain generation and chronification. Fundamental to the process of central sensitisation is abnormal activation of the N-methyl-d-aspartate receptor, which can be antagonised by S-ketamine. The RESET trial is investigating the analgaesic and antihyperalgesic effect of S...


Low serum vitamin D levels are not associated with increased postoperative pain and opioid requirements: a historical cohort study.
CONCLUSION: We did not find any association between preoperative vitamin D levels and postoperative pain scores/opioid consumption in morbidly obese patients undergoing bariatric surgery. PMID: 25752462 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)


Multi-chronic musculoskeletal pain is a useful clinical index to predict the risk of falls in older adults with normal motor function.
CONCLUSIONS: The nCMSP represents a potential risk factor for falls in older adults with NMF. PMID: 25753186 [PubMed - as supplied by publisher] (Source: Aging Clinical and Experimental 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>


Eccentric exercise in adults with cardiorespiratory disease: A systematic review.
CONCLUSION: Eccentric exercise is beneficial and at least comparable with traditional exercise in improving walking and strength for people with chronic cardiorespiratory disease. It was well tolerated and we identified no safety concerns for the use of this intervention for this population. PMID: 25758944 [PubMed - as supplied by publisher] (Source: Clinical Rehabilitation)


The Shared Neuroanatomy and Neurobiology of Comorbid Chronic Pain and PTSD: Therapeutic Implications
This article focuses on neurobiological factors that may contribute to the coprevalence and synergistic interactions of chronic pain and PTSD. First, we outline how circuits that mediate emotional distress and physiological threat, including pain, converge. Secondly, we discuss specific neurobiological mediators and modulators of these circuits that may contribute to chronic pain and PTSD symptoms. For example, neuropeptide Y, and the neuroactive steroids allopregnanolone and pregnanolone (together termed ALLO) have antistress and antinociceptive properties. Reduced levels of neuropeptide Y and ALLO have been implicated in the pathophysiology of both chronic pain and PTSD. The potential contribution of opioid and cannabinoid system factors also will be discussed. Finally, we address potent...


A Prospective 2-Year Examination of Cognitive and Behavioral Correlates of Provoked Vestibulodynia Outcomes
Discussion: Changes in both cognitive and behavioral variables were significantly associated with improved pain and sexual satisfaction outcomes. However, it was the positive changes in SE that better predicted changes in avoidance behavior, pain, and sexual satisfaction. Cognitive-behavior therapy is often focused on changing negative pain-related cognitions to reduce avoidance and pain, but the present results demonstrate the potential importance of bolstering positive self-beliefs as well. Indeed, before engaging in exposure therapies, SE beliefs should be assessed and potentially targeted to improve adherence to exposure strategies. (Source: The Clinical Journal of Pain)


Ability of the Central Sensitization Inventory to Identify Central Sensitivity Syndromes in an Outpatient Chronic Pain Sample
Conclusions: The CSI is a useful and valid instrument for screening patients for the possibility of a CSS, although the chances of false positives are relatively high when evaluating patients with complex pain and psychophysiological disorders. (Source: The Clinical Journal of Pain)


The Effect of Neck-specific Exercise With, or Without a Behavioral Approach, on Pain, Disability, and Self-Efficacy in Chronic Whiplash-associated Disorders: A Randomized Clinical Trial
Objectives: The aim of this study was to compare the effect on self-rated pain, disability, and self-efficacy of 3 interventions for the management of chronic whiplash-associated disorders: physiotherapist-led neck-specific exercise (NSE), physiotherapist-led NSE with the addition of a behavioral approach, or Prescription of Physical Activity (PPA). Materials and Methods: A total of 216 volunteers with chronic whiplash-associated disorders participated in this randomized, assessor blinded, clinical trial of 3 exercise interventions. Self-rated pain/pain bothersomeness (Visual Analogue Scale), disability (Neck Disability Index), and self-efficacy (Self-Efficacy Scale) were evaluated at baseline and at 3 and 6 months. Results: The proportion of patients reaching substantial reduction in 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>


A Randomized, Placebo-controlled Trial of the Analgesic Efficacy and Safety of the p38 MAP Kinase Inhibitor, Losmapimod, in Patients With Neuropathic Pain From Lumbosacral Radiculopathy
Discussion: Losmapimod could not be differentiated from placebo in terms of analgesia. The lack of response could reflect insufficient losmapimod levels in the spinal cord or differences between lumbosacral radiculopathy and animal models of neuropathic pain. (Source: The Clinical Journal of Pain)


Intravenous nonopioid analgesic drugs in chronic low back pain patients on chronic opioid treatment: A crossover, randomised, double-blinded, placebo-controlled study: Retraction
No abstract available (Source: European Journal of Anaesthesiology)


Hyperalgesia induced by low-dose opioid treatment before orthopaedic surgery: An observational case–control study
CONCLUSION: Chronic pain patients treated with low doses of opioid had hyperalgesia before surgery. These results highlight the need to personalise the management of patients treated with opioids before surgery. TRIAL REGISTRATION: ID-RCB 2011-A00304-37. (Source: European Journal of Anaesthesiology)


Ultrasound versus fluoroscopic-guided epidural steroid injections in patients with degenerative spinal diseases: A randomised study
CONCLUSION: We have demonstrated the feasibility of ultrasound-assisted epidural steroid injections. (Source: European Journal of Anaesthesiology)


Sexual Function in Patients with Chronic Renal Failure on Hemodialysis and Its Effects on Patients’ Perception of Health and Life Satisfaction
Abstract This descriptive and correlational study was conducted to determine both sexual functions of patients with chronic renal failure on hemodialysis and the relationship between sexual function and “life satisfaction and perception of health”. The study was conducted with 125 patients with chronic renal failure who were treated at dialysis centers. Data were collected with the socio-demographic information form, Arizona Sexual Experience Scale (ASEX), Satisfaction with Life Scale and Nottingham Health Profile questionnaire. Of the participants, 72 % were over the age of 50 and 64.8 % had a chronic illness for six or more years. All the participants were receiving hemodialysis treatment. Of the participants, 85.6 % suffered from sexual dysfunction. There was a moderatel...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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, body mass index and cardiovascular disease risk factors: tests of moderation, unique and shared relationships in the Study of Women’s Health Across the Nation (SWAN)
Abstract Chronic pain may be related to cardiovascular disease (CVD) risk. The current study examined whether persistent bodily pain was related to cardiovascular disease risk factors, whether these effects were moderated by body mass index (BMI), and, if not, whether chronic pain accounted for unique variance in CVD risk factors. Participants were women (N = 2,135) in the Study of Women’s Health Across the Nation. A high pain frequency variable (high pain in 0 through 4 assessments) was coded to reflect the frequency of high levels of bodily pain across the first 3 years of the study. Six CVD risk factors and BMI were measured at follow-up year 3. High pain frequency and BMI were correlated significantly with risk factors, although effects for the former were small. Hierarc...


New hope for treating knee injuries
An experimental new surgery could solve the problem of chronic knee pain from wear and tear of the meniscus cartilage (Source: Health News: CBSNews.com)


Two-step treatment improved function, decreased pain severity in veterans
A stepped-care strategy improved function and decreased pain severity, producing at least a 30 percent improvement in pain-related disability, investigators report. Although U.S. military veterans who have returned from Iraq or Afghanistan are more likely to suffer chronic pain than veterans of any other conflict in American history, little headway has been made in helping them manage the often debilitating effects of chronic pain, authors say. (Source: ScienceDaily Headlines)


Current preventative and health promotional care offered to patients by chiropractors in the United Kingdom: a survey
Conclusions: UK chiropractors are participating in promoting positive lifestyle changes in areas common to preventative healthcare and health promotion areas; however, more can be done, particularly in the areas of smoking and over-consumption of alcohol. In addition, goal-setting to support patient-provider relationships should be more widespread, potentially increasing the utility of such valuable advice and resources. (Source: Chiropractic and Osteopathy)


The use of negative pressure wound therapy with instillation in the management of cervical necrotizing fasciitis
Conclusion: The role of NPWTi continues to expand and can be used in the management of both acute and chronic wounds in the head and neck. This article is protected by copyright. All rights reserved. (Source: Head and Neck)


Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts A Randomized Clinical Trial
Conclusions and RelevanceA stepped-care intervention that combined analgesics, self-management strategies, and brief cognitive behavioral therapy resulted in statistically significant reductions in pain-related disability, pain interference, and pain severity in veterans with chronic musculoskeletal pain.Trial Registrationclinicaltrials.gov Identifier: NCT00386243 (Source: JAMA Internal Medicine)


Epigenetic mechanisms of chronic pain.
Authors: Descalzi G, Ikegami D, Ushijima T, Nestler EJ, Zachariou V, Narita M Abstract Neuropathic and inflammatory pain promote a large number of persisting adaptations at the cellular and molecular level, allowing even transient tissue or nerve damage to elicit changes in cells that contribute to the development of chronic pain and associated symptoms. There is evidence that injury-induced changes in chromatin structure drive stable changes in gene expression and neural function, which may cause several symptoms, including allodynia, hyperalgesia, anxiety, and depression. Recent findings on epigenetic changes in the spinal cord and brain during chronic pain may guide fundamental advances in new treatments. Here, we provide a brief overview of epigenetic regulation in the nervous ...


Cannabinoid Hyperemesis Syndrome: A Cause of Refractory Nausea and Vomiting in Pregnancy.
CONCLUSION: Cannabinoid hyperemesis syndrome should be considered in pregnant women with intractable nausea relieved by frequent hot bathing. By considering this diagnosis, extensive diagnostic testing can be avoided and the correct therapy, abstaining from cannabis use, can be recommended. PMID: 25774930 [PubMed - as supplied by publisher] (Source: Obstetrics and Gynecology)


DR MARK ABRAHAMS tells how to end chronic pain and regain control of your body
Imagine a life with a pain that stops you dead and sucks away your ability to enjoy work, limiting your social life, and destroying relationships, writes DR MARK ABRAHAMS. (Source: the Mail online | 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>


Large ileocecal submucosal lipoma presenting as hematochezia, a case report and review of literature
Conclusion We, hereby, describe a case of benign ileocecal lipoma that presented with hematochezia which is an unusual presentation. Also, there is a great controversy regarding the treatment of colonic lipomas. In this article, we tried to answer several questions concerning the management of ileocecal lipomas. (Source: International Journal of Surgery Case Reports)


Evaluation of clinical measurements and development of new diagnostic criteria for Takayasu arteritis in a Chinese population.
CONCLUSIONS: The new diagnostic criteria exhibited high sensitivity and specificity and have demonstrated to be feasible in the diagnosis of TA. PMID: 25738632 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Rheumatology)


Contribution of chronic diseases to the disability burden in a population 15 years and older, Belgium, 1997–2008
Conclusions: To reduce the burden of disability in Belgium, interventions should target musculoskeletal, cardiovascular and respiratory diseases especially among elderly. Furthermore, attention should also be given to depression in young individuals. (Source: BioMed Central)


Migraine and Epilepsy: Review of the Literature
Migraine and epilepsy are disorders that are common, paroxysmal, and chronic. In many ways they are clearly different diseases, yet there are some pathophysiological overlaps, and overlaps in clinical symptomatology, particularly with regard to visual and other sensory disturbances, pain, and alterations of consciousness. Epidemiological studies have revealed that the two diseases are comorbid in a number of individuals. Both are now recognized as originating from electrical disturbances in the brain, although their wider manifestations involve the recruitment of multiple pathogenic mechanisms. An initial excess of neuronal activity in migraine leads to cortical spreading depression and aura, with the subsequent recruitment of the trigeminal nucleus leading to central sensitization and pai...


