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Medworm: Chronic Pain - Recent Medical Updates

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Melatonin prevents morphine-induced hyperalgesia and tolerance in rats: role of protein kinase C and N-methyl-D-aspartate receptors
Conclusions: Our findings demonstrate that melatonin have potential to attenuate repetitive morphine-induced hyperalgesia and tolerance, possibly by inhibiting PKCgamma and NR1 activities in the spinal cord. (Source: BMC Anesthesiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A New Approach to Urologic Chronic Pelvic Pain Syndromes: Applying Oncologic Principles to “Benign” Conditions
Abstract The urologic chronic pelvic pain syndromes—interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome—continue to be both a major cause of morbidity in patients and huge challenge to clinicians. This is largely because patients with common symptoms but differing underlying pain mechanisms are grouped together. In addition, frustration with poor outcomes leads to cynicism and negativism producing an important nocebo effect, further compromising patient care. A new approach is needed. Utilizing principles borrowed from our oncologic colleagues to UCPPS patients can improve all aspects of care: Diagnosis of clinically relevant phenotypes Objectively staging the severity of d...


Comparative pilot study of implantation techniques for pudendal neuromodulation: technical and clinical outcome in first 20 patients with chronic pelvic pain
Conclusions The STAR approach appears to achieve technical standardisation and optimized reproducibility in pudendal lead placement resulting into an increased feasibility of PNM. (Source: World Journal of Urology)


Abdominal aortic aneurysm causing lumbar vertebral erosion in Behçet’s disease presenting by low back pain
In this report, we describe a case of a 55-year-old male with Behçet’s disease who presented with a low back pain and sciatica. Imaging studies showed that he had a destruction of the third lumbar vertebra because of abdominal aortic aneurysm-related Behçet’s disease. Aortic aneurysms with vertebral body erosion have been rarely reported, but this vascular complication is a life-threatening clinical picture. Therefore, among the causes of chronic lumbar pain in a BD patient, abdominal aortic aneurysm should be remembered. (Source: Rheumatology International)


Hypovitaminosis D in widespread pain: its effect on pain perception, quality of life and nerve conduction studies
This study confirm that hypovitaminosis D is related with higher pain intensity and lower QoL scores in patients with CWP when compared with control group. Additionally, we identified for the first time that there were negative correlations between vitamin D levels and some findings of NCSs. (Source: Rheumatology International)


Obesity and sleepiness in women with fibromyalgia
The objective of the present study was to investigate the relationship between obesity and sleepiness in women with FM. A total of 100 adult female patients with a prior medical diagnosis of FM participated in the study. Body mass, height and waist circumference were measured, and body mass index (BMI) was calculated. The diet quality was evaluated by the Healthy Eating Index. Subjective analyses of daytime sleepiness [Epworth Sleepiness Scale (ESS)] and sleep quality (Pittsburgh Sleep Quality) were performed. An obesity rate of 41 % was found in all women (56.1 % were sleepy and 43.9 % were not, p = 0.04). Obese women showed a greater level of sleepiness when compared with non-obese (10.2 and 7.0, respectively, p = 0.004). Sleepy women showed a greater weight gain after the diagnos...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Elevation of plasma 1‐deoxy‐sphingolipids in type 2 diabetes mellitus: a susceptibility to neuropathy?
Conclusion1‐deoxy‐sphingolipid plasma levels are significantly elevated in DSPN. They are already detectable in early disease stages but do not correlate with the clinical course. Further knowledge on 1‐deoxy‐sphingolipids might lead to a better pathophysiological understanding and future treatment options in DSPN. (Source: European Journal of Neurology)


Point‐of‐care musculoskeletal ultrasound is critical for the diagnosis of hemarthroses, inflammation and soft tissue abnormalities in adult patients with painful haemophilic arthropathy
Summary We previously demonstrated in adult patients with haemophilia (PWH) that hemarthrosis is present in only ~1/3rd of acutely painful joints by using point‐of‐care‐musculoskeletal ultrasound (MSKUS). Therefore, other unrecognized tissue abnormalities must contribute to pain. Using high resolution MSKUS, employing grey scale and power Doppler, we sought to retrospectively (i) investigate soft tissue abnormalities in painful haemophilic joints and (ii) to determine to what extent MSKUS findings, functional or radiographic joint scores correlate with biomarkers of inflammation in PWH. Findings were correlated with Hemophilia Joint Health Scores (HJHS), Pettersson scores, high sensitivity C‐reactive protein and von Willebrand factor activity and antigen levels. A total of 65 MSKUS...


Involvement of neuronal transforming growth factor‐beta activated kinase 1 in the development of tolerance to morphine‐induced anti‐nociception in rat spinal cord
Conclusions and ImplicationsOverall, the present work demonstrated that TAK1 plays a pivotal role in the development of morphine‐induced anti‐nociceptive tolerance, and modulation of TAK1 activation by the selective inhibitor (5Z)‐7‐oxozeaenol in the lumbar spinal cord may prove to be an attractive adjuvant therapy to attenuate such tolerance. (Source: British Journal of Pharmacology)


A novel selective and orally bioavailable NaV1.8 blocker PF‐01247324 attenuates nociception and sensory neuron excitability
CONCLUSIONS AND IMPLICATIONSStudies using a PF‐01247324, have confirmed a role for NaV1.8 in both inflammatory and neuropathic pain in agreement with studies using previously disclosed NaV1.8 blockers. In addition, using PF‐01247324 we demonstrated a key role for NaV1.8 in action potential upstroke and repetitive firing of rat and human DRG neurons. (Source: British Journal of Pharmacology)


Gender is a determinative factor in the initial clinical presentation of eosinophilic esophagitis
Summary Eosinophilic esophagitis (EoE) is a chronic, immune‐mediated disease resulting in symptoms of esophageal dysmotility. Abnormalities include dysphagia, food impaction and reflux. Although men appear to comprise a majority of the EoE population, few studies have directly assessed gender‐associated clinical differences. The aim of this study is to identify the effect of gender on the initial clinical presentation of adult‐onset EoE patients. We reviewed our electronic medical record database from January 2008 to December 2011 for adults diagnosed with EoE per the 2011 updated consensus guidelines. Patient demographics, presenting symptoms, endoscopy findings and complications were recorded. Proportions were compared using chi‐squared analysis, and means were compared using the...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Do Cognitive and Physical Fatigue Tasks Enhance Pain, Cognitive Fatigue, and Physical Fatigue in People With Fibromyalgia?
ConclusionThese data show that people with fibromyalgia show larger increases in pain, perceived cognitive fatigue, and perceived physical fatigue to both cognitive and physical fatigue tasks compared to healthy controls. The increases in pain and fatigue during cognitive and physical fatigue tasks could influence subject participation in daily activities and rehabilitation. (Source: Arthritis Care and Research)


FDA Okays Senza Spinal Cord Stimulation System for PainFDA Okays Senza Spinal Cord Stimulation System for Pain
Nevro Corp has received an 'approvable' letter from the FDA for neurostimulation system for treatment of chronic pain. FDA Approvals (Source: Medscape Neurology and Neurosurgery Headlines)


How I've learnt to take my dodgy hip in my stride
Since a road accident as a child, Liz Hunt has suffered chronic pain - so could learning to 'Walkactive' be the answer? (Source: The Telegraph : Health Advice)


Chronic pain, activity restriction and flourishing mental health.
This study uses a measure of mental health (flourishing), rather than mental illness to examine associations between pain and activity restrictions. DATA AND METHODS: Data from the 2011/2012 Canadian Community Health Survey were used to study the relationship between pain intensity, pain-related activity prevention, and flourishing mental health in people aged 18 or older. Multivariate logistic regression was used in a sample of 26,429 people with chronic pain to identify significant relationships, while adjusting for potential confounders. RESULTS: In 2011/2012, an estimated 6 million Canadians aged 18 or older (22%) reported chronic pain. They were less likely to be in flourishing mental health than were people without chronic pain (69% versus 79%). The prevalence of flourishing ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 chronic prostatitis/chronic pelvic pain syndrome
Chronic prostatitis is a poorly understood and difficult‐to‐treat condition. The authors discuss a guideline produced by the Prostatitis Expert Reference Group (PERG), which provides a framework for initial assessment and effective management in the community. Roger Kirby and Culley Carson comment from a secondary‐care perspective on page 17. (Source: Trends in Urology, Gynaecology and Sexual Health)


Trunk muscles activation pattern during walking in subjects with and without chronic low back pain: A Systematic Review
Conclusions Chronic LBP subjects exhibit higher global trunk muscles activity. However, the activation pattern appears to vary depending on sub-phases of gait. It seems that increased walking velocity challenges the stability of the spine and the control system increases muscular activation and variability level to cope with this problem. Further standardized studies with sub-typed LBP cases are needed to clarify the controversial findings. (Source: PMandR)


The somatosensory link: S1 functional connectivity is altered by sustained pain and associated with clinical/autonomic dysfunction in fibromyalgia
Conclusion: Our study demonstrates that both somatic and non‐somatic dysfunction in FM, including clinical pain, pain catastrophizing, autonomic dysfunction, and amplified temporal summation, are all closely linked with the degree to which evoked deep‐tissue pain alters S1 connectivity to salience/affective pain processing regions. Additionally, diminished connectivity between S1 subregions at REST in FM may result from ongoing widespread clinical pain. This article is protected by copyright. All rights reserved. (Source: Arthritis and Rheumatism)


Quality of life prediction in children with joint hypermobility syndrome
ConclusionChildren with JHS experience poor HRQOL and disabling fatigue, with parent scores providing a good proxy. Pain, fatigue and the presence of stress incontinence symptoms have the greatest impact on their HRQOL. (Source: Journal of Paediatrics and Child Health)


Trunk muscles activation pattern during walking in subjects with and without chronic low back pain: A Systematic Review
The purpose of this study was to identify how activity patterns of trunk muscles change in chronic LBP during walking. Type A systematic review Literature surveyELSEVIER, Pro Quest, PubMed, Google scholar and MEDLINE electronic databases were explored for the earliest researchable time to August 2014 period. Articles investigating patients with chronic LBP and analyzing trunk muscles with surface electromyography (EMG) during walking were included. (Source: PM and 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>


Symptoms and signs of lower gastrointestinal disease
Symptoms of lower gastrointestinal (GI) disease are common and frequently trigger consultation in primary and secondary care. Diarrhoea, abdominal pain and constipation are presentations of a wide range of different underlying pathologies, from chronic, benign, functional conditions to acutely life-threatening emergencies. Lower GI bleeding is often due to serious pathology and requires rational investigation based on a systematic clinical assessment. Extra-intestinal manifestations of lower GI disease can often give a clue to the underlying diagnosis. (Source: Medicine)


Evolving Role of Palliative Care and Hospice for Patients with Advanced Cardiac Disease (P15)
Advances in cardiovascular medicine have led to remarkable success in life extension, which in turn has increased the prevalence of people living with heart failure and other chronic cardiac diseases. Many patients with advanced cardiac diseases require coordinated symptom management and decision support as the illness progresses, which offers an opportunity for synergism between HPM providers, primary care physicians, cardiologists, and cardiothoracic surgery teams. The opportunity for palliative care clinicians to partner in the care of cardiac patients will continue to grow in the future. (Source: Journal of Pain and Symptom Management)


A Health Plan’s Innovative Telephonic Case Management Model to Provide Palliative Care (TH303)
SCAN Health Plan is a Medicare Advantage Plan in California and Arizona serving 170,000 members. In 2013, SCAN launched a case management program to assist members with multiple chronic health conditions manage their symptoms and medications. The Program for Advanced Illness (PAI) is designed to manage the sickest patients in the last months and years of life. The goals of the program are to better manage symptoms, improve member and family/caregiver satisfaction, and improve overall quality of care, while reducing inpatient/ER utilization. (Source: Journal of Pain and Symptom Management)


Palliative Care and COPD: Bundling Up with Medicare (TH313)
Chronic obstructive pulmonary disease (COPD) is an increasingly common condition in the United States, and patients with advanced COPD represent significant utilizers of healthcare resources throughout their illness. Certainly as the disease progresses, the role of palliative and supportive care for these patients grows as they become more fragile and in many cases require increasing resources, including clinic and emergency department visits, home services, and hospitalizations. This session will provide a general introduction to several of the newer payment mechanisms emerging as part of the Affordable Care Act, with particular emphasis on integrated practice units (IPUs) and bundled payments. (Source: Journal of Pain and Symptom Management)


A Practical Guide to Making Decisions to Withhold and/or Withdraw Life-Sustaining Treatment: Walking the Walk, Teaching the Talk (TH315)
Although withholding and withdrawing medical treatments from the seriously ill are not new, public debate over the appropriate use of life-sustaining treatment (LST) in seriously ill patients is at unprecedented levels, driven by multiple factors, including advances in medical technology, an aging population, ballooning healthcare costs, the increasing prevalence of life-threatening chronic disease, and more patients dying within healthcare institutions. (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>


Home Is Where the Care Is: Bringing Palliative Care Expertise into the Community (FR411)
As the population ages and more people live with multiple chronic illnesses, the number of patients with functional limitations grows. Palliative care and primary care services overlap when caring for this complicated and fragile population with a high symptom burden and unpredictable prognoses. Care must emphasize quality of life, complex decision-making, coordination of care, family involvement, and individualization of patient care. (Source: Journal of Pain and Symptom Management)


Integrated Palliative Care for Management of Elderly Patients with Advanced Chronic Kidney Disease (FR433)
Integration of palliative care services with standard nephrology practice for elderly patients with advanced kidney disease can be beneficial in the shared decision-making process regarding management options for the patient’s kidney disease and its associated symptoms, as well as in facilitating transition planning during a patient’s clinical course. Patients older than 75 are the fastest growing ESRD population. These patients are often burdened by multimorbidity, frailty, and other geriatric syndromes, all of which should be considered in the discussion of renal replacement therapy (RRT) versus conservative management (CM). (Source: Journal of Pain and Symptom Management)


De“liver”ing Palliative Care to Patients with Advanced Liver Diease: Creating Collaborative Models Between GI and Palliative Medicine (FR462)
End-stage liver disease (ESLD) is defined as chronic liver disease with a decompensating event, such as ascites formation, variceal bleeding, or hepatic encephalopathy, and is a leading cause of morbidity and mortality. Though its disease manifestations, symptoms, and effects on psychosocial distress are frequent and burdensome, few cooperative models between gastroenterology and palliative care have been reported. Further collaboration would provide an extra layer of support to this population through better understanding of unmet needs and unique perspectives for symptom management that leverages the expertise and resources of each service. (Source: Journal of Pain and Symptom Management)


“But the Family Is Asking for a Blood Transfusion”: Managing the Hematologic Malignancy Patient in Hospice (SA503)
Hospice physicians are increasingly receiving referrals from hematologists. Hematologic malignancies are a challenging group of diseases because they are a heterogeneous group of cancers comprising more than 50 subtypes. Disease trajectories can be erratic. Patients with indolent diseases, such as primary myelofibrosis or chronic lymphocytic leukemia, often stabilize in hospice care and are challenging to recertify, while patients with acute leukemia are frequently admitted later in their clinical course and often live only hours to days in hospice. (Source: Journal of Pain and Symptom Management)


All Bones and No Meat: Advances in the Management of Cancer Cachexia (SA535)
The cachexia-anorexia syndrome (CAS) is a multifactorial syndrome characterized by involuntary loss of skeletal muscle and fat, decreased quality of life, and shortened survival. Although typically associated with cancer, CAS is also common in many chronic illnesses, such as heart failure, chronic obstructive pulmonary disease, human immunodeficiency virus infection, and renal and hepatic failure. Over the past few years, significant progress has been made toward our understanding of the pathogenesis of this syndrome, resulting in the development of novel therapeutics. (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>


The Trifecta of Community-Based Palliative Care: Preventing Hospitalizations, Improving Symptoms, and Timely End-of-Life Care (SA541)
Studies on the efficacy of home-based palliative care programs are sparse, as the bulk of research has been conducted on hospital-based consult teams. As the face of health care changes and hospitals receive more scrutiny over repeat hospitalizations for symptom-based admissions, attention is turning to home-based palliative care programs as a means to managing patients who fall “into the gap” between chronic care and hospice care. Very little research exists on the benefit of home-based programs in terms of outcomes; the first journal article addressing home-based palliative care program efficacy was published in the September 2013 issue of the Journal of Palliative Medicine. (Source: Journal of Pain and Symptom Management)


Advanced Management of Neuropathic Pain in Pediatric Palliative Care: The Concept of Multimodal Analgesia (SA544)
The majority of children with life-limiting conditions experience pain during their last weeks of life. Clinicians need to differentiate between somatic/acute, visceral, chronic, and neuropathic pain, as the analgesic management for each pain type differs. Emerging data reveal that neuropathic pain in children with advanced cancer and other progressive serious diseases is common, underrecognized, and undertreated. This session will review the pharmacological and integrative (nonpharmacological) management of neuropathic pain. (Source: Journal of Pain and Symptom Management)


Expressions of Teenagers Under Palliative Care on Facebook: A Fresh Approach for Healthcare Professionals (S714)
Children with long-term chronic illnesses need broad types of support that can be offered in creative ways by the palliative care team. An increasing number of health related communities on the Internet show that people who use virtual socialization are also looking for support. (Source: Journal of Pain and Symptom Management)


Embedded Outpatient Palliative Care Clinic for COPD & HF Patients: Structure, Process and Outcomes (S732)
Clinic-based palliative care for patients with advanced chronic obstructive pulmonary disease and heart failure holds tremendous promise. (Source: Journal of Pain and Symptom Management)


Exploring the Stigma of Having Pain and Its Effects on Community-Dwelling Elders (S737)
Chronic pain is a common complaint among elders with chronic conditions, often unrecognized and undertreated. Should uncontrolled pain require opioid use, clinician's attitudes, family concerns, potential side effects, and lack of patient's education may play a role against pain control. Studies have yet to explore elders' self-perceptions about pain, developing potential interventions to enhance patient education. (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>


State-Mandated Prescribing Agreements for Patients with Chronic Non-malignant Pain in a Palliative Medicine Outpatient Clinic: Year Two (S754)
In response to an epidemic of deaths from opioid overdoses, Florida enacted laws that restricted prescribing of controlled pain medications for chronic non-malignant pain. Although hospice physicians were exempted from this mandate, physicians practicing palliative care in non-hospice settings were required to use prescribing agreements. (Source: Journal of Pain and Symptom Management)


A Novel Advance Care Planning Group Medical Visit for Older Adults in Primary Care is Feasible, Acceptable, and Helpful (S761)
The group medical visit model can effectively engage older adults in behavior change related to management of chronic illnesses. Primary care needs models that facilitate high-quality advance care planning. The potential of utilizing the group medical visit model to enhance advance care planning in the primary care setting has not been explored. (Source: Journal of Pain and Symptom Management)


Events Preceding Final Hospitalizations or Deaths and End-Of-Life Decisions in Patients on Chronic Dialysis (S768)
Healthcare intensity at end-of-life in chronic dialysis patients is high. However, the medical events leading to final hospitalizations or imminent deaths and end-of-life decisions in these patients have not been well described. (Source: Journal of Pain and Symptom Management)


Trajectories of Patient Well-Being During Chronic Illness and End Of Life (S786)
Although palliative care includes patients across the spectrum from serious illness to end-of-life, little data describe patterns of experience over time and whether bio-psychosocial needs differ between stages of advanced illness. (Source: Journal of Pain and Symptom Management)


Evaluating Hospice and Palliative Medicine Education in Pediatric Sub-Specialty Training Programs (S791)
Hospice and Palliative Medicine (HPM) competencies are a growing area of importance in the training of other pediatric subspecialties. In 2009, the Accreditation Council for Graduate Medical Education (ACGME) provided further emphasis; stating that pediatric trainees should understand the “impact of chronic disease, terminal conditions and death on patients and their families.” Despite this emphasis, there may still be a continued deficit of formal HPM training in other pediatric sub-specialties. (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>


Unused Opioids: Prescribing Practices in Chronic Cancer Pain (S803)
Most victims of the current epidemic of prescription pain medicine (PPM) overdoses are nonpatients, with 75% of overdoses attributed to opioids prescribed to someone else. Responsible prescribing of PPM should include monitoring the amount of unused PPM and reducing refills accordingly. (Source: Journal of Pain and Symptom Management)


Characteristics of the Oldest Old Referred to a Palliative Care Consultation Team (PCCT) in a Community Hospital (S806)
The oldest old cohort is the most rapidly expanding population in the USA. There are currently 5.5 million in the USA. This number will quadruple by 2050. There is an anticipated addition of 10 years to life expectancy upon reaching 85. Many factors influence quality of life and survival including multiple chronic illnesses, functional decline, frailty, and geriatric syndromes. (Source: Journal of Pain and Symptom Management)


Sinomenine alleviates mechanical hypersensitivity in mice with experimentally induced rheumatoid arthritis
Conclusions We have shown that sinomenine is effective in alleviating localized and spread hypersensitivities in CAIA mice both during acute inflammation and in post-inflammatory phase. Further, repeated sinomenine administration has elevated the baseline mechanical threshold without producing tolerance. Implications Sinomenine may be clinically useful to treat chronic pain in RA, including wide-spread pain which appears to be a difficult clinical problem despite the improvement in the acute treatment of RA by disease modifying agents. (Source: Scandinavian Journal of Pain)


Phantom Limb Pain: An Energy/Trauma Model
Publication date: November–December 2014 Source:EXPLORE: The Journal of Science and Healing, Volume 10, Issue 6 Author(s): Eric Leskowitz Phantom limb pain (PLP) is a form of chronic neuropathic pain that responds poorly to treatment interventions derived from the neuroanatomic understanding of pain and analgesia. Several new psychological and behavioral treatments that have proven more effective have been explained by invoking neural plasticity as their mechanism of action. Other novel treatments that are based on an “energy medicine” model also appear to be quite effective, especially when addressing the psychological trauma of the amputation itself, a factor that is generally overlooked in the standard surgical approach to limb amputation. A speculative trauma/energy model for t...


Rheumatic Symptoms in Autoimmune Thyroiditis
Abstract Autoimmune thyroiditis (ATD) is generally regarded as a classic example of single organ autoimmunity with a high association with endocrine thyroid disorders. However, it is closely associated with several autoimmune diseases including rheumatologic syndromes and has long been known to have several rheumatic manifestations particularly in association with hypothyroidism. More recently, it has also been implicated in rheumatologic syndromes in the absence of hypothyroidism or subclinical hypothyroidism. There is also an emerging body of evidence that ATD is highly linked to chronic generalized pain syndromes including fibromyalgia. This review examines the rheumatic symptoms of ATD described in the current literature and discusses the clinical relevance of ATD in 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>


Non‐contact low‐frequency ultrasound therapy compared with UK standard of care for venous leg ulcers: a single‐centre, assessor‐blinded, randomised controlled trial
Abstract ‘Hard‐to‐heal’ wounds are those which fail to heal with standard therapy in an orderly and timely manner and may warrant the use of advanced treatments such as non‐contact low‐frequency ultrasound (NLFU) therapy. This evaluator‐blinded, single‐site, randomised controlled trial, compared NLFU in addition to UK standard of care [SOC: (NLFU + SOC)] three times a week, with SOC alone at least once a week. Patients with chronic venous leg ulcers were eligible to participate. All 36 randomised patients completed treatment (17 NLFU + SOC, 19 SOC), and baseline demographics were comparable between groups. NLFU + SOC patients showed a −47% (SD: 38%) change in wound area; SOC, −39% (38%) change; and difference, −7·4% [95% confidence intervals (CIs) −33·...


Exercise Training for Management of Peripheral Arterial Disease: A Systematic Review and Meta-Analysis
Conclusions and relevance Exercise training improves cardio-respiratory fitness, pain-free and total flat-ground walking distances, as well as graded treadmill performance in PAD. Exercise prescriptions for PAD may consider arm cranking as well as lower limb exercise, possibly at short vigorous intensity intervals, but only to a threshold of mild pain. (Source: Sports Medicine)


Muscle weakness in treatment of palmar hyperhidrosis with botulinum toxin type a: can it be prevented?
CONCLUSIONS: BTX-A led to the reduction of disease severity while transient side effects were reported. PMID: 25607695 [PubMed - in process] (Source: Journal of Drugs in Dermatology)


Postoperative Pain Control
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. (Source: Surgical Clinics of North America)


Small bowel ischaemia
can present acutely as an abdominal surgical emergency or as a more chronic condition, usually due to slow atherosclerotic occlusion of the visceral arteries. Early diagnosis of acute bowel ischaemia is essential. Other common causes of acute abdominal pain must be ruled out. CT scanning is the key investigation with an approximate 90% sensitivity and specificity. Plasma markers such as raised lactate can support the diagnosis but should not be relied upon. Due to the rapid deterioration that occurs with transmural necrosis, a low threshold for early surgical intervention with laparoscopy or laparotomy is needed. (Source: 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>


Genome-wide enrichment analysis between endometriosis and obesity-related traits reveals novel susceptibility loci
Endometriosis is a chronic inflammatory condition in women that results in pelvic pain and subfertility, and has been associated with decreased body mass index (BMI). Genetic variants contributing to the heritable component have started to emerge from genome-wide association studies (GWAS), although the majority remain unknown. Unexpectedly, we observed an intergenic locus on 7p15.2 that was genome-wide significantly associated with both endometriosis and fat distribution (waist-to-hip ratio adjusted for BMI; WHRadjBMI) in an independent meta-GWAS of European ancestry individuals. This led us to investigate the potential overlap in genetic variants underlying the aetiology of endometriosis, WHRadjBMI and BMI using GWAS data. Our analyses demonstrated significant enrichment of common varian...


Woman With Rare Genetic Disorder Elects Amputation to End Chronic Pain
No abstract available (Source: Topics in Pain Management)


Internet-based guided self-help intervention for chronic pain based on Acceptance and Commitment Therapy: A randomized controlled trial
Abstract Acceptance-based psychological interventions can potentially minimize the burden of chronic pain. This randomized controlled trial evaluated an internet-delivered, guided self-help intervention based on Acceptance and Commitment Therapy (ACT). A total of 238 chronic pain sufferers from the general population were randomly allocated to either ACT (n = 82), an internet-based control condition Expressive Writing (n = 79) or a waiting list condition (n = 77). Participants completed measures at baseline, posttreatment (3 months) and at a 3-month follow-up. At follow-up, ACT participants had improved in pain interference in daily life (primary outcome) compared to participants in Expressive Writing (Cohen’s d = .47), but not compared to waiting list participants (p ...


Intrathecal siRNA Against GPNMB Attenuates Nociception in a Rat Model of Neuropathic Pain
Abstract Neuropathic pain is characterized by hyperalgesia, allodynia, and spontaneous pain. Recent studies have shown that glycoprotein nonmetastatic melanoma B (GPNMB) plays a pivotal role in neuronal survival and neuroprotection. However, the role of GPNMB in neuropathic pain remains unknown. The aim of the present study was to assess the role of GPNMB in neuropathic pain. In cultured spinal cord neurons, we used two small interfering RNAs (siRNAs) targeting the complementary DNA (cDNA) sequence of rat GPNMB that had potent inhibitory effects on GPNMB, and siRNA1-GPNMB was selected for further in vivo study as it had the higher inhibitory effect. After sciatic nerve injury in rats, the endogenous level of GPNMB was increased in a time-dependent manner in the spinal cord. Furth...


A hybrid approach to urine drug testing using high-resolution mass spectrometry and select immunoassays.
CONCLUSIONS: The hybrid approach to urine drug testing provides a simplified and analytically specific testing process that minimizes the need for secondary confirmation. PMID: 25596249 [PubMed - in process] (Source: American Journal of Clinical Pathology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Fragility of Life and Lung: My Dad's Severe Pneumonia Story
The first message arrived midday on a Sunday, picking up the latest in the long paper and electronic trail that chronicles our family's health. Mom, Jan. 4, 12:49 p.m.: Yesterday morning Dad woke up very sick. He has a terrible cough. Mom, Jan. 5, 2:52 p.m.: Dad has the flu. Mom, Jan. 6, 3:40 p.m.: Doc said Dad has to get down fluid. He spit up water twice. If he can't, I have to take him to an urgent care clinic. Don't come home! This is highly contagious. Dad, Jan. 7, 2:15 p.m.: I will be visiting the doctor again today. I had a very bad night last night and I am very weak. You must stay away from the house. When I was 4 years old, my dad lived on red meat and his total cholesterol reached 300. His doctor began him on Lipitor -- a cholesterol-reducing medication -- and told him he mu...


Nevro surges on Senza approvable letter from FDA
Nevro shares surge on news of its receipt of an 'approvable letter' from the FDA for its Senza spinal cord stimulator for chronic pain. Food & Drug Administration (FDA), Nevro Corp.News Well, Neuromodulation/Neurostimulation, Pain Management, Regulatory/Complianceread more (Source: Mass Device)


Myofascial Pelvic Pain: Rationale and Treatment
Abstract Chronic pelvic pain, in its many forms, commonly has a myofascial component that must be considered in the evaluation and treatment of women and men seeking medical care. Myofascial pain syndrome is a regional pain syndrome characterized by myofascial trigger points. At this time, the exact mechanism surrounding the formation of a trigger point is not known. Myofascial pelvic pain can develop as a result of a trigger point within the pelvic floor musculature or from extra-pelvic muscles that can refer into the pelvic region. Identification and appropriate therapeutic management of the myofascial trigger points is paramount to successful treatment of the pain and symptoms associated with chronic pelvic pain. (Source: Current Bladder Dysfunction Reports)


Celiac Artery Decompression for Median Arcuate Ligament Syndrome: A United States National Inpatient Sample Study
The objective of this study was to evaluate the outcomes of MALS after celiac artery decompression (CAD). (Source: Journal of Vascular Surgery)


Principles of Rehabilitation and Reactivation: Interstitial Lung Disease, Sarcoidosis and Rheumatoid Disease with Respiratory Involvement
The interstitial lung diseases (ILDs) are characterised by dyspnoea on exertion, exercise-induced hypoxaemia, reduced skeletal muscle function and exercise intolerance. Evidence from nine randomised controlled trials shows that pulmonary rehabilitation improves exercise capacity, dyspnoea and quality of life in ILD, with moderately large effect sizes from 0.59 to 0.68. Participants with idiopathic pulmonary fibrosis, the most common and most progressive of the ILDs, achieve benefits in exercise capacity and quality of life that are of equal magnitude to those seen in other ILDs, with effect sizes from 0.59 to 0.75. Whole body exercise training is a core component of pulmonary rehabilitation for ILD. The standard exercise prescription used for other chronic lung diseases is effective in ILD...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 influence of personality traits on perception of pain in older adults – Findings from the Swedish National Study on Aging and Care – Blekinge study
Conclusions Personality traits and pain were related among the older adults but there were gender differences. The relationship between pain and neuroticism in women was about the same in strength as the relation between pain and neuroticism/openness in men. Both sexes suffer from insomnia. The relationship between personality traits and pain was only affected to a minor extent by insomnia. Implications There is a need to increase awareness of the impact of personality as well as to provide improved treatment for pain and insomnia in older people. (Source: Scandinavian Journal of Pain)


A Rare Case of Chronic Diarrhea
Question: A 58-year-old African-American man with well-controlled hypertension and diabetes presented with 18 months of 6–8 watery loose brown stools per day, nocturnal stools, and 40-pound weight loss. He denied steatorrhea and stool frequency was unaffected by fasting. He denied any abdominal pain, nausea, vomiting, melena, hematochezia, fevers, or chills. He did not have any history of abdominal surgery. Medications included irbesartan and sitagliptin, both of which had been started well after the onset of diarrhea. (Source: Gastroenterology)


MY APPROACH to Low-Level Troponin Elevations
Cardiac troponin (cTn) I and T complement clinical assessment and the ECG in the early diagnosis of acute myocardial infarction (AMI). cTns are structural proteins unique to the heart. cTn levels in peripheral blood are quantitative markers of cardiomyocyte damage. Thereby, cTns are organ-specific, but not disease-specific, markers. Although AMI is a very important cause of cardiomyocyte damage, and clearly the dominant one in patients presenting with acute chest pain and substantial cTn elevations (eg, 50 times the 99th percentile), multiple other acute and chronic disorders seem to lead to cardiomyocyte damage that can be detected using modern cTn assays. (Source: Trends in Cardiovascular Medicine)


Patient-Clinician Communication About End-of-Life Care in Patients with Advanced Chronic Organ Failure During One Year
Patient-clinician communication is an important prerequisite to delivering high-quality end-of-life care. However, discussions about end-of-life care are uncommon in patients with advanced chronic organ failure. (Source: Journal of Pain and Symptom Management)


When is Surgery Appropriate for Chronic Back Pain
According to Dr. Praveen Kadimcherla back surgery is typically an option only when more conservative treatments such as pain relievers and physical therapy haven’t worked and the patient’s pain is persistent and disabling. Dr. Kadimcherla offers tips to seniors with back issues. (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>


Evidence does not support use of long-term opioid therapy for chronic pain
3.5 out of 5 stars The Effectivenss and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Chou R et al.  Ann Intern Med 2015 Jan 13 [Epub ahead of print] Abstract Although prescription opioids have been advocated and used for long-term treatment of chronic non-cancer pain, there is scant literature supporting such use. Most studies have been limited to a time period of 3 months or less. The purpose of this literature review was to assess the evidence pertaining to safety and effectiveness of long-term (&gt; 1 year) opioid therapy for pain. The authors point out that when evaluating this question, in addition to potential benefits of pain relief, known risks of opioid therapy must be considered, inc...


Time-Course of Prednisone Effects on Hormonal and Inflammatory Responses at Rest and During Resistance Exercise
Horm Metab ResDOI: 10.1055/s-0034-1395608Glucocorticoids are among the most commonly used drugs. They are widely administered for acute and chronic musculoskeletal pain, as well as for several other pain syndromes, although their therapeutic use is sometimes diverted for doping purposes. Their time-course effects on hormonal and inflammatory responses nevertheless remain poorly understood, both at rest and during exercise. We therefore studied the alterations induced by 1 week of prednisone treatment (60 mg daily) in recreationally trained male athletes after 2 days (i. e., acute) and 7 days (i. e., short-term). Hormonal (i. e., DHEA, DHEA-S, aldosterone, and testosterone) and pro- and anti-inflammatory markers (i. e., IL-6, IL-10, and IL-1β) were investigated at rest and after ...


Influence of chronic back pain on kinematic reactions to unpredictable arm pulls
Observed reflex delays and identified kinematic differences inside and outside the region of pain during impaired movement indicated that chronic low back pain patients have an altered motor control that is not restricted to the lumbo-pelvic region. This applied paradigm of external perturbations can be used to detect chronic low back pain patients and also persons without chronic low back pain but with an altered motor control. Further investigations are essential to reveal whether healthy persons with changes in motor function have an increased potential to develop chronic back pain. (Source: Clinical Biomechanics)


An Examination of Anatomic Variants and Incidental Peroneal Tendon Pathologic Features: A Comprehensive MRI Review of Asymptomatic Lateral Ankles
Publication date: Available online 22 January 2015 Source:The Journal of Foot and Ankle Surgery Author(s): Melissa M. Galli , Nicole M. Protzman , Eiran M. Mandelker , Amit D. Malhotra , Edward Schwartz , Stephen A. Brigido Intraoperatively, foot and ankle surgeons will encounter peroneal pathologic features in patients with asymptomatic lateral ankles. The purpose of the present study was to review the ankle magnetic resonance imaging (MRI) scans of patients without a history of ankle trauma or lateral ankle pain to determine which anatomic variants correlate with peroneal tendon pathologic features and noted pathophysiology. A total of 500 MRI scans were screened, 108 (41.90 ± 20.42) of which met the inclusion criteria. The peroneus brevis tendon was intact in 104 MRI scans (96.30%)...


Sensory manifestations of diabetic neuropathies: Anatomical and clinical correlations
Conclusions: Diabetic neuropathies can involve any segment of peripheral nerves from nerve roots to the nerve endings giving different patterns of abnormal sensation. It is the involvement of small fibers that causes positive sensory symptoms like pain early during the course of disease, bringing subjects to physician&rsquo;s care. Clinical Relevance This article emphasizes on the fact that diabetic neuropathies are not a single entity. They are rather different varieties of conditions with more or less separate pathophysiological mechanisms and anatomical localization. Clinicians should keep this in mind when assessing patients with diabetes on the first visit or follow-up. (Source: Prosthetics and Orthotics International)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Measuring health‐related quality of life with the EQ‐5D‐Y instrument in children and adolescents with asthma
ConclusionThe EQ‐5D‐Y instrument seemed to provide feasibility and convergent validity for measuring health‐related quality of life in children and adolescents with asthma. (Source: Acta Paediatrica)


Sleep Disturbance and Chronic Widespread Pain
Abstract Musculoskeletal pain is common and often occurs at multiple sites. Persons with chronic widespread pain (CWP) often report disturbed sleep. Until recently, the relationship between sleep disturbance and CWP has been unclear: does poor sleep increase the risk of developing CWP, do people with CWP develop poor sleep as a consequence of their pain, or is the relationship bi-directional? In this article, we have focused on the relationship between insomnia and CWP. We briefly present descriptive epidemiological data for insomnia and CWP. We then summarise the available evidence which supports the hypothesis that the relationship is bi-directional. Finally, we discuss the clinical management of CWP and insomnia in primary care, where the vast majority of cases of CWP are mana...


Could low grade bacterial infection contribute to low back pain? A systematic review
Evidence from a systematic review suggests the presence of bacteria in spinal discs could be associated with low back pain and disc herniation, but more research is needed to determine whether low-grade infection contributes to chronic pain. (Source: BMC Medicine)


Pharmacological Management of Chronic Lower Back Pain: A Review of Cost Effectiveness
Abstract Lower back pain is one of the most prevalent musculoskeletal conditions in the developed world and accounts for significant health services use. The American College of Physicians and the American Pain Society have published a joint clinical guideline that recommends providing patients with information on prognosis and self-management, the use of medications with proven benefits and, for those who do not improve, consideration be given to the use of spinal manipulation (for acute lower back pain only), interdisciplinary rehabilitation, exercise, acupuncture, massage, yoga, cognitive behavioural therapy or relaxation. The purpose of this review was to evaluate published economic evaluations of pharmacological management for chronic lower back pain. A total of seven studies...


Cranial Treatment and Spinal Manipulation for a Patient With Low Back Pain: A Case Study
The purpose of this case study is to present chiropractic management of a patient with chronic low back pain by focusing on the craniomandibular system. (Source: Journal of Chiropractic 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>


Engagement in paid work as a protective predictor of basic activities of daily living disability in Japanese urban and rural community‐dwelling elderly residents: An 8‐year prospective study
ConclusionsWorking might be protective from a decline in BADL only for men, but not for women. Regarding the difference of sex roles in conventional Japanese society, working would be an effective solution especially for men to participate in social activities. Geriatr Gerontol Int 2015; ●●: ●●–●●. (Source: Geriatrics and Gerontology International)


Patient-Reported Outcomes and Therapeutic Affordances of Social Media: Findings From a Global Online Survey of People With Chronic Pain
Conclusions: Results did not uncover definitive demographics or characteristics of PWCP for which health outcomes are impacted. However, findings corroborate literature within this domain suggesting that there is a typical profile of people who use social media for health and that social media are more suited to particular health outcomes. Exploration of the relationship between social media&#8217;s therapeutic affordances and health outcomes, in particular the narration affordance, warrants further attention by patients and clinicians. (Source: Journal of Medical Internet Research)


[Heterozygote forms of familial Mediterranean fever can be manifested in adults as myofacial pain syndrome.]
This article presents evidence that 9 out of 12 Mediterranean patients with recurrent myofascial pain syndrome and mild inflammation revealed heterozygote mutations in the MEFV gene and 7 of these patients benefitted from treatment with colchicine. DISCUSSION: As colchicine treatment not only improved the myofascial pain but also prevented FMF-associated amyloidosis and nephropathy, differential diagnosis of fibromyalgia in patients of Mediterranean origin should include FMF and a genetic screening of the MEFV locus. PMID: 25604326 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Rheumatologie)


Patient-Reported Outcomes and Therapeutic Affordances of Social Media: Findings From a Global Online Survey of People With Chronic Pain
Conclusions: Results did not uncover definitive demographics or characteristics of PWCP for which health outcomes are impacted. However, findings corroborate literature within this domain suggesting that there is a typical profile of people who use social media for health and that social media are more suited to particular health outcomes. Exploration of the relationship between social media&#8217;s therapeutic affordances and health outcomes, in particular the narration affordance, warrants further attention by patients and clinicians. (Source: Journal of Medical Internet Research)


Smoking cessation and bone healing: optimal cessation timing


Product/Study: Chronic pain, activity restriction and flourishing mental health , Health Reports
Catalogue number 82-003-X201500114130 (Source: Statistics Canada, The Daily: Health)


Visible and occult microscopic lesions of endometriosis
Publication date: Available online 20 January 2015 Source:Gynecology and Minimally Invasive Therapy Author(s): Khaleque Newaz Khan , Michio Kitajima , Koichi Hiraki , Akira Fujishita , Masahiro Nakashima , Hideaki Masuzaki Endometriosis is a multifactorial disease mostly affecting women of reproductive age and is associated with chronic pelvic pain and infertility. Even after 300 years, most of the literature claims that pathogenesis and/or pathophysiology of endometriosis is still elusive. Recurrence of pain and lesion continues to occur after effective medical or surgical therapies. Once generated within the pelvis due to retrograde entry of menstrual debris, peritoneal endometriotic lesions time-dependently change their color appearance resulting from certain biochemical change within...


Spontaneous suprachoroidal hemorrhage: Case report and review of the literature
We present the clinical course, management, and final outcome of spontaneous suprachoroidal hemorrhage (SSCH) in an age-related macular degeneration (AMD) patient—a 64-year-old male receiving antiplatelet therapy who developed SSCH during the Valsalva maneuver. In addition to our case study, we discuss the results of a systemic review of the literature and reference lists of retrieved studies published from January 2001 to December 2013. Among a total of 31 patients (32 eyes), acute secondary glaucoma was a complication in 87.5% of the cases, and over half of the cases (20 eyes, 62.5%) received surgery. Twenty cases (64.5%) were characterized by systemic hypertension (HTN), followed by cardiovascular or cerebral vascular disease in 17 cases (54.8%). The Valsalva maneuver was performed in...


Isolated Gastrocnemius Recession for Achilles Tendinopathy: Strength and Functional Outcomes
Conclusions: Isolated gastrocnemius recession provides significant and sustained pain relief for chronic Achilles tendinopathy. Good function can be expected for activities of daily living, but power and endurance activities were more problematic for the Achilles tendinopathy group. Isokinetic strength assessment may not effectively capture patient-reported functional deficits. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: The Journal of Bone and Joint Surgery)


Medial Malleolar Stress Fracture in an Adolescent Athlete
We present the case of a medial malleolar stress fracture in a 14-year-old football player, who was successfully able to return to competition 4 weeks after surgical treatment. We have also provided a review of the published data regarding the management of these injuries and recommendations for returning athletes to competition. (Source: The Journal of Foot and Ankle Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Anti-inflammatory T-cell shift in neuropathic pain
Conclusions: Our investigation revealed a clear shift of T-cell subsets towards anti-inflammation in patients with neuropathic pain. Interestingly, this is quite similar to our previous findings in CLBP patients, but even more pronounced. Therefore, it remains to be elucidated in future investigations whether the immune changes represent an underlying pathophysiological mechanism or an epiphenomenon induced by ongoing pain and stress.German Clinical Trial Register (DRKS)Trial registration number: DRKS00005954 (Source: Journal of Neuroinflammation)


Medial Malleolar Stress Fracture in an Adolescent Athlete
We present the case of a medial malleolar stress fracture in a 14-year-old football player, who was successfully able to return to competition 4 weeks after surgical treatment. (Source: Journal of Foot and Ankle Surgery)


Dexamethasone decreases substance P expression in human tendon cells: an in vitro study
Conclusion. This study demonstrates that dexamethasone treatment of human tendon fibroblasts reduces the expression of SP through a glucocorticoid receptor&ndash;dependent pathway. Drugs interfering with SP signalling could be a future target in the treatment of tendinopathy. (Source: Rheumatology)


Deviations in gait metrics in patients with chronic ankle instability: a case control study
Conclusions: The results outline a gait profile for patients suffering from CAI. Significant differences were found in most spatiotemporal gait metrics. An important finding was a significantly wider base of support. It may be speculated that these gait alterations may reflect a strategy to deal with imbalance and pain. These findings suggest the usefulness of gait metrics, alongside with the use of self-evaluation questionnaires, in assessing disease severity of patients with CAI. (Source: Journal of Foot and Ankle Research)


Chikungunya and Its Interaction With the Host Cell
Abstract Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus belonging to the Togaviridae family. It is a virus with a single-stranded, positive sense RNA genome, maintained in a sylvatic and urban cycle, involving humans and mosquitoes from Aedes species, mainly Aedes aegypti and Aedes albopictus. In less than 10 years, CHIKV has spread from the coast of Kenya throughout the Indian Ocean, Pacific Ocean, and Caribbean regions, causing millions of infections in over 50 countries. In other words, CHIKV has emerged as a true global pathogen. The clinical signs include non-specific flu-like symptoms and a characteristic rash accompanied by joint pain that may last long time after the resolution of the infection. The molecular mechanism underlying the chronic polyarthralgia...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Venlafaxine Extended-Release for Depression Following Spinal Cord Injury A Randomized Clinical Trial
Conclusions and RelevanceVenlafaxine XR was well tolerated by most patients and an effective antidepressant for decreasing core symptoms of depression and improving SCI-related disability. Further research is needed to determine the optimal treatment and measurement approaches for depression in chronic SCI.Trial Registrationclinicaltrials.gov Identifier: NCT00592384 (Source: JAMA Psychiatry)


Somatosensory pleasure circuit: from skin to brain and back
This article is protected by copyright. All rights reserved. (Source: Experimental Dermatology)


Achalasia and chronic opiate use: innocent bystanders or associated conditions?
Summary High‐resolution manometry identifies three subtypes of achalasia. However, type 3 differs from classic achalasia. Although opiates affect esophageal motility, opiate use and achalasia have not been studied. Patients with a new diagnosis of achalasia at Mayo Clinic Rochester between June 1, 2012 and January 3, 2014 were identified. Clinical records were reviewed to assess symptoms, opiate use, and therapy. Fifty‐six patients with achalasia were identified, 14 (25%) were on opiates. Opiate prescription was unrelated to achalasia in all cases, with chronic back and joint pain constituting the majority. Of patients on opiates, five (36%) had type 3 achalasia compared with four (10%) not on opiates (P = 0.02). No patients on opiates had type 1 achalasia. Clinical presentation did no...


Role of methionine containing antioxidant combination in the management of pain in chronic pancreatitis: a systematic review and meta-analysis
Pain in CP results from inflammation and neuroimmune alterations that are associated with oxidative stress, among other mechanisms. This is marked by depletion of antioxidant defenses including methionine, which is a donor of methyl moieties that maintains the acinar transsulfuration pathway. We performed a systematic review and meta-analysis of trials evaluating methionine-containing antioxidants in CP. (Source: Pancreatology)


Editorial for Manuscript ID: EJH‐2014‐751/R1 ‐ (1043)
This article is protected by copyright. All rights reserved. (Source: European Journal of Haematology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Replication of a cognitive behavioral therapy for chronic pain group protocol by therapists in training.
Authors: Cosio D Abstract Abstract According to the American Psychological Association (Division 12), there is strong, long-standing research support for cognitive behavioral therapy (CBT) to treat chronic pain. Furthermore, meta-analytic comparisons have shown CBT to be highly efficacious. However, not all researchers agree with this conclusion. The purpose of the current pilot study was to determine whether a CBT outpatient, group-based treatment facilitated by junior therapists benefited veterans who suffer from mixed idiopathic, chronic, noncancer pain, thus replicating results from effective CBT programs from the past. A sample of 46 veterans aged 33 to 81 years with chronic, noncancer pain who participated in an outpatient CBT pain group therapy protocol at a Midwestern Veter...


Scrotal pain: Evaluation and management.
This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia. PMID: 25598931 [PubMed - as supplied by publisher] (Source: Korean Journal of Urology)


Interstitial Lung Disease, Sarcoidosis and Rheumatoid Disease with Respiratory Involvement
The interstitial lung diseases (ILDs) are characterised by dyspnoea on exertion, exercise-induced hypoxaemia, reduced skeletal muscle function and exercise intolerance. Evidence from nine randomised controlled trials shows that pulmonary rehabilitation improves exercise capacity, dyspnoea and quality of life in ILD, with moderately large effect sizes from 0.59 to 0.68. Participants with idiopathic pulmonary fibrosis, the most common and most progressive of the ILDs, achieve benefits in exercise capacity and quality of life that are of equal magnitude to those seen in other ILDs, with effect sizes from 0.59 to 0.75. Whole body exercise training is a core component of pulmonary rehabilitation for ILD. The standard exercise prescription used for other chronic lung diseases is effective in ILD...


Seattle Pain Relief Now Finding Success With Laser Therapy for Over a...
Seattle Pain Relief, one of the top pain clinics in Seatte, is now offering laser therapy for a dozen pain conditions. The treatment has shown effectiveness for all types of acute and chronic pain...(PRWeb January 19, 2015)Read the full story at http://www.prweb.com/releases/seattle-pain-center/laser-therapy/prweb12454827.htm (Source: PRWeb: Medical Pharmaceuticals)


Top San Antonio Pain Clinic, Premier Pain Consultants, Now Offering...
The top pain management clinic in San Antonio, Premier Pain Consultants, is now offering intrathecal pain pumps for those with chronic, intractable pain. The pain pump procedure may be able to change...(PRWeb January 19, 2015)Read the full story at http://www.prweb.com/releases/pain-doctor-san-antonio/intrathecal-pain-pump/prweb12455779.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>


San Antonio Pain Management Center, Premier Pain Consultants, Now...
Top San Antonio pain management center, Premier Pain Consultants, is now offering intracranial electrical stimulation for those with chronic migraines. The treatment is highly successful and may be a...(PRWeb January 19, 2015)Read the full story at http://www.prweb.com/releases/migraine-specialist/sanantoniopainmanagement/prweb12456269.htm (Source: PRWeb: Medical Pharmaceuticals)


What Is The Role Of Opioids In The Treatment Of Chronic Pain?
Chronic pain has been at the center of the debate over how physicians can make a dent in opioid addiction. More than 100 million Americans suffering from chronic pain are waiting for a solution from physicians that can minimize the risk of becoming dependent on prescription painkillers. Research conducted by an independent panel might point to part of the answer: "individualized, patient-centric care." (Source: Forbes.com Healthcare News)


Bronchogenic Stress Cardiomyopathy: A Case Series
Despite a growing awareness of stress (takotsubo) cardiomyopathy, the diversity in precipitants beyond emotional distress remains under-appreciated. Emerging data implicate a differential influence of precipitant type on the variable presentations of stress cardiomyopathy. We outline 5 cases of stress cardiomyopathy where the precipitant was an acute exacerbation of chronic obstructive pulmonary disease treated with high-dose bronchodilator therapy. In this setting, an atypical and insidious presentation of the stress cardiomyopathy was consistently observed that was difficult to distinguish from the acute airway exacerbation itself, with an absence of chest pain in particular. Scrutiny of published single-case reports reveals a similar atypical presentation; this supports the existence of...


Surgery Not Better for Spine Narrowing, Study Finds
Title: Surgery Not Better for Spine Narrowing, Study FindsCategory: Health NewsCreated: 1/19/2015 12:00:00 AMLast Editorial Review: 1/20/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Transcutaneous electrical nerve stimulation for chronic post‐herpetic neuralgia
Abstract Postherpetic neuralgia remains a therapeutic challenge for the clinician. Many modalities have been utilized with limited success. In this pilot randomized study of patients who were refractory to previous medicinal treatment, the patients were treated with transcutaneous nerve stimulation with a biofeedback capability. After every two treatments with the sham and true device, the patients were required to fill out a standard neuropathic pain scale score. The patients were allowed to select the other device after three consecutive treatments if they felt an inadequate decrease in their pain. The true device was chosen over the sham device by all patients. The majority of these patients treated by the true device reported a statistically significant decrease in pain scores (P &lt;...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Paediatric cerebral sinovenous thrombosis: findings of the International Paediatric Stroke Study
Conclusions Our study extends the observations of previously published smaller studies in children with CSVT that this is a morbid disease with diverse underlying causes and risk factors. Divergent treatment practices among highly specialised centres as well as limited data on treatment efficacy and safety suggest that further study of this condition is warranted. (Source: Archives of Disease in Childhood)


Pain: Converging on LTP
Nature Reviews Neuroscience 16, 63 (2015). doi:10.1038/nrn3913 Author: Darran Yates Chronic pain and anxiety may be mechanistically linked by a presynaptic form of long-term potentiation that occurs at synapses in the anterior cingluate cortex. (Source: Nature Reviews Neuroscience)


Combined inhibition of monoacylglycerol lipase and cyclooxygenases synergistically reduces neuropathic pain in mice
Conclusions and ImplicationsCombining COX and MAGL inhibition is a promising therapeutic approach for reducing neuropathic pain with minimal side effects. (Source: British Journal of Pharmacology)


The spinal anti-inflammatory mechanism of motor cortex stimulation: cause of success and refractoriness in neuropathic pain?
Conclusions: These results indicate that MCS induces analgesia through a spinal anti-neuroinflammatory effect and the activation of the cannabinoid and opioid systems via descending inhibitory pathways. As a possible explanation for MCS refractoriness, we propose that CB2 activation is compromised, leading to cannabinoid resistance and consequently to the perpetuation of neuroinflammation and opioid inefficacy. (Source: Journal of Neuroinflammation)


Footwear experiences of people with chronic musculoskeletal diseases
Conclusion: Key categories describing the important issues surrounding the footwear experiences of respondents with chronic musculoskeletal diseases were identified which may provide important targets for improving footwear and foot care services, and self‐management strategies. This article is protected by copyright. All rights reserved. (Source: Arthritis Care and Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Living with chronic neuropathic pain after spinal cord injury: an interpretative phenomenological analysis of community experience.
Conclusions: The results are discussed in terms of the possible application of acceptance-based therapy to NP and the potential for the alleviation of the debilitating consequences of NP. Implications for Rehabilitation Chronic NP after SCI is often described as worse than the injury itself, often impacting upon the sufferers physical and psychological health. The experiences of persons with SCI-specific NP highlight the impact of pain on their physical, psychological and social health. This indicates that healthcare professionals should incorporate a biopsychosocial approach for managing pain post-SCI. Routine clinical follow-up of SCI patients with chronic NP, as well as comprehensive pain management treatment programmes, could address the three themes evidenced in the current study, by ...


Adhesive Capsulitis Mimicking Metastasis on 18F-FDG-PET/CT
We describe a new location of benign FDG avidity at the rotator interval due to adhesive capsulitis that can mimic neoplasm. (Source: Clinical Nuclear Medicine)


Seattle Pain Relief Is Now Offering a Revolutionary MigraineTreatment...
Seattle Pain Relief now offering revolutionary migraine treatment with intracranial electrical stimulation. For those suffering with chronic migraines, the treatment has been amazing for decreasing...(PRWeb January 18, 2015)Read the full story at http://www.prweb.com/releases/migraine-specialist/seattle-pain-center/prweb12452955.htm (Source: PRWeb: Medical Pharmaceuticals)


Testing Before Seeing the Patient
Practice varies around the United States and across each institution, but I would bet that every reader could give multiple examples of situations in which tests are ordered automatically before talking to or examining a patient. There are situations in which ordering tests before examining a patient is reasonable and promotes efficiency. Primary care physicians often order tests before sending a patient to a specialist. These tests are based on the primary care physician’s history and examination, sometimes with advice from the specialist, and tailored to the individual patient’s case. It would not make sense to send a patient to a pulmonologist for a chronic cough without first obtaining a chest x-ray. It is also reasonable for clinic protocols to include specific tests based in inta...


A prospective evaluation of the Chronic Pain Self-Management Programme in a Danish population of chronic pain patients
Chronic pain is pain which persists beyond normal tissue healing time, which is defined as 3 months [1]. The estimated prevalence of chronic pain in the European Union is 27% [2] with human costs such as a reduced quality of life [3], and an increased risk of developing common mental disorders [4]. Waiting lists for specialized pain clinics are often long with deterioration in health as an unacceptable consequence [5]. Therefore, low cost interventions have great individual and societal relevance. (Source: Patient Education and Counseling)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Study on self-assessment regarding knowledge of temporomandibular disorders in children/adolescents by Swedish and Saudi Arabian dentists.
Conclusions. This study showed that there is a difference in the accuracy of self-assessment of own knowledge between the dentists in Sweden and Saudi Arabia. The Swedish dentists have a better ability to assess their level of knowledge compared to Saudi Arabian dentists regarding TMD in children and adolescents. This difference could be related to several factors such as motivation, positive feedback, reflection, psychomotor, and interpersonal skills, which all are more dominant in the Swedish educational tradition. PMID: 25597273 [PubMed - as supplied by publisher] (Source: Acta Odontologica Scandinavica)


[Hypocomplementaemic urticarial vasculitis with bullous lesions and pericardial involvement.]
We report a case of HUVS associated with specific pericarditis and bullous lesions. PATIENTS AND METHODS: A 63-year-old woman consulted for chronic urticaria that had appeared ten months earlier. Her skin lesions were associated with weight loss of 10kg, deterioration of respiratory function and abdominal pain. Leukocytoclastic vasculitis was seen in the skin biopsy sample. Hypocomplementaemia and anti C1q antibodies were present and a diagnosis of HUVS was made. During hospitalisation, extensive compressive pericardial effusion was identified, and histological examination of the biopsy revealed specific pericardial lymphocytic vasculitis. During follow-up, four episodes of infectious pneumonitis were noted. Bullous skin lesions were also observed. DISCUSSION: HUVS is a disease cau...


AS1069562, the (+)-isomer of indeloxazine, exerts analgesic effects in rat models of nociceptive pain.
Discussion: AS1069562 exerts analgesic effects on inflammatory and noninflammatory nociceptive pain in rat models of arthritis pain, and repeated administration of AS1069562 exerts a more persistent analgesic effect on arthritis pain than duloxetine. These findings suggest that AS1069562 has an attractive analgesic profile for the treatment of nociceptive pain. PMID: 25591424 [PubMed - as supplied by publisher] (Source: Neurological Research)


A systematic review of the evidence on clitoral reconstruction after female genital mutilation/cutting
Conclusions Women who request clitoral reconstruction should be informed about the scarcity of evidence available. Additional research is needed on the safety and efficacy of the procedure to identify both long-term outcomes and which women might benefit. (Source: International Journal of Gynecology and Obstetrics)


Jennifer Aniston: 'Almost Just As Good To Be No. 1 Snubbed Than To Be Nominated'
It would be naïve to assume that as a top celebrity in Hollywood, Jennifer Aniston could get any role she wanted. But the actress revealed Friday that she was drawn to play a mourning addict in the upcoming film “Cake” because she had her own doubts about herself. “I needed to do it so I could prove to myself that I was able to do it. So I wasn’t sitting there frustrated that I wasn’t getting certain parts because they knew something I didn’t know -- which was that I couldn’t do it,” Aniston told The Huffington Post Friday afternoon in Los Angeles. Seated on a couch in a hotel suite at the Four Seasons, settled near the sunlight and in the path of a warm California breeze, it’s clear that Aniston is a pro. She has tirelessly promoted “Cake” ever since it premiered a...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Effectiveness of Intra-Articular Injection in Wrist Joints According to Triamcinolone Hexacetonide Dose in Rheumatoid Arthritis: A Randomized Controlled Double-Blind Study
ConclusionsHigh and low triamcinolone hexacetonide doses had good effectiveness in wrist-blinded intra-articular injection of rheumatoid arthritis patients, without statistical difference between them. (Source: American Journal of Physical Medicine and Rehabilitation)


Differences in the Course of Daily Activity Level Between Persons with and Without Chronic Pain
ConclusionsPersons with and persons without chronic pain differed in daily activity level with regard to average movement intensity, peak movement intensity, and postures. No differences were found in the course of daily activity between the two groups. (Source: American Journal of Physical Medicine and Rehabilitation)


Sex Differences in Predicting Chronicity of Low-Back Pain After Acute Trauma Using Lumbar Muscle Area
ConclusionsIn the men, the cross-sectional area of the multifidus and erector spinae muscles at the lower lumbar level can be considered to be prognostic factors for the chronic low-back pain after acute trauma. The authors thus suggest that strengthening of lumbar paraspinal muscles could be helpful for preventing chronicity of low-back pain. (Source: American Journal of Physical Medicine and Rehabilitation)


Re: Berg S, Tullberg T. Letter to the editor regarding Mannion, Brox, Fairbank. Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials. Spine J 2014;14:1087
We follow with great interest the ongoing debate on the role of lumbar fusion in the treatment of chronic nonspecific low back pain (LBP). Since evidence from randomized clinical trials (RCTs) comparing conservative and surgical treatments for this condition is rare, meticulous interpretation of all available data is certainly essential [1]. However, delaying the reversal of ineffective or harmful medical practices has its own obvious consequences [2]. (Source: The Spine Journal)


Reply to letter to the editor from Berg S, Tullberg T. Letter to the editor regarding Mannion, Brox, Fairbank. Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials. Spine J 2014;14:1087
We thank Berg and Tulberg [1] for their interest in our article [2] and would like to respond to their criticisms of our work. They find it questionable whether intention to treat (ITT) analyses—the recommended method for analyzing randomized controlled trial data—should have been applied to our data and instead plead for removal from the analysis of the patients who crossed over. They will be aware that with ITT, patients are analyzed in the group to which they were randomly allocated (regardless of what happens afterwards), otherwise the benefit of randomization will be lost. (Source: The Spine Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


An analysis of the NIH-supported sickle cell disease research portfolio
This report provides a detailed analysis of grants funded by the NIH for SCD research in Fiscal Years 2007 through 2013. During this period, the NIH supported 247 de novo grants totaling $272,210,367 that address various aspects of SCD. 83% of these funds supported research project grants investigating the following 5 scientific themes: Pathology of Sickle Red Blood Cells; Globin Gene Expression; Adhesion and Vascular Dysfunction; Neurological Complications and Organ-specific Dysfunction; and Pain Management and Intervention. The remaining 17% of total funds supported career development and training grants; Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) grants; large Center grants; and Conference grants. Further analysis showed that the National Hea...


