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Medworm: Chronic Pain - Recent Medical Updates

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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>


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...


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)


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)


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


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)


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)


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...


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


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)


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...


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


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)


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


Pilot 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)


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


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


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


Electroacupuncture inhibits 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 ...


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)


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)


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


U.S. 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)


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


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


Effect of 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...


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)


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


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


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


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...


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


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


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)


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


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)


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


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)


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


Effect of 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)


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


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)


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


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


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)


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


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


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...


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


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


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


Re: 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)


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


Chronic Widespread Pain 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)


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


Foot 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)


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


The impact of 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...


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


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 ...


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


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)


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


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)


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


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)


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


A rare 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 ...


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


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 ...


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


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


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)


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


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)


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


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


Gastrointestinal 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)


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


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)


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


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)


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


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)


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


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...


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


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)


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


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 ...


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


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


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)


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


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)


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


Attitudes 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 ...


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


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)


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


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)


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


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


Increased 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...


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)


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


Sexual 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...


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


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


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...


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


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...


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


Using 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)


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


Intra-articular 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...


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


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


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)


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


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


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...


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


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


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)


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


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...


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


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


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...


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


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)


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


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


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)


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


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


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


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)


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


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)


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


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)


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


[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)


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


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


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...


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)


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...


Psychological flexibility and nonjudgemental acceptance in voice hearers: relationships with omnipotence and distress
Conclusions: The study results suggest that psychological flexibility and nonjudgemental acceptance are related to general emotional well being and resistance response styles to voices, but not to specific dimensions of voice hearing. (Source: Australian and New Zealand Journal of 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>


Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis.
CONCLUSIONS: Adeno-/tonsillectomy leads to a reduction in the number of episodes of sore throat and days with sore throat in children in the first year after surgery compared to (initial) non-surgical treatment. Children who were more severely affected were more likely to benefit as they had a small reduction in moderate/severe sore throat episodes. The size of the effect is very modest, but there may be a benefit to knowing the precise timing of one episode of pain lasting several days - it occurs immediately after surgery as a direct consequence of the procedure. It is clear that some children get better without any surgery, and that whilst removing the tonsils will always prevent 'tonsillitis', the impact of the procedure on 'sore throats' due to pharyngitis is much less predictable.Ins...


Opioid prescribing patterns for non-malignant chronic pain for rural versus non-rural US adults: a population-based study using 2010 NAMCS data
Conclusions: Our results clearly indicated that rurality is an important factor in opioid prescribing patterns that cannot be ignored and bears further investigation. Further research on the growing concern about the over-prescribing of opioids in the US should now include rurality as a variable in data generation and analysis. Future research should also attempt to document the ecological, sociological and political factors impacting opioid prescribing and care in rural communities. Prescribers and health care policy makers need to critically evaluate the implications of our findings and their relationship to patient needs, best practices in a rural setting, and the overall consequences of increased opioid prescribing on rural communities. (Source: BMC Health Services Research)


Therapy gloves for patients with rheumatoid arthritis: a review
This study aims to review the available literature on the effects of wearing therapy gloves on patients&rsquo; hand function and symptoms as well as to discuss the attributes of gloves that might influence the glove performance. An electronic databases search of MEDLINE, Physiotherapy Evidence Database, Occupational Therapy Systematic Evaluation of Evidence, Wiley Online Library, ScienceDirect and Cochrane Central Register of Controlled Trial was performed. Eight articles met the inclusion criteria, and covered seven clinical trials and one case study. Seven outcome measures were identified from the included studies and were then classified into two categories: hand function and hand symptoms. The hand symptoms such as pain, stiffness and swelling improve substantially when the therapy glo...


13 (Non-Pharmaceutical) Ways to Deal With PTSD
Creative Commons image Apothecary cabinet, courtesy of Birmingham Museum and Art Gallery on Flickr. On Oct. 28, 2000 I witnessed the murder of my dear friend Wendy, and the shadow of that trauma has shaped my life ever since. But that's not my whole story, nor do I want it to be. (I can almost hear Wendy out in her Great Beyond singing, "Finally, Sezin. Finally.") Post-traumatic stress disorder (PTSD) is like any chronic illness -- it needs managing. So, each day I wake up and decide how I will find moments of peace, and over the years I've developed an extensive emotional apothecary, none of which involve pharmaceuticals. Here are 13 healing "potions" from my kit: 1) Avoid stressful situations whenever possible. If you had nightmares or generally woke up on the wrong side of PT...


Anterior T wave inversions and PE.
Last week, I described the case of a middle-aged male with a vague history of heart failure who had been having progressive shortness of breath for 4-5 days. On the day he called 911, he had been walking a short distance when he syncoped. EMS obtained an ECG: Inverted T waves are seen in III and aVF, as well as V1-V4. Compared with the prior ECG, the anterior T wave inversions appeared new. Subtle S1Q3T3, but no ATWI What can cause anterior T wave inversion (ATWI)? There are some rare entities that show up with ATWI; e.g. ARVC. Young women can also have a benign variant, the so-called persistent juvenile T wave pattern. But in this clinical context, we should consider two main categories: 1) myocardial ischemia, and 2) right ventricular strain. ATWI and myocardial ischemia Posterior STEMIs...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Immunostimulation in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a one-year prospective, double-blind, placebo-controlled study
Conclusions This placebo-controlled study evaluating OM-89 in patients with CP/CPPS showed a significant and long-lasting (12 months) favorable response with OM-89, but also with placebo. OM-89 was safe and well tolerated. EudraCT 2007-004609-85. (Source: World Journal of Urology)


Treatment of acute pelvic inflammatory disease.
Authors: Sweet RL Abstract Pelvic inflammatory disease (PID), one of the most common infections in nonpregnant women of reproductive age, remains an important public health problem. It is associated with major long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In addition, treatment of acute PID and its complications incurs substantial health care costs. Prevention of these long-term sequelae is dependent upon development of treatment strategies based on knowledge of the microbiologic etiology of acute PID. It is well accepted that acute PID is a polymicrobic infection. The sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis, are present in many cases, and microorganisms comprising the endogenous vaginal a...


Q Fever: an old but still a poorly understood disease.
Authors: Honarmand H Abstract Q fever is a bacterial infection affecting mainly the lungs, liver, and heart. It is found around the world and is caused by the bacteria Coxiella burnetii. The bacteria affects sheep, goats, cattle, dogs, cats, birds, rodents, and ticks. Infected animals shed this bacteria in birth products, feces, milk, and urine. Humans usually get Q fever by breathing in contaminated droplets released by infected animals and drinking raw milk. People at highest risk for this infection are farmers, laboratory workers, sheep and dairy workers, and veterinarians. Chronic Q fever develops in people who have been infected for more than 6 months. It usually takes about 20 days after exposure to the bacteria for symptoms to occur. Most cases are mild, yet some severe case...