Resolution of Chronic Vulvar Pruritus with Replacement of Neuromodulation Device
We report a case in which a patient experienced chronic vulvar pruritus that was refractory to medical treatments without a pathological diagnosis. (Source: The 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>


Chronic Whiplash Pain
This article gives a clinical perspective on current understanding of these pain generators, including the phenomenon of CNS sensitization. (Source: Physical Medicine and Rehabilitation Clinics of North America)


Treatment With Prolonged-Release Oxycodone/Naloxone Improves Pain Relief and Opioid-Induced Constipation Compared With Prolonged-Release Oxycodone in Patients With Chronic Severe Pain and Laxative-Refractory Constipation.
Authors: Poelaert J, Koopmans-Klein G, Dioh A, Louis F, Gorissen M, Logé D, Van Op den Bosch J, van Megen YJ Abstract PURPOSE: Laxative-refractory opioid-induced constipation (OIC) is defined as OIC despite using 2 laxatives with a different mechanism of action (based on the Anatomical Therapeutic Chemical Classification System level 4 term [contact laxatives, osmotically acting laxatives, softeners/emollients, enemas, and others]). OIC has a significant impact on the treatment and quality of life of patients with severe chronic pain. This noninterventional, observational, real-life study in Belgium investigated the efficacy of prolonged-release oxycodone/naloxone combination (PR OXN) treatment regarding pain relief and OIC compared with previous prolonged-release oxycodone (PR OX...


Protracted anaphylaxis developed after peginterferon α-2a administration for chronic hepatitis C.
Authors: Sakatani A, Doi Y, Matsuda T, Sasai Y, Nishida N, Sakamoto M, Uenoyama N, Matsumoto Y, Kinoshita K Abstract Peginterferon is a key drug used to treat chronic viral hepatitis that is known for causing various side effects. Side effects occurring immediately after administration include headache, nausea, and influenza-like symptoms, such as fever and joint pain. However, reports of anaphylactic shock are extremely rare. Here we report a patient with protracted anaphylaxis who suffered shock symptoms after peginterferon α-2a administration for chronic hepatitis C. Although the patient improved temporarily with shock treatment, symptoms of anaphylaxis recurred. As peginterferon is often administered on an outpatient basis, it is important to recognize life-threatening side ef...


Use of other treatment before hysterectomy for benign conditions: what about PCS and CD10?
Corona et al,1 in a large retrospective review of the histopathological findings after hysterectomy found that the frequency of unsupportive pathology was higher in women aged younger than 40 years and highest among women with endometriosis or chronic pain. (Source: American Journal of Obstetrics and Gynecology)


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. (Source: The 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>


Measurement of intervertebral cervical motion by means of dynamic x-ray image processing and data interpolation.
Authors: Bifulco P, Cesarelli M, Romano M, Fratini A, Sansone M Abstract Accurate measurement of intervertebral kinematics of the cervical spine can support the diagnosis of widespread diseases related to neck pain, such as chronic whiplash dysfunction, arthritis, and segmental degeneration. The natural inaccessibility of the spine, its complex anatomy, and the small range of motion only permit concise measurement in vivo. Low dose X-ray fluoroscopy allows time-continuous screening of cervical spine during patient's spontaneous motion. To obtain accurate motion measurements, each vertebra was tracked by means of image processing along a sequence of radiographic images. To obtain a time-continuous representation of motion and to reduce noise in the experimental data, smoothing splin...


The One Change That Will Save Your Life
Almost dying may not give you bragging rights, but what it does give you is the ability to offer sound advice about how to pull through a gam-changing experience. Two years ago, when I was unable to breath, pee, poop, talk, and sit up on my own, I had a choice to make. I could let my head swarm like termite infestation eating away at the sound structure of my brain, or I could choose to look closely at what was happening and embrace it. At least these are the two options I saw for myself at the time. In retrospect, it still makes sense. In a society that thrives off of perfectionism, consumerism, and competition, it is no wonder most of us have spent some time being riddled with anxiety. Or maybe it has been happening the majority of your life. However long you felt the experience, lookin...


A longitudinal analysis on pain treatment satisfaction among Chinese patients with chronic pain: predictors and association with medical adherence, disability, and quality of life
Conclusions Distinct trajectories in pain treatment satisfaction were displayed in the current sample of Chinese patients with different disability grading chronic pain. Within pain treatment, only medication characteristics significantly impacted patients’ medical adherence. (Source: Quality of Life Research)


Sex differences in depression-like behavior after nerve injury are associated with differential changes in brain-derived neurotrophic factor levels in mice subjected to early life stress - Nishinaka T, Kinoshita M, Nakamoto K, Tokuyama S.
We recently demonstrated that exposure to early life stress exacerbates nerve injury-induced thermal and mechanical hypersensitivity in adult male and female mice. Accumulating evidence suggests that chronic pain causes emotional dysfunction, such as anxie... (Source: SafetyLit: All (Unduplicated))


Experience-sampling methodology with a mobile device in fibromyalgia.
Authors: Diana C, Cristina B, Azucena GP, Luis F, Ignacio M Abstract This work describes the usability studies conducted in the development of an experience-sampling methodology (ESM) system running in a mobile device. The goal of the system is to improve the accuracy and ecology in gathering daily self-report data in individuals suffering a chronic pain condition, fibromyalgia. The usability studies showed that the developed software to conduct ESM with mobile devices (smartphones, cell phones) can be successfully used by individuals with fibromyalgia of different ages and with low level of expertise in the use of information and communication technologies. 100% of users completed the tasks successfully, although some have completely illiterate. Also there seems to be a clear diff...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Postinjury treatment with magnesium sulfate attenuates neuropathic pains following spinal cord injury in male rats
Spinal cord injury (SCI) has a number of severe and disabling consequences including chronic pain. Approximately 40% of patients experience neuropathic pain, which appears to be persistent. Previous studies have demonstrated the neuroprotective effects of magnesium sulfate (MgSO4). We aimed to investigate the effect of MgSO4 on neuropathic pains following SCI in male rats. Thirty-two adult male rats (weight 300–350 g) were used. After laminectomy, a complete SCI was induced by compression of the spinal cord for 1 min with an aneurysm clip. A single dose of 300 or 600 mg/kg MgSO4 was injected intraperitoneally. Tail-flick latency and acetone drop test scores were evaluated before surgery and once a week for 4 weeks after surgery. Rats in groups SCI+Mg300 and SCI+Mg600 showed signifi...


Tapentadol and nitric oxide synthase systems
Tapentadol, a new analgesic drug with a dual mechanism of action (μ-opioid receptor agonism and norepinephrine reuptake inhibition), is indicated for the treatment of moderate to severe acute and chronic pain. In this paper, the possible additional involvement of the nitric oxide synthase (NOS) system in the antinociceptive activity of tapentadol was investigated using an unspecific inhibitor of NOS, L-NOArg, a relatively specific inhibitor of neuronal NOS, 7-NI, a relatively selective inhibitor of inducible NOS, L-NIL, and a potent inhibitor of endothelial NOS, L-NIO. Tapentadol (1–10 mg/kg, intraperitoneal) increased the threshold for mechanical (Randall–Selitto test) and thermal (tail-flick test) nociceptive stimuli in a dose-dependent manner. All four NOS inhibitors, administere...


Distinct interactions of cannabidiol and morphine in three nociceptive behavioral models in mice
Cannabinoid and opioid agonists can display overlapping behavioral effects and the combination of these agonists is known to produce enhanced antinociception in several rodent models of acute and chronic pain. The present study investigated the antinociceptive effects of the nonpsychoactive cannabinoid, cannabidiol (CBD) and the µ-opioid agonist morphine, both alone and in combination, using three behavioral models in mice, to test the hypothesis that combinations of morphine and CBD would produce synergistic effects. The effects of morphine, CBD, and morphine/CBD combinations were assessed in the following assays: (a) acetic acid-stimulated stretching; (b) acetic acid-decreased operant responding for palatable food; and (c) hot plate thermal nociception. Morphine alone produced antinocic...


Blockade and reversal of spinal morphine tolerance by P2X3 receptor antagonist
In recent years, studies have substantiated the view that P2X3 receptors play a part in the generation and transmission of purinergic signals in inflammatory and chronic neuropathic pain. Data have also been presented to suggest that the process of P2X3 receptor antagonism inhibits inflammatory hyperalgesia, involving the spinal opioid system. The aim of this study was to investigate the effect of the selective P2X3 receptor antagonist A-317491 on the development of antinociceptive tolerance to chronic morphine administration in mice. Daily systemic injection of A-317491 attenuated the morphine-induced antinociceptive tolerance to von Frey and thermal stimuli. Repeated morphine injections alone led to a significant rightward shift in the morphine dose–response curve compared with that wi...