A New Version of the Impairment and Functioning Inventory for Patients With Chronic Pain (IFI-R)
Conclusions The IFI-R appears to be a valid and reliable measurement tool for the assessment of perceived daily functioning and impairment in people with chronic pain. (Source: PMandR)


Relationship of Herpes Simplex Encephalitis and
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that delivers weak polarizing direct currents (1–2mA) to the cortex using two electrodes placed on the scalp. During recent years, tDCS has been used for various neurologic disorders such as stroke, chronic pain, Parkinson's disease and depression [1–11]. Common side effects, though infrequent include mild tingling, fatigue, pruritus, headache, nausea and insomnia [12]. While it is well-known that herpes simplex virus reactivation may be triggered by trauma [13] (i.e surgery and UV–radiation), to date there has been no reported association between exposure to tDCS and exacerbation of herpes simplex encephalitis (HSE). (Source: Journal of Clinical Virology)


[Multidisciplinary outpatient care program vs. usual care : Cost-benefit analysis in patients with chronic low back pain.]
CONCLUSION: This study provides important information which is of value for decision-making and making an adequate allocation of medical resources for patients with CLBP. A multidisciplinary outpatient care programme can facilitate rapid return to work. PMID: 25595921 [PubMed - as supplied by publisher] (Source: Schmerz)


Relationship of herpes simplex encephalitis and transcranial direct current stimulation–a case report
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that delivers weak polarizing direct currents (1–2mA) to the cortex using two electrodes placed on the scalp. During recent years, tDCS has been used for various neurologic disorders such as stroke, chronic pain, Parkinson’s disease and depression [1–11]. Common side effects, though infrequent include mild tingling, fatigue, pruritus, headache, nausea and insomnia [12]. While it is well-known that herpes simplex virus reactivation may be triggered by trauma [13] (i.e., surgery and UV – radiation), to date there has been no reported association between exposure to tDCS and exacerbation of herpes simplex encephalitis (HSE). (Source: Journal of Clinical Virology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Allostatic Dysregulation of Natural Reward Processing in Prescription Opioid Misuse: Autonomic and Attentional Evidence.
Authors: Garland EL, Froeliger B, Howard MO Abstract Chronic pain patients who misuse prescription opioids may suffer from allostatic dysregulation of natural reward processing. Hence, this study examined whether prescription opioid misusers with chronic pain (n=72) evidenced decreased natural reward responsiveness relative to non-misusers with chronic pain (n=26). Subjects completed a dot probe task containing pain-related, opioid-related, and natural reward stimuli while attentional bias (AB) scores and heart rate variability (HRV) responses were assessed. Compared to non-misusers, misusers evidenced significantly more attenuated HRV responses to opioid, pain, and natural reward cues presented during the dot probe task. These significant between-groups differences in HRV were lar...


Health Tip: When a Shoulder Injury Needs Treatment
Title: Health Tip: When a Shoulder Injury Needs TreatmentCategory: Health NewsCreated: 1/16/2015 12:00:00 AMLast Editorial Review: 1/16/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Is there a gender bias in the recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment?
Conclusion: Our findings indicate that the interdisciplinary teams in specialist healthcare may discriminate against women with chronic pain when physiotherapy and radiological investigation are recommended. The team's choice of recommendations might be influenced by gendered attitudes, but this field of research needs to be studied further. PMID: 25587848 [PubMed - as supplied by publisher] (Source: Journal of Rehabilitation Medicine)


Scientific fraud
This article will describe challenges in evaluating and weighing the evidence from clinical studies. As a prominent example, meta-analyses of studies on chronic pain and its treatment by opioid analgesics will be described, because this topic is receiving increasing public attention. Both the medical community and policy makers have recognized that opioid use in chronic pain needs to be scrutinized with regard to analgesic effectiveness and adverse side effects, and clinical guidelines need to be revised. The development of an evidence-based guideline, reactions to its results by the media and by the opioid-producing pharmaceutical industry, as well as implications for scientific integrity will be discussed. (Source: Trends in Anaesthesia and Critical Care)


Approach to diagnosis and management of optic neuropathy
This article briefly describes the important causes of optic neuropathy in the Indian context and outlines a practical approach to management. (Source: Neurology India)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Symptomatic Pain and Fibromyalgia Treatment Through Multidisciplinary Approach for Primary Care
Publication date: January–February 2015 Source:Reumatología Clínica (English Edition), Volume 11, Issue 1 Author(s): Jaime Gonzalez Gonzalez , Maria del Mar del Teso Rubio , Carmen Nelida Waliño Paniagua , Juan Jose Criado-Alvarez , Javier Sanchez Holgado Introduction Fibromyalgia is a chronic disease of unknown etiology characterized by widespread muscle pain, with occupational, familial, social, physical and psychological performance involvement. The multidisciplinary approach to the disease leads to improvement in quality of life and symptomatology. Objectives To evaluate the improvement of activities of daily living (ADL) and quality of life following a multidisciplinary intervention (Health Primary Care and Occupational Therapy). Materials and methods Pretest–posttest study...


Hamstring elongation quantified using ultrasonography during the straight leg raise test in individuals with low back pain
Conclusion These results indicate that the SLR score is not determined by hamstring elongation (quantified using ultrasonography). (Source: PMandR)


Theory of Mind and Emotional Functioning in Fibromyalgia Syndrome: An Investigation of the Relationship between Social Cognition and Executive Function
Conclusions The results show the presence of several impairments in social cognition skills in patients with FM, which are largely independent of both executive function deficits and symptoms of psychological distress. The impairments reported highlight the importance of adequately assessing ToM and emotional functioning in clinical practice. (Source: PLoS One)


Acupuncture for chronic knee pain: a randomized clinical trial. Authors' reply.
Authors: Hinman RS, Forbes A, Williamson E, Bennell KL PMID: 25595194 [PubMed - as supplied by publisher] (Source: Acupuncture in Medicine : journal of the British Medical Acupuncture Society)


Kinesio taping in musculoskeletal pain and disability that lasts for more than 4 weeks: is it time to peel off the tape and throw it out with the sweat? A systematic review with meta-analysis focused on pain and also methods of tape application.
DISCUSSION: Kinesio taping is superior to minimal intervention for pain relief. Existing evidence does not establish the superiority of Kinesio taping to other treatment approaches to reduce pain and disability for individuals with chronic musculoskeletal pain. PMID: 25595290 [PubMed - as supplied by publisher] (Source: British Journal of Sports 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>


MicroRNAs: Emerging Role in the Endogenous Mu Opioid System.
Authors: Barbierato M, Zusso M, Skaper SD, Giusti P Abstract MicroRNAs (miRNAs) are small non-coding RNAs that function as translational repressors and represent an important element in tissue development as well as disease. MiRNA sequences and their target sites in mRNAs show an extensive degree of conservation across species. A single miRNA is now believed to recognize the 3'untranslated region of mRNAs in a sequence-specific manner to inhibit the protein expression of literally hundreds of targeted mRNAs. The human genome encodes more than 1000 miRNAs which target over 60% of mammalian and human transcripts. It is thus not surprising that expression changes in miRNAs can have a far-reaching impact on cellular functions, including the opioid system. Opioids, psychoactive chemical...


Study reveals lack of data on opioid drugs for chronic pain
Researchers have found little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain, despite the explosive recent growth in the use of the drugs. (Source: ScienceDaily Headlines)


Cake Rings True
It often really concerns me that many people get their medical information from watching movies and television. That's because most shows are wildly medically inaccurate and truly misinform, especially in the arena of mental health. So I was particularly intrigued to watch Cake with Jennifer Aniston, which would be dealing with the subject of addiction. Besides being touchingly absorbing, Cake spells out that in reality ANYONE can develop a drug addiction, which is a painfully horrible way to live, often deadly and that it most often goes untreated. When we think of a drug addict, we tend not to think about young mothers, upstanding citizens or those with means. Cake's main character, Claire, is all of these. This is accurate because addiction cuts across ALL demographics. That is because...


Developing a Capability-Based Questionnaire for Assessing Well-Being in Patients with Chronic Pain
Abstract This paper reports a qualitative study which sought to operationalise Sen’s capability approach in the context of chronic pain. The resulting capability-instrument will allow treatments and services to be evaluated according to whether they enable users to achieve those things which they value in life. This is particularly important in chronic conditions, where the emphasis is often on helping the patient to live their life as fully as possible despite persistent symptoms. Participatory methods were used to identify a list of capabilities deemed important to those with chronic pain. Respondents were recruited through a Pain Management Clinic in the East of England (n = 16). Focus groups were followed-up by individual interviews (n = 6). The following eight capa...


Laparoscopic hernia repair with adductor tenotomy for athletic pubalgia: an established procedure for an obscure entity
Conclusion Athletic pubalgia is a disease with a multifactorial etiology that can be treated surgically by a laparoscopic totally extraperitoneal hernia repair with synthetic mesh accompanied with an ipsilateral adductor longus tenotomy allowing patients to return to sports-related activity early with minimal complications. (Source: Surgical Endoscopy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


What is Toxic Shame?
When shame becomes toxic, it can ruin our lives. Everyone experiences shame at one time another. It’s an emotion with physical symptoms like any other that come and go, but when it’s severe, it can be extremely painful. Strong feelings of shame stimulate the sympathetic nervous system, causing a fight/flight/freeze reaction. We feel exposed and want to hide or react with rage, while feeling profoundly alienated from others and good parts of ourselves. We may not be able to think or talk clearly and be consumed with self-loathing, which is made worse because we&#8217;re unable to be rid of ourselves. We all have our own specific triggers or tender points that produce feelings of shame. The intensity of our experience varies, too, depending upon our prior life experiences, cultural belie...


Can Mindfulness Really Reduce Chronic Pain?
Pain, suffering and stress can be intolerable – but it doesn’t have to be this way. The second week of our t three-week course reveals a series of simple practices that you can incorporate into your daily life to relieve chronic pain and the suffering and stress of illness. Clinical trials show that mindfulness meditation can be as effective as prescription painkillers. Weread more (Source: Psychology Today Depression Center)


Factors Associated with Insomnia among Elderly Patients Attending a Geriatric Centre in Nigeria.
Conclusion. The high prevalence of insomnia among elderly patients in this setting calls for concerted effort by healthcare workers to educate the elderly on lifestyle modification. PMID: 25587270 [PubMed] (Source: Current Gerontology and Geriatrics Research)


Retained Dental Needle Migration Across the Skull Base to the Cochlea Presenting as Hearing Loss
ConclusionTo our knowledge, based on a thorough PubMed and Google Scholar search, there are no reports of such a foreign body migration from the oral cavity to the skull base. (Source: Otology and Neurotology)


Chronicity factors of temporomandibular disorders: a critical review of the literature
Facial pain often persists long after any identifiable organic pathology has healed. Moreover, in a subgroup of patients with temporomandibular disorder (TMD), no treatment is effective. Knowledge of factors associated with persistent pain in TMD could help identify personalized treatment approaches. Therefore, we conducted a critical review of the literature for the period from January 2000 to December 2013 to identify factors related to TMD development and persistence. The literature findings showed that chronic TMD is marked by psychological distress (somatization and depression, affective distress, fear of pain, fear of movement, and catastrophizing) and characteristics of pain amplification (hyperalgesia and allodynia). Furthermore, these factors seem to interact in TMD development. 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>


PET/MRI spots neuroinflammation from chronic back pain
PET/MR images have led researchers for the first time to confirm evidence of (more) (Source: AuntMinnie.com Headlines)


Study reveals lack of data on opioid drugs for chronic pain
(University of Connecticut) A National Institutes of Health white paper that was released today finds little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain, despite the explosive recent growth in the use of the drugs. (Source: EurekAlert! - Medicine and Health)


A Chinese medicinal formulation ameliorates dextran sulfate sodium-induced experimental colitis by suppressing the activity of nuclear factor-kappaB signaling
Conclusions Our findings suggest that MZWD is a potential remedy for treating IBD, and the mechanism of its efficacy is an anti-inflammatory effect associated with the suppression of the NF-κB pathway. Graphical abstract (Source: Journal of Ethnopharmacology)


Viscosupplementation: Techniques, indications, results
Publication date: Available online 14 January 2015 Source:Orthopaedics &amp; Traumatology: Surgery &amp; Research Author(s): V. Legré-Boyer Viscosupplementation by hyaluronic acid (HA) injections is frequently used for local treatment of osteoarthritis (OA), due to ease of use and good tolerance. A profusion of linear or reticulated HA derivates are marketed, with varied characters and levels of evidence. Viscosupplementation has demonstrated moderate but significant efficacy (20%) versus placebo in terms of pain and function, with a high rate of responders (60–70%) in knee osteoarthritis. It allows reduced administration of opioid analgesics and NSAIDs, with improved risk/benefit ratio, and may delay joint replacement. Cartilage protection remains to be proven. Clinical effic...


Contributions to the Quality of Life of Chronic Renal Insufficient Patients
Conclusions We would like to point out through these results, the importance this type of research, in that it has given some contribution to the quality of life of haemodialysis patients. (Source: Procedia Social and Behavioral 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>


Successful Treatment of Athletic Pubalgia in a Lacrosse Player with Ultrasound-Guided Needle Tenotomy and Platelet-Rich Plasma Injection: A Case Report
Publication date: January 2015 Source:PM&amp;R, Volume 7, Issue 1 Author(s): Paul M. Scholten , Stephen Massimi , Nick Dahmen , Joanne Diamond , James Wyss Athletic pubalgia is a syndrome of persistent groin pain due to chronic repetitive trauma or stress involving the pelvic joints and many musculotendinous structures that cross the anterior pelvis. As a result, the differential diagnosis can be complex, but insertional tendinopathies are the most common. This case report describes a novel approach to the treatment of distal rectus abdominis tendinopathies with ultrasound-guided needle tenotomy and platelet-rich plasma (PRP) injection. After injection, the patient returned to pain-free play at his previous level of intensity. This suggests that PRP may be a useful treatment for this...


A New Version of The Impairment and Functioning Inventory for Chronic Pain Patients (IFI-R)
Conclusions The IFI-R appears to be a valid and reliable measurement tool for the assessment of perceived daily functioning and impairment in people with chronic pain. (Source: PMandR)


How the rheumatologist can guide the patient with rheumatoid arthritis on sexual function
Publication date: Available online 14 January 2015 Source:Revista Brasileira de Reumatologia (English Edition) Author(s): Pedro Henrique Tavares Queiroz de Almeida , Clarissa de Castro Ferreira , Patricia Shu Kurizky , Luciana Feitosa Muniz , Licia Maria Henrique da Mota Sexuality, an integral part of human life and quality of life, is one of those factors responsible for individual welfare. Sexual dysfunction can be defined as a change in any component of sexual activity, which may cause frustration, pain and decreased sexual intercourse. Although it is known that chronic diseases, such as rheumatoid arthritis (RA), influence the quality of sexual life, sexual dysfunction is still underdiagnosed, due to two reasons: (i) patients fail to report the complaint because of shame or frustrati...


Chronic pain: Do opioid painkillers really help?
Doctors are prescribing powerful painkillers without any formal guidelines, which could do more harm than good (Source: Health News: CBSNews.com)


Little evidence opioid drug treatments help chronic pain, study finds
More than 100 million Americans suffer from chronic pain, with five to eight million needing powerful narcotics to fight the pain. However, an expert panel is declaring there is little evidence these treatment programs work. CBS News medical contributor Dr. David Agus joins "CBS This Morning" from Los Angeles to discuss the research. (Source: Health News: CBSNews.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>


Patterns and Predictors of Sleep Quality Before, During, and After Hospitalization in Older Adults
Conclusions:Clinicians should exercise caution in assessing sleep quality in inpatient settings. Alterations in the cutoffs employed may result in discordant clinical classifications of older adults. Pain and depression warrant detailed considerations when working with older adults on inpatient units when poor sleep is a concern.Citation:Dzierzewski JM, Mitchell M, Rodriguez JC, Fung CH, Jouldjian S, Alessi CA, Martin JL. Patterns and predictors of sleep quality before, during, and after hospitalization in older adults. J Clin Sleep Med 2015;11(1):45&#8211;51. (Source: Journal of Clinical Sleep Medicine : JCSM)


Tuning In to Music May Ease Kids' Post-Op Pain, Study Finds
Title: Tuning In to Music May Ease Kids' Post-Op Pain, Study FindsCategory: Health NewsCreated: 1/13/2015 12:00:00 AMLast Editorial Review: 1/14/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Therapists Must Ease Patients' Fear When Treating Chronic Fatigue Syndrome: Study
Title: Therapists Must Ease Patients' Fear When Treating Chronic Fatigue Syndrome: StudyCategory: Health NewsCreated: 1/14/2015 12:00:00 AMLast Editorial Review: 1/14/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Suffer from pain? Skip the ibuprofen and try these natural alternatives instead
(NaturalNews) It is your body's way of telling you that something is amiss -- pain, and for many people, the chronic variety that only the constant use of painkillers seems to mitigate. The advice of many conventional doctors is to just pop a few aspirin or ibuprofen when it shows... (Source: NaturalNews.com)


Benefits of Reiki in older individuals with chronic pain
In conclusion, this therapeutic practice significantly improves chronic pain complaints, in addition to contributing to the balance of the physical, mental, emotional and spiritual needs of older people. Reiki se caracteriza por ser una terapia complementar llevado a cabo a través de la imposición de manos en el ser humano con la intención de restablecer el equilibrio físico, mental y espiritual. El objetivo de esta investigación fue identificar y analizar los beneficios experimentados con la práctica de Reiki, en sujetos ancianos con dolor crónico no oncológica. Se trata de un estudio cualitativo, descriptivo y exploratorio. Para la recolección se utilizó la entrevista semiestructurada, con cuestiones abiertas y cerradas. Los datos fueron recogidos entre julio y agosto de 2012. ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Meta-Analysis Examining the Use of Fibrin Glue Mesh Fixation versus Suture Mesh Fixation in Open Inguinal Hernia Repair
Conclusions: During the 6-15 months follow-up, fibrin glue mesh fixation is a feasible alternative for mesh fixation with sutures in open inguinal hernia repair. However, the poor quality of the included trials limits the evidence; rigorously designed trials are warranted to confirm this conclusion.Dig Surg 2014;31:444-451 (Source: Digestive Surgery)


Pancreatitis in dogs and cats: definitions and pathophysiology
This article reviews histological and clinical definitions and current understanding of the pathophysiology and causes in small animals by comparison with the much more extensive literature in humans, and suggests many areas that need further study in dogs and cats. (Source: The Journal of Small Animal Practice)


Oxytocin enhances the expression of morphine-induced conditioned place preference in rats
Opioids, such as heroin and morphine, are widely used for pain management (Morgan and Christie, 2011), and the increasing number of patients with chronic pain has led to an increase in the use of opioid analgesics (de Leon-Casasola, 2012). However, addiction to opioids is a major public health problem (Compton and Volkow, 2006) and there is a pressing need to understand the mechanisms that underpin opioid addiction to improve the management and treatment of addicts. A particularly problematic aspect affecting the success of treatment of drug addiction is relapse following abstinence (Hyman et al., 2006). (Source: Psychoneuroendocrinology)


Being female is a risk factor for chronic pain. Are inflammatory processes to blame?
Publication date: Available online 13 January 2015 Source:Brain, Behavior, and Immunity Author(s): Jarred W. Younger (Source: Brain, Behavior, and Immunity)


Search for Microorganisms in Men with Urologic Chronic Pelvic Pain Syndrome: A Culture-Independent Analysis in the MAPP Research Network
We used next-generation, state-of-the-art, culture-independent methodology to survey urine microbiota of UCPPS males and control participants enrolled in the MAPP Network to investigate a possible microbial etiology. (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>


Chronic Pain: Cytokines, Lymphocytes and Chemokines.
Authors: de Miguel M, Kraychete DC, Meyer Nascimento RJ Abstract Chronic pain is a debilitating condition and, in most cases, difficult to treat. A prominent example of this is neuropathic pain. Understanding pathophysiological mechanisms of pain and, therefore, make this knowledge into an effective treatment is still a challenge to experts. Pain can now be considered a neuro-immune disorder, since recent data indicates critical involvement of innate and adaptive immune responses following injury, and this interaction plays an important role in the onset and perpetuation of chronic pain. The aim of this article is to review the relationship between immune system and chronic pain, especially about neuropathic pain, and focusing on cytokines, chemokines and lymphocytes. PMID: 255...


From "mechanical" to "neuropathic" back pain concept in FBSS patients. A systematic review based on factors leading to the chronification of pain (part C).
CONCLUSION: A clear understanding of the factors leading to the chronification of back pain should help us to move to the choice of mechanism related pain treatments to improve outcomes in FBSS chronic condition. PMID: 25596973 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)


Pelvic inflammatory disease in the adolescent: a poignant, perplexing, potentially preventable problem for patients and physicians
Purpose of review: The present review considers recent pelvic inflammatory disease literature. It remains a difficult condition to accurately diagnose and manage in the adolescent woman. Failure of accurate diagnosis and prompt management leads to complications, including chronic pelvic pain and infertility. Recent findings: Annual chlamydia screening of sexually active adolescents is an important method for early identification of this common cause of this disorder. Youth with positive screens can be lost for treatment if effective follow-up plans are not in place in clinical practice. The intrauterine device is not a risk factor for this condition in adolescents and is a recommended contraceptive device in sexually active adolescent women. A variety of chlamydial antigens are being used ...


Scant Evidence for Long-Term Opioid Therapy in Chronic PainScant Evidence for Long-Term Opioid Therapy in Chronic Pain
A new review found insufficient evidence that long-term opioid therapy improves chronic pain outcomes, but data showed that serious opioid-related harms, such as overdose, are apparently dose dependent. Medscape Medical News (Source: Medscape Neurology and Neurosurgery Headlines)


Chronic Pain Associated with Activation of Brain's Glial Cells
Patients with chronic pain show signs of glial activation in brain centers that modulate pain, according to results from a PET-MRI study -- Read more on ScientificAmerican.com (Source: Scientific American - Official RSS Feed)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


100 million Americans live with chronic pain, but treatment research is insufficient
An estimated 100 million Americans live with chronic pain. A new report has found a need for evidence-based, multidisciplinary approaches to pain treatment that incorporate patients' perspectives and desired outcomes while also avoiding potential harms. (Source: ScienceDaily Headlines)


Expert Panel Final Report on Opioids in Chronic PainExpert Panel Final Report on Opioids in Chronic Pain
An independent expert panel convened by NIH has published a final report identifying knowledge gaps and calling for more research into various aspects of chronic pain management and long-term opioid use. Medscape Medical News (Source: Medscape Neurology and Neurosurgery Headlines)


Current Evidence in the Management of Poststroke Hemiplegic Shoulder Pain: A Review
ABSTRACT: Hemiplegic shoulder pain is a common, complex, and distressing complication, which is related to stroke and occurs in the paralytic side of the patient. It not only presents in the early stage but also can persist into the chronic stage of stroke. The incidence of this complication varies from 12% to 58%, and the most common period of occurrence is at 8–10 weeks poststroke. The multifactorial etiology and underlying mechanisms make it intractable. It is difficult to get a clear description of the percentage of patients receiving adequate pain relief because of a large number of treatments and different results found in interventional studies performed in subjects in different stages of stroke. This review summarizes the incidence, temporal presentation, and etiology of hemipleg...


Do Patients with Chronic Pain Diseases Believe in Guardian Angels: Even in a Secular Society? A Cross-Sectional Study Among German Patients with Chronic Diseases
Abstract We intended to analyze whether patients with chronic diseases believe in guardian angels (GdA) as a coping resource. In a cross-sectional survey, we analyzed data from 576 German patients with chronic diseases (mean age 51.3 ± 15.4 years). We found that 56 % of the patients often or even regularly believed in GdA, with significantly more women than men believing. Particularly interesting was the fact that 38 % of patients who were identified as neither religious nor spiritual (R−S−) believed in GdAs. This belief may indicate that patients are interested in bridging the gap between the concrete struggle to manage illness and non-rational/transcendent realms. (Source: Journal of Religion and Health)


Brain Scans Give New Clues to Chronic Pain
Title: Brain Scans Give New Clues to Chronic PainCategory: Health NewsCreated: 1/12/2015 12:00:00 AMLast Editorial Review: 1/13/2015 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>


100 million Americans live with chronic pain, but treatment research is insufficient
(Indiana University) An estimated 100 million Americans live with chronic pain. A new report by an independent panel convened by NIH has found a need for evidence-based, multidisciplinary approaches to pain treatment that incorporate patients' perspectives and desired outcomes while also avoiding potential harms. Panel member Christopher Callahan, M.D. of Regenstrief Institute and Indiana University comments. (Source: EurekAlert! - Social and Behavioral Science)


Idiopathic Vitritis in the Setting of Boston Keratoprosthesis
Conclusions:The current paradigm for idiopathic vitritis after keratoprosthesis implantation includes sudden painless loss of vision with full recovery of vision on treatment with periocular corticosteroids. However, idiopathic vitritis after keratoprosthesis can also mimic infectious endophthalmitis with pain and external signs of inflammation. Visual loss can be gradual. Vision may not recover to baseline despite treatment. Vitritis may be a part of a common pathway of chronic inflammation after keratoprosthesis. (Source: Cornea)


Little Evidence to Guide Opioid Use for Chronic Pain Management (FREE)
By Kelly Young Edited by Jaye Elizabeth Hefner, MD There is little evidence that patients with chronic pain who receive long-term opioid treatment have improved function, enhanced quality of life, or diminished pain, according to a … (Source: Physician's First Watch current issue)


Virological response after 6 week triple-drug regimens for hepatitis C: a proof-of-concept phase 2A cohort study
This study is registered with ClinicalTrials.gov, number NCT01805882. Findings Between Jan 11, 2013, and Dec 17, 2013, we enrolled 60 patients, and sequentially assigned them into three groups of 20. We noted an SVR12 in all 20 patients (100%, 95% CI 83–100) allocated to sofosbuvir and ledipasvir for 12 weeks; in 19 (95%, 75–100) of the 20 patients allocated to sofosbuvir, ledipasvir, and GS-9669 for 6 weeks (one patient relapsed 2 weeks after completion of treatment); and in 19 (95%, 75–100%) of the 20 patients allocated to sofosbuvir, ledipasvir, and GS-9451 for 6 weeks (one patient was lost to follow-up after reaching sustained viral response at 4 weeks). Most adverse events were mild and no patients discontinued treatment. Two serious adverse events occurred (pain after a post-t...


Transcriptional Regulation of Brain-Derived Neurotrophic Factor (BDNF) by Methyl CpG Binding Protein 2 (MeCP2): a Novel Mechanism for Re-Myelination and/or Myelin Repair Involved in the Treatment of Multiple Sclerosis (MS)
Abstract Multiple sclerosis (MS) is a chronic progressive, neurological disease characterized by the targeted immune system-mediated destruction of central nervous system (CNS) myelin. Autoreactive CD4+ T helper cells have a key role in orchestrating MS-induced myelin damage. Once activated, circulating Th1-cells secrete a variety of inflammatory cytokines that foster the breakdown of blood–brain barrier (BBB) eventually infiltrating into the CNS. Inside the CNS, they become reactivated upon exposure to the myelin structural proteins and continue to produce inflammatory cytokines such as tumor necrosis factor α (TNFα) that leads to direct activation of antibodies and macrophages that are involved in the phagocytosis of myelin. Proliferating oligodendrocyte precursors (OPs) mig...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Mild renal dysfunction and long-term adverse outcomes in women with chest pain: results from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE)
Conclusions Even mild CKD is a strong independent predictor of all-cause and cardiac mortality in women with symptoms/signs of ischemia, regardless of underlying obstructive CAD severity, underscoring the need to better understand the interactions between ischemic heart disease and CKD. (Source: American Heart Journal)


The Pain—Suffering Association, A Review
ConclusionsThe above results indicate a consistent association between suffering and pain in some patient groups. Studies addressing suffering are needed in CNPM patients. (Source: Pain Medicine)


Improving Our Understanding of Gastroparesis
This issue of Gastroenterology Clinics of North America was written to help provide physicians and clinical investigators a better understanding of gastroparesis, a symptomatic chronic disorder of the stomach characterized by delayed gastric emptying. Gastroparesis is an increasingly recognized and diagnosed disorder. Symptoms of gastroparesis can be variable and include early satiety, nausea, vomiting, postprandial fullness, and upper abdominal pain. These symptoms can range from mild to severe, leading to such complications as malnutrition, functional disability, and multiple hospitalizations. (Source: Gastroenterology Clinics of North America)


Adults with congenital limb deficiency in Norway: demographic and clinical features, pain and the use of health care and welfare services. A cross-sectional study.
Conclusions: Persons with CLD reported increased prevalence of chronic pain, mostly bilateral, and increased prevalence of early retirement. A greater focus on the benefits of the use of assistive devices, the consequences of overuse and vocational guidance may moderate pain and prevent early retirement. Further studies of more representative samples should be conducted to confirm our findings. Implications for Rehabilitation Most adults with congenital limb deficiency (CLD) live ordinary lives and experience normal life events. However, several report chronic pain and retire before normal retirement age. In spite of free and accessible prosthetic services, a large fraction chooses not to use prosthesis, more use grip-improving devices for specific activities. These preferences should be a...


National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain.
This article is an abridged version of the panel's report, the full version of which is available at at https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/opioids-chronic-pain/workshop-resources#finalreport. PMID: 25581341 [PubMed - as supplied by publisher] (Source: Annals of Internal Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop.
Conclusion: Evidence is insufficient to determine the effectiveness of long-term opioid therapy for improving chronic pain and function. Evidence supports a dose-dependent risk for serious harms. Primary Funding Source: Agency for Healthcare Research and Quality. PMID: 25581257 [PubMed - as supplied by publisher] (Source: Annals of Internal Medicine)


Failed back surgery syndrome: Who has failed?
CONCLUSION: The initial pejorative connotation of FBSS suggesting failure or blame must now be replaced to direct the patient and therapists towards a temporal concept focusing on the future rather than the past. In addition to the redefinition of an optimised care pathway, a consensus based on consultation would allow redefinition and renaming of this syndrome in order to ensure a more positive approach centered on the patient. PMID: 25595592 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)


Enterobius vermicularis: An unusual cause of recurrent urinary tract infestation in a 7-year-old girl: case report and review of the literature.
Authors: Patel B, Sharma T, Bhatt GC, Dhingra Bhan B Abstract Enterobius vermicularis, the pinworm, is one of the most prevalent intestinal parasites in the world. Ectopic infestations in the genital or urinary tracts rarely occur and chronic enterobiasis of the urinary tract has rarely been reported. Here we present such a case in a 7-year-old girl presenting with fever, pain in the abdomen, vomiting and burning micturition. Ultrasonography and micturating cystourethrogram (MCU) studies were normal. The ova were demonstrated from both the patient's urine and stool specimen. This child was treated successfully with Albendazole and Ivermectin. PMID: 25586573 [PubMed - as supplied by publisher] (Source: Tropical Doctor)


Being female is a risk factor for chronic pain. Are inflammatory processes to blame?
Authors: Younger JW PMID: 25596175 [PubMed - as supplied by publisher] (Source: Brain, Behavior, and Immunity)


Scant Evidence for Opioids in Chronic Pain (CME/CE)
(MedPage Today) -- A two-day NIH workshop concludes there's little evidence for opioids in chronic pain. (Source: MedPage Today Geriatrics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Panel cites need for individualized, patient-centered approach to treat and monitor chronic pain
Panel concerned about long-term effectiveness of treating chronic pain with prescription opioids. (Source: National Institutes of Health (NIH) News Releases)


Brain Scans Give New Clues to Chronic Pain
In patients with back pain, certain cells produced a protein that might someday be treatment targetSource: HealthDay Related MedlinePlus Page: Chronic Pain (Source: MedlinePlus Health News)


What Causes Muscle Cramps?
Discussion Leg pain is a relatively common problem in children. Usually it is idiopathic in origin but can be the sign of organic pathology. The differential diagnosis can be found here. Noctural legs cramps have been found to occur in about 7% of healthy children. They start after age 8 and peak at 16-18 years of age. Cramps that are idiopathic are unilateral, and those with organic causes can be uni- or bi-lateral. Most episodes last only a few minutes but those lasting longer than 10 minutes are more likely to have an organic etiology. Learning Point The differential diagnosis of nocturnal muscle cramping in children includes: Idiopathic &#8211; most common Endocrine Diabetes Hypothyroidism Hyperthyroidism Exercise Myalgia due to overuse Compartment syndrome Myoglobinuria Fluids and...


Repetitive Transcranial Magnetic Stimulation for Fibromyalgia: Systematic Review and Meta‐Analysis
ConclusionIn comparison with sham stimulation, rTMS demonstrated superior effect on the QoL of patients with FM 1 month after starting therapy. However, further studies are needed to determine optimal treatment protocols and to elucidate the mechanisms involved with this effect, which does not seem to be mediated by changes in depression, but that may involve pain modulation. Level of evidence 1b. (Source: Pain Practice)


How Well Do Medical Oncologists Manage Chronic Cancer Pain?: A National Survey.
CONCLUSION: These data suggest that oncologists and other medical specialists who manage cancer pain have knowledge deficiencies in cancer pain management. These gaps help clarify the need for pain management education. PMID: 25582140 [PubMed - as supplied by publisher] (Source: The Oncologist)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 up-regulation of spinal Toll-like receptor 4 in rats with inflammatory pain induced by complete Freund's adjuvant.
Authors: Zhao XH, Zhang T Abstract Peripheral inflammation induces central sensitization that displays the features by the development of pain hypersensitivity to the stimuli. It has been shown that activation of glia contributes to the development of behavioral hypersensitivity after peripheral inflammation. It has been suggested that Toll-like receptor 4 (TLR4) primarily expressed on microglia affects central pain response. The present study was designed to examine the expressions of TLR4 and microglia in the spinal cord in different time points of inflammatory pain induced by complete Freund's adjuvant (CFA). The results show that CFA induces significant pain hypersensitivity and paw edema as well as spinal dorsal horn (SDH) microglia activation with the increased expressions of...


Mechanisms of morphine-venlafaxine interactions in diabetic neuropathic pain model.
CONCLUSIONS: The results of our study show that single administration of VFX potentiates antinociceptive action of morphine in DNPM. This effect is probably mediated by both, noradrenergic and serotonergic systems. On the other hand, 21-days administration of VFX significantly decreases analgesic action of MRF. Moreover, there is a possibility that VFX acts as an antagonist of N-methyl-d-aspartate receptors. PMID: 25560581 [PubMed - in process] (Source: Pharmacological Reports)


Prevalence of depressive and anxiety symptoms in patients with chronic pain
Conclusion The present study showed high prevalence of depressive and anxiety symptoms in patients with chronic pain. There was also significant association of these psychiatric symptoms with some types and intensity of pain. (Source: Jornal Brasileiro de Psiquiatria)


Epidemiology of Chronic Pruritus: Where Have We Been and Where Are We Going?
We present an up-to-date summary of the epidemiology of chronic itch in different cutaneous and systemic conditions. While we have endeavored to discuss some of the most common causes of chronic pruritus, this review does not encompass all of the myriad different diseases in which chronic pruritus can occur. (Source: Current Dermatology Reports)


Increased risks of healthcare-seeking behaviors of anxiety, depression and insomnia among patients with bladder pain syndrome/interstitial cystitis: a nationwide population-based study
Conclusion Patients with BPS/IC are at risk of development of anxiety, depression, and insomnia. These findings can help guide urologists, urogynecologists, and psychiatrists toward early identification and treatment of psychological complications that may develop in BPS/IC patients. (Source: International Urology and Nephrology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 chronic residual peripheral neuropathy in eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome): a multicenter, double-blind trial
This study indicates that IVIg treatment for EGPA patients with residual peripheral neuropathy should be considered even when laboratory indices suggest remission of the disease. (Source: Journal of Neurology)


[Behavioral concepts in the treatment of chronic pain.]
Authors: Kaiser U, Nilges P Abstract In recent decades there has been much work on cognitive behavioral approaches to chronic pain. Now there is a considerable variety of concepts and interventions which share the same roots but differ in theoretical issues and application. Psychotherapeutic interventions are ideally embedded into an interdisciplinary setting and base on a bio-psycho-social perspective. Starting from a classical operant model we will describe the model of fear avoidance and the model of acceptance in the therapy of chronic pain. The latter have been influencing therapy and theory in recent years. The cognitive behavioral perspective on chronic pain has, therefore, not only become more differentiated and complex but also more complicated. PMID: 25576181 [PubMed ...


Managing chronic pain in survivors of torture - Amris K, Williams AC.
All generalist and specialist clinicians are likely to encounter torture survivors among refugees and asylum seekers. A minority of people survive torture and a smaller minority reach a developed country; those who do tend to be the more resilient and reso... (Source: SafetyLit: All (Unduplicated))


The relationship between hemoglobin level and disease activity in patients with rheumatoid arthritis
Conclusion In conclusion, we determined that low hemoglobin level was significantly related to disability and impairment, disease activity, articular damage, pain and disease duration in RA patients in our study. We believe that by keeping disease activity under control, therefore preventing articular damage, the disability in RA patients can be lessened or possibly even eliminated. (Source: Revista Brasileira de Reumatologia)


Optic neuritis in juvenile idiopathic arthritis patient
In conclusion, a low prevalence of ON was observed in our JIA population. The absence of anti-AQP4 antibody and the normal brain MRI do not exclude the possibility of demyelinating disease associated with chronic arthritis. Therefore, rigorous follow up is required. (Source: Revista Brasileira de Reumatologia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Tips for Love & Pain
Couples in hot romantic love feel fantastic! They glow. And, it turns out that love has a surprising protective effect against pain. Intense romantic love brings euphoric pleasure and it also confers analgesic benefit, according to two separate Stanford studies.read more (Source: Psychology Today Relationships Center)


Altered cognition-related brain activity and interactions with acute pain in migraine
Publication date: Available online 10 January 2015 Source:NeuroImage: Clinical Author(s): Vani A. Mathur , Shariq A. Khan , Michael L. Keaser , Catherine S. Hubbard , Madhav Goyal , David A. Seminowicz Little is known about the effect of migraine on neural cognitive networks. However, cognitive dysfunction is increasingly being recognized as a comorbidity of chronic pain. Pain appears to affect cognitive ability and the function of cognitive networks over time, and decrements in cognitive function can exacerbate affective and sensory components of pain. We investigated differences in cognitive processing and pain-cognition interactions between 14 migraine patients and 14 matched healthy controls using an fMRI block-design with two levels of task difficulty and concurrent heat (painful an...


Acceptance: what’s in a name? A content analysis of acceptance instruments in individuals with chronic pain
Instruments to assess chronic pain acceptance have been developed and used. Uninvestigated is whether and to what extent the content of the items reflects acceptance. A content analysis of thirteen instruments that aim to measure acceptance of chronic pain was performed. A coding scheme was used that consisted of three categories that represent key components of acceptance, i.e. “disengagement from pain control”, “pain willingness”, and “engagement in activities other than pain control”. The coding scheme consisted of five additional categories in order to code items that do not to represent acceptance, i.e., “controlling pain”, “pain costs”, “pain benefits”, “unclear”, and “no fit”. (Source: The Journal of Pain)


Chronic pain and suicide attempt in the elderly through a case narration - Gaillardou D, Matusevich D.
We sought to reconstruct the case of an elderly patient who made a suicide attempt. We have isolated and identified certain risk factors which could have determined the patient's final decision, such as chronic pain, social isolation, narcissistic personal... (Source: SafetyLit: All (Unduplicated))


End of the Road for a Dysfunctional End Organ: Laparoscopic Gastrectomy for Refractory Gastroparesis
Conclusions Regardless of etiology, medically refractory gastroparesis can be a devastating disease. Near-total gastrectomy can ameliorate or relieve nausea, belching, and bloating. Chronic abdominal pain commonly resolved or improved with resection. Despite attendant morbidity, gastrectomy can effectively palliate symptoms of gastroparesis. (Source: Journal of Gastrointestinal 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>


Measuring Lumbar Reposition Accuracy in Patients With Unspecific Low Back Pain: Systematic Review and Meta-analysis
Conclusion. Although patients with NSCLBP seemed to produce a larger lumbar RE compared with healthy controls, study limitations render firm conclusions unsafe. Future studies should pay closer attention to power, precision, and reliability of the measurement approach, definition of outcome measures, and patient selection. We recommend a large, well-powered, prospective randomized control study that uses a standardized measurement approach and definitions for absolute error, CE, and variable error to address the hypothesis that proprioception may be impaired with CLBP. Level of Evidence: 1 (Source: Spine)


Cross-Cultural Adaptation and Validation of the Neck Disability Index to European Portuguese Language
Conclusion. The NDI-PT demonstrated excellent reliability and good construct validity and it may be useful for assessing functional status of Portuguese-speaking patients with CNP. Level of Evidence: N/A (Source: Spine)


The Oswestry Disability Index (Version 2.1a): Validation of a Dutch Language Version
Conclusion. The Dutch ODI version 2.1a is a valid and valuable tool for the measurement of functional status and disability among Dutch patients with chronic low back pain. This translated condition-specific patient-reported outcome measure version is recommended for use in future back pain research and to evaluate outcome of back care in the Netherlands. Level of Evidence: 4 (Source: Spine)


Can Mindfulness Meditation Really Reduce Pain and Suffering?
Recent clinical trials show that mindfulness meditation can reduce pain and suffering by 90 percent. This three week course by bestselling Mindfulness author Dr Danny Penman shows you how to begin.read more (Source: Psychology Today Depression Center)


Endoscopic Ultrasound in the Evaluation of Chronic Upper Abdominal Pain of Unknown Etiology: A Retrospective Chart Review Examining the Efficacy of EUS in Determining a New Diagnosis
Conclusions: Our results support the fact that the majority of patients UAP with prior imaging will have no identifiable organic etiology found on EUS to explain their pain; however, we suggest that EUS be considered in patients with suspected pancreatic or biliary pathology. (Source: Journal of Clinical 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>


Welcome to Chronic Pain 360: Real Hope for Recovery
We need to rethink the way we treat chronic pain.read more (Source: Psychology Today Addiction Center)


Antinociceptive effect of intracerebroventricular administration of glycine transporter-2 inhibitor ALX1393 in rat models of inflammatory and neuropathic pain
Publication date: Available online 9 January 2015 Source:Pharmacology Biochemistry and Behavior Author(s): Yoshihiro Takahashi , Koji Hara , Yasunori Haranishi , Tadanori Terada , Goh Obara , Takeyoshi Sata Glycinergic transmission has an important role in regulating nociception in the spinal cord. The glycine transporter-2 (GlyT2) is localized at presynaptic terminals of glycinergic neurons and eliminates glycine from the synaptic cleft to terminate glycinergic transmission. Systemic and intrathecal administration of GlyT2 inhibitors alleviate various types of pain. Although the GlyT2s and glycine receptors are widely distributed in the central nervous system, little is known about the role of glycinergic transmission in pain perception at supraspinal regions. The present study examined...


GDNF‐mediated enhancement of noradrenergic descending inhibition in the locus coeruleus exerts a prolonged analgesic effect on 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)


Effectiveness of Acupuncture on Chronic Prostatitis–Chronic Pelvic Pain Syndrome Category IIIB Patients: A Prospective, Randomized, Nonblinded, Clinical Trial
To compare the acupuncture treatment and the medical treatment with antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs) on pain control, urinary symptoms, and quality of life of category IIIB chronic prostatitis–chronic pelvic pain syndrome (CP-CPPS). (Source: Urology)


Exercise for osteoarthritis of the knee.
CONCLUSIONS: High-quality evidence indicates that land-based therapeutic exercise provides short-term benefit that is sustained for at least two to six months after cessation of formal treatment in terms of reduced knee pain, and moderate-quality evidence shows improvement in physical function among people with knee OA. The magnitude of the treatment effect would be considered moderate (immediate) to small (two to six months) but comparable with estimates reported for non-steroidal anti-inflammatory drugs. Confidence intervals around demonstrated pooled results for pain reduction and improvement in physical function do not exclude a minimal clinically important treatment effect. Since the participants in most trials were aware of their treatment, this may have contributed to their improvem...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


ASICs as therapeutic targets for migraine.
Authors: Dussor G Abstract Migraine is the most common neurological disorder and one of the most common chronic pain conditions. Despite its prevalence, the pathophysiology leading to migraine is poorly understood and the identification of new therapeutic targets has been slow. Several processes are currently thought to contribute to migraine including altered activity in the hypothalamus, cortical-spreading depression (CSD), and afferent sensory input from the cranial meninges. Decreased extracellular pH and subsequent activation of acid-sensing ion channels (ASICs) may contribute to each of these processes and may thus play a role in migraine pathophysiology. Although few studies have directly examined a role of ASICs in migraine, studies directly examining a connection have gene...


The dichotomized role for acid sensing ion channels in musculoskeletal pain and inflammation.
Authors: Sluka KA, Gregory NS Abstract Chronic muscle pain affects between 11-24% of the world's population with the majority of people experiencing musculoskeletal pain at some time in their life. Acid sensing ion channels (ASICs) are important sensors of modest decreases in extracellular pH that occur within the physiological range. These decreases in extracellular pH occur in response to inflammation, fatiguing exercise,, and ischemia. Further, injection of acidic saline into muscle produces enhanced nociceptive behaviors in animals and pain in human subjects. Of the different types of ASICs, ASIC3 and ASIC1 have been implicated in transmission of nociceptive information from the musculoskeletal system. The current review will provide an overview of the evidence for ASIC3 and AS...


Pelvic inflammatory disease in the adolescent: a poignant, perplexing, potentially preventable problem for patients and physicians
Purpose of reviewThe present review considers recent pelvic inflammatory disease literature. It remains a difficult condition to accurately diagnose and manage in the adolescent woman. Failure of accurate diagnosis and prompt management leads to complications, including chronic pelvic pain and infertility. Recent findingsAnnual chlamydia screening of sexually active adolescents is an important method for early identification of this common cause of this disorder. Youth with positive screens can be lost for treatment if effective follow-up plans are not in place in clinical practice. The intrauterine device is not a risk factor for this condition in adolescents and is a recommended contraceptive device in sexually active adolescent women. A variety of chlamydial antigens are being used to h...


The Role of Positive Affect in Pain and Its Treatment
Discussion: We offer an “upward spiral” model of PA, resilience and pain self-management, which makes specific predictions that PA will buffer maladaptive cognitive and affective responses to pain, and promote active engagement in valued goals that enhance CP self-management. (Source: The Clinical Journal of Pain)


Outcome Measures in Randomized-controlled Trials of Neuropathic Pain Conditions: A Systematic Review of Systematic Reviews and Recommendations for Practice
Discussion: These results demonstrate that measures of pain are predominantly used in trials of NeP conditions and highlight the scant usage of functional outcome measures. The lack of standardization for the diagnostic criteria in NeP trials is also an issue that needs to be considered for future research and guideline development. (Source: The Clinical Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Attachment and Adjustment in Adolescents and Young Adults With a History of Pediatric Functional Abdominal Pain
This study tested predictions of the Attachment-Diathesis Model (ADM) of Chronic Pain in a cross-sectional sample of adolescents and young adults with a history of childhood functional abdominal pain (FAP). ADM posits that attachment anxiety is a diathesis for poor adjustment (physical health, mental health, and functioning) in the context of chronic pain and that pain self-efficacy, pain threat appraisal, and passive coping mediate this effect. Methods: Participants (N=261) were recruited from a database of consecutive new patients evaluated for abdominal pain at a pediatric gastroenterology clinic. Participants’ mean age at the follow-up assessment was 21 years. Structural equation modeling was used to test the fit of our conceptual model to the data. Results: Model fit was good (compa...


Pain Self-efficacy Mediates the Relationship Between Depressive Symptoms and Pain Severity
We examined the relationships between depressive symptoms, pain severity, and pain self-efficacy (PSE) in patients with chronic low back pain (CLBP). We hypothesized that change in depressive symptoms would significantly influence change in pain severity, and that PSE indirectly affects this relationship. Materials and Methods: Participants were 109 CLBP patients in a 4-week multidisciplinary rehabilitation program for CLBP. They completed measures of PSE, depression, and pain severity at admission and discharge. Structural equation modeling was used to test the significant direct and indirect effects from pretreatment to posttreatment. Results: Change in depressive symptoms significantly predicted change in pain severity in affective (β=0.358; 95% confidence interval [CI], 0.206-0.480; P...


A Self-Regulation Perspective on Avoidance and Persistence Behavior in Chronic Pain: New Theories, New Challenges?
Discussion: Several implications and challenges arising from this review are discussed. In particular, a self-regulation perspective does not consider avoidance and persistence behavior to be intrinsically adaptive or maladaptive, but argues that their effects on disability and well-being rather depend on the goals underlying these behaviors. Such view would require a shift in how avoidance and persistence behavior are assessed and approached in clinical interventions. (Source: The Clinical Journal of Pain)


Subgrouping of Low Back Pain Patients for Targeting Treatments: Evidence from Genetic, Psychological, and Activity-related Behavioral Approaches
Conclusions: For future research and treatment it might be challenging to develop theoretical frameworks combining different subgrouping classifications. On the basis of this framework, tailoring treatments more specifically to the patient needs may result in improvements in treatment programs for patients with LBP. (Source: The Clinical Journal of Pain)


Exercise, Not to Exercise, or How to Exercise in Patients With Chronic Pain? Applying Science to Practice
Conclusion: Exercise therapy has found to be beneficial in CP, but it should be appropriately and individually tailored with emphasis on prevention of symptom flares and applying adequate recovery strategies. (Source: The Clinical Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pain among institutionalized stroke patients and its relation to emotional distress and social engagement
ConclusionsPain is a serious and multidimensional problem among institutionalized stroke patients. It is related to increased ED, which in turn can be a pathway to low SE as an indicator of social vulnerability. Future research should reveal how pain management in nursing homes can be tailored to the needs of this patient group. Copyright © 2014 John Wiley & Sons, Ltd. (Source: International Journal of Geriatric Psychiatry)


Gallbladder tuberculosis mimicking carcinoma gallbladder: A case report
Conclusion Tuberculosis of gall bladder can mimic carcinoma gall bladder. (Source: International Journal of Surgery Case Reports)


Pulsed Radiofrequency for Chronic Intractable Lumbosacral Radicular Pain: A Six‐Month Cohort Study
ConclusionsPRF treatment of the DRG may be considered for patients with chronic, severe lumbosacral radicular pain refractory to conventional medical management. (Source: Pain Medicine)


The Risk and Benefit of Benzodiazepine Use in Patients with Chronic Pain
(Source: Pain Medicine)


Topical sodium nitrite for chronic leg ulcers in patients with sickle cell anaemia: a phase 1 dose-finding safety and tolerability trial
This study is registered with ClinicalTrials.gov, number NCT01316796. Findings Between April 4, 2011, and March 19, 2013, we enrolled 18 adult patients with sickle cell anaemia and leg ulcers into our trial. We assigned three patients into each cohort, and each cohort was treated with a different concentration of sodium nitrite cream (cohort 1: 0·5%, cohort 2: 1·0%, cohort 3: 1·5%, and cohort 4: 2·0%). Patients were not enrolled into the next cohort dose until we were able to establish that no dose-limiting toxicities were observed. An additional six patients were enrolled to cohort 3a: 1·8%, after two patients in cohort 4 had asymptomatic drops in diastolic blood pressure. No grade 3–4 adverse events were observed, and there were no serious adverse events or dose-limiting side-eff...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 common link between functional somatic syndromes may be central sensitisation
Functional somatic syndromes are common and disabling conditions that all include chronic pain, and which may be related to central nervous system sensitisation. Here, we address the concept of central sensitisation as a physiological basis for the functional somatic syndromes. (Source: Journal of Psychosomatic Research)


Differential changes in gingival somatosensory sensitivity after painful electrical tooth stimulation.
In conclusion, modest increased gingival sensitivity to warmth, painful heat and pressure stimuli as well as desensitization to non-painful mechanical stimulation were demonstrated after tooth stimulation. This suggests involvement of competing heterotopic facilitatory and inhibitory mechanisms. Furthermore, stimulation below the sensory threshold induced similar thermal sensitization suggesting the possibility of activation of axon-reflex-like mechanisms even at intensities below the perception threshold. These findings may have implications for interpretation of somatosensory results in patients with chronic intraoral pain. PMID: 25567087 [PubMed - as supplied by publisher] (Source: Experimental Brain Research)


Nortriptyline for neuropathic pain in adults.
CONCLUSIONS: We found little evidence to support the use of nortriptyline to treat the neuropathic pain conditions included in this review. There were no studies in the treatment of trigeminal neuralgia. The studies were methodologically flawed, largely due to small size, and potentially subject to major bias. The results of this review do not support the use of nortriptyline as a first line treatment. Effective medicines with much greater supportive evidence are available, such as duloxetine and pregabalin. PMID: 25569864 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


[Giant cell tumor of the lumbar spine. Case report and review of the literature.]
We report the case of a 32-year-old patient complaining of chronic low back pain radiating to his left thigh. His MRI showed a lytic L1 vertebral body injury. A transpedicular biopsy confirmed the diagnosis of giant cell tumor. He underwent a L1 vertebrectomy and vertebral body replacement with a titanium cylinder using anterior approach, followed by the removal of the L1 posterior arch and the placement of pedicle screws through a posterior approach. The giant cell tumor is a rare benign primary bone tumor that can be locally aggressive and can potentially spread to other areas, usually to the lungs. Although it most frequently affects long bones, approximately 10% of tumors are located in the spine. To minimise the risk of recurrence, the elective management option is surgery. PMID: ...


A 10-year experience of totally extraperitoneal endoscopic repair for adult inguinal hernia
Conclusions The results obtained for TEP over 10 years support this as a promising procedure for the treatment of adult inguinal hernia. (Source: Surgery Today)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Viral vectors encoding endomorphins and serine histogranin attenuate neuropathic pain symptoms after spinal cord injury in rats
Conclusions: Findings from this study support the potential for direct gene therapy to provide a robust and sustained alleviation of chronic neuropathic pain following SCI. The combination strategy utilizing potent mu-opioid peptides with a naturally-derived NMDA antagonist may produce additive or synergistic analgesic effects without the tolerance development for long-term management of persistent pain. (Source: Epidemiologic Perspectives and Innovations)


Injury-specific promoters enhance herpes simplex virus mediated gene therapy for treating neuropathic pain in rodents
In this study we sought to use an injury-specific promoter to deliver the mu opioid receptor (MOR) transgene such that expression would only occur during the injured state in response to release of injury-specific galanin. To determine whether an injury specific promoter can produce neuron-specific MOR expression and enhanced antinociception we compared animals infected with a galanin promoter virus (galMOR) or a human cytomegalovirus (CMV) promoter virus. (Source: The Journal of Pain)


The Potential Utility of the Patient Health Questionnaire as a Screener for Psychiatric Comorbidity in a Chronic Disabling Occupational Musculoskeletal Disorder Population
ConclusionsThe strong specificity of the PHQ appears to be its primary strength for this cohort. Due to its high specificity, the PHQ could be employed as an additional screening tool to help rule out potential psychiatric comorbidity in patients with CDOMD. The low sensitivity of the PHQ in this population, however, remains a weakness of the PHQ. (Source: Pain Practice)


Acute Rhabdomyolysis in a Patient with Long‐Term Exposure to Intrathecal Ziconotide: A Case Report
We present a case of an acute rhabdomyolysis following an intrathecal bolus injection of ziconotide on a patient who had long‐term exposure to the drug. Case ReportThe patient suffered from chronic neuropathic pain with diagnosis of failed back surgery syndrome and received intrathecal ziconotide for 2 years. Moderate side effects resulting from dose escalation led to a discontinuation of the drug. The pump medication was changed to morphine, which failed to provide adequate analgesia even with dose titration. A single intrathecal bolus of ziconotide, as an adjunctive therapy, resulted in good pain control. Two months later, the patient received a second ziconotide injection. Sixteen hours after the injection, she presented to local emergency center with nausea, vomiting, diarrhea, and ...


Twelve‐Month Follow‐Up of a Randomized Trial Assessing Cooled Radiofrequency Denervation as a Treatment for Sacroiliac Region Pain
ConclusionsThese favorable 12‐month results illustrate the durability of effective CRF/LBN‐mediated treatment of SI region pain for selected patients. Furthermore, successful CRF/LBN treatments in unblinded crossover study subjects demonstrate the unlikelihood that such positive outcomes are attributable to a “placebo” effect, and suggest that CRF/LBN is an effective therapeutic option for alleviating pain, and improving physical function and quality of life, with few complications. (Source: Pain Practice)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Interdisciplinary expert consensus on management of type B intramural haematoma and penetrating aortic ulcer [REVIEWS]
An expert panel on the treatment of type B intramural haematoma (IMH) and penetrating atherosclerotic ulcer (PAU) consisting of cardiologists, cardiothoracic surgeons, vascular surgeons and interventional radiologists reviewed the literature to develop treatment algorithms using a consensus method. Data from 46 studies considered relevant were retrieved for a total of 1386 patients consisting of 925 with IMH, and 461 with PAU. The weighted mean 30-day mortality from IMH was 3.9%, 3-year aortic event-related mortality with medical treatment 5.4%, open surgery 23.2% and endovascular therapy 7.1%. In patients with PAU early and 3-year aortic event-mortality rates with open surgery were 15.9 and 25.0%, respectively, and with TEVAR were 7.2 and 10.4%, respectively. According to panel consensus ...


Systematic mechanism-orientated approach to chronic pancreatitis pain.
Authors: Bouwense SA, de Vries M, Schreuder LT, Olesen SS, Frøkjær JB, Drewes AM, van Goor H, Wilder-Smith OH Abstract Pain in chronic pancreatitis (CP) shows similarities with other visceral pain syndromes (i.e., inflammatory bowel disease and esophagitis), which should thus be managed in a similar fashion. Typical causes of CP pain include increased intrapancreatic pressure, pancreatic inflammation and pancreatic/extrapancreatic complications. Unfortunately, CP pain continues to be a major clinical challenge. It is recognized that ongoing pain may induce altered central pain processing, e.g., central sensitization or pro-nociceptive pain modulation. When this is present conventional pain treatment targeting the nociceptive focus, e.g., opioid analgesia or surgical/endoscopic in...


Pain sensitivity and tactile spatial acuity are altered in healthy musicians as in chronic pain patients
Inmaculada Riquelme (Source: Frontiers in Human Neuroscience)


There's No Back Pain Surgery Can't Make Worse
Surgery is much less science-based than the rest of medicine. It is almost impossible to subject it to studies that are double-blind and placebo-controlled. Surgical guidelines are therefore necessarily much more anecdotal than based on evidence. Lots of elective surgery is probably unnecessary, and back operations are the most notorious example. Back pain is an inevitable and fairly ubiquitous complication of the human condition, arising from our incomplete postural adaptation to bipedal locomotion and the fact that we now live much longer than our backs are adapted for. Back surgery is performed when the patient has a combination of pain and imaging pictures that show spinal abnormalities. The natural assumption is that what shows up in the pictures must be causing the pain. But that a...


Smiling Again with Laughing Gas
And so, maybe it is time to look at what we already have: Although ketamine has gained interest in recent years as a rapidly acting potential therapy for treatment refractory depression, researchers say an even better option may lie in another well-known agent with a similar mechanism of action ― nitrous oxide, better known as laughing gas. (Image from Google.)read more (Source: Psychology Today Depression Center)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pre-clinical studies in cough research: Role of Transient Receptor Potential (TRP) channels
Publication date: October 2013 Source:Pulmonary Pharmacology &amp; Therapeutics, Volume 26, Issue 5 Author(s): Megan S. Grace , Eric Dubuis , Mark A. Birrell , Maria G. Belvisi Cough is a protective reflex and defence mechanism in healthy individuals, which helps clear excessive secretions and foreign material from the lungs. Cough often presents as the first and most persistent symptom of many respiratory diseases and some non-respiratory disorders, but can also be idiopathic, and is a common respiratory complaint for which medical attention is sought. Chronic cough of various aetiologies is a regular presentation to specialist respiratory clinics, and is reported as a troublesome symptom by a significant proportion of the population. Despite this, the treatment options for cough ar...