Longitudinal associations of depressive symptoms and pain with quality of life in patients receiving chronic hemodialysis


Case reports: orthotic treatment of adult scoliosis patients with chronic back pain
This article presents two cases in which individualized torso orthoses were successfully used to treat patients with degenerative diseases and disorders of the sagittal line as well as three dimensional deformities of the spine. Using torso orthoses allows treatment of these patients with as few invasive measures as possible without losing maximal functionality. (Source: Scoliosis)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Alternative diagnoses in patients in whom the GP considered the diagnosis of pulmonary embolism
Conclusion. In primary care patients suspected of PE, the most common clinically relevant diagnosis other than PE was pneumonia. A positive Wells rule or a positive d-dimer test are not only positively associated with PE, but also with a high probability of other clinically relevant disease. (Source: Family Practice)


Teen smokers may run heightened risk of chronic severe period pain
Starting to smoke by the age of 13 may have greatest impact, suggests studyRelated items from OnMedicaPassive smoking could raise risk of breast cancer DysmenorrhoeaCombined contraceptive pill relieves painful period symptoms Weight gain weakens cardio benefits of smoking cessationFetal exposure to nicotine linked to later obesity (Source: OnMedica Latest News)


The Bioethics of Pain Management: Beyond Opioids
Emily Dickinson, that great nineteenth century American poet, knew about suffering. Chronic pain, oedema and agoraphobia blighted her life. She also understood the power of language&mdash;how to shape words into almost visceral evocations of illness, amputation, blindness, anorexia and madness. One of her most famous poems, though, is about pain itself. In words that echo those of pain sufferers throughout time, Dickinson claimedPain &ndash; has an Element of Blank &ndash; It cannot recollect When it began &ndash; or if there were A time when it was not &ndash; It has no Future &ndash; but itself &ndash; Its Infinite Contain Its Past &ndash; enlightened to perceive New Periods &ndash; of Pain. It was a profound depiction of what it means to live in chronic pain: its timelessness, the way i...


Multilocular cystic nephroma: A case report and review of the literature
In this report, we describe the clinical presentation, radiological finding, and histopathology of this case. (Source: Urological Science)


Effect of ω-conotoxin MVIIA and Phα1β on paclitaxel-induced acute and chronic pain
Publication date: December 2013 Source:Pharmacology Biochemistry and Behavior, Volumes 114–115 Author(s): Flávia K. Rigo , Gerusa D. Dalmolin , Gabriela Trevisan , Raquel Tonello , Mariane A. Silva , Mateus F. Rossato , Jonatas Z. Klafke , Marta do N. Cordeiro , Célio J. Castro Junior , Danuza Montijo , Marcus V. Gomez , Juliano Ferreira The treatment with the chemotherapeutic agent paclitaxel produces a painful peripheral neuropathy, and is associated with an acute pain syndrome in a clinically significant number of patients. However, no standard therapy has been established to manage the acute pain or the chronic neuropathic pain related to paclitaxel. In the present study, we evaluated the analgesic potential of two N-type voltage-gated calcium channel (VGCC) blockers, ω-conotoxi...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 long-lasting sensitization of primary afferent nociceptors induced by inflammation involves prostanoid and dopaminergic systems in mice
Publication date: January 2013 Source:Pharmacology Biochemistry and Behavior, Volume 103, Issue 3 Author(s): Cristiane Flora Villarreal , Mani Indiana Funez , Fernando de Queiroz Cunha , Carlos Amílcar Parada , Sérgio Henrique Ferreira In recent years, evidence that sensitization of primary afferent nociceptors is an important event associated with chronic pain has been accumulating. The present study aimed to evaluate the participation of the prostaglandin and sympathetic components in the long-lasting sensitization of nociceptors induced by acute inflammation in mice. The intraplantar administration of carrageenan (100μg) enhanced the nociceptive response to a small dose of PGE2 (9ng/paw) or dopamine (3μg/paw) up to 30days later. This long-lasting sensitization is dependent on dopa...


The Roland–Morris disability scale for the assessment of non-specific low back pain outcomes among disability sector workers
This study aimed to understand the LBP disability outcomes and determinants of care workers for people with intellectual, autistic and associated multiple disabilities. Study subjects included 678 care workers in 15 disability institutions who reported that they had experienced acute or chronic nonspecific LBP in the previous year. The effects of the LBP outcome were measured by the Roland–Morris Disability Questionnaire (RDQ), which is a self-rated assessment of pain-related disability used in this study. The mean score of the RDQ was 3.97 (range 0–24). Of the respondents, 14% expressed that they were free from pain disability (score=0), 66.4% subjects expressed they had a little pain disability (score 1–6), 14.7% subjects reported that they were mildly affected by pain disability (...


One-year course and predictors of abdominal pain in children with autism spectrum disorders: The role of anxiety and sensory over-responsivity
Conclusions Abdominal pain appears to be common and persistent among children with ASD. The relations among SOR, anxiety and abdominal pain offer information about potential underlying mechanisms. (Source: Research in Autism Spectrum Disorders)


Evaluation of a modified clinical prediction rule for use with spinal manipulative therapy in patients with chronic low back pain: a randomized clinical trial
Conclusions: We found no evidence that a modification of the original CPR can be used to discriminate CLBP patients that would benefit more from SMT. Further studies are needed to further clarify the patient characteristics that moderate treatment responsiveness to specific interventions for CLBP.Trial registrationISRCTN30511490 (Source: Chiropractic and Osteopathy)


Relationship between chronic pathologies of the supraspinatus tendon and the long head of the biceps tendon: systematic review
Conclusions: The review of literature corroborates an association between the chronic pathology of the supraspinatus tendon and LHBT due to the epidemiological data. In addition, some authors confirm the existence of an anatomical and functional relationship between LHBT and the supraspinatus tendon, the latter being part of the LHBT pulley. (Source: BMC Musculoskeletal Disorders)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Proteomic analysis of rat cartilage: the identification of differentially expressed proteins in the early stages of osteoarthritis
Conclusions: The proteins that we identified indicate that energy metabolism, cartilage matrix remodelling, and protective cellular mechanisms are associated with early OA. In addition, latexin expression during the early stages of OA is implicated in cartilage repair. (Source: Proteome Science)


Pain sensitivity in posttraumatic stress disorder and other anxiety disorders: a preliminary case control study
Conclusions: These findings are similar to some of the prior research and suggest that individuals with PTSD may exhibit lower cold pain sensitivity compared to those with other anxiety disorders. There is a need for future research to determine explanatory mechanisms. (Source: Annals of General Psychiatry)


Evaluation of a modified clinical prediction rule for use with spinal manipulative therapy in patients with chronic low back pain: a randomized clinical trial
Conclusions: We found no evidence that a modification of the original CPR can be used to discriminate CLBP patients that would benefit more from SMT. Further studies are needed to further clarify the patient characteristics that moderate treatment responsiveness to specific interventions for CLBP.Trial registrationISRCTN30511490 (Source: Chiropractic and Osteopathy)


New Medical Practice Offers Cutting-Edge and Holistic Pain Management...
Black Stone Physical Medicine recently opened its doors to treat patients with chronic pain and sports injuries. Dr. Marc Musson, a licensed Doctor of Osteopathic Medicine and Physical Medicine and...(PRWeb November 16, 2014)Read the full story at http://www.prweb.com/releases/corvallis-pain-doctor/blackstonephysicalmed/prweb12330012.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>


5 Ways to Treat Chronic Pain
Several options exist for managing persistent aches, ranging from straightforward lifestyle changes to major surgery -- Read more on ScientificAmerican.com (Source: Scientific American - Official RSS Feed)


“I’m Just In the Band”
Discussion Instrumental music, either as an avocation or profession, provides great pleasure for those performing and listening. Unfortunately it can also cause health problems. Many of the problems are musculoskeletal or neurological in etiology due to overuse and the musician may experience pain. Prelude to pain can include stiffness or tingling or other skin sensations. Musicians may experience weakness, loss of function, control (accuracy) and ability (speed) as well as problems with tone. &#8220;The most prevent problems involve overuse of muscles resulting from repetitive movements of playing, often in combination with prolonged weight bearing in an awkward positions.&#8221; String players have the highest prevalence of musculoskeletal problems. Musculoskeletal strain can also be ca...