Boston Medical Center to play key role in back pain treatment study
(Boston University Medical Center) Boston Medical Center (BMC) researchers are part of a national clinical trial that will examine how best to treat acute low back pain and potentially prevent it from being chronic. BMC will receive $2.3 million for its role in the five-year study that was recently approved for a $14 million award by the Patient-Centered Outcomes Research Institute. (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>


A semiautomatic method for in vivo three-dimensional quantitative analysis of fascial layers mobility based on 3D ultrasound scans
Conclusions Obtained results preliminarily demonstrate the viability of the proposed algorithm for the analysis of fascia mobility. Such analysis can enable clinicians to better understand the fascia role in musculoskeletal dynamics and disorder. Further experiments are needed to optimize the method in consideration of the anatomical region to be studied. (Source: International Journal of Computer Assisted Radiology and Surgery)


Interventional Procedures for Chronic Pain in Children and Adolescents: A Review of the Current Evidence
Abstract This review discusses the role of interventional procedures in the treatment of chronic pain in children and adolescents. Due to lack of scientific evidence, significant controversy surrounds the utility of invasive techniques for managing pediatric chronic pain states. Interventional procedures are a widely accepted modality for pain management in adults. The use of such techniques in children is supported only by case reports, case series, and very few randomized controlled studies. In addition, the potential for severe complications leaves open a debate on the safety of these invasive procedures, which must be confirmed by more extensive and accurate prospective studies. (Source: Pain Practice)


Management of Neuropathic Pain Associated with Spinal Cord Injury
Abstract Spinal cord injury (SCI) is an injury to the spinal cord that leads to varying degrees of motor and/or sensory deficits and paralysis. Chronic pain of both neuropathic and nociceptive type is common and contributes to reduced quality of life. The aim of the review is to provide current clinical understanding as well as discuss and evaluate efficacy of pharmacological interventions demonstrated in the clinical studies. The review was based on literature search in PubMed and Medline with words “neuropathic pain” and “spinal cord injury”. The review included clinical studies and not experimental data nor case reports. A limited number of randomized and placebo-controlled studies concerning treatment options of neuropathic pain after SCI were identified. Amitriptyline...


Local knockdown of the NaV1.6 sodium channel reduces pain behaviors, sensory neuron excitability, and sympathetic sprouting in rat models of neuropathic pain
In this study, we injected small inhibitory (si) RNA directed against the NaV1.6 sodium channel isoform into the DRG before SNL. This isoform can mediate high-frequency repetitive firing, like that seen in spontaneously active neurons. Local knockdown of NaV1.6 markedly reduced mechanical pain behaviors induced by SNL, reduced sympathetic sprouting into the ligated sensory ganglion, and blocked abnormal spontaneous activity and other measures of hyperexcitability in myelinated neurons in the ligated sensory ganglion. Immunohistochemical experiments showed that sympathetic sprouting preferentially targeted NaV1.6-positive neurons. Under these experimental conditions, NaV1.6 knockdown did not prevent or strongly alter single evoked action potentials, unlike previous less specific methods use...


Clinical and 22‐item Sino‐Nasal Outcome Test symptom patterns in primary headache disorder patients presenting to otolaryngologists with “sinus” headaches, pain or pressure
ConclusionProminent rhinologic symptoms can be present in PHD patients in the absence of rhinosinusitis. In particular, high symptom‐burden/SNOT‐22 scores and high psychosocial symptoms should raise suspicion of PHD when endoscopy and/or CT results do not correlate with symptoms. (Source: International Forum of Allergy and Rhinology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Facilitation of Synaptic Transmission in the Anterior Cingulate Cortex in Viscerally Hypersensitive Rats
In conclusion, we demonstrated for the first time that visceral hypersensitivity is associated with alterations of synaptic plasticity in the ACC. The ACC synaptic strengthening in chronic visceral pain may engage signal transduction pathways that are in common with those activated by electrical stimulation, and serves as an attractive cellular model of functional visceral pain. (Source: Cerebral Cortex)


Perineural steroids for trauma and compression-related peripheral neuropathic pain: a systematic review and meta-analysis.
CONCLUSIONS: Perineural steroids may provide analgesic efficacy for one to three months in patients with chronic peripheral NP of traumatic or compressive origin; however, the strength of this recommendation is weak. Well-designed large randomized studies are required. PMID: 25744141 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)


Preoperative Ultra-Rapid Opiate Detoxification for the Treatment of Post-operative Surgical Pain
Over the past two decades, the prescription of high does opiate therapy has continued to accelerate in an attempt to treat patients with chronic pain. This presents a substantial challenge when patients on high dose opiate therapy require surgery, as opiate pain relief is a cornerstone of postoperative pain management. These patients have exceptionally challenging pain to control. This is likely due to downregulation of existing opiate receptors and the reluctance of clinicians to increase doses of opiates to exceptionally high levels to facilitate pain relief. (Source: Medical Hypotheses)


Pro-Nociceptive and Anti-Nociceptive Effects of a Conditioned Pain Modulation Protocol in Participants with Chronic Low Back Pain and Healthy Control Subjects
People with chronic pain may exhibit pro-nociceptive phenotypes characterised partly by reduced conditioned pain modulation (CPM). Characterising variability in CPM in people with chronic low back pain (CLBP) may inform management. (Source: Manual Therapy)


Alleviation of neuropathic pain by regulating T-type calcium channels in rat anterior cingulate cortex
Conclusions: TCCs in the ACC may be contributing to the maintenance of neuropathic pain, and the neuropathic pain can be alleviated by inhibiting the neuronal activity of ACC through modulating the TCCs. (Source: Molecular 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>


Morphology and neurochemistry of rabbit iris innervation.
Authors: He J, Bazan HE Abstract The aim of this study was to map the entire nerve architecture and sensory neuropeptide content of the rabbit iris. Irises from New Zealand rabbits were stained with antibodies against neuronal-class βIII-tubulin, calcitonin gene-related peptide (CGRP) and substance P (SP), and whole-mount images were acquired to build a two-dimensional view of the iridal nerve architecture. After taking images in time-lapse mode, we observed thick nerves running in the iris stroma close to the anterior epithelia, forming four to five stromal nerve rings from the iris periphery to the pupillary margin and sub-branches that connected with each other, constituting the stromal nerve plexus. In the anterior side, fine divisions derivated from the stromal nerves, formin...


Depression and pain: an appraisal of cost effectiveness and cost utility of antidepressants - Pan YJ, Pan CH, Chan HY, Kuo KH.
BACKGROUND: Although depression and chronic pain frequently co-occur, there is a lack of clarity in the literature regarding the cost-effectiveness and cost-utility of antidepressants in the presence of these two conditions. From the perspective of healthc... (Source: SafetyLit: All (Unduplicated))


Couples Over 50 Are More Likely To Divorce When The Wife Gets Sick, Study Suggests
Couples vow on their wedding days to love one another in sickness and in health, but apparently, that's not a promise they always keep. A new study published in the Journal of Health and Social Behavior has found that when a wife gets sick, marriages are more likely to end in divorce than "till death do us part." Researchers at Iowa State University looked at 2,701 couples over the age of 50 from the Health and Retirement Study, conducted between 1992 and 2010. They wanted to see if a diagnosis of cancer, heart problems, lung disease and/or stroke could potentially affect marital outcomes. And it did, but only for women: A wife's major illness was associated with a 6 percent higher probability of subsequent divorce, while a husband's illness had no effect on divorce rates whatsoever. "T...


NeuroMetrix tries Indiegogo for Quell OTC chronic pain device
Crowdfunding site Indiegogo is an unconventional marketing tool for the medical device world, but for NeuroMetrix it appears to have paid off. Indiegogo, NeurometrixNews Well, Over-the-counter (OTC), Pain Managementread more (Source: Mass Device)


Study: Interactive, tailored web content may improve patient health, knowledge
Offering interactive web-based content that is personalized for a patient may increase the patient&#8217;s knowledge of their condition and reduce their incidence of negative effects, according to a study conducted by researchers in the Department of Medical Psychology at Germany-based University Medical Center Hamburg-Eppendorf. The study, a randomized control trial of 561 people with either type 2 diabetes or chronic [&#8230;] (Source: mobihealthnews)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Achilles Tendinosis: Treatment Options.
Authors: Lopez RG, Jung HG Abstract Athletes usually complain of an ongoing or chronic pain over the Achilles tendon, but recently even non-athletes are experiencing the same kind of pain which affects their daily activities. Achilles tendinosis refers to a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation. Treatment is based on whether to stimulate or prevent neovascularization. Thus, until now, there is no consensus as to the best treatment for this condition. This paper aims to review the common ways of treating this condition from the conservative to the surgical options. PMID: 25729512 [PubMed - as supplied by publisher] (Source: Clinics in Orthopedic Surgery)


83% of British people recognise chronic pain as a serious medical condition, only 15% get treatment
Almost 10 million people in the UK suffer from chronic pain, which has a major impact on quality of life and day to day activities, such as work; (1) however many of those people do not have their pain under control or know how to go about seeking the right treatment. A survey, which was conducted by St. Jude Medical in collaboration with Pain UK, recently interviewed 1614 people (1090 general respondents and 524 chronic pain sufferers) and found that although chronic pain is quite prevalent, there is a general lack of awareness about what chronic pain is and how it should be treated. (Source: Pharmacy Europe)


Fibromyalgia is characterized by altered frontal and cerebellar structural covariance brain networks
In this study, voxel-based morphometry structural covariance networks were compared between fibromyalgia patients (N = 42) and age- and sex-matched pain-free adults (N = 63). We investigated network topology using spectral partitioning, which can delineate local network submodules with consistent structural covariance. We also explored white matter connectivity between regions comprising these submodules and evaluated the association between probabilistic white matter tractography and pain-relevant clinical metrics. Our structural covariance network analysis noted more connections within the cerebellum for fibromyalgia patients, and more connections in the frontal lobe for healthy controls. For fibromyalgia patients, spectral partitioning identified a distinct submodule with cerebellar...


The mixed-action delta/mu opioid agonist MMP-2200 does not produce conditioned place preference but does maintain drug self-administration in rats, and induces in vitro markers of tolerance and dependence
This study evaluated the rewarding and reinforcing effects of a lead candidate, mixed-action delta/mu agonist MMP-2200, using a conditioned place preference assay as well as a drug self-administration procedure in rats. In place conditioning studies, rats underwent a 2-week conditioning protocol and were then tested for chamber preference. Rats receiving MMP-2200, at previously determined analgesic doses, could not distinguish between the drug and saline-paired chamber, whereas rats receiving the opioid agonist morphine showed a strong preference for the morphine-paired chamber. In self-administration studies, rats were trained to respond for the high efficacy mu opioid receptor agonist fentanyl on an FR5 schedule of reinforcement. Following complete dose–response determinations for fent...