Derivation and validation phase for the development of clinical prediction rules for rehabilitation in chronic nonspecific low back pain patients: study protocol for a randomized controlled trial
In this study, a sufficiently large sample will be included in both the derivation and validation phase.Trial registration: This trial was registered with Clinicaltrials.gov on 10 February 2014, registration number: NCT02063503. (Source: Epidemiologic Perspectives and Innovations)


Prognosis and course of pain in patients with chronic non‐specific low back pain: A 1‐year follow‐up cohort study
ConclusionThe results of this study indicate that in chronic NSLBP patients, bio‐psychosocial prognostic factors may be important for clinicians when predicting recovery in back pain intensity during a 1‐year period. (Source: European Journal of Pain)


Lasting Prolonged-Release Tapentadol for Moderate/Severe Non-Cancer Musculoskeletal Chronic Pain
Conclusions Twelve weeks of PR tapentadol in outpatients with moderate/severe chronic musculoskeletal pain showed satisfactory analgesic efficacy and tolerability, and had a positive influence on life quality and chronicity stage. The results are robust enough to warrant a subsequent study with a larger sample and a longer observation period. (Source: Pain and Therapy)


Endogenous adenosine A3 receptor activation selectively alleviates persistent pain states
Chronic pain is a global burden that promotes disability and unnecessary suffering. To date, efficacious treatment of chronic pain has not been achieved. Thus, new therapeutic targets are needed. Here, we demonstrate that increasing endogenous adenosine levels through selective adenosine kinase inhibition produces powerful analgesic effects in rodent models of experimental neuropathic pain through the A3 adenosine receptor (A3AR, now known as ADORA3) signalling pathway. Similar results were obtained by the administration of a novel and highly selective A3AR agonist. These effects were prevented by blockade of spinal and supraspinal A3AR, lost in A3AR knock-out mice, and independent of opioid and endocannabinoid mechanisms. A3AR activation also relieved non-evoked spontaneous pain behaviour...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes
Treatment-induced neuropathy in diabetes (also referred to as insulin neuritis) is considered a rare iatrogenic small fibre neuropathy caused by an abrupt improvement in glycaemic control in the setting of chronic hyperglycaemia. The prevalence and risk factors of this disorder are not known. In a retrospective review of all individuals referred to a tertiary care diabetic neuropathy clinic over 5 years, we define the proportion of individuals that present with and the risk factors for development of treatment-induced neuropathy in diabetes. Nine hundred and fifty-four individuals were evaluated for a possible diabetic neuropathy. Treatment-induced neuropathy in diabetes was defined as the acute onset of neuropathic pain and/or autonomic dysfunction within 8 weeks of a large improvement in...


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...


Activation of GPR30 attenuates chronic pain-related anxiety in ovariectomized mice
Pain is an unpleasant sensory and emotional experience essential for safety and associated with potential or actual tissue damage (McKelvey et al., 2013). However, chronic pain (also referred to as persistent pain) persists for a prolonged period and is usually caused by various diseases or abnormal conditions (Siddall and Cousins, 2004). Chronic pain is highly associated with mood disorders, such as anxiety and depression (Bardel et al., 2013; Blackburn-Munro and Blackburn-Munro, 2001; Rouwette et al., 2012). (Source: Psychoneuroendocrinology)


Long-term morphine tolerance and mRNA changes [Pharmacology]
Chronic morphine administration is associated with the development of tolerance, both clinically and in animal models. Many assume that tolerance is a continually progressive response to chronic opioid dosing. However, clinicians have long appreciated the ability to manage cancer pain in patients for months on stable opioid doses, implying that... (Source: Proceedings of the National Academy of Sciences)


Exploring the lived experience of adults using prescription opioids to manage chronic noncancer pain.
Authors: Brooks EA, Unruh A, Lynch M PMID: 25562838 [PubMed - as supplied by publisher] (Source: Pain Research and 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>


Adhesion prevention agents for gynaecological surgery: an overview of Cochrane reviews.
CONCLUSIONS: There is insufficient evidence to allow us to draw any conclusions about the effectiveness and safety of anti-adhesion agents in gynaecological surgery, due to the lack of data on pelvic pain, fertility outcomes, quality of life or safety. A substantial proportion of research in this field has been funded by private companies that manufacture these agents, and further high powered, independent trials will be needed before definitive conclusions can be made. PMID: 25561409 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Effects of terbinafine and itraconazole on the pharmacokinetics of orally administered tramadol
Conclusions Terbinafine may reduce the opioid effect of tramadol and increase the risk of its monoaminergic adverse effects. Itraconazole has no meaningful interaction with tramadol in subjects who have functional CYP2D6 enzyme. (Source: European Journal of Clinical Pharmacology)


Novel approaches in pain management in cardiac surgery
This article reviews the literature regarding various modalities for management of postoperative pain after cardiac surgery. Recent findings: Paravertebral block of the spinal nerve roots provides similar analgesia to thoracic epidural without the risk of hypotension or epidural hematoma. Continuous α-2 agonist infusion reduces opioid requirements in the immediate postoperative period and may convey a morbidity and mortality benefit in cardiac surgery patients that persists for 12 months. Antiepileptics may significantly decrease opioid requirements and improve pain scores. Finally, complementary and alternative practices such as acupuncture, music, and behavioral exercises both pre and postoperatively may improve acute pain and lessen conversion to chronic pain. Summary: Although publish...


Chronic low back pain, chronic disability at work, chronic management issues
Low-back pain (LBP) stands out as the leading musculoskeletal disorder because it is both highly prevalent and the disability with which people live for the greatest number of years (1, 2). Reaching a peak between the ages of 30–50 years, LBP affects a population at a time of career advancement (3, 4). Back pain is the most expensive disease in terms of indirect costs due to sickness absence and work disability. Indirect (or productivity) costs contribute 93% to total costs, illustrating the importance of the consequences of the disease for work performance (5, 6). On a personal level, low self-motivation and self-confidence make it harder to initiate the return-to-work (RTW) process, especially when problems at work are related to the reason for sick leave (7, 8). At the workplace level,...


Item-level informant discrepancies between children and their parents on the PROMIS ® pediatric scales
Conclusions Parent–child item-level discrepancies were lower for more objective or visible items than for items measuring internal states or less observable items measuring latent variables such as peer relationships and fatigue. Future research should focus on the child and parent characteristics that influence domain-specific item-level discrepancies, and under what conditions item-level parent–child discrepancies predict child health outcomes. (Source: Quality of Life Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Investigation of the Relationship between Increased Vertical Overlap with Minimum Horizontal Overlap and the Signs of Temporomandibular Disorders
ConclusionWithin the limitations of this study, deviation upon maximum opening, tenderness of lateral pterygoid muscles (upon palpation), and opening‐closing joint sounds occurred more often in the increased vertical overlap occlusions with minimum horizontal overlap compared to the control groups. These results indicated that clinicians should pay special attention to the tempormandibuar joint status of patients with significant vertical overlap anteriorly and position of the incisors when performing dental treatments that require reestablishment of incisor relationships. (Source: Journal of Prosthodontics)


Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study
Conclusion: The older community-dwelling people with multimorbidity in this study suffered from a high symptom burden with a high prevalence of pain. Persons with poor vision, likelihood of depression, and diseases of the digestive system are at risk of a higher total symptom burden and might need age-specific standardized guidelines for appropriate management. (Source: BMC Geriatrics)


People with pain were less likely to learn to live with disease symptoms: Welsh Health Survey, 2012
In this study, therefore, it was aimed to examine in a country-wide and population-based setting on whether people could live through their life with symptoms after having health problems and if pain could be the mediator. (Source: International Journal of Cardiology)


Real-time modulation of visual feedback on human full-body movements in a virtual mirror: development and proof-of-concept
Conclusions: The new "virtual mirror" extends existing VR systems for motor and pain rehabilitation by enabling the use of realistic full-body avatars and scaled feedback. Proof-of-concept was demonstrated for the assessment of body perception during active movement in healthy controls. The next step will be to apply this system to assessment of body perception disturbances in patients with chronic pain. (Source: Journal of NeuroEngineering and Rehabilitation)


Chronic pelvic allodynia is mediated by CCL2 through mast cells in an experimental autoimmune cystitis model
The cause of chronic pelvic pain in interstitial cystitis/painful bladder syndrome (IC/PBS) remains unclear; autoimmunity is a possible etiology. We have recently shown that injection of a single immunogenic peptide of uroplakin 3A (UPK3A 65-84) induces experimental autoimmune cystitis (EAC) in female BALB/cJ mice that is unique among experimental models in accurately reflecting both the urinary symptoms and pelvic pain of IC/PBS. The aim of this project was to identify the roles of mast cells and mast cell chemoattractant/activator monocyte chemoattractant protein-1 [chemokine (C-C motif) ligand 2 (CCL2)] in the allodynia in this model. We immunized 6- to 8-wk-old female BALB/cJ mice with UPK3A 65-84 peptide and, 5&ndash;40 days later, observed increased responses to stimulation of the su...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 low back pain, chronic disability at work, chronic management issues.
Authors: Petit A PMID: 25561278 [PubMed - as supplied by publisher] (Source: Scandinavian Journal of Work, Environment and Health)


Serum IL-6, IL-10, and TNFα levels in pediatric sickle cell disease patients during vasoocclusive crisis and steady state condition.
Authors: Sarray S, Saleh LR, Lisa Saldanha F, Al-Habboubi HH, Mahdi N, Almawi WY Abstract Vaso-occlusive crisis (VOC) is a significant complication of sickle cell disease (SCD), and altered production of pro-inflammatory and anti-inflammatory molecules contributed to its pathogenesis. In view of the association of chronic inflammation with VOC onset, and given the capacity of interleukin (IL)-10 as anti-inflammatory, and IL-6, and TNFα as pro-inflammatory cytokines, we tested the association of altered IL-10, IL-6, and TNFα secretion with VOC pathogenesis and its severity. Study subjects comprised 147 SCD patients with active VOC (VOC Group), and 63 pain-free SCD patients for at least 9months before blood collection (Steady-state Group). Serum cytokine concentrations were determi...


Although unseen, chronic pain is real—A phenomenological study
Conclusions In health care, pain without any obvious pathology may be considered to be imaginary pain. Despite the recommendations, to see chronic pain as a biopsychosocial experience, chronic pain is still regarded as a symptom of an underlying disease. Although the holistic approach is well known and recommended, it is applied too sparsely in clinical practice. Implications The Cartesian legacy, keeping the mind and body apart, lives strong in treatment of chronic pain despite recommendations. The biopsychosocial approach seems to be rhetoric. (Source: Scandinavian Journal of Pain)


Ethical procedures and patient consent differ in Europe
CONCLUSION: There is a considerable variation in the administrative requirements for approval procedures by research ethics committees in Europe. This results in variation of the extent of information and consent procedures for the patients involved. TRIAL REGISTRATION: euCPSP in Clinicaltrials.gov identifier: NCT01467102; PAIN-OUT in Clinicaltrials.gov identifier: NCT02083835. (Source: European Journal of Anaesthesiology)


The effects of substance P on tendinopathy are dose-dependent: An in vitro and in vivo model study
Conclusion SP enhances the proliferation of TDSCs in vitro and the effects of SP on tendinopathy are dose-dependent in vivo.. (Source: The Journal of Nutrition, Health and 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>


A multicenter, randomized, double-blind clinical study on Wufuxinnaoqing Soft Capsule (五福心脑清胶囊) in treatment of chronic stable angina patients with blood stasis syndrome
Conclusion In treatment of chronic stable angina (blood stasis syndrome), WSC can reduce angina attacks and consumption of nitroglycerin, decrease angina severity degree, effectively relieve the blood stasis syndromes, such as chest pain, chest tightness, palpitations, dark purple tongue and other symptoms. Besides, adverse events and cardiovascular adverse events in the treatment group and the control group showed no difference. All shows that the drug is safe and effective. [This study was registered in Chinese Clinical Trial Registry (ChiCTR), with registration number: ChiCTR-TRC-14005158.] (Source: Chinese Journal of Integrative Medicine)


NeuroMetrix unveils over-the-counter pain product as it opens new Woburn site
On Sunday, Waltham-based NeuroMetrix will unveil the new consumer model of its wearable pain-relief device as the company looks forward to launching sales in coming months. The device, called Quell, is largely the same as the company's Sensus device, which was first approved by the U.S. Food and Drug Administration in 2012 for use by patients with chronic pain due to diabetes, sciatica, fibromyalgia, and degenerative knee conditions. That device, which uses electrical stimulation to raise levels… (Source: bizjournals.com Health Care:Pharmaceuticals headlines)


A Mixed Methods Study of Patient-Provider Communication about Opioid Analgesics
Chronic pain affects approximately 76.2 million Americans--more than diabetes, heart disease and cancer combined [1]. Some of these patients seek the expertise of health care professionals to relieve their pain, often through pharmacologic means. In recent years opioid pain medications have become more frequently used to treat patients with chronic and severe pain [2]. Consequently, pain management is now a frequent topic of conversation between patients and their healthcare providers, with a recent study from the National Center for Health Statistics finding that analgesics were the most common type of therapeutic drug mentioned in outpatient visits [3]. (Source: Patient Education and Counseling)


Recombinant interleukin-1 receptor antagonist attenuates the severity of chronic pancreatitis induced by TNBS in rats.
In conclusion, IL-1Ra may play a protective role in CP and rhIL-1Ra would be a potential therapeutic target for the treatment of CP, while its possile mechanisms and clinical usage still need further investigation. PMID: 25559498 [PubMed - as supplied by publisher] (Source: Biochemical Pharmacology)


A mixed methods study of patient–provider communication about opioid analgesics
Chronic pain affects approximately 76.2 million Americans – more than diabetes, heart disease and cancer combined [1]. Some of these patients seek the expertise of health care professionals to relieve their pain, often through pharmacologic means. In recent years opioid pain medications have become more frequently used to treat patients with chronic and severe pain [2]. Consequently, pain management is now a frequent topic of conversation between patients and their healthcare providers, with a recent study from the National Center for Health Statistics finding that analgesics were the most common type of therapeutic drug mentioned in outpatient visits [3]. (Source: Patient Education and Counseling)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Changing trends in use of laparoscopy: a clinical audit.
Conclusion. Over the years, there has been a rise in the rate of operative laparoscopy. Though the indications for laparoscopy have remained almost similar during the years, laparoscopy for diagnosis and treatment of CPP and AUB has now increased. PMID: 25548664 [PubMed] (Source: Minimally Invasive Surgery)


Urban Athlete: A Class in the MELT Method of Body Work
The MELT method claims to address a host of middle-age complaints: chronic pain, aching joints, weight gain, stress, wrinkles, digestive problems, low energy and insomnia. (Source: NYT Health)


Effect of Colon Transection on Spontaneous and Meal-Induced High-Amplitude–Propagating Contractions in Children
Background: After Hirschsprung disease (HD) surgery, many children experience fecal incontinence caused by increased number of high-amplitude–propagating contractions (HAPCs) through the neorectum to the anal verge. The aim of this study was to determine whether children with HD have more HAPCs than children with colon transections for reasons other than HD. Methods: We reviewed 500 colon manometries. Children (age 7.6 ± 5.1 years, 275 boys) with functional constipation (n = 237, age 7.4 ± 5.0 years, 126 boys) and chronic abdominal pain (n = 48, age 9.8 ± 5.8 years, 25 boys) served as controls compared with subjects with HD (n = 56, age 6.9 ± 4.1 years, 44 boys) and colon transection for other reasons (n = 24, age 6.1 ± 5.8 years, 12 boys). We exc...


The Health Care and Productivity Costs of Back and Neck Pain in A Multi-Employer Sample of Utility Industry Employees
Conclusions: Many covered employees did not use formal care. The effect of care choices on productivity costs requires closer scrutiny. (Source: Journal of Occupational and Environmental Medicine)


Creating an Interdisciplinary Medical Home for Survivors of Human Trafficking
ABSTRACT: Human trafficking refers to situations of forced labor and/or sexual servitude. At any given time, millions of individuals are trafficked worldwide. It is estimated that up to 17,500 individuals are trafficked into the United States annually; more than 20% are involved in sexual trafficking. Survivors of human trafficking are victims of psychological, physical, and sexual abuse that leave them vulnerable to a variety of medical conditions. Moreover, these patients are often fearful, distrust medical providers, and may resist attempts to evaluate them. In May 2012, an article published in Obstetrics & Gynecology (Obstet Gynecol 2012;119:1045) called for action by obstetrician-gynecologists and other health care providers to address the health-delivery needs of victims of human tra...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Nerve injury induces a new profile of tactile and mechanical nociceptor input from undamaged peripheral afferents
Chronic pain after nerve injury is often accompanied by hypersensitivity to mechanical stimuli, yet whether this reflects altered input, altered processing, or both remains unclear. Spinal nerve ligation or transection results in hypersensitivity to mechanical stimuli in skin innervated by adjacent dorsal root ganglia, but no previous study has quantified the changes in receptive field properties of these neurons in vivo. To address this, we recorded intracellularly from L4 dorsal root ganglion neurons of anesthetized young adult rats, 1 wk after L5 partial spinal nerve ligation (pSNL) or sham surgery. One week after pSNL, hindpaw mechanical withdrawal threshold in awake, freely behaving animals was decreased in the L4 distribution on the nerve-injured side compared with sham controls. Ele...


Arthroscopic synovectomy in the treatment of functional ankle instability: outcomes and gait analysis
Conclusion Improved long-term clinical results and scores were obtained in our patient group when compared with the preoperative scores. Also, three-dimensional gait analysis showed that the involved ankles demonstrate similar gait patterns to the uninvolved ankles in patients with FAI. (Source: European Journal of Orthopaedic Surgery and Traumatology)


Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years
This study evaluates clinical and ultrasound (US) outcomes after surgical repair of acute and chronic PM tendon rupture. Materials and methods Twelve men with PM tendon rupture (9 right and 3 left shoulders) were enrolled. Mean age was 34.6 years, and mean follow-up was 60 months (range 12–108). Rupture was diagnosed by magnetic resonance imaging. Eight patients underwent direct tendon repair (acute group) and 4 had allograft reconstruction (chronic group). Pain, range of motion, strength recovery and return to sports were assessed. Postoperative X-ray and US scans were obtained in all patients. Final outcomes were graded as excellent, good, fair or poor. Isometric strength in adduction/abduction, flexion, internal rotation (IR) and external ...


Coexistence of Two Forms of LTP in ACC Provides a Synaptic Mechanism for the Interactions between Anxiety and Chronic Pain
Publication date: Available online 31 December 2014 Source:Neuron Author(s): Kohei Koga , Giannina Descalzi , Tao Chen , Hyoung-Gon Ko , Jinshan Lu , Shermaine Li , Junehee Son , TaeHyun Kim , Chuljung Kwak , Richard L. Huganir , Ming-gao Zhao , Bong-Kiun Kaang , Graham L. Collingridge , Min Zhuo Chronic pain can lead to anxiety and anxiety can enhance the sensation of pain. Unfortunately, little is known about the synaptic mechanisms that mediate these re-enforcing interactions. Here we characterized two forms of long-term potentiation (LTP) in the anterior cingulate cortex (ACC); a presynaptic form (pre-LTP) that requires kainate receptors and a postsynaptic form (post-LTP) that requires N-methyl-D-aspartate receptors. Pre-LTP also involves adenylyl cyclase and protein kinase A an...


60-Year-Old Man With Chronic Diarrhea and Peptic Ulcer Disease
A 60-year-old man was transferred to our hospital with a 5-year history of worsening daily watery, nonbloody, nongreasy diarrhea. One year previously, recurrent vomiting had developed. Over the month preceding the current admission, he experienced 4 episodes of intractable, large-volume diarrhea with abdominal pain, upper and lower extremity muscle cramping, and orthostatic light-headedness. His diarrhea did not improve with fasting, and each of these episodes required hospitalization for intravenous fluid and electrolyte replacement. (Source: Mayo Clinic Proceedings)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Test–retest reliability of pain extent and pain location using a novel method for pain drawing analysis
ConclusionsA novel method for the acquisition of PD was presented. Test–retest reliability of reporting pain extent and pain location was supported in people with CNP and CLBP. Future research is needed to establish psychometric properties of PD. (Source: European Journal of Pain)


Appendiceal adhesion to synthetic mesh after laparoscopic sacrocolpopexy: a case report
Abstract Minimally invasive alternatives to abdominal sacrocolpopexy have been shown to be equivalent with low overall complication rates. A small number of direct mesh-related gastrointestinal complications have been reported in the literature. Sacrocolpopexy with mesh retroperitonealization is recommended to minimize bowel adhesions. A 53-year-old nulligravid woman presented with persistent right lower-quadrant pain 1 year after laparoscopic sacrocolpopexy. The polypropylene mesh used during the case was retroperitonealized. Computed tomography (CT) prior to surgical exploration revealed no obvious pathology. On diagnostic laparoscopy, appendiceal adhesion to mesh requiring an appendectomy was observed. The patient’s symptoms resolved after surgical intervention. Appendiceal ...


Postoperative pain outcomes after transvaginal mesh revision
Conclusions Excision or revision of vaginal mesh appears to be effective in improving patients’ pain symptoms most of the time. Patients with a history of chronic pelvic pain are at an increased risk of no improvement or of worsening pain. (Source: International Urogynecology Journal)


Participant and Site Characteristics Related to Participant Retention in a Diabetes Prevention Translational Project
Abstract Using multilevel analysis, this study investigated participant and site characteristics associated with participant retention in a multisite diabetes prevention translational project among American Indian and Alaska Native (AI/AN) people. We analyzed data from the Special Diabetes Program for Indians Diabetes Prevention Program (SDPI-DP), a lifestyle intervention to prevent diabetes implemented in 36 AI/AN grantee sites. A total of 2,553 participants were recruited and started the intervention between January 1, 2006 and July 31, 2008. They were offered the 16-session Lifestyle Balance Curriculum from the Diabetes Prevention Program (DPP) in the first 16–24 weeks of intervention. Generalized estimating equation models and proportional hazards models with robust standa...


Treatment efficacy for pain complaints in women with endometriosis of the lesser pelvis after laparoscopic electroablation vs. CO 2 laser ablation
Abstract Endometriosis is a chronic disease affecting mainly women of the reproductive age. Its most common manifestations include impaired fecundity, pelvic pain, and dyschezia. Laparoscopic removal of endometriotic foci remains to be the gold standard for the treatment of endometriosis. More effective techniques of endoscopic approach—among others, laser application—are continually being developed. The aim of the study was to evaluate the efficacy of laparoscopic treatment with the use of CO2 laser ablation vs. electroablation with regard to pain complaints in the affected patients. The study included 48 women (aged 22–42) with varying degrees of endometriosis of the lesser pelvis. The Numeric Rating Scale (NRS) was used to evaluate pain intensity before the surgery in al...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Implication of delta opioid receptor subtype 2 but not delta opioid receptor subtype 1 in the development of morphine analgesic tolerance in a rat model of chronic inflammatory pain
Abstract Opioids are well known for their robust analgesic effects. Chronic activation of mu opioid receptors (MOPs) is, however, accompanied by various unwanted effects such as analgesic tolerance. Among other mechanisms, interactions between MOPs and delta opioid receptors (DOPs) are thought to play an important role in morphine‐induced behavioral adaptations. Interestingly, certain conditions such as inflammation enhance the function of the DOP through a MOP‐dependent mechanism. Here, we investigated the role of DOPs during the development of morphine tolerance in an animal model of chronic inflammatory pain. Using behavioral approaches, we first established that repeated systemic morphine treatment induced morphine analgesic tolerance in rats coping with chronic inflammatory pain. ...


Low Pain Catastrophization and Disability Predict Successful Outcome to Radiofrequency Neurotomy in Individuals with Chronic Whiplash
ConclusionsLow levels of pain catastrophizing and disability independently predicted a successful response to cRFN in patients with chronic WAD. (Source: Pain Practice)


A Multicentre Prospective Evaluation of the Impact of Renal Insufficiency on In-hospital and Long-term Mortality of Patients with Acute ST-elevation Myocardial Infarction.
CONCLUSIONS: RI is very common in STEMI patients. RI evaluated by eGFR is an important independent predictor of short-term and long-term outcome in patients with acute STEMI. PMID: 25563305 [PubMed - in process] (Source: Chinese Medical Journal)


Evaluation of an Extended‐Release, Abuse‐Deterrent, Microsphere‐in‐Capsule Analgesic for the Management of Patients with Chronic Pain With Dysphagia (CPD)
ConclusionA new ER, abuse‐deterrent, microsphere‐in‐capsule formulation of oxycodone can be administered by sprinkling onto soft food without affecting the drug release profile of the formulation. The formulation can also be administered directly via enteral tubes without affecting drug release and without clogging enteral tubes. Oxycodone DETERx® may offer physicians and patients with CPD an alternate treatment option, especially in those patients who have dysphagia or an aversion to swallowing monolithic tablet/capsule formulations and for whom analgesic patches or other opioid formulations are not a viable therapeutic option. (Source: Pain Practice)


A 65-year-old man with persistent cough and large nodular opacity.
Authors: Grimes BS, Albores J, Barjaktarevic I Abstract A 65-year-old Asian man with a history of chronic hepatitis B infection presented to our pulmonary clinic for second opinion of his chronic, persistent, nonproductive cough. He was evaluated 10 months earlier with chest CT scan, which revealed a large lingular nodular opacity that was diagnosed as nodular cryptogenic organizing pneumonia by CT scan-guided percutaneous lung biopsy. Systemic corticosteroids were initiated and continued over the next 10 months. The dry cough persisted, and he developed intermittent left-sided pleuritic chest pain. He denied fevers, night sweats, hemoptysis, weight loss, or dyspnea. He was a lifelong nonsmoker and moved to the United States from China during childhood. PMID: 25560867 [PubMed ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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: The Psychiatric Perspective
Why rheumatic pain is more than a joint issue (Source: The Rheumatologist)


Parotid duct transposition in dogs
Keratoconjunctivitis sicca (KCS) is a consequence of deficiency in the aqueous component of the tear film and is characterized by excessive drying of the conjunctiva and the cornea. Immune-mediated KCS is the most common form of the condition in dogs, and it presents as a bilateral disease. Canine KCS is generally amenable to medical management, particularly topical cyclosporine. Uncontrolled KCS can result in blinding complications and chronic ocular pain. Consequently, surgery may be indicated in patients that prove to be refractive to medical management. (Source: Advances in Small Animal Medicine and Surgery)


Association between Cardiovascular Drugs and Chronic Kidney Disease in Non‐Institutionalized elderly patients
ConclusionRenal safety of cardiovascular drugs in the elderly appears acceptable and should not be a barrier to their use.This article is protected by copyright. All rights reserved. (Source: Basic and Clinical Pharmacology and Toxicology)


Spectrum of intradialytic complications during hemodialysis and its management: A single-center experience.
This study was performed to evaluate the various intradialytic complications that occur during HD and their management. This is a retrospective study performed in patients who underwent conventional HD during the period of 1 January 2000 to 31 December 2011 at our center. Clinical details, various complications faced and their management were retrieved from dialysis case sheets. A total of 2325 patients of renal failure (790 ARF and 1535 CRF patients) were assessed for the intradialytic complications of HD. During the study period, there were 12,785 bicarbonate dialyses performed on these patients. In the ARF patients, the common intradialytic complications were: Hypotension, seen in 1296 sessions (30.4%), nausea and vomiting seen in 1125 sessions (26.4%), fever and chills seen in 818 sess...


Placebo effect in burning mouth syndrome
Stomatodynia or burning mouth syndrome (BMS) manifests as a burning dysesthesia of the oral cavity that usually affects the tongue but also occurs on the inner aspect of the lips and anterior hard palate. This chronic pain condition has no definable local or systemic causes, but can also cause xerostomia, dysgeusia, and other oral dysesthesias. BMS is more common with increasing age and in postmenopausal women. Prevalence rates vary from 0.7% to 15%, but the epidemiology of BMS is unclear. Although it is probable that the pathophysiology of BMS includes interactions between local, systemic, and/or psychogenic factors, a neuropathic mechanism has been suggested. (Source: Dental Abstracts)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Ergonomics
Dental professionals suffer some of the highest rates of musculoskeletal injuries of any professional group, with 87% reporting at least one such complaint, 30% having chronic pain, and many retiring early because of their musculoskeletal problems. Reducing the risk of work-related musculoskeletal injuries in dental professionals is an important goal. Efforts to address the problem include employing simple, effective ergonomic strategies that will guard against injury. (Source: Dental Abstracts)


Buprenorphine Transdermal System Improves Sleep Quality and Reduces Sleep Disturbance in Patients with Moderate‐to‐Severe Chronic Low Back Pain: Results from Two Randomized Controlled Trials
ConclusionBuprenorphine Transdermal System improved sleep quality and disturbance for opioid‐naïve and opioid‐experienced patients with moderate‐to‐severe CLBP. Benefits of BTDS for these sleep outcomes emerged within 4 weeks and were maintained over the entire 12‐week treatment period. (Source: Pain Practice)


A successful treatment for a lesion of chronic total occlusion with contralateral angiography in a single radial access
Abstract A 50-year-old man was admitted due to effort chest pain. Coronary angiogram showed a total occlusion of LAD. The 5-French JL 3.5 was engaged into the left coronary artery. The XT-A guidewire was advanced to the distal of the occluded lesion. Contralateral angiography was performed using JL 3.5. The guiding catheter was pullback from the left coronary orifice leaving the guidewire at LAD, and the catheter tip was rotated clockwise to right coronary cusp for right coronary angiography. We could confirm that the guidewire was in the true lumen vessel. (Source: Cardiovascular Intervention and Therapeutics)


Transaction Cost Analysis of In‐Clinic Versus Telehealth Consultations for Chronic Pain: Preliminary Evidence for Rapid and Affordable Access to Interdisciplinary Collaborative Consultation
ConclusionsU.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits. © 2015 Wiley Periodicals, Inc. (Source: Pain Medicine)


The 12 Leads of Christmas: aVR
Conclusion to 83 Year Old Male: Shortness of Breath (My earlier primer on diffuse subendocardial ischemia) A Non STEMI That Needs the Cath Lab Now (Post by Dr. Smith that covers the management of emergent NSTEMI&#8217;s) Five Primary Patterns of Ischemic ST depression, without ST elevation. (Amazing post by Dr. Smith on patterns of ST-depression) Marked ST depression refractory to maximal medical therapy (More NSTEMI goodness from Dr. Smith) ST elevation in aVR, with widespread ST depression (Another NSTEMI that needs the cath lab) Deep and widespread ST depression signifies high risk coronary lesion (One final NSTEMI that needs the cath lab) &nbsp; I hope you’re enjoying our 12 Leads of Christmas series. You can check out the rest of the posts below (updated as new posts come out): 12 L...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Forgotten Ones: Challenges and Needs of Children Living with Disabling Parental Chronic Pain
A qualitative study explored the challenges and needs of children living with parental chronic pain. Young adult children (n=30) of parents with chronic pain were interviewed. Parents (n=20) with chronic pain participated in four focus groups. Content analysis yielded five categories of child challenges: (a) understanding the big picture; (b) enduring hardships; (c) grieving losses; (d) communicating with parent, and; (e) isolating self from peers. Three categories of child needs emerged: (a) knowledge; (b) skills, and; (c) supervised interaction. (Source: Journal of Pediatric Nursing)


Ankle Syndesmosis: A Qualitative and Quantitative Anatomic Analysis
Conclusion: The qualitative and quantitative anatomy of the syndesmotic ligaments was reproducibly described and defined with respect to surgically identifiable bony prominences. Clinical Relevance: Data regarding anatomic attachment sites and distances to bony prominences can optimize current surgical fixation techniques, improve anatomic restoration, and reduce the risk of iatrogenic injury from malreduction or misplaced implants. Quantitative data also provide the consistency required for the development of anatomic reconstructions. (Source: The American Journal of Sports Medicine)


Development and validation of a questionnaire to measure the severity of functional limitations and reduction of sports ability in German-speaking patients with exercise-induced leg pain
Conclusions EILP-G questionnaire is a valid and reliable self-administered and disease-related outcome tool to measure the severity of symptoms that impact on function and sports ability in patients with exercise-induced leg pain. It can be recommended as a robust tool for measuring the subjectively perceived severity in German-speaking patients with exercise-induced leg pain. (Source: British Journal of Sports Medicine)


Are people who do yoga any better at a motor imagery task than those who do not?
Conclusions People who do regular yoga perform no differently in a left/right judgement task than people who do not. (Source: British Journal of Sports Medicine)


Immunomodulatory Effects of Endogenous and Synthetic Peptides Activating Opioid Receptors.
Authors: Pomorska DK, Gach K, Janecka A Abstract The main role of endogenous opioid peptides is the modulation of pain. Opioid peptides exert their analgesic activity by binding to the opioid receptors distributed widely in the central nervous system (CNS). However, opioid receptors are also found on tissues and organs outside the CNS, including the cells of the immune system, indicating that opioids are capable of exerting additional effects in periphery. Morphine, which is a gold standard in the treatment of chronic pain, is well-known for its immunosuppressive effects. Much less is known about the immunomodulatory effects exerted by endogenous (enkephalins, endorphins, dynorphins and endomorphins) and synthetic peptides activating opioid receptors. In this review we tried to sum...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Management of abdominal pain in children.
Authors: El-Radhi AS Abstract Abdominal pain (AP) is a very common complaint caused by a variety of conditions. Mild or moderate AP affects practically all children of all ages. The pain usually settles spontaneously without medical intervention. AP severe enough to require medical intervention has both surgical and non-surgical causes. It is responsible for considerable morbidity, missed school days, and significant use of health resources. Children usually present either with an acute or recurrent AP. In comparison, chronic AP with persistent symptoms, lasting days or weeks, is rare in children. Surgical conditions may be the underlying causes in acute AP, but non-surgical conditions are diagnosed more commonly in children with recurrent AP. Management can be difficult, time-cons...


Case studies of long-acting, extended-release, and sustained-release opioids for the treatment of chronic nonmalignant pain.
Authors: Sloan PA PMID: 25539291 [PubMed - in process] (Source: Journal of Opioid Management)


Specific pharmacology of long-acting, extended-release, and sustained-release opioids for the treatment of chronic nonmalignant pain.
Authors: Sloan PA, Davis MP, Gamier P PMID: 25539290 [PubMed - in process] (Source: Journal of Opioid Management)


General pharmacology of long-acting, extended-release, and sustained-release opioids for the treatment of chronic nonmalignant pain.
Authors: Davis MP, Gamier P, Sloan PA PMID: 25539289 [PubMed - in process] (Source: Journal of Opioid Management)


Extended-release and long-acting opioids for chronic pain management.
Authors: Sloan PA, Davis MP PMID: 25539288 [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>


This Muscle Could Save Your Life
You probably know someone who’s fallen and broken a hip. But what you may not know is that it’s not just elders who fall. The risk for breaking a hip doubles every five years after you turn fifty. And 30% of people who fall and break a hip develop complications and die within a year.1 The good news is you can use the power of your muscles to avoid falling and breaking your hip, starting today. The fact is falling down doesn’t have to be a part of aging. You just have to decide that you’re not going to take it lying down. It involves strengthening your quadriceps muscles. You see, the signals to your muscles start to slow down as you get older, making it harder for your muscles to respond. Researchers looked at how muscles respond when the brain cells that activate them – called n...


Chronic noncancer pain management in primary care: family medicine physicians' risk assessment of opioid misuse.
Conclusion: Knowledge and competency of the family physicians in managing CNCP were improved as was expected. Although the rate of eagerness about risk assessment of opioid misuse was increased, expected increase in the rate of using risk assessment was not achieved. Further studies are needed to identify the reasons of the difficulties on changing the attitudes and practices of primary care physicians about this subject. PMID: 25539797 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)


Reflections on The Role of Opioids in the Treatment of Chronic Pain: A Shared Solution for Prescription Opioid Abuse and Pain
This article is protected by copyright. All rights reserved. (Source: Journal of Internal Medicine)


Was The Guardian's 2014 crystal ball accurate?
In January 2014, The Guardian took the brave, and possibly foolhardy, step of predicting the six big health breakthroughs of 2014. We're taking a look at just how accurate the paper's crystal ball turned out to be, and gave each our own Behind the Headlines &quot;Mystic Meg&quot; rating for predictive accuracy.  Prediction one: IVF success rates to improve after 20 years of stagnation Prediction two: Better screening for ovarian cancer Prediction three: New insights into dementia Prediction four: Open-access surgery Prediction five: Ninja polymers to fight athlete's foot Prediction six: Faecal transplants   Prediction one: IVF success rates to improve after 20 years of stagnation The Guardian based this prediction on a technique comprising time-lapse imaging camer...


New Treatment for Opioid-Induced Constipation
* The opioid antagonist naloxegol (Movantik) is now approved to treat opioid-induced constipation in adults with chronic noncancer pain. * The most common adverse effects are abdominal pain, diarrhea, nausea, flatulence, vomiting, and headache. (Source: AJN)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Eliminate chronic pain in 2015
(NaturalNews) The beauty of the body is that it has several feedback mechanisms to alert you that something is going wrong. We often call this feedback a "symptom", and rather than valuing it and seeking to remedy the imbalance, we often set out to destroy the mechanism that provides... (Source: NaturalNews.com)


An unusual cause of right heart failure
A 48year old woman was admitted to our department for cardiac catheterization. She was complaining of dyspnea on light exertion and chest pain for 3months and increasing headaches for about 4weeks. The symptoms started acutely after microsurgical nucleotomy at L5/S1. Acute pulmonary embolism was excluded shortly after the onset of symptoms in a CT scan of the lung. A pulmonary consultant saw no signs of pulmonary failure. During the 3months before admittance to our department, our patient had also been seen by a cardiologist who saw signs of chronic right heart failure and a mild tricuspid insufficiency. (Source: International Journal of Cardiology)


Ulnar Collateral Ligament Injuries of the Thumb
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. (Source: Orthopedic Clinics of North America)


Corticotrophin‐releasing factor 1 activation in the central amygdale and visceral hyperalgesia
Abstract Corticotropin‐releasing factor (CRF)‐CRF1 receptor in the brain plays a key role in stress‐related alterations of behavior including anxiety/depression, and autonomic and visceral functions. In particular, CRF1 signaling mediates hypersensitivity to colorectal distension (CRD) in various models (early life adverse events, repeated psychological stress, chronic high anxiety, postcolonic inflammation, or repeated nociceptive CRD). So far, knowledge of brain sites involved is limited. A recent article demonstrates in rats that CRF microinjected into the central amygdala (CeA) induces a hyperalgesic response to CRD and enhances the noradrenaline and dopamine levels at this site. The visceral and noradrenaline, unlike dopamine, responses were blocked by a CRF1 antagonist injected...


Neural circuitry of abdominal pain‐related fear learning and reinstatement in irritable bowel syndrome
Conclusions & InferencesAbdominal pain‐related fear learning and memory processes are altered in IBS, mediated by amygdala, cingulate cortex, prefrontal areas, and hippocampus. Enhanced reinstatement may contribute to hypervigilance and central pain amplification, especially in anxious patients. Preventing a ‘relapse’ of learned fear utilizing extinction‐based interventions may be a promising treatment goal in IBS. The response to abdominal pain is shaped by expectations, likely resulting from learning processes affecting brain responses in anticipation of pain. In a differential fear conditioning model of abdominal pain‐related fear with painful rectal distensions as unconditioned stimuli, we investigated the neural circuitry underlying acquisition, extinction, and reinstat...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Fatigue in psoriasis: a phenomenon to be explored.
This article is protected by copyright. All rights reserved. PMID: 25557165 [PubMed - as supplied by publisher] (Source: The British Journal of Dermatology)


Advanced Pain Medical Group Now Offering New Chronic Pain Treatment...
The top pain management clinics in the San Fernando Valley, Advanced Pain Medical Group, are now offering a new chronic pain treatment with spinal cord stimulator implants. The implants have been...(PRWeb December 28, 2014)Read the full story at http://www.prweb.com/releases/sanfernandopainclinic/spinal-cord-stimulator/prweb12416011.htm (Source: PRWeb: Medical Pharmaceuticals)


Nociception and role of immune system in pain
Abstract Both pain and inflammation are protective responses. However, these self-limiting conditions (with well-established negative feedback loops) become pathological if left uncontrolled. Both pain and inflammation can interact with each other in a multi-dimensional manner. These interactions are known to create an array of ‘difficult to manage’ pathologies. This review explains in detail the role of immune system and the related cells in peripheral sensitization and neurogenic inflammation. Various neuro-immune interactions are analyzed at peripheral, sensory and central nervous system levels. Innate immunity plays a critical role in central sensitization and in establishing acute pain as chronic condition. Moreover, inflammatory mediators also exhibit psychologic...


Cochrane Corner: Antioxidants to reduce pain in chronic pancreatitis
Publication date: Available online 29 December 2014 Source:Advances in Integrative Medicine Author(s): Shaun Holt (Source: Advances in Integrative Medicine)


Purified Type I Collagen Wound Matrix Improves Chronic Wound Healing in Patients with Recessive Dystrophic Epidermolysis Bullosa
Abstract Recessive dystrophic epidermolysis bullosa is a severe genetic blistering skin condition resulting in chronic wounds. Nonhealing wounds were treated over 8 weeks using a reconstituted natural purified type I collagen skin substitute. Chronic wounds were defined as nonhealing wounds present for longer than 6 months. For each patient, two chronic wounds were identified and randomized into a control or treatment group. Both groups received standard‐of‐care wound dressings. The treatment group received an additional type I collagen skin substitute. Wound size was measured at baseline and weeks 1, 4, and 8. Pain, pruritus, and burning and stinging were assessed. Wound cultures were obtained at baseline and thereafter as was considered clinically relevant. Ten subjects were enroll...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Regression of Adenomyosis on MRI After a Course of Hormonal Suppression in Adolescents: A Case Series
To demonstrate that adenomyosis is a rare cause of dysmenorrhea or chronic pelvic pain(CPP) in the adolescent population that can be identified by magnetic resonance imaging (MRI), and to report resolution of adenomyosis by MRI after a course of hormonal suppression in 4 adolescents. (Source: Journal of Pediatric and Adolescent Gynecology)


The relationship between drug use, drug-related arrests, and chronic pain among adults on probation
This study examined whether chronic pain was associated with opiate use, other illicit drug use, and drug-related arrests in a sample of substance-using probationers. We expected that probationers with chronic pain-related diagnoses would report more opiate use and drug-related arrests. This study used baseline data from 250 adults on probation in Baltimore, Maryland and Dallas, Texas who were participating in a larger clinical trial. (Source: Journal of Substance Abuse Treatment)


Pain Beliefs and Perceptions Inventory: A Cross-Sectional Study in Chronic and Episodic Migraine.
This study aims to compare differences in pain beliefs according to headache type, chronic vs episodic migraine, in a large cohort of patients, using the Pain Beliefs and Perceptions Inventory (PBPI), and to identify possible predictive factors of the same pain beliefs. METHODS: All patients referring for the first time at our center in 2011 were screened using PBPI and the Hamilton Anxiety and Depression Scale (a total of 1032 patients). PBPI is a 4-subscale questionnaire that explores a patient's personal beliefs on their subjective experience of pain. Headache patients also completed the Headache Impact Test (HIT-6) and a 30-day headache diary. For all participants, age, gender, duration of pain were collected. The sample was narrowed down to 899 as we experienced a nonresponse rate...


Finding the balance in complex regional pain syndrome: Expertise, optimism, and evidence
Complex regional pain syndrome (CRPS), perhaps more than any other chronic pain disorder, is perplexing. It is highly disabling, particularly once it has "set in," and it has a tendency to polarize the community&mdash;some view it as a quasidiagnosis to obscure malingering or conceal substandard clinical skills,1 and others as a multiple system overprotective response.2 What is agreed is that its pathophysiology is not completely understood and that it is difficult to treat. In light of this rather murky backdrop, we welcome the new perspectives article in this issue of Neurology&reg; by Birklein et al.3 They describe their own clinical approach to the problem and their impressions of what works, what does not, and where the field might be heading. The lead author is the most prolific and ...


Complex regional pain syndrome: An optimistic perspective
Complex regional pain syndrome (CRPS) presents with clinical symptoms that can no longer be explained by the initial trauma, including pain, sensory, motor, and trophic symptoms, and impairment of autonomic control of the limb. These symptoms spread distally and go beyond single nerve innervation territories. Typically, the symptoms change through the course of CRPS as a result of the varying pathophysiology. Diagnosis is made clinically after the rigorous elimination of other possible causes, and 3-phase bone scintigraphy can be a useful tool for confirming CRPS. In acute stages, inflammatory symptoms prevail and should be treated with anti-inflammatory agents (steroids), bisphosphonates, or topical application of dimethyl sulfoxide. In chronic stages, many symptoms are related to so-call...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Perioperative Factors Associated with HCAHPS Responses of 2,758 Surgical Patients
ConclusionsThese data suggest that demographic factors, preadmission medications, and PACU pain scores but not analgesic medications are associated with patient satisfaction with regards to both pain management and overall satisfaction. (Source: Pain Medicine)


Short‐Term Variability in Outpatient Pain Intensity Scores in a National Sample of Older Veterans with Chronic Pain
ConclusionsThe majority of patients in the sample had clinically meaningful variation in pain scores within a given month. This finding highlights the need for clinicians and their patients to consider multiple NRS scores when making chronic pain treatment decisions. (Source: Pain Medicine)


All the Rage: A Film About Dr Sarno, Emotions, and Health
What do Howard Stern, Larry David, John Stossel, Senator Tom Harkin, and pro-golfer Ben Crane have in common? They all suffered from debilitating pain until they met Dr. John Sarno. All the Rage is a feature film about Sarno and others who are pioneering mind body approaches to treating chronic illness. read more (Source: Psychology Today Personality Center)


Physical Activity and Experience of Total Knee Replacement in Patients One to Four Years Postsurgery in the Dominican Republic: A Qualitative Study
ConclusionOur findings underscore the potential of TKR to permit patients in the developing world to return to physical activities. This research also demonstrates the influence of patients' education, culture, and religion on patients' return to physical activity. As the global burden of musculoskeletal disease increases, it is important to characterize the impact of activity limitation on patients' lives in diverse settings and the potential for surgical intervention to ease the burden of chronic arthritis. (Source: Arthritis Care and Research)


Evaluation of the usefulness of the MRI jelly method for diagnosing complete cul-de-sac obliteration.
CONCLUSION: The MRI jelly method is a potentially useful, beneficial, and simple approach for diagnosing Pouch of Douglas adhesions. PMID: 24812616 [PubMed - indexed for MEDLINE] (Source: Biomed Res)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 pelvic adhesions on ultrasound examination in women with a history of Cesarean section
ConclusionsPelvic adhesions are present in more than a third of women with a history of Cesarean section and they are associated with chronic pelvic pain. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. (Source: Ultrasound in Obstetrics and Gynecology)


Treatment of low back pain: extended follow up of an original trial (NCT00600197) comparing a multidisciplinary group‐based rehabilitation program with oral drug treatment alone up to 30 months
ConclusionThe proposed multidisciplinary program could improve mental health and disability up to 30 months in chronic low back pain patients. (Source: APLAR Journal of Rheumatology)


Exam 1: Chronic Pancreatitis Pain Pattern and Severity Are Independent of Abdominal Imaging Findings
(Source: Clinical Gastroenterology and Hepatology)


Low testosterone in a young combat veteran with dual diagnosis and suicidal behavior: a case study - Kiraly DD, Sher L.
Suicide and suicidal behaviors amongst combat veterans is an important public health issue. Exposure to military combat predisposes patients to increased levels of major depression, post-traumatic stress disorder (PTSD), substance abuse, and chronic pain -... (Source: SafetyLit: All (Unduplicated))


[Sexual dysfunction in migraine patients who receive preventive treatment: identification by means of two screening tests].
CONCLUSIONS. Simple sexual dysfunction screening tests often detect sexual dysfunctions in patients with migraine on preventive treatment and changes in their sex life that can be attributed to these drugs. PMID: 25522859 [PubMed - in process] (Source: Revista de Neurologia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Factors Predictive of Treatment-Emergent Adverse Events of Prucalopride: An Integrated Analysis of Four Randomized, Double-Blind, Placebo- Controlled Trials.
Conclusions: Prucalopride treatment was positively associated with diarrhea, headache, and nausea. Asian patients tended to have a higher frequency of diarrhea but lower frequencies of headache, abdominal pain, and nausea compared with non- Asians. PMID: 25534573 [PubMed - as supplied by publisher] (Source: Gut and Liver)


Refining the Management of Rheumatoid Arthritis: the Benefits of Subcutaneous Tocilizumab
Abstract Rheumatoid arthritis (RA) is a chronic systemic autoimmune condition which affects approximately 1% of the adult population worldwide and is characterized by joint inflammation, with extra-articular features being common. Interleukin 6 (IL-6) is one of the chief pro-inflammatory cytokines found in the joints and sera of patients with RA. Increased levels of IL-6 correlate with inflammation, disease activity, and radiological damage. RA treatment should focus on minimizing the signs and symptoms of disease (pain, stiffness, and swelling of the joints) and on preventing or minimizing joint damage to preserve functionality and quality of life. The benefits of early, intensive intervention are now acknowledged, with all patients with newly diagnosed, active RA being started o...


Ketamine cystitis: The urological impact and its management
Publication date: Available online 25 December 2014 Source:Urological Science Author(s): Yao Chou Tsai , Hann-Chorng Kuo Ketamine, an n-methyl-d-aspartic acid receptor complex antagonist, has been used as an anesthetic and/or analgesic. However, in the past decade, ketamine has been illegally available as a recreational drug in Asian countries and Taiwan. Due to the characteristic of being short-acting, youngsters widely assume that ketamine is not as harmful as other drugs, such as heroin. Consequently, many young patients used this drug for a longer duration before they presented with severe urinary frequency and urgency symptoms. Subsequently, other cases have been reported in Taiwan, Hong Kong, Singapore, Malaysia, and Europe. Ketamine abuse is increasing, with rates of 0.30% in 2006...


Effect of pain chronification and chronic pain on an endogenous pain modulation circuit in rats
Publication date: 12 February 2015 Source:Neuroscience, Volume 286 Author(s): J. Miranda , S.M.S. Lamana , E.V. Dias , M. Athie , C.A. Parada , C.H. Tambeli We tested the hypothesis that chronic pain development (pain chronification) and ongoing chronic pain (chronic pain) reduce the activity and induce plastic changes in an endogenous analgesia circuit, the ascending nociceptive control. An important mechanism mediating this form of endogenous analgesia, referred to as capsaicin-induced analgesia, is its dependence on nucleus accumbens μ-opioid receptor mechanisms. Therefore, we also investigated whether pain chronification and chronic pain alter the requirement for nucleus accumbens μ-opioid receptor mechanisms in capsaicin-induced analgesia. We used an animal model of pain chronific...


Care related pain in rehabilitation after orthopedic trauma: An exploratory study with qualitative data
Conclusion Our data may suggest new keys to motivate patient to be active in rehabilitation for example in choosing carefully arguments or words which may fit theirs’ beliefs about CRP, or in using various means to manage CRP. Promoting the use of relational competences with chronic pain patients and of a patient-centred approach may also be a concern in training caregivers. (Source: Annals of Physical and 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>


For this drug developer, 2014 was 'best year in company history'
Mark Sirgo, the BioDelivery Sciences International CEO who has been described as a "street fighter," called 2014 the "best year in company history," and predicted 2015 would be "another positive year." It's hard to argue. On Wednesday, BioDelivery Sciences (Nasdaq: BDSI) submitted a new drug application to the U.S. Food and Drug Administration for a new chronic pain treatment that could hit $500 million in peak annual sales. Although BioDelivery's partner, Endo Pharmaceuticals, owns most of the… (Source: bizjournals.com Health Care:Physician Practices headlines)


Adiposis dolorosa.
We report a 46-year-old woman with a nine-year history of obesity; chronic diffuse pain in the adipose tissue of her medial upper arms, lower trunk, and thighs; multiple biopsy-proven lipomas and angiolipomas; and a lipomatous pseudomass of the breast. Her systemic symptoms included generalized weakness, fatigue, memory impairment, and arthralgias. Although some of the lesions were tender, most were only appreciated with palpation. Her clinical history and histopathologic data suggested adiposis dolorosa (Dercum's disease). Owing to the chronic pain, an interdisciplinary approach with the use of analgesics and doxycycline has been initiated. PMID: 25526345 [PubMed - in process] (Source: Dermatol Online J)


Meaning in life in chronic pain patients over time: associations with pain experience and psychological well-being
We examined the directionality of the relationships among the meaning in life dimensions (Presence of Meaning and Search for Meaning) and indicators of adjustment (depressive symptoms, life satisfaction, pain intensity, and pain medication use). We found that Presence of Meaning was an important predictor of well-being. Secondly, we used a typological methodology to distinguish meaning in life profiles, and the relationship of individual meaning in life profiles with indicators of adjustment. Five meaning in life profiles emerged: High Presence High Search, High Presence Low Search, Moderate Presence Moderate Search, Low Presence Low Search, and Low Presence High Search. Each meaning in life profile was associated with a unique adjustment outcome. Profiles that scored high on Presence of M...


The Effect of Arm Support Combined With Rehabilitation Games on Upper-Extremity Function in Subacute Stroke: A Randomized Controlled Trial
Conclusions. AS training with computerized exercises is as effective as conventional therapy dedicated to the arm to improve arm function and activity in subacute stroke rehabilitation, when applied at the same dose. (Source: Neurorehabilitation and Neural Repair)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 role of the dorsolateral funiculi in the pain relieving effect of spinal cord stimulation: a study in a rat model of neuropathic pain.
Authors: Saadé NE, Barchini J, Tchachaghian S, Chamaa F, Jabbur SJ, Song Z, Meyerson BA, Linderoth B Abstract Activation of the dorsal columns is relayed to supraspinal centers, involved in pain modulation, probably via the descending fibers in the dorsolateral funiculi (DLF). The present study examines the role of the DLF in the attenuation of pain-related signs by spinal cord stimulation (SCS). Several groups of rats were subjected to nerve injury and to chronic bilateral DLF lesions at C5-7 level. In each animal, two sets of miniature electrodes were implanted, a caudal system placed in the dorsal epidural space at low thoracic level and another implanted over the dorsal column nuclei, rostral to the lesions. Stimulation (50 Hz, 0.2 ms; 70 % of motor threshold) was applied f...


Allergic Fungal Sinusitis
Abstract A 42 year old male presents with worsening pain and an increase in thick chronic drainage of the left sinus. Image studies show complete opacification of the left frontal sinus, left sphenoid sinus, and the left maxillary sinus. The patient was taken to the operating room and tissue for microscopic evaluation was obtained. The microscopic findings were classic for allergic fungal sinusitis: areas of alternating mucinous material and inflammatory cell debris and abundant Charcot–Leyden crystals. Cultures were performed and the patient began steroid therapy and desensitization therapy. (Source: Head and Neck Pathology)


Addiction Is a Disease That Shatters Lives -- It's Time to Say ENOUGH #WeAreShatterproof
I know how terrible the disease of addiction can be. Three years ago, my son Brian -- 15 months clean but unable to handle the shame and stigma of his disease -- took his own life. He was just 25 years old. He had struggled with addiction for nearly a decade and tried time and again to get clean and stay healthy. But addiction is a dark and lonely road for those who walk it. Brian's death shattered my family, and tragically we are not alone. Our story is shared by hundreds of thousands of other parents across the country. Every day, about 22 million Americans struggle with addiction, and it's only getting worse. Fatal overdose rates have skyrocketed across the country in recent years. That's why I founded Shatterproof. Yet despite the thousands of loved ones we lose to addiction ever...


American Financial joins in on $30M investment in Cincinnati health firm
Assurex Health revealed today that it has lined up $30 million in new funding to further develop and market the Mason company's genetic tests, which help doctors determine the best medications to treat mental illness and chronic pain. New investors include American Financial Group, the Cincinnati insurance firm led by Carl Lindner III and Craig Lindner. In addition to being co-CEO of American Financial, Craig Lindner is the founder and chairman of the board of UC Health's Lindner Center of Hope,… (Source: bizjournals.com Health Care:Physician Practices headlines)


A multicenter, 12-month, open-label, single-arm safety study of oxycodone-hydrochloride/naltrexone-hydrochloride extended-release capsules (ALO-02) in patients with moderate-to-severe chronic noncancer pain.
CONCLUSIONS: Repeat dosing of ALO-02 for up to 12 months is safe and well tolerated in a CNCP population of both opioid-experienced and opioid-naïve patients. ALO-02 demonstrated a safety profile consistent with extended-release opioids and the expected analgesic efficacy. The addition of sequestered naltrexone had no significant clinical effect on patients when taken as directed. PMID: 25531960 [PubMed - as supplied by publisher] (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>


Beliefs and attitudes about opioid prescribing and chronic pain management: Survey of primary care providers.
CONCLUSION: This study indicates a general concern and reluctance of primary care physicians to manage the prescribing of opioids among their patients with chronic pain and younger providers expressed more concern about opioids than older providers. PMID: 25531955 [PubMed - as supplied by publisher] (Source: Journal of Opioid Management)


Ditch the pills, sleep easy and work out: Top tips to break the pain barrier
MILLIONS of us suffer from chronic discomfort and rely on pills to get through the day. Our reporter looks at some alternatives (Source: Daily Express - Health)


Reliability of Ultrasound Imaging for the Assessment of Lumbar Multifidi Thickness in Older Adults With Chronic Low Back Pain
Conclusions:Good-to-excellent intra- and interexaminer USI procedural reliability may provide clinicians a direct assessment technique for clinical evaluation of the lumbar multifidi in older adults with CLBP. SEMs and MDCs may allow for accurate interpretation of USI assessments in this population. (Source: Journal of Geriatric Physical Therapy)


How Torture Physically Changes The Brain Forever
WASHINGTON (AP) — At times, waterboarding rendered al-Qaida terror suspect Abu Zubaydah hysterical. But later, a message to CIA headquarters described an interrogator merely lifting his eyebrow and snapping his fingers, leading Zubaydah to "slowly (walk) on his own to the water table" to lie down. The Senate torture report released earlier this month describes how the CIA's harsh interrogation program sought to make detainees passive and powerless to resist, using techniques from sleep deprivation to stress positions to waterboarding to induce a state that psychologists call "learned helplessness." ''Compliant" was the interrogators' description of Zubaydah. Whatever it's labeled, specialists say the brain clearly can become conditioned by extreme fear and stress, notwithst...


Health Tip: Take Back Strain Out of Work
Title: Health Tip: Take Back Strain Out of WorkCategory: Health NewsCreated: 12/23/2014 12:00:00 AMLast Editorial Review: 12/23/2014 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>


Sutured Repair of Primary Small Umbilical and Epigastric Hernias: Concomitant Rectus Diastasis Is a Significant Risk Factor for Recurrence
Conclusion We strongly recommend preoperatively checking for rectus diastasis and using nonabsorbable sutures as an alternative to mesh repair only when repairing small umbilical or epigastric hernias (&lt;2 cm) and there is no concomitant rectus diastasis. Patients with coexistent rectus diastasis definitely benefit from mesh-based repair of the midline to decrease the recurrence rate. (Source: World Journal of Surgery)


Evaluation of pain associated with chronic venous insufficiency in Spanish postmenopausal women
ConclusionsVenous pain is a consistent symptom in postmenopausal women with chronic venous insufficiency, in whom nociceptive thresholds are generally decreased. Reduced physical activity, venous reflux, and osteoarthritis seem to influence pain level in chronic venous insufficiency. (Source: Menopause)


Pre‐operative baroreflex sensitivity and efferent cardiac parasympathetic activity are correlated with post‐operative pain
ConclusionsThe findings suggest that a low pre‐operative level of baroreflex sensitivity is associated with higher post‐operative pain intensity. To our knowledge, this is the first study to show the correlation between baroreflex sensitivity and post‐operative pain. (Source: Acta Anaesthesiologica Scandinavica)


Effect of naltrexone on neuropathic pain in mice locally transfected with the mutant μ‐opioid receptor gene in spinal cord
Conclusions and ImplicationsSystemic injection of naltrexone after the expression of a mutant μ opioid receptor, MOR‐S196ACSTA, in the spinal cord may have therapeutic potential for chronic neuropathic pain, without the development of dependence or addiction. Linked ArticlesThis article is part of a themed section on Opioids: New Pathways to Functional Selectivity. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2015.172.issue-2 (Source: British Journal of Pharmacology)


A comparison of cognitive-behavioral couple therapy and lidocaine in the treatment of provoked vestibulodynia: study protocol for a randomized clinical trial
DiscussionThe randomized clinical trial design is the most appropriate to examine the efficacy of cognitive-behavioral couple therapy, a recently developed and pilot-tested psychosocial intervention for couples coping with PVD, in comparison to a frequent first-line treatment option, topical lidocaine. Findings from this study will provide important information about empirically supported treatment options for PVD, and inform future treatment development and research for this patient population.Trial registration: Clinicaltrials.gov NCT01935063; registration date: 27 August 27 2013. (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>


Laparoscopic Discoid Anterior Rectal Excision with the Circular Stapler for Rectosigmoid Endometriosis, Performed by the Gynecologic Surgeon
Conclusion Laparoscopic discoid excision of an anterior rectal nodule using the circular stapler is an effective option for treating selected cases of rectosigmoid endometriosis. The technique might be reproducible by gynecologic surgeons after proper training. (Source: Journal of Minimally Invasive Gynecology)


Long-Term Clinical Outcomes Following Resectoscopic Endometrial Ablation of Non-Atypical Endometrial Hyperplasia in Women With Abnormal Uterine Bleeding
Conclusion When performed by surgeons experienced in hysteroscopy, resectoscopic endometrial ablation is feasible, safe, and effective for treatment of SH and CH without atypia in women with AUB. (Source: Journal of Minimally Invasive Gynecology)


Biomechanical analysis of the camelid cervical intervertebral disc
Publication date: Available online 23 December 2014 Source:Journal of Orthopaedic Translation Author(s): Dean K. Stolworthy , R. Amy Fullwood , Tyler M. Merrell , Laura C. Bridgewater , Anton E. Bowden Chronic low back pain (LBP) is a prevalent global problem, which is often correlated with degenerative disc disease. The development and use of good, relevant animal models of the spine may improve treatment options for this condition. While no animal model is capable of reproducing the exact biology, anatomy, and biomechanics of the human spine, the quality of a particular animal model increases with the number of shared characteristics that are relevant to the human condition. The purpose of this study was to investigate the camelid (specifically, alpaca and llama) cervical spine as a mo...