Safety and neurological assessments after autologous transplantation of bone marrow mesenchymal stem cells in subjects with chronic spinal cord injury
Conclusion: Intralesional transplantation of autologous mesenchymal stem cells in subjects with chronic, complete spinal cord injury is safe, feasible, and may promote neurological improvements.Trial registration: ClinicalTrials.gov NCT01325103 - Registered 28 March 2011 (Source: BioMed Central)


Cannabinoid receptor 2 agonist attenuates pain related behavior in rats with chronic alcohol / high fat diet induced pancreatitis
Conclusion: LY3038404 HCl, a potent CB2 receptor agonist, possesses tissue protective and analgesic properties without effects on higher brain function. Thus, activation of CB2 receptors is suggested as a potential therapeutic target for visceral inflammation and pain management. (Source: Epidemiologic Perspectives and Innovations)


Is the incidence of temporomandibular disorder increased in polycystic ovary syndrome?
Publication date: November 2014 Source:British Journal of Oral and Maxillofacial Surgery, Volume 52, Issue 9 Author(s): Sidika Sinem Soydan , Kagan Deniz , Sina Uckan , Aslı Dogruk Unal , Neslihan Bascıl Tutuncu The prevalence of temporomandibular disorders is higher among women than men (ratio 3:1 -9:1). Polycystic ovary syndrome(PCOS) is the most common endocrine disorder in women, which is characterised by chronic low-grade inflammation and excess of androgenic hormones that lead to metabolic aberrations and ovarian dysfunction. Increased activities of various matrix metalloproteinases (particularly MMP-2 and 9) in the serum of these patients has been reported, and it has been hypothesised that high activities of MMP may contribute to loss of matrix and chronic inflammation 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>


Pilates versus general exercise on pain and functionality in non-specific chronic low back pain subjects: A randomised, controlled trial
Low back pain (LBP) is one of the most common causes of disability, and the Pilates method has been associated with improvements in symptoms. The purpose of this study was to assess the effectiveness of the Pilates method, when compared to general exercises, on pain and functionality after eight weeks (16 sessions, 2x/week) and a follow-up of three months, in subjects with non-specific chronic low back pain (NSCLBP). A randomised controlled trial composed of 22 subjects was proposed. Subjects were allocated into two groups: the Pilates group (PG) (n=11) and the general exercise group (GEG) (n=11). (Source: Journal of Bodywork and Movement Therapies)


Cannabinoid receptor 2 agonist attenuates pain related behavior in rats with chronic alcohol/high fat diet induced pancreatitis
Conclusion: LY3038404 HCl, a potent CB2 receptor agonist, possesses tissue protective and analgesic properties without effects on higher brain function. Thus, activation of CB2 receptors is suggested as a potential therapeutic target for visceral inflammation and pain management. (Source: Molecular Pain)


Headache Following Occipital Brain Lesion: A Case of Migraine Triggered by Occipital Spikes?
This study describes the case of an 8-year-old boy who developed a genuine migraine after the surgical excision, from the right occipital lobe, of brain abscesses due to selective infestation of the cerebrum by Entamoeba histolytica. After the surgical treatment, the boy presented daily headaches with typical migraine features, including right-side parieto-temporal pain, nausea, vomiting, and photophobia. Electroencephalography (EEG) showed epileptiform discharges in the right occipital lobe, although he never presented seizures. Clinical and neurophysiological observations were performed, including video-EEG and polygraphic recordings. EEG showed "interictal" epileptiform discharges in the right occipital lobe. A prolonged video-EEG recording performed before, during, and after an acute a...


Translational investigations for chronic pain.
Authors: Zhuo M PMID: 25410621 [PubMed - as supplied by publisher] (Source: Current Pharmaceutical Design)


Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects
Low back pain (LBP) is one of the most common causes of disability, and the Pilates method has been associated with improvements in symptoms. The purpose of this study was to assess the effectiveness of the Pilates method, when compared to general exercises, on pain and functionality after eight weeks (16 sessions, 2×/week) and a follow-up of three months, in subjects with non-specific chronic low back pain (NSCLBP). A randomised controlled trial composed of 22 subjects was proposed. Subjects were allocated into two groups: the Pilates group (PG) (n = 11) and the general exercise group (GEG) (n = 11). (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>


OPRM1 receptor as new biomarker to help the prediction of post mastectomy pain and recurrence in breast cance.
Authors: De Gregori M, Diatchenko L, Belfer I, Allegri M Abstract Breast cancer is the most common type of cancer among women worldwide. Short--term post--surgical recovery is complicated by many factors, including imbalanced inflammatory and immune response, acute pain associated with functional impairment, and chronic post--mastectomy pain (CPMP), developed by about 25--60% of patients. Opioids, most common drugs used for treatment of cancer pain, are immunosuppressive, and therefore, they might directly and/or indirectly influence long--term cancer recurrence. Moreover, they also produce endocrinopathy, which consists primarily of hypothalamic--pituitary--gonadal axis or hypothalamic--pituitary--adrenal axis dysfunction. The interindividual variability in both CPMP and opioid re...


Single-shot epidural-spinal anesthesia followed by oral oxycodone/naloxone and ketoprofen combination in patients undergoing total hip replacement: analgesic efficacy and tolerability.
CONCLUSIONS: Single-shot epidural spinal anaesthesia followed by OXN-based analgesia after hip replacement provided effective pain management, with high patient satisfaction rates. PMID: 24861719 [PubMed - as supplied by publisher] (Source: Minerva Anestesiologica)


Analgesic effects of topical ketamine.
Authors: Kopsky DJ, Keppel Hesselink JM, Bhaskar A, Hariton G, Romanenko V, Casale R Abstract Topical analgesics may play an important role in the management of chronic pain and have good tolerability. Systemic ketamine has limited usage as an anaesthetic and along with its potential for addiction and dependence has not gained popularity as an analgesic compound. Topical ketamine however, is devoid of serious side effects, and thus can be used in the management of various pain states such as neuropathic pain and complex regional pain syndrome. Despite using high concentrations of topical ketamine, clinically significant side effects are rare. The measured plasma levels of ketamine and norketamine in various studies were mostly below the threshold of detection. Topical ketamine has ...


A Case of Codeine Induced Anaphylaxis via Oral Route.
Authors: Yoo HS, Yang EM, Kim MA, Hwang SH, Shin YS, Ye YM, Nahm DH, Park HS Abstract Codeine is widely prescribed in clinical settings for the relief of pain and non-productive coughs. Common adverse drug reactions to codeine include constipation, euphoria, nausea, and drowsiness. However, there have been few reports of serious adverse reactions after codeine ingestion in adults. Here, we present a case of severe anaphylaxis after oral ingestion of a therapeutic dose of codeine. A 30-year-old Korean woman complained of the sudden onset of dyspnea, urticaria, chest tightness, and dizziness 10 minutes after taking a 10-mg dose of codeine to treat a chronic cough following a viral infection. She had previously experienced episodes of asthma exacerbation following upper respiratory in...