The occurrence and characteristics of pain in HIV-1 positive persons – A challenge in the aging population
Conclusion Almost 40% of respondents reported chronic pain. We have found a strong correlation between age and chronic pain in the HIV infected population with the 7% increase in the odds of experiencing pain with each year of age. (Source: HIV and AIDS Review)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 treatment for chronic knee pain: study by Hinman et al underestimates acupuncture efficacy.
Authors: Zhang Q, Yue J, Lu Y PMID: 25742694 [PubMed - as supplied by publisher] (Source: Acupuncture in Medicine : journal of the British Medical Acupuncture Society)


Introduction and validation of a less painful algorithm to estimate the nociceptive flexion reflex threshold.
Authors: Lichtner G, Golebiewski A, Schneider MH, von Dincklage F Abstract The nociceptive flexion reflex (NFR) is a widely used tool to investigate spinal nociception for scientific and diagnostic purposes, but its clinical use is currently limited due to the painful measurement procedure, especially restricting its applicability for patients suffering from chronic pain disorders. Here we introduce a less painful algorithm to assess the NFR threshold. Application of this new algorithm leads to a reduction of subjective pain ratings by over 30% compared to the standard algorithm. We show that the reflex threshold estimates resulting from application of the new algorithm can be used interchangeably with those of the standard algorithm after adjusting for the constant difference betw...


Cholecystectomy for biliary dyskinesia in gastroparesis: mimic or misfortune?
CONCLUSIONS: Considering the overlap and correlation between gastric and gallbladder function, we should raise the threshold for biliary dyskinesia and reassess the appropriateness of surgical therapy, especially in patients with coexisting dyspeptic symptoms. PMID: 25502153 [PubMed - indexed for MEDLINE] (Source: Southern Medical Journal)


A comprehensive approach to glenohumeral arthritis.
This article reviews the basic science and clinical management of osteoarthritis of the glenohumeral joint. PMID: 25188621 [PubMed - indexed for MEDLINE] (Source: Southern Medical Journal)


The mixed-action delta/mu opioid agonst MMP-2200 does not produce conditioned place preference but does maintain drug self-administration in rats, and induces in vitro markers of tolerance and dependence.
This study evaluated the rewarding and reinforcing effects of a lead candidate, mixed-action delta/mu agonist MMP-2200, using a conditioned place preference assay as well as a drug self-administration procedure in rats. In place conditioning studies, rats underwent a 2-week conditioning protocol and were then tested for chamber preference. Rats receiving MMP-2200, at previously determined analgesic doses, could not distinguish between the drug and saline-paired chamber, whereas rats receiving the opioid agonist morphine showed a strong preference for the morphine-paired chamber. In self-administration studies, rats were trained to respond for the high efficacy mu opioid receptor agonist fentanyl on an FR5 schedule of reinforcement. Following complete dose–response determinations for fent...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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’ Impression of Change Following Treatment for Chronic Pain: Global, Specific, a Single Dimension, or Many?
Patients’ global impression of change (PGIC) has frequently been used as an indicator of meaningful change in treatments for chronic pain. However, limited research has examined the validity of PGIC items despite their wide adoption in clinical trials for pain. Additionally, research has not yet examined predictors of PGIC ratings following psychologically-based treatment for pain. The purpose of the present study was to examine the validity, factor structure, and predictors of PGIC ratings following an interdisciplinary psychologically-based treatment for chronic pain. (Source: The Journal of Pain)


Anticoagulation and interventional pain management
Interventional pain management is a specialty that uses invasive procedures to diagnose and treat chronic pain. Patients undergoing these treatments may be receiving exogenous anticoagulants and antithrombotics. Even though the risk of major bleeding is very small, the consequences can be catastrophic. However, the role of antithrombotic therapy for primary and secondary prevention of cardiovascular disease to decrease the incidence of acute cerebral and cardiovascular events is also crucial. (Source: Techniques in Regional Anesthesia and Pain Management)


Radiofrequency techniques: Complications and troubleshooting
Radiofrequency (RF) is a minimally invasive, target-selective technique that has demonstrated success in reducing pain in several chronic pain conditions. The lack of standard continuous RF ablation protocols for specific targets makes it difficult to compare the percentage of complications of RF between different studies addressing the same pain syndrome. The present article reviews the most frequent complications associated with the most widely used percutaneous continuous RF techniques in pain treatment, and the strategies used to minimize such complications. (Source: Techniques in Regional Anesthesia and Pain Management)


A missed opportunity: tophaceous gout
Several features of one patient’s case belied the original diagnosis. A 70-year-old Filipino man presented to the clinic, complaining of subacute worsening of chronic hand pain. Two weeks prior, he experienced increasing pain and swelling of the metacarpophalangeal joints and both wrists. Over the past several years, he had similar episodes, each lasting 2-3 weeks; shorter when he received oral nonsteroidal anti-inflammatory drugs or prednisone. Between these periods, minimal joint swelling and stiffness remained. (Source: The American Journal of Medicine)


Chronic Pain Assessment
This article focuses on the history and examination and emphasizes pitfalls associated with overreliance on medical technology. (Source: Physical Medicine and Rehabilitation 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>


Patient-reported Outcomes for Multicentric Castleman’s Disease in a Randomized, Placebo-controlled Study of Siltuximab
Conclusions Patients with MCD commonly report impairments in functioning, wellbeing, and fatigue at baseline. Siltuximab-treated patients reported significant improvements in these outcomes after treatment. (Source: The Patient - Patient-Centered Outcomes Research)


Effectiveness of chronic heart treatments can be improved if patients accept their illness.
Authors: Abstract Patients with chronic heart failure who cannot accept their illness are more likely to experience severe pain, negative emotional reactions and sleep disorders, a nurse-led study suggests. PMID: 25736645 [PubMed - in process] (Source: Nursing Standard)


A pilot study - the potential value of an activity-based feedback system for treatment of individuals with chronic lower back pain.
Conclusions: This pilot study suggested that an individual-tailored feedback system that focuses on the activity behavior of the patient has potential as the treatment of individuals with CLBP. Implications for Rehabilitation Activity-based feedback for individuals with chronic low back pain: Many patients are not aware of their activity patterns. The activity patterns of patients differ from those of healthy controls. It is important to make patients aware of their activity patterns in order to change activity behavior. An individual-tailored feedback system seems promising in decreasing pain intensity levels for a subgroup of patients. PMID: 25738912 [PubMed - as supplied by publisher] (Source: Disability and Rehabilitation)


Comparative and quantitative proteomic analysis of normal and degenerated human annulus fibrosus cells.
This article is protected by copyright. All rights reserved. PMID: 25739836 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Pharmacology and Physiology)


Patients' Impression of Change Following Treatment for Chronic Pain: Global, Specific, a Single Dimension, or Many?
The Patient Global Impression of Change (PGIC) measure has frequently been used as an indicator of meaningful change in treatments for chronic pain. However, limited research has examined the validity of PGIC items despite their wide adoption in clinical trials for pain. Additionally, research has not yet examined predictors of PGIC ratings following psychologically based treatment for pain. The purpose of the present study was to examine the validity, factor structure, and predictors of PGIC ratings following an interdisciplinary psychologically based treatment for chronic pain. (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>


Is long-term paracetamol use not as safe as we thought?
Conclusion This is a valuable review that has searched the literature and identified eight observational studies in adults that have looked at the adverse effects that may be associated with paracetamol use. As the researchers say, it will add to information on the potential harms of paracetamol – an area where up-to-date information has been lacking. The studies included very large population sizes, and collectively provide some evidence suggesting potential effects upon the cardiovascular system, kidney and gastrointestinal system. There was also a suggestion of increased risk of all-cause mortality. However, it is very important that these findings are interpreted in the right context. The eight studies were a very variable mix, with very different populations, study duration, measu...


Does Long-Term Acetaminophen Use Raise Health Risks?
Title: Does Long-Term Acetaminophen Use Raise Health Risks?Category: Health NewsCreated: 3/2/2015 12:00:00 AMLast Editorial Review: 3/3/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Transvaginal repair of stage III–IV cystocele using a lightweight mesh: safety and 36-month outcome
Conclusion Transvaginal cystocele repair using a lightweight transobturator polypropylene mesh was safe and efficient in the medium term. Long-term data and comparative studies are needed. (Source: International Urogynecology Journal)


Computational psychological study of the Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP) for patients with chronic low back pain: verification of responsiveness
Discussion The present findings indicate that the BS-POP possesses sufficient responsiveness from a computational psychology perspective. The BS-POP constitutes a tool enabling orthopaedists to easily identify psychiatric problems in orthopaedic patients. (Source: Journal of Orthopaedic Science)


The importance of TRPV1-sensitisation factors for the development of neuropathic pain
Publication date: March 2015 Source:Molecular and Cellular Neuroscience, Volume 65 Author(s): Natalia Malek , Agnieszka Pajak , Natalia Kolosowska , Mateusz Kucharczyk , Katarzyna Starowicz Transient receptor potential vanilloid type 1 (TRPV1), classically associated with transduction of high-temperature and low-pH pain, underlies pain hypersensitivity in neuropathic pain. The molecular regulation of TRPV1 channel activity is not yet fully understood. Therefore, we investigated factors regulating sensitisation of this receptor during development of neuropathic pain in a rat model of chronic construction injury (CCI) in the dorsal root ganglia (DRG). In the rat CCI model, elevated levels of pro-inflammatory cytokines (TNFα, IL-1β and IL-6) in DRG corresponded to development of neuropath...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Reduction of spinal PGE2 concentrations prevents swim stress-induced thermal hyperalgesia
Publication date: 30 March 2015 Source:Neuroscience Letters, Volume 591 Author(s): Coram Guevara , Ana Cristina Fernandez , Ricardo Cardenas , Heberto Suarez-Roca We evaluated the association between spinal PGE2 and thermal hyperalgesia following repeated stress. Thermal nociception was determined in male Sprague–Dawley rats using the hot-plate test, before and after forced-swimming; non-conditioned rats served as controls. Animals were pretreated with ketoprofen or meloxicam, preferential COX-1 and COX-2 inhibitors, respectively. After the second hot-plate test, we measured serum corticosterone (stress marker), and lumbar spinal PGE2 (neuroinflammation marker) under peripheral inflammation (1% formalin plantar injection). Stressed rats displayed response latencies 40% shorter and infl...