Chronic wrist pain in a goalkeeper; bilateral scaphoid stress fracture: A case report
Conclusion Bilateral stress fractures of the scaphoid can be considered for the wrist pain, especially for the patients that had repetitive minor wrist trauma, and in spite of developments in surgical techniques and materials used, treatment by plaster casting should still be considered initially for non-displaced, stable scaphoid stress fractures. (Source: International Journal of Surgery Case Reports)


Inhaled hydrogen sulfide prevents neuropathic pain after peripheral nerve injury in mice
In this study, we examined the effects of hydrogen sulfide breathing on neuropathic pain in mice. C57BL/6J mice were subjected to chronic constriction injury (CCI) of the sciatic nerve. After CCI, mice breathed air alone or air mixed with hydrogen sulfide at 40 ppm for 8 h on 7 consecutive days. The expression levels of inflammatory cytokines including interleukin 6 (IL-6) were measured in the spinal cord. Effects of hydrogen sulfide on IL-6-induced activation of microglia were examined in primary rat microglia. Mice that breathed air alone exhibited the neuropathic pain behavior including mechanical allodynia and thermal hyperalgesia and increased mRNA levels of IL-6 and chemokine CC motif ligand 2 (CCL2) after CCI. Inhaled hydrogen sulfide prevented the neuropathic pain behavior and ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Discovering the Truth Beyond the Truth
The question "What is truth?" is one of the oldest questions in philosophy. Truth within the field of medicine has gained relevance because of its fundamental relationship to the principle of patient autonomy. In order to fully participate in their medical care, patients must be told the truth – even in the most difficult of situations. Palliative care emphasizes patient autonomy and a patient-centered approach, and it is precisely among patients with chronic, life-threatening, or terminal illnesses that truth plays a particularly crucial role. (Source: Journal of Pain and Symptom Management)


Parasympathetic Reactivity in Fibromyalgia and Temporomandibular Disorder: Associations with Sleep Problems, Symptom Severity, and Functional Impairment
Despite evidence of autonomic disturbances in chronic multi-symptom illnesses such as temporomandibular joint disorder (TMD) and fibromyalgia (FM), additional work is needed to characterize the role of parasympathetic reactivity in these disorders. Given the high levels of comorbidity with psychiatric disorders characterized by stronger parasympathetic reductions than controls in safe contexts (leading to higher arousal), it was hypothesized that individuals with TMD and FM would respond similarly. (Source: The Journal of Pain)


Idiopathic Gastroparesis
Gastroparesis is a chronic symptomatic disorder of the stomach characterized by delayed emptying without evidence of mechanical obstruction. Idiopathic gastroparesis refers to gastroparesis of unknown cause not from diabetes; not from prior gastric surgery; not related to other endocrine, neurologic, rheumatologic causes of gastroparesis; and not related to medications that can delay gastric emptying. There is overlap in the symptoms of idiopathic gastroparesis and functional dyspepsia. Patients with idiopathic gastroparesis often have a constellation of symptoms including nausea, vomiting, early satiety, postprandial fullness, and upper abdominal pain. Current treatment options of dietary management, prokinetics agents, antiemetic agents, and symptom modulators do not adequately address c...


Gastroparesis
is a chronic symptomatic disorder of the stomach characterized by delayed emptying without evidence of mechanical obstruction. Symptoms of gastroparesis include nausea, vomiting, early satiety, postprandial fullness, and upper abdominal pain. The 3 main causes are diabetic, postsurgical, and idiopathic. Diagnosis is confirmed by demonstrating delayed gastric emptying. Gastric emptying rates measured by gastric motor testing generally correlate poorly with symptoms and quality of life in patients with gastroparesis. It may be appropriate to reconsider the definition of gastroparesis, recognizing it as a broader spectrum of gastric neuromuscular dysfunction. (Source: Gastroenterology Clinics of North America)


Clinical outcomes of bilateral lung transplantation for cystic fibrosis in frame of the european multicentric COLT study
The objective of the study is to describe clinical outcomes of cystic fibrosis (CF) patients in COLT, with at least one year follow up post transplantation.From september 2009 to june 2012, 156 CF patients underwent bilateral lung transplantation. 48% were men, with mean age 27,5 and 18 IMC. 65% lung transplant recipients (LTR) with CF were infected with Pseudomonas aeruginosa, 33% with Staphylococcus Aureus. Before transplantation, 38% patients were colonizated with Aspergillus Fumigatus. The median time on waiting list was 123+/- 418 days with 27% High Emergency (HE) transplanted patients (waiting time: 7 +/- 5 days). 38% were transplanted with a miss-match of CMV, 12% for EBV. Patients required invasive ventilation during 9 days (median: 2 days) in intensive care unit. The post-transpla...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 medical thoracoscopy (MT) service at Basildon Hospital, UK
Conclusion:MT is a relatively safe procedure for the diagnosis of patient with an exudative pleural effusion.Serious complications are rare,however,complications led to prolonged hospital stay,and therefore cost. (Source: European Respiratory Journal)


Presence of depression/anxiety and related factors in bronchiectasis
This study aimed to investigate depression and anxiety and related factors with bronchiectasis patients.Patients with confirmed diagnosis of bronchiectasis with high resolution computed tomography were investigated. This was a single center cross-sectional study of 75 patients with bronchiectasis. Patients were clinically stable in previous two weeks evaluated using hospital depression anxiety scales (HAD). Symptoms, pulmonary function tests and radiological findings were recorded.The mean age was 48&plusmn;14.7 (17-75) years, 44 (58.7%) was women. Fifteen (20%) patients showed symptoms of depression and 29 (38.7%) showed symptoms of anxiety. The chest pain was related to depression and anxiety, respectively (p=0.009 and p=0.016). The admission to emergency department was associated with d...


Pleural complicationsin patients with chronic and end-stage renal disease
Conclusion: Pleural eff. the most common pl. complications followed by pyopneumothorax in patients with CKD & ESRD. Themost common cause of unilateral pl. eff. is parapneumonic eff. while in bilateral pl. eff. is hypervolaemia. (Source: European Respiratory Journal)


Structural brain changes in patients with chronic obstructive pulmonary disease (COPD)
Patients with COPD suffer from dyspnea, but little is known about brain pathology related to dyspnea in these patients. To test for regional gray matter volume (GMV) differences, 30 stable outpatients with moderate-to-severe COPD were compared with 30 gender- and age-matched healthy control subjects. T1-weighted structural brain images were acquired with magnetic resonance imaging and analyzed using voxel-based morphometry. A two-sample t-test between patients and controls included smoker status as covariate.Compared to healthy controls, patients with COPD showed decreased GMV in the posterior cingulate cortex (PCC; whole brain family-wise error corrected (FWE) P &lt; .05), the posterior mid-cingulate cortex (pMCC; region of interest FWE P &lt; .05), and the rostral anterior cingulate cort...


Mindfulness-based stress reduction in patients with interstitial lung disease: A pilot study
Interstitial lung diseases (ILDs) are characterized by a chronic and progressive course with reduced quality of life (QoL). Depressive symptoms are common and persistent in patients with ILD.Mindfulness-based stress reduction (MBSR) is a protocol integrating Buddhist meditation with contemporary clinical and psychological practice; MBSR has already proven to reduce negative moods related to chronic symptoms.Nineteen ILD patients (M=11, mean age &plusmn; SD: 65 &plusmn; 8 years; 12 affected by idiopathic pulmonary fibrosis) were enrolled in a prospective, open-label, observational study evaluating feasibility, safety, and effect on QoL and lung function of a MBSR program. The intervention consisted of 8 weekly group meetings and 45 minutes-long daily home training. Three quarterly group mee...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cytological types of lung cancer in a referral population in Western Greece during the past decade
Discussion: The most common type of malignancy in the population that was investigated was squamous cell carcinoma with a rate of 36,8%, followed by adenocarcinoma 34,3%. The patients that were found to have small cell lung carcinoma (SCLC) were fewer (16,0%), while there are patients reported with other types of endobronchial lesions (12,9%) such as large cell carcinoma, benign tumors etc. About 60% of the male patients were smokers and 75% of them were heavy smokers (over 40 packs/year). About 45% of female patients were smokers and 20% of those were heavy smokers. The ratio between men:women was 3,6:1. (Source: European Respiratory Journal)


A new biomarker for chronic lung allograft dysfunction
Conclusion :This new in vitro model suggests the implication of immune cells in airway remodeling by the induction of extracellular matrix marker and suggest a link between MCP-1 and MMP-9. It appears as a relevant tool for biomarker discovery. Plasmatic MMP-9 secretion may be a valuable biomarker for CLAD. (Source: European Respiratory Journal)


Assessment of public awareness on chronic obstructive pulmonary disease in Slovenia
ConclusionsPublic awareness and knowledge about COPD is low and COPD is not considered as relevant public health problem. Strategies to inform and educate Slovenian public about COPD are urgently needed. (Source: European Respiratory Journal)


Isolated hypocapnia: A sign not to be neglected
In pulmonary embolism (PE) hypocapnia is frequent and due to hyperventilation in response to hypoxemia. But unspecific clinical presentation with isolated hypocapnia and without hypoxemia were described.To study clinical feature of PE with a normal arterial oxygen pressure (PaO2) but hypocapnia, we analyzed all cases of PE hospitalized in our department from January 2009 until December 2012. Only patients presenting PE and hypocapnia without hypoxemia were included. All PE cases were confirmed by CT angiography.On 80 cases of PE only 15 patients met criteria (18.75%). All patients were men and 12 were smokers. Median age was 56.13 years. All cases had no suspected high risk PE. It was discovered incidentally in 8 cases. In the other cases the most frequent clinical signs were dyspnea, tach...


Examination about what determine quality of life (QOL) and the association between QOL and therapeutic intervention for patients with chronic thromboembolitic pulmonary hypertension (CTEPH)
Conclusion: PF and PCS were associated with PVR and 6MD in CTEPH patients. Mental as well as physical QOL was improved after both surgical and medical therapies. PAH-specific therapy improved survival regardless of low PF and PCS at diagnosis. (Source: European Respiratory 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>


Pulmonary nocardiosis (PN) complicating chronic pulmonary diseases
We reviewed 32 PN consecutive episodes seen in our Department in 10 years. Isolates were studied by sequencing the 900-bp internal fragment of the 16S rRNA gene and susceptibility tests by microdilution (Sensititre&reg;) were repeated. Patient characteristics: 23 (72%) males, 71&plusmn;14 years, 21 (66%) active/former smokers, moderate-severe COPD in 19 (59%), bronchiectasis in 8 (25%) and ILDs in 5 (16%). Oral/IV steroids in 15 (47%), inhaled steroids in 22 (69%), both in 5 (16%), and none in 6 (19%). Clinical course duration: 2 weeks in 14 (44%), 2-6 weeks in 12 (37%) and 6 weeks in 6 (19%). Clinical picture: productive cough in 26 (81%), fever in 18 (56%) and chest pain in 11 (34%). Rx findings: pseudonodules in 14 (44%), patchy infiltrates in 7 (22%), cavitation in 4 (12%) and no chang...


Qualitative analysis of satisfaction of patients with chronic obstructive pulmonary disease (COPD) submitted to exercise training in water and on land
Conclusion: The satisfaction of COPD patients submitted to exercise training in water and on land can be characterized as multifactorial. Patient and therapist relationship was an important factor for success. Furthermore, exercising in water promoted additional benefits in comparison to the land environment. (Source: European Respiratory Journal)


Chronic obstructive pulmonary disease and myocardial infarction: Special aspects of clinical course in comorbid conditions
A new edition of GOLD focuses on effect of concomitant cardiovascular diseases on the course of chronic obstructive pulmonary disease (COPD).The issue of exclusive clinical course of myocardial infarction (MI) in COPD patients is still poorly understood. We analyzed the course of MI in 31 patients with COPD, moderate COPD was diagnosed in 34.7% subjects and severe COPD in 65.3% subjects, mean age (56.7&plusmn;4.3 ys) compared it with the data from the reference group - 35 patients, mean age (65.7&plusmn;6.2 ys) with MI without history of COPD. We have learnt that 9 (29.4%) patients with COPD and MI were admitted to a hospital within 24 hours after start of pain syndrome, whilst the majority of patients without COPD (26 (75%)) within 12 hours. 47.1% of COPD patients demonstrated shortness o...


Serum vitamin D, magnesium and calcium on lung function and QoL in COPD: A cross-sectional study
Discussion: Serum levels of vitamin D, magnesium and calcium were not related to FEV1. Most patients in this study were serum vitamin D-, magnesium- and calcium sufficient. Women had higher serum vitamin D than men.Serum magnesium was associated with QoL in COPD. No associations were seen between QoL and serum vitamin D and calcium.Prospective randomized studies are needed to substantiate these findings. (Source: European Respiratory Journal)


Effects of "passive tear gas exposure"
Conclusion: The results of the study has shown that tear gas has environmental health effects. Repeated use of tear gas during a protest with a long duration may harm respiratory health of the people living and working in the district. Tear gas must be controlled legally like tobacco smoke. (Source: European Respiratory 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>


Antinocieptive effects of lacosamide on spinal neuronal and behavioural measures of pain in a rat model of osteoarthritis
Conclusions: Our in vivo electrophysiological results show that the inhibitory effects of LCM were MIA dependent. This suggests that if used in OA patients, LCM may allow physiological transmission yet suppress secondary hyperlagesia and allodynia. The inhibitory effect on spinal neuronal firing aligned with analgesic efficacy on nociceptive behaviours and suggests that LCM may still prove worthwhile for OA pain treatment and merits further clinical investigation. (Source: Arthritis Research and Therapy)


Herbal medicine for low-back pain.
CONCLUSIONS: C. frutescens (Cayenne) reduces pain more than placebo. Although H. procumbens, S. alba, S. officinale L., S. chilensis, and lavender essential oil also seem to reduce pain more than placebo, evidence for these substances was of moderate quality at best. Additional well-designed large trials are needed to test these herbal medicines against standard treatments. In general, the completeness of reporting in these trials was poor. Trialists should refer to the CONSORT statement extension for reporting trials of herbal medicine interventions. PMID: 25536022 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


An observational study on the costs and consequences of acupuncture for the management of chronic low back pain in Korean patients.
CONCLUSIONS: The use of acupuncture to manage CLBP in general clinical practice in Korea inexpensively improved pain, functional disability and quality of life. The study results are meaningful and consistent with the results of previous trials performed in other European countries but the power of the study is not strong, having major design weaknesses. A large-scale cohort or registry based on practice may be helpful to strengthen the evidence of the cost-effectiveness of acupuncture. PMID: 25538293 [PubMed - as supplied by publisher] (Source: Acupuncture in Medicine : journal of the British Medical Acupuncture Society)


Overview review: Comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions
ConclusionsAt standard doses in different painful conditions, ibuprofen was usually superior producing more patients with the degree of pain relief that patients feel worthwhile. Neither of the drugs will be effective for everyone, and both are needed. This overview questions the practice of routinely using paracetamol as a first line analgesic because there is no good evidence for efficacy of paracetamol in many pain conditions. (Source: European Journal of Pain)


Effectiveness of balneotherapy and spa therapy for the treatment of chronic low back pain: a review on latest evidence
Abstract In most European countries, balneotherapy and spa therapy are widely prescribed by physicians and preferred by European citizens for the treatment of musculoskeletal problems including chronic low back pain (LBP). We aimed to review and evaluate the recent evidence on the effectiveness of balneotherapy and spa therapy for patients with LBP. We comprehensively searched data bases for randomized controlled trials (RCTs) published in English between July 2005 and December 2013. We identified all trials testing balneotherapy or spa therapy for LBP that reported that the sequence of allocation was randomized. We finally included total of eight RCTs: two on balneotherapy and six on spa therapy. All reviewed trials reported that balneotherapy was superior in long term to tap wat...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Therapeutic Affordances of Social Media: Emergent Themes From a Global Online Survey of People With Chronic Pain
Conclusions: Much of the efficacy of social media may be explicable via a closer examination of therapeutic affordances. Particular areas that warrant attention include social media&#8217;s ability to filter and guide people to useful information, connect individuals, and share experiences. Further research into a variety of chronic conditions is warranted. Coupled with the results of the present study, a greater theoretical basis detailing how social media may foster health outcomes may lead to an improved evidence base for conducting research and may inform recommendations for social media use in chronic disease management. (Source: Journal of Medical Internet Research)


Trans-venous occlusion of incompetent pelvic veins for chronic pelvic pain in women: a systematic review
Publication date: Available online 18 December 2014 Source:European Journal of Obstetrics &amp; Gynecology and Reproductive Biology Author(s): Vivak Hansrani , Abeera Abbas , Sahil Bhandari , Ann-Louise Caress , Mourad Seif , Charles N. McCollum Chronic pelvic pain (CPP) affects 24% of women worldwide; the cause cannot be identified in 40% despite invasive investigations. Dilated, refluxing pelvic veins may be a cause of CPP and treatment by trans-venous occlusion is increasingly performed when gynaecological causes are excluded, but is it effective? A systematic review of the literature published between 1966 and July 2014 was conducted. Two authors independently reviewed potential studies according to a set of eligibility criteria, with a third assessor available as an arbiter. Thi...


Therapeutic Affordances of Social Media: Emergent Themes From a Global Online Survey of People With Chronic Pain
Conclusions: Much of the efficacy of social media may be explicable via a closer examination of therapeutic affordances. Particular areas that warrant attention include social media&#8217;s ability to filter and guide people to useful information, connect individuals, and share experiences. Further research into a variety of chronic conditions is warranted. Coupled with the results of the present study, a greater theoretical basis detailing how social media may foster health outcomes may lead to an improved evidence base for conducting research and may inform recommendations for social media use in chronic disease management. (Source: Journal of Medical Internet Research)


The dynamic pain connectome.
We describe how recent progress in our understanding of individual differences in intrinsic attention to pain and neural network dynamics in chronic pain can facilitate development of personalized pain therapies. Furthermore, we emphasize that the dynamics of pain-attention interactions must be accounted for in the contemporary search for a 'neural signature' of the pain connectome. PMID: 25541287 [PubMed - as supplied by publisher] (Source: Trends in Neurosciences)


Investigating the size and dynamics of voltage-gated sodium channel fenestrations.
Investigating the size and dynamics of voltage-gated sodium channel fenestrations. Channels (Austin). 2014;8(3):264-77 Authors: Kaczmarski JA, Corry B Abstract Eukaryotic voltage-gated sodium channels (VGSCs) are essential for the initiation and propagation of action potentials in electrically excitable cells, and are important pharmaceutical targets for the treatment of neurological disorders such as epilepsy, cardiac arrhythmias, and chronic pain. Evidence suggests that small, hydrophobic, VGSC-blocking drugs can gain access to binding residues within the central cavity of these channels by passing through lateral, lipid-filled “fenestrations” which run between the exterior of the protein and its central pore. Here, we use molecular dynamics simulations to invest...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Eight principles for safer opioid prescribing and cautions with benzodiazepines.
Authors: Webster LR, Reisfield GM, Dasgupta N Abstract Abstract The provision of long-term opioid analgesic therapy for chronic pain requires a careful risk/benefit analysis followed by clinical safety measures to identify and reduce misuse, abuse, and addiction and their associated morbidity and mortality. Multiple data sources show that benzodiazepines, prescribed for comorbid insomnia, anxiety, and mood disorders, heighten the risk of respiratory depression and other adverse outcomes when combined with opioid therapy. Evidence is presented for hazards associated with coadministration of opioids and benzodiazepines and the need for caution when initiating opioid therapy for chronic pain. Clinical recommendations follow, as drawn from 2 previously published literature reviews, one...


Hormone abnormalities in patients with severe and chronic pain who fail standard treatments.
Authors: Tennant F Abstract Abstract Some patients with severe and chronic pain fail to obtain adequate pain relief with standard pharmacologic treatment agents, including low to moderate dosages of opioids. Understandably, physicians might not believe patients who claim that a standard opioid dosage is an ineffective treatment. These patients may be severely impaired, nonfunctional, and bedridden or housebound. To help characterize these individuals and develop treatment strategies for them, a serum hormone profile consisting of adrenocorticotropin, cortisol, pregnenolone, progesterone, dehydroepiandrosterone, and testosterone was obtained on 61 chronic pain patients who failed standard treatments; 49 patients (80.3%) demonstrated ≥ 1 hormone abnormality defined as a serum conce...


Buprenorphine transdermal system compared with placebo reduces interference in functioning for chronic low back pain.
This study examines the efficacy of the buprenorphine transdermal system (BTDS) for reducing the interference of pain on physical and emotional functioning associated with chronic low back pain (CLBP). Methods: A post-hoc analysis used data from a randomized, placebo-controlled, double-blind trial of patients with moderate-to-severe CLBP. The Brief Pain Inventory (BPI) measured pain interference at screening, following a run-in period, and during the 12-week double-blind treatment phase. Statistical analyses examined treatment arm differences (BTDS vs placebo) for the following: BPI Interference subscale items and subscale scores at the trial end point (week 12); patterns of change in the Interference subscale scores over time; proportions of patients indicating mild or no interference fol...


Efficacy and safety of once-daily, extended-release hydrocodone in individuals previously receiving hydrocodone/acetaminophen combination therapy for chronic pain.
Conclusion: In patients whose primary pretrial analgesic was hydrocodone/acetaminophen combination tablets, single-entity HYD was effective in reducing pain intensity and in maintaining analgesia over time without need for continued dose increase. HYD's safety and tolerability profiles were similar to other opioid analgesics. PMID: 25526227 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)


A rare complication: misdirection of an indwelling urethral catheter into the ureter.
We report 3 patients with the rare complication of an indwelling urethral catheter misdirected into the ureter. This is the largest series to date. Patients were referred to us for a variety of reasons following exchange of their chronic indwelling urinary catheters. CT in all cases demonstrated the urinary catheters residing in the left ureter. The ages of the patients were 37, 67 and 81 years old. All patients suffered from neurogenic bladder. Two patients were female, one was male, and 2 of the 3 had a sensory disorder inhibiting their pain response. The catheters were replaced with open-end Foley catheters. Extensive follow-up CT scans were obtained in one case, demonstrating improvement of hydronephrosis and no evidence of ureteral stenosis. Cystoscopy in this patient demonstrated nor...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


In Reply:
Administration of vitamin C for preventing complex regional pain syndrome (CRPS) after a distal radius fracture (DRF) is an intriguing possibility. CRPS is a devastating syndrome that has no clear etiology other than the hypothesis of sympathetic overtone that can cause chronic pain after a trauma. Owing to the absence of a case definition and an identifiable unified etiology, the diagnosis of CRPS is based on subjective criteria defined by the International Association for the Study of Pain (IASP). (Source: The Journal of Hand Surgery)


The relationship between hemoglobin level and disease activity in patients with rheumatoid arthritis
Conclusion In conclusion, we determined that low hemoglobin level was significantly related to disability and impairment, disease activity, articular damage, pain and disease duration in RA patients in our study. We believe that by keeping disease activity under control, therefore preventing articular damage, the disability in RA patients can be lessened or possibly even eliminated. (Source: Revista Brasileira de Reumatologia)


Optic neuritis in juvenile idiopathic arthritis patient
In conclusion, a low prevalence of ON was observed in our JIA population. The absence of anti-AQP4 antibody and the normal brain MRI do not exclude the possibility of demyelinating disease associated with chronic arthritis. Therefore, rigorous follow up is required. (Source: Revista Brasileira de Reumatologia)


Polyneuropathy and radiculopathy in rheumatoid arthritis patients with low back pain: Clinical characteristics, functional disability, depression, anxiety and quality of life
Conclusions Chronic radicular low back and leg pain in patients with RA may be due to probable lumbar radiculopathy as well as an indicator for polyneuropathy. (Source: The Egyptian Rheumatologist)


Spinal neuroimmune activation is independent of T-cell infiltration and attenuated by A3 adenosine receptor agonists in a model of oxaliplatin-induced peripheral neuropathy
Publication date: February 2015 Source:Brain, Behavior, and Immunity, Volume 44 Author(s): Kali Janes , Carrie Wahlman , Joshua W. Little , Timothy Doyle , Dillip K. Tosh , Kenneth A. Jacobson , Daniela Salvemini Many commonly used chemotherapeutics including oxaliplatin are associated with the development of a painful chemotherapy-induced peripheral neuropathy (CIPN). This dose-limiting complication can appear long after the completion of therapy causing a significant reduction in quality-of-life and impeding cancer treatment. We recently reported that activation of the Gi/Gq-coupled A3 adenosine receptor (A3AR) with selective A3AR agonists (i.e., IB-MECA) blocked the development of chemotherapy induced-neuropathic pain in models evoked by distinct agents including oxaliplatin without 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>


Select steroid hormone glucuronide metabolites can cause toll-like receptor 4 activation and enhanced pain
Publication date: February 2015 Source:Brain, Behavior, and Immunity, Volume 44 Author(s): Susannah S. Lewis , Mark R. Hutchinson , Morin M. Frick , Yingning Zhang , Steven F. Maier , Tarek Sammakia , Kenner C. Rice , Linda R. Watkins We have recently shown that several classes of glucuronide metabolites, including the morphine metabolite morphine-3-glucuronide and the ethanol metabolite ethyl glucuronide, cause toll like receptor 4 (TLR4)-dependent signaling in vitro and enhanced pain in vivo. Steroid hormones, including estrogens and corticosterone, are also metabolized through glucuronidation. Here we demonstrate that in silico docking predicts that corticosterone, corticosterone-21-glucuronide, estradiol, estradiol-3-glucuronide and estradiol-17-glucuronide all dock with the MD-2 com...


Medical treatment of ureteral obstruction associated with ovarian remnants and/or endometriosis: report of 3 cases and review of the literature
Conclusions Low dose intermittent danazol or GnRH-a alone or with add-back, may be effective long-term therapies in endometriosis-associated ureteral obstruction when surgery is contraindicated, refused or difficult to perform. (Source: Journal of Minimally Invasive Gynecology)


Physical and Psychological Correlates of Fatigue and Physical Function: A Stanford-NIH Open Source Pain Registry 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. Methods: 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. (Source: The Journal of Pain)


Can experimentally induced positive affect attenuate generalization of fear of movement-related pain?
Recent experimental data show that associative learning processes are involved not only in the acquisition but also the spreading of pain-related fear. Clinical studies suggest involvement of positive affect in resilience against chronic pain. Surprisingly, the role of positive affect in associative learning in general and in fear generalization in particular has received scant attention. In a voluntary movement paradigm, in which one arm movement (CS+) was followed by a painful stimulus and another was not (CS-), we tested generalization of fear to five novel but related generalization movements (GSs; within-subjects) after either a positive affect induction or a control exercise (Group = between-subjects) in healthy participants (N = 50). (Source: The Journal of Pain)


New and Lower Estimate of the Prevalence of Chronic Pain in the United States
No abstract available (Source: The Back Letter)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Should Physicians Simply No Longer Offer Opioids As a Treatment Option for Chronic Low Back Pain?
No abstract available (Source: The Back Letter)


[This Week in Medicine] December 20/27, 2014–January 2, 2015
The National Institutes of Health Task Force on Research Standards for Chronic Low-Back Pain has released a set of standards for clinical back pain research aimed at producing more reliably designed research and better treatment solutions for those affected by back pain. The recommendations include a standard set of data collection questions intended to increase consistency between studies. (Source: LANCET)


ketoprofen; Note: This branded product is no longer on the market (Nexcede, Orudis, Oruvail, Actron)
Title: ketoprofen; Note: This branded product is no longer on the market (Nexcede, Orudis, Oruvail, Actron)Category: MedicationsCreated: 12/31/1997 12:00:00 AMLast Editorial Review: 12/19/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Long-term prediction of changes in health status, frailty, nursing care and mortality in community-dwelling senior citizens - results from the longitudinal urban cohort ageing study (LUCAS)
Conclusions: Disability free lifetime and its development over time are important topics in public health. In this context, the FA index presented here provides answers to two questions. First, how to screen the heterogeneous population of community-dwelling senior citizens, i.e. for their functional ability / competence, and second, how far away they are from disability / dependency. Furthermore, the index provides a tool to address the urgent question whether incipient functional decline / incipient frailty can be recognized early to be influenced positively.The FA index predicted change in functional status, future need of nursing care, and mortality in an unselected population of community-dwelling seniors. It implies an operational specification of the classification into Robust, post...


Attenuation of neuropathic pain by sodium butyrate in an experimental model of chronic constriction injury in rats
Conclusion It may be concluded that the anti-inflammatory actions mediated by sodium butyrate are responsible for its beneficial effects in neuropathic pain in rats. (Source: Journal of the Formosan Medical Association)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Clinical Trials Update 2014: Year in Review
This section of Headache annually reviews the status of recently completed and ongoing major clinical trials involving common headache disorders. The review will focus on multicenter trials of new therapies as well as novel formulations of previously approved therapeutics. Table 1 summarizes the major therapeutic headache trials that were ongoing at the end of 2014, according to data obtained from both the “ClinicalTrials.Gov” website and from corporate press releases and presentations. Title Conditions Interventions Phases Single‐ascending dose study of AMG 333 in healthy subjects and subjects with migraines Migraine AMG 333 Phase 1 TI‐001 (intranasal oxytocin) for treatment of chronic migraine Chronic migraine TI‐001 Phase 2 Study to determine the effica...


Soluble Factors from the Notochordal-rich Intervertebral Disc Inhibit Endothelial Cell Invasion and Vessel Formation in the Presence and Absence of Pro-inflammatory cytokines
Chronic low back pain can be associated with the pathological ingrowth of blood vessels and nerves into intervertebral discs (IVDs). The notochord patterns the IVD during development and is a source of anti-angiogenic soluble factors such as Noggin and Chondroitin sulfate (CS). These factors may form the basis for a new minimally invasive strategy to target angiogenesis in the IVD. (Source: Osteoarthritis and Cartilage)


Management of Pain in ADPKD and Anatomy of Renal Innervation
Chronic pain is a prominent feature of autosomal dominant polycystic kidney disease (ADPKD) that is difficult to treat and manage, often resulting in a decrease in quality of life. Understanding the underlying anatomy of renal innervation and different etiologies of pain that occur in ADPKD can help to guide proper treatments to manage pain. Reviewing the previously studied treatments for pain in ADPKD can help to characterize treatment in a stepwise fashion. (Source: The Journal of Urology)


Medical treatment of ureteral obstruction associated with ovarian remnants and/or endometriosis: report of 3 cases and review of the literature
Endometriosis is a systemic disease affecting multiple body organs and systems and it may result in chronic pelvic pain, infertility and obstruction of viscera such as bowel and/or ureters. Although medical therapies with danazol or gonadotropin-releasing hormone agonists (GnRH-a) are very effective in alleviating endometriosis effects, their use is limited due to patient intolerability, adverse systemic effects and physician bias. Presently, we report our experience with low dose intermittent danazol or prolonged GnRH-a with and without add-back therapy in endometriosis associated ureteral obstruction. (Source: The Journal of Minimally Invasive Gynecology)


Adherence to Prescription Opioid Monitoring Guidelines among Residents and Attending Physicians in the Primary Care Setting
ConclusionsWith some variability, residents and attending physicians were only partly compliant with national guidelines. Residents were more likely to manage patients with a higher likelihood of opioid misuse. (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>


Treatment of Chronic Lumbosacral Radicular Pain Using Adjuvant Pulsed Radiofrequency: A Randomized Controlled Study
ConclusionThe TFEI provided significant short‐term pain relief and PRF can be applied in conjunction with TFEI to achieve higher treatment efficacy compared with TFEI alone. (Source: Pain Medicine)


Dorsal Root Ganglion Pulsed Radiofrequency for the Management of Intractable Vertebral Metastatic Pain: A Case Series
ConclusionDRG pulsed RF procedure provided sound pain relief for patients with intractable vertebral metastatic pain. Metastatic bone pain is characteristic of cancer pain and is a form of refractory cancer pain, as the pain includes not only nociceptive but also neuropathic pain. Although some drugs are effective in the management of painful bone metastases, pain while moving is one of the most refractory forms of pain. DRG pulsed RF procedure provided sound pain relief for patients with intractable vertebral metastatic pain. (Source: Pain Medicine)


Can a Psychologically Based Treatment Help People to Live with Chronic Pain When They Are Seeking a Procedure to Reduce It?
ConclusionPeople seeking medical interventions to reduce pain appear able to benefit from an interdisciplinary treatment aimed to improve daily functioning and mental health through increased psychological flexibility. (Source: Pain Medicine)


Reduction of Pain Sensitivity is Associated with the Response to Treatment in Women with Chronic Pelvic Pain
ConclusionThe sensitivity to experimental pain was reduced after 6 months of multidisciplinary treatment for CPP. Our data provided additional evidence of central sensitization in women with CPP. (Source: Pain Medicine)


A Qualitative Study of Veterans on Long‐Term Opioid Analgesics: Barriers and Facilitators to Multimodality Pain Management
ConclusionsVeterans with chronic pain on long‐term opioids hold pervasive attitudes that prevent them from using multimodality pain management options, lack social support and social norms for non‐opioid‐based pain treatment options, and have poor perceived control due to poor access to multimodality care. (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>


Dose Escalation During the First Year of Long‐Term Opioid Therapy for Chronic Pain
ConclusionsDose escalation during the first year of long‐term opioid therapy is associated with higher rates of substance use disorders and more frequent outpatient encounters, especially non face‐to‐face encounters. (Source: Pain Medicine)


Aerobic Exercise and Cold Pressor Test Induce Hypoalgesia in Active and Inactive Men and Women
ConclusionsCold pressor stimulation and aerobic exercise caused comparable multisegmental increases in PPT in active and inactive men and women. The CPM and EIH responses were correlated, but they have different temporal manifestation of hypoalgesia. (Source: Pain Medicine)


A Nationwide Study of Chronic Pain Prevalence in the General Spanish Population: Identifying Clinical Subgroups Through Cluster Analysis
ConclusionsPain affects an important proportion of the Spanish adult population and that it has a strong personal impact. Two pain groups were clearly distinguished by their clinical characteristics. (Source: Pain Medicine)


Chronic Pain in “Probable” Vascular Dementia: Preliminary Findings
ConclusionAs VaD patients may experience greater pain than controls, it is essential for prescribers to be aware of the presence of this neuropathology if these patients are to receive adequate treatment. (Source: Pain Medicine)


Synthesis and biological evaluation of compact, conformationally constrained bifunctional opioid agonist - Neurokinin-1 antagonist peptidomimetics.
Authors: Guillemyn K, Kleczkowska P, Lesniak A, Dyniewicz J, Van der Poorten O, Van den Eynde I, Keresztes A, Varga E, Lai J, Porreca F, Chung NN, Lemieux C, Mika J, Rojewska E, Makuch W, Van Duppen J, Przewlocka B, Vanden Broeck J, Lipkowski AW, Schiller PW, Tourwé D, Ballet S Abstract A reported mixed opioid agonist - neurokinin 1 receptor (NK1R) antagonist 4 (Dmt-D-Arg-Aba-Gly-(3',5'-(CF3)2)NMe-benzyl) was modified to identify important features in both pharmacophores. The new dual ligands were tested in vitro and subsequently two compounds (lead structure 4 and one of the new analogues 22, Dmt-D-Arg-Aba-β-Ala-NMe-Bn) were selected for in vivo behavioural assays, which were conducted in acute (tail-flick) and neuropathic pain models (cold plate and von Frey) in rats. Compare...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Methionine Containing Antioxidants for Pain in Chronic Pancreatitis: A Systematic Review and Meta-analysis
Pain is the most compelling symptom of chronic pancreatitis (CP). This meta-analysis aimed to evaluate the efficacy of methionine-containing antioxidants for pain management in CP. (Source: Clinical Gastroenterology and Hepatology)


Cognitive-behavioral therapy and educational counseling for chronic pain and opioid dependence
Aims: To examine the efficacy of cognitive behavioral therapy (CBT) and educational counseling (EC)—the educational component of CBT augmented by additional psychoeducation on chronic pain and addiction—for co-occurring chronic low-back pain and opioid dependence (POD). (Source: Drug and Alcohol Dependence)


Prescription opioid use is associated with increased mortality in the reasons for geographic and racial differences in stroke study
Aims: Prescription opioid use (POU) for chronic non-malignant pain has increased in the US over the last decade. Previous research has demonstrated increased mortality related to POU overdose or abuse but population-based studies have not examined the relationship between POU and all cause mortality (ACM), adjusting for a variety of underlying chronic conditions as well as levels of chronic pain, which was the purpose of this study. (Source: Drug and Alcohol Dependence)


Progressive ratio responding for morphine is differentially altered in the presence of chronic peripheral neuropathy in male vs. female C57Bl/6 mice
Aims: Clinical management of chronic pain with prescription opioids remains a challenge due to concerns about opioid-induced dependence and addiction. Sex-differences in pain sensitivity, opioid analgesia, and reinforcing effects of opioids are observed in rodents. The purpose of our study is to test the hypothesis that the presence of paclitaxel-induced chronic peripheral neuropathy will differentially alter the sensitivities of male and female mice to morphine-induced reinforcing effects. (Source: Drug and Alcohol Dependence)


Benzodiazepine use among a sample of chronic pain patients prescribed opioids
Aims: Previous research documents harms from long-term benzodiazepine (BZD) use, and there is little evidence to support the use of BZD in the treatment of chronic non-cancer pain. The aim of this study was examine BZD use in people prescribed opioids for chronic pain. (Source: Drug and Alcohol Dependence)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The association between benzodiazepine prescription and aberrant drug behaviors in primary care patients receiving chronic opioid therapy
Aims: Benzodiazepine (BZD) use in the setting of opioid therapy for chronic pain has been associated with an increased risk of overdose, but little is known about its association with aberrant drug behaviors. We aimed to examine the association between BZD prescription and aberrant drug behaviors in patients receiving chronic opioid therapy. (Source: Drug and Alcohol Dependence)


Chronic pain volatility predicts outcomes of buprenorphine-naloxone for prescription opioid dependence
Aims: Prescription opioid (PO) dependence frequently co-occurs with chronic pain. Prior studies did not find poorer buprenorphine-naloxone (BUP-NLX) outcomes in chronic pain patients, but more dynamic indicators of chronic pain may impact treatment. We hypothesized that greater pain volatility would predict opioid use during BUP-NLX taper in adults with PO dependence and chronic pain. (Source: Drug and Alcohol Dependence)


In Which I Inadvertently Subject Myself to One of the Most Controversial Psychology Experiments of All Time
It was the most beautiful airport security line I'd ever seen. Where exactly this beauty came from, I couldn't quite say, but there it was: an incredible aura of magic and mystery surrounding this crowd of waiting people, the likes of which I'd never experienced before. I felt awash with emotion: gratitude, for the guards who patiently asked for our boarding passes and IDs; kinship, with my fellow line-standers who complied so diligently with their requests; and awe, at this remarkable--nay, inspiring--feat of organizational prowess. "You guys run such a tight ship!" I told a nearby officer. His head tilted slightly to the left. "No, I mean, it's all so civilized!" I said. "Thank you?" he said. The line wasn't the first thing that had wowed me that morning in Denver. On the way to th...


Expert opinion on emerging drugs: chronic low back pain
Expert Opinion on Emerging Drugs, Ahead of Print. (Source: Expert Opinion on Emerging Drugs)


Confirmatory factor analysis of the Patient Assessment of Constipation-Symptoms (PAC-SYM) among patients with chronic constipation
Conclusion Our analysis shows that the rectal domain may not represent a relevant cluster of symptoms for patients with chronic constipation. We developed a modified version of the PAC-SYM which might better represent symptom severity of most patients seeking care in gastroenterology referral centers. (Source: Quality of Life Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Reply to Letter: “Nerve Management and Chronic Pain After Open Inguinal Hernia Repair”
No abstract available (Source: Annals of Surgery)


Nerve Management and Chronic Pain After Open Inguinal Hernia Repair
No abstract available (Source: Annals of Surgery)


Total Pancreatectomy With Islet Autotransplantation: Summary of an NIDDK Workshop
A workshop sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases focused on research gaps and opportunities in total pancreatectomy with islet autotransplantation (TPIAT) for the management of chronic pancreatitis. The session was held on July 23, 2014 and structured into 5 sessions: (1) patient selection, indications, and timing; (2) technical aspects of TPIAT; (3) improving success of islet autotransplantation; (4) improving outcomes after total pancreatectomy; and (5) registry considerations for TPIAT. The current state of knowledge was reviewed; knowledge gaps and research needs were specifically highlighted. Common themes included the need to identify which patients best benefit from and when to intervene with TPIAT, current limitations of the surgical proc...


The current status of imaging in anti-NGF clinical trials
Nerve Growth Factor (NGF) is a neurotrophin that regulates the structure and function of responsive sensory neurons and is a regulator of pain sensitivity and processing1. The concept of targeting NGF to target chronic pain syndromes has been gaining momentum since 19902. To date, there have been 44 clinical trials registered/listed on www.clinicaltrials.gov (last accessed June 10, 2014) with anti-NGF (aNGF) monoclonal antibodies (mAbs): 42 were conducted with two studies “Withdrawn” prior to subject enrollment (see Table I). (Source: Osteoarthritis and Cartilage)


"Change is possible": Patients' experience of a multimodal chronic pain rehabilitation programme.
Conclusion: Individuals living with disabling chronic pain can create a better life by integrating their illness. A prerequisite is that healthcare professionals empower patients to develop the strength to take responsibility for their daily lives. This process is facilitated by skills to reduce pain and handle life, plus support from significant others. PMID: 25502883 [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>


Evidence-based treatment of common extensor tendinopathy
This article presents a comprehensive review of the current literature on the treatment of common extensor tendinopathy (Source: Current Physical Medicine and Rehabilitation Reports)


The use of self-gripping (Progrip™) mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair: a prospective feasibility and long-term outcomes study
Conclusions Self-gripping mesh can be safely used during laparoscopic TEP inguinal hernia repairs; our cohort had a rapid recovery, and at the 1-year follow-up visit, there were no recurrences and no patients reported any chronic pain as defined by a CCS™ &gt; 1. (Source: Surgical Endoscopy)


The social negotiation of fitness for work: Tensions in doctor-patient relationships over medical certification of chronic pain
The UK government is promoting the health benefits of work, in order to change doctors&rsquo; and patients&rsquo; behaviour and reduce sickness absence. The rationale is that many people &lsquo;off sick&rsquo; would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacement of the &lsquo;sick note&rsquo; with the &lsquo;fit note&rsquo; and a national educational programme are intended to reduce sickness-certification rates, but how will these initiatives impact on doctor&ndash;patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be uncl...


Uncertainty in anticipation of uncomfortable rectal distension is modulated by the autonomic nervous system — A fMRI study in healthy volunteers
Publication date: 15 February 2015 Source:NeuroImage, Volume 107 Author(s): Amandine Rubio , Lukas Van Oudenhove , Sonia Pellissier , Huynh Giao Ly , Patrick Dupont , Hugo Lafaye de Micheaux , Jan Tack , Cécile Dantzer , Chantal Delon-Martin , Bruno Bonaz The human brain responds both before and during the application of aversive stimuli. Anticipation allows the organism to prepare its nociceptive system to respond adequately to the subsequent stimulus. The context in which an uncomfortable stimulus is experienced may also influence neural processing. Uncertainty of occurrence, timing and intensity of an aversive event may lead to increased anticipatory anxiety, fear, physiological arousal and sensory perception. We aimed to identify, in healthy volunteers, the effects of uncertainty in...


Anti-inflammatory, analgesic and anti-pyretic activities of standardized root extract of Jasminum sambac
Conclusions The study confirms the anti-inflammatory, analgesic and antipyretic activity of EJS which may be attributed to the presence of various phytoconstituents quantified especially hesperidin which have already been reported for its significant role in the treatment of inflammation and associated problems. Graphical abstract (Source: Journal of Ethnopharmacology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Milk and Molasses Enemas: Clearing Things Up
Discussion Our nursing survey showed that varying practice exists regarding technique and dosing of milk and molasses enemas. Historical chart review showed that milk and molasses enemas in our emergency department were safe and effective with minimal side effects. (Source: Journal of Emergency Nursing)


Improving the Assessment and Treatment of Pelvic Inflammatory Disease Among Adolescents in an Urban Children’s Hospital Emergency Department
Discussion The study demonstrated a significant improvement in all 3 aims related to improved care of adolescents with PID. PowerPoint presentations and the physical presence of the CDC treatment guidelines in the provider treatment areas were instrumental for success. Nurses play a pivotal role in the implementation and success of quality improvement projects for improving patient outcomes. (Source: Journal of Emergency Nursing)


Trans-venous occlusion of incompetent pelvic veins for chronic pelvic pain in women: a systematic review
Chronic pelvic pain (CPP) affects 24% of women worldwide; the cause cannot be identified in 40% despite invasive investigations. Dilated, refluxing pelvic veins may be a cause of CPP and treatment by trans-venous occlusion is increasingly performed when gynaecological causes are excluded, but is it effective?A systematic review of the literature published between 1966 and July 2014 was conducted. Two authors independently reviewed potential studies according to a set of eligibility criteria, with a third assessor available as an arbiter. (Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology)


Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain, stress and work ability among laboratory technicians: randomized controlled trial protocol
This study will provide experimental evidence to guide workplace initiatives designed towards reducing chronic musculoskeletal pain and stress.Trial registration number: NCT02047669. (Source: BMC Musculoskeletal Disorders)


Walking Exercise for Chronic Musculoskeletal Pain: Systematic Review and Meta-Analysis
To systematically review the evidence examining effects of walking interventions on pain and self-reported function in individuals with chronic musculoskeletal pain. (Source: Archives of Physical Medicine and Rehabilitation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A New Version of The Impairment and Functioning Inventory for Chronic Pain Patients (IFI-R)
There are few instruments with adequate psychometric properties for assessing daily functioning in patients with musculoskeletal pain. In addition, none of these instruments assess the perceived decrease in levels of daily activities after pain onset. (Source: PM and R)


Normal laser‐evoked cortical responses in patients with chronic hemibody pain
ConclusionsThe present results show that our patients with chronic hemibody pain do not show signs of spinothalamic tract lesion. This indicates normal processing of sensory aspects of painful stimuli, while higher pain processing areas show altered activation. We conclude that normal laser‐evoked magnetic fields (LEF) or laser‐evoked potentials (LEP) may not exclude central pain condition. (Source: European Journal of Pain)


Interpretation biases in chronic pain patients: an incidental learning task
ConclusionThese results show clear evidence that chronic pain patients do demonstrate an interpretation bias towards painful faces and that this bias is greater for those who catastrophize more and have higher levels of fear of pain, but experienced less pain in the preceding week. Given the recent potential shown for interventions that modify cognitive biases, this paradigm would seem to be well suited to future efforts to modify interpretation biases in pain. (Source: European Journal of Pain)


The Brief Irritability Test (BITe): A Measure of Irritability for Use Among Men and Women
This study aimed to develop a brief, reliable, and valid self-report measure of irritability that is suitable for use among both men and women and that displays minimal overlap with related constructs. First, 63 candidate items were generated, including items from two recent irritability scales. Second, 1,116 participants (877 university students and 229 chronic pain outpatients) completed a survey containing the irritability item pool and standardized measures of related constructs. Item response theory was used to develop a five-item scale (the Brief Irritability Test) with a strong internal structure. All five items displayed minimal conceptual overlap with related constructs (e.g., depression, anger), and test scores displayed negligible gender bias. The Brief Irritability Test shows p...


Differential tolerance to morphine antinociception in assays of pain-stimulated vs. pain-depressed behavior in rats.
This study compared morphine antinociceptive tolerance in parallel assays of pain-stimulated and pain-depressed behavior in male Sprague-Dawley rats. Intraperitoneal injection of dilute lactic acid served as a noxious stimulus to stimulate a stretching response in one group of rats and to depress operant responding for electrical brain stimulation (intracranial self-stimulation; ICSS) in another group of rats. Antinociception produced by morphine (1.0mg/kg) was determined after a regimen of chronic treatment with either saline or morphine in separate subgroups of rats in each procedure. In rats receiving chronic saline, acid alone stimulated a stretching response and depressed ICSS, and both acid effects were blocked by 1.0mg/kg morphine. Rats receiving chronic morphine displayed hyperalge...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


-venous occlusion of incompetent pelvic veins for chronic pelvic pain in women: a systematic review
Chronic pelvic pain (CPP) affects 24% of women worldwide; the cause cannot be identified in 40% despite invasive investigations. Dilated, refluxing pelvic veins may be a cause of CPP and treatment by trans-venous occlusion is increasingly performed when gynecological causes are excluded, but is it effective?A systematic review of the literature published between 1966 and July 2014 was conducted. Two authors independently reviewed potential studies according to a set of eligibility criteria, with a third assessor available as an arbiter. (Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology)


A New Version of the Impairment and Functioning Inventory for Patients With Chronic Pain (IFI-R)
Few instruments are available that have adequate psychometric properties for assessing daily functioning in patients with musculoskeletal pain. In addition, none of these instruments assesses the perceived decrease in levels of daily activities after the onset of pain. (Source: PM and R)


The role of 12 lead ECG in Pediatric Pulmonary Hypertension
A 10 year old male presents to the Emergency Department with complaint of substernal chest pain, 6/10, unable to describe the sensation but non-radiating, which started during a basketball game, while running. Primary assessment: Patent airway Adequate respiratory effort with no signs of distress skin is pink, warm and dry, with no signs of hypoperfusion Pertinent medical Hx: Chronic Interstitial Lung Diseases secondary to Human T-cell Lymphotropic Virus (HTLV) Secondary Pulmonary Hypertension No allergies reported Medications: Acetaminophen PRN furosemide  20mg Flovent Baseline vital signs: Heart rate: 112 beats/min Respiratory rate: 24 breaths/min SpO2: 97% on 2 lpm O2 Capillary refill: &lt; 2 seconds The patient is evaluated and admitted due to the current complaint and pri...


Health Tip: Spot the Signs of a Fractured Thumb
Title: Health Tip: Spot the Signs of a Fractured ThumbCategory: Health NewsCreated: 12/17/2014 12:00:00 AMLast Editorial Review: 12/17/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Pedunculated focal nodular hyperplasia masquerading as perigastric mass identified by EUS-FNA
A 35-year-old white woman was referred for EUS evaluation of a perigastric mass detected by CT scan (A) that was performed for chronic abdominal pain. EUS revealed a well-circumscribed, mixed echogenic 2.89-cm × 2.7-cm mass (B) that appeared to arise from the muscularis propria of the gastric wall with extramural extension. Although the EUS appearance was suggestive of a GI stromal tumor, rapid on-site evaluation of fine-needle aspiration (FNA) revealed uniform cells with granular cytoplasm, consistent with benign hepatocytes (C). (Source: Gastrointestinal Endoscopy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Validity, Reliability, and Responsiveness of the Korean Version of American Academy of Orthopedic Surgeons Foot and Ankle Questionnaire
Publication date: January–February 2015 Source:The Journal of Foot and Ankle Surgery, Volume 54, Issue 1 Author(s): Ji-Beom Kim , Je Kyun Kim , Sang Gyo Seo , Dong Yeon Lee The American Academy of Orthopaedic Surgeons Foot and Ankle Questionnaire (AFAQ) reflects patients' subjective disorder due to foot and ankle conditions. We evaluated the validity, reliability, and responsiveness of the Korean version of the AFAQ, after translation and transcultural adaptation of the original AFAQ into the Korean language. A total of 206 patients were enrolled, including 152 with chronic problems (experimental group) and 54 with acute problems (control group). We used the intraclass correlation coefficient to assess the test–retest reliability and Cronbach's α to assess internal reliability. Pear...


Ultrasonography-Guided Identification With Methylene Blue Tattooing of the Ilioinguinal Nerve for Neurectomy for Chronic Pain A Case Series
We present our experience in ilioinguinal neurectomy with preoperative ultrasonography-guided identification and perineural injection of methylene blue to tattoo the nerve. (Source: JAMA Surgery)


Bilateral femoral neck fractures secondary to chronic carbamazepine use treated by bilateral dynamic hip screw: A case report
Conclusion To our knowledge, this is the first case in the literature of bilateral femoral neck insufficiency fracture due to chronic carbamazepine use. Joint and bone pain with a history of long-term use of anti-epileptic drug should be investigated carefully, and insufficiency fractures should be kept in mind. (Source: International Journal of Surgery Case Reports)


Re: Atypical Microorganisms in Expressed Prostatic Secretion from Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Microbiological Results from a Case-Control Study
J. Xiao, L. Ren, H. Lv, Q. Ding, S. Lou, W. Zhang and Z. Dong (Source: The Journal of Urology)


Characterization of chronic pain in breast cancer survivors using the McGill Pain Questionnaire
The aim of the present study was to characterize pain in breast cancer survivors using the McGill Pain Questionnaire (MPQ). A descriptive, cross-sectional study was conducted with 30 women aged 30 to 80 years who had been submitted to treatment for breast cancer (surgery and complementary treatment) at least 12 months earlier with reports of pain related to the therapeutic procedures. Pain was characterized using the full-length version of the MPQ, which is made up of 78 descriptors divided into four categories: sensory (ten items), affective (five items), evaluative (one item) and miscellaneous (four items). (Source: Journal of Bodywork and Movement Therapies)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic Spinal and Oral Morphine‐Induced Neuroendocrine and Metabolic Changes in Noncancer Pain Patients
ConclusionsHypogonadotrophic hypogonadism was more prevalent in the morphine groups and was correlated with clinical findings. Significant bone mass loss occurred in morphine users, even without hormone dysfunction when compared to nonopioid treatment. Growth hormone, thyroid stimulating hormone, adrenocorticotrophic hormones, and cardiovascular risk parameters were less compromised in morphine users. (Source: Pain Medicine)


Do Male and Female General Practitioners Differently Prescribe Chronic Pain Drugs to Older Patients?
ConclusionMale and female GPs prescribe analgesics in a similar manner. However, male GPs prescribe more antineuropathic pain drugs, but fewer SySADOA. (Source: Pain Medicine)


Accuracy of the Modified Somatic Perception Questionnaire and Pain Disability Index in the Detection of Malingered Pain-Related Disability in Chronic Pain.
This study used a criterion groups validation design (retrospective cohort of patients with chronic pain, n = 328) with a simulator group (college students, n = 98) to determine the accuracy of the MSPQ and PDI in detecting Malingered Pain Related Disability. Patients were grouped based on independent psychometric evidence of MPRD. Results showed that MSPQ and PDI scores were not associated with objective medical pathology. However, they accurately differentiated Not-MPRD from MPRD cases. Diagnostic statistics associated with a range of scores are presented for application to individual cases. Data from this study can inform the clinical management of chronic pain patients by screening for psychological overlay and malingering, thus alerting clinicians to the possible presence of psychosoc...


Serotonin, glutamate and glycerol are released after the injection of hypertonic saline into human masseter muscles – a microdialysis study
Conclusions 5-HT, glutamate and glycerol increased after a painful hypertonic saline injection into the masseter muscle, but without sex differences. Since increased levels of 5-HT and glutamate have been reported in chronic myalgia, this strengthens the validity of the pain model. Glycerol warrants further investigations. (Source: The Journal of Headache and Pain)


Stop Saying Yoga Isn't Exercise
Professional athletes of all stripes say that incorporating yoga into their training is a great way to stay limber, flexible and build strength in muscles that might otherwise go ignored. But a new meta-analysis published Monday in the European Journal of Preventive Cardiology suggests that practicing breathing-based (or asana) yoga could also be a way to protect cardiovascular health. That puts yoga, an ancient spiritual practice that incorporates mind and body, in a class of activities that include walking and biking as a way to avoid weight gain, high blood pressure and high cholesterol levels. The meta-analysis authors are excited about the finding because yoga is a relatively accessible exercise to ease into for the elderly, those with joint or muscle pain or those with weak heart...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


9 Tips to Stop Anger and Injustice from Hurting You
Stop past hurts from hurting you now by dissolving anger and feelings of injustice. 9 tips and know-bits to get you started on release and freedom from trauma and betrayal.read more (Source: Psychology Today Relationships Center)


Reducing complexity: a visualisation of multimorbidity by combining disease clusters and triads
Conclusions: We were able to show which diseases were associated with each other in our data set, to which clusters the diseases were assigned, and which diseases were responsible for overlapping clusters. The disease with the highest number of associations, and the most important mediator between diseases, was chronic low back pain. In females, depression was also associated with many other diseases. We found a multitude of associations between disorders of the metabolic syndrome of which hypertension was the most central disease. The most prominent bridges were between the metabolic syndrome and musculoskeletal disorders. Guideline developers might find our approach useful as a basis for discussing which comorbidity should be addressed. (Source: BMC Public Health)


Low-dose oxycodone/naloxone for chronic pain in older patients
Guerriero F, Sgarlata C, Marcassa C, Ricevuti G, Rollone M (Source: Clinical Interventions in Aging)


Chronic Low-Back Pain Research Standards
This blog post by NCCAM Director Dr. Josephine Briggs presents a video clip about new research standards for low-back pain. (Source: NCCAM Featured Content)


Modeling pain in a dish: Nociceptors made from skin recreate pain physiology
We report and comment on medical innovations and advances &ndash; from bench to bedside &ndash; touching on scientific, business and policy issues. Our ranks include science writers, physicians, lab researchers, market analysts and others inside and outside the hospital. Neurons from patients could lead researchers to better drugs for chronic pain. By Nancy Fliesler Chronic pain, affecting tens of millions of Americans alone, is debilitating and demoralizing. It has many causes, and in the worst cases, people become "hypersensitized" &ndash; their nervous systems fire off pain signals in response to very minor triggers. Boston Children&#039;s HospitalNews Well, Vector Blog, Big Data, Blogread 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>


The Effect of Chronic Low Back Pain on Trunk Accuracy in a Multidirectional Isometric Tracking Task
Conclusion. The results provided additional evidence of a change in trunk control strategies in patients with chronic LBP. Decreased accuracy of trunk during isometric tracking tasks especially in higher levels of asymmetric exertions may explain higher risk of low back injuries in these activities. Level of Evidence: 4 (Source: Spine)


Plasma concentrations of lignocaine and prilocaine and analgesic efficacy in leg ulcer‐related pain during 10 days’ daily application of lignocaine‐prilocaine cream (EMLA™)
This article is protected by copyright. All rights reserved. (Source: British Journal of Dermatology)


Chronic constipation‐associated symptoms in Asians and non‐Asians, and effects of 12‐week prucalopride treatment: A pooled analysis of 4 randomized, placebo‐controlled trials
ConclusionsPrucalopride 2 mg/day was found to be well‐tolerated and efficacious in relieving all chronic constipation‐associated symptoms in both Asians and non‐Asians, except for abdominal pain in Asians, over 12 weeks, regardless of their severity. (Source: Journal of Digestive Diseases)


Genetic, epigenetic, and mechanistic studies of temporomandibular disorders and overlapping pain conditions
Discussions were directed toward formulating a set of recommendations to advance research in this field. (Source: BioMed Central)


Effectiveness of app-based relaxation for patients with chronic low back pain (Relaxback) and chronic neck pain (Relaxneck): study protocol for two randomized pragmatic trials
DiscussionThe designed studies reflect a usual self-care setting and will provide evidence on a pragmatic self-care intervention that is easy to combine with care provided by medical professionals.Trial registration: ClinicalTrials.gov identifier Relaxback NCT02019498, Relaxneck NCT02019134 registered on 18 December 2013. (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>


Undetected intraocular metallic foreign body causing hyphema in a patient undergoing MRI: A rare occurrence demonstrating the limitations of pre-MRI safety screening
The case reported is of a 47-year-old man with an undetected ferromagnetic metallic intraocular foreign body in the right eye who underwent elective MR examinations for chronic neck and low back pain. The patient underwent the MR scans and subsequently developed blurred vision in his right eye caused by a hyphema associated with an anterior chamber metallic foreign body. Case reports of orbital injuries in patients with intraocular metallic foreign bodies undergoing MRI are rare, with only one prior report in the radiology literature. (Source: Magnetic Resonance Imaging)


Plasma concentrations of lignocaine and prilocaine and analgesic efficacy in leg ulcer-related pain during 10 days' daily application of lignocaine-prilocaine cream (EMLA(™) ).
This article is protected by copyright. All rights reserved. PMID: 25494699 [PubMed - as supplied by publisher] (Source: The British Journal of Dermatology)


[Mesenteric panniculitis: A rare cause of chronic abdominal pain.]
Authors: Chebbi W, Jerbi S, Alaya W, Salem WB, Sfar MH PMID: 25522884 [PubMed - as supplied by publisher] (Source: Presse Medicale)


The global challenges and opportunities in the practice of rheumatology: White paper by the World Forum on Rheumatic and Musculoskeletal Diseases
The objective of this review is to increase awareness of the RMDs and to identify opportunities to address RMD challenges on both a local and global scale. On 26 September 2014, rheumatology experts from five different continents met at the World Forum on Rheumatic and Musculoskeletal Diseases (WFRMD) to discuss and identify some key challenges for the RMDs community today. The outcomes are presented in this review, focusing on access to rheumatology services, diagnostics and therapies, rheumatology education and training and on clinical trials, as well as investigator-initiated and epidemiological research. The long-term vision of the WFRMD is to increase perception of the RMDs as a major burden to society and to explore potential opportunities to improve global and local RMD care. (Sourc...


[Opioids in chronic low back pain : A systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks duration.]
CONCLUSION: Opioids were superior to placebo in terms of efficacy and inferior in terms of tolerability. Opioids and placebo did not differ in terms of safety during the study period. The conclusion on the safety of opioids compared to placebo is limited by the low number of serious adverse events and deaths. Short-term and intermediate-term opioid therapy may be considered in selected CLBP patients. The English full-text version of this article is freely available at SpringerLink (under "Supplemental"). PMID: 25503883 [PubMed - as supplied by publisher] (Source: Schmerz)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Bioactive dietary peptides and amino acids in inflammatory bowel disease.
Authors: Zhang H, Hu CA, Kovacs-Nolan J, Mine Y Abstract Inflammatory bowel disease (IBD), most commonly ulcerative colitis (UC) and Crohn's disease (CD), is a chronic inflammation of the gastrointestinal tract. Patients affected with IBD experience symptoms including abdominal pain, persistent diarrhea, rectal bleeding, and weight loss. There is no cure for IBD; thus treatments typically focus on preventing complications, inducing and maintaining remission, and improving quality of life. During IBD, dysregulation of the intestinal immune system leads to increased production of pro-inflammatory cytokines, such as TNF-α and IL-6, and recruitment of activated immune cells to the intestine, causing tissue damage and perpetuating the inflammatory response. Recent biological therapies ...