The effects of anesthetics on tumor progression.
Authors: Mao L, Lin S, Lin J Abstract More and more cancer patients receive surgery and chronic pain control. Cell-mediated immunosuppression from surgical stress renders perioperative period a vulnerable period for tumor metastasis. Retrospective studies suggest that regional anesthesia reduces the risk of tumor metastasis and recurrence. This benefit may be due to the attenuation of immunosuppression by regional anesthesia. On the other hand, accumulating evidence points to a direct role of anesthetics in tumor progression. A variety of malignancies exhibit increased activity of voltage-gated sodium channels. Blockade of these channels by local anesthetics may help inhibit tumor progression. Opioids promote angiogenesis, cancer cell proliferation and metastasis. It will be intere...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Selective suppression of microglial activation by paeoniflorin attenuates morphine tolerance
ConclusionPaeoniflorin directly suppresses morphine‐induced microglial activation and thus results in potentiation of morphine acute analgesia and attenuation of morphine chronic antinociceptive tolerance. (Source: European Journal of Pain)


Optimisation of rheumatology assessments - the actual situation in axial spondyloarthritis including ankylosing spondylitis.
Authors: Braun J, Kiltz U, Baraliakos X, van der Heijde DM Abstract The spondyloarthritides (SpA) are currently differentiated into axial and peripheral SpA. Patients with axial SpA (axSpA) may be further classified into the classical form ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA). The SpA are genetically linked, and the subtypes including psoriatic arthritis (PsA) share characteristic clinical symptoms such as inflammatory back pain (IBP) and enthesitis. IMP can be due to sacroiliitis and spondylitis, enthesitis may occur with or without arthritis, and anterior uveitis, as well as other extraarticular manifestations such as psoriasis and chronic inflammatory bowel disease (IBD). In addition to clinical findings, imaging, mainly conventional radiography and ...


An evidence-based approach to laboratory tests in usual care of patients with rheumatoid arthritis.
Authors: Pincus T, Gibson KA, Shmerling RH Abstract Laboratory tests often are regarded as the most important information in clinical care by patients and doctors, and dominate clinical decisions in many chronic diseases such as diabetes and hyperlipidemia. Most patients with rheumatoid arthritis (RA) have a positive test for rheumatoid factor or anti-cyclic citrullinated peptide antibodies (ACPA), or an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). However, about a third of RA patients, have negative tests for rheumatoid factor or ACPA, and more than 40% have a normal ESR or CRP at presentation ('false-negative' results). Furthermore, many normal people have a positive test for rheumatoid factor or ACPA but do not have RA, even among those with extensi...


Osteoprotegerin correlates with disease activity and endothelial activation in non-diabetic ankylosing spondylitis patients undergoing TNF-α antagonist therapy.
CONCLUSIONS: OPG shows a correlation with markers of disease activity and endothelial activation in non-diabetic ankylosing spondylitis patients undergoing TNF-α antagonist therapy. PMID: 25190453 [PubMed - in process] (Source: Clinical and Experimental Rheumatology)


Autoimmune pancreatitis complicated with inflammatory bowel disease and comparative study of type 1 and type 2 autoimmune pancreatitis
Conclusions A characteristic feature of type 2 AIP compared with type 1 AIP is a low frequency of obstructive jaundice that is related to rare lower bile duct stricture due to lower prevalence of pancreatic head swelling. Contrary to type 1 AIP, lower bile duct stricture in this condition has no apparent relation to sclerosing cholangitis. (Source: Journal of Gastroenterology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Subdural motor cortex stimulation: feasibility, efficacy and security on a series of 18 consecutive cases with a follow-up of at least 3 years
Conclusion We report an efficacy at least as good as ED MCS, with no complications specific to SD MCS, even with prolonged follow-up. The data are insufficient to actually prove a lower energy use in SD MCS. (Source: Acta Neurochirurgica)


Relationship between physical activity and chronic musculoskeletal pain among community-dwelling Japanese adults.
CONCLUSIONS: This cross-sectional study showed that there were no significant linear or quadratic relationships of self-reported PA with CLBP and CKP. Future longitudinal study with objective measurements is needed. PMID: 25070208 [PubMed - in process] (Source: Journal of Epidemiology)


Medication Overuse Headache
Abstract Medication overuse headache (MOH) is a common and disabling headache disorder. It has a prevalence of about 1–2 % in the general population. The International Classification of Headache Disorders 3rd edition (beta version) has defined MOH as a chronic headache disorder in which the headache occurs on 15 or more days per month due to regular overuse of medication. These headaches must have been present for more than 3 months. The pathophysiology is complex and not completely known. It involves genetic and behavioural factors. There is evidence that cortical spreading depression, trigeminovascular system and neurotransmitters contribute to the pain pathway of MOH. The treatment of MOH includes patient education, stopping the offending drug(s), rescue therapy for withdr...


Blockade of spinal glutamate recycling produces paradoxical antinociception in rats with orofacial inflammatory pain
Publication date: 3 March 2015 Source:Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 57 Author(s): Kui Y. Yang , Jun H. Mun , Ki D. Park , Min J. Kim , Jin S. Ju , Seong T. Kim , Yong C. Bae , Dong K. Ahn In our current study, we investigated the role of spinal glutamate recycling in the development of orofacial inflammatory pain. DL-threo-β-benzyloxyaspartate (TBOA) or methionine sulfoximine (MSO) was administered intracisternally to block spinal glutamate transporter and glutamine synthetase activity in astroglia. Intracisternal administration of high dose TBOA (10μg) produced thermal hyperalgesia in naïve rats but significantly attenuated the thermal hyperalgesia in rats that had been pretreated with interleukin (IL)-1β or Complete Freund's Adjuvant (CFA). ...


Assessing Clinically Meaningful Treatment Effects in Controlled Trials: Chronic Migraine as an Example
In addition to headache, persons with chronic migraine experience multiple symptoms, both ictal and interictal, that may contribute to their suffering. Translating clinical trial results into practice requires assessment of the results’ clinical meaningfulness. When examining treatment benefit in this disabled patient population, multiple headache-symptom measures should be considered to fully reflect clinical relevance. Currently, only onabotulinumtoxinA is approved specifically for headache prophylaxis in adults with chronic migraine. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Is number sense impaired in chronic pain patients?
Conclusions Audit data suggest patients with chronic pain interpret numbers differently from acute pain sufferers. Support is gained by experiments indicating impaired number sense in one-third of chronic pain patients. These results cast doubts on the appropriateness of the use of visual analogue and numeric rating scales in chronic pain in clinics and research. (Source: British Journal of Anaesthesia)


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...