Effectiveness of a Web-Based Tailored Interactive Health Communication Application for Patients With Type 2 Diabetes or Chronic Low Back Pain: Randomized Controlled Trial
Conclusions: The primary analysis did not support the study hypothesis. However, content tailoring and interactivity may increase knowledge and reduce health-related negative effects in persons who use IHCAs. There were no main effects of the intervention on other dimensions of patient empowerment or decision-related outcomes. This might be due to our tailored IHCA being, at its core, an educational intervention offering health information in a personalized, empathic fashion that merely additionally provides decision support. Tailoring and interactivity may not make a difference with regard to these outcomes. Trial Registration: International Clinical Trials Registry: DRKS00003322; http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00003322 (Archived by WebCite at http://www.webcitati...


A cross-sectional assessment of the prevalence of multiple chronic conditions and medication use in a sample of community-dwelling adults with fibromyalgia in Olmsted County, Minnesota
Conclusions The results of our study highlight the problem of multiple chronic conditions and high prevalence of polypharmacy in fibromyalgia. Clinicians who care for patients with fibromyalgia should take into consideration the presence of multiple chronic conditions when recommending medications. (Source: BMJ Open)


Computational psychological study of the Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP) for patients with chronic low back pain: verification of responsiveness.
DISCUSSION: The present findings indicate that the BS-POP possesses sufficient responsiveness from a computational psychology perspective. The BS-POP constitutes a tool enabling orthopaedists to easily identify psychiatric problems in orthopaedic patients. PMID: 25727356 [PubMed - as supplied by publisher] (Source: Pain Physician)


Effectiveness of a Web-Based Tailored Interactive Health Communication Application for Patients With Type 2 Diabetes or Chronic Low Back Pain: Randomized Controlled Trial
Conclusions: The primary analysis did not support the study hypothesis. However, content tailoring and interactivity may increase knowledge and reduce health-related negative effects in persons who use IHCAs. There were no main effects of the intervention on other dimensions of patient empowerment or decision-related outcomes. This might be due to our tailored IHCA being, at its core, an educational intervention offering health information in a personalized, empathic fashion that merely additionally provides decision support. Tailoring and interactivity may not make a difference with regard to these outcomes. Trial Registration: International Clinical Trials Registry: DRKS00003322; http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00003322 (Archived by WebCite at http://www.webcitati...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Tendon injury: from biology to tendon repair
Nature Reviews Rheumatology 11, 223 (2015). doi:10.1038/nrrheum.2015.26 Authors: Geoffroy Nourissat, Francis Berenbaum & Delphine Duprez Tendon is a crucial component of the musculoskeletal system. Tendons connect muscle to bone and transmit forces to produce motion. Chronic and acute tendon injuries are very common and result in considerable pain and disability. The management of tendon injuries remains a challenge for clinicians. (Source: Nature Reviews Rheumatology)


Pain is an overlooked cause of sleep disorders
Approximately half of Americans have chronic or acute pain may regularly prevent them from getting a full night of rest (Source: Health News: CBSNews.com)


Your Upset Tummy Could Be Early Signs Of Parkinson’s
You&#8217;ve probably had a gut feeling once or twice in your life. That&#8217;s because your gut and your brain have a special connection. And that&#8217;s why the first sign of many brain disorders could be an upset stomach. I often explain to patients at my wellness clinic that nerve and biochemical pathways run between your gut and brain. And these might be linked to a number of degenerative illnesses, such as Parkinson&#8217;s disease and multiple sclerosis, as well as mental health problems. In fact, the gut and brain share the same nerve chemistry and, with the help of microbes in your digestive tract, these two regions of the human body have an ongoing dialogue. I think of these microbes like a kind of &#8220;biochemical telegraph&#8221; system that helps coordinate your brain, ner...


Inspired Like You: Luc Is Laughing His Way Through The Pain
Luc, 14, has such a severe gastrointestinal disease that his doctors had to remove his colon. But his sharp sense of humor is helping him cope—and raise awareness. by Luc Hyman as told to Jane Bianchi Imagine having to down more than 40 pills every day and never eating ice cream or cake or burritos (in my opinion, the best food of all time!). And when your friends want to grab some pizza, there is nothing for you to eat. Even broccoli is off-limits. Welcome to my life! You see, in the spring of 2012, I got really sick and felt exhausted, and I spent almost a whole month in the hospital while doctors figured out what was causing my painful stomachaches, fevers, and diarrhea. I was eventually diagnosed with a condition called ulcerative colitis, which is a form of inflammatory bowel di...


Immune System Changes Tied to Chronic Fatigue Syndrome
Title: Immune System Changes Tied to Chronic Fatigue SyndromeCategory: Health NewsCreated: 2/27/2015 12:00:00 AMLast Editorial Review: 3/2/2015 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>


Belief in Acupuncture Key to Effect on Back Pain, Study Suggests
Title: Belief in Acupuncture Key to Effect on Back Pain, Study SuggestsCategory: Health NewsCreated: 2/27/2015 12:00:00 AMLast Editorial Review: 3/2/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Sleep in America poll finds pain a significant challenge when it comes to Americans' sleep
(National Sleep Foundation) A new poll by the National Sleep Foundation finds that pain is a key factor in the gap between the amount of sleep Americans say they need and the amount they're getting -- an average 42 minute sleep debt for those with chronic pain and 14 minutes for those who've suffered from acute pain in the past week. (Source: EurekAlert! - Medicine and Health)


Childhood adversities and adult‐onset chronic pain: Results from the World Mental Health Survey, Japan
ConclusionsThe results of this study suggest that in Japan, some forms of CA may be associated with certain types of adult‐onset chronic pain, in particular neck/back pain. (Source: European Journal of Pain)


Comparing the effects of cryotherapy with nitrous oxide gas versus topical corticosteroids in the treatment of oral lichen planus
Conclusion: Cryotherapy with nitrous oxide gas is as effective as topical triamcinolone acetonide in the treatment of OLP with no systemic side effects and needs less patient compliance. It can be considered as an alternative or adjuvant therapy in OLP patients to reduce the use of treatments with adverse effects. (Source: Table of Contents : Indian Journal of Dental Research : 2006 - 17(3))


The village that helped me face fear: Reflections on the training and early career experiences of the 2014 Donald O. Hebb Award recipient.
In June 2014 I had the honour and privilege of receiving the Donald O. Hebb Award for Distinguished Contributions to Psychology as a Science from the Canadian Psychological Association. Although I was the individual upon whom this award was bestowed, my career contributions to the science of psychology have required the labours of many. In this article I pay homage to the “village” that helped me tackle the complexities of various forms of fear and eventually shape current understanding of chronic and disabling pain and its associations with posttraumatic stress disorder. In the spirit of paying forward some of the wisdom graciously imparted on me by that village, and with hopes that this may in some small way benefit others venturing down the career path of Canadian academic psycholog...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cav2.2 channels: Therapeutic target for chronic arthritic pain?
(Source: Arthritis and Rheumatism)


A Discordant Monozygotic-Twin Approach to Potential Risk Factors for Chronic Widespread Pain in Females.
The objective of the present study was to explore the role of previously reported psychosocial and interpersonal risk factors on variation in CWP by investigating CWP discordant monozygotic (MZ) twins. This approach allows separation of cause and effect relationships, albeit imperfectly, as well the control for critical confounding variables such as common environment or genetics. In a total sample of N = 3,266 female twins aged 18-89 years, MZ (113 full pairs) and DZ twins (180 full pairs) discordant for CWP were selected. Items from the London fibromyalgia symptom screening questionnaire were used to discriminate cases from controls. To assess potential risk factors, including body mass index, anxiety sensitivity (AS), emotional intelligence, personality, obsessive-compulsive behavior, a...


Drug-Incorporated Electrospun Fibers Efficiently Prevent Postoperative Adhesion.
Authors: Shi B, Ding J, Wei J, Fu C, Zhuang X, Chen X Abstract adhesion (POA) is a serious event that always causes chronic pain and functional obstruction. Up to now, a variety of matrices prepared by diverse technologies have been employed as physical barriers to prevent POA. Among them, the electrospun fibers of biodegradable polymers exhibited more obvious advantages, such as large surface area, high porosity, and excellent anti-adhesion efficiency. However, the pure electrospun fibers for anti-adhesion cannot effectively regulate the cellular behaviors, and tissue inflammation and healing. In recent years, the polymeric electrospun fibers loaded with various drugs, such as antimicrobial agents, anti-inflammatory drugs, and healing accelerators, have been developed. The advance...


Ameliorative potential of angiotensin-converting enzyme inhibitor (ramipril) on chronic constriction injury of sciatic nerve induced neuropathic pain in mice
Conclusion: It may be concluded that angiotensin-converting enzyme inhibitor may be a potential new target for the management of neuropathic pain. (Source: Journal of the Renin-Angiotensin-Aldosterone System : JRAAS)


Image-guided treatment shown to break the migraine cycle
An innovative interventional radiology treatment has been found to offer chronic migraine sufferers sustained relief of their headaches, according to new research. Clinicians have used a treatment called image-guided, intranasal sphenopalatine ganglion blocks to give patients enough ongoing relief that they required less medication to relieve migraine pain. (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>


The Club-Level Road Cyclist: Injury, Pain, and Performance
Conclusions: Cycling is a sport in which injury risk and prevention need to be further studied. Cyclists are frequently injured but continue to participate in cycling at volumes equal to their healthy peers. Clinical Relevance: This study outlines a clinically reproducible cyclist assessment and discusses behaviors common to the cycling patient. (Source: Clinical Journal of Sport Medicine)


Evaluation of Dynamic Weight Bearing for Measuring Nonevoked Inflammatory Hyperalgesia in Mice
Discussion: Mice with inflammation showed alterations in weight bearing as well as increased thermal hyperalgesia in comparison with control groups. These findings support the use of the DWB test as a tool for measuring nonevoked inflammatory hyperalgesia in a mouse model. (Source: Nursing Research)


Challenges in Managing Acute on Chronic Pain in a Pregnant Woman at High Risk for Opioid Use Disorder in the General Hospital Setting
No abstract available (Source: Harvard Review of Psychiatry)


Pain Management Strategies for Urogynecologic Surgery: A Review
ABSTRACT: Surgery-related pain is common and is difficult to manage during the postoperative period. In some studies, more than 30% of patients who underwent either vaginal surgery or abdominal surgery reported inadequate pain control at postoperative days 3 and 7. Poor pain control during the acute postoperative period causes heightened sympathetic discharge (increasing the risk for myocardial infarction and stroke) and decreased ambulation (increasing the risk for thromboembolism). Poor acute postoperative pain control can also result in poor inspiratory effort, resulting in an increased risk for postoperative pneumonia, and central sensitization with resultant chronic pain sequelae. Opioid drug therapy is the current mainstay for management of acute postoperative pain. However, opioid-r...