72. Impaired pain processing in patients with silent myocardial ischemia
The aim of the study was to investigate the nociceptive system in patients with silent Myocardial Ischemia (MI) by CO2 laser evoked potential (LEP) recording. We studied 3 groups: (1) 11 asymptomatic, non-diabetic patients with documented obstructive Coronary Artery Disease (CAD) (silent-MI group); (2) 10 patients with obstructive CAD showing the clinical pattern of chronic stable angina (symptomatic-MI group); (3) 14 healthy subjects matched for age and gender to patients (control group). LEPs were recorded from 3 electrodes, placed at Cz, Fz, and T3 according to 10–20 International System, in response to chest as well as right hand skin stimulation. (Source: Clinical Neurophysiology)


86. Efficacy of botulinum toxin on pain and spastic gait disorders in multiple sclerosis
To assess the efficacy of botulinum toxin (BT-A) and additional physiotherapy in subjects affected by progressive multiple sclerosis (MS) with chronic lower limb spasticity. 15 patients able to walk with assistance were consecutively recruited in a open-label study. All patients received a set of intramuscular injections of BT-A performed with EMG-guidance, according to each patient’s individual pattern of spasticity, followed by additional physiotherapy. Each patient was assessed at baseline, 6 and 12weeks for muscle tone, spasms frequency, leg pain, gait velocity, self-analysis of gait function. (Source: Clinical Neurophysiology)


Infantile colic, regurgitation, and constipation: an early traumatic insult in the development of functional gastrointestinal disorders in children?
Conclusion: According to our data, children with a history of gastrointestinal infantile distress have a higher prevalence of FGIDs years later. (Source: European Journal of Pediatrics)


Clinical implications of Prescribing Nonsteroidal Anti-inflammatory Drugs in Oral Health Care – A Review
This article reviews therapeutic and analgesic uses of NSAIDs in dentistry. The various issues surrounding NSAIDs-induced adverse reactions and its implications in dentistry are also discussed. Teaser Acute pain is the most common complaint that causes patients to seek help from oral healthcare professionals. NSAIDs are routinely prescribed drugs but they have been associated with adverse reactions. Therefore, medical history and analgesic requirement of patient is essential. (Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral 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>


Peri-articular suprascapular neuropathy
Publication date: December 2014 Source:Orthopaedics &amp; Traumatology: Surgery &amp; Research, Volume 100, Issue 8, Supplement Author(s): P. Clavert , H. Thomazeau Suprascapular nerve entrapment was first described in 1959 by Kopell and Thompson. Although rare, this condition is among the causes of poorly explained shoulder pain in patients with manifestations suggesting a rotator-cuff tear but normal tendons by imaging studies. Suprascapular nerve entrapment may cause 2% of all cases of chronic shoulder pain. Among the many reported causes of suprascapular nerve entrapment, the most common are para-labral cysts, usually in the spinoglenoid notch, and microtrauma in elite athletes. The potential relevance of concomitant rotator-cuff tears remains debated. Less common causes incl...


[Long-term opioid therapy in chronic noncancer pain : A systematic review and meta-analysis of efficacy, tolerability and safety in open-label extension trials with study duration of at least 26 weeks.]
CONCLUSION: Only a minority of patients selected for opioid therapy at randomization finished the long-term open-label study. However, sustained effects of pain reduction could be demonstrated in these patients. LtOT can be considered in carefully selected and monitored CNCP patients who experience clinically meaningful pain reduction with at least tolerable AE in short-term opioid therapy. The English full-text version of this article is freely available at SpringerLink (under "Supplementary Material"). PMID: 25503691 [PubMed - as supplied by publisher] (Source: Schmerz)


Cytokine expression provides clues to the pathophysiology of Gulf War illness and myalgic encephalomyelitis.
Authors: Khaiboullina SF, DeMeirleir KL, Rawat S, Berk GS, Gaynor-Berk RS, Mijatovic T, Blatt N, Rizvanov AA, Young SG, Lombardi VC Abstract Gulf War illness (GWI) is a chronic disease of unknown etiology characterized by persistent symptoms such as cognitive impairment, unexplained fatigue, pervasive pain, headaches, and gastrointestinal abnormalities. Current reports suggest that as many as 200,000 veterans who served in the 1990-1991 Persian Gulf War were afflicted. Several potential triggers of GWI have been proposed including chemical exposure, toxins, vaccines, and unknown infectious agents. However, a definitive cause of GWI has not been identified and a specific biological marker that can consistently delineate the disease has not been defined. Myalgic encephalomyelitis (ME...


Depression and attempted suicide under pregabalin therapy - Kustermann A, Möbius C, Oberstein T, Müller HH, Kornhuber J.
Originally developed for the treatment of epilepsy, pregabalin has become a compound with a wide spectrum of indications comprising anxiety disorders and chronic pain and is therefore largely prescribed. Thus, it is important for clinicians to be aware of ... (Source: SafetyLit: All (Unduplicated))


Giant inguinal hernia: the challenging hug technique
Conclusion The technique proposed permits to treat with success giant inguinaoscrotal hernia, avoiding the use of further specific procedure such as the preoperative progressive pneumoperitoneum. All our patients were satisfied with the surgeries and their quality of daily life had definitely improved. (Source: Hernia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic Low-Back Pain Research Standards
Several leading back pain journals have now published recommendations from the NIH Pain Consortium's Task Force on Research Standards for Chronic Low-Back Pain. Earlier this year, Dr. Partap Khalsa blogged about these recommended standards and the challenges of comparing studies and pooling data without such standards.   (Source: NCCAM Featured Content)


Stimwave Technologies launches new chronic pain trial for mini neurostim device
Stimwave Technologies launches a placebo-controlled trial of its miniature, wireless neuromodulation anti-pain device for treating chronic, non-specific-origin lower back pain. Stimwave Technologies said it's launching a new clinical trial for its miniature, wireless neuromodulation anti-pain device for treating chronic, non-specific-origin lower back pain. Stimwave TechnologiesNews Well, Clinical Trials, Neuromodulation/Neurostimulation, Pain Managementread more (Source: Mass Device)


A Pooled Analysis Evaluating the Efficacy and Tolerability of Tapentadol Extended Release for Chronic, Painful Diabetic Peripheral Neuropathy
Conclusion Results of this pooled analysis indicate that tapentadol ER was effective for managing DPN-related pain, and provided consistent analgesic efficacy across different patient subgroups. (Source: Clinical Drug Investigation)


A Virtual Refuge From Real Pain
Title: A Virtual Refuge From Real PainCategory: Health NewsCreated: 12/12/2014 12:00:00 AMLast Editorial Review: 12/12/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Pilot study: bone marrow stem cells as a treatment for dogs with chronic spinal cord injury
Conclusion: The transplantation of bone marrow stem may be a promising, reliable and safe treatment for chronic spinal cord injury. (Source: BioMed Central)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Effects of unstable shoes on chronic low back pain in health professionals: A randomized controlled trial
Conclusions The results of this clinical trial suggest that wearing unstable shoes for 6weeks significantly decreases low back pain in patients suffering from chronic low back pain but had no significant effect on quality of life and disability scores. (Source: Joint Bone Spine)


Study of the relationship of dyspnea with depression and functional status in patients with interstitial lung disease
Conclusion Dyspnea is common in ILD and is strongly correlated with functional status and psychiatric disorders. Dyspnea score, functional status and psychiatric disorders are more affected in ILD with PHTN than in ILD without PHTN. Accordingly, routine screening for mental disorders is recommended for patients with ILD, and should be accompanied by accurate assessment of patient’s symptoms, particularly in patients with high levels of functional impairment. (Source: Egyptian Journal of Chest Diseases and Tuberculosis)


Rare Occurrence of Chemical Peritonitis: A case report of laparoscopic management of spontaneous ruptured dermoid cyst in pregnancy and the literature review
Conclusion Careful management intraoperatively by intact removal of the cyst or copious peritoneal irrigation in case of ruptured cyst are crucial in preventing subsequent complications of chemical peritonitis. (Source: International Journal of Surgery Case Reports)


A case report of 3-level degenerative spondylolisthesis with spinal canal stenosis
Conclusion Thorough evaluation for multilevel segmental involvement in degenerative spondylolisthesis is important because of the frequency of severe symptomatic spinal stenosis or foraminal encroachment. Good surgical outcome can be expected from decompression and stabilisation. The pathogenesis of multi-level lumbar degenerative spondylolisthesis can be complex and heterogeneous. (Source: International Journal of Surgery Case Reports)


A study of respiratory function among the workers engaged in ginning processes
Conclusions: Studies on cotton textile workers have shown both cross-shift and chronic decline of values. In this study on ginning workers, chronic effect only is observed. This difference of observation may be explained by different nature of exposure in case of ginning. This study recommends regular periodic clinical examination, lung function test and monitoring of dust, gram-negative bacteria and endotoxins in such workplaces. (Source: Indian Journal of Occupational and Environmental 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>


IJERPH, Vol. 11, Pages 12938-12968: Overall Accessibility to Traveling by Rail for the Elderly with and without Functional Limitations: The Whole-Trip Perspective
Elderly persons’ perceived accessibility to railway traveling depends on their functional limitations/diseases, their functional abilities and their travel behaviors in interaction with the barriers encountered during whole trips. A survey was conducted on a random sample of 1000 city residents (65–85 years old; 57% response rate). The travels were perceived least accessible by respondents with severely reduced functional ability and by those with more than one functional limitation/disease (e.g., restricted mobility and chronic pain). Those who traveled “often”, perceived the accessibility to be better than those who traveled less frequently. For travelers with high functional ability, the main barriers to more frequent traveling were travel costs and low punctuality. For those wi...


Enhancement of nerve-injury-induced thermal and mechanical hypersensitivity in adult male and female mice following early life stress
Publication date: 15 January 2015 Source:Life Sciences, Volume 121 Author(s): Takashi Nishinaka , Kazuo Nakamoto , Shogo Tokuyama Aims Early life stress contributes to the pathogenesis of psychiatric disorders and chronic pain in adult patients. However, information about the effect of early life stress on chronic pain in mice is limited. In the present study, we evaluated the effect of early life stress on baseline pain sensitivity and thermal or mechanical hypersensitivity induced by nerve injury in male and female mice. Main methods Early life stress was induced by maternal separation and social isolation (MSSI). Mice were separated from dam and littermates for 6h/day during postnatal days 15–21 and then were housed individually until the end of the study. At 9weeks of age, the sci...


Pain perception in narcolepsy with cataplexy patients
Narcolepsy with cataplexy (NC) has an estimated prevalence of 0.026% to 0.056% [1], and it results from a selective loss of hypocretin/orexin-producing neurons in the lateral hypothalamus. Recent studies have highlighted the role of hypocretin/orexin in central nociceptive processing [2,3], and it has been reported that chronic pain is more common and disabling in people with NC compared to healthy controls [4]. The present study hypothesized that hypocretin/orexin deficiency in NC might lead to a dysregulation in the control of nociception. (Source: Sleep Medicine)


Threatening Social Context Facilitates Pain-related Fear Learning
This study investigated the effects of a threatening and a safe social context on learning pain-related fear, a key factor in the development and maintenance of chronic pain. We measured self-reported pain intensity, pain expectancy, pain-related fear (verbal ratings and eyeblink startle responses), and behavioral measures of avoidance (movement-onset latency and duration), using an established differential voluntary movement fear conditioning paradigm. Participants (N = 42) performed different movements with a joystick: during fear acquisition one movement direction (CS+) was followed by a painful stimulus (pain-US) whereas another movement (CS-) was not. (Source: The Journal of Pain)


Clinical implications of prescribing nonsteroidal anti-inflammatory drugs in oral health care—a review
Nonsteroidal anti-inflammatory drugs (NSAIDs), including both the traditional nonselective NSAIDs and the selective cyclooxygenase (COX)-2 inhibitors, are widely used for their anti-inflammatory and analgesic effects. They are routinely prescribed in dental practice for the management of pain and swelling. Their use in treating acute dental pain and chronic orofacial pain, as adjuncts to the treatment of periodontal disease, and to minimize edema following surgical procedures is well documented. (Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chicago Is Holding Big Pharma Accountable for Their Role in Fueling the Rx Opioid Abuse Epidemic
At the Chicago Department of Public Health, many of the diseases we seek to fend off are as inevitable as natural disasters, but the prescription drug epidemic -- consisting largely of the abuse of narcotic prescription pain medications known as opioids -- is not. Mayor Rahm Emanuel is taking action and proving Chicago is a leader in the U.S. in the fight against this preventable addiction, which was fueled in part by pharmaceutical companies seeking to increase their profits. This manufactured epidemic of addiction has taken a toll on our country's health systems, a problem most recently documented in a national study of hospital emergency department visits for opioid overdoses in JAMA Internal Medicine. The study found that nearly seven in 10 opioid overdoses that were treated in emer...


A Virtual Refuge From Real Pain
Some researchers have turned to virtual reality to help certain people control temporary pain during procedures -- but research is expanding into ongoing, chronic pain as well. (Source: WebMD Health)


Cognitive behavioural treatment for the chronic post-traumatic headache patient: a randomized controlled trial - Kjeldgaard D, Forchhammer HB, Teasdale TW, Jensen RH.
BACKGROUND: Chronic post-traumatic headache (CPTH) after mild head injury can be difficult to manage. Research is scarce and successful interventions are lacking.To evaluate the effect of a group-based CBT intervention in relation to headache, pain percept... (Source: SafetyLit: All (Unduplicated))


Chronic low-back pain research standards announced by NIH task force
Better research may help address health issue that affects millions An NIH task force has announced new recommended standards for clinical low-back pain research. The standards will promote more consistent research design and should aid in the development of better approaches to the treatment of chronic low-back pain. (Source: NCCAM Featured Content)


Evidence-based clinical practice guidelines for irritable bowel syndrome
Abstract New strategies for the care of irritable bowel syndrome (IBS) are developing and several novel treatments have been globally produced. New methods of care should be customized geographically because each country has a specific medical system, life style, eating habit, gut microbiota, genes and so on. Several clinical guidelines for IBS have been proposed and the Japanese Society of Gastroenterology (JSGE) subsequently developed evidence-based clinical practice guidelines for IBS. Sixty-two clinical questions (CQs) comprising 1 definition, 6 epidemiology, 6 pathophysiology, 10 diagnosis, 30 treatment, 4 prognosis, and 5 complications were proposed and statements were made to answer to CQs. A diagnosis algorithm and a three-step treatment was provided for patients with ...


Prevalence and Risk Factors of Helicobacter pylori Infection in Saudi Children: A Three‐Year Prospective Controlled Study
ConclusionHelicobacter pylori infection had a high prevalence among Saudi children in the cities of Jeddah and Riyadh. It was a relatively common cause of abdominal pain and anorexia. In this cohort of children, H. pylori infection was associated with variables indicative of a crowded environment and poor living conditions, further supporting the conclusion that improving socioeconomic conditions and designing a preventive health strategy in Saudi Arabia will likely protect children against this infection. (Source: Helicobacter)


New insights and challenges in microscopic colitis
Microscopic colitis (MC) is described as an inflammatory bowel disease characterized by chronic, bloodless diarrhea with normal or close to normal endoscopic findings. Histopathological examination reveals two subtypes: collagenous colitis (CC) and lymphocytic colitis (LC), which are indistinguishable clinically. The disease debuts typically in middle-aged patients, but can occur at all ages, including children. A female predominance is found in both CC and LC, but is not confirmed by others in LC. The etiology is unclear, but the disease has been assumed to be of autoimmune origin. However, several etiologies may render a microscopic inflammation in the mucosa; this is a common, universal reaction to a variety of irritants in contact with the intestinal lumen. Furthermore, some patients w...


The Role of Parent Psychological Flexibility in Relation to Adolescent Chronic Pain: Further Instrument Development
Parental responses to their child's pain are associated with the young person's functioning. Psychological flexibility, defined as the capacity to persist with or change behavior, depending on one’s values and the current situation, while recognizing cognitive and non-cognitive influences on behavior, may provide a basis for further investigating the role of these responses. The Parent Psychological Flexibility Questionnaire (PPFQ) is a promising but preliminary measure of this construct. Parents of 332 young people with pain (301 mothers, 99 fathers, 68 dyads) completed the PPFQ during appointments in a pediatric pain clinic. (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>


Experience of adjunctive cannabis use for chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) study
Chronic non-cancer pain (CNCP) is a common disorder that makes a major contribution to disease burden. The recent Global Burden of Disease 2010 study estimated that in 2010, low back pain, neck pain and migraines were the 1st, 4th and 8th largest contributors respectively to global non-fatal health burden (years lived with disability; Vos et al., 2012). CNCP also affects other domains, and can have a major adverse impact on social and financial well-being, as well as health care costs (Beubler et al., 2006). (Source: Drug and Alcohol Dependence)


Electroacupuncture inhibits excessive interferon-{gamma} evoked up-regulation of P2X4 receptor in spinal microglia in a CCI rat model for neuropathic pain
Conclusions EA ameliorated tactile allodynia after peripheral nerve injury by down-regulating excessive expression of IFN- in the spinal cord and subsequently reducing expression of P2X4R. (Source: British Journal of Anaesthesia)


Isometric yoga improves the fatigue and pain of patients with chronic fatigue syndrome who are resistant to conventional therapy: a randomized, controlled trial
Background: Patients with chronic fatigue syndrome (CFS) often complain of persistent fatigue even after conventional therapies such as pharmacotherapy, cognitive behavioral therapy, or graded exercise therapy. The aim of this study was to investigate in a randomized, controlled trial the feasibility and efficacy of isometric yoga in patients with CFS who are resistant to conventional treatments. Methods: This trial enrolled 30 patients with CFS who did not have satisfactory improvement after receiving conventional therapy for at least six months. They were randomly divided into two groups and were treated with either conventional pharmacotherapy (control group, n?=?15) or conventional therapy together with isometric yoga practice that consisted of biweekly, 20-minute sessions with a yoga ...


The analgesic-like properties of the alpha7 nAChR silent agonist NS6740 is associated with non-conducting conformations of the receptor.
Authors: Papke RL, Bagdas D, Kulkarni AR, Gould T, AlSharari SD, Thakur GA, Damaj MI Abstract The α7 nicotinic acetylcholine receptor (nAChR) is a promising drug target for a number of neurological disorders including chronic pain and inflammatory diseases. Since α7 can function as a ligand-gated ion channel, drug development initially focused on ligands that were selective activators of the α7 ion channel. However, the best α7 drugs for chronic pain and inflammation indications may not be ion channel activators but rather "silent agonists", which bind to the receptor but preferentially induce non-conducting states that modulate signal transduction in non-neuronal cells. One such compound is NS6740. We show that NS6740 selectively induces prolonged desensitization of α7 nAChRs...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Hyperkyphosis and back pain are not associated with prevalent vertebral fractures in women with osteoporosis.
In conclusion, these data suggest that prevalent VFs are not significantly associated with kyphosis or chronic back pain, in patients with manifest spinal osteoporosis. PMID: 25495768 [PubMed - as supplied by publisher] (Source: Physiotherapy Theory and Practice)


A retrospective study of the clinical benefit from acetylsalicylic acid desensitization in patients with nasal polyposis and asthma
Conclusions: ASA desensitization helps improve symptoms in patients with AERD. Further, it allows patients to tolerate additional ASA and other non-steroidal anti-inflammatories (NSAIDs) when needed for supplemental analgesia or for cardio-protection. This is of particular benefit in those who require these medications for improved quality of life, and for reduced morbidity and mortality, such as those with cardiovascular disease or chronic pain. There should be further studies conducted in Canada as well as consideration for ASA desensitization to be included in the next clinical practice guidelines. (Source: Allergy, Asthma and Clinical Immunology)


Loving Someone with Borderline Personality Disorder
Caring about someone with borderline personality disorder (BPD) tosses you on a roller coaster ride from being loved and lauded to abandoned and bashed. Having BPD is no picnic, either. You live in unbearable psychic pain most of the time on the border between reality and psychosis. Your illness distorts your perceptions, causing antagonistic behavior and making the world a perilous place. The pain and terror of abandonment and feeling unwanted can be so great that suicide feels like a better choice. If you like drama, excitement, and intensity, enjoy the ride, because things will never be calm. Following a passionate beginning, expect a stormy relationship that includes accusations and anger, jealousy, bullying, control, and breakups due to the insecurity of the person with BPD. Nothing i...


Picture of Slipped Disc
Title: Picture of Slipped DiscCategory: ImagesCreated: 2/3/2011 1:13:00 PMLast Editorial Review: 12/10/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Chronic multisite pain in major depression and bipolar disorder: cross-sectional study of 149,611 participants in UK Biobank
Individuals who report chronic pain and multiple sites of pain are more likely to have depression and are at higher risk of bipolar disorder, highlighting an important aspect of comorbidity between these two disorders. (Source: BMC 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>


Measuring the Pain Area: An Intra‐ and Inter‐Rater Reliability Study Using Image Analysis Software
Abstract Pain drawings have frequently been used for clinical information and research. The aim of this study was to investigate intra‐ and inter‐rater reliability of area measurements performed on pain drawings. Our secondary objective was to verify the reliability when using computers with different screen sizes, both with and without mouse hardware. Pain drawings were completed by patients with chronic neck pain or neck–shoulder–arm pain. Four independent examiners participated in the study. Examiners A and B used the same computer with a 16‐inch screen and wired mouse hardware. Examiner C used a notebook with a 16‐inch screen and no mouse hardware, and Examiner D used a computer with an 11.6‐inch screen and a wireless mouse. Image measurements were obtained using GIMP and...


Could acupuncture be useful in the treatment of Temporomandibular Dysfunction?
In this study the effects of acupuncture in comparison with flat occlusal plane appliance were evaluated in patient with myogenic TMD. The sample consisted of 40 women with TMD and unbalanced energy predominance of Yang Liver Ascension, selected by the Renying and Cunkou pulses, randomly divided into 2 groups: acupuncture and splint. The effect of treatments on the masseter and anterior temporal muscles was evaluated after the period of 4 weeks of treatment, by means of electromyographic activity (Root Mean Square – RMS) and Pain Pressure Threshold (PPT). Pain intensity was measured by Visual Analog Scale (VAS) and range of mouth opening (ROM) was evaluated with a millimeter ruler. All evaluations were performed at the beginning and end of treatment. VAS was reduced equally in the two gr...


Intestinal capillariasis in the 21 st century: clinical presentations and role of endoscopy and imaging
Conclusions: In endemic area, intestinal capillariasis should be considered if patients develop chronic watery diarrhea accompanied by significant weight loss and severe hypoalbuminemia. Stool examination had quite low sensitivities in making diagnosis in our study. Deep enteroscopy with biopsy guided by imaging or VCE may improve diagnostic yield. Empirical therapy may also be justifiable due to the very good response rate and less side effects. (Source: BMC Gastroenterology)


Adolescents of parents with chronic pain whose parents were 'shut off' report more hardship and feelings of distance than those with a more open relationship
Commentary on: Umberger W, Martsolf D, Jacobson A, et al.. The shroud: ways adolescents manage living with parental chronic pain. J Nurs Scholarsh 2013;45:344&ndash;54. Implications for practice and research Social connectedness, for example having friends and other caring adults outside the family, is essential for healthy adolescent development. Family members, including adolescents, must be included in the assessment and planning of interventions for adults with chronic pain. Future research with larger samples and data from additional family members could further validate the concepts and processes identified in this study. Context It is estimated that nearly one-third of people over 18&nbsp;years of age have experienced chronic pain lasting at least 6&nbsp;months.1 When chronic pain a...


Efficacy of the addition of interferential current to Pilates method in patients with low back pain: a protocol of a randomized controlled trial
This study will be a randomized controlled trial with two arms and blinded evaluator, conducted at an outpatient Physical Therapy Department in Brazil. Patients with nonspecific chronic low back pain and pain equal to or greater than 3 in the Pain Numerical Rating Scale (0/10) will be randomly assigned to one of two groups: Group with active interferential current + Pilates (n = 74) will be submitted to the active interferential current associated to the modified Pilates exercises, and Group with sham interferential current + Pilates (n = 74) will be submitted to the sham interferential current associated with the modified Pilates exercises during 18 sessions. The outcomes pain intensity, pressure pain threshold, general and specific disability, global perceived effect and kinesiophobia wi...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Autologous Islet Transplantation With Remote Islet Isolation After Pancreas Resection for Chronic Pancreatitis
Conclusions and RelevancePancreatic resection with autologous islet transplantation for severe chronic pancreatitis is a safe and effective final alternative to ameliorate debilitating pain and to help prevent the development of surgical diabetes. Because many centers lack access to an islet-isolating facility, we describe our experience using a regional 2-center collaboration as a successful model to remotely isolate cells, with outcomes similar to those of larger case series. (Source: JAMA Surgery)


The involvement of the TRPA1 receptor in a mouse model of sympathetically maintained neuropathic pain.
Authors: Pinheiro FD, Villarinho JG, da Silva CR, de Oliveira SM, Pinheiro KD, Petri D, Rossato MF, Guerra GP, Trevisan G, Antonello Rubin M, Geppetti P, Ferreira J, André E Abstract Sympathetic fibres maintain some forms of neuropathic pain, but the underlying mechanisms are poorly understood. Therefore, this study investigated the possible involvement of transient receptor potential ankyrin 1 (TRPA1) and the role of the sympathetic nervous system (involved in sympathetically maintained neuropathic pain) in a model of neuropathic pain induced by sciatic nerve chronic constriction injury (CCI) in mice. Systemic injection of the selective TRPA1 antagonist HC-030031 reversed the mechanical and cold allodynia that was induced by sciatic nerve chronic constriction injury (CCI). Nerve ...


Life and Death on Your Terms
There comes a time when, despite your own and your family's wishes, beliefs or hope, death stares you in the face. A defining moment comes when you, as a family member, realize you are no longer prolonging a loved one's life but prolonging your loved one's dying process. I have learned that no one can tell you when that time is; it is a point that one must reach on their own. The decision to let go is usually made after endless hours at your loved one's bedside and recognizing the pain and suffering your loved one has endured. I have watched countless doctors and nurses attempt to convey the need to make a decision to a family, but the advice is usually offered in vain. The timing is personal to every family. Families can make various choices at the end of life. Different agencies can as...


Risk Factors for the Development of Chronic Back Pain After Percutaneous Vertebroplasty Versus Conservative Treatment
In conclusion, 23 % of patients with symptomatic osteoporotic VF developed severe CBP independently of the type of treatment. Symptom onset time before VP and persistence of severe CBP after treatment were the main factors related to CBP with teriparatide treatment decreasing the risk of this complication. (Source: Calcified Tissue International)


Age-related cutoffs for cervical movement behaviour to distinguish chronic idiopathic neck pain patients from unimpaired subjects
Conclusions By including such classifications, the present findings expand actual research stating an age-related decrease in kinematic behaviour only using categorising span widths across decades. Future study is warranted to reveal our results’ potential applicability for intervention onset decision making for idiopathic neck pain patients. (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>


Spinal Modulation closes enrollment in Axium chronic pain study
Spinal Modulation closes enrollment in a U.S. pivotal study of its Axium neurotransmitter system for the treatment of chronic pain. Spinal Modulation said it completed enrollment in a U.S. pivotal study of its Axium neurotransmitter system for the treatment of chronic pain. Spinal Modulation, St. Jude MedicalNews Well, Clinical Trials, Neuromodulation/Neurostimulation, Pain Managementread more (Source: Mass Device)


U.S. Doctors Cutting Back on Painkiller Prescriptions: Study
Title: U.S. Doctors Cutting Back on Painkiller Prescriptions: StudyCategory: Health NewsCreated: 12/8/2014 12:00:00 AMLast Editorial Review: 12/9/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Health Tip: Battling Bunion Pain
Title: Health Tip: Battling Bunion PainCategory: Health NewsCreated: 12/9/2014 12:00:00 AMLast Editorial Review: 12/9/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Hammer Toe
Title: Hammer ToeCategory: Doctor's ViewsCreated: 10/6/2005 12:00:00 AMLast Editorial Review: 12/9/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Quality of life in relation to the traffic pollution indicators NO2 and NOx: results from the Swedish GA(2)LEN survey.
CONCLUSIONS: At moderate exposure levels traffic pollution appears not to affect quality of life. PMID: 25478186 [PubMed - as supplied by publisher] (Source: Respiratory Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Impact of a multidisciplinary pain program for the management of chronic low back pain in patients undergoing spine surgery and primary total hip replacement: a retrospective cohort study.
CONCLUSIONS: The indication for surgical intervention in patients with chronic low back pain and degenerative diseases must be critically assessed. THA in this cohort should focus on functional aspects, such as the improvement of range of motion, rather than the reduction of pain. Spine surgery in chronic low back pain patients after multidisciplinary pain program including cognitive - behavioral therapy cannot be recommended due to its questionable success. PMID: 25473419 [PubMed - as supplied by publisher] (Source: Patient Safety in Surgery)


Chronic Idiopathic Anal Pain. Results of a Diagnostic-Therapeutic Protocol in a Colorectal Referral Unit
Conclusion Through proper anamnesis, physical examination and complementary tests, a specific diagnosis of the cause of CAP by FAD can be achieved, reducing exclusion diagnosis of CIAP to 25% of cases. Conservative measures combined with biofeedback achieved an improvement in pain in more than 40% of the cases of CIAP in our study. Sacral nerve stimulation can be considered as a treatment option in refractory cases. (Source: Cirugia Espanola)


Open incisional hernia repair with a self-gripping retromuscular Parietex mesh: A retrospective cohort study
This study aimed to evaluate the safety and feasibility of the Parietex™ Progrip self-gripping mesh in retromuscular position for the treatment of incisional hernias. (Source: International Journal of Surgery)


Suppression of MicroRNA-155 Attenuates Neuropathic Pain by Regulating SOCS1 Signalling Pathway.
Authors: Tan Y, Yang J, Xiang K, Tan Q, Guo Q Abstract Chronic neuropathic pain is an unfavourable pathological pain characterised by allodynia and hyperalgesia which has brought considerable trouble to people's physical and mental health, but effective therapeutics are still lacking. MicroRNAs (miRNAs) have been widely studied in the development of neuropathic pain and neuronal inflammation. Among various miRNAs, miR-155 has been widely studied. It is intensively involved in regulating inflammation-associated diseases. However, the role of miR-155 in regulating neuropathic pain development is poorly understood. In the present study, we aimed to investigate whether miR-155 is associated with neuropathic pain and delineate the underlying mechanism. Using a neuropathic pain model of ...


Autologous platelet-rich plasma in treatment of chronic venous leg ulcers: A prospective case series.
CONCLUSION: Platelet-rich plasma seems effective in terms of promoting healing of venous leg ulcers. Improvement in wound depth was slightly more prominent than that in wound area, indicating a potential role of platelet-rich plasma especially in deep venous ulcers. PMID: 25492574 [PubMed - as supplied by publisher] (Source: Vascular)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Attenuation of oxidative stress, inflammation and apoptosis by ethanolic and aqueous extracts of Crocus sativus L. stigma after chronic constriction injury of rats.
In this study, we explored anti-inflammatory, anti-oxidant and anti-apoptotic effects of such extracts in CCI animals. A total of 72 animals were divided as vehicle-treated CCI rats, sham group, CCI animals treated with the effective dose of aqueous and ethanolic extracts (200 mg/kg, i.p.). The lumbar spinal cord levels of proinflammatory cytokines including tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β) and interleukin 6 (IL-6), were evaluated at days 3 and 7 after CCI (n=3, for each group). The apoptotic protein changes were evaluated at days 3 and 7 by western blotting. Oxidative stress markers including malondialdehyde (MDA) and glutathione reduced (GSH), were measured on day 7 after CCI. Inflammatory cytokines levels increased in CCI animals on days 3 and 7, which were su...


Effect of Pain Neuroscience Education and dry needling on chronic elbow pain as a result of cyberchondria: a case report.
Authors: Anandkumar S Abstract Abstract This case report describes a 31-year-old male who presented with complaints of chronic pain in his right elbow. Detailed subjective examination revealed that the patient had searched Google for extensive online information relating to his pain, ultimately self-labeling with various diagnoses. After researching in YouTube, the patient self-treated with ice, exercises, neural mobilization, self-massage and taping, all resulting in a failed outcome. Clinical findings revealed trigger points in his right brachioradialis muscle with added symptoms of central pain. This is a potential first-time description of physical therapy management of brachioradialis myofascial pain syndrome with superadded central pain caused as a result of cyberchondria whe...


Therapeutic potential of group III metabotropic glutamate receptor ligands in pain.
Authors: Acher F, Goudet C Abstract Metabotropic glutamate receptors (mGluRs) modulate neurotransmission all along the pain neuraxis. While the involvement of group I and group II mGluRs in pain is well documented, information has only just started to emerge concerning the role and contribution of group III mGluRs subtypes to pain modulation. Recent data suggest that these receptors reduce symptoms in animal models of chronic pain, as well as regulate neurotransmission at different levels of ascending and descending pain pathway, suggesting that group III mGluRs may be interesting therapeutic targets for the development of analgesics. PMID: 25498980 [PubMed - as supplied by publisher] (Source: Current Opinion in Pharmacology)


Prospects for Treating Chronic Pain Are Improving
Burning. Aching. Shooting. Whatever form it takes, chronic pain can defy treatment. New insights into the causes are leading to fresh ideas for combating it -- Read more on ScientificAmerican.com (Source: Scientific American - Official RSS Feed)


Is Internet use unhealthy? A cross-sectional study of adolescent Internet overuse.
CONCLUSIONS: Our results confirm that problematic internet users report health problems more frequently, with lack of sleep being the most strongly associated and seeming to act as mediator regarding the other ones. Clinicians should remember to screen for excessive internet use their patients complaining of sleep-related problems, back or musculoskeletal pain or overweight. Clinicians should advise parents to limit the amount of time their adolescent children can spend online for leisure activities. Furthermore, limiting the number of devices used to connect to the internet could help warrant enough sleeping time. PMID: 25474244 [PubMed - in process] (Source: Swiss Medical Weekly)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Descending mechanisms activated by the anterior pretectal nucleus initiate but do not maintain neuropathic pain in rats
ConclusionAPtN exerts a tonic inhibitory influence on persistent pain. The results point out to an important role of opioid and serotonergic mediation into the APtN to inhibit hyperalgesia during the initial phase of neuropathic pain. (Source: European Journal of Pain)


Multisite musculoskeletal pain predicts medically certified disability retirement among Finns
ConclusionsThe number of pain sites independently predicted DP retirement. Employees with multisite pain may need specific support to maintain their work ability. (Source: European Journal of Pain)


An update on pathophysiological mechanisms related to idiopathic oro‐facial pain conditions with implications for management
Summary Chronic oro‐facial pain conditions such as persistent idiopathic facial pain (PIFP), atypical odontalgia (AO) and burning mouth syndrome (BMS), usually grouped together under the concept of idiopathic oro‐facial pain, remain a diagnostic and therapeutic challenge. Lack of understanding of the underlying pathophysiological mechanisms of these pain conditions is one of the important reasons behind the problems in diagnostic and management. During the last two decades, neurophysiological, psychophysical, brain imaging and neuropathological methods have been systematically applied to study the trigeminal system in idiopathic oro‐facial pain. The findings in these studies have provided evidence for neuropathic involvement in the pathophysiology of PIFP, AO and BMS. The present qua...


Patient-centered medical homes bested others in chronic pain management
Read the full story on MD Consult: Patient-centered medical homes bested others in chronic pain management (Source: MD Consult: News: Top Stories)


Cumulative Life Course Impairment (CLCI): A new concept to characterize persistent patient burden in chronic wounds
Publication date: July 2013 Source:Wound Medicine, Volume 1 Author(s): Matthias Augustin , Anke Mayer , Lisa M. Goepel , Katrin Baade , Kristina Heyer , Katharina Herberger Cumulative Life Course Impairment (CLCI) is a theoretical construct referring to the non-reversible burden of a chronic skin disease over time. In some patients and situations, this burden may lead to chronic impairment and missed opportunities and, finally, persisting psychosocial and personal damage. Chronic wounds such as leg ulcers, diabetic or ischemic foot ulcers and pressure ulcers are a heterogeneous group of chronic tissue defects which share the stagnation of wound healing due to an underlying disease. Most patients suffer from marked reductions of quality of life, including pain, physical discomfort, functi...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 assessment in elderly adults with dementia
Publication date: December 2014 Source:The Lancet Neurology, Volume 13, Issue 12 Author(s): Thomas Hadjistavropoulos , Keela Herr , Kenneth M Prkachin , Kenneth D Craig , Stephen J Gibson , Albert Lukas , Jonathan H Smith Chronic pain is highly prevalent in the ageing population. Individuals with neurological disorders such as dementia are susceptible patient groups in which pain is frequently under-recognised, underestimated, and undertreated. Results from neurophysiological and neuroimaging studies showing that elderly adults are particularly susceptible to the negative effects of pain are of additional concern. The inability to successfully communicate pain in severe dementia is a major barrier to effective treatment. The systematic study of facial expressions through a computerised s...


Prescription Drug Abuse A National Survey of Primary Care Physicians
Chronic pain is one of the most common reasons for seeking medical attention in the United States, and such pain is frequently treated with prescription opioids. The clinical use of these products nearly doubled between 2000 and 2010, with simultaneous increases in the incidence of opioid abuse, addiction, injury, and death. Because primary care physicians play a critical role in maximizing the safe use of these products, we examined their beliefs and self-reported practices regarding prescription opioid use. (Source: JAMA Internal Medicine)


Evaluation and Comparison of Postmortem Hydrocodone Concentrations in Peripheral Blood, Central Blood and Liver Specimens: A Minimal Potential for Redistribution
Hydrocodone is a widely prescribed analgesic opioid used to treat chronic pain [1]. For this reason, it may also be abused [2] and can contribute wholly or partly to the death of an individual exposed to it [3,4]. Blood concentrations of hydrocodone and its metabolite dihydrocodeine [5] are widely used as evidence to determine cause of death (Fig. 1) [6]. Postmortem concentrations of drugs are often difficult to interpret because many variables need to be considered. This is particularly true because concentrations in postmortem samples may not necessarily reflect the original drug concentration at the time of death [7,8]. (Source: Forensic Science International)


Lipidomic Profiling of Mastoid Bone and Tissue from Patients with Chronic Otomastoiditis
Conclusion We used a lipidomics approach to develop an efficient (both in time and tissue amount) methodology for analysis of these tissues, identify the most abundant and common lipid species, and create a base of knowledge from which more focused endeavors in biomarker discovery can emerge. In an effort toward improved patient categorization and individualized intervention, the ultimate goal of this work is to correlate these lipid molecules to disease state and progression. This is the first reported study of its kind on these tissues.[...]Thieme Publicações Ltda Rio de Janeiro, BrazilArticle in Thieme eJournals:Table of contents  |  Abstract  |  open access Full text (Source: International Archives of Otorhinolaryngology)


Mechanism of spinal pain transmission and its regulation.
Authors: Watanabe C Abstract   Morphine has been widely used for the treatment of acute, chronic, and cancer pain and is considered the strongest analgesic in clinical care. Conversely, morphine-induced analgesia may be accompanied by several side effects. Animal studies have demonstrated that low doses of morphine administered intrathecally can produce reliable analgesia for thermal, mechanical, and chemical nociceptive stimulation. On the other hand, high doses of morphine administered intrathecally may induce spontaneous nociceptive responses such as scratching, biting, and licking in mice as well as agitation and vocalization in rats. In addition, similar nociceptive responses including hyperalgesia, allodynia, and myoclonus have been observed in humans following intrathecal ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Electromyographic and patient-reported outcomes of a computer-guided occlusal adjustment performed on patients suffering from chronic myofascial pain.
Conclusions: According to this EMG study, this computer-guided occlusal adjustment is able to reduce the activity of the masseters and the self-reported muscular pain of patients one-month after treatment. PMID: 25475783 [PubMed - as supplied by publisher] (Source: Medicina Oral, Patologia Oral y Cirugia Bucal)


Periodontal therapy for severe chronic periodontitis with periodontal regeneration and different types of prosthesis.
We report a patient with severe chronic periodontitis requiring regenerative periodontal surgery and different types of prosthesis in the maxillary and mandibular regions. The patient was a 57-year-old woman who presented with the chief complaint of occlusal pain. An initial clinical examination revealed that 73% of sites had a probing depth of ≥4 mm, and 60% of sites exhibiting bleeding on probing. Radiographic examination revealed vertical bone defects in the molar region and widening of the periodontal ligament space around teeth #17 and 24. Initial periodontal therapy was implemented based on a clinical diagnosis of severe chronic periodontitis. Surgical periodontal therapy was subsequently performed at selected sites. Periodontal regenerative therapy using enamel matrix derivative w...


Familial hypocalciuric hypercalcemia associated with crystal deposition disease
We report the case of a 61-year-old female with chronic hypercalcemia and joint pain. Clinical and biological data revealed chondrocalcinosis associated with FHH. Since primary hyperparathyroidism may mimic FHH, calcium to creatinine clearance ratio should be calculated in every case to avoid a wrong diagnosis and useless parathyroid surgery. The paucity of FFH complications, including chondrocalcinosis, makes their study difficult: additional studies are needed to clearly evaluate the link between FHH and chondrocalcinosis. (Source: Joint Bone Spine)


P006 Association between trigeminal neuralgia and multiple sclerosis: A population-based study
Conclusions Our results showed a significant association between these two disorders supporting previous hypothesis based on the role of MS in etiology of TN. (Source: Multiple Sclerosis and Related Disorders)


[Practice of regional anesthesia for chronic pain patients in specialized pain services : A nationwide survey in Germany.]
CONCLUSION: This survey describes the current structures of specialized pain facilities for regional anesthesia in Germany including responses from predominantly anesthesiologists in a hospital-associated setting. In light of the limited evidence in the literature there is no consensus on the interventional therapeutic management of chronic pain. Especially the application of a series of blocks and the frequency as well as criteria to support continuing or terminating a series of regional anesthesia interventions are not sufficiently evaluated. This survey also gives an incentive for a possible revision of the existing practice in regional anesthesia in the context of multimodal therapy and currently existing guidelines in future clinical studies. PMID: 25479710 [PubMed - as supplied b...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Mollie's Story: A Case and a Place That Exemplify Person-Centered Care.
Authors: Nelson EC, Lazar J Abstract First we present a case vignette. Mollie is a 50-year-old woman with chronic, disabling back and knee pain, who has struggled with depression and alcohol misuse, is the primary caregiver for her ailing mother and a newcomer to the community. As a primary care patient at Dartmouth Health Connect, whose mission is "bringing humanity back to health care," Mollie receives exemplary person-centered care from her physician, health coach and behavioral health specialist. Second, we summarize the care model design features that enable care for people with challenging health and social circumstances. The design features include: primary care capitation, interdisciplinary team care, daily huddles and bi-weekly work rounds, and systematic use of patient-re...


The Psychological Evaluation of Patients with Chronic Pain: a Review of BHI 2 Clinical and Forensic Interpretive Considerations.
This article will review how the BHI 2 was developed, BHI 2 concepts, validation research, and an overview of the description and interpretation of its scales. Like all measures, the BHI 2 has strengths and weaknesses of which the forensic psychologist should be aware, and particular purposes for which it is best suited. Guided by that knowledge, the BHI 2 can play a useful role in the forensic psychologist's toolbox. PMID: 25478059 [PubMed - as supplied by publisher] (Source: Pain Physician)


Percutaneous vertebroplasty of the entire thoracic and lumbar vertebrae for vertebral compression fractures related to chronic glucocorticosteriod use: case report and review of literature.
We report a case of a 67-year-old man with intractable pain caused by successional VCFs treated by PVP. PMID: 25469092 [PubMed - in process] (Source: Korean Journal of Radiology)


Mollie's Story: A Case and a Place That Exemplify Person-Centered Care
First we present a case vignette. Mollie is a 50-year-old woman with chronic, disabling back and knee pain, who has struggled with depression and alcohol misuse, is the primary caregiver for her ailing mother and a newcomer to the community. As a primary care patient at Dartmouth Health Connect, whose mission is “bringing humanity back to health care,” Mollie receives exemplary person-centered care from her physician, health coach and behavioral health specialist. Second, we summarize the care model design features that enable care for people with challenging health and social circumstances. The design features include: primary care capitation, interdisciplinary team care, daily huddles and bi-weekly work rounds, and systematic use of patient-reported information and guidance. (Source:...


Persistence of Noncancer-related Musculoskeletal Chronic Pain Among Community-dwelling Older People: A Population-based Longitudinal Study in Finland
Conclusions:Chronic musculoskeletal pain is a highly persistent condition among community-dwelling older persons and it is related to poor health and mobility difficulties. In addition, the use of daily analgesic is low despite the continuous nature of chronic pain. (Source: The Clinical Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Association of Pain and Depression in Those With Chronic Low Back Pain: The Mediation Effect of Patient Sexual Functioning
This study sought to test this hypothesis by considering the mediating effect of sexual functioning on the association between pain intensity and depressive symptoms in sexually active patients with chronic low back pain. Materials and Methods:This was a cross-sectional study on consecutive patients attending a chronic pain management clinic in Iran. All measures (pain intensity, depressive symptoms, sex-specific sexual function) were obtained by a self-report questionnaire, completed by patients while attending the clinic. Sobel testing, including bias-corrected bootstrapping, was used to produce 95% confidence intervals (95% CI) to test the mediating effect of sexual function. Results:A total of 742 patients (351 men, 391 women) took part in this study. Both the male and female mediation...


Cold Hyperalgesia Associated With Poorer Prognosis in Lateral Epicondylalgia: A 1-Year Prognostic Study of Physical and Psychological Factors
Background:Predictors of outcome in lateral epicondylalgia, which is mainly characterized as a mechanical hyperalgesia, are largely limited to sociodemographic and symptomatic factors. Quantitative sensory testing is used to study altered pain processing in various chronic pain conditions and may be of prognostic relevance. Methods:The predictive capacity of early measures of physical and psychological impairment on pain and disability and mechanical hyperalgesia, were examined using data from 41 patients assigned to placebo in a prospective randomized controlled trial of unilateral lateral epicondylalgia. Quantitative sensory testing (pressure, cold pain thresholds), motor function (pain-free grip), and psychological factors (Tampa Scale of Kinesiophobia, Hospital Anxiety and Depression S...


MiR-203 Involves in Neuropathic Pain Development and Represses Rap1a Expression in Nerve Growth Factor Differentiated Neuronal PC12 Cells
This study revealed substantially (∼10-fold) decreased miR-203 expression in the spinal dorsal horns but not the dorsal root ganglions, hippocampus, or anterior cingulate cortexes of bCCI rats. Rap1a protein expression was upregulated in bCCI rat spinal dorsal horns. We further verified that miR-203 directly targeted the 3′-untranslated region of the rap1a gene, thereby decreasing rap1a protein expression in neuron-like cells. Discussion:Rap1a has diverse neuronal functions and their perturbation is responsible for several mental disorders. For example, Rap1a/MEK/ERK is involved in peripheral sensitization. These data suggest a potential role for miR-203 in regulating neuropathic pain development, and Rap1a is a validated target gene in vitro. Results from our study and others indicate...


Chronic Postoperative Pain After Primary and Revision Total Knee Arthroplasty
This study aimed to investigate the difference in pain, mobility, and quality of life (QoL) in patients after revision TKA compared with patients after primary TKA. Methods:A total of 99 OA patients after revision TKA surgery and 215 patients after primary TKA surgery were investigated in a cross-sectional study using: a pain description of current pain (non-existent, mild, moderate, severe, or unbearable), the pain intensity visual analogue scale, the Knee Society Score, and the Osteoarthritis Research Society International questionnaire. Results:Nineteen percent after primary TKA surgery and 47% after revision TKA surgery experienced severe to unbearable chronic postoperative pain. After revision TKA surgery patients reported higher pain intensities during rest (P=0.039), while walking (...


Acute Parvovirus B19 Infection in Adults: A Retrospective Study of 49 Cases
Conclusions This is the largest case series of acute parvovirus B19 infection published to date. This infection should be suspected on observing signs of purplish skin rashes, no matter the location or pattern of distribution, or vasculitis, especially if accompanied by fever and joint pain in young women in the spring. Measures to avoid infection should be recommended to individuals at risk. (Source: Actas Dermo-Sifiliograficas)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Acute pain management in burn patients: Appraisal and thematic analysis of four clinical guidelines
Conclusion The study demonstrated variability in quality, transparency, and core content in clinical guidelines on pain management in burn patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn patients in the clinic, to unify guideline construction, and to enable interdepartmental comparison of treatment and outcomes. (Source: Burns)


Quality of Life and Healthcare Resource in Patients Receiving Opioids for Chronic Pain: A Review of the Place of Oxycodone/Naloxone
In conclusion, randomized studies using the BFI, as well as real-world clinical practice observations, have demonstrated improved QoL for patients taking OXN PR. This combination should allow more patients to benefit from the analgesic efficacy of opioid therapy and should minimize the side effects of constipation that correspond to improvements in QoL and healthcare offsets. (Source: Clinical Drug Investigation)


Modality and sex differences in pain sensitivity during human endotoxemia
Publication date: Available online 5 December 2014 Source:Brain, Behavior, and Immunity Author(s): B. Karshikoff , M. Lekander , A. Soop , F. Lindstedt , M. Ingvar , E. Kosek , C. Olgart Höglund , J. Axelsson Systemic inflammation can induce pain hypersensitivity in animal and human experimental models, and has been proposed to be central in clinical pain conditions. Women are overrepresented in many chronic pain conditions, but experimental studies on sex differences in pain regulation during systemic inflammation are still scarce. In two randomized and double blind placebo controlled experiments, we used low doses of lipopolysaccharide (LPS) as an experimental model of systemic inflammation. The first study employed 0.8 ng/kg LPS in a within-subject design of 8 individuals (1 woman), ...


Mechanistic experimental pain assessment in computer users with and without chronic musculoskeletal pain
Conclusions: This suggests that the excitability of the central pain system is normal in a large group of computer users with low pain intensity chronic upper extremity and/or neck-shoulder pain and that increased excitability of the pain system cannot explain the reported pain. However, computer users with higher pain intensity and lower PPTs were found to have decreased efficiency in descending pain modulation. (Source: BMC Musculoskeletal Disorders)


The Diagnosis and Treatment of Joplin's Neuroma
In conclusion, surgical resection of the medial plantar nerve to the hallux with implantation of the proximal end of the nerve into the arch of the foot, can be expected to result in good to excellent relief of pain in 80% of the patients. (Source: The Journal of Foot and Ankle Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


NMP-7 inhibits chronic inflammatory and neuropathic pain via block of Cav3.2 T-type calcium channels and activation of CB2 receptors
Conclusions: Overall, our work shows that NMP-7 mediates a significant analgesic effect in a model of persistent inflammatory and chronic neuropathic pain by way of T-type channel modulation and CB2 receptor activation. Thus, this study provides a novel therapeutic avenue for managing chronic pain conditions via mixed CB ligands/T-type channel blockers. (Source: Molecular Pain)


Burden of herpes zoster-associated chronic pain in Italian patients aged 50 years and over (2009¿2010): a GP-based prospective cohort study
Conclusions: These results suggest that HZ and PHN represent an important burden of disease in the elderly. There is a need for interventions that can prevent and reduce the burden of HZ to help improve the quality of life of the elderly. These data may be useful as baseline epidemiology data for the assessment of the impact of the VZV vaccine in Italy, after its implementation. (Source: BMC Infectious Diseases)


NMP-7 inhibits chronic inflammatory and neuropathic pain via block of Cav3.2 T-type calcium channels and activation of CB2 receptors
Conclusions: Overall, our work shows that NMP-7 mediates a significant analgesic effect in a model of persistent inflammatory and chronic neuropathic pain by way of T-type channel modulation and CB2 receptor activation. Thus, this study provides a novel therapeutic avenue for managing chronic pain conditions via mixed CB ligands/T-type channel blockers. (Source: Molecular Pain)


I've Got Your Back: Tips to Lessen Back Pain
Ergonomics is the design of our environment with the goal of making it more efficient and comfortable. Given that we spend two-thirds of our time at the workplace and in bed, it makes sense to discuss how we can improve these environments to lessen back pain. Media outlets run stories on how back pain can be lessened by sitting less, repositioning our computer screens, and changing our office chairs. If our workplace can be the cause of back pain, then surely we can modify our workplace to prevent back pain, right? Actually, no. While altering our environments can help, it's only a part of the story. According to medical studies, our efforts to alter the workplace to avoid back pain have been scrutinized by evidence-based medicine and found to be largely ineffective. The reason is becaus...


Scientists Map Spinal Circuitry Responsible for Chronic Pain
Pain typically has a clear cause - but not always. When a person touches something hot or bumps into a sharp object, it’s no surprise that it hurts. But for people with certain chronic pain disorders, including fibromyalgia and phantom limb pain, a gentle caress can result in agony. (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>


Mindfulness intervention boosts brain activation for healthy pleasures
How can people who are dependent on prescription opioids reduce their cravings? Learn to enjoy other aspects of their lives. Researchers report that after a sample of chronic pain patients misusing opioids went through MORE, they exhibited increased brain activation on an EEG to natural healthy pleasures. The MORE intervention concentrates on helping people to recover a sense of meaning and fulfillment in everyday life, embracing its pleasures and pain without turning to substance use as a coping mechanism. (Source: ScienceDaily Headlines)


Spinal circuitry responsible for chronic pain charted
Pain typically has a clear cause–but not always. When a person touches something hot or bumps into a sharp object, it’s no surprise that it hurts. But for people with certain chronic pain disorders, including fibromyalgia and phantom limb pain, a gentle caress can result in agony. Findings of new research could lead to new therapeutics for disorders such as fibromyalgia and phantom limb pain. (Source: ScienceDaily Headlines)


Effect of intraoperative infiltration with local anesthesia on the development of chronic pain after inguinal hernia repair: A randomized, triple-blinded, placebo-controlled trial
The objective of this randomized trial was to assess the effect of intraoperative infiltration with local anesthetic versus placebo on the development of chronic pain after inguinal hernia repair. (Source: Surgery)


Immediate Effects of Core Stability Exercises and Clinical Massage on Dynamic Balance Performance of Patients With Chronic Specific Low Back Pain.
CONCLUSION: CS exercises immediately increase the PPT of active MTrPs in physically active adults with clinical instability of the lumbar spine and chronic myofascial pain syndrome. When MTrP therapy is added, side-to-side asymmetries in dynamic balance are minimized. PMID: 25474502 [PubMed - as supplied by publisher] (Source: Journal of Sport Rehabilitation)


Health Tip: Prevent Back Strain
Title: Health Tip: Prevent Back StrainCategory: Health NewsCreated: 12/5/2014 12:00:00 AMLast Editorial Review: 12/5/2014 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>


FDA Approves Injectable Device for Back, Leg Pain
Title: FDA Approves Injectable Device for Back, Leg PainCategory: Health NewsCreated: 12/5/2014 12:00:00 AMLast Editorial Review: 12/5/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Salk and Harvard scientists chart spinal circuitry responsible for chronic pain
(Salk Institute) New findings could lead to new therapeutics for disorders such as fibromyalgia and phantom limb pain. (Source: EurekAlert! - Biology)


Utah study: Mindfulness intervention boosts brain activation for healthy pleasures
(University of Utah Health Sciences) After a sample of chronic pain patients misusing opioids went through MORE, they exhibited increased brain activation on an EEG to natural healthy pleasures. (Source: EurekAlert! - Medicine and Health)


First Microsized, Injectable Wireless Device for Chronic Pain to Hit the U.S. Market (FREE)
By Amy Orciari Herman Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS The FDA has cleared for marketing … (Source: Physician's First Watch current issue)


Relationship between Premature Ejaculation and Chronic Prostatitis/Chronic Pelvic Pain Syndrome
ConclusionsOur data showed a significant correlation between the PEDT score and the NIH‐CPSI score. We suggest routine screening for CP/CPPS in men with PE and PE in men with CP/CPPS. Lee JH and Lee SW. Relationship between premature ejaculation and chronic prostatitis/chronic pelvic pain syndrome. 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>


Peripheral Oxidative Stress Blood Markers in Patients With Chronic Back or Neck Pain Treated With High-Velocity, Low-Amplitude Manipulation
The purpose of this study was to investigate oxidative-stress parameters in individuals with chronic neck or back pain after 5 weeks of treatment with high-velocity, low-amplitude (HVLA) spinal manipulation. (Source: Journal of Manipulative and Physiological Therapeutics)


TMD in class III patients referred for orthognathic surgery: Psychological and dentition-related aspects
Conclusion With respect to subjects without a malocclusion, TMD in class III dentofacial deformities is similar in prevalence, but differs in clinical appearance. Occlusal, but not psychosocial features deviate from those in the controls. While psychosocial variables accompanied TMD and myofascial pain, increased RCP-ICP slide was related to disc displacement in class III patients. (Source: Journal of Cranio Maxillofacial Surgery)


The Diagnosis and Treatment of Joplin's Neuroma
Joplin's neuroma is a rare perineurial fibrosis of the medial plantar digital proper nerve arising from various etiologies but most commonly after bunion surgery. Treatment for this painful great toe problem remains controversial. It is our purpose to describe our experience with this chronic pain problem, considering it to be a neuroma requiring resection. A retrospective medical record review of 8 patients with medial hallux pain related to the digital nerve was performed. Each patient had failed to respond to >6 months of nonoperative therapy. (Source: Journal of Foot and Ankle Surgery)


The effects of gluten-free diet versus hypocaloric diet among patients with fibromyalgia experiencing gluten sensitivity symptoms: Protocol for a pilot, open-label, randomized clinical trial
Fibromyalgia is a chronic musculoskeletal pain syndrome characterized by a broad spectrum of manifestations. Patients with fibromyalgia frequently suffer from manifestations similar to those experienced by patients with gluten-related disorders raising the possibility that some patients with fibromyalgia could suffer from underlying gluten sensitivity. (Source: Contemporary Clinical Trials)


[Methodology of the development of the updated LONTS guidelines for long-term administration of opioids in noncancer pain.]
CONCLUSION: The guidelines will be published in several forms: complete and short scientific versions, as well as clinical practice and patient versions. PMID: 25472889 [PubMed - as supplied by publisher] (Source: Schmerz)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The Value of SPECT/CT in Localizing Pain Site and Prediction of Treatment Response in Patients with Chronic Low Back Pain.
Authors: Lee I, Budiawan H, Moon JY, Cheon GJ, Kim YC, Paeng JC, Kang KW, Chung JK, Lee DS Abstract In many circumstances, causing sites of low back pain (LBP) cannot be determined only by anatomical imaging. Combined functional and morphological imaging such as bone scan with single-photon emission computed tomography/computed tomography (SPECT/CT) may be helpful in identifying active lesions. The purpose of this study was to evaluate the usefulness of bone SPECT/CT in localizing the pain site and the treatment of chronic LBP. One hundred seventy-five patients suffering from chronic LBP who underwent SPECT/CT were included, retrospectively. All of the patients received multiple general treatments according to the symptoms, and some of them underwent additional target-specific trea...


Discovery of novel tetrahydroisoquinoline derivatives as orally active N-type calcium channel blockers with high selectivity for hERG potassium channels.
Authors: Ogiyama T, Inoue M, Honda S, Yamada H, Watanabe T, Gotoh T, Kiso T, Koakutsu A, Kakimoto S, Shishikura J Abstract N-type calcium channels represent a promising target for the treatment of neuropathic pain. The selective N-type calcium channel blocker ziconotide ameliorates severe chronic pain but has a narrow therapeutic window and requires intrathecal administration. We identified tetrahydroisoquinoline derivative 1a as a novel potent N-type calcium channel blocker. However, this compound also exhibited potent inhibitory activity against hERG channels. Structural optimizations led to identification of (1S)-(1-cyclohexyl-3,4-dihydroisoquinolin-2(1H)-yl)-2-{[(1-hydroxycyclohexyl)methyl]amino}ethanone ((S)-1h), which exhibited high selectivity for hERG channels while retaini...


Forthcoming Issues
Chronic Pain (Source: Physical Medicine and Rehabilitation Clinics of North America)


Osteochondrosis of the accessory ossification centre of the medial malleolus
We report a case of a painful accessory ossification centre of the medial malleolus in an 11-year-old girl who was not involved in sports activities. The patient was treated conservatively, with complete clinical and radiographic healing of the medial malleolus 6 months after the first presentation. We ruled out the uncommon pathological conditions causing chronic pain in the medial malleolus during skeletal growth, such as traction apophysitis of the medial malleolus, osteochondrosis, osteochondritis or avascular necrosis of the distal tibial epiphysis. We speculate that this painful condition may be classified as an osteochondrosis of the accessory ossification centre of the medial malleolus. (Source: Journal of Pediatric Orthopaedics B)


FDA Okays Injectable Stimulation Device for Back, Leg PainFDA Okays Injectable Stimulation Device for Back, Leg Pain
The FDA has approved an injectable microchip neuromodulation device for relief of chronic back and leg pain. FDA Approvals (Source: Medscape Neurology and Neurosurgery 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>


Stimwave Receives FDA Clearance For World's First Injectable Wireless, Microtechnology Neuromodulation Device
Stimwave Technologies Incorporated, a medical device manufacturer and independent research institute headquartered in Miami Beach, Fla., has received FDA clearance to market the world&rsquo;s first wireless, micro-technology neuromodulation device for relief of chronic back and leg pain. (Source: Medical Design Online News)


Chronic Achilles Tendon Rupture Reconstructed With Achilles Tendon Allograft and Xenograft Combination
Publication date: Available online 2 December 2014 Source:The Journal of Foot and Ankle Surgery Author(s): Shane Hollawell , William Baione More than 20% of acute Achilles tendon injuries are misdiagnosed, leading to chronic or neglected ruptures. Some controversy exists regarding how to best manage an acute Achilles tendon rupture. However, a general consensus has been reached that chronic rupture with ≥3 cm of separation is associated with functional morbidity and, therefore, should be managed operatively. It has been demonstrated that the functional outcomes of surgically treated Achilles ruptures are superior to the nonoperative outcomes in a chronic setting. In the present report, we reviewed 4 patients with chronic Achilles tendon ruptures that were successfully treated with an ...