Antinociceptive and Antihyperglycemic Effects of Melissa officinalis Essential Oil in an Experimental Model of Diabetes
Conclusions: This study shows that chronic administration of MOEO displays efficacy in an experimental model of diabetic hyperalgesia. MOEO may therefore show promise as a treatment for painful diabetic neuropathy.Med Princ Pract (Source: Medical Principles and Practice)


Chronic pain at ages 12 to 44.
Authors: Ramage-Morin PL, Gilmour H Abstract According to results from the 2007/2008 Canadian Community Health Survey, about 1 in 10 Canadians aged 12 to 44-9% of males and 12% of females, an estimated 1.5 million people--experienced chronic pain. The prevalence of chronic pain increased with age and was significantly higher among people in households where the level of educational attainment was low and among the Aboriginal population. The most common pain-related chronic conditions at ages 12 to 44 were back problems and migraine headaches. Chronic pain prevented at least a few activities in the majority of sufferers. It was associated with activity limitations and needing help with everyday tasks, and had work-related implications. Individuals with chronic pain were frequent use...


Immune System/Stem Cell Health and Aging
Looking, feeling and &nbsp;performing your best depends on balanced immunity and stem cell vitalityAs we age we encounter:Slower healingLonger recovery time from vigorous exerciseMore general aches and painsLonger recovery from illnessWrinkled, dry and thinning skinWhy is that? What are the causes? Answers can be found by a better understanding of immune/inflammatory response and stem cell systems. As we age our immune system weakens or becomes dysregulated (autoimmunity) and our stem cell "bank balances" deplete. My friend and world class stem cell therapies expert, Dr. Neil Riordan, gives an excellent description of the process: Your Body’s Stem Cell Bank Account.To oversimplify, the immune system is responsible for cleansing the body of pathogens, toxins, allergens and damaged tissues...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Prefrontal lactate predicts exercise-induced cognitive dysfunction in Gulf War Illness.
CONCLUSION: Prefrontal lactate levels may be a potential biomarker for exercise-induced subgroups in GWI. The alterations in brain energetics may be in part responsible for a subgroup of GWI and underlie some of the symptoms present in the patient population. PMID: 23573365 [PubMed] (Source: American Journal of Translational Research)


Approach to Pain Management in Chronic Opioid Users Undergoing Orthopaedic Surgery.
Authors: Devin CJ, Lee DS, Armaghani SJ, Bible J, Shau DN, Martin PR, Ehrenfeld JM Abstract Opioids are commonly used for the management of pain in patients with musculoskeletal disorders; however, national attention has highlighted the potential adverse effects of the use of opioid analgesia in this and other nonmalignant pain settings. Chronic opioid users undergoing orthopaedic surgery represent a particularly challenging patient population in regard to their perioperative pain control and outcomes. Preoperative evaluation provides an opportunity to estimate a patient's preoperative opioid intake, discuss pain-related fears, and identify potential psychiatric comorbidities. Patients using high levels of opioids may also require referral to an addiction specialist. Various region...


Malignant Transformation in Chronic Osteomyelitis: Recognition and Principles of Management.
Authors: Panteli M, Puttaswamaiah R, Lowenberg DW, Giannoudis PV Abstract Malignant transformation as a result of chronic osteomyelitis represents a relatively rare and late complication with a declining incidence in the modern world. For most patients, the interval between the occurrence of the original bacterial infection and the transformation to malignant degeneration is several years. The diagnosis of malignant transformation in a chronic discharging sinus requires a high index of clinical suspicion. Wound biopsies should be obtained early, especially with the onset of new clinical signs such as increased pain, a foul smell, and changes in wound drainage. Squamous cell carcinoma is the most common presenting malignancy. Definitive treatment is amputation proximal to the tumor ...


Plantar and medial heel pain: diagnosis and management.
Authors: Lareau CR, Sawyer GA, Wang JH, DiGiovanni CW Abstract Heel pain is commonly encountered in orthopaedic practice. Establishing an accurate diagnosis is critical, but it can be challenging due to the complex regional anatomy. Subacute and chronic plantar and medial heel pain are most frequently the result of repetitive microtrauma or compression of neurologic structures, such as plantar fasciitis, heel pad atrophy, Baxter nerve entrapment, calcaneal stress fracture, and tarsal tunnel syndrome. Most causes of inferior heel pain can be successfully managed nonsurgically. Surgical intervention is reserved for patients who do not respond to nonsurgical measures. Although corticosteroid injections have a role in the management of select diagnoses, they should be used with caution...


Anterior ankle impingement: diagnosis and treatment.
Authors: Talusan PG, Toy J, Perez JL, Milewski MD, Reach JS Abstract Anterior ankle impingement is a common clinical condition characterized by chronic anterior ankle pain that is exacerbated on dorsiflexion. Additional symptoms include instability; limited ankle motion; and pain with squatting, sprinting, stair climbing, and hill climbing. Diagnosis is typically confirmed with plain radiographs. Nonsurgical management includes physical therapy, strengthening exercises, activity modification, bracing, and anti-inflammatory medication. Although arthroscopic treatment is sufficient in some patients, most require an open approach to address related pathology. We advocate aggressive range of motion as well as weight bearing postoperatively. Further study is needed to confirm current un...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Management of chronic musculoskeletal pain.
Authors: Uhl RL, Roberts TT, Papaliodis DN, Mulligan MT, Dubin AH Abstract Chronic musculoskeletal pain results from a complex interplay of mechanical, biochemical, psychological, and social factors. Effective management is markedly different from that of acute musculoskeletal pain. Understanding the physiology of pain transmission, modulation, and perception is crucial for effective management. Pharmacologic and nonpharmacologic therapies such as psychotherapy and biofeedback exercises can be used to manage chronic pain. Evidence-based treatment recommendations have been made for chronic pain conditions frequently encountered by orthopaedic surgeons, including low back, osteoarthritic, posttraumatic, and neuropathic pain. Extended-release tramadol; select tricyclic antidepressants...


Extended indications for foot and ankle arthroscopy.
Authors: Hsu AR, Gross CE, Lee S, Carreira DS Abstract Advances in foot and ankle arthroscopy have allowed surgeons to diagnose and treat a broadening array of disorders that were previously limited to open procedures. Arthroscopy of the posterior ankle, subtalar joint, and first metatarsophalangeal joint and tendoscopy can be used to address common foot and ankle ailments, with the potential benefits of decreased pain, fast recovery, and low complication rates. Posterior ankle and subtalar arthroscopy can be used to manage impingement, arthrofibrosis, synovitis, arthritis, fractures, and osteochondral defects. First metatarsophalangeal joint arthroscopy can address osteophytes, chronic synovitis, osteochondral defects, and degenerative joint disease. Tendoscopy is a minimally inva...


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)


New Technique of Soft Tissue Reconstruction for Proximal Tibiofibular Joint Instability Using Iliotibial Band and Biceps Femoris Longhead Autograft
Instability of the proximal tibiofibular joint is an uncommon problem, which may occur in multiple directions and because of multiple etiologies. Proximal tibiofibular joint instability can be divided into 3 types: acute traumatic dislocations, chronic or recurrent dislocation, and atraumatic subluxations. Instability of this joint may be in the anterolateral, posteromedial, or superior directions. Chronic instability results in lateral knee pain and instability with snapping or catching often leading to a misdiagnosis of lateral meniscal injury. Subluxation may be treated nonsurgically with activity modification, supportive straps, and knee strengthening therapy. Chronic pain or instability is an indication for surgical treatment including arthrodesis, fibular head resection, or soft tiss...