Coping Strategies for Health and Daily-Life Stressors in Patients With Rheumatoid Arthritis, Ankylosing Spondylitis, and Gout: STROBE-Compliant Article
This article aims to identify the strategies for coping with health and daily-life stressors of Mexican patients with chronic rheumatic disease. We analyzed the baseline data of a cohort of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout. Their strategies for coping were identified with a validated questionnaire. Comparisons between health and daily-life stressors and between the 3 clinical conditions were made. With regression analyses, we determined the contribution of individual, socioeconomic, educational, and health-related quality-of-life variables to health status and coping strategy. We identified several predominant coping strategies in response to daily-life and health stressors in 261 patients with RA, 226 with AS, and 206 with gout. Evasive and 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>


Cervical Spondylosis and Hypertension: A Clinical Study of 2 Cases
We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis. (Source: Medicine)


Tendinopathy of the Achilles Tendon: Volume Assessed by Automated Contour Detection in Submillimeter Isotropic 3-Dimensional Magnetic Resonance Imaging Data Sets Recorded at a Field Strength of 3 T
Conclusions: Tendon volume and size are adequate surrogate parameters to differentiate patients with chronic TEN from healthy subjects, and may discriminate symptomatic TEN from asymptomatic “silent” TEN in patients with unilateral symptoms. (Source: Journal of Computer Assisted Tomography)


Computed Tomographic–Guided Genitofemoral Nerve Block: A Simple Anterior Approach
We present a novel technique to blocking the genitofemoral nerve in males using an anterior approach with computed tomographic guidance. (Source: Journal of Computer Assisted Tomography)


Best Practices for Patients With Chronic Migraine
Headache and migraine are common medical complaints among patients visiting primary care physicians (PCPs). A number of these patients may have chronic migraine, which is more difficult to diagnose and manage than many other headache disorders. Identification of those at risk, correct diagnosis, and establishment of a comprehensive management plan for patients with chronic migraine will require a joint effort between the PCP and the headache specialist. Together, the PCP and headache specialist will need to assess the patient for modifiable exacerbating factors and comorbidities while managing prophylactic and as-needed therapies. (Source: Mayo Clinic Proceedings)


Don't Forget Palliative Patients
To the Editor We appreciate the Viewpoint by Dr Schechter recently published in JAMA Pediatrics on the hazards of indiscriminate use of opioids in children. He has made major contributions to pain management for children and his words deserve great respect. We accept that pediatricians have insufficient data about the effectiveness of opioids for chronic pain and even less information about how opioid use contributes to substance abuse and harm in developing brains. Nonetheless, we have concerns about Dr Schechter’s call for caution. At the very least, we need thoughtful consideration of how curtailing opioids might adversely affect subpopulations of children with chronic pain. (Source: JAMA Pediatrics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Suppression of peripheral pain by blockade of Cav2.2 channels in nociceptors induces RANKL and impairs recovery from inflammatory arthritis
Conclusion. Altogether, 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. This article is protected by copyright. All rights reserved. (Source: Arthritis and Rheumatism)


What Is New in the Mechanisms of Chronic Pelvic Pain?: Best Articles From the Past Year.
Authors: Soper DE Abstract In this month's feature, we focus on articles that enhance our understanding of the evaluation and treatment of women with chronic pelvic pain. Dr. Soper discusses four recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in Box 1 on this page, along with direct links to the abstracts. PMID: 25730238 [PubMed - as supplied by publisher] (Source: Obstetrics and Gynecology)


Association of Chronic Pelvic Pain and Endometriosis With Signs of Sensitization and Myofascial Pain.
CONCLUSION:: Sensitization and myofascial trigger points were common in women with pain regardless of whether they had endometriosis at surgery. Those with any history of endometriosis were most likely to have sensitization. Traditional methods of classifying endometriosis-associated pain based on disease, duration, and anatomy are inadequate and should be replaced by a mechanism-based evaluation, as our study illustrates. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00073801. LEVEL OF EVIDENCE:: II. PMID: 25730237 [PubMed - as supplied by publisher] (Source: Obstetrics and Gynecology)


Clinical outcome after treatment of pelvic congestion syndrome: Sense and nonsense.
Authors: Meissner M, Gibson K Abstract Chronic pelvic pain accounts for approximately 10% of outpatient gynecologic visits and among the varied causes, pelvic congestion syndrome is second only to endometriosis in frequency. Manifestations may include pelvic pain, dyspareunia, dysuria, and dysmenorrhea as well as external varices and a number of psychosocial symptoms. Although a variety of treatments have been proposed-including pharmacologic ovarian suppression, hysterectomy with or without oophorectomy, and ovarian vein resection-transcatheter embolization is the least invasive and most efficacious management option. Complete or partial symptom improvement has been reported in 68.2-100% of patients and there has been a consistent reduction in visual analog pain scores after treat...


Diagnostic imaging of pelvic congestive syndrome.
Authors: Arnoldussen C, de Wolf M, Wittens C Abstract Many female patients are affected by chronic pelvic pain and a significant number of referrals to the gynecology department result in a clinical suspicion of pelvic congestion syndrome. Additionally, patients referred to the vascular surgery department for venous disease can also present with complaints of a persistent dull lower abdominal pain in addition to typically distributed leg varicosities (that extend from the leg through the pelvic floor) which should be evaluated for the presence of pelvic congestion syndrome. In this article, we focus on imaging pelvic vein insufficiency and related (extending) varicosities: how should we evaluate the pelvic veins, what are the signs to look for, and what are the currently establishe...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 threshold and intensity in rheumatic patients: correlations with the Hamilton Depression Rating scale
This study aims to investigate the relationship between depression and pain intensity and threshold in a group of rheumatic patients compared to healthy subjects. One hundred twenty-four individuals of whom 50 were affected by rheumatoid arthritis (RA), 23 by psoriatic arthritis (PsA), 23 by ankylosing spondylitis (AS), and 28 age-matched controls without chronic pain underwent quantitative sensory testing to assess pressure pain threshold with pressure algometry. Pain intensity was evaluated through the visual analogue scale (VAS) and depression through the Hamilton Depression Rating scale (HAMD). A significant inverse correlation between HAMD values and pressure pain thresholds was found in the entire group of patients (p &lt; 0.0001), in controls (p = 0.02), and also in RA (p ...


Evaluation of the incidence of haemorrhoidal disease in patients with ankylosing spondylitis
Abstract Haemorrhoidal disease (HD) is one of the most common diseases encountered by the clinicians of general surgery. Chronic constipation, pushing during defecation and increased abdominal pressure play an important role in development of haemorrhoidal disease. Patients with ankylosing spondylitis (AS) frequently use the Valsalva manoeuvre in their daily lives, which may increase the abdominal pressure, leading to formation of haemorrhoids. The purpose of this study was to evaluate the incidence of haemorrhoidal disease in patients with AS. A total of 221 individuals were included in this study in three groups as follows: 72 patients with ankylosing spondylitis (AS), 75 patients with chronic low back pain (LBP) and 74 healthy control subjects. Patients were examined both phys...


2014 JOSPT Awards Focus on 2 Contemporary Topics: Dry Needling and Knee Articular Cartilage Defects.
Authors: Simoneau GG Abstract During the American Physical Therapy Association's Combined Sections Meeting in Indianapolis, Indiana in February 2015, JOSPT recognized the authors of the most outstanding research and clinical practice manuscripts published in JOSPT during the 2014 calendar year. The 2014 JOSPT Excellence in Research Award was presented to Rocio Llamas-Ramos, Daniel Pecos-Martín, Tomás Gallego-Izquierdo, Inés Llamas-Ramos, Gustavo Plaza-Manzano, Ricardo Ortega-Santiago, César Fernández-de-las-Peñas, and Joshua A. Cleland for their paper entitled "Comparison of the Short-Term Outcomes Between Trigger Point Dry Needling and Trigger Point Manual Therapy for the Management of Chronic Mechanical Neck Pain: A Randomized Clinical Trial." The 2014 George J. Davies-Jame...


Pain perception in female adolescents with borderline personality disorder
Abstract Borderline personality disorder (BPD) is a severe and often debilitating psychiatric disorder that begins during adolescence. Core features of BPD are affective dysregulation, dysfunctional self-concepts, and difficulties in social interactive domains. A widely accepted marker for severe emotion dysregulation in adult BPD is decreased pain sensitivity. Until now it is unclear whether this characteristic feature of BPD is already present during adolescence. Thus, this study aims to investigate pain sensitivity in adolescent patients meeting DSM-IV criteria for BPD. 20 female adolescent patients with BPD (mean age 16.4 years) and 20 healthy age-matched control participants were investigated. Detection and pain thresholds for thermal stimuli were assessed on both hands. Fu...


Treatment of a patient with posterior cortical atrophy (PCA) with chiropractic manipulation and Dynamic Neuromuscular Stabilization (DNS): A case report.
CONCLUSION: PCA is a progressive and debilitating condition. Because of poor awareness of PCA by physicians, patients usually receive incomplete care. Additional efforts must be centered on the musculoskeletal features of PCA, aiming enhancement in quality of life and functional improvements (FI). Adjunctive rehabilitative treatment is considered essential for individuals with cognitive and motor disturbances, and manual medicine procedures may be consider a viable option. PMID: 25729084 [PubMed] (Source: Pain Physician)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cross-cultural adaptation and validation of the Neck Bournemouth Questionnaire in the Italian population
Conclusions The validation process revealed acceptable psychometric properties of the NBQ, whose Italian version can be used for research and clinical purposes. (Source: Quality of Life Research)


Chronic popliteal entrapment with calcified lesions results in an acute occlusion after blunt knee trauma in a 17-year-old soccer player
A 17-year-old soccer player noticed intermittent claudication after reconvalescence from a severe blunt knee trauma with laceration of the anterior cruciate ligament. Physical examination revealed a pulseless right leg without rest pain. Magnetic resonance imaging documented a short occlusion of the popliteal artery with sparse but visible collaterals (A). Cross-sectional imaging demonstrated an atypical bundle or accessory insertion of the gastrocnemius muscle (popliteal entrapment syndrome type III) (B). (Source: Journal of Vascular Surgery)


A Qualitative Study of Potential Suicide Risk Factors Among Operation Iraqi Freedom/Operation Enduring Freedom Soldiers Returning to the Continental United States (CONUS)
ConclusionsFindings highlight the utility of the IPTS in understanding precursors to suicide associated with transition from deployment, as well as treatment strategies that may reduce risk in Soldiers during reintegration. (Source: Journal of Clinical Psychology)


Migraine and epilepsy: review of the literature.
Authors: Nye BL, Thadani VM Abstract Migraine and epilepsy are disorders that are common, paroxysmal, and chronic. In many ways they are clearly different diseases, yet there are some pathophysiological overlaps, and overlaps in clinical symptomatology, particularly with regard to visual and other sensory disturbances, pain, and alterations of consciousness. Epidemiological studies have revealed that the two diseases are comorbid in a number of individuals. Both are now recognized as originating from electrical disturbances in the brain, although their wider manifestations involve the recruitment of multiple pathogenic mechanisms. An initial excess of neuronal activity in migraine leads to cortical spreading depression and aura, with the subsequent recruitment of the trigeminal nuc...