The population prevalence of symptomatic radiographic foot osteoarthritis in community-dwelling older adults: cross-sectional findings from the Clinical Assessment Study of the Foot
Conclusions While cautious interpretation due to non-response is warranted, our study suggests that symptomatic radiographic foot OA affects one in six older adults and the majority report associated disability. Clinicians should consider OA as a possible cause of chronic foot pain in older people. (Source: Annals of the Rheumatic Diseases)


Overview of neurodevelopment and pain research, possible treatment targets
Publication date: April 2014 Source:Best Practice &amp; Research Clinical Rheumatology, Volume 28, Issue 2 Author(s): Suellen M. Walker Pain is a common presenting and often persistent symptom for children with rheumatological disease. Pain is not clearly related to disease severity in children with inflammatory juvenile idiopathic arthritis, and presentations of non-inflammatory musculoskeletal pain are common but there is limited evidence to guide management. Pain assessment must extend beyond measures of pain severity to more fully evaluate characteristics of pain, functional impact and psychosocial effects and family interactions. Evaluation of mechanisms of joint pain in adults has identified potential treatment targets, but additional studies are required as the acute and long-...


Reconstruction of scaphoid non-union and total scaphoid avascular necrosis in a pediatric patient: a case report
Conclusions Technical considerations for harvest of the medial femoral condyle bone graft in the skeletally immature patient are discussed. (Source: Hand)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Spinal astrocyte gap junction and glutamate transporter expression contributes to a rat model of bortezomib-induced peripheral neuropathy
Publication date: 29 January 2015 Source:Neuroscience, Volume 285 Author(s): C.R. Robinson , P.M. Dougherty There is increasing evidence implicating astrocytes in multiple forms of chronic pain, as well as in the specific context of chemotherapy-induced peripheral neuropathy (CIPN). However, it is still unclear what the exact role of astrocytes may be in the context of CIPN. Findings in oxaliplatin and paclitaxel models have displayed altered expression of astrocytic gap junctions and glutamate transporters as means by which astrocytes may contribute to observed behavioral changes. The current study investigated whether these changes were also generalizable to the bortezomib CIPN. Changes in mechanical sensitivity were verified in bortezomib-treated animals, and these changes were preven...


Genetics of chronic post-surgical pain: a crucial step toward personal pain medicine
Conclusions Pharmacogenomic technologies and strategies provide an opportunity to expand our knowledge in CPSP treatment that may manifest in a personalized approach to diagnosis, prevention, and therapy. Capitalizing on this genomic knowledge will necessitate the analysis of many tens of thousands of study patients. This will require an international coordinated effort to which anesthesiologists and surgeons can contribute substantially. (Source: Canadian Journal of Anesthesia)


Five hematologic tests and treatments to question
Choosing Wisely&reg; is a medical stewardship initiative led by the American Board of Internal Medicine Foundation in collaboration with professional medical societies in the United States. The American Society of Hematology (ASH) released its first Choosing Wisely&reg; list in 2013. Using the same evidence-based methodology as in 2013, ASH has identified 5 additional tests and treatments that should be questioned by clinicians and patients under specific, indicated circumstances. The ASH 2014 Choosing Wisely&reg; recommendations include: (1) do not anticoagulate for more than 3 months in patients experiencing a first venous thromboembolic event in the setting of major, transient risk factors for venous thromboembolism; (2) do not routinely transfuse for chronic anemia or uncomplicated pai...


Systematic review of endometriosis pain assessment: how to choose a scale?
CONCLUSIONS When using pain scales their strengths and weaknesses must be known and included in the analysis. VAS is the most frequently used pain scale and, together with NRS, seems the best adapted for endometriosis pain measurement. The use of VAS or NRS for each type of typical pain related to endometriosis (dysmenorrhea, deep dyspareunia and non-menstrual chronic pelvic pain), combined with the CGI and a quality-of-life scale will provide both clinicians and researchers with tools to evaluate treatment response. (Source: Human Reproduction Update)


High hopes for cannabinoid agonists in the treatment of rheumatic diseases
There are two well-characterised isoforms of cannabinoid receptor; CB1 and CB2 and of these CB2 is under active investigation as a potential target for treatment of the chronic pain associated with widespread and intractable joint diseases osteoarthritis and rheumatoid arthritis. The recent report by Fukuda et al (BMC Musculoskelet Disord 15:275, 2014) in BMC Musculoskeletal Disorders investigates the efficacy of a selective CB2 agonist, JW133, in both in vitro and in vivo models of rheumatoid arthritis and provides encouraging data. The report shows that JW133 inhibits expression of the CCL2 cytokine, osteoclastogenesis and reduces histological indicators of joint degeneration. Each of these could potentially contribute to beneficial analgesic effects in a therapeutic context. (Source: BM...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Etanercept ameliorates inflammation and pain in a novel mono-arthritic multi-flare model of streptococcal cell wall induced arthritis
Background: The impact of anti-TNF, corticosteroid and analgesic therapy on inflammation and pain was evaluated in a novel mono-arthritic multi-flare rat Streptococcal Cell Wall (SCW) model using Etanercept, Dexamethasone and Buprenorphine. Methods: Multiple flares of arthritis were induced with an intra-articular injection of SCW in the hind ankle on day 1, followed by intravenous challenges on days 21 and 42. Inflammation and pain were monitored in the hind paws. Cytokine profiling, cell phenotyping, bioluminescence imaging and histopathological evaluation were also performed. Results: Local injection of SCW caused a rapid onset of inflammation and pain in the injected ankle which resolved within 4 days (Flare 1). Intravenous injection 20 days after sensitization resulted in an increase ...


Reliability, construct and discriminative validity of clinical testing in subjects with and without chronic neck pain
Conclusions: The majority of the tests evaluated showed satisfactory reliability and construct validity supporting their use in the clinical evaluation of patients with chronic neck pain. (Source: BMC Musculoskeletal Disorders)


Development and Optimization of a High-Throughput Micro-Computed Tomography Imaging Method Incorporating a Novel Analysis Technique to Evaluate Bone Mineral Density of Arthritic Joints in a Rodent Model of Collagen Induced Arthritis
Rheumatoid arthritis (RA) is a chronic autoimmune disease resulting in joint inflammation, pain, and eventual bone loss. Bone loss and remodeling caused by symmetric polyarthritis, the hallmark of RA, is readily detectable by bone mineral density (BMD) measurement using micro-CT. Abnormalities in these measurements over time reflect the underlying pathophysiology of the bone. To evaluate the efficacy of anti-rheumatic agents in animal models of arthritis, we developed a high throughput knee and ankle joint imaging assay to measure BMD as a translational biomarker. (Source: Bone)


Trunk Muscle Activation During Different Quadruped Stabilization Exercises in Individuals with Chronic Low Back Pain
ConclusionsLR should be recommended over AR for individuals with chronic LBP. Moreover, the application of ALR should be approached carefully on the basis of progress and ability to stabilize the spine in this patient population. Copyright © 2014 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)


Depression and attempted suicide under pregabalin therapy
Originally developed for the treatment of epilepsy, pregabalin has become a compound with a wide spectrum of indications comprising anxiety disorders and chronic pain and is therefore largely prescribed. Thus, it is important for clinicians to be aware of rare, but serious adverse effects. The following report illustrates the case of a 20-year-old male with a severe depressive syndrome following pregabalin medication which even led to a suicide attempt. (Source: Annals of General 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>


Genetics of chronic post-surgical pain: a crucial step toward personal pain medicine.
CONCLUSIONS: Pharmacogenomic technologies and strategies provide an opportunity to expand our knowledge in CPSP treatment that may manifest in a personalized approach to diagnosis, prevention, and therapy. Capitalizing on this genomic knowledge will necessitate the analysis of many tens of thousands of study patients. This will require an international coordinated effort to which anesthesiologists and surgeons can contribute substantially. PMID: 25471684 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)


Comparison of Clonidine and Midazolam Premedication Before Endoscopic Sinus Surgery: Results of Clinical Trial.
CONCLUSION: Premedication with clonidine provides better attenuation of hemodynamic response and reduction of intraoperative remifentanil requirements in patients undergoing ESS. Postoperative pain seems to be better controlled after clonidine premedication as well. PMID: 25436051 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Otorhinolaryngology)


FDA gives the green light to Stimwave's mini spinal cord stimulator
With 510(k) clearance from the FDA in hand, Stimwave Technologies plans to hit the market in January with a tiny, wireless neuromodulation implant designed to treat chronic back and leg pain. Stimwave Technologies won the FDA's 510(k) clearance for a wireless neuromodulation anti-pain device created with the idea that &quot;smaller is better.&quot; Food & Drug Administration (FDA), Stimwave TechnologiesNews Well, 510(k), Neuromodulation/Neurostimulation, Pain Management, Regulatory/Complianceread more (Source: Mass Device)


Subarachnoid versus General Anesthesia in Penile Prosthetic Implantation: Outcomes Analyses.
Authors: Henry GD, Saccà A, Eisenhart E, Cleves MA, Kramer AC Abstract The leading patient complaint during the perioperative period for penile prosthesis implantation is postoperative pain, while emesis and urticaria also affect the procedure's perceived success. In analyzing surgical outcomes, assessment of the anesthetic for postoperative pain and side effects should be included. This paper retrospectively reviews 90 consecutive, primary inflatable penile prosthetic operations performed by a single surgeon at one private medical center. Fifty-seven patients were included in final analysis. Patients who had more than one procedure that day or who used chronic pain medication were excluded. The type and amount of each drug used for each respective side effect (within the first 24...


Management of the Patient with Chronic Pain
This article provides insight into and awareness of the various elements that should be addressed, along with interventions for the patient with chronic pain in the perioperative setting. (Source: Critical Care Nursing 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>


Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis.
Authors: Ganem VJ, Mora AG, Varney SM, Bebarta VS Abstract Chronic pain is a common reason for emergency department (ED) visits. Our objective was to describe opioid prescribing practices of ED providers when treating patients with chronic pain. We retrospectively evaluated opioid prescriptions from EDs at two tertiary care military hospitals. We queried the outpatient record database to obtain a list of opioid medications prescribed and ICD-9 codes associated with visits for chronic pain. We collected provider type and gender, number of pills, opioid type, and refills. We compared the incidence with chi-square or Fisher's exact tests. Wilcoxon test was used for non-parametric continuous variables. Over 3 years, 28,103 visits generated an opioid prescription. One thousand three hu...


Rethinking how we understand individual healthcare needs for people living with long‐term conditions: a qualitative study
This study considers whether this view of health offers an alternative view of healthcare need in people living with long‐term conditions. We know that chronic disease can be disruptive for some people; but not all. Our research question asked: Why do people experience long‐term conditions differently, and what are the implications for understanding healthcare need? Our phenomenographic study involved qualitative interviews with 24 people living with at least one of the three conditions (diabetes, depression and chronic pain) and explored resources for and demands on daily living. Interviews all took place during 2012 and 2013. A narrative form analysis identified three patterns of illness experience (Gliding Swan, Stormy Seas and Stuck Adrift). Narrative content analysis revealed four...


Re: A Prospective Study on Association of Prostatic Calcifications with Sexual Dysfunction in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)
(Source: The Journal of Sexual Medicine)


Rebuttal: A Prospective Study on Association of Prostatic Calcifications with Sexual Dysfunction in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)
(Source: The Journal of Sexual Medicine)


Diurnal and nocturnal skin temperature regulation in chronic Complex Regional Pain Syndrome
We examined the response to external heating as well as circadian temperatures changes over several days in the affected legs of 14 chronic CRPS patients with abnormal posturing, and 17 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>


Results of Lumbar Endoscopic Adhesiolysis Using a Radiofrequency Catheter in Patients with Postoperative Fibrosis and Persistent or Recurrent Symptoms After Discectomy
ConclusionEndoscopic adhesiolysis is a potentially useful treatment for the relief of chronic intractable low back and lower limb pain in patients with previous lumbar spine surgery and epidural fibrosis. The use of larger volumes of saline during endoscopy and the employment of radiofrequency for the lysis of epidural adhesions are safe procedures, which may provide an additional benefit to the intervention. (Source: Pain Practice)


Mobility Limitations and Fall‐Related Factors Contribute to the Reduced Health‐Related Quality of Life in Older Adults With Chronic Musculoskeletal Pain
ConclusionOlder adults with CMP have pronounced mobility limitations and increased falls risk factors, and these are associated with a marked reduction in HRQOL. Future prospective research is required to build on this cross‐sectional study. (Source: Pain Practice)


Chronic Widespread Pain Drawn on a Body Diagram is a Screening Tool for Increased Pain Sensitization, Psycho‐Social Load, and Utilization of Pain Management Strategies
This study demonstrates that calculating PPSA on a body diagram (using the RON method) is a valid and convenient “snapshot” screening tool to identify patients with an increased likelihood of pain sensitization, psycho‐social load, and utilizing pain management resources. (Source: Pain Practice)


Naloxegol: Treatment for Opioid-Induced Constipation in Chronic Non-Cancer Pain.
CONCLUSION: OIC affects many individuals treated with opioids for chronic non-cancer pain. Previous over-the-counter or prescription treatment options were limited by a lack of adequate and well-controlled studies, multiple daily dosing, or need for injections. Cost issues may limit therapy with naloxegol to select patients. PMID: 25471070 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)


Magnetic suppression of perceptual accuracy is not reduced in episodic migraine without aura
Conclusions The results demonstrate that occipital cortex inhibition as assessed with MSPA is not reduced in episodic migraine without aura. This suggests a larger role of occipital cortex excitability in episodic migraine with aura and in chronic migraine compared to episodic migraine without aura. Test-retest reliability of MSPA was good. (Source: The Journal of Headache and Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pelvic pain and associated characteristics among women in northern Mexico.
CONCLUSION: Pelvic pain associated with menstruation, pelvic pain during or after sexual intercourse, and chronic pelvic pain are common complaints among Mexican women of reproductive age. Health care providers should pay greater attention to these conditions. PMID: 20663745 [PubMed - indexed for MEDLINE] (Source: International Perspectives on Sexual and Reproductive Health)


The epidemiology and patterns of acute and chronic toxicity associated with recreational ketamine use.
Authors: Kalsi SS, Wood DM, Dargan PI Abstract Ketamine was originally synthesised for use as a dissociative anaesthetic, and it remains widely used legitimately for this indication. However, there is increasing evidence of non-medical recreational use of ketamine, particularly in individuals who frequent the night-time economy. The population-level and sub-population (clubbers) prevalence of recreational use of ketamine is not known but is likely to be similar, or slightly lower than, that of other recreational drugs such as cocaine, MDMA, and amphetamine. The predominant features of acute toxicity associated with the recreational use of ketamine are neuro-behavioural abnormalities such as agitation, hallucinations, anxiety, and psychosis. Secondary to these, individuals put thems...


Pain treatment in arthritis-related pain: beyond NSAIDs.
Authors: van Laar M, Pergolizzi JV, Mellinghoff HU, Merchante IM, Nalamachu S, O'Brien J, Perrot S, Raffa RB Abstract Managing pain from chronic conditions, such as, but not limited to, osteoarthritis and rheumatoid arthritis, requires the clinician to balance the need for effective analgesia against safety risks associated with analgesic agents. Osteoarthritis and rheumatoid arthritis pain is incompletely understood but involves both nociceptive and non-nociceptive mechanisms, including neuropathic mechanisms. Prevailing guidelines for arthritis-related pain do not differentiate between nociceptive and non-nociceptive pain, sometimes leading to recommendations that do not fully address the nature of pain. NSAIDs are effective in treating the nociceptive arthritis-related pain. How...


Foot problems in a group of patients with rheumatoid arthritis: an unmet need for foot care.
CONCLUSION: In our study, foot involvement and foot symptoms were seen frequently in RA but there is an unmet need for provision and monitoring of foot care in patients suffering from this chronic disease. PMID: 23066434 [PubMed] (Source: Open Rheumatology Journal)


Identification of patients with neuropathic pain using electronic primary care records.
CONCLUSION: Computerised health records offer an excellent opportunity to improve the identification of patients for clinical research in complex conditions like chronic neuropathic pain. To make full use of data from these records, standardisation of clinical coding and consensus on diagnostic criteria are needed. PMID: 22417818 [PubMed - indexed for MEDLINE] (Source: Informatics in Primary Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cara Therapeutics Announces Positive Top-Line Results From Phase 1a / 1b Trial of Tablet Formulation of Oral CR845 for the Treatment of Acute and Chronic Pain
(Source: Medical News (via PRIMEZONE))


United States Chronic Pain Industry 2014 Trends and 2019 Opportunities...
MarketReportsOnline.com adds &quot;The US Chronic Pain Market - Focus on Opioids: Trends & Opportunities (2014-2019)&quot; report to its research store.(PRWeb December 02, 2014)Read the full story at http://www.prweb.com/releases/US-chronic-pain-market/2014-analysis/prweb12364976.htm (Source: PRWeb: Medical Pharmaceuticals)


Histopathological audit of 373 nononcological hysterectomies in a teaching hospital.
This study highlights that regular audit of surgeries can help improve quality of health care services and provide safe conservative option to patients. PMID: 25295217 [PubMed] (Source: Pathology Research International)


The impact of platelet-rich plasma on chronic synovitis in hemophilia.
Authors: Teyssler P, Kolostova K, Bobek V Abstract Untreated chronic haemophiliac synovitis leads to the development of haemophilic arthropathy (HA) by affecting the metabolism of chondrocytes. Symptoms are progressive and often surgical intervention is required to prevent total loss of joint function. The focus of our study was to influence the chronic haemophiliac synovitis by means of autologous platelet-rich plasma (PRP) injection. Six patients with hemophilia (PWH), aged between 9 and 45 and manifesting chronic synovitis of the ankle joint on one or on both sides (8 joints in total) were included into the PRP-study. The patients were classified depending on their joint status using the Hemophilia Joint Health Score (HJHS) prior to and again two months after treatment. Three to...


Treatment of massive rotator-cuff tears with a polyester ligament (LARS) patch.
We describe and analyse the results of our technique for repairing chronic massive tears (Goutallier grade 3 or 4) of the rotator cuff using a ligament augmentation and reconstruction system. This prospective, single surgeon series included 29 symptomatic patients (21 male, 8 female) with a mean age of 67.1 years who underwent 31 ligament augmentation and reconstruction system procedures (two bilateral procedures) with a mean follow-up period of 3 years. All patients had clinical, radiographic, magnetic resonance imaging and arthroscopic evidence of a chronic massive rotator cuff tear. The primary outcome measure was assessed using the Oxford Shoulder Score and visual analogue score pre-operatively and at follow-up. Postoperative overall Oxford shoulder score and visual analogue score resu...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Osteoarthritis in young, active, and athletic individuals.
Authors: Amoako AO, Pujalte GG Abstract Osteoarthritis (OA) is one of the most devastating chronic conditions that affect people around the world. Although the usual population associated with the condition is the elderly, who are mostly inactive, athletes and younger individuals are also susceptible. Depending on the population, the etiology may differ; injuries, occupational activities, and obesity appear to be the most common causes of OA in young and athletic populations. Diagnosing OA in athletes and young individuals is sometimes challenging because of their increased pain tolerance. However, the treatment of OA in these populations does not differ from its management in the general population. Several considerations need to be taken into account when choosing a treatment mod...


Monitoring Osteoarthritis: A Cross-sectional Survey in General Practice.
CONCLUSIONS: The majority of respondents felt that monitoring OA was important, but this was not reflected in their reported current practice. Much of what they favored for monitoring was in line with published guidance, suggesting provision of suboptimal care does not result from lack of knowledge and interventions to improve OA care must address barriers to GPs engaging in optimal care provision. PMID: 24324351 [PubMed] (Source: Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders)


Fibromyalgia syndrome and spa therapy: myth or reality?
The objective of this review is to summarize the currently available information on clinical effects and mechanism of action of spa therapy in FS. We also provide some suggestions for further development in this area. PMID: 22408369 [PubMed] (Source: Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders)


Hylan g-f 20: review of its safety and efficacy in the management of joint pain in osteoarthritis.
Authors: Migliore A, Giovannangeli F, Granata M, Laganà B Abstract BACKGROUND: Osteoarthritis (OA) is a chronic degenerative joint disease that is a clinically and economically important disease. The increased prevalence of OA with aging, coupled to the demographics of aging populations, make OA a high priority health care problem. Viscosupplementation (VS) is a well-established treatment option in knee OA that is included in the professional guidelines for treatment of this joint disease, and could potentially provide a useful alternative in treating such patients with painful OA. Theoretically VS is an approach that should apply to all synovial joints. OBJECTIVES: The aim of this review is to assess the efficacy and safety of viscosupplementation with Hylan GF-20 (Synvisc(®...


Intractable Chronic Low-Back Pain Caused by Ligamentopathia Treated Using a Spinous Process Plate (S-plate).
We report a case of intractable chronic low-back pain in a gymnast that was caused by ligamentopathia in the interspinous region of the lumbar vertebrae. Sprained interspinous ligaments are a common mechanical cause of acute low-back pain in athletes. Although conservative therapy is generally effective in such cases, in this case it was not. The patient experienced severe low-back pain during lumbar flexion with tension between the L5/S interspinous ligaments. We performed interspinous fixation by using a spinous process plate system, which has been developed for short in situ fusions, and following which the low-back pain resolved. Conservative therapy for low-back pain caused by ligamentopathia is first-line choice, but interspinous fixation with instrumentation might be recommended in ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Persistent genital arousal in women with pelvic and genital pain.
CONCLUSION: Further research is needed to build on the current understanding of PGAD. Patients should be asked about persistent arousal as part of a sexual and reproductive history, especially in the case of common comorbidities. PMID: 24798670 [PubMed - indexed for MEDLINE] (Source: Journal of Obstetrics and Gynaecology Canada : JOGC)


Woman who suffers from gigantomastia has ONE STONE of tissue removed from her breasts
A CHINESE woman, who suffers from a rare medical condition, has undergone drastic boob reduction surgery after her enormous breasts left her with chronic back and shoulder pain (Source: Daily Express - Health)


Prevalence of lower urinary tract symptoms and level of quality of life in men and women with chronic pelvic pain
Scandinavian Journal of Urology, Ahead of Print. (Source: Scandinavian Journal of Urology)


Gabapentin versus pregabalin in relieving early post-surgical neuropathic pain in patients after lumbar disc herniation surgery: a prospective clinical trial.
DISCUSSION: Many patients may suffer from neuropathic pain in the early post-surgical period after lumbar discectomy. Gabapentin and pregabalin are anticonvulsant agents that may decrease perioperative central sensitization and early post-surgical neuropathic pain. Gabapentin and pregabalin effectively relieved neuropathic pain and prevented the conversion of acute pain to chronic pain at the 1-year follow-up after lumbar discectomy. PMID: 24938318 [PubMed - in process] (Source: Neurological Research)


Long-term use of a static hand-wrist orthosis in chronic stroke patients: a pilot study.
Conclusions. These pilot data suggest that a number of stroke patients cannot tolerate a static orthosis over a long-term period because of discomfort. Without appropriate treatment opportunities, these patients will remain at risk of developing a clenched fist and will experience problems with daily activities and hygiene maintenance. PMID: 23533961 [PubMed] (Source: Stroke Research and Treatment)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain.
Authors: Apuzzo D, Giotti C, Pasqualetti P, Ferrazza P, Soldati P, Zucco GM Abstract Acute low back pain (LBP) is the fifth most common reason for physician visits and about nine out of ten adults experience back pain at some point in their life. In a large number of patients LBP is associated with disc herniation (DH). Recently, oxygen-ozone (O2O3) therapy has been used successfully in the treatment of LBP, reducing pain after the failure of other conservative treatments. The aim of this study was to assess the effects of O2O3 therapy in back pain rehabilitation, comparing three groups of patients suffering from chronic back pain associated with DH submitted to three different treatments: intramuscular O2O3 infiltrations, global postural An observational retrospective/horizontal s...


Head Posture Influences Low Back Muscle Endurance Tests in 11-Year-Old Children.
This study examined low back muscle endurance with changing head and neck posture in a sample of 117 children using the Biering-Sørensen test. Each subject performed the test in a neutral posture followed by randomly selected flexed and extended head and neck positions. Head posture was found to significantly influence low back muscle endurance within subjects (p &lt; .001), with extension yielding the highest endurance scores (boys = 186.6 ± 66.2 s; girls = 192.1 ± 59 s), followed by a neutral posture (boys = 171.3 ± 56.5 s; girls = 181.7 ± 57.3 s), and flexion (boys = 146.2 ± 63.8 s; girls = 159.8 ± 49.3 s). Given the minimal influence of changing moment from head and neck posture, it appears other mechanisms influence endurance score. PMID: 25425052 [PubMed - as supplie...


Acute experimentally induced neck pain does not affect fatigability of the peripheral biceps brachii muscle.
Authors: Hung LY, Maracle E, Srbely JZ, Brown S HM Abstract Evidence has shown that upper limb muscles peripheral to the cervical spine, such as the biceps brachii, can demonstrate functional deficits in the presence of chronic neck pain. However, few studies have examined how neck pain can affect the fatigability of upper limb muscles; therefore we were motivated to investigate the effects of acutely induced neuropathic neck pain on the fatigability of the biceps brachii muscle during isometric contraction to exhaustion. Topical capsaicin was used to induce neck pain in 11 healthy male participants. Surface EMG signals were recorded from the biceps brachii during an isometric elbow flexion fatigue task in which participants held a weight equivalent to 30% of their MVC until exhaus...


Two Cases of Laparoscopic Adhesiolysis for Chronic Abdominal Pain without Intestinal Obstruction after Total Gastrectomy.
Authors: Choi HJ, Yoon SC, Kim YJ Abstract Chronic abdominal pain remains a challenge to all known diagnostic and treatment methods with patients undergoing numerous diagnostic work-ups including surgery. However, the surgical treatment of patients with chronic intractable abdominal pain is controversial. There has been no discussion of the indications for adhesiolysis in cases of obstruction or strangulation of the bowel, and adhesiolysis by laparotomy has never gained acceptance as a treatment modality for chronic abdominal pain. One of the reasons for this lack of acceptance is the high complication rate during and after adhesiolysis. Laparoscopic surgery has been accepted as a technique for diagnostic and therapeutic procedures in general surgery. Laparoscopy allows surgeons to...


Contribution of ultrasound to the diagnosis of chronic pancreatitis and to evaluating its main complications.
Authors: Badea R, Diaconu B Abstract Chronic pancreatitis is a disease with a potentially severe evolution due to the pain altering life quality and to the possibility of causing exocrine and endocrine pancreatic insufficiency. Ultrasound represents the main imaging technique to be used in this disease since the identification of pancreatic calcifications has diagnostic significance. Endoscopic ultrasound may sometimes identify parenchymal changes facilitating diagnosis in the early stages of chronic pancreatitis when transabdominal ultrasound and endoscopic retrograde cholangiopancreatography show normal situations or non-characteristic changes. PMID: 15990941 [PubMed - indexed for MEDLINE] (Source: Journal of Gastrointestinal and Liver 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>


Primary combined intra- and extra- abdominal actinomycosis. A case report.
We present a rare case of a combined intra- and extra- abdominal actinomycosis in a 50 year old female patient, with no underlying predisposing factors. The patient complained of a right lower quadrant pain. Although we first diagnosed a peri-appendiceal abscess, the CT scan suggested a right colon tumor. The patient underwent segmental colectomy and the histological examination of the specimen revealed colon actinomycosis. A review of the possible pathogenesis and therapeutic modalities is also presented. PMID: 15624033 [PubMed - indexed for MEDLINE] (Source: Journal of Gastrointestinal and Liver Diseases)


Ultrasound assisted liver biopsy for the staging of diffuse chronic hepatopathies.
In conclusion, ultrasound-assisted liver biopsy is still the "gold standard" of hepatologic evaluation, being a safe and accurate method for staging the diffuse chronic hepatopathies. PMID: 15624025 [PubMed - indexed for MEDLINE] (Source: Journal of Gastrointestinal and Liver Diseases)


Non-pharmacological interventions for chronic pain in people with spinal cord injury.
CONCLUSIONS: Evidence is insufficient to suggest that non-pharmacological treatments are effective in reducing chronic pain in people living with SCI. The benefits and harms of commonly used non-pharmacological pain treatments should be investigated in randomised controlled trials with adequate sample size and study methodology. PMID: 25432061 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)


Sulfasalazine for ankylosing spondylitis.
CONCLUSIONS: There is not enough evidence to support any benefit of sulfasalazine in reducing pain, disease activity, radiographic progression, or improving physical function and spinal mobility in the treatment of AS. A statistically significant benefit in reducing the erythrocyte sedimentation rate and easing spinal stiffness was mentioned in the previous version. However, the effect size was very small and not clinically meaningful. More withdrawals because of side effects occurred with sulfasalazine. Further studies, with larger sample sizes, longer duration, and using validated outcome measures are needed to verify the uncertainty of sulfasalazine in AS. PMID: 25427435 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)


Salicylate-containing rubefacients for acute and chronic musculoskeletal pain in adults.
CONCLUSIONS: The evidence does not support the use of topical rubefacients containing salicylates for acute injuries or chronic conditions. They seem to be relatively well tolerated in the short-term, based on limited data. The amount and quality of the available data mean that uncertainty remains about the effects of salicylate-containing rubefacients. PMID: 25425092 [PubMed - in process] (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>


Interventions for the management of taste disturbances.
CONCLUSIONS: We found very low quality evidence that was insufficient to conclude on the role of zinc supplements to improve taste perception by patients, however we found moderate quality evidence that zinc supplements improve overall taste improvement in patients with zinc deficiency/idiopathic taste disorders. We also found low quality evidence that zinc supplements improve taste acuity in zinc deficient/idiopathic taste disorders and very low quality evidence for taste recognition improvement in children with taste disorders secondary to chronic renal failure. We did not find any evidence to conclude the role of zinc supplements for improving taste discrimination, or any evidence addressing health-related quality of life due to taste disorders.We found low quality evidence that is not ...


Precocious presentation of autoimmune polyglandular syndrome type 2 associated with an AIRE mutation.
Authors: Resende E, Gόmez GN, Nascimento M, Loidi L, Saborido Fiaño R, Cabanas Rodrίguez P, Castro-Feijoo L, Barreiro Conde J Abstract Autoimmune polyglandular syndrome type 2 (type 2 APS), or Schmidt's syndrome, is defined by the presence of Addison's disease in combination with type 1 diabetes and/or autoimmune thyroid disease. The estimated prevalence of this syndrome is 1.4-4.5 per 100,000 inhabitants and it is more frequent in middle-aged females, whilst it is quite rare in children. Type 2 APS, which shows a pattern of autosomal dominant inheritance with low penetrance, has been associated with HLA specific DR3/DQ2 and DR4/DQ8 haplotypes. However, it has been hypothesized that genetic variability in the AIRE gene, which causing type 1 APS, may play a role in more common or...


Control of neonatal spinal networks by nociceptors: a potential role for TRP channel based therapies.
In conclusion, studies in neonatal models may lead to therapeutic strategies and pharmaceuticals for chronic pain and motor dysfunction after SCI during development. PMID: 23958200 [PubMed - indexed for MEDLINE] (Source: Journal of Pharmacy and Pharmaceutical Sciences)


A rare case report of chronic cholecystitis complicated with incomplete gallbladder volvulus.
Authors: Luo P, Wang C, Zhang G Abstract Gallbladder volvulus, or gallbladder torsion, is a rare condition. There have been very few case reports of chronic cholecystitis complicated by incomplete gallbladder volvulus. A 63-year-old woman had suffered recurrent right upper quadrant pain for 3 years, which had grown worse during the past day. She was admitted through the emergency department on February 24, 2012. Laparoscopic exploration revealed approximately 180° torsion of the gallbladder. Postoperative pathologic examination suggested a diagnosis of chronic cholecystitis, without operative complications. Incomplete gallbladder volvulus is associated with anatomic changes to the gallbladder mesentery, constipation, and increased bowel movements. Early diagnosis and laparoscopic ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Neuropathic itch of the back: a case of notalgia paresthetica.
We report here a particular case of notalgia paresthetica in a 55-year-old woman. The patient visited our hospital for tingling pain around the left inferior angle of the scapula. Pruritus was first reported seven years ago with tingling pain developing only four months ago. There were no specific skin lesions observed except for excoriation and vague hyperpigmentation. A skin biopsy revealed only epidermal thinning with pigmentary incontinence. The patient was treated with 600 mg of gabapentin daily as well as capsaicin cream. The response was deemed unsatisfactory. PMID: 24966642 [PubMed] (Source: Annals of Dermatology)


Shine on: Review of Laser- and Light-Based Therapies for the Treatment of Burn Scars.
Authors: Hultman CS, Edkins RE, Lee CN, Calvert CT, Cairns BA Abstract Restoration of form and function after burn injury remains challenging, but emerging laser and pulsed light technologies now offer hope for patients with hypertrophic scars, which may be associated with persistent hyperemia, chronic folliculitis, intense pruritis, and neuropathic pain. In addition to impairing body image, these scars may limit functional recovery, compromise activities of daily living, and prevent return to work. Three different platforms are now poised to alter our reconstructive algorithm: (1) vascular-specific pulsed dye laser (PDL) to reduce hyperemia, (2) ablative fractional CO(2) laser to improve texture and pliability of the burn scar, and (3) intense pulsed light (IPL) to correct burn sc...


Silent Burdens in Disease: Fatigue and Depression in SLE.
Authors: Fonseca R, Bernardes M, Terroso G, de Sousa M, Figueiredo-Braga M Abstract At a time when health is being recognized as more than just avoiding death, age and comorbidity are becoming increasingly important aspects of chronic disease. Systemic Lupus Erythematous (SLE) is probably one of the best paradigms of modern chronic disease, sitting at the crossroads of numerous somatic health problems, immune activation, depression, pain, and fatigue. One hundred forty-eight female participants were enrolled in the present study: 50 diagnosed with SLE, 45 with major depressive disorder (MDD), and 53 age-matched controls. Statistically significant lower scores in quality-of-life dimensions related to physical impairment were found in SLE. Patients with MDD presented significant leve...


Further validation of an opioid risk assessment tool: The Brief Risk Interview.
Authors: Jones T, Lookatch S, Grant P, McIntyre J, Moore T Abstract Opioids remain a common method of treating chronic pain conditions despite some controversy. In an effort to address some of the risks of opioid medications, opioid risk assessment has become a standard of care when opioids are used to treat a chronic pain condition. Research to date has found that clinical interviews may be superior to currently available patient-completed written questionnaires in identifying patients likely to engage in medication aberrant behavior. The Brief Risk Interview (BRI) has been developed as a risk assessment tool that has the sensitivity of a clinical interview while eliminating the need for the lengthy process of an interview. The current study compared the predictive ability of the ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pharmacological and toxicological profile of opioid-treated, chronic low back pain patients entering a mindfulness intervention randomized controlled trial.
CONCLUSIONS: Study findings corroborate existing evidence for high medication burden and high likelihood of substance misuse among opioid-treated CLBP patients. Further research is needed to help understand causality and ways to optimize care and clinical outcomes. PMID: 25350474 [PubMed - in process] (Source: Journal of Opioid Management)


Hydromorphone extended release for neuropathic and non-neuropathic/nociceptive chronic low back pain: A post hoc analysis of data from a randomized, multicenter, double-blind, placebo-controlled clinical trial.
CONCLUSIONS: The results of this study indicate that hydromorphone ER is efficacious and generally well tolerated in the management of patients with non-neuropathic and neuropathic chronic LBP. PMID: 25350473 [PubMed - in process] (Source: Journal of Opioid Management)


Buprenorphine in the workers' compensation setting.
This article reviews buprenorphine's approved indications, formulations, pharmacology, clinical efficacy, and special considerations in the workers' compensation setting. PMID: 25162607 [PubMed - in process] (Source: Journal of Opioid Management)


Opioid analgesics: Does potency matter?
Authors: Passik SD, Webster L Abstract Prescription opioid analgesics with a wide range of potencies are currently used for the treatment of chronic pain. Yet understanding the clinical relevance and therapeutic consequences of opioid potency remains ill defined. Both patients and clinicians alike have misperceptions about opioid potency, expecting that less-potent opioids will be less effective or fearing that more-potent opioids are more dangerous or more likely to be abused. In this review, common myths about the potency of opioid analgesics will be discussed. Clinicians should understand that pharmacologic potency per se does not necessarily imply more effective analgesia or higher abuse liability. Published dose conversion tables may not accurately calculate the dose for effec...


Academic family medicine physicians' confidence and comfort with opioid analgesic prescribing for patients with chronic nonmalignant pain.
CONCLUSIONS: Most academic family physicians currently prescribed opioid analgesics to patients with chronic nonmalignant pain. There was a strong inverse relationship between confidence regarding opioid prescription and concern about negative consequences. Similarly, comfort level was tied to increased satisfaction with the overall process of opioid prescription. PMID: 25162605 [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>


Lack of correlation between the effective dose of fentanyl sublingual spray for breakthrough cancer pain and the around-the-clock opioid dose.
CONCLUSIONS: These findings highlight the importance of titrating the dose of fentanyl sublingual spray to optimize dosing for individual patients. PMID: 25162604 [PubMed - in process] (Source: Journal of Opioid Management)


An evaluation of the performance of the Opioid Manager clinical tool in primary care: a qualitative study.
CONCLUSIONS: Overall, the OM was viewed positively for improving pain management practices but further work is required to refine the tool's potential. PMID: 24944069 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Patient aberrant drug taking behaviors in a large family medicine residency program: a retrospective chart review of screening practices, incidence, and predictors.
CONCLUSIONS: These results suggest that routine evaluation of risk for abuse or misuse of opioid analgesics occurs infrequently in a large family medicine training program. pADTB exhibited by patients using opioids for chronic pain syndromes in this sample were consistent with those reported in other similar settings. Policies and procedures in primary care settings for improved risk evaluation and ongoing monitoring of chronic opioid therapy is needed. PMID: 24944067 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Implementation of a collaborative care management program with buprenorphine in primary care: a comparison between opioid-dependent patients and patients with chronic pain using opioids nonmedically.
CONCLUSION: Collaborative care management for opioid dependence with buprenorphine may be feasible in a primary care clinic. More research is needed to understand the role of buprenorphine in managing patients with chronic pain using opioids nonmedically. PMID: 24944066 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Observation of improved adherence with frequent urine drug testing in patients with pain.
CONCLUSIONS: Adherence for prescribed medications is higher with frequent urine monitoring. UDT can be used as tool that may help improve this in patients with chronic pain. PMID: 24715666 [PubMed - indexed for MEDLINE] (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>


Electrocardiographic and cardiovascular diagnostic characteristics of patients receiving long-term opioid therapy for pain.
CONCLUSIONS: Patients with significant chronic pain requiring opioids have underlying clinical disorders that may be associated with abnormal cardiovascular physiology and ECGs. Clinicians who manage patients with chronic pain should be aware of the higher incidence of cardiovascular disease in this group. PMID: 24715665 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


It made my life a little easier: primary care providers' beliefs and attitudes about using opioid treatment agreements.
CONCLUSIONS: Substantial variability in PCP use of OTAs reflects differences in PCP beliefs and attitudes. Research to understand the impact of OTA use on providers, patients, and the therapeutic alliance is urgently needed to guide best practices. PMID: 24715664 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


A systematic review of smartphone applications for chronic pain available for download in the United States.
CONCLUSION: Overall, most of the pain-related apps included within our review not only lacked evidence of HCP input regarding development but also contained few evidence-based pain management features. PMID: 24604571 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Monitoring oxycodone use in patients with chronic pain: analysis of oxycodone and metabolite excretion in saliva and urine.
CONCLUSIONS: Oxycodone is predominant over noroxycodone in saliva (similar to plasma), while the reverse relationship exists in urine. Much greater oxycodone concentrations were found in saliva than are expected in plasma (up to a 1,000-fold difference). Saliva concentrations are lower than urine concentrations but still may not reflect plasma disposition. Possible explanations include medication residue in the mouth (recent medication use or misuse) or active secretion into saliva. Saliva analysis may be used for qualitative drug monitoring of oxycodone, with detection rates similar to urine; however, further characterization is needed for appropriate interpretation. PMID: 24604569 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Potential impact of abrupt opioid therapy discontinuation in the management of chronic pain: a pilot study on patient perspective.
CONCLUSIONS: These data suggest that opioid therapy discontinuation is an emotionally distressing experience for most patients, and the transition to nonopioid treatments is a complex process that will require patient participation to achieve optimal care. PMID: 24604565 [PubMed - indexed for MEDLINE] (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>


Opioid overuse pain syndrome (OOPS): the story of opioids, prometheus unbound.
This article proposes a clinically relevant paradigm of opioid overuse pain syndrome. The goal of this article is to inform the clinicians of the complicated neurobiology of opioids. It is our hope that scientists rather than government regulators dictate the appropriate response to the epidemic of over prescription of opioids. A similar designation of "medication overuse headache" has resulted in near extinction of excessive use of opioids in the field of headache medicine. PMID: 24481931 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


A review of the use of ketamine in pain management.
Authors: Tawfic QA Abstract Ketamine is a noncompetitive antagonist of N-methyl-d-aspartate receptor. It has been widely used in anesthesia and pain management. Ketamine has been administered via the intravenous, intramuscular, subcutaneous, oral, rectal, topical, intranasal, sublingual, epidural, and caudal routes. Ketamine improves postoperative and posttrauma pain scores and reduces opioid consumption. It has special indication for patients with opioid tolerance, acute hyperalgesia, and neuropathic pain. It also has a role in the management of chronic pain including both cancer and noncancer pain. Recreational use of ketamine is increasing as well through different routes of administration like inhalation, smoking, or intravenous injection. Long-time exposure to ketamine, especi...


A pooled analysis of patient-specific factors and efficacy and tolerability of tapentadol extended release treatment for moderate to severe chronic pain.
CONCLUSIONS: Results suggest that tapentadol ER (100-250 mg bid) provides similar pain relief and tolerability, regardless of baseline pain intensity, prior opioid experience, gender, or BMI. PMID: 24353047 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Patterns of care and side effects for patients prescribed methadone for treatment of chronic pain.
CONCLUSION: Despite recommendations for standardized assessment and cardiac risk monitoring, few patients prescribed methadone received an ECG, and this occurred at a rate that did not differ from patients prescribed morphine SR. Patients discontinued both medications at high rates. Further research is needed to evaluate the clinical significance of QTc prolongation in patients treated with methadone. PMID: 24353045 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Aberrant behaviors in a primary care-based cohort of patients with chronic pain identified as misusing prescription opioids.
CONCLUSIONS: Previously postulated and novel ADRBs suggestive of opioid misuse were identified in a community primary care setting. Differences in resident and attending physician's ability to identify key predictive ADRBs and lack of training in pain or addiction underscores the need for changes in medical school and residency programs. PMID: 24353044 [PubMed - indexed for MEDLINE] (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>


The prevalence and economic impact of prescription opioid-related side effects among patients with chronic noncancer pain.
CONCLUSIONS: Prevalence of opioid-related side effects among patients with CNCP who initiated opioids was substantially higher based on patient survey than from charts or claims. Opioid-related side effects were associated with significantly higher healthcare costs. PMID: 24353017 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Undetected Ultracet™ dependence in an adolescent with nonmalignant back pain.
This report discusses an 18-year-old woman with idiopathic scoliosis and clinical depression secondary to undertreated refractory chronic back pain who underwent surgery to correct pseudoarthrosis after a prior spinal instrumentation operation. This intervention in conjunction with a course of patient-controlled analgesia, hydromorphone, and outpatient tramadol, naproxen, methadone, and gabapentin was successful in addressing her long-standing lumbar pain. The patient, however, continued to complain to her pain management team of postsurgical discomfort and insisted on being prescribed Ultracet™ (acetaminophen-tramadol) rather than generic tramadol. The patient's eventual disclosure of severe withdrawal discomfort and history of covert abuse of Ultracet™ is discussed with respect to ke...


Opioid prescribing knowledge and practices: provider survey following promulgation of guidelines-Utah, 2011.
CONCLUSIONS: System-level changes such as inclusion of screening tools into EMRs will be needed to improve compliance with the Guidelines. Providers find treatment of chronic pain to be challenging and something for which they desire additional training and referral support. PMID: 23771571 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Gastrointestinal events after opioid treatment in nonmalignant pain: correlates of occurrence and impact on health-related quality of life.
CONCLUSION: GI symptoms accompanying oral opioid treatment are common and negatively affect HRQoL differentially for those with AP and CP. Effective approaches for managing opioid-induced GI symptoms are warranted. PMID: 23771570 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Usefulness of the opioid risk tool to predict aberrant drug-related behavior in patients receiving opioids for the treatment of chronic pain.
CONCLUSIONS: Neither the patient-completed nor the physician-completed ORT was strongly predictive of moderate-to-severe ADRB in patients receiving chronic opioid therapy for the treatment of noncancer pain in our pain center. PMID: 23771568 [PubMed - indexed for MEDLINE] (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>


A clinical trial to determine if corelease of morphine and naltrexone from crushed extended-release capsules induces withdrawal in opioid-dependent patients: a descriptive analysis of six patients.
CONCLUSION: Crushing the MSN capsule may precipitate moderate-to-severe signs and symptoms of opioid withdrawal in opioid-dependent individuals. The negligible exposure to naltrexone following exposure to intact MSN supports that intact capsules may be taken safely without precipitating withdrawal in opioid-dependent individuals. PMID: 23709323 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Ultralow dose fentanyl prevents development of chronic neuropathic pain in rats.
CONCLUSIONS: Pre-emptive use of ULD μ-opioid (not κ-opiod) blocked initiation (not maintenance) of neuropathic pain after CCI in rats. These data may suggest a novel treatment approach in situations when the potential development of neuropathy can be anticipated. PMID: 23709318 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Pharmacokinetic evaluation of hydrocodone/acetaminophen for pain management.
Authors: Singla A, Sloan P Abstract Hydrocodone/acetaminophen is not only the most commonly prescribed opioid in the United States but also the most common prescription medication written in America. Although original and early trials confirmed its ability to manage acute pain from surgery and musculoskeletal injury, it is perhaps more widely used today in the management of chronic pain. However, the opioid product was introduced for the management of moderate to moderately severe pain. Because it has been greatly abused as a prescription opioid medication, physicians need to be aware of the current knowledge regarding this analgesic drug. This review summarizes the current knowledge of the pharmacokinetics, pharmacodynamics, and metabolism of hydrocodone. Recent information regard...


Composite measure to assess efficacy/gastrointestinal tolerability of tapentadol ER versus oxycodone CR for chronic pain: pooled analysis of randomized studies.
CONCLUSIONS: Tapentadol ER was associated with significantly better composite outcomes than oxycodone CR. Because both pain relief and gastrointestinal tolerability appeared to be related to outcomes, the composite measure may represent a useful tool for comparing opioids that merits further evaluation. PMID: 23709304 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Open-label study to evaluate the efficacy and safety of extended-release hydromorphone in patients with chronic neuropathic pain.
CONCLUSIONS: Patients with chronic neuropathic pain were safely and effectively converted to and maintained on OROS hydromorphone ER. PMID: 23709303 [PubMed - indexed for MEDLINE] (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>


Preliminary data on a new opioid risk assessment measure: the Brief Risk Interview.
This study compares the predictions of medication aberrant behavior made by the Opioid Risk Tool, the Screener and Opioid Assessment for Patients with Pain-Revised, and the new interview rating scale, the Brief Risk Interview (BRI). A sample of 196 patients was assessed by each of the three risk measures and then follow-up data were gathered at 6 months post interview to determine which patients had engaged in medication aberrant behavior and had been discharged from the practice. The BRI shows superior predictive ability in identifying patients who later engage in medication aberrant behavior. Although more study in other settings is needed, these preliminary data suggest that the Brief Risk Interview could be a useful tool for any pain clinician in assessing risk through the use of infor...


Sublingual buprenorphine/naloxone for chronic pain in at-risk patients: development and pilot test of a clinical protocol.
CONCLUSION: Based on this experience, the protocol recommends Bup/Nx for pain only when baseline opioid doses are within bounds that reduce AEs at transition and incorporates dose flexibility to further reduce risks. This protocol warrants further testing. PMID: 23264315 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Improving use of narcotics for nonmalignant chronic pain: a lesson from Community Care of North Carolina.
CONCLUSIONS: This county wide medical initiative appears to have resulted in a significant improvement in the abuse and diversion of medically derived opioids. PMID: 23264314 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Risk factors for drug diversion in a pain clinic patient population.
CONCLUSIONS: Drug diversion in a pain clinic population was common in this brief survey. Such diversion may contribute to the problems of nonmedical use of prescription drugs. PMID: 23264313 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Rethinking methadone for the management of chronic pain.
Authors: Reisfield GM, Sloan PA PMID: 23264283 [PubMed - indexed for MEDLINE] (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>


Which skills are associated with residents' sense of preparedness to manage chronic pain?
CONCLUSIONS: Few internal medicine residents felt prepared to manage CNMP. Our findings suggest that educational interventions to improve residents' preparedness to manage CNMP should target complex pain syndromes (eg, fibromyalgia and neuropathic pain), safer opioid prescribing practices, and alternatives to opioid analgesics. PMID: 23247909 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Safety and tolerability of OROS® hydromorphone ER in adults with chronic noncancer and cancer pain: pooled analysis of 13 studies.
CONCLUSIONS: OROS hydromorphone was generally well tolerated in short- and long-term studies and demonstrated a consistent AE profile over time. PMID: 23247907 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


High opioid dosage rapid detoxification of cancer patient in palliative care with the Raffaeli model.
CONCLUSIONS: The results suggested that the detoxification protocol may be effective in preventing withdrawal signs in patients needing a therapeutic change because of opioid-induced tolerance, hyperalgesia, or toxicity. PMID: 23247906 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Risk assessment and counseling behaviors of healthcare professionals managing patients with chronic pain: a national multifaceted assessment of physicians, pharmacists, and their patients.
CONCLUSIONS: Patients having chronic pain and concomitant risk factors for opioid abuse, misuse, and diversion are prevalent, yet many physicians, especially PCPs, are uncomfortable managing opioid therapy in such patients. Education on best practices for risk assessment, patient monitoring during treatment, strategies for more effective counseling, patient chart documentation, and management strategies to enhance effective treatment of chronic pain are essential to ensure that PCPs and specialists maximize effective and safe use of opioid medications. Pharmacists could be a valuable member of this interdisciplinary team and should be involved in patient counseling and monitoring for aberrant behavior. PMID: 23247904 [PubMed - indexed for MEDLINE] (Source: Journal of Opioid Management)


Clinical effectiveness and safety of OROS® hydromorphone in break-through cancer pain treatment: a multicenter, prospective, open-label study in Korean patients.
CONCLUSION: Once-daily OROS® hydromorphone is efficient in the reduction of cancer pain-related BTP episodes, including end-of-dose pain. PMID: 22941852 [PubMed - indexed for MEDLINE] (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>


Depression and somatic symptoms may influence on chronic prostatitis/chronic pelvic pain syndrome: a preliminary study.
Authors: Koh JS, Ko HJ, Wang SM, Cho KJ, Kim JC, Lee SJ, Pae CU Abstract The present study is the first one to investigate the impacts of depression and somatization on the disease severity and quality of life (QoL) in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The Korean version of National Institutes of Health (NIH)- Chronic Prostatitis Symptom Index (CPSI) for severity of CP/CPPS. Korean version of Patient Health Questionnaire-9 (PHQ-9) for depression, Korean version of Patient Health Questionnaire-15 (PHQ-15) for somatization, and Korean version of EuroQol Questionnaire-5 Dimensions (EQ-5D)- [(EQ-5D utility index and visual analog scale (EQ-5D VAS)] for QoL, were administered. Eighty patients were enrolled. The NIH-CPSI total scores were significa...


Risk Factors for Suicidal Ideation among Patients with Complex Regional Pain Syndrome.
CONCLUSION: Significant risk factors for suicidal ideation in patients with CRPS include severity of pain, depressive symptoms, and decreased functioning. These results suggest that psychiatric evaluation and intervention should be included in the treatment of CRPS. PMID: 24605121 [PubMed] (Source: Psychiatry Investigation)


Treatment options for atypical optic neuritis
Conclusions: Unlike demyelinating ON, atypical ON requires treatment to preserve vision. (Source: Indian Journal of Ophthalmology)


Ultrasound-guided dry needling with percutaneous paratenon decompression for chronic Achilles tendinopathy
Conclusion Combined therapy of dry needling with percutaneous hydrostatic paratenon decompression under ultrasound guidance is a well-tolerated procedure with good short- and long-term pain and functional outcomes. Level of evidence Prospective case series, Level IV. (Source: Knee Surgery, Sports Traumatology, Arthroscopy)


A Comparison of the Types of Screening Tool Administration Methods Used for the Detection of Intimate Partner Violence: A Systematic Review and Meta-Analysis
The objective of this systematic review and meta-analysis was to assess the rate of IPV disclosure in adult women (&gt;18 years of age) with the use of three different screening tool administration methods: computer-assisted self-administered screen, self-administered written screen, and face-to-face interview screen. A comprehensive literature search was conducted in the MEDLINE, EMBASE, PsycINFO, CINAHL, Database of Abstracts of Reviews of Effectiveness, and the Cochrane library databases. We identified 746 potentially relevant articles; however, only 6 were randomized controlled trials (RCTs) and included for analysis. No significant differences were observed when women were screened in face-to-face interviews or with a self-administered written screen (Odds of disclosing: 1.02, 95% con...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


PRP improves short term clinical results in tendinopathy of Achilles tendon
Conclusion Local PRP injections showed effective results in chronic Achilles tendinopathy without any complications and seems to be a good treatment alternative in this entity. Moreover it might have the ability to avoid surgical intervention. Level of Evidence IV. (Source: Sports Orthopaedics and Traumatology)


Prevalence of chronic axial pain, inflammatory back pain and spondyloarthritis in diagnosed psoriasis
Conclusion There is a higher prevalence of lower axial pain, IBP, SpA, and alternating buttock pain associated with a prior diagnosis of psoriasis. This data may influence the way psoriasis patients are approached in primary care and specialty clinics. This article is protected by copyright. All rights reserved. (Source: Arthritis Care and Research)


Cognitive behavioural treatment for the chronic post-traumatic headache patient: a randomized controlled trial
Conclusions Our primarily negative findings confirm that management of patients with CPTH still remains a considerable challenge. Psychological group therapy with CBT might be effective in an earlier stage of CPTH and in less severely affected patients but our findings strongly underline the need for randomized controlled studies to test the efficacy of psychological therapy. (Source: The Journal of Headache and Pain)


Neuromodulation in cluster headache.
Authors: Fontaine D, Vandersteen C, Magis D, Lanteri-Minet M Abstract Medically refractory chronic cluster headache (CH) is a severely disabling headache condition for which several surgical procedures have been proposed as a prophylactic treatment. None of them have been evaluated in controlled conditions, only open studies and case series being available. Destructive procedures (radiofrequency lesioning, radiosurgery, section) and microvascular decompression of the trigeminal nerve or the sphenopalatine ganglion (SPG) have induced short-term improvement which did not maintain on long term in most of the patients. They carried a high risk of complications, including severe sensory loss and neuropathic pain, and consequently should not be proposed in first intention.Deep brain stim...


Juvenile chronic arthritis and the craniovertebral junction in the paediatric patient: review of the literature and management considerations.
CONCLUSION: Whenever the cervical spine is involved in rheumatoid arthritis patients without neurological deficits, conservative treatment is legitimate. Once patients develop neurological signs and symptoms, surgical treatment should be considered with particular focus to age, severity of the disease, and general health condition. Skilled anaesthesia is crucial and the surgical procedure should only be carried out in centres with experience in craniovertebral junction abnormalities. PMID: 24309924 [PubMed - in process] (Source: Advances and Technical Standards in Neurosurgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Percutaneous pedicle screw implantation for refractory low back pain: from manual 2D to fully robotic intraoperative 2D/3D fluoroscopy.
Authors: Raftopoulos C, Waterkeyn F, Fomekong E, Duprez T Abstract Many surgical treatments for chronic low back pain that is refractory to medical treatments focus on spine stabilization. One of the main surgical procedures consists of placing an interbody cage with bone grafts associated with pedicle screws [2, 25, 30]. This technique can be performed using different approaches: a large open posterior approach, tubular approaches (minimal open) or percutaneously (minimally invasive percutaneous or MIP) [5, 28]. One of the main difficulties is to precisely locate the screws into the pedicle avoiding especially infero-medial pedicle breaches. This difficulty is even great- er when working percutaneously. This paper focuses on percutaneously placed pedicle screws (PPS), reports the ...


Functional exploration for neuropathic pain.
Authors: Maarrawi J, Mertens P, Peyron R, Garcia-Larrea L, Sindou M Abstract Neuropathic pain (NP) may become refractory to conservative medical management, necessitating neurosurgical procedures in carefully selected cases. In this context, the functional neurosurgeon must have suitable knowledge of the disease he or she intends to treat, especially its pathophysiology. This latter factor has been studied thanks to advances in the functional exploration of NP, which will be detailed in this review. The study of the flexion reflex is a useful tool for clinical and pharmacological pain assessment and for exploring the mechanisms of pain at multiple levels. The main use of evoked potentials is to confirm clinical, or detect subclinical, dysfunction in peripheral and central somato-se...


Spinal cord stimulation for ischemic heart disease and peripheral vascular disease.
Authors: De Vries J, De Jongste MJ, Spincemaille G, Staal MJ Abstract Ischemic disease (ID) is now an important indication for electrical neuromodulation (NM), particularly in chronic pain conditions. NM is defined as a therapeutic modality that aims to restore functions of the nervous system or modulate neural structures involved in the dysfunction of organ systems. One of the NM methods used is chronic electrical stimulation of the spinal cord (spinal cord stimulation: SCS). SCS in ID, as applied to ischemic heart disease (IHD) and peripheral vascular disease (PVD), started in Europe in the 1970s and 1980s, respectively. Patients with ID are eligible for SCS when they experience disabling pain, resulting from ischaemia. This pain should be considered therapeutically refractory to...


Minimally invasive procedures for the treatment of failed back surgery syndrome.
Authors: Mavrocordatos P, Cahana A Abstract Failed back surgery syndrome has become unfortunately a common clinical entity. FBSS does not have one specific treatment because it does not have one specific cause. Some features are shared with chronic low back pain (CLBP) and some pathological processes are specific. Both pathologies are leading causes of disability in the industrialized world and costly medical and surgical treatments are continuously used despite their limited efficacy. Nonetheless, evidence based practice guidelines are systematically developed. In this chapter we cautiously review the vast, complex and at times contradictory literature regarding the treatment of FBSS. Interventional Pain literature suggests that there is moderate evidence (small randomized or non ...


Sacral neuromodulation in lower urinary tract dysfunction.
Authors: Vignes JR, De Seze M, Dobremez E, Joseph PA, Guérin J Abstract Vesico-urethral dysfunction is a major problem in daily medical practice due to its psychological disturbances, its social costs and its high impact on quality of life. Recently, sacral neuromodulation, namely the electrical stimulation of the sacral nerves, appears to have become an alternative for radical bladder surgery particularly in cases of idiopathic bladder overactivity. The mechanism of action is only partially understood but it seems to involve a modulation in the spinal cord due to stimulation of inhibitory interneurons. Temporary sacral nerve stimulation is the first step. It comprises the temporary application of neuromodulation as a diagnostic test to determine the best location for the implant ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chikungunya virus infection: an overview.
Authors: Caglioti C, Lalle E, Castilletti C, Carletti F, Capobianchi MR, Bordi L Abstract Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus belonging to the Togaviridae family, first isolated in Tanzania in 1952. The main vectors are mosquitoes from the Aedes species. Recently, the establishment of an envelope mutation increased infectivity for A. albopictus. CHIKV has recently re-emerged causing millions of infections in countries around the Indian Ocean characterized by climate conditions favourable to high vector density. Importation of human cases to European regions with high density of suitable arthropod vectors (such as A. albopictus) may trigger autochthonous outbreaks. The clinical signs of CHIKV infection include non-specific flu-like symptoms, and a characte...


“The right doctors and the right game plan” help teen with IBD
First grade is a time rich in reading, writing and recess. But for Kimberlee Roy, first grade was far from a jovial time. At the tender age of 6, Kimberlee experienced the sudden onset of excruciating stomach pain and bouts of bleeding and diarrhea. “It got so bad that when I went to the bathroom, I would be yelling and crying because there was so much pain in my stomach,” recalls Kimberlee, now 16. “It was the worst pain I ever felt.” In need of medical care, Kimberlee was admitted to a hospital near her hometown in western Massachusetts. After multiple tests and procedures and a three-week stay, Kimberlee was diagnosed with Crohn’s disease, a form of inflammatory bowel disease (IBD), a condition in which one or more parts of the intestinal tract become inflamed. “I thought...


Advances in managing ankylosing spondylitis.
Authors: Daikh DI, Chen PP Abstract Ankylosing spondylitis (AS) is a chronic inflammatory disease with prominent involvement of the spine and sacroiliac joints which frequently leads to significant spine deformity and disability. The development of effective therapies for AS, particularly with anti-tumor necrosis factor agents, has resulted in improved symptoms and functions for many patients, and clinical research increasingly suggests that effective therapy can also prevent destruction in the spine and other structures. Recent focus of disease classification in AS has emphasized that many individuals with features of inflammatory back pain but no visible changes on plain x-rays have active inflammatory disease when imaged with magnetic resonance imaging (MRI). Recent studies indi...