Effect of Prucalopride in the Treatment of Chronic Constipation in Asian and Non-Asian Women: A Pooled Analysis of 4 Randomized, Placebo-controlled Studies.
CONCLUSIONS: Prucalopride 2-mg once-daily treatment over 12-weeks was more efficacious than placebo in promoting SCBMs and improve-ment of CC-associated symptoms in Asian and non-Asian women, and was found to be safe and well-tolerated. There were numeric differences between Asian and non-Asian patients on efficacy and treatment emergent adverse events, which may be partially due to the overlap with functional gastrointestinal disorders in non-Asian patients.(J Neurogastroenterol Motil 2014;20:458-468). PMID: 25273116 [PubMed] (Source: Journal of Neurogastroenterology and Motility)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Perceived value of spinal manipulative therapy and exercise among seniors with chronic neck pain: A mixed methods study.
CONCLUSION: Relationship dynamics should be leveraged in clinical encounters to enhance patient satisfaction and perceived value of care. PMID: 25258045 [PubMed - in process] (Source: Journal of Rehabilitation Medicine)


Effects of neck coordination exercise on sensorimotor function in chronic neck pain: A randomized controlled trial.
CONCLUSION: Neck coordination exercise is no better than strength training and massage in improving sensorimotor function. Further research should investigate the use of cut-offs for sensorimotor dysfunctions prior to proprioceptive or coordinative training. PMID: 25182501 [PubMed - in process] (Source: Journal of Rehabilitation Medicine)


Changes in Multidimensional Pain Inventory profile after a pain rehabilitation programme indicate the risk of receiving sick leave benefits one year later.
CONCLUSION: The number of persons with DYS profiles decreased after rehabilitation. Those with other profiles had less full-time sick leave one year later than those with DYS profiles, indicating that leaving the DYS profile is a positive prognostic sign long-term. Furthermore, the gender differences observed suggest the need to tailor rehabilitative strategies differently for men and women. PMID: 25148537 [PubMed - in process] (Source: Journal of Rehabilitation Medicine)


Factors influencing observed and self-reported functional ability in women with chronic widespread pain: A cross-sectional study.
CONCLUSION: Observation-based assessment of functional ability in patients with chronic widespread pain is less influenced by pain and psychosocial factors than are self-reported evaluations. Valid observation-based assessment tools, such as the AMPS, should be included in clinical evaluation and future research addressing functional outcomes in this patient population. PMID: 25095717 [PubMed - in process] (Source: Journal of Rehabilitation Medicine)


Use of kinematic algorithms to distinguish people with chronic non-specific low back pain from asymptomatic subjects: a validation study.
CONCLUSION: These results support the validity of using 2 movement algorithms, range of motion and speed, to discriminate asymptomatic subjects from those with low back pain. However, people simulating low back pain cannot be distinguished from those with real low back pain using this method. PMID: 24925284 [PubMed - in process] (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>


Long-term outcomes of a multidisciplinary cognitive behavioural programme for coping with chronic neuropathic spinal cord injury pain.
CONCLUSION: This exploratory study suggests that a multidisciplinary cognitive behavioural programme might have lasting improvements on pain intensity, pain-related disability, anxiety, and participation in activities in people with chronic neuropathic spinal cord injury pain and highlights the potential of such programmes. PMID: 24818861 [PubMed - in process] (Source: Journal of Rehabilitation Medicine)


Regional versus widespread pain in patients with chronic low back pain: it does matter!
Authors: Skouen JS PMID: 24733313 [PubMed - indexed for MEDLINE] (Source: Journal of Rehabilitation Medicine)


Neck pain intensity does not predict pressure pain hyperalgesia: re-analysis of seven randomized controlled trials.
DISCUSSION: No coherent correlations between pressure pain thresholds and pain intensity were found. Further research is needed to evaluate the relationship between pain intensity and pressure pain thresholds before its use as a valid substitute of pain rating can be supported. Until then, the results of trials with respect to using pressure pain thresholds as an outcome variable must be interpreted with care. PMID: 24715237 [PubMed - in process] (Source: Journal of Rehabilitation Medicine)


Cost of pain medication to treat adult patients with nonmalignant chronic pain in the United States.
CONCLUSIONS: This study demonstrated national prescribing costs and use within various drug categories of pain medications in a large outpatient population over an 8-year period in the United States. Policymakers, stakeholders, and health plan decision makers may consider this cost analysis, since they need to know how drug costs are being allocated. Moreover, information about costs and use of pain medications is valuable for the practitioner making individual patient care decisions, as well as for those who make population based decisions. This study reported an increasing trend of outpatient pain visits in the United States. Therefore, policymakers and health plan decision makers may expect a growing number of pain-related outpatient visits in coming years and allocate resources accordi...


The prevalence of opioid-related major potential drug-drug interactions and their impact on health care costs in chronic pain patients.
CONCLUSIONS: Exposure to potential drug-drug interactions may result in unnecessary and unintended health care costs. Physicians should be made aware of commonly administered cytochrome P450 (CYP450) metabolized drugs in the chronic pain patient and consider prescribing non-CYP450 metabolized opioid and nonopioid analgesics. Managed care's use of utilization management tools to avoid these exposures may reduce costs. PMID: 24761818 [PubMed - in process] (Source: Journal of Managed Care Pharmacy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Why Do You Gain Weight When You Exercise?
You begin a rigorous exercise program because it could not hurt to lose a little weight and, as I tell my patients, such exercise can improve many things, including chronic pain. But then you find you are gaining weight. Is it time to raise the white flag and buy that cookies-of-the-month club subscription?read more (Source: Psychology Today Food and Diet Center)


Cannabinoid hyperemesis syndrome.
Authors: Galli JA, Sawaya RA, Friedenberg FK Abstract Coinciding with the increasing rates of cannabis abuse has been the recognition of a new clinical condition known as Cannabinoid Hyperemesis Syndrome. Cannabinoid Hyperemesis Syndrome is characterized by chronic cannabis use, cyclic episodes of nausea and vomiting, and frequent hot bathing. Cannabinoid Hyperemesis Syndrome occurs by an unknown mechanism. Despite the well-established anti-emetic properties of marijuana, there is increasing evidence of its paradoxical effects on the gastrointestinal tract and CNS. Tetrahydrocannabinol, cannabidiol, and cannabigerol are three cannabinoids found in the cannabis plant with opposing effects on the emesis response. The clinical course of Cannabinoid Hyperemesis Syndrome may be divided ...


Petroleum ether extractive of the hips of Rosa multiflora ameliorates collagen-induced arthritis in rats
Publication date: 18 November 2014 Source:Journal of Ethnopharmacology, Volume 157 Author(s): Jianhong Wu , Xingxian Liu , Chi-on Chan , Daniel K.W. Mok , Shun-wan Chan , Zhiling Yu , Sibao Chen Ethnopharmacological relevance The hip of Rosa multiflora Thunb. (HRM) has been traditionally used as a dietary supplement and a herbal remedy for the treatment of various diseases, including inflammation, osteoarthritis, rheumatoid arthritis and chronic pain, in China. The current study was to evaluate the therapeutic efficacy of the petroleum ether extractive of HRM (PEE) on type II collagen-induced rheumatoid arthritis (CIA) in male Wistar rats. In addition, the anti-inflammatory mechanism(s) of PEE on type II CIA was explored. Materials and methods Rheumatoid arthritis (RA) was induced by in...