An evaluation of short-stretch compression systems for chronic lower-limb leg ulcers.
Authors: Carr C, Shadwell J, Regan P, Hammett S Abstract An evaluation of a new short-stretch compression system (CoFlex UBZ, TLC and TLC Lite, Aspen Medical Europe Ltd) was undertaken in four leg ulcer clinics. A total of 19 patients aged 42-93 years were treated for up to 4 weeks, or until healed. Collated data included age, underlying diseases, leg ulcer type, ulcer duration and current treatment. The evaluation included quality of life measurements, wear time, slippage, exudate strikethrough and pain using a numerical pain score. Patients were asked to document sleep patterns. Compression was applied according to clinical need. Inclusion criteria were non-healing wounds on the lower limb existing for more than 6 weeks that were suitable for compression. Exclusion criteria inclu...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 children in primary care.
CONCLUSIONS: Chronic abdominal pain sufficient to affect well-being is common among children initially seen for abdominal pain by family physicians. Although the risk of this outcome increases with number of predictors, these predictors are of limited value in identifying children in whom pain will become chronic, suggesting that other, as yet unidentified factors play an important role. PMID: 25755037 [PubMed - in process] (Source: Annals of Family Medicine)


Traditional Uses of Medicinal Plants from the Canadian Boreal Forest for the Management of Chronic Pain Syndromes
ConclusionsOur study showed the potential of boreal plants as alternative and complementary medicines for the treatment of chronic pain syndromes that could be enhanced by further research on efficacy and safety issues. (Source: Pain Practice)


Pain Management Programmes for Non‐English‐Speaking Black and Minority Ethinic Groups With Long‐Term or Chronic Pain
Abstract Increasing ethnic diversity in the UK means that there is a growing need for National Health Service care to be delivered to non‐English‐speaking patients. The aims of the present systematic review were to: (1) better understand the outcomes of chronic pain management programmes (PMPs) for ethnic minority and non‐English‐speaking patients and (2) explore the perspectives on and experiences of chronic pain for these groups. A systematic review identified 26 papers meeting the inclusion criteria; no papers reported on the outcomes of PMPs delivered in the UK. Of the papers obtained, four reported on PMPs conducted outside the UK; eight reported on ethnic differences in patients seeking support from pain management services in America; and the remaining papers included litera...


Pharmacologic interventions for painful diabetic neuropathy: comparative analysis using network meta‐analysis
This article is protected by copyright. All rights reserved. (Source: Journal of Diabetes Investigation)


Intrathecal analgesia: Time to consider it for your patient?
Authors: Shaparin N, Sim A, Pappagallo M, Gritsenko K, Carullo V, Tsukanov J, Kosharskyy B Abstract When systemic analgesics or antispasmodics fail to control chronic pain or cause intolerable adverse effects, an intrathecal drug delivery system may be the best bet. PMID: 25789343 [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>


Clomiphene Citrate as a Preventive Treatment for Intractable Chronic Cluster Headache: A Second Reported Case With Long‐Term Follow‐Up
DiscussionThis 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. (S...


An Approach to Pain Management in End Stage Renal Disease: Considerations for General Management and Intradialytic Symptoms
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 effects guiding selection of agents. Overall, evidence is ...


Interim analysis: An interdisciplinary team approach in facilitating weight reduction and improving function for people with knee or hip osteoarthritis. The Osteoarthritis Chronic Care Program at Royal North Shore Hospital
ConclusionsThe programme assisted participants in promoting weight loss and those with knee osteoarthritis improved clinically in mobility and walking capacity by 26 weeks. Complete data set is required to validate these findings. (Source: Nutrition and Dietetics)


The Presence of Is Associated With Increased Leukocyte Counts and Pain Severity in Men With Chronic Pelvic Pain Syndrome
To examine the role of urinary chlamydial infection in patients with chronic prostatitis and/or chronic pelvic pain syndrome (CP-CPPS). (Source: Urology)


The pain paradox: borderline personality disorder features, self-harm history, and the experience of pain - Carpenter RW, Trull TJ.
Individuals with borderline personality disorder (BPD), compared to controls, report a relative absence of acute pain. In contrast, BPD is overrepresented among chronic pain patients, suggesting they experience a relative excess of chronic pain. To date, t... (Source: SafetyLit: All (Unduplicated))<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 of low back pain among nurses: predisposing factors and role of work place violence - Rezaee M, Ghasemi M.
BACKGROUND: Ergonomic factors predispose nurses to low back pain (LBP). Few studies have clarified the role of workplace violence in LBP occurrence. OBJECTIVES: The present study was designed to investigate acute and chronic LBP in Iranian nurses a... (Source: SafetyLit: All (Unduplicated))


The prevalence and correlates of chronic pain and suicidality in a nationally representative sample - Campbell G, Darke S, Bruno R, Degenhardt L.
BACKGROUND: Research suggests that people suffering from chronic pain have elevated rates of suicidality. With an ageing population, more research is essential to gain a better understanding of this association. AIMS: To document the prevalence and correla... (Source: SafetyLit: All (Unduplicated))


Why Sitting Up Straight Makes You Feel Better
This article was originally published in Positive Health Issue 220 Feb 2015. http://www.positivehealth.com/article/mind-body/sit-up-straight-a-simple-technique-to-feel-better-and-have-more-energy (Source: Psych Central)


The Reported Pain Coping Strategies of Pediatric Burn Survivors—Does a Correlation Exist Between Coping Style and Development of Anxiety Disorder?
This study sought to determine whether an association existed between self-reported pain coping skills and anxiety levels in a cohort of pediatric burn patients, and whether gender would influence their responses. The sample comprised burn-injured children in attendance at one of three mature burn camp sites. The self-report measures utilized included the 41-item Screen for Child Anxiety Related Disorders Child Version and the 39-item Pain Coping Questionnaire. Parental consent was obtained. A psychologist administered the measures. Participants included 187 youth, mean age 12.4 ± 2.4 years, girls (n = 89) boys (n = 98) with 67% reporting visible burn scars. Among boys, the use of Internalizing Coping Strategies was moderately correlated with elevated scores on Panic Disorder symptoms (r ...


Healthpointe is Now Performing Arthroscopic Surgery Techniques for...
Over ten Healthpointe clinics are available throughout Southern California to help assess and treat acute and chronic elbow, hand and wrist pain.(PRWeb February 27, 2015)Read the full story at http://www.prweb.com/releases/2015/02/prweb12548915.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>


3 Quick And Easy Ways To Prevent Running Injuries
By Jason Fitzgerald, founder of Strength Running, for Life by DailyBurn We get it. You want to get better at your sport while keeping running injuries at bay -- but you're busy. You don't have time for an extra 30-minute strength session on top of your current training plan. And forget about that 20-minute head-to-toe flexibility "warm-up." You're just struggling just to get your runs in, period. It's true that a comprehensive injury prevention routine can be time consuming. In fact, many professional athletes devote hours every day to core exercises, cross-training and massage (among many other things), on top of their sport-specific training. But keeping your body healthy doesn't always need to be a time suck. In fact, some of the best techniques take little or no extra time at all. O...


Population pharmacokinetics of S -ketamine and norketamine in healthy volunteers after intravenous and oral dosing
Conclusions Given that the analgesic effect of S-ketamine is due to both S-ketamine and norketamine, relatively small oral doses of S-ketamine can be assumed to be a feasible alternative to repeated intravenous dosing, for example in the setting of chronic pain. (Source: European Journal of Clinical Pharmacology)


Pain Experience and Expression in Rett Syndrome: Subjective and Objective Measurement Approaches
This study investigated pain experience and expression using multiple complementary subjective and objective approaches among a clinical RTT sample. Following informed consent, 18 participants (all female) with RTT (mean age = 12.8 years, SD = 6.32) were characterized in terms of pain experience and interference, typical pain expression, and elicited pain behavior during a passive range of motion-like examination procedure. Parents completed the Dalhousie Pain Interview (DPI; pain type, frequency, duration, intensity), the Brief Pain Inventory (BPI; pain interference), and the Non-Communicating Children’s Pain Checklist – Revised (NCCPC-R; typical pain expression). A Pain Examination Procedure (PEP) was conducted and scored using the Pain and Discomfort Scale (PADS). The major...


One year in review: novelties in the treatment of rheumatoid arthritis.
Authors: Guidelli GM, Barskova T, Brizi MG, Lepri G, Parma A, Talarico R, Cantarini L, Frediani B Abstract Rheumatoid arthritis (RA) is a chronic disease characterised by inflammation of the synovial tissue in joints, which can lead to joint destruction. The primary aim of the treatment is to control pain and inflammation, reduce joint damage and disability, and maintain or improve physical function and quality of life. In this article, we provide a critical analysis of the recent literature on the novelties in the treatment of RA, with a particular focus on the most relevant studies published over the last two years. PMID: 25719499 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Rheumatology)


Increased postoperative day one discharges after implementation of a hysterectomy enhanced recovery pathway: a retrospective cohort study
Conclusion For patients undergoing abdominal hysterectomy, implementation of a HER pathway is associated with a higher POD 1 discharge rate, with no increase in the early return to hospital rate. (Source: Canadian Journal of Anesthesia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Changes of postural control and muscle activation pattern in response to external perturbations after neck flexor fatigue in young subjects with and without chronic neck pain
Chronic neck pain (CNP) is a common musculoskeletal disease with a reported one-year prevalence ranging from 10.4% to 75.1% in the adult population worldwide [1]. It is one of the most common causes of long-term physical and psychosocial disabilities with a high recurrence rate[2,3]. Higher perceived neck disability and fear of movement in individuals with CNP may also lead to reduced physical activity[4]. (Source: Gait and Posture)


Sensory nerve fibers containing calcitonin gene-related peptide in gastrocnemius, latissimus dorsi and erector spinae muscles and thoracolumbar fascia in mice
This study used multiple-labeling immunofluorescence and retrograde axonal tracing to identify dorsal root ganglion cells associated with muscle, and to characterize the distribution and density of their nerve fibers in mouse gastrocnemius and back muscles and in the thoracolumbar fascia. Most nerve fibers in these tissues contained CGRP and two major subpopulations of neurons were found: those containing CGRP and substance P (SP) and those containing CGRP but not SP. Innervation density was three times higher in the thoracolumbar fascia than in muscles of the back. These studies show mouse back and leg muscles are predominantly innervated by neurons containing CGRP, an important modulator of pain signal transmission. There are two distinct populations of neurons containing this peptide an...