Clinical significance of national institutes of health classification in patients with chronic prostatitis/chronic pelvic pain syndrome.
CONCLUSIONS: Although combination treatment reduced the CPSI score in both groups, there was no significant difference between the groups after combination treatment. We suggest that factors other than inflammation also contribute to symptoms associated with CP/CPPS. PMID: 24741418 [PubMed] (Source: Korean Journal of Urology)


Physical examination of the epididymis made easy: a novel, reproducible and structured approach.
We describe a novel scrotal examination technique that is reproducible and easy to learn. Our technique utilizes a maneuver we call testicular 'framing', and in our experience this maneuver almost invariably leads to proper diagnosis of epididymal pathology by facilitating successful palpation of the epididymal head, body and tail. PMID: 25171287 [PubMed - in process] (Source: Canadian 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>


Secondary pelvic congestion syndrome: description and radiographic diagnosis.
CONCLUSION: Secondary PCS is distinct from primary PCS in that it arises from clearly identifiable vascular flow abnormalities and occurs in both males and females. The diverse set of underlying etiologies, as well as the resulting congested varices, can be reliably and adequately visualized using CTU as the initial imaging modality. PMID: 25171280 [PubMed - in process] (Source: Canadian Journal of Urology)


An online UPOINT tool for phenotyping patients with chronic prostatitis.
CONCLUSIONS: Men using an online tool to clinically phenotype CP/CPPS show similar correlations between UPOINT domains, symptom severity, age and duration. While symptom severity was worse in patients seen in a tertiary referral clinic, the differences were small. PMID: 24775571 [PubMed - in process] (Source: Canadian Journal of Urology)


Fibromyalgia: 3 Things to Do
Title: Fibromyalgia: 3 Things to DoCategory: Doctor's ViewsCreated: 10/10/2001 12:00:00 AMLast Editorial Review: 12/1/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Phantom Limb Pain: Mirror Therapy Treatment
Title: Phantom Limb Pain: Mirror Therapy TreatmentCategory: Doctor's ViewsCreated: 3/24/2008 12:00:00 AMLast Editorial Review: 12/1/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Fibromyalgia Treatments Without Drugs
Title: Fibromyalgia Treatments Without DrugsCategory: Doctor's ViewsCreated: 5/27/2008 12:00:00 AMLast Editorial Review: 12/1/2014 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>


Sidelined by a Dislocated Shoulder
Title: Sidelined by a Dislocated ShoulderCategory: Doctor's ViewsCreated: 5/18/2009 12:00:00 AMLast Editorial Review: 12/1/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Stand-Up Advice for Preventing Back Pain
Title: Stand-Up Advice for Preventing Back PainCategory: Health NewsCreated: 11/30/2014 12:00:00 AMLast Editorial Review: 12/1/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


ACOEM Practice Guidelines: Opioids for Treatment of Acute, Subacute, Chronic, and Postoperative Pain
Description: The American College of Occupational and Environmental Medicine's guidelines have been updated to develop more detailed guidance for treatment of acute, subacute, chronic, and postoperative pain with opioids. Methods: Literature searches were performed using PubMed, EBSCO, Cochrane Review, and Google Scholar without publication date limits. Of 264,617 articles' titles screened and abstracts reviewed, 263 articles met inclusion criteria. Of these, a total of 157 were of high and moderate quality addressing pain treatment. Comprehensive literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel to develop evidence-based guidance. Recommendations: No quality evidenc...


Intraepithelial Giardia Intestinalis: A Case Report and Literature Review
Abstract: The giardiasis is a neglected parasitic disease. The WHO has estimated more than 280 million of human infections each year; however, intraepithelial giardiasis is a rare entity, there are only 5 reports showing invasive giardiasis. A pediatric female patient with chronic abdominal pain, diarrhea, or pasty stools, without fever, was seen in the Gastroenterology and Nutrition Service. The stool studies were negative for pathogens and lactose hydrogen breath test was positive. The presumptive clinical diagnosis was giardiasis and the patient was empirically treated with nitazoxanide. But, the patient persisted with abdominal pain and pasty stools. Endoscopy was indicated to search for Helicobacter and Giardia. Guardian and patient gave written informed consent. Hematological profile...


Chronobiology of chronic pain: focus on diurnal rhythmicity of neuropathic pain
Purpose of review: Although circadian rhythmicity has long been recognized in various nociceptive pain conditions such as arthritis, diurnal pain patterns in neuropathic conditions have only recently been described. The purpose of this article is to review emerging evidence and discuss future research to further understand this phenomenon. Recent findings: Secondary analyses of neuropathic pain clinical trials demonstrate that pain intensity fluctuations exhibit a distinct diurnal pattern that contrasts that of nociceptive pain conditions. Ongoing preclinical investigations support the phenomenon of circadian pain fluctuations and provide the opportunity to better describe pain chronobiology and to elucidate underlying mechanisms of circadian pain rhythmicity. Summary: The observation of 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>


Dorsolateral Excision of the Fibular Sesamoid: Technique and Results
Discussion: Compared with previously published reports, our results for isolated fibular sesamoidectomy show similar satisfaction rates with equivalent time to return to activities and a low complication rate while avoiding a plantar incision. Level of Evidence: Diagnostic Level 3. See Instructions for Authors for a complete description of levels of evidence. (Source: Techniques in Foot and Ankle Surgery)


Patellar Tendinopathy - Recent Developments toward Treatment.
Authors: Christian RA, Rossy WH, Sherman OH Abstract Patellar tendinopathy (PT) is a clinical and chronic overuse condition of unknown pathogenesis and etiology marked by anterior knee pain typically manifested at the inferior pole of the patella. PT has been referred to as "jumper's knee" since it is particularly common among populations of jumping athletes, such as basketball and volleyball play- ers. Due to its common refractory response to conservative treatment, a variety of new treatments have emerged recently that include dry-needling, sclerosing injections, platelet-rich plasma therapy, arthroscopic surgical procedures, surgical resection of the inferior patellar pole, extracorporeal shock wave treatment, and hyperthermia thermotherapy. Since PT has an unknown pathogenesis ...


Diagnosis and management of plantar fasciitis.
Authors: Thompson JV, Saini SS, Reb CW, Daniel JN Abstract Plantar fasciitis, a chronic degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year. Individuals with plantar fasciitis experience pain that is most intense during their first few steps of the day or after prolonged standing. The authors provide an overview of the diagnosis and management of a common problem encountered in the primary care setting. Routine imaging is not initially recommended for the evaluation of plantar fasciitis but may be required to rule out other pathologic conditions. Overall, plantar fasciitis carries a good prognosis when patients use a combination of several conservative treatment modalities. Occasionally, referral to a spec...


Toll-like receptor 4-mediated nuclear factor-κB activation in spinal cord contributes to chronic morphine-induced analgesic tolerance and hyperalgesia in rats
Abstract Nuclear factor kappa B (NF-κB) in the spinal cord is involved in pro-inflammatory cytokine-mediated pain facilitation. However, the role of NF-κB activation in chronic morphine-induced analgesic tolerance and the underlying mechanisms remain unclear. In the present study, we found that the level of phosphorylated NF-κB p65 (p-p65) was increased in the dorsal horn of the lumbar 4–6 segments after intrathecal administration of morphine for 7 consecutive days, and the p-p65 was co-localized with neurons and astrocytes. The expression of TNF-α and IL-1β was also increased in the same area. In addition, pretreatment with pyrrolidinedithiocarbamate (PDTC) or SN50, inhibitors of NF-κB, prevented the development of morphine analgesic tolerance and alleviated morphine wit...


Transversus abdominis plane block for chronic abdominal pain in a critically ill patient
We report the case of a patient with chronic colitis treated with intermittent transversus abdominis plane block (TAPB) to control hyperalgesia of the abdominal wall in the intensive care unit (ICU). TAPB contributed to the patient’s clinical recovery and early discharge from the ICU. We suggest that intermittent TAPB injection is more suitable than continuous administration, depending on patient status. In our experience, TAPB is useful for the management of both postoperative and chronic pain. Furthermore, ultrasound guidance increases the accuracy and safety of TAPB, even in critically ill patients. (Source: Anaesthesia and Intensive Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pain Terminology
To the Editor I read with interest the Viewpoint recently published in JAMA Pediatrics expressing frustration with the term functional pain to describe the common scenario of chronic pain from unidentified causes. However, I question the author’s recommendation to change the name to primary pain disorder. Just because the cause of a symptom is unknown does not mean that it has no cause; absence of proof is not proof of absence. Diagnostic delay is common in complex illnesses and not all patients have access to comprehensive diagnostic evaluations. (Source: JAMA Pediatrics)


Attitudes among healthcare providers and patients diagnosed with sickle cell disease.
Authors: O'Connor S, Hanes D, Lindsey A, Weiss M, Petty L, Overcash J Abstract Sickle cell disease (SCD) is a chronic condition that affects thousands of people worldwide. The purpose of this study is to illustrate some of the challenges and perceptions of people diagnosed with SCD. The aims were to describe stressors, problematic symptoms, sources of support, and interactions with healthcare providers. This descriptive study, using mostly open-ended questions and conceptual analysis, included a sample of patients with SCD who were older than 18 years in ambulatory (57%) and inpatient (43%) clinics. Participants completed a 20-minute interview. Pain or SCD crisis were the chief reasons for hospitalization, and a wellness checkup was the chief reason people returned to an ambulatory...


Sleep problems, exercise and obesity and risk of chronic musculoskeletal pain: The Norwegian HUNT study
Conclusion: Sleep problems are associated with an increased risk of chronic pain in the low back and neck/shoulders. Regular exercise and maintenance of normal body weight may reduce the adverse effect of mild sleep problems on risk of chronic pain. (Source: The European Journal of Public Health)


Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study
ConclusionsOffice gel SVG appears to be an effective outpatient imaging technique for the prediction of bowel DIE, with a higher accuracy for the prediction of rectosigmoid compared with anterior rectal DIE. Although the sensitivity for vaginal and RVS DIE was limited, gel SVG had a high specificity and NPV for all forms of posterior DIE, indicating that a negative gel SVG examination is highly suggestive of the absence of DIE at laparoscopy. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. (Source: Ultrasound in Obstetrics and Gynecology)


Acute Severe Hip Pain Associated With Labral Calcific Deposition Disease.
Authors: Jimenez CL, Beebe MJ, Maak TG, Aoki SK Abstract Calcific tendinitis is a term used to describe radiographic evidence of calcific deposition within a tendon. This condition, also known as calcium deposition disease, has been described in the gluteus maximus, the peroneus longus tendon, the popliteus tendon, the longus colli muscle in the neck, and the tendon of the rectus femoris. However, most of the literature on calcific tendinitis relates to crystal deposition within the rotator cuff of the shoulder. The peri-articular pain related to calcium deposition may be indolent and chronic, and patients can have varying degrees of functional deficit. Patients also may present with an acute inflammatory event, with severe incapacitation and restricted passive range of motion and ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Patient With Systolic Dysfunction and an Alternating Axis
A woman in her 70s presented to our hospital with progressive shortness of breath, fatigue, and lower extremity edema. Her history included nonischemic cardiomyopathy with a left ventricular ejection fraction of 25%, New York Heart Association functional class IIIb to IV heart failure, cardiac resynchronization therapy for a left bundle branch block, atrial fibrillation, and stage 3 chronic kidney disease. Her medications included metoprolol succinate, furosemide, digoxin, and dabigatran etexilate. She was intolerant of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockade, and aldosterone antagonists because of symptomatic hypotension. She reported that during the preceding month she had experienced increasing orthopnea, paroxysmal nocturnal dyspnea, and weight gain b...


Estimates of Minimally Important Differences (MIDs) for Two Patient‐Reported Outcomes Measurement Information System (PROMIS) Computer‐Adaptive Tests in Chronic Pain Patients
This study is among the first to address MIDs for PROMIS measures; it is the first study to establish usable MIDs for psychological symptoms on outpatients with chronic/persistent pain. The results may be used to gauge minimally important clinical difference and/or treatment response for individuals within this patient population. MIDs for PROs are particularly useful when treatment responses are significant to the patient but are difficult to evaluate during the clinical visit. (Source: Journal of Applied Biobehavioral Research)


The Understanding of Pain by Older Adults Who Consider Themselves to Have Aged Successfully
ConclusionsThe findings of the present study suggest that predictable experiences of pain as one ages may contribute to an acceptance of pain as a biomedical certainty, a belief reinforced both by health professionals and society. However, one may have chronic pain and yet consider oneself to have aged successfully, and it should therefore be recognized that there is a distinction between having pain and having a problem with pain. Copyright © 2014 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)


People with chronic facial pain perform worse than controls at a facial emotion recognition task, but it is not all about the emotion
Summary Alexithymia, or a lack of emotional awareness, is prevalent in some chronic pain conditions and has been linked to poor recognition of others' emotions. Recognising others' emotions from their facial expression involves both emotional and motor processing, but the possible contribution of motor disruption has not been considered. It is possible that poor performance on emotional recognition tasks could reflect problems with emotional processing, motor processing or both. We hypothesised that people with chronic facial pain would be less accurate in recognising others' emotions from facial expressions, would be less accurate in a motor imagery task involving the face, and that performance on both tasks would be positively related. A convenience sample of 19 people (15 females) with ...


[Treatment of myofascial lumbar dorsal pain : Effective clinical diagnostics and therapy].
CONCLUSION: The results indicate that targeted treatment of muscles and fascia in patients with chronic back pain can lead to a reduction of pain symptoms. The consideration of the myofascial systems, particularly in relation to nonspecific back pain, could contribute to improving the treatment of pain and contribute to lowering costs. PMID: 25465246 [PubMed - in process] (Source: Schmerz)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Credibility of a comparative sham control intervention for Craniosacral Therapy in patients with chronic neck pain.
CONCLUSIONS: Patients' expectancy, credibility and therapeutic alliance did not appear to affect study outcomes, blinding patients to group allocation was possible, and sham intervention was tolerable and safe. The design can therefore be recommended as control for non-specific treatment effects in future CST clinical trials. PMID: 25453528 [PubMed - in process] (Source: Complementary Therapies in Medicine)


Yoga leads to multiple physical improvements after stroke, a pilot study.
CONCLUSIONS: A group therapeutic-yoga intervention may improve multiple aspects of physical functioning after stroke. Such an intervention may be complementary to traditional rehabilitation. PMID: 25453519 [PubMed - in process] (Source: Complementary Therapies in Medicine)


Acupuncture and immune function in chronic prostatitis/chronic pelvic pain syndrome: A randomized, controlled study.
CONCLUSIONS: The specific effect of acupuncture on CP/CPPS remains unclear. Further research is warranted to examine the mechanisms by which acupuncture therapy may improve clinical symptoms in patients with CP/CPPS. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT00260637). PMID: 25453515 [PubMed - in process] (Source: Complementary Therapies in Medicine)


Role of TRPV1 and ASIC3 in formalin-induced secondary allodynia and hyperalgesia.
CONCLUSIONS: Data suggest that TRPV1 and ASIC3 participate in the development and maintenance of long-lasting secondary allodynia and hyperalgesia induced by formalin in rats. The use of TRPV1 and ASIC3 antagonists by peripheral administration could prove useful to treat chronic pain. PMID: 25443722 [PubMed - in process] (Source: Pharmacological Reports)


Alloimmunization in sickle cell disease: changing antibody specificities and association with chronic pain and decreased survival.
CONCLUSION: Alloimmunization in SCD may be associated with chronic pain, risk of end-organ damage, and shorter survival. These novel findings suggest new directions for the investigation of immune response-mediated pathways common to alloimmunization and chronic pain. PMID: 25444611 [PubMed - as supplied by publisher] (Source: Transfusion)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


[Standard wrist arthroscopy : Technique and documentation].
Authors: Löw S, Herold A, Eingartner C Abstract OBJECTIVE: Minimally invasive approach to the wrist in order to diagnose and treat different wrist pathologies. INDICATIONS: Diagnosis of unclear chronic pain syndromes, cartilage status, intra-articular ligament structures as well as post-traumatic and inflammatory conditions of the wrist. Treatment of ulnar impaction syndrome, dorsal ganglia and also in fracture treatment and various different wrist interventions. CONTRAINDICATIONS: Soft tissue infections around the wrist, severe scarring may impede access to the joint. SURGICAL TECHNIQUE: Supine position with the forearm upright and in neutral position, the elbow flexed by 90°, axial traction of 3-4 kg. Superficial stab incision, blunt preparation through joint capsu...


[Evaluation and analysis of pain in chronic hemodialysis].
CONCLUSION: Pain in chronic hemodialysis patients is a very common complaint. Therefore, it is necessary to assess it regularly, using a suitable questionnaire. PMID: 25449761 [PubMed - in process] (Source: Nephrologie and Therapeutique)


Efficacy of low‐level laser therapy in the treatment of TMDs: a meta‐analysis of 14 randomised controlled trials
This study was designed to evaluate the efficacy of low‐level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMDs). We searched electronic databases and references lists of relevant articles, retrieved all of the published randomised controlled trials in regard to these issues and then performed a meta‐analysis. Fourteen highly qualified RCTs reporting on a total of 454 patients, which evaluated the effectiveness of LLLT for patients suffering from TMDs were retrieved. The results indicated that LLLT was not better than placebo in reducing chronic TMD pain (weighted mean difference = −19·39; 95% confidence interval = −40·80–2·03; P &lt; 0·00001; I2 = 99%). However, the LLLT provided significant better functional outcomes in terms of maximum activ...


Assessing the affective load in the narratives of women suffering from fibromyalgia: the clinicians' appraisal
ConclusionThe affective load in the narratives of these patients with fibromyalgia was high and had a negative undertone when considered from the clinicians' perspective. This study highlights the importance of considering the affective resonance in the context of therapeutic relationships that are often emotionally laden and highly challenging for the clinician. (Source: Health Expectations)


United States Physical Therapists' Knowledge About Joint Hypermobility Syndrome Compared with Fibromyalgia and Rheumatoid Arthritis
ConclusionsThe results suggest that many physical therapists in the United States are not familiar with the diagnostic criteria, prevalence or common clinical presentation of JHS. Copyright © 2014 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


[Concerning the Impact of Psychological Comorbidity for Chronic Back Pain: Frequency, Reduced Earning Capacity Pension and Rehabilitation Aftercare in the Course of the Rehabilitation Cohorts 2002-2009.]
Conclusion: The frequencies of psychological comorbidities as reported in the discharge letters for the cohorts of patients in rehabilitation are below the reported frequencies of epidemiological studies. Psychological comorbidities have a considerable impact on pension for reduced earnings capacity. This finding could be useful for recommending aftercare programs. PMID: 25494344 [PubMed - as supplied by publisher] (Source: Die Rehabilitation)


Increased dosage of cyclosporine induces myopathy with increased seru creatine kinase in an elderly patient on chronic statin therapy
Summary What is known and objectiveThe concomitant administration of atorvastatin and cyclosporine has been shown to increase the serum concentration of 3‐hydroxy‐3‐methylglutaryl coenzyme A, which may be associated with the elevation of creatine kinase and an increased risk of myopathy. Our objective is to report on a case of statin‐induced myopathy associated with concomitant use of cyclosporine and other contributing factors. Case summaryAn 88‐year‐old Chinese male patient with comorbidities received polypharmacy treatment, including atorvastatin and cyclosporine. After the dosage of cyclosporine was increased to 300 mg every day for 8 months, the patient developed body pain and leg weakness, with a serum creatine kinase increase and evidence on magnetic resonance imaging of...


10 Tips for Opioid Prescribing
How to manage the risks when prescribing medications for patients in chronic pain (Source: The Rheumatologist)


Fallout from False Assumptions in Medicine
How the lack of clear, concise data has impacted opioid prescribing for chronic pain and is clouding the issue of medical recertification (Source: The Rheumatologist)


Prescribing smoked cannabis for chronic noncancer pain: Preliminary recommendations.
CONCLUSION: Future guidelines should be based on systematic review of the literature on the safety and effectiveness of smoked cannabis. Further research is needed on the effectiveness and long-term safety of smoked cannabis compared with pharmaceutical cannabinoids, opioids, and other standard analgesics. PMID: 25500598 [PubMed - as supplied by publisher] (Source: Canadian Family Physician Medecin de Famille Canadien)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


[Primary hepatic angiosarcoma: A retrospective analysis of eight cases].
Authors: Cazorla A, Félix S, Delabrousse E, Valmary-Degano S Abstract Angiosarcoma is a malignant tumor of vascular endothelial cell origin. Primary hepatic angiosarcoma is rare, most often associated with chronic exposure to toxic substances. The diagnosis of angiosarcoma is based on histological examination. Presenting symptoms are nonspecific, including abdominal pain, impaired general condition and fever. Primary hepatic angiosarcoma is a fast-growing tumor and the diagnosis is usually made at an advanced stage of the disease. The prognosis is poor. Surgical resection is recommended as the curative choice in localized forms, highlighting the key role of screening programs of occupational medicine that may help to diagnose tumors at an earlier, localized stage. Radiotherapy and...


Pharmacological modulation of hand pain in osteoarthritis: A double‐blinded placebo‐controlled functional magnetic resonance imaging study using naproxen
Conclusion This study demonstrates the sensitivity of fMRI to detect the mechanisms underlying treatments of known efficacy. These data illustrate the enticing potential of fMRI as an adjunct to self‐report for detecting early signals of efficacy for novel therapies, both pharmacological and non‐pharmacological, in small numbers of individuals suffering persistent pain. This article is protected by copyright. All rights reserved. (Source: Arthritis and Rheumatism)


Simultaneous non-Hodgkin lymphoma of the external auditory canal and thyroid gland: A case report.
We report the case of a 53-year-old woman with underlying systemic lupus erythematosus and autoimmune hemolytic anemia that were in remission. She presented with chronic left ear pain, a mass in the left EAC, and rapid growth of an anterior neck swelling that had led to left vocal fold palsy. High-resolution computed tomography (CT) of the temporal bone and CT of the neck detected a mass lateral to the left tympanic membrane and another mass in the anterior neck that had infiltrated the thyroid gland. The patient was diagnosed with simultaneous B-cell lymphoma of the left EAC and thyroid gland. She was treated with chemotherapy. She responded well to treatment and was lost to follow-up after 1 year. To the best of our knowledge, the simultaneous occurrence of a lymphoma in the EAC and the ...


Understanding of myofascial trigger points.
CONCLUSION: This review provides a clear understanding of MTrP pain and introduces the most useful treatment approaches in China. PMID: 25533832 [PubMed - in process] (Source: Chinese Medical Journal)


Fatigue in psoriasis: a phenomenon to be explored
This article is protected by copyright. All rights reserved. (Source: British Journal of Dermatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Effects of chronic disease self-management programs for participants with higher depression scores: secondary analyses of an on-line and a small-group program
This study utilized longitudinal secondary data analysis of depression cohorts (PHQ-8 ≥ 10) from two independent translational implementations of the CDSMP, small-group (N = 175) and Internet-based (N = 110). At baseline, 27 and 55  % of the two samples had PHQ-8 10 or greater. This decreased to 16 and 37  % by 12  months (p &lt; 0.001). Both depressed and non-depressed cohorts demonstrated improvements in most 12-month outcomes (pain, fatigue, activity limitations, and medication adherence). The CDSMP was associated with long-term improvements in depression regardless of delivery mode or location, and the programs appeared beneficial for participants with and without depression. (Source: Translational Behavioral Medicine)


Infectious Complications of Intrathecal Drug Administration Systems for Spasticity and Chronic Pain: 145 Patients From a Tertiary Care Center
ConclusionsAs seen in this study, infectious complications following implantation of IPD are not uncommon and include a variety of microorganisms. Antibiotic therapy without pump removal may be enough for superficial surgical site infections, but our data suggests that pump removal is the treatment of choice for deep infections as the infection may proceed to meningitis. (Source: Neuromodulation: Technology at the Neural Interface)


Effects of Different Dosage of Dexamethasone on Behavioral, Electrophysiological, and Histomorphological Recovery in a Chronic Sciatic Nerve Compression Model
ConclusionsTopical Dex reversed electrophysiological, behavioral, and structural changes in chronically compressed sciatic nerves. Differences between the beneficial effects of high‐dose and low‐dose Dex were nonsignificant. (Source: Pain Medicine)


Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up
Conclusion The authors believe that athletic pubalgia or sports hernia should be considered as a ‘groin disruption injury’, the result of functional instability of the pelvis. The surgical approach is aimed at strengthening the anterior pelvic soft tissues that support and stabilise the symphysis pubis. (Source: Hernia)


Ketamine-an update on its clinical uses and abuses.
Authors: Xu J, Lei H Abstract This review highlights the recent clinical research that supports the therapeutic utility of ketamine as a multifaceted drug. After long-term use as a dissociative anesthetic, it has re-emerged as a useful agent for ameliorating pain, asthmaticus, and depression. In addition, it is also a substance of abuse. Chronic ketamine abuse over prolonged periods (weeks, months, and years) can produce toxicity to the gastrointestinal and urinary tract. In this review, we described the recent progress on its clinical uses and abuses. PMID: 25417928 [PubMed - in process] (Source: CNS Neuroscience and 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>


Immunity Genes and Susceptibility to Otitis Media: A Comprehensive Review
Publication date: 20 November 2014 Source:Journal of Genetics and Genomics, Volume 41, Issue 11 Author(s): Rahul Mittal , Giannina Robalino , Robert Gerring , Brandon Chan , Denise Yan , M'hamed Grati , Xue-Zhong Liu Otitis media (OM) is a middle ear infection associated with inflammation and pain. This disease frequently afflicts humans and is the major cause of hearing loss worldwide. OM continues to be one of the most challenging diseases in the medical field due to its diverse host targets and wide range of clinical manifestations. Substantial morbidity associated with OM is further exacerbated by high frequency of recurrent infections leading to chronic suppurative otitis media (CSOM). Children have greater susceptibility to, and thus, suffer most frequently from OM, which can cause...


Neuroinflammation, Microglia and Mast Cells in the Pathophysiology of Neurocognitive Disorders: A Review.
Authors: Skaper SD, Facci L, Giusti P Abstract Cells of the immune system and the central nervous system are capable of interacting with each other. The former cell populations respond to infection, tissue injury and trauma by releasing substances capable of provoking an inflammatory reaction. Inflammation is a key element in the pathobiology of chronic pain, neurodegenerative diseases, stroke, spinal cord injury, and neuropsychiatric disorders such as anxiety/depression and schizophrenia. Neuroinflammation may also raise the brain's sensitivity to stress, resulting in stress-related neuropsychiatric disorders, such as anxiety or depression. The cytokine network plays a large part in how immune system cells influence the central nervous system. Further, inflammation resulting from ...


Sexual dysfunctions and psychological disorders associated with type IIIa chronic prostatitis: a clinical survey in China
Conclusion Our data indicate that a moderate level of sexual dysfunctions exists among the type IIIa CP patients, and highlight the association of depression and anxiety with erectile dysfunction in CP patients, suggestting that special attention should be paid to these psychological issues in clinical treatments of the prostatitis symptoms and the associated erectile dysfunctions. (Source: International Urology and Nephrology)


Off Switch for Pain - Activating Adenosine A3 Receptor Subtype Key to Powerful Pain Relief
In research published in the medical journal Brain, Saint Louis University researcher Daniela Salvemini, Ph.D. and colleagues within SLU, the National Institutes of Health (NIH) and other academic institutions have discovered a way to block a pain pathway in animal models of chronic neuropathic pain including pain caused by chemotherapeutic agents and bone cancer pain suggesting a promising new approach to pain relief. (Source: Disabled World)


Surgical Treatment of Flail Chest and Rib Fractures.
Authors: Fowler TT, Taylor BC, Bellino MJ, Althausen PL Abstract Despite significant advances in critical care management, flail chest remains a clinically significant finding, with a mortality rate of up to 33%. Nonsurgical management is associated with prolonged ventilator support, pneumonia, respiratory difficulties, and lengthy stays in the intensive care unit, as well as chronic pain from nonunion and malunion of the bony thorax. Treatment with aggressive pulmonary toilet, ventilator support, and different modalities of pain control remains the benchmark of care. However, several recent randomized controlled studies of surgical intervention of flail chest have demonstrated an improvement in the number of ventilator days, intensive care unit and hospital stays, incidence of pne...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 three month controlled intervention of intermittent whole body vibration designed to improve functional ability and attenuate bone loss in patients with rheumatoid arthritis
This study is a semi randomised, controlled trial consisting of a cohort of patients with established RA assigned to either a WBV group or a CON (control) group. Patients in the WBV group will undergo three months of twice weekly intermittent WBV sessions, while the CON group will receive standard care and continue with normal daily activities. All patients will be assessed at baseline, following the three month intervention, and six months post intervention. Main outcomes will be an improvement in functional ability as assessed by the HAQ. Secondary outcomes are attenuation of loss of bone mineral density (BMD) at the hip and changes in RA disease activity, HRQoL, habitual physical activity levels and body composition.DiscussionThis study will provide important information regarding the e...


Kidney function as an underestimated factor for reduced health related quality of life in patients with Fabry disease
This study aimed to explore the role of chronic kidney disease (CKD) in a large cohort of patients with FD. Methods: In 96 patients (53% female; age 40 +/- 12 yrs) with genetically proven FD, HRQoL was assessed by the Medical Outcomes Study (SF-36) questionnaire. All patients were naive to enzyme replacement therapy. Three categories for kidney dysfunction were chosen, eGFR >=/ (Source: BMC Nephrology)


An unusual cause for chronic right-sided abdominal pain: question
Publication date: December 2014 Source:Journal of Clinical Neuroscience, Volume 21, Issue 12 Author(s): Jordan Jones , Nathan Wong , Katharine J. Drummond , Andrew H. Kaye (Source: Journal of Clinical Neuroscience)


An unusual cause for chronic right-sided abdominal pain: answer
Publication date: December 2014 Source:Journal of Clinical Neuroscience, Volume 21, Issue 12 Author(s): Jordan Jones , Nathan Wong , Katharine J. Drummond , Andrew H. Kaye (Source: Journal of Clinical Neuroscience)


[Chronic pancreatitis : Operation indications and procedures.]
Authors: Niedergethmann M, Nephuth O, Hasenberg T Abstract Chronic pancreatitis can lead to intractable pain, pancreatic duct obstruction, duodenal stenosis and vascular compression syndromes. Surgical interventions can effectively treat these symptoms. Endoscopic procedures are principally possible but rarely lead to a lasting relief of symptoms. The type of surgical intervention should be selected depending on the morphological changes of the pancreas. Up to 90 % of patients present with an inflammatory mass in the head of the pancreas. In these cases a duodenum-preserving pancreatic head resection (DPPHR) modified according to Beger, Frey or Berne should be preferred. These procedures are comparable in terms of the postoperative course. The Kausch-Whipple procedure is indicate...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Avulsion fracture of the coracoid process in a patient with chronic anterior shoulder instability treated with the Latarjet procedure: a case report
Conclusions Patients suffering from anterior shoulder dislocation might develop accompanying lesions after numerous dislocations that are not present upon first visit. Different techniques for the reconstruction of the glenoid rim and the restoration of shoulder joint stability have been described in the literature. We opted for a coracoid transfer and achieved an optimal reconstruction, as shown on the postoperative computed tomography scan. An avulsion fracture of the coracoid process with dislocation of the conjoined tendons can not only be found in patients suffering a direct trauma as pointed out in the literature, but also in patients with anterior shoulder instability with recurrent anterior shoulder dislocation. (Source: Journal of Medical Case Reports)


Risks and responsibilities in prescribing opioids for chronic noncancer pain, part 2: best practices.
Authors: Cone EJ, DePriest AZ, Gordon A, Passik SD Abstract Opioids are increasingly prescribed to provide effective therapy for chronic noncancer pain, but increased use also means an increased risk of abuse. Primary care physicians treating patients with chronic noncancer pain are concerned about adverse events and risk of abuse and dependence associated with opioids, yet many prescribers do not follow established guidelines for the use of these agents, either through unawareness or in the mistaken belief that urine toxicology testing is all that is needed to monitor compliance and thwart abuse. Although there is no foolproof way to identify an abuser and prevent abuse, the best way to minimize the risk of abuse is to follow established guidelines for the use of opioids. These gu...


Prescribing opioids for chronic noncancer pain in primary care: risk assessment.
Authors: Gordon A, Cone EJ, DePriest AZ, Axford-Gatley RA, Passik SD Abstract The use of opioids for patients with chronic noncancer pain has increased dramatically, and with increasing use there is increasing concern about the potential for abuse and addiction during long-term treatment. Clinicians should avoid viewing formal or subjective risk assessment as a means of classifying patients into 2 distinct categories: compliant patients and substance abusers. The provider who perceives a patient as compliant may have a complacent attitude toward aberrant drug-related behavior, presuming that these signs reflect inadequately controlled pain, to be addressed by dose escalation. The provider who perceives a patient as a substance abuser may refuse to provide treatment for pain, leavin...


Chronic pelvic pain syndrome: a clinical enigma.
Authors: Stein A, May T, Dekel Y Abstract Chronic nonbacterial prostatitis is an ill-defined, painful clinical condition that is characterized by various nonspecific symptoms, some of which are related to urination or the male reproductive organs. Urologists diagnose this particular condition when the symptoms are not associated with urinary bacterial growth before and after transrectal prostate massage. In this review, we describe the recommended and optional tests that can be performed in these cases. There is significant overlap between chronic nonbacterial prostatitis and other unexplained pain conditions, raising the question as to whether the prostate is the culprit. The sources and mediators of pain and the psychological aspects of this complex condition are discussed. Treat...


Combining opioid and adrenergic mechanisms for chronic pain.
Authors: Smith HS, Raffa RB, Pergolizzi JV, Taylor R, Tallarida RJ Abstract Chronic pain is a highly prevalent medical problem in the United States. Although opioids and serotonin-norepinephrine reuptake inhibitors (SNRIs) have demonstrated efficacy for relief of chronic pain, each has risks of adverse events in patients. Because of the risk of opioid abuse and addiction, combinations reducing opioid requirements are particularly valuable. Opioid and SNRI agents relieve pain by different pathways; concurrent use of each agent separately offers many potential benefits: complementary and possibly synergistic analgesic efficacy, separate titrations of opioid and SNRI effects, and the reduction of opioid requirements. However, few clinical studies have investigated the ideal ratios 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>


A review of the literature on multiple factors involved in postoperative pain course and duration.
CONCLUSION: Advances in individualized pharmacologic treatment for postoperative pain have resulted in better pain control. Moreover, the recognition of sub-acute pain as a new entity is important because many surgical patients will need therapy beyond the first 8 days after surgery. In this group of patients the diagnosis of a neuropathic pain component will be important so that appropriate multimodal therapy may be implemented. PMID: 25141242 [PubMed - indexed for MEDLINE] (Source: Postgraduate Medicine)


'Off switch' for pain discovered: Brain receptor could hold key to alleviating suffering in cancer patients
Scientists at Saint Louis University in Missouri managed to block a pain pathway in rodents with chronic neuropathic pain, which develops due to nerve damage. (Source: the Mail online | Health)


Technical refinement of mini-laparoscopic hernia repair in infants and children
Conclusions Our refined laparoscopic technique is a safe and effective method in the management of groin hernias in infants and children with a minimal early recurrence rate. (Source: Hernia)


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


Reprint of: Health outcomes and socio-economic status among the mid-aged and elderly in China: Evidence from the CHARLS national baseline data
Publication date: Available online 31 October 2014 Source:The Journal of the Economics of Ageing Author(s): Xiaoyan Lei , Xiaoting Sun , John Strauss , Yaohui Zhao , Gonghuan Yang , Perry Hu , Yisong Hu , Xiangjun Yin Using a very rich set of health indicators that include both self-reported measures and biomarkers from the CHARLS national baseline data, we document health conditions of the Chinese mid-aged and elderly, examine correlations between these health outcomes and socio-economic status and compare these associations by gender, hukou status and region. As expected, we find that Chinese mid-aged and elderly are facing challenges from chronic diseases including hypertension. Overnutrition has become a bigger problem than undernutrition, particularly for women, reflected in a highe...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Repetitive Transcranial Magnetic Stimulation (rTMS) in Chronic Pain: a review of the literature
To review the literature on the analgesic effects of rTMS in chronic pain according to the different pain syndromes and stimulation parameters. (Source: Archives of Physical Medicine and Rehabilitation)


Misplaced central venous catheter in the vertebral artery: endovascular treatment of foreseen hemorrhage during catheter withdrawal.
CONCLUSION: Central venous catheterization (CVC) is not a risk-free procedure and arterial injuries are in a wide spectrum from a simple puncture to rupture of the artery. Inadvertent VA cannulation is a rare and serious complication necessitating prompt diagnosis and early treatment. If an arterial injury with a large-caliber catheter occurs, endovascular treatment with stent-graft seems to be a safe and effective option in terms of achieving hemostasis and preserving arterial patency. Recent findings suggest that endovascular management of inadvertent cervical arterial injury secondary to CVC seems to be the safest strategy. PMID: 25041914 [PubMed - in process] (Source: The Journal of Vascular Access)


Using tunneled femoral vein catheters for "urgent start" dialysis patients: a preliminary report.
CONCLUSIONS: Femoral vein tunneled catheters appear to be a safe, well tolerated, and effective temporary access in urgent start dialysis patients while they await more appropriate long-term access. PMID: 24817465 [PubMed - in process] (Source: The Journal of Vascular Access)


How I'm Honoring My Mother, My #1 Fan, Who Passed Away 7 Years Ago Today
Seven years ago today my mother Ann passed away 26 days after being diagnosed with four types of cancer. My mom was my rock, my confidant and my best friend. She was an elementary school teacher who worked with students with disabilities and she lived every day giving back to her family and her community. She also managed to be her kids' #1 fan, and supported my siblings and me in all of our endeavors. I know that my success is because of her support and faith in me. My mother's death was the hardest thing I have ever experienced and I needed a way to channel my pain. I started to do my research and learned some sobering statistics -- the American Cancer Society estimates that about half of all men and one third of all women will develop cancer during their lifetimes. Those living in low ...


Peripheral nerve blocks in the treatment of migraine in pregnancy.
CONCLUSION: Peripheral nerve blocks for treatment-refractory migraine may be an effective therapeutic option in pregnancy. LEVEL OF EVIDENCE: : III. PMID: 25415168 [PubMed - in process] (Source: Obstetrics and Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pharmacokinetics of oral amantadine in greyhound dogs
This study reports the pharmacokinetics of amantadine in greyhound dogs after oral administration. Five healthy greyhound dogs were used. A single oral dose of 100 mg amantadine hydrochloride (mean dose 2.8 mg/kg as amantadine hydrochloride) was administered to nonfasted subjects. Blood samples were collected at predetermined time points from 0 to 24 h after administration, and plasma concentrations of amantadine were measured by liquid chromatography with triple quadrupole mass spectrometry. Noncompartmental pharmacokinetic analyses were performed. Amantadine was well tolerated in all dogs with no adverse effects observed. The mean (range) amantadine CMAX was 275 ng/mL (225–351 ng/mL) at 2.6 h (1–4 h) with a terminal half‐life of 4.96 h (4.11–6.59 h). The results of this ...


The involvement of norepinephrine in pain modulation in the nucleus accumbens of morphine-dependent rats
In this study, we examined the role of NE on the evoked discharges of pain-excitation neurons (PENs) and pain-inhibition neurons (PINs) in the nucleus accumbens (NAc) of rats, following the development of morphine dependence. Our results revealed that NE inhibited the evoked discharges of PENs and attenuated the inhibition of PINs, while phentolamine enhanced the evoked discharges of PENs and facilitated the inhibition of PINs. These results indicate that the inhibitory action of NE on pain modulation acts via alpha adrenoceptors in the NAc of morphine-dependent rats. (Source: Neuroscience Letters)


Intra-articular administration of an antibody against CSF-1 receptor reduces pain-related behaviors and inflammation in CFA-induced knee arthritis
Publication date: 1 January 2015 Source:Neuroscience Letters, Volume 584 Author(s): P.A. Alvarado-Vazquez , C.E. Morado-Urbina , G. Castañeda-Corral , R.I. Acosta-Gonzalez , H. Kitaura , K. Kimura , T. Takano-Yamamoto , J.M. Jiménez-Andrade Several studies have shown that blockade of colony stimulating factor-1 (CSF-1) or its receptor (CSF-1R) inhibits disease progression in rodent models of rheumatoid arthritis (RA); however, the role of the CSF-1/CSF-1R pathway in RA-induced pain and functional deficits has not been studied. Thus, we examined the effect of chronic intra-articular administration of a monoclonal anti-CSF-1R antibody (AFS98) on spontaneous pain, knee edema and functional disabilities in mice with arthritis. Unilateral arthritis was produced by multiple injections of com...


Antiallodynic effect through spinal endothelin-B receptor antagonism in rat models of complex regional pain syndrome
Publication date: 1 January 2015 Source:Neuroscience Letters, Volume 584 Author(s): Yeo Ok Kim , In Ji Kim , Myung Ha Yoon Complex regional pain syndrome (CRPS) is a very complicated chronic pain disorder that has been classified into two types (I and II). Endothelin (ET) receptors are involved in pain conditions at the spinal level. We investigated the role of spinal ET receptors in CRPS. Chronic post-ischemia pain (CPIP) was induced in male Sprague–Dawley rats as a model for CRPS-I by placing a tourniquet (O-ring) at the ankle joint for 3h, and removing it to allow reperfusion. Ligation of L5 and L6 spinal nerves to induce neuropathic pain was performed as a model for CRPS-II. After O-ring application and spinal nerve ligation, the paw withdrawal threshold was significantly decreased...


Spanish consensus on the physical health of patients with depressive disorders
Publication date: Available online 26 November 2014 Source:Revista de Psiquiatría y Salud Mental (English Edition) Author(s): José Giner , Jerónimo Saiz Ruiz , Julio Bobes , Enric Zamorano , Francisco López , Teresa Hernando , Fernando Rico-Villademoros , Cecilio Álamo , Jorge A. Cervilla , Ángela Ibáñez Cuadrado , Elena Ibáñez Guerra , Silvia López , Pedro Morán , Diego J. Palao , Montserrat Romacho Comorbidity between depression and physical illnesses is very common and has a significant impact on the health and management of the patient. With the support of the Sociedades Españolas de Psiquiatría y Psiquiatría Biológica and Sociedad Española de Médicos de Atención Primaria (SEMERGEN) a consensus was prepared on physical health in patients with depression and it is 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>


Intramuscular pain modulatory substances before and after exercise in women with chronic neck pain
ConclusionsThe findings at baseline indicated algesic and analgesic alterations in the painful trapezius muscles. The findings for CNSP after the exercise intervention, with changes in peripheral substances and decreased pain intensity and sensitivity, could reflect a long‐term physiological effect of the exercise. (Source: European Journal of Pain)


Temporomandibular disorders in fibromyalgia syndrome: a short-communication
Publication date: Available online 26 November 2014 Source:Revista Brasileira de Reumatologia (English Edition) Author(s): Maísa Soares Gui , Marcele Jardim Pimentel , Célia Marisa Rizzatti Barbosa Fibromyalgia syndrome (FMS) is a chronic painful syndrome and the coexistence of a painful condition caused by Temporomandibular Disorders (TMD) and FMS has been frequently raised for several studies; however, a more likely hypothesis is that a set of FMS characteristics may lead to the onset of TMD symptoms and they are not merely coexisting conditions. Therefore, our aim is presenting a review of literature about the relation between fibromyalgia and the signs and symptoms of temporomandibular disorders. For this purpose, a bibliographic search was performed for the period of 1990–2013, ...


The dynamics of the pain system is intact in patients with knee osteoarthritis: An exploratory experimental study
Conclusions Acute experimental knee pain induced in patients with knee OA caused hyperalgesia and facilitated temporal summation of pain at the knee and surrounding muscles, illustrating that the pain system in individuals with knee OA can be affected even after many years of nociceptive input. This study indicates that the adaptability in the pain system is intact in patients with knee OA, which opens for opportunities to prevent development of centralized pain syndromes. (Source: Scandinavian Journal of Pain)


Remifentanil versus fentanyl during cardiac surgery on the incidence of chronic thoracic pain (REFLECT): study protocol for a randomized controlled trial
The objective of this trial is to determine the influence of perioperative remifentanil on long-term pain outcomes for cardiac patients in a prospective randomized trial. The results may be used to optimize perioperative analgesia techniques and, thereby, improve quality of life after cardiac surgery.Trial registration: Clinicaltrials.gov NCT02031016 on 13 December 2013. (Source: Trials)


The Influence of Chronic Pain on the Daily Lives of Underprivileged South Africans
Chronic pain is a major public health problem that changes lives and has devastating consequences for the person experiencing the pain, the family, and society. Living with chronic pain is not easy, especially in South Africa where the public health care system, serving 80% of the population, fails people suffering from chronic pain. The purpose of the study was to explore how experiencing chronic pain influenced the daily lives of underprivileged patients receiving nursing care at the palliative care clinic serving a resource-poor community in Tshwane, South Africa. (Source: Pain Management Nursing)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Evidence for the use of drug eluting stent in below-the-knee lesions.
In conclusion, DES is one of the solutions to the increase of BTK arteriopathy in CLI patients. Angiographic results are better, compared to BMS, in terms of primary patency, restenosis and TLR rates. However clinical results are missing. Treated lesions in the literature are short lesions. And DES is a metal balloon expandable stent with greater risks of compressions and stent fractures than nitinol self expandable stents, and such complications are known to increase post operative restenosis rates. Further reports are still needed on this matter. PMID: 25428562 [PubMed - as supplied by publisher] (Source: The Journal of Cardiovascular Surgery)


Refractory chronic cluster headache: a consensus statement on clinical definition from the European Headache Federation
Abstract Chronic cluster headache (CCH) often resists to prophylactic pharmaceutical treatments resulting in patients’ life damage. In this rare but pragmatic situation escalation to invasive management is needed but framing criteria are lacking. We aimed to reach a consensus for refractory CCH definition for clinical and research use. The preparation of the final consensus followed three stages. Internal between authors, a larger between all European Headache Federation members and finally an international one among all investigators that have published clinical studies on cluster headache the last five years. Eighty-five investigators reached by email. Proposed criteria were in the format of the International Classification of Headache Disorders III-beta (description, criteri...


Kinematic effect of Chinese herbal fomentation on patients with chronic neck pain
Conclusions Chinese herbal fomentation could improve abnormal mobility in terms of ROM and ICR. Chinese herbal fomentation might be an effective treatment for chronic neck pain. (Source: Chinese Journal of Integrative Medicine)


Anesthesia-free procedures for benign prostate obstruction: worth it?
Purpose of review: Perhaps, 30% of patients with benign prostate obstruction experience no symptom relief with drug therapy, necessitating surgical intervention. General anesthesia can be too dangerous for elderly or frail men, making local anesthesia desirable. Such minimally invasive procedures may offer time-saving, effective, gentle, and well tolerated alternatives. Recent findings: Recent interest has focused on the mechanical devices and intraprostatic injections. The commercially available UroLift system demonstrates promising short-term data in randomized multicenter trials. Rezum steam injection therapy is intriguing, although currently study-based with limited data. NX1207 and PRX302 are new intraprostatic injection drugs demonstrating interesting results in phase I and II studie...


'Off switch' for pain discovered: Activating the adenosine A3 receptor subtype is key to powerful pain relief
A way to block a pain pathway in animal models of chronic neuropathic pain has been discovered by researchers, suggesting a promising new approach to pain relief. (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>


Uneven or large breasts can cause teen angst
ConclusionThis study found young females with macromastia report lower quality of life and physical health, as well as more pain and poorer mental health than females with asymmetrical breasts or those with average breasts. However, in this study, females with asymmetrical breasts of more than a cup size difference did report lower self-esteem. Contrary to the media reporting, the study did not assess the impact of any treatment or surgical interventions on self-esteem, physical or mental health.The study also did not find that females developed eating disorders because of their breasts. The researchers found women with asymmetrical breasts scored higher on a questionnaire about disordered attitudes to eating than controls, but this was no longer significant if BMI was taken into account. ...


Chronic physical illness: a psychophysiological approach for chronic physical illness.
Authors: Purdy J Abstract Growing evidence demonstrates that psychological risk variables can contribute to physical disease. In an effort to thoroughly investigate potential etiological origins and optimal interventions, this broad review is divided into five sections: the stress response, chronic diseases, mind-body theoretical models, psychophysiological interventions, and integrated health care solutions. The stress response and its correlation to chronic disorders such as cardiovascular, gastrointestinal, autoimmune, metabolic syndrome, and chronic pain are comprehensively explored. Current mind-body theoretical models, including peripheral nerve pathway, neurophysiological, and integrative theories, are reviewed to elucidate the biological mechanisms behind psychophysiologica...


FDA Panel Says Steroid Shots for Back Pain Can Continue
Title: FDA Panel Says Steroid Shots for Back Pain Can ContinueCategory: Health NewsCreated: 11/25/2014 12:00:00 AMLast Editorial Review: 11/26/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


SLU researcher finds an off switch for pain
(Saint Louis University) Researchers have discovered a way to block a pain pathway in animal models of chronic neuropathic pain suggesting a promising new approach to pain relief. (Source: EurekAlert! - Medicine and Health)


Delayed diagnosis of subacute angle closure glaucoma in patients presenting with headaches
This study characterizes the medical course and symptoms of patients with SACG in whom headache was the major symptom. This retrospective observational study consisted of 30 consecutive patients, suffering from headaches and diagnosed with SACG, collected from the Glaucoma Service at the Ophthalmology Department of Meir Medical Center, Kfar Saba, Israel, a tertiary care referral facility. The primary study outcomes were reasons for referral, number of specialists visited and number of imaging studies performed before diagnosing SACG and headache characteristics. The majority of the patients experienced headaches once or twice a week. Four patients suffered a classic SACG pain involving the eye and frontal or hemicranial area. The mean time from onset of headaches to diagnosis was 2.6 year...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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: pathophysiology, clinical consequences, and management.
Authors: Kumar L, Barker C, Emmanuel A Abstract Although opioids offer potent analgesia for severe acute and chronic noncancer pain, adverse gastrointestinal effects potentially undermine their clinical utility. In particular, between 40% and 95% of patients develop opioid-induced constipation (OIC). Therefore, there is a consensus that patients should commence laxatives at the start of opioid therapy and continue throughout treatment. Nevertheless, laxatives are not routinely coprescribed with opioids. Even when concurrent laxatives are prescribed, approximately half the patients treated for OIC do not achieve the desired improvement. Moreover, laxatives do not target the underlying cause of OIC (opioid binding to the μ -receptors in the enteric system) and as such are not very e...


Sleep problems, exercise and obesity and risk of chronic musculoskeletal pain: The Norwegian HUNT study
Conclusion: Sleep problems are associated with an increased risk of chronic pain in the low back and neck/shoulders. Regular exercise and maintenance of normal body weight may reduce the adverse effect of mild sleep problems on risk of chronic pain. (Source: The European Journal of Public Health)


Task-Specificity of Bilateral Anticipatory Activation of the Deep Abdominal Muscles in Healthy and Chronic Low Back Pain Populations
The deep abdominal muscles, and in particular the transversus abdominis (TrA), have received substantial attention for their role in lumbo-pelvic motor control [1–3]. This is first because TrA is thought to provide stiffness to the lumbosacral spine during a bilaterally symmetrical contraction [4,5] [6] through its attachments to the pelvis [7] and the thoracolumbar fascia [8]. Then, a series of studies on healthy individuals in the mid-1990s suggested that TrA was always activated in anticipation to rapid unilateral limb movements and independently of the direction of movement whereas the activation of other trunk muscles was direction-specific [1–3]. (Source: Gait and Posture)


The effect of a self-determination theory-based communication skills training program on physiotherapists’ psychological support for their patients with chronic low back pain: A randomized controlled trial
To examine communication skills training effects on physiotherapists’ supportive behavior during clinical practice. (Source: Archives of Physical Medicine and Rehabilitation)


Two-pore domain potassium channels: potential therapeutic targets for the treatment of pain.
Authors: Mathie A, Veale EL Abstract Recent evidence points to a pivotal contribution of a variety of different potassium channels, including two-pore domain potassium (K2P) channels, in chronic pain processing. Expression of several different K2P channel subunits has been detected in nociceptive dorsal root ganglion neurons and trigeminal ganglion neurons, in particular, TREK1, TREK2, TRESK, TRAAK, TASK3 and TWIK1 channels. Of these, the strongest body of evidence from functional studies highlights the importance of TREK1, TRESK and, recently, TREK2 channels. For example, TREK1 knockout mice are more sensitive than wild-type mice to a number of painful stimuli but less sensitive to morphine-induced analgesia. TRESK knockdown mice show behavioural evidence of increased pain and inc...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


[Long-term application of opioids in chronic noncancer pain (LONTS 2) : Urgently required new guidelines.]
Authors: Treede RD, Zenz M PMID: 25421273 [PubMed - as supplied by publisher] (Source: Schmerz)


Relations between pain-related anxiety, tobacco dependence, and barriers to quitting among a community-based sample of daily smokers.
Authors: Ditre JW, Langdon KJ, Kosiba JD, Zale EL, Zvolensky MJ Abstract There is increasing recognition that complex and potentially bidirectional relations between pain and smoking may be relevant to the maintenance of tobacco addiction. Pain-related anxiety has been identified as a mechanism in the onset and progression of painful disorders, and initial evidence indicates that pain-related anxiety may be associated with essential features of tobacco dependence among smokers with chronic pain. However, there has not been an empirical study of pain-related anxiety in relation to tobacco dependence and self-reported barriers to quitting among a community-based sample of daily smokers. The current sample was comprised of 122 daily smokers who were recruited from the local community ...


Effect of a Self-Determination Theory–Based Communication Skills Training Program on Physiotherapists' Psychological Support for Their Patients With Chronic Low Back Pain: A Randomized Controlled Trial
To examine the effects of communication skills training on physiotherapists' supportive behavior during clinical practice. (Source: Archives of Physical Medicine and Rehabilitation)


In Vivo Phenotypic Screening for Treating Chronic Neuropathic Pain: Modification of C2-Arylethynyl Group of Conformationally Constrained A3 Adenosine Receptor Agonists
Journal of Medicinal ChemistryDOI: 10.1021/jm501021n (Source: Journal of Medicinal Chemistry)


Referral Patterns, Diagnosis, and Disease Management of Patients With Axial Spondyloarthritis: Results of an International Survey
Conclusions: Referral patterns, diagnosis, and disease management for axial SpA were similar among WE, North America, and RoW rheumatologists and in academic/community practices, although more WE and RoW rheumatologists referred to Assessment of SpondyloArthritis International Society criteria in clinical practice. Disease-modifying antirheumatic drugs were commonly prescribed for axial SpA patients, although it was unclear whether these were prescribed for axial or peripheral symptoms. (Source: JCR: Journal of Clinical 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>


Does presence of anterior greater tuberosity cysts change the function in patients with chronic rotator cuff tear?
CONCLUSION: Our findings demonstrated that decreased function, larger cuff tears and muscle atrophy can be observed patients with anterior greater tuberosity cysts. Anterior greater tuberosity cysts can be detected by plain X-rays. The presence of these cysts should warn the physician regarding the possibility of decreased shoulder function, muscle atrophy and larger cuff tear before ordering a magnetic resonance imaging. PMID: 25413458 [PubMed - in process] (Source: Pain Physician)


Effectiveness of pulsed radiofrequency with multifunctional epidural electrode in chronic lumbosacral radicular pain with neuropathic features.
CONCLUSIONS: PRF of dorsal root ganglion performed with a multifunctional electrode for &gt; 240 seconds appears to be safe and might be more effective than the classic 120 seconds needle-mediated approach. Therefore, it may be considered as a valuable tool for the treatment of lumbosacral radicular pain with neuropathic features. PMID: 25415772 [PubMed - in process] (Source: Pain Physician)


A survey on teaching ultrasound-guided chronic pain procedures in pain medicine fellowship programs.
CONCLUSION: The teaching of ultrasound guided chronic pain procedures varies significantly between individual programs. Though many program directors do require that fellows demonstrate competency in the technique before graduation, as of today there is no ACGME guideline regarding this. The advancement in ultrasound technology and the increase in number of trained faculty may significantly impact the use of USG in training fellows to perform chronic pain procedures. PMID: 25415783 [PubMed - in process] (Source: Pain Physician)


Lumbar interlaminar epidural injections are superior to caudal epidural injections in managing lumbar central spinal stenosis.
CONCLUSIONS: The results of this assessment showed significant improvement in patients suffering with chronic lumbar spinal stenosis with caudal and interlaminar epidural approaches with local anesthetic only, or with steroids in a long-term follow-up of up to 2 years, in contemporary interventional pain management setting, with the interlaminar approach providing significantly better results. PMID: 25415784 [PubMed - in process] (Source: Pain Physician)


Pulsed radiofrequency for occipital neuralgia.
CONCLUSION: Clinical studies to date examining the efficacy of PRF as a treatment for occipital neuralgia have yielded promising results, demonstrating sustained improvement in pain, quality of life, and adjuvant pain medication usage. Despite these encouraging clinical studies, conclusive evidence in support of PRF as an interventional treatment option for occipital neuralgia awaits to be seen. PMID: 25415786 [PubMed - in process] (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>


Development of an Effective Topical Liposomal Formulation for Localized Analgesia and Anti-inflammatory Actions in the Complete Freund's Adjuvant Rodent Model of Acute Inflammatory Pain.
CONCLUSIONS: The study demonstrates that topically applied loperamide encapsulated within liposomal systems has improved therapeutic efficacy over conventional formulations for the local treatment of acute peripheral inflammatory pain conditions where the skin has remained intact. Once in the inflamed peripheral tissue, loperamide provides analgesic and anti-inflammatory effects in a similar manner to peripheral endogenous opioids. This preparation optimises the retention of drug at the site where action is required. PMID: 25415787 [PubMed - in process] (Source: Pain Physician)


Hemiparesis and Facial Sensory Loss following Cervical Epidural Steroid Injection.
Authors: Maddela R, Wahezi SE, Sparr S, Brook A Abstract Interlaminar cervical epidural steroid injections (ic-ESI) are safe and effective treatment options for the management of acute and chronic radiculopathy, spinal stenosis, and other causes of neck pain not responding to more conservative measures. However, the procedure inherently lends itself to possible spinal cord injury (SCI). Though reports of such events have been documented, the clinical presentation of patients with needle puncture SCI varies. In part, this may be due to anatomic considerations, as symptoms may be dependent on the cervical level intruded, as well as the volume and type of injectate used. Many cases go unreported and therefore the true incidence of cord injections during ic-ESI is not known. Cervical e...


Greater trochanteric pain syndrome due to tumoral calcinosis in a patient with chronic kidney disease.
We report our experience of symptomatic improvement following the repeated ultrasound-guided aspiration of calcific fluid and the injection of a mixture of local anesthetic and steroid. PMID: 25415793 [PubMed - in process] (Source: Pain Physician)


Neuromodulation of the suprascapular nerve.
Authors: Elahi F, Reddy CG Abstract The shoulder joint is an enarthrodial or ball-and-socket joint. A complex network of anatomic structures endows the human shoulder with tremendous mobility, greater than any other joint in the body. Many pathologies can been found in those patients with chronic shoulder pain. The painful limitation of shoulder motion affects hand and arm motion as well; therefore, it significantly influences work performance and everyday activities as well as the quality of life. Therefore, the treatment of patients with chronic shoulder pain has major social and health economic implications. In this article we present a patient with a complex history of shoulder pathology including 7 surgeries that left the patient with chronic debilitating shoulder pain. She wa...


Tryptamine levels are low in plasma of chronic migraine and chronic tension-type headache
Abstract The primary aim of this study (TA-CH, Tryptophan Amine in Chronic Headache) was to investigate a possible role of tryptophan (TRP) metabolism in chronic migraine (CM) and chronic tension-type headache (CTTH). It is not known if TRP metabolism plays any role in CM and/or CTTH. Plasma levels of serotonin (5-HT), 5-hydroxyindolacetic acid (5-HIAA), metabolite of 5-HT, and tryptamine (TRY) were tested in 73 patients with CM, 15 patients with CTTH and 37 control subjects. Of these, plasmatic TRY was significantly lower in CM (p &lt; 0.001) and in CTTH (p &lt; 0.002) patients with respect to control subjects, while 5-HIAA levels in plasma were within the same range in all groups. 5-HT was undetectable in the plasma of almost all subjects. Our results support the hypothesis...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Central antalgic activity of resveratrol.
In this study, the response to painful stimuli of the animals treated with resveratrol had a bimodal profile with hypoalgesia or hyperalgesia. In the selected experimental conditions, resveratrol had a definite analgesic effect; the increase in time to reaction ranged from 100-120% (8 rats) to 600-700% (9 rats). In this experiment resveratrol exerts evident central antalgic effects in the majority of rats, which are related to the individual level of excitation and vigilance at baseline. Antinociceptive induced by resveratrol icv injection was maximal at 4-10 min and lasted no longer than 15 min. The effect of resveratrol to produce analgesia after a single icv injection may be interesting for preventing chronic pain. PMID: 21308652 [PubMed - indexed for MEDLINE] (Source: Archives Ital...


Metabolomics insights into pathophysiological mechanisms of interstitial cystitis.
Authors: Fiehn O, Kim J Abstract Interstitial cystitis (IC), also known as painful bladder syndrome or bladder pain syndrome, is a chronic lower urinary tract syndrome characterized by pelvic pain, urinary urgency, and increased urinary frequency in the absence of bacterial infection or identifiable clinicopathology. IC can lead to long-term adverse effects on the patient's quality of life. Therefore, early diagnosis and better understanding of the mechanisms underlying IC are needed. Metabolomic studies of biofluids have become a powerful method for assessing disease mechanisms and biomarker discovery, which potentially address these important clinical needs. However, limited intensive metabolic profiles have been elucidated in IC. The article is a short review on metabolomic anal...