Fibrocalculous pancreatic diabetes (FCPD)
Abstract Fibrocalculous pancreatic diabetes (FCPD) is an uncommon form of diabetes that occurs as a result of chronic calcific pancreatitis, in the absence of alcohol abuse. The disease is restricted to tropical regions of the world, and southern India has the highest known prevalence of FCPD. The typical patient with FCPD is a lean adolescent or young adult of either sex, presenting with history of recurrent bouts of abdominal pain and steatorrhea. Demonstration of large, discrete pancreatic calculi by plain radiographs or ultrasonography of the abdomen is diagnostic. While the exact etiology of FCPD is unknown, genetic, nutritional and inflammatory factors have been hypothesized to play a role. Diabetes in FCPD is often brittle and difficult to control; most patients require...


Prevalence and risk factors of dry eye disease in a British female cohort
Conclusions DED is common and increases with age within this cohort of female twins. We confirmed established risk factors for the first time in a British population, and found important risk factors that might relate to an underlying aetiology involving chronic pain predisposition or somatisation. (Source: British Journal of Ophthalmology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Downregulation of connexin36 in mouse spinal dorsal horn neurons leads to mechanical allodynia
Connexin36 (Cx36), a component of neuronal gap junctions, is crucial for interneuronal communication and regulation. Gap junction dysfunction underlies neurological disorders, including chronic pain. Following a peripheral nerve injury, Cx36 expression in the ipsilateral spinal dorsal horn was markedly decreased over time, which paralleled the time course of hind paw tactile allodynia. Intrathecal (i.t.) injection of Cx36 siRNA (1 and 5 pg) significantly reduced the expression of Cx36 protein in the lumbar spinal cord, peaking 3 days after the injection, which corresponded with the onset of hind paw tactile allodynia. It is possible that some of the tactile allodynia resulting from Cx36 downregulation could be mediated through excitatory neuromodulators, such as glutamate and substance P. ...


Effective local control of vertebral metastases by simultaneous integrated boost radiotherapy
Conclusion SBRT with simultaneous, integrated boost was associated with excellent local control of 93 % after 24 months. This result shows the possibility of delivering escalated doses to the target while still keeping the incidence of side effects low. This study forms the basis for a future randomised controlled trial comparing conventional radiotherapy (10 fractions of 3 Gy) with hypofractionated dose intensified SBRT (12 fractions of 3 Gy + integrated boost 12 fractions of 4 Gy) for improvement of local tumour control and pain. (Source: Strahlentherapie und Onkologie)


Three Cases of Hemiplegia after Cervical Paraspinal Muscle Needling
Muscle needling therapy is common for chronic pain management, but the development of unusual complications such as hemiplegia is not well understood. (Source: The Spine Journal)


Uricosuric medications for chronic gout.
CONCLUSIONS: There was moderate-quality evidence that there is probably no important difference between benzbromarone and allopurinol at achieving serum urate normalisation, but that benzbromarone is probably more successful than probenecid at achieving serum urate normalisation in people with gout. There is some uncertainty around the effect estimates, based on low-quality evidence from only one or two trials, on the number of acute gout attacks, the number of withdrawals due to adverse events or the total number of participants experiencing adverse events when comparing benzbromarone with allopurinol. However, when compared with probenecid, benzbromarone resulted in fewer withdrawals due to adverse events and fewer participants experiencing adverse events. Low-quality evidence from one s...


The assessment and treatment of back and neck pain: an initial investigation in a primary care practice-based research network.
Authors: Fischbein R, McCormick K, Selius BA, Labuda Schrop S, Hewit M, Baughman K, Meeker J Abstract Aim The purpose of this study was to conduct an exploratory examination of the current state of non-malignant acute and chronic back and neck pain assessment and management among primary care providers in a multi-site, practice-based research network. BACKGROUND: Acute and chronic pain are distinct conditions that often require different assessment and management approaches, however, little research has examined assessment and management of acute and chronic pain as separate conditions. The large majority of patients with acute and chronic back and neck pain are managed in primary care settings. Given the differences between acute and chronic pain, it is necessary to identify d...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Bowel endometriosis: Colorectal surgeon's perspective in a multidisciplinary surgical team.
Authors: Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A Abstract Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Up to 15% of women in their reproductive period are affected by this condition. Deep endometriosis is defined as endometriosis located more than 5 mm beneath the peritoneal surface. This type of endometriosis is mostly found on the uterosacral ligaments, inside the rectovaginal septum or vagina, in the rectosigmoid area, ovarian fossa, pelvic peritoneum, ureters, and bladder, causing a distortion of the pelvic anatomy. The frequency of bowel endometriosis is unknown, but in cases of bowel infiltration, about 90% are localized on th...


Legally prescribed opioid use may increase mortality in chronic pain patients
Associations between opioid-related overdoses and increased prescription of opioids for chronic noncancer pain are well known. But some suggest that overdose occurs predominately in individuals who obtain opioids from nonmedical sources. In a new study, researchers found an increased risk of death associated with chronic pain without opioid treatment, as well as an even higher risk among those prescribed opioids for long-term use and a somewhat lower risk associated with short-term use. (Source: ScienceDaily Headlines)


Decentering, rumination, cognitive defusion, and psychological flexibility in people with chronic pain
Abstract The psychological flexibility model appears to be useful for organizing research into chronic pain. One component of the model is called “cognitive defusion.” A process referred to as decentering, measured by the Experiences Questionnaire (EQ), appears similar to cognitive defusion. The purpose of this study is to extend previous investigations of the EQ, to evaluate its factor structure, and examine both indirect and direct roles for decentering in relation to key clinical outcomes. 352 people seeking pain treatment participated in this study. All completed the EQ and standard measures of daily functioning, including emotional functioning. Confirmatory factor analysis (CFA) and structural equation models (SEMs) were utilized to examine the factor structure of the EQ...


Chronic pain and cardiovascular stress responses in a general population: the Tromsø Study


Health Tip: Feeling Weak in the Knee?
Title: Health Tip: Feeling Weak in the Knee?Category: Health NewsCreated: 11/13/2014 12:00:00 AMLast Editorial Review: 11/13/2014 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>


Trunk motor variability in patients with non-specific chronic low back pain
Conclusion Muscle recruitment is altered in patients with chronic LBP in the presence of muscle fatigue. Consequently, these patients exhibit changes in muscle recruitment pattern and intensity (lower levels of motor variability) during sustained isometric contraction that may be attributed to variation in the control of motor units within and between muscles. However, patients with LBP are able to increase their motor variability over time but with a lower increase compared to healthy participants. (Source: European Journal of Applied Physiology)


Testing a Path-Analytic Mediation Model of How Motivational Enhancement Physiotherapy Improves Physical Functioning in Pain Patients
Conclusions The effect of motivational enhancement therapy on physical functioning can be explained by social–cognitive factors such as motivation, outcome expectancy, and working alliance. The use of motivational interviewing techniques to increase outcome expectancy of patients and improve working alliance could further strengthen the impact of physiotherapy on rehabilitation outcomes of patients with chronic LBP. (Source: Journal of Occupational Rehabilitation)