Complications in interventional pain treatment
Interventional pain management, as defined by the National Uniform Claims Committee, is the discipline of medicine dedicated to the diagnosis and treatment of pain by the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatments.1 Intervention procedures for pain treatment are world widely performed and its number is growing exponentially.2 As in all invasive treatments, complications may arise. (Source: Techniques in Regional Anesthesia and Pain Management)


Increased postoperative day one discharges after implementation of a hysterectomy enhanced recovery pathway: a retrospective cohort study.
CONCLUSION: For patients undergoing abdominal hysterectomy, implementation of a HER pathway is associated with a higher POD 1 discharge rate, with no increase in the early return to hospital rate. PMID: 25724789 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)


Robust evidence that chronic fatigue syndrome is a biological illness
Researchers have identified distinct immune changes in patients diagnosed with chronic fatigue syndrome, known medically as myalgic encephalomyelitis or systemic exertion intolerance disease. The findings could help improve diagnosis and identify treatment options for the disabling disorder, in which symptoms range from extreme fatigue and difficulty concentrating to headaches and muscle pain. (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>


Bariatric Surgery Patients’ Response to a Chronic Pain Rehabilitation Program
Conclusions These results suggest that bariatric patients may be at risk for treatment non-adherence and have difficulty reducing medication use in the treatment of chronic pain. (Source: Obesity Surgery)


Chronic Fatigue Syndrome (CFS or SEID)
Title: Chronic Fatigue Syndrome (CFS or SEID)Category: Diseases and ConditionsCreated: 12/31/1997 12:00:00 AMLast Editorial Review: 2/27/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Scientists discover robust evidence that chronic fatigue syndrome is a biological illness
(Columbia University's Mailman School of Public Health) Researchers at the Center for Infection and Immunity at Columbia University's Mailman School of Public Health identified distinct immune changes in patients diagnosed with chronic fatigue syndrome, known medically as myalgic encephalomyelitis or systemic exertion intolerance disease. The findings could help improve diagnosis and identify treatment options for the disabling disorder, in which symptoms range from extreme fatigue and difficulty concentrating to headaches and muscle pain. (Source: EurekAlert! - Infectious and Emerging Diseases)


One in every three women could potentially be spared chronic pain after breast cancer surgery
(Source: St. Michael's Hospital News and Media)


The PREEMPT study - evaluating smartphone-assisted n-of-1 trials in patients with chronic pain: study protocol for a randomized controlled trial
DiscussionTrialist will allow patients and clinicians to conduct personalized n-of-1 trials. In prior studies, n-of-1 trials have been shown to encourage greater patient involvement with care, which has in turn been associated with better health outcomes. mHealth technology implemented using smartphones may offer an efficient means of facilitating n-of-1 trials so that more patients can benefit from this approach.Trial registrationClinicalTrials.gov: NCT02116621, first registered 15 April 2014. (Source: Trials)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy
Conclusions When used by patients with chronic Achilles tendinopathy, rocker shoes cause a significant reduction in plantar flexion moment in the late stance phase of running and walking without substantial adaptations in triceps surae muscular activity. (Source: Journal of Science and Medicine in Sport)


Glial cell line‐derived neurotrophic factor‐mediated enhancement of noradrenergic descending inhibition in the locus coeruleus exerts prolonged analgesia in neuropathic pain
Conclusions and ImplicationsGDNF injection into the LC exerts prolonged analgesic effects on neuropathic pain in rats by enhancing descending noradrenergic inhibition. (Source: British Journal of Pharmacology)


Muscle energy technique for non-specific low-back pain.
CONCLUSIONS: The quality of research related to testing the effectiveness of MET is poor. Studies are generally small and at high risk of bias due to methodological deficiencies. Studies conducted to date generally provide low-quality evidence that MET is not effective for patients with LBP. There is not sufficient evidence to reliably determine whether MET is likely to be effective in practice. Large, methodologically-sound studies are necessary to investigate this question. PMID: 25723574 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


[Interdisciplinary Diagnosis and Treatment of Deep Infiltrating Endometriosis.]


Trigeminal neuralgia: pain, pricks, and anxiety.
Authors: Puskar KR, Droppa M Abstract Trigeminal neuralgia (TN) is one of the most common forms of neuralgia experienced by older adults. Early in the course of the illness, individuals may be misdiagnosed, with associated delays in treatment. The current article uses an individual example to provide a framework for assessment and clinical management. Because pain associated with TN may be chronic, specific quality of life issues and related management approaches are presented, as well as guidelines for monitoring response to treatment. Targeted strategies to prevent pain triggers and suggestions for supportive coaching provide direction for health providers caring for older adults with TN. [Journal of Gerontological Nursing, 41(3), 8-12.]. PMID: 25710263 [PubMed - in process]...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 care practices with suicide attempts in US veterans prescribed opioid medications for chronic pain management - Im JJ, Shachter RD, Oliva EM, Henderson PT, Paik MC, Trafton JA.
IMPORTANCE: Patients receiving opioid therapy are at elevated risk of attempting suicide. Guidelines recommend practices to mitigate risk, but it is not known whether these are effective. OBJECTIVE: Our aim was to examine associations between the r... (Source: SafetyLit: All (Unduplicated))


A Look Behind the Bedroom Door at What's Causing Your Low Libido
In today's pop culture, sex appears to be everywhere, especially as the 50 Shades of Grey books and movie continue to spur conversation about sexual desires and fantasies. But while our society seems more comfortable with women talking about sex, wanting sex and having sex, many still squirm at the idea of having a conversation with their partners, friends and health care providers. In my practice, many women bring up their sexual problems with "oh by the way..." when their hand is on the doorknob as they leave my office. What these women may not know is sexual health can have a serious impact on overall health, relationships and mental wellbeing, which is why it shouldn't be an afterthought when talking to your health care provider. They can help you find solutions! There are different...


Involvement of nitridergic and opioidergic pathways in the antinociception of gabapentin in the orofacial formalin test in mice.
CONCLUSIONS: These results suggest that gabapentin produce antinociception partly via the activation nitridergic pathways and opioid system. PMID: 25712671 [PubMed - in process] (Source: Pharmacological Reports)


A Brief Guide To The Basic Fundamentals Of Art Therapy
The British Association of Art Therapists defines art therapy as "a form of psychotherapy that uses art media as its primary mode of communication." There are no limits on who can participate and no constrictions on what artistic supplies can be incorporated. The field, available to children and adults of all backgrounds and circumstances, opens up avenues of communication that extend beyond verbal language, exploring feelings that cannot be spoken. Over the past few months, we've published a series of articles suggesting relaxation techniques -- inspired by the field of art therapy -- meant to help readers unwind, heal and express these unspoken feelings. We are not art therapists, and although the various artistic methods are based on therapy methods, art therapy can really only be defi...


Evaluation and Management of Back Pain in the Elderly
Abstract Back pain is common in the elderly. Most back pain is uncomplicated but identifying back pain due to serious systemic disease is essential. History and physical exam are critical to this distinction and guide further diagnostic evaluation. There are numerous treatments available for acute and chronic back pain, yet there are special considerations when treating the elderly. Treatment is comprehensive with pharmacotherapy, physical therapy, and alternative methods. Pharmacologic therapy for back pain is targeted at reducing inflammation and providing analgesia. Physical therapy is a necessary part of any treatment plan. Non-pharmacologic treatments are broad in scope and consist of activity-based modalities and alternative therapies. Acute back pain generally has a good pr...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial
Conclusion: Subxyphoid pleural drainage in severe Chronic obstructive pulmonary disease patients determined better preservation and recovery of pulmonary capacity and volumes with lower pulmonary shunt fraction and better clinical outcomes on early postoperative off-pump coronary artery bypass grafting. Objetivo: Avaliar a função pulmonar e os resultados clínicos em pacientes com doença pulmonar obstrutiva crônica grave submetidos à cirurgia de revascularização do miocárdio sem circulação extracorpórea, com enxerto da artéria torácica interna esquerda, comparando a inserção do dreno pleural intercostal versus subxifoide. Métodos: Estudo clínico, controlado e randomizado. Pacientes com doença pulmonar obstrutiva crônica foram randomizados em dois grupos de acordo com a p...


Attachment insecurity predicts responses to an interdisciplinary chronic pain rehabilitation program
Abstract The aim of this study was to examine the hypothesis that attachment insecurity is associated with poorer responses to interdisciplinary treatment for chronic pain. Patients (n = 235) admitted to a 4-week interdisciplinary rehabilitation program were recruited. At pre-treatment, participants completed a battery of questionnaires assessing adult attachment styles and dimensions, as well as pain intensity, disability, self-efficacy, pain catastrophizing, and depressive symptoms. The latter measures were completed again at post-treatment. Nearly two-thirds of participants (65.5 %) reported having an insecure attachment style. Attachment insecurity was unrelated to pre- and post-treatment reports of pain intensity and pain-related disability, but was significantly associate...


Evaluation of a Telementoring Intervention for Pain Management in the Veterans Health Administration
ConclusionsSCAN‐ECHO‐PM was associated with increased utilization of physical medicine services and initiation of nonopioid medications among patients with CNCP. SCAN‐ECHO‐PM may provide a novel means of building pain management competency among primary care providers. (Source: Pain Medicine)


Factors Affecting Mobility in Community-dwelling Older Koreans with Chronic Illnesses
Conclusion A high-risk group for mobility limitation includes low income, sedentary older men who are at risk for increased fatigue and sleep deficit. Further research should incorporate other psychological and lifestyle factors such as depression, smoking, drinking behavior, and/or obesity into the prediction model of mobility to generate specific intervention strategies for mobility enhancement recommendations for older adults. (Source: Asian Nursing Research)