Pain, catastrophizing, and depression in chronic prostatitis/chronic pelvic pain syndrome.
Authors: Kwon JK, Chang IH Abstract Persistent and disabling pain is the hallmark of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, disease severity (as measured by objective indexes such as those that use radiography or serology) is only marginally related to patients' reports of pain severity, and pain-related presentation can differ widely among individuals with CP/CPPS. Increasing evidence in support of the biopsychosocial model of pain suggests that cognitive and emotional processes are crucial contributors to inter-individual differences in the perception and impact of pain. This review describes the growing body of literature relating depression and catastrophizing to the experience of pain and pain-related sequelae in CP/CPPS. Depression and catastroph...


Effects of a Short Course of Oral Prednisolone in Patients with Bladder Pain Syndrome with Fluctuating, Worsening Pain despite Low-Dose Triple Therapy.
CONCLUSIONS: In patients with BPS/IC who show transient, fluctuating, worsening pain as flare-up symptoms despite undergoing low-dose triple therapy, a short course of oral prednisolone therapy was sufficiently effective. However, large-scale studies should be performed to verify our findings. PMID: 23346483 [PubMed] (Source: International Neurourology Journal)


'Omics' approaches to understanding interstitial cystitis/painful bladder syndrome/bladder pain syndrome.
Authors: You S, Yang W, Anger JT, Freeman MR, Kim J Abstract Recent efforts in the generation of large genomics, transcriptomics, proteomics, metabolomics and other types of 'omics' data sets have provided an unprecedentedly detailed view of certain diseases, however to date most of this literature has been focused on malignancy and other lethal pathological conditions. Very little intensive work on global profiles has been performed to understand the molecular mechanism of interstitial cystitis/painful bladder syndrome/bladder pain syndrome (IC/PBS/BPS), a chronic lower urinary tract disorder characterized by pelvic pain, urinary urgency and frequency, which can lead to long lasting adverse effects on quality of life. A lack of understanding of molecular mechanism has been a chall...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 prevalence of sacroiliitis and spondyloarthritis in patients with sarcoidosis.
Conclusion. We found spondyloarthritis in patients with sarcoidosis at a higher percentage rate than in the general population (1-1.9%). Controlled trials involving large series of patients are required for the confirmation of the data. PMID: 24899899 [PubMed] (Source: International Journal of Rheumatology)


The Relationship between Mechanical Hyperalgesia Assessed by Manual Tender Point Examination and Disease Severity in Patients with Chronic Widespread Pain: A Cross-Sectional Study.
The objective of this study was to assess the relationship between mechanical hyperalgesia assessed by manual TP examination and clinical disease severity. 271 women with CWP were recruited from a clinical setting. Data collection included patient-reported symptoms, health-related quality of life variables, and observation-based measures of functional ability, muscle strength, 6-minute walk, and pressure pain thresholds measured by cuff algometry. TP examination was conducted according to ACR-guidelines. Relationships between disease variables and TP count (TPC) were analyzed with logistic regression in a continuum model, allowing the TPC to depend on the included disease variables and two regression models carried out for a TPC threshold level, varying between 1 and 17. The threshold anal...


Quantitative sensory testing in painful hand osteoarthritis demonstrates features of peripheral sensitisation.
Authors: Wajed J, Ejindu V, Heron C, Hermansson M, Kiely P, Sofat N Abstract Hand osteoarthritis (HOA) is a prevalent condition for which treatments are based on analgesia and physical therapies. Our primary objective was to evaluate pain perception in participants with HOA by assessing the characteristics of nodal involvement, pain threshold in each hand joint, and radiological severity. We hypothesised that inflammation in hand osteoarthritis joints enhances sensitivity and firing of peripheral nociceptors, thereby causing chronic pain. Participants with proximal and distal interphalangeal (PIP and DIP) joint HOA and non-OA controls were recruited. Clinical parameters of joint involvement were measured including clinical nodes, VAS (visual analogue score) for pain (0-100 mm sca...


23-year-old female with dyspnea, hematuria, and seizure progressing to respiratory failure.
We report a 23-year old female who presented with fever, shortness of breath and abdominal pain. Shortly thereafter the patient developed hematuria, hemoptysis and seizure progressing to respiratory failure. She was found to have aortitis and alveolar hemorrhage. We discuss the clinical manifestations and the diagnostic work up of Takayasu arteritis. The patient's response to therapy and a discussion on treatment modalities of the disease are also included in the report. PMID: 24003540 [PubMed - indexed for MEDLINE] (Source: Sarcoidosis Vasculitis and Diffuse Lung Diseases)


Two-Dimensional Ultrasound and Ultrasound Elastography Imaging of Trigger Points in Women with Myofascial Pain Syndrome Treated by Acupuncture and Electroacupuncture: A Double-Blinded Randomized Controlled Pilot Study.
Authors: Müller CE, Aranha MF, Gavião MB Abstract Chronic pain has been often associated with myofascial pain syndrome (MPS), which is determined by myofascial trigger points (MTrP). New features have been tested for MTrP diagnosis. The aim of this study was to evaluate two-dimensional ultrasonography (2D US) and ultrasound elastography (UE) images and elastograms of upper trapezius MTrP during electroacupuncture (EA) and acupuncture (AC) treatment. 24 women participated, aged between 20 and 40 years (M ± SD = 27.33 ± 5.05) with a body mass index ranging from 18.03 to 27.59 kg/m2 (22.59 ± 3.11), a regular menstrual cycle, at least one active MTrP at both right (RTPz) and left trapezius (LTPz) and local or referred pain for up to six months. Subjects were randomized into EA and...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Ultrasonic characterization of the upper trapezius muscle in patients with chronic neck pain.
Authors: Turo D, Otto P, Shah JP, Heimur J, Gebreab T, Zaazhoa M, Armstrong K, Gerber LH, Sikdar S Abstract Myofascial trigger points (MTrPs) are palpable, tender nodules in taut bands of skeletal muscle that are painful on compression. MTrPs are characteristic findings in myofascial pain syndrome (MPS). The role of MTrPs in the pathophysiology of MPS is unknown. Localization, diagnosis, and clinical outcome measures of painful MTrPs can be improved by objectively characterizing and quantitatively measuring their properties. The goal of this study was to evaluate whether ultrasound imaging and elastography can differentiate symptomatic (active) MTrPs from normal muscle. Patients with chronic (&gt;3 months) neck pain with spontaneously painful, palpable (i.e., active) MTrPs and heal...


P2X(7) Receptors in Neurological and Cardiovascular Disorders.
Authors: Skaper SD, Debetto P, Giusti P Abstract P2X receptors are ATP-gated cation channels that mediate fast excitatory transmission in diverse regions of the brain and spinal cord. Several P2X receptor subtypes, including P2X(7), have the unusual property of changing their ion selectivity during prolonged exposure to ATP, which results in a channel pore permeable to molecules as large as 900 daltons. The P2X(7) receptor was originally described in cells of hematopoietic origin, and mediates the influx of Ca(2+) and Na(+) and Ca(2+) and Na(+) ions as well as the release of proinflammatory cytokines. P2X(7) receptors may affect neuronal cell death through their ability to regulate the processing and release of interleukin-1beta, a key mediator in neurodegeneration, chronic inflamm...


P2X(7) Receptors as a Transducer in the Co-Occurrence of Neurological/Psychiatric and Cardiovascular Disorders: A Hypothesis.
Authors: Skaper SD, Giusti P Abstract Background. Over-stimulation of the purinergic P2X(7) receptor may bring about cellular dysfunction and injury in settings of neurodegeneration, chronic inflammation, as well as in psychiatric and cardiovascular diseases. Here we speculate how P2X(7) receptor over-activation may lead to the co-occurrence of neurological and psychiatric disorders with cardiovascular disorders. Presentation. We hypothesize that proinflammatory cytokines, in particular interleukin-1beta, are key players in the pathophysiology of neurological, psychiatric, and cardiovascular diseases. Critically, this premise is based on a role for the P2X(7) receptor in triggering a rise in these cytokines. Given the broad distribution of P2X(7) receptors in nervous, immune, and v...


Revision of infected total knee arthroplasty: two-stage reimplantation using an antibiotic-impregnated static spacer.
CONCLUSIONS: This technique is a reasonable procedure to eradicate chronic infection in knee arthroplasty and provides proper functional and clinical results. However, it sometimes requires extensile surgical approaches that could imply arduous surgeries. Metallic augments with cementless stems available in most of the knee revision systems are a suitable alternative to handle bone deficiencies, avoiding the use of bone allografts with its complications. PMID: 24009903 [PubMed - indexed for MEDLINE] (Source: Clinics in Orthopedic Surgery)


Clinical and radiological predictive factors to be related with the degree of lumbar back muscle degeneration: difference by gender.
CONCLUSIONS: The PT was the important predictive factor for lumbar back muscle degeneration in both, the male and the female group. However, age and BMI were predictive factors in the female group only. PMID: 25177458 [PubMed - in process] (Source: Clinics in Orthopedic 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>


Randomized controlled study on resistive vibration exercise (EVE study): protocol, implementation and feasibility.
CONCLUSIONS: These data suggest positive effects of resistance exercise upon cardiovascular health and vascular responsiveness and a further beneficial effect of superimposed vibrations in decreasing resting diastolic blood pressure. Finally, development of back pain may be fostered by superimposed vibrations to high training loads, particularly at higher frequencies. PMID: 23728101 [PubMed - indexed for MEDLINE] (Source: Journal of Musculoskeletal Neuronal Interactions)


A Comparative Pilot Study to Evaluate the Adjunctive Role of Levosulpride with Trigger Point Injection Therapy in the Management of Myofascial Pain Syndrome of Orofacial Region
Conclusions The combined therapy with conventional trigger point injection and levosulpride as antidepressant significantly reduce pain and depression in the study subjects suffering from chronic myofascial pain with moderate to severe depression in the orofacial region. (Source: Journal of Maxillofacial and Oral Surgery)


A comparative analysis of magnetic resonance imaging and radiographic examinations of patients with atypical odontalgia.
CONCLUSION: MRI examination revealed no changes in the painful region in a majority of patients with AO, suggesting that inflammation was not present. MRI findings were significantly correlated to radiographic findings. PMID: 25068217 [PubMed - indexed for MEDLINE] (Source: Journal of Orofacial Pain)


Beliefs and distress about orofacial pain: patient journey through a specialist pain consultation.
CONCLUSION: Patients' fears and beliefs about chronic orofacial pain are dominated by worrying and searching for meaning before consultation. Information about their chronic pain condition counters feelings of helplessness and supports sense-making around pain when explanations are clear, are delivered sensitively from a trusted source, and take into account the patient's existing health beliefs; this promotes self-management. These findings underline the important functions of specialist consultation in achieving a shared accurate understanding of pain and options for treatment. PMID: 25068216 [PubMed - indexed for MEDLINE] (Source: Journal of Orofacial Pain)


Masticatory and cervical muscle tenderness and pain sensitivity in a remote area in subjects with a temporomandibular disorder and neck disability.
CONCLUSION: The results of this study have highlighted the importance of assessing TMD patients not only in the craniofacial region but also in the neck and other parts of the body. Future studies should focus on testing the effectiveness of treatments addressing the neck and the pain sensitivity in the hand in patients with TMD. PMID: 24829929 [PubMed - indexed for MEDLINE] (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>


Bilateral stellate ganglion blockade for recalcitrant oral pain from Burning Mouth Syndrome: a case report.
This article presents a case report of stellate ganglion blockade as a treatment for recalcitrant pain from BMS. PMID: 24822241 [PubMed - indexed for MEDLINE] (Source: Journal of Orofacial Pain)


Topical review: the enigma of fibromyalgia.
This article reviews the epidemiology, etiology, pathophysiology, and clinical presentation of fibromyalgia, as well as therapeutic advances. Also highlighted are issues that are important to the oral health care provider, including orofacial manifestations and oral health care considerations for patients with fibromyalgia. PMID: 24822234 [PubMed - indexed for MEDLINE] (Source: Journal of Orofacial Pain)


Antinociceptive effects of mirtazapine, pregabalin, and gabapentin after chronic constriction injury of the infraorbital nerve in rats.
CONCLUSION: Intraspinal administration of either mirtazapine, gabapentin, or pregabalin reverses the lowered facial mechanical thresholds produced in a rat model of trigeminal neuropathic pain. PMID: 24482789 [PubMed - indexed for MEDLINE] (Source: Journal of Orofacial Pain)


Search for antisickling agents from plants.
Authors: Dash BP, Archana Y, Satapathy N, Naik SK Abstract The sickle cell disease is fatal in nature. Thousands of children are dying off due to this health problem throughout the globe. Due to the rapid development of diagnosis and clinical managements such patients are living up to a respectable age. But as there is no permanent cure the patients are suffering from bone and joint pain, jaundice, hepato-splenomegaly, chronic infections etc. The main physiological complicacy is due to the polymerization of sickle hemoglobin (HbS), (sickling process) inside the red blood cell (RBC) of these patients during deoxygenating state. The change of RBC from spherical to sickle shape is due to the polymerization of mutant hemoglobin (HbS) inside the RBC and membrane distortion during anoxic...


Pain-related worry in patients with chronic orofacial pain.
CONCLUSIONS: Participants with chronic orofacial pain reported experiencing substantial levels of trait worry, anxiety, PC and worry about pain that related to pain ratings directly and indirectly. PRACTICAL IMPLICATIONS: Clinicians should assess pain-related worry in patients with chronic orofacial pain to understand the effects of worry on pain and functioning. Clinicians could treat these patients more effectively by helping them reduce their levels of pain-related worry and focusing on improved coping. PMID: 24982278 [PubMed - in process] (Source: Journal of the American Dental Association)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Clitoral Reconstruction after Female Genital Mutilation/Cutting: Case Studies
ConclusionWe show a positive outcome in pain reduction and improved sexual function, self body image, and gender after psychosexual therapy and clitoral reconstruction. More evidence is needed about clitoral reconstruction to develop guidelines on best practices. Until research is conducted that rigorously evaluates clitoral reconstruction for its impact on pain and sexuality, we advise always offering a multidisciplinary care, including sexual therapy before and after the surgery. Abdulcadir J, Rodriguez MI, Petignat P, and Say L. Clitoral reconstruction after female genital mutilation/cutting: Case studies. J Sex Med **;**:**–**. (Source: The Journal of Sexual Medicine)


Blowing Away the Pain: A Technique for Pediatric Pain Management
We describe a distraction technique for pediatric pain management that involves “blowing away the pain.” This technique may be used for acute pediatric procedures as well as for patients with chronic pain. (Source: Pediatric Dermatology)


Laparoscopic ventral mesh rectopexy in male patients with internal or external rectal prolapse
ConclusionLVMR is an effective treatment for external and symptomatic internal rectal prolapse in men, leading to significant improvement in QoL and function. (Source: Colorectal Disease)


Association of neutrophil extracellular traps with endometriosis-related chronic inflammation
Conclusion This is the first study, which evaluated and described the presence of NETs in the PF of endometriosis patients. Our study shows, that NETs may be involved in the complex pathophysiology of endometriosis. (Source: European Journal of Obstetrics and Gynecology and Reproductive Biology)


Spinal cord infarction as a complication of hemodialysis
A 76-year-old man with past history of hypertension, hyperlipidemia, diabetes mellitus and chronic kidney disease was referred because of acute onset paraplegia occurring shortly after hemodialysis. He experienced severe hypotension in the middle of dialysis session and acute onset low back pain afterwards. On examination he had a T9-T10 sensory level. MR Imaging revealed a longitudinal T2 hyperintense lesion extending from T8 to L1 in the center of the cord without gadolinium enhancement (Figure 1). (Source: The Spine Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Association Between Experimental Pain Biomarkers and Serologic Markers in Patients With Different Degrees of Painful Knee Osteoarthritis
ConclusionA platform of mechanistic pain biomarkers in combination with structure‐related serologic biomarkers provides new possibilities for understanding how osteoarthritis‐related structural features may be associated with pain and pain sensitization. This study showed significant correlations between central pain sensitization and CRPM as a possible measure for chronic inflammation. Future pain association studies should include biomarkers representing the local joint environment more specifically. (Source: Arthritis and Rheumatism)


Chronic Pain and Health Care Spending: An Analysis of Longitudinal Data from the Medical Expenditure Panel Survey
ConclusionsChronic pain limitations are associated with higher health care expenditures. Results underscore the substantial cost of pain to the health care system. (Source: Health Services Research)


Targeting C5aR for pain relief [Pharmacology]
Chronic pain resulting from inflammatory and neuropathic disorders causes considerable economic and social burden. Pharmacological therapies currently available for certain types of pain are only partially effective and may cause severe adverse side effects. The C5a anaphylatoxin acting on its cognate G protein-coupled receptor (GPCR), C5aR, is a potent pronociceptive... (Source: Proceedings of the National Academy of Sciences)


The influence of microglia activation on the efficacy of amitriptyline, doxepin, milnacipran, venlafaxine and fluoxetine in a rat model of neuropathic pain.
Authors: Zychowska M, Rojewska E, Makuch W, Przewlocka B, Mika J Abstract The analgesic properties of antidepressants are often used in the treatment of neuropathy, however their influence on glial cells in maintaining neuropathic pain is unknown. Our studies examined the neuropathic pain-relieving properties after intraperitoneal injection of amitriptyline, doxepin, milnacipran, venlafaxine and fluoxetine 7 days after sciatic nerve injury (CCI) in rats and its influence on microglia/macrophages (IBA-1) and astroglia (GFAP) activation in the spinal cord and dorsal root ganglia (DRG) using Western blot. All tested antidepressants significantly reduced CCI-induced allodynia but hyperalgesia was only antagonized by fluoxetine, doxepine and venlafaxine. The strongest analgesia was obse...


Tapentadol Potentiates Descending Pain Inhibition in Chronic Pain Patients With Diabetic Polyneuropathy
No abstract available (Source: Survey of Anesthesiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Type 2 Diabetes: Not Invisible, but Misunderstood
Sourced from The Hysterectomy Association: Hysterectomy Association - Hysterectomy Association - hysterectomy, menopause and hormone replacement therapy (hrt) information and support for women. Type 2 diabetes is a rapidly growing global health concern. It is estimated to affect more than 300 million people worldwide, and around 90% of all diabetics have this form of the condition. However, despite type 2 being well and truly in the spotlight, it is still frequently misunderstood. Much has been said in the media about the connection between type 2 diabetes, obesity and a sedentary lifestyle – so much so that perhaps we’re inclined to feel unsympathetic towards type 2 patients? But even while it’s true that Type 2 diabetes can be prevented in many cases, it remains a serious and incur...


Sickle Cell Anemia Treatment So Successful in Kids That Trial Is Halted
Title: Sickle Cell Anemia Treatment So Successful in Kids That Trial Is HaltedCategory: Health NewsCreated: 11/21/2014 12:00:00 AMLast Editorial Review: 11/24/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


What Types of Patients Can Be Referred for Palliative Care Services?
Discussion Pediatric pallative care (PPC) is care for patients who have life-threatening conditions or need end of life care. The main stakeholders receiving PPC are the patients and all members of the family which may include siblings, grandparents and other members. Other stakeholders are the medical care team including ancillary staff at the hospital and other venues where the patient receives care. PPC is provided by an interdisciplinary team including physicians, nurses, social workers, pharmacists, psychologists, chaplains/faith workers and others who assist families in four main areas: &#8220;&#8230;relieve suffering, improve quality of life, facilitate informed decision-making and assist in care coordination between clinicians and across sites of care.&#8221; PPC providers can hel...


Perspectives in Pain Research 2014: Neuroinflammation and glial cell activation: The cause of transition from acute to chronic pain?
Conclusions The present perspective paper indicates that neuroinflammation and the associated release of pro-inflammatory cytokines in dorsal root ganglion and at the spinal cord contribute to the transition from acute to chronic pain. Neuroinflammatory changes have not only been identified in the spinal cord and brainstem, but more recently, in the sensory ganglia and in the nerves as well. The glial cell activation may be responsible for contralateral spreading and possible widespread sensitisation. Implications Communication between glia and neurons is proposed to be a critical component of neuroinflammatory changes that may lead to chronic pain. Sensory ganglia neurons are surrounded by satellite glial cells but how communication between the cells contributes to altered pain sensitivi...


Stereotactic body radiation therapy for abdominal and pelvic oligometastases: Dosimetric targets for safe and effective local control
Conclusions Our results suggest that SBRT doses 40-50 Gy in 5 fractions (biological effective dose 72-100 Gy10) with bowel V20Gy ≤20 mL are efficacious and associated with minimal toxicity for abdominal pelvic nodal and soft-tissue oligometastases. Palliation of symptoms is achievable in most patients with symptomatic lesions. SBRT for oligometastases may be a good alternative to systemic therapy in selected patients. (Source: Practical Radiation Oncology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


σ1 receptors activate astrocytes via p38 MAPK phosphorylation leading to the development of mechanical allodynia in a mouse model of neuropathic pain
Conclusions and ImplicationsSpinal σ1 receptors are localized in astrocytes and blockade of σ1 receptors inhibits the pathological activation of astrocytes via modulation of p‐p38, which ultimately prevents the development of MA in neuropathic mice. (Source: British Journal of Pharmacology)


The non‐peptide GLP‐1 receptor agonist WB4‐24 blocks inflammatory nociception by stimulating β‐endorphin release from spinal microglia
Conclusions and ImplicationsOur results suggest that WB4‐24 inhibits inflammatory nociception by releasing analgesic β‐endorphin rather than inhibiting the expression of proalgesic pro‐inflammatory cytokines in spinal microglia, and that the spinal GLP‐1 receptor is a potential target molecule for the treatment of pain hypersensitivity including inflammatory nociception. (Source: British Journal of Pharmacology)


In vivo properties of KNT‐127, a novel δ opioid receptor agonist: receptor internalization, antihyperalgesia and antidepressant effects in mice
Conclusions and ImplicationsThe DOP receptor agonist KNT‐127 induced agonist‐specific acute and chronic responses, at both behavioural and cellular levels. It displays activities similar to the other recently reported DOP agonists, AR‐M1000390, ADL5747 and ADL5859, and differs from SNC80. SNC80 differs from the other DOP receptor agonists including KNT‐127, by exhibiting ligand‐biased tolerance at this receptor. (Source: British Journal of Pharmacology)


Gender Differences in Acute and Chronic Pain in the Emergency Department: Results of the 2014 Academic Emergency Medicine Consensus Conference Pain Section
Abstract Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were r...


Mobile Pharmacy: An Innovative Community Pharmacy Primary Care Collaboration for Complex Co-Morbid and Chronic Pain Patients (Scott Vincent Monte PharmD)
Power point presentation outlining clinical and operational collaboration opportunities between primary care and community pharmacy. (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>


High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency - a prospective study.
Conclusion: Even in educated patients with chronic adrenal insufficiency AC occurs in a substantial proportion of cases. Furthermore, we identified AC associated mortality in about 6% of AC. Our findings further emphasize the need for improved management of AC in patients with chronic AI. PMID: 25419882 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)


Gender Differences in Acute and Chronic Pain in the Emergency Department: Results of the 2014 Academic Emergency Medicine Consensus Conference Pain Section.
Authors: Musey PI, Linnstaedt SD, Platts-Mills TF, Miner JR, Bortsov AV, Safdar B, Bijur P, Rosenau A, Tsze DS, Chang AK, Dorai S, Engel KG, Feldman JA, Fusaro AM, Lee DC, Rosenberg M, Keefe FJ, Peak DA, Nam CS, Patel RG, Fillingim RB, McLean SA Abstract Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED...


Advances in Diagnosis and Treatment of Interstitial Cystitis/Painful Bladder Syndrome
Abstract Interstitial cystitis/bladder pain syndrome (IC/BPS) is a prevalent chronic condition that can be challenging not only to diagnose but also to treat. We review recent diagnostic markers and therapies for IC/BPS from non-medication-based therapies, oral therapies, intravesical therapies, and surgical treatments. (Source: Current Infectious Disease Reports)


Neuroinflammation and glial cell activation in pathogenesis of chronic pain
Publication date: Available online 23 November 2014 Source:Scandinavian Journal of Pain Author(s): Elisabeth Hansson (Source: Scandinavian Journal of Pain)


Erratum
In the article by Malay S and Chung KC in the November 2014 issue of the Journal (“Testing the Validity of Preventing Chronic Regional Pain Syndrome With Vitamin C After Distal Radius Fracture”, Vol. 39A, No. 11, pp 2251–2257), the title is incorrect. The article title should be “Testing the Validity of Preventing Complex Regional Pain Syndrome With Vitamin C After Distal Radius Fracture.” (Source: The Journal of Hand 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>


Cervicobrachial Polymyositis
Conclusions:Cervicobrachial polymyositis presents with predominant or isolated proximal upper limb and neck weakness. It has marked female preponderance and affects neck flexors and extensors and trapezius and deltoid muscles severely. Wrist and finger extensors are also weakened. In a proportion of patients, it is associated with serological markers of autoimmune disorders and interstitial lung disease. In addition to serum creatine kinase, electromyography, and muscle biopsy, magnetic resonance imaging forms a noninvasive adjunct test in the diagnostic process. Because of the pattern of weakness, cervicobrachial polymyositis tends to be confused with other common neurological conditions having upper girdle weakness, leading to delay in the diagnosis of this potentially treatable conditio...


Mast Cell Activation Syndrome as a Significant Comorbidity in Sickle Cell Disease
Abstract:Some sickle cell anemia (SCA) patients suffer significantly worse phenotypes than others. Causes of such disparities are incompletely understood. Comorbid chronic inflammation likely is a factor. Recently, mast cell (MC) activation (creating an inflammatory state) was found to be a significant factor in sickle pathobiology and pain in a murine SCA model. Also, a new realm of relatively noncytoproliferative MC disease termed MC activation syndrome (MCAS) has been identified recently. MCAS has not previously been described in SCA. Some SCA patients experience pain patterns and other morbidities more congruent with MCAS than traditional SCA pathobiology (eg, vasoocclusion). Presented here are 32 poor-phenotype SCA patients who met MCAS diagnostic criteria; all improved with MCAS-targ...


Do silver-based wound dressings reduce pain? A prospective study and review of the literature
Silver-containing dressings are a mainstay in the management of burn injury and acute and chronic wounds. In addition to antimicrobial activity, there is anecdotal evidence that silver dressings may modulate or reduce wound pain. Pain is subjective and difficult to quantify, and most studies of silver-containing dressings evaluate pain as a secondary rather than a primary outcome. Nevertheless, a dressing with a proven ability to reduce pain independent of systemic analgesics would have great utility. (Source: Burns : Journal of the International Society for Burn Injuries)


[Case Report] A pregnant woman with chronic meningococcaemia from Neisseria meningitidis with lpxL1-mutations
In February, 2014, a 29-year-old woman at 17 weeks' gestation was referred to our hospital with a 7 day history of maculopapular rash, joint pain, and swelling of her fingers and toes. Medical history was unremarkable apart from 4 months of chronic sinusitis. On examination she looked well, with temperature 36·6°C, pulse 80 beats per min, and blood pressure 110/60 mm Hg. She had disseminated maculopapular blanching lesions on her arms and legs (), and swollen fingers and toes which were tender to palpation. (Source: LANCET)


Risk Factors of Chronic Daily Headache or Chronic Migraine
Abstract Chronic daily headache (CDH) is a common neurological condition that affects 1–4 % of the general population. Most individuals with CDH originally suffered from episodic headaches, but over time, this developed into CDH. Although the pathophysiology of CDH is not fully understood, recent clinical and epidemiological studies suggest some risk factors that are associated with an increased risk of transformation from episodic headaches. If risk factors can be identified, they could provide a base for aggressive preventive intervention and thus decrease the transformation from episodic headaches to eventual CDH. In this article, we review and summarize the current data on risk factors for CDH. (Source: Current Pain and Headache Reports)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Sleep and Chronic Daily Headache
Abstract Sleep and headache have a complex and extensive interrelationship. This review focuses on the relationship between sleep and chronic daily headache, examining recent advances in the epidemiology and insights into possible mechanisms of this relationship as well as reviewing advances in treatment. There is a clear relationship between obstructive sleep apnoea (OSA) and snoring and morning headache, but the relationship between OSA and snoring and other primary headaches requires clarification. OSA and chronic migraine share both obesity and patent foramen ovale (PFO) as possible co-morbidities. Hypoxia does not clearly predispose to morning headache. Continuous positive airway pressure (CPAP) is an established treatment for OSA, and mixed results have been reported with r...


Update of Chronic Tension-Type Headache
Abstract Tension-type headache (TTH) is the most common type of primary headaches, and its chronic form, chronic tension-type headache (CTTH), is affecting 0.5 to 4.8 % of the worldwide population. Although the mechanism underlying CTTH remains unclear, the role of central versus peripheral mechanisms has always been discussed while explaining the pathogenesis of CTTH. There is always a debate on differential diagnosis between CTTH and chronic migraine without aura which are regarded as different aspects of chronic daily headache spectrum because of many similarities and fuzzy boundaries. Compared with pharmacological treatments, non-pharmacological treatments have been popular as alternative interventions for CTTH in recent years. This review summaries the update knowledge on C...


Animal Models of Chronic Migraine
Abstract Many animal models of migraine have been described. Some of them have been useful in the development of new therapies. All of them have their shortcomings. Animal models of chronic migraine have been relatively less frequently described. Whether a rigid distinction between episodic and chronic migraine is useful when their underlying pathophysiology is likely to be the same and that migraine frequency probably depends on complex polygenic influences remains to be determined. Any model of chronic migraine must reflect the chronicity of the disorder and be reliable and validated with pharmacological interventions. Future animal models of chronic migraine are likely to involve recurrent activation of the trigeminal nociceptive system. Valid models would provide a means for ...


Non-healing gastro-duodenal ulcer: a rare presentation of primary abdominal tuberculosis
Conclusion This case has illustrated the difficulties associated with a prompt diagnosis of an unusual case of primary duodenal tuberculosis from chronic peptic ulcer disease in an immunocompetent patient. (Source: International Journal of Surgery Case Reports)


Movement coaching: study protocol of a randomized controlled trial evaluating effects on physical activity and participation in low back pain patients
DiscussionDue to the burden of physical inactivity, there is a need to develop, evaluate and disseminate approaches that are effective in promoting physical activity and especially promoting the maintenance of physical activity in relevant target groups. Considering the high prevalence and socioeconomic impact of low back pain and its multifactorial etiology, low back pain patients seem to be a relevant target group for physical activity promotion. A multilevel approach to bridge the interface of (inpatient) rehabilitation and self-directed physical activity will help to target group-specific PA promotion.Trial registration: German Clinical Trials Register (DRKS)-ID: DRKS00004878. (Source: Epidemiologic Perspectives and Innovations)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Narcotic induced pain
A man in his 40s with a history of Diabetes mellitus type 1, hypertension, neuropathy on chronic opioids and end stage renal disease was referred to our hospital for management of chronic abdominal pain, nausea, vomiting and anorexia of two years duration. (Source: The American Journal of Medicine)


Acupuncture for chronic pain? Clinical wisdom undecided despite over 4000 years of practice
While healers and practitioners have used acupuncture to relieve pain for millennia, modern clinical trials assessing the efficacy of this approach yield seemingly inconsistent and contradictory results. For example, in multiple rigorous studies focusing on chronic lower back pain, acupuncture outperformed standard-of-care (e.g., combination of drugs, physical therapy, and exercise); surprisingly, sham acupuncture and placebo controls similarly outperformed conventional treatment.1,2 Zetetics sometimes discount this conundrum by dismissing the formidable psychosocial influence of both actual and sham acupuncture treatments. (Source: The American Journal of Medicine)


Dienogest in women with persistent endometriosis-related pelvic pain during norethisterone acetate treatment
Conclusions This study confirms the efficacy of DNG in treating symptomatic women with rectovaginal endometriosis even in a particular endometriotic subpopulation of NETA “resistant” patients. Further randomized clinical trials comparing these two progestins both in first than second line are warranted. (Source: European Journal of Obstetrics and Gynecology and Reproductive Biology)


Expression of AKR1B1, AKR1C3 and other genes of prostaglandin F2α biosynthesis and action in ovarian endometriosis tissue and in model cell lines
Publication date: Available online 22 November 2014 Source:Chemico-Biological Interactions Author(s): Maša Sinreih , Maja Anko , Neli Hevir Kene , Vida Kocbek , Tea Lanišnik Rižner Endometriosis is a frequent benign gynecological disease characterized by endometrial tissue outside the uterine cavity. The estimated prevalence in the general population is 6%-10%, but this reaches 30%-50% in women with infertility and/or pain. As ectopic tissue within the pelvic cavity provokes inflammation, endometriosis is also considered a chronic inflammatory disease, and is characterized by increased peritoneal fluid levels of prostaglandin (PG)E2 and PGF2α. The AKR1B1 and AKR1C3 enzymes act as PG synthases and catalyze reduction of PGH2 to PGF2α, and PGD2 to 9α,11β-PGF2α, respectively. AKR1B1 ...


Expression of AKR1B1, AKR1C3 and other genes of prostaglandin F2α biosynthesis and action in ovarian endometriosis tissue and in model cell lines.
Authors: Sinreih M, Anko M, Kene NH, Kocbek V, Rižner TL Abstract Endometriosis is a frequent benign gynecological disease characterized by endometrial tissue outside the uterine cavity. The estimated prevalence in the general population is 6-10%, but this reaches 30-50% in women with infertility and/or pain. As ectopic tissue within the pelvic cavity provokes inflammation, endometriosis is also considered a chronic inflammatory disease, and is characterized by increased peritoneal fluid levels of prostaglandin (PG)E2 and PGF2α. The AKR1B1 and AKR1C3 enzymes act as PG synthases and catalyze reduction of PGH2 to PGF2α, and PGD2 to 9α,11β-PGF2α, respectively. AKR1B1 and AKR1C3 may thus be associated with increased PGF2α production in endometriosis patients, as supported by our...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Anatomy, physiology and neurobiology of the nociception: A focus on low back pain (part A).
CONCLUSION: The mechanical component of FBSS cannot be understood unless the functioning of the pain system is known. But ultimately, the highly variable nature of back pain expression among individuals would require a careful pathophysiological dissection of the potential generators of back pain to guide pain management strategies. PMID: 25441598 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)


Avoidance behavior in chronic pain research: A cold case revisited.
Authors: Volders S, Boddez Y, De Peuter S, Meulders A, Vlaeyen JW Abstract In chronic musculoskeletal pain, avoidance behavior is a prominent behavioral characteristic that can manifest itself in various ways. It is also considered a crucial component in the development and maintenance of chronic pain-related disability, supposedly fueled by pain-related fear and catastrophic beliefs. Despite the frequent occurrence of avoidance behavior and its potential impact on quality of life, relatively little research has been dedicated to the nature of avoidance in chronic pain and its assessment, leaving its underlying mechanisms poorly understood. In the current paper, we stipulate some of the existing parallels between chronic pain research and more basic fear and anxiety research inspir...


Narcotic-induced Pain
A man in his 40s with a history of diabetes mellitus type 1, hypertension, neuropathy on chronic opioids, and end-stage renal disease was referred to our hospital for management of chronic abdominal pain, nausea, vomiting, and anorexia of 2 years duration. (Source: The American Journal of Medicine)


Prevalence of depressive and anxiety symptoms in patients with chronic pain
Conclusion The present study showed high prevalence of depressive and anxiety symptoms in patients with chronic pain. There was also significant association of these psychiatric symptoms with some types and intensity of pain. (Source: Jornal Brasileiro de Psiquiatria)


The Case Files: The Effects of an Epidural Steroid Injection
This study showed that the duration of absorption of 50 ml of air decreased from 5.8 to 1.9 weeks by 40% FiO2 from 1.9 to 0.6 weeks on room air and 100% FiO2, respectively. (Anesthesiology 1996;84[2]:442.)     Several diagnoses should be added to the headache differential diagnosis in the case of a patient receiving recent epidural spinal injections. Post-procedural headache or low-pressure headache, as well as pneumocephalus, should be added to the differential. The patient can be easily placed on a face mask to expedite air resorption, and can be provided symptom control as needed. This patient was successfully managed using supplemental oxygen and analgesia.Tags: case files, epidural, epidural steroid injection, post-procedural headache, pneumocephalus, emergency medicine, emergency...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 economic impact of chronic pain: a nationwide population-based cost-of-illness study in Portugal
Abstract In addition to its high frequency and relevant individual and social impact, chronic pain (CP) has been shown to be a major contributor to increased healthcare utilisation, reduced labour productivity, and consequently large direct and indirect costs. In the context of a larger nationwide study, we aimed to assess the total annual direct and indirect costs associated with CP in Portugal. A population-based study was conducted in a representative sample of the Portuguese adult population. The 5,094 participants were selected using random digit dialling and contacted by computer-assisted telephone interviews. Questionnaires included the brief pain inventory and pain disability index. Estimates were adequately weighted for the population. From all CP subjects identified, a s...


A Partnered Approach to Opioid Management, Guideline Concordant Care and the Stepped Care Model of Pain Management
CONCLUSIONS We demonstrate improvements in the management of veterans receiving OT that are consistent with the SCM-PM and published practice guidelines. We highlight how partnerships among funders, researchers, clinicians, and administrators contributed to the project’s design and implementation, and to the dissemination strategy and future directions for improving opioid management and pain care. (Source: Journal of General Internal Medicine)


Measuring the Symptoms of Pediatric Constipation and Irritable Bowel Syndrome with Constipation: Expert Commentary and Literature Review
Conclusion Findings demonstrate consistency in the literature on key CIC/IBS symptoms to measure in pediatric trials, but existing COAs do not meet regulatory standards. (Source: The Patient - Patient-Centered Outcomes Research)


Seasonal changes in symptoms in patients with chronic prostatitis/chronic pelvic pain syndrome: a seasonal follow-up study
Scandinavian Journal of Urology, Volume 48, Issue 6, Page 533-537, December 2014. (Source: Scandinavian Journal of Urology)


CKD: Exercise May Improve Pain, Physical Function CKD: Exercise May Improve Pain, Physical Function
Patients with chronic kidney disease improved on fitness tests and quality-of-life measures after completing a 12-week exercise program. Medscape Medical News (Source: Medscape Nephrology 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>


[Deep Brain Stimulation: New Frontier in the Treatment of CNS Disorders.]
Conclusions: In most of these clinical situations, deep brain stimulation is a safe and useful therapeutic resource that must be considered whenever the usual therapies are useless or not enough; in the other cases a greater experience is needed to make it a regular indication. PMID: 25409221 [PubMed - as supplied by publisher] (Source: Acta Medica Portuguesa)


Abuse-Resistant Prescription Painkiller Approved
Title: Abuse-Resistant Prescription Painkiller ApprovedCategory: Health NewsCreated: 11/20/2014 12:00:00 AMLast Editorial Review: 11/21/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Clinical characteristics and in-hospital outcome of patients with acute coronary syndromes and systemic lupus erythematosus
Conclusions Despite the small number of patients, our findings were similar to those in the literature, showing coronary artery disease in young people with SLE due to premature atherosclerosis and a high mortality rate. (Source: Revista Portuguesa de Cardiologia)


FDA Approves Harder-to-Abuse Hydrocodone (FREE)
By Kristin J. Kelley Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS Hydrocodone bitartrate (marketed as Hysingla ER) has been approved by the FDA for treating chronic, "around-the-clock" pain in … (Source: Physician's First Watch current issue)


Assessment of function in patients with rotator cuff tears: Functional test versus self-reported questionnaire
Conclusions: In addition to the weak association between WORC and 9PEG, the difference between the parameters related to each method suggests that they should not be used interchangeably to determine the upper extremity function. We recommend the utilization of 9PEG instead of WORC in assessing the upper extremity function in the setting of loss of muscle strength. Level of Evidence: Level IV, Therapeutic study. (Source: Table of Contents : International Journal of Shoulder Surgery : 2007 - 1(1))<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


On high heels and short muscles: A multiscale model for sarcomere loss in the gastrocnemius muscle
Publication date: 21 January 2015 Source:Journal of Theoretical Biology, Volume 365 Author(s): Alexander M. Zöllner , Jacquelynn M. Pok , Emily J. McWalter , Garry E. Gold , Ellen Kuhl High heels are a major source of chronic lower limb pain. Yet, more than one third of all women compromise health for looks and wear high heels on a daily basis. Changing from flat footwear to high heels induces chronic muscle shortening associated with discomfort, fatigue, reduced shock absorption, and increased injury risk. However, the long-term effects of high-heeled footwear on the musculoskeletal kinematics of the lower extremities remain poorly understood. Here we create a multiscale computational model for chronic muscle adaptation to characterize the acute and chronic effects of global muscle sho...


The antinociceptive effect of reversible monoamine oxidase-A inhibitors in a mouse neuropathic pain model
Publication date: 1 July 2013 Source:Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 44 Author(s): Jardel Gomes Villarinho , Kelly de Vargas Pinheiro , Francielle de Vargas Pinheiro , Sara Marchesan Oliveira , Pablo Machado , Marcos Antônio Pinto Martins , Helio Gauze Bonacorso , Nilo Zanatta , Roselei Fachinetto , Juliano Ferreira Neuropathic pain is a debilitating condition that is often resistant to common analgesics, such as opioids, but is sensitive to some antidepressants, an effect that seems to be mediated by spinal cord 5-HT3 receptors. Because the analgesic potential of monoamine oxidase-A (MAO-A) inhibitors is understudied, we evaluated the potential antinociceptive effect of the reversible MAO-A inhibitors moclobemide and 2-(3,4-dimethoxy-phenyl)-4,5-d...


Tongue Piercing and Chronic Abdominal Pain With Nausea and Vomiting—Two Cases
The objectives of the study were as follows: (1) To demonstrate the usefulness of an integrative medicine treatment approach in two cases of patients with chronic abdominal pain, nausea, and vomiting of unclear etiology who had failed standard medical management. (2) To identify scars from tongue piercings as a possible contributing factor in chronic upper GI symptoms of unclear etiology. Two retrospective case studies are presented of young adult females who were seen in a private multi-physician integrative medicine practice in the US. The patients were treated with neural therapy and acupuncture. The desired outcome was the cessation or reduction of the frequency of abdominal pain, nausea, and vomiting. Both patients had resolution of their symptoms. From this study, we have concluded t...


Long-term effect of cupping for chronic neck pain
Publication date: Available online 14 October 2014 Source:Integrative Medicine Research Author(s): Jungtae Leem (Source: Integrative Medicine Research)


A Challenging Cause of Chronic Diarrhea
Question: An 88-year-old man with no significant past medical history presented with nine months history of diarrhea and weight loss of 40 pounds. There was no associated abdominal pain or blood in stools. On examination the patient looked cachectic; the remaining physical examination was unremarkable. Complete blood count with differential and comprehensive metabolic panel were unremarkable except for a high alkaline phosphatase of 248 U/L. Abdominal computed tomography revealed a discrete, circumscribed, 5 × 5-cm solid mass in the inferior part of spleen (FigureA). (Source: Gastroenterology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Neuroscience Education in Addition to Trigger Point Dry Needling for The Management of Patients with Mechanical Chronic Low Back Pain: A Preliminary Clinical Trial
The objective of the current study was to determine the short-term effects of trigger point dry needling (TrP-DN) alone or combined with neuroscience education on pain, disability, kinesiophobia and widespread pressure sensitivity in patients with mechanical low back pain (LBP). Twelve patients with LBP were randomly assigned to receive either TrP-DN (TrP-DN) or TrP-DN plus neuroscience education (TrP-DN+EDU). Pain intensity (Numerical Pain Rating Scale, 0-10), disability (Roland-Morris Disability Questionnaire-RMQ-, Oswestry Low Back Pain Disability Index-ODI), kinesiophobia (Tampa Scale of Kinesiophobia-TSK), and pressure pain thresholds (PPT) over the C5-C6 zygapophyseal joint, transverse process of L3 vertebra, second metacarpal, and tibialis anterior muscle were collected at baseline ...


Opioid Prescribing Patterns for Non-Malignant Chronic Pain for Rural Versus Non-Rural U.S. Adults: A Population-Based Study Using 2010 NAMCS Data
Discusses the results of a survey comparing rural and non-rural prescribing patterns of opioid drugs for non-malignant chronic pain management. Rurality was indicated to be a factor in the over-prescribing of opioids. -- (Source: Rural publications via the Rural Assistance Center)


Modulation of the TRPV1 channel: current clinical trials and recent patents with focus on neurological conditions.
Authors: De Petrocellis L, Moriello AS Abstract The transient receptor potential vanilloid-1 cat ion channel (TRPV1) is a nonspecific cation channel that can be activated by multiple endogenous stimuli and is expressed predominantly in sensory neurons, where it serves as a key nodal point in pain transmission pathways. In mammals, TRPV1 displays a wide tissue and cellular expression including both the peripheral and central nervous system, and in the latter it is now recognized to have a broader distribution and function. The pharmacological modulation of TRPV1 represents a strategy for the treatment of a variety of disease states, particularly those requiring chronic pain management. The validation of the TRPV1 channel as a therapeutic target for the control of pain and inflammato...


A survey of recent patents on CB2 agonists in the management of pain.
Authors: Murineddu G, Asproni B, Pinna GA Abstract Pain, a homeostatic and protective mechanism which can go awry in disease states and therefore needs treatment, is a complex and differentiated sensorial perception which may be classified as physiological, inflammatory and neuropathic. Chronic pain represents a major health problem throughout the world, thus several companies and researchers have embarked on the search for new drugs and targets to treat the disease. The different types of receptors in the CNS involved in the mediation of analgesia include the cannabinoid receptors: in particular, CB2 modulators seem to represent a new potential class of analgesic. This review covers recent patents and advances in CB2 agonist studies in the management of pain. PMID: 22280338 [P...


Analgesic and antineuropathic drugs acting through central cholinergic mechanisms.
Authors: Bartolini A, Di Cesare Mannelli L, Ghelardini C Abstract The role of muscarinic and nicotinic cholinergic receptors in analgesia and neuropathic pain relief is relatively unknown. This review describes how such drugs induce analgesia or alleviate neuropathic pain by acting on the central cholinergic system. Several pharmacological strategies are discussed which increase synthesis and release of acetylcholine (ACh) from cholinergic neurons. The effects of their acute and chronic administration are described. The pharmacological strategies which facilitate the physiological functions of the cholinergic system without altering the normal modulation of cholinergic signals are highlighted. It is proposed that full agonists of muscarinic or nicotinic receptors should be avoided....<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


From antidepressant drugs to beta-mimetics: preclinical insights on potential new treatments for neuropathic pain.
This article reviews the findings leading to propose beta-mimetics for neuropathic pain treatment and other recent patents on the topic. PMID: 19538157 [PubMed - indexed for MEDLINE] (Source: Recent Patents on CNS Drug Discovery)


Health Tip: Seek Treatment for a Broken Toe
Title: Health Tip: Seek Treatment for a Broken ToeCategory: Health NewsCreated: 11/20/2014 12:00:00 AMLast Editorial Review: 11/20/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


3 natural pain relievers that are as powerful as drugs, without the side effects
(NaturalNews) Unfortunately, acute or chronic pain is something that everyone in their life experiences at one time or another. Even though this is a powerful reminder from the body that something is either healing or going terribly wrong, a way to manage the pain is often required... (Source: NaturalNews.com)


Muscle progenitor cell regenerative capacity in the torn rotator cuff
This article is protected by copyright. All rights reserved (Source: Journal of Orthopaedic Research)


Histopathological classification criteria of rat model of chronic prostatitis/chronic pelvic pain syndrome
Conclusion The histopathological classification criteria of rat model of CP/CPPS will serve for further research of the pathogenesis and treatment strategies of the disease. (Source: International Urology and Nephrology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Hyperbaric oxygenation treatment alleviates CCI‐induced neuropathic pain and decreases spinal apoptosis
ConclusionsOverly expressed proapoptosis genes, and subsequent increase in spinal apoptotic cells, seem to contribute to the development of CCI‐induced neuropathic pain. The inhibitory role of HBO on spinal proapoptosis genes and apoptotic changes may contribute to its beneficial effect on CCI‐induced neuropathic pain. (Source: European Journal of Pain)


Intravenous dextromethorphan/quinidine inhibits activity of dura‐sensitive spinal trigeminal neurons in rats
ConclusionsIt is evident that the observed DM/Q‐induced suppression of trigeminal neuron excitability can lead to a reduction in nociceptive transmission from meninges to higher centres of the brain. Since the same mechanism is believed to underlie the pharmacodynamics of many well‐known antimigraine drugs, results of the present study enable us to anticipate the potential efficacy of DM/Q in migraine. (Source: European Journal of Pain)


Applying the Gender Lens to Emergency Care: From Bench to Bedside
This article outlines the history, need, and evolution of gender medicine in emergency care research. Clinical examples are used where sex and gender play a role in diagnosis, management, or prognosis of patients in the emergency department (ED). The ED serves as an ideal setting to advance sex‐ and gender‐specific research as the primary access point for health care for much of the U.S. population, with more than 136 million annual visits. Gender medicine provides the biologic and social framework to provide high‐quality, safe, equitable, and cost‐effective sex‐ and gender‐specific care in the ED. With a 24‐hour hospital presence, and with access to high‐acuity patients, emergency physicians are well positioned to lead sex‐ and gender‐specific clinical studies for time...


Fluoroscope-guided celiac plexus block in a pregnant patient: a case report
A 28-weeks gestation pregnant patient with chronic pacreatitis and severe abdominal pain leading to impaired nutrition is presented. After detailed consideration of the case, fluoroscopic-guided celiac plexus neurolysis was performed. The block was performed using the transaortic approach as it reduces radiation exposure. (Source: Journal of Clinical Anesthesia)


Management of chronic neuropathic pain: a protocol for a multiple treatment comparison meta-analysis of randomised controlled trials
Introduction Chronic neuropathic pain is associated with reduced health-related quality of life and substantial socioeconomic costs. Current research addressing management of chronic neuropathic pain is limited. No review has evaluated all interventional studies for chronic neuropathic pain, which limits attempts to make inferences regarding the relative effectiveness of treatments. Methods and analysis We will conduct a systematic review of all randomised controlled trials evaluating therapies for chronic neuropathic pain. We will identify eligible trials, in any language, by a systematic search of CINAHL, EMBASE, MEDLINE, AMED, HealthSTAR, DARE, PsychINFO and the Cochrane Central Registry of Controlled Trials. Eligible trials will be: (1) enrol patients presenting with chronic 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>


Serotonergic System and Its Role in Epilepsy and Neuropathic Pain Treatment: a Review Based on Receptor Ligands.
Authors: Pańczyk K, Gołda S, Waszkielewicz A, Zelaszczyk D, Gunia-Krzyżak A, Marona H Abstract The serotonergic system is involved in pathomechanisms of both epilepsy and neuropathic pain. So far, participation in the epileptogenesis and maintenance of epilepsy was proved for 5-HT1A, 5-HT2C, 5-HT3, 5-HT4 and 5-HT7 receptors as well as 5-HTT serotonin transporter. Depending on the receptor type or its localization, its stimulation may increase or decrease neuronal excitability. According to the available data, neuropathic pain mechanisms involve 5-HT1A/1B/1D, 5-HT2A/2B/2C, 5-HT3, 5-HT4, 5-HT6, 5-HT7 receptors and 5-HTT serotonin transporter. Changes in their expression modulate pain mainly by affecting the transmission through serotonergic descending pathways. Several compounds, ...


Applying the Gender Lens to Emergency Care: From Bench to Bedside.
This article outlines the history, need, and evolution of gender medicine in emergency care research. Clinical examples are used where sex and gender play a role in diagnosis, management, or prognosis of patients in the emergency department (ED). The ED serves as an ideal setting to advance sex- and gender-specific research as the primary access point for health care for much of the U.S. population, with more than 136 million annual visits. Gender medicine provides the biologic and social framework to provide high-quality, safe, equitable, and cost-effective sex- and gender-specific care in the ED. With a 24-hour hospital presence, and with access to high-acuity patients, emergency physicians are well positioned to lead sex- and gender-specific clinical studies for time-sensitive condition...


[Conversion to tapentadol PR improves analgesia and quality of life in patients with severe and chronic pain despite using tramadol > 300 mg/d.]
CONCLUSIONS: Data analysis shows a clinically relevant benefit in patients unsuccessfully pretreated with tramadol by consecutive conversion to the potent analgesic tapentadol PR. PMID: 25409951 [PubMed - as supplied by publisher] (Source: Wiener Klinische Wochenschrift)


Depletion of Foxp3+ regulatory T cells increases severity of mechanical allodynia and significantly alters systemic cytokine levels following peripheral nerve injury.
Authors: Lees JG, Duffy SS, Perera CJ, Moalem-Taylor G Abstract Neuropathic pain is a debilitating condition caused by damage to the somatosensory nervous system, such as peripheral nerve injury. The immune system, and in particular the adaptive T cell response, plays a key role in mediating such pain. Regulatory T (Treg) cells are a small subpopulation of inhibitory T cells that prevent autoimmunity, limit immunopathology and maintain immune homeostasis. Here, we investigated the effects of conditional depletion of Treg cells on mechanical allodynia and serum cytokines in mice with chronic constriction injury (CCI) of the sciatic nerve, an animal model of neuropathic pain. We demonstrate that CCI induced the infiltration of small numbers of Treg cells within effected neuronal tiss...


Pathophysiological characterisation of back pain generators in failed back surgery syndrome (part B).
CONCLUSION: Clinical investigations of the low back pain component in FBSS patients should be based on meticulous dissection of all potential triggers that could be a source of the nociceptive pain characteristics and possibly amenable to further aetiological treatment. Clinicians should therefore refine pain management strategies to ensure that the chronic nature of the pain becomes the guiding principle for multidisciplinary assessement. PMID: 25456443 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Multicolumn spinal cord stimulation for significant low back pain in failed back surgery syndrome: Design of a national, multicentre, randomized, controlled health economics trial (ESTIMET Study).
Authors: Roulaud M, Durand-Zaleski I, Ingrand P, Serrie A, Diallo B, Peruzzi P, Hieu PD, Voirin J, Raoul S, Page P, Fontaine D, Lantéri-Minet M, Blond S, Buisset N, Cuny E, Cadenne M, Caire F, Ranoux D, Mertens P, Naous H, Simon E, Emery E, Gadan B, Regis J, Sol JC, Béraud G, Debiais F, Durand G, Guetarni Ging F, Prévost A, Brandet C, Monlezun O, Delmotte A, d'Houtaud S, Bataille B, Rigoard P Abstract BACKGROUND: Many studies have demonstrated the efficacy of spinal cord stimulation (SCS) for chronic neuropathic radicular pain over recent decades, but despite global favourable outcomes in failed back surgery syndrome (FBSS) with leg pain, the back pain component remains poorly controlled by neurostimulation. Technological and scientific progress has led to the development of new...


Abdominal Pain and the Neurotrophic System in Ulcerative Colitis
Conclusions:We did not observe changes in mucosal innervation and did not see a significant relationship between nerve fiber density, inflammatory mediators, neurotrophic factors, or mucosal ion channel expression and pain. In contrast, the importance of depression as the only independent predictor of pain ratings mirrors functional disorders, where central processes significantly contribute to symptom development and/or perpetuation. (Source: Inflammatory Bowel Diseases)


Significance of the Epithelioid Granuloma in Biopsies of Crohn's Colitis
Conclusions:In colonic biopsies from patients with Crohn's disease, granulomas constitute a rare finding. Presence of granulomas is associated with younger patient age, more severe histopathologic expression of the underlying disease, and more clinical symptoms. (Source: Inflammatory Bowel Diseases)


Distraction Analgesia in Chronic Pain Patients: The Impact of Catastrophizing
Conclusion: Distraction produced greater analgesia among chronic pain patients with higher catastrophizing, suggesting that catastrophizing’s pain-amplifying effects may be due in part to greater attention to pain, and these patients may benefit from distraction-based pain management approaches. Furthermore, these data suggest that distraction analgesia and conditioned pain modulation may involve separate underlying mechanisms. (Source: Anesthesiology)


PTSD Symptoms Mediate the Effect of Attachment on Pain and Somatisation after Whiplash Injury.
CONCLUSION: Acknowledging that PTSD is part of the aetiology involved in explaining persistent symptoms after whiplash, may help sufferers to gain early and more suited treatment, which in turn may prevent the condition from becoming chronic. PMID: 23802016 [PubMed] (Source: Clinical Practice and Epidemiology in Mental 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>


Vitamin D and autoimmune thyroid diseases: facts and unresolved questions
Abstract Vitamin D deficiency (levels lower than 20 ng/ml) is becoming a global health problem, since it is increasingly represented even among healthy subjects. Vitamin D, as an environmental factor, is involved in many biological processes, like perception of chronic pain and response to infections. In recent years, evidence has emerged pointing to an involvement of vitamin D in the development of many autoimmune diseases, and a severe vitamin D deficiency has been especially demonstrated in patients affected with autoimmune thyroid disease (AITD). Low levels of vitamin D were found associated with antithyroid antibody presence, abnormal thyroid function, increased thyroid volume, increased TSH levels, and adverse pregnancy outcome in women with AITD. Vitamin D mediates its eff...


Predicting Postcesarean Delivery Pain
Abstract Poorly treated acute pain after cesarean delivery is associated with significant short-term and long-term morbidity in young women. Due to the importance of treating perioperative pain, more emphasis has been placed on improving postoperative pain management. However, individual differences in pain perception make postoperative pain management challenging after cesarean delivery. In this review, we will identify recent studies that have utilized a variety of preoperative tests to predict acute and/or chronic postoperative pain scores after cesarean delivery. (Source: Current Anesthesiology Reports)


Chronic pelvic floor dysfunction
Publication date: October 2014 Source:Best Practice &amp; Research Clinical Obstetrics &amp; Gynaecology, Volume 28, Issue 7 Author(s): Dee Hartmann , Julie Sarton The successful treatment of women with vestibulodynia and its associated chronic pelvic floor dysfunctions requires interventions that address a broad field of possible pain contributors. Pelvic floor muscle hypertonicity was implicated in the mid-1990s as a trigger of major chronic vulvar pain. Painful bladder syndrome, irritable bowel syndrome, fibromyalgia, and temporomandibular jaw disorder are known common comorbidities that can cause a host of associated muscular, visceral, bony, and fascial dysfunctions. It appears that normalizing all of those disorders plays a pivotal role in reducing complaints of chronic vul...


Effects of proprioceptive exercises on pain and function in chronic neck- and low back pain rehabilitation: a systematic literature review
Conclusions: There are few relevant good quality studies on proprioceptive exercises. A descriptive summary of the evidence suggests that there is no consistent benefit in adding PrT to neck- and low back pain rehabilitation and functional restoration. (Source: BMC Musculoskeletal Disorders)


Association of Atypical Femoral Fractures with Bisphosphonate Use by Patients with Varus Hip Geometry
Conclusions: Patients on chronic bisphosphonate therapy who presented with atypical femoral fracture(s) had more varus proximal femoral geometry than those who took bisphosphonates without sustaining a fracture. Although no causative effect can be determined, a finding of varus geometry may help to better identify patients at risk for fracture after long-term bisphosphonate use. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: The Journal of Bone and Joint 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>


Work related upper limb disorders
Publication date: December 2014 Source:Indian Journal of Rheumatology, Volume 9, Supplement 2 Author(s): Michael Hutson Neuropathic arm pain (NAP), commonly referred to as ‘RSI’, diffuse upper limb disorder or type II work related upper limb disorder (WRULD) is a regional pain syndrome affecting the upper limb(s), characterized by persistent pain and dysaesthesiae. It is commonly associated with long periods of keyboard use, though may also occur in workers engaged in other types of repetitive stereotyped activities of the hands. Adverse ergonomics is commonly present. Sleep pattern is usually disturbed, and depression, headaches, chronic fatigue, and frustration are frequently experienced. The pathogenesis of NAP is probably linked to overloading of sensorineural mechanisms responsi...


Diagnosis and management of neck and back pain
Publication date: December 2014 Source:Indian Journal of Rheumatology, Volume 9, Supplement 2 Author(s): Andrew O. Frank Neck and back pains are features of life worldwide. Few with spinal pain (SP) have serious medical (non-spinal) conditions; significant spinal pathology; or compression of root or cord such as to require surgery. Although the causes of most episodes of SP remain unclear in practice, physical stress and its consequences on discs, facet joints and supporting soft tissue structures at work or leisure activities are thought to trigger many initial attacks. But prognosis usually depends on psychosocial issues. A minority of episodes are prolonged, intractable and disabling, contributing to the high cost for society. Around 10% of those presenting to a rheumatological servic...


Psychological therapies help reduce headache and non-headache pain in children and adolescents
Commentary on: Eccleston C, Palermo TM, Williams AC, et al.. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2014;5:CD003968. Context Chronic and recurrent pain, especially in the head, abdomen and limbs affects up to 30% of children and adolescents.1 Pain can be severely disabling, disrupting school and social activities and if left untreated, may extend towards adulthood. Increasing evidence shows that psychological factors are pivotal in the transition from acute to chronic disabling pain. As a result, psychological interventions have been developed to modify the emotional, cognitive and behavioural processes that are considered to maintain pain, disability and distress. Psychological interventions initiall...


Ledipasvir/Sofosbuvir administration achieves very high rate of viral clearance in patients with HCV genotype 1 infection without cirrhosis, regardless of ribavirin co-administration or length of treatment
Commentary on: Kowdley KV, Gordon SC, Reddy KR, et al.. Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis. N Engl J Med 2014;370:1879&ndash;88. Context Approximately 150 million people worldwide are estimated to be chronic carriers of hepatitis C virus (HCV). Estimates indicate a quarter of HCV carriers will develop liver cirrhosis, which entails a risk of severe complications (hepatocellular carcinoma, decompensation, end-stage liver failure, death).1 Viral clearance significantly decreases disease progression and increases survival rates. Two antiviral approaches are currently available: interferon-based and interferon-free. Interferon-free therapies are the future of HCV treatment thanks to the optimal tolerability and safety, high efficacy and because they c...