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


Impact of Epidural Analgesia on Quality of Life and Pain in Advanced Cancer Patients
The objective of this study was to determine if epidural self-controlled analgesia reduced the incidence of chronic pain and improved the quality of life when compared with intravenous self-controlled analgesia. A total of 50 patients diagnosed with advanced cancer who received analgesia treatment were randomly divided into two groups, epidural self-controlled analgesia group (EA group, n = 26) and intravenous self-controlled analgesia group (IA group, n = 24). (Source: Pain Management Nursing)


Dientamoeba fragilis and chronic abdominal pain in children: a case-control study
Conclusions There were no differences in symptoms comparing children with and without D fragilis infection. Furthermore, no relation was found between clinical and microbiological response after treatment for D. fragilis. This retrospective study suggests that there is no association between chronic AP and D. fragilis infection. (Source: Archives of Disease in Childhood)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Answers to Epilogue questions
Epilogue Quiz Answers From questions on page 238 1. The correct answer is B Status dystonicus (aka Dystonic storm) is defined as a movement disorder emergency in which there is prolonged, generalised, intense and painful muscle contraction. Up to 60% of the reported cases are children,1 but the true incidence is unknown. SD is probably under recognised and can be fatal in up to 10% of cases.1 Patients at risk are those with chronic dystonias (primary and secondary), quadriplegic cerebral palsy, neurodegenerative disorders, post acquired brain injury and acute drug withdrawal (especially baclofen). Common triggers are pain, infection, surgery and drugs. Main differentiating features of SD are hypertonia, abnormal dystonic postures, preservation of consciousness and hyperCKaemia. Non-convuls...


Prehabilitation for men undergoing radical prostatectomy: a multi-centre, pilot randomized controlled trial
DiscussionThe primary outcome of this study is to determine the feasibility of conducting a full-scale, randomized controlled trial of PREHAB versus UC and to estimate effect sizes that will inform sample size determinations for subsequent trials in this field. To our knowledge, this is the first study to examine a structured presurgical exercise program for men undergoing RP for PCa. This trial will advance our understanding of strategies to efficiently and effectively use the preoperative period to optimize postoperative recovery.Trial registration: Clinicaltrials.gov Identifier: NCT02036684 (Source: BMC Surgery)


Chronic Low Back Pain: A Supplement to Neuromodulation
(Source: Neuromodulation: Technology at the Neural Interface)


The Differential Diagnosis of Low Back Pain: A Primer on the Evolving Paradigm
ConclusionsLBP is an extremely common condition associated, as a symptom, with various disease processes, regardless of their relationship with the lumbar spine or its innervation. This article underscores the broad nature of LBP as a symptom of many diagnoses. The primary conclusion reached by the authors is the most important recommendation by all mentors in medicine, which is to obtain a comprehensive history and perform a complete physical examination on each patient. Despite the fact that there is an emerging school of thought questioning the validity of the physical examination, this tool continues to be the current standard of care and used by a majority of clinicians around the world. The physician must analyze the information obtained from his/her history, physical examination, an...


Medical Management of Chronic Low Back Pain: Efficacy and Outcomes
Conclusions:  Personalized treatment plans should be informed by response to therapies previously tried, the severity and persistence of symptoms, and the availability of specialist expertise. (Source: Neuromodulation: Technology at the Neural Interface)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Noninvasive and Alternative Management of Chronic Low Back Pain (Efficacy and Outcomes)
ConclusionsThere are a wide variety of noninvasive and alternative therapies for the treatment of chronic low back pain. Those with the strongest evidence in the literature for good efficacy and outcomes include exercise therapy with supervised physical therapy, multidisciplinary biopsychosocial rehabilitation, and acupuncture. Therapies with fair evidence or moderately supported by literature include yoga, back schools, thermal modalities, acupressure, and cognitive‐behavioral therapy. Those therapies with poor evidence or little to no literature support include manipulation, transcutaneous electrical nerve stimulation, low‐level laser therapy, reflexology, biofeedback, progressive relaxation, hypnosis, and aromatherapy. Providers delivering care for patients with chronic low back pai...


Interventional Therapies for Chronic Low Back Pain
ConclusionsImplementation of interventional pain procedures in the treatment framework of LBP has resulted in improvement of pain intensity in at least the short and medium terms, but equivocal results have been observed in functional improvement. (Source: Neuromodulation: Technology at the Neural Interface)


Anatomic Surgical Management of Chronic Low Back Pain
ConclusionDespite the number of spine surgeries that have been performed for CLBP, the surgical outcome still remains questionable. Until a precise identification of the cause of CLBP in any given patient can be precisely determined, surgical solutions will continue to be less than optimal. (Source: Neuromodulation: Technology at the Neural Interface)


Neurostimulation for the Treatment of Axial Back Pain: A Review of Mechanisms, Techniques, Outcomes, and Future Advances
ConclusionsImproved technology and a better understanding of the goals of stimulation have led to a new ability to stimulate the axial low back and increase the effectiveness of these therapies to reduce pain. New paddle lead constructs, percutaneous paddle lead introduction, and other new technologies have led to an increased number of potential candidates for spinal cord stimulation. Optimizing the application of neurostimulation for chronic axial back pain will depend upon answering questions relating to patient selection, implantation technique, and stimulation parameters. (Source: Neuromodulation: Technology at the Neural Interface)


A Review of Economic Factors Related to the Delivery of Health Care for Chronic Low Back Pain
ConclusionThe fact that chronic low back pain arises from a variety of causes makes choosing appropriate treatment difficult. Determining the cost‐effectiveness of various treatments for chronic low back pain depends on well‐designed and well‐executed randomized controlled trials with parallel economic evaluations. Researchers can use economic models to extrapolate costs and outcomes over the long term. (Source: Neuromodulation: Technology at the Neural Interface)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A Clinical Hypnosis Handbook for Pain Management and Palliative Care
The complexity of providing pain and symptom management to patients with chronic nonmalignant pain or receiving palliative care has highlighted the need to develop evidence-based nonpharmacologic strategies as part of the treatment plan. Among the psychological and integrative medicine approaches, clinical hypnosis has received increased recognition for its potential not only to improve psychological well-being in patients but also as a modality for directly improving pain and symptom control. (Source: Journal of Pain and Symptom Management)


A two-item short form of the Pain Self-Efficacy Questionnaire: Development and psychometric evaluation of PSEQ-2
The Pain Self-Efficacy Questionnaire (PSEQ) is an established 10-item measure of pain self-efficacy that is widely used in clinical and research settings. However, a shorter measure would reduce patient and researcher burden and save valuable time in busy clinical settings. The aim of this study was to develop and confirm the psychometric properties of a valid and reliable two-item short form of the PSEQ (PSEQ-2). We used a large sample of 1,511 chronic pain patients which we randomly split into two smaller groups. (Source: The Journal of Pain)


Esophageal, Gastric, and Intestinal Pneumatosis
An 85-year-old man presented to the Emergency Department with vomiting and progressively worsening abdominal pain. He had a history of congestive heart failure, chronic obstructive pulmonary disease, chronic atrial fibrillation, and peptic ulcer disease. He denied diarrhea, constipation, passage of tarry or bloody stool, fever, or chills. He was not on anticoagulation. On arrival, his vital signs were temperature of 36°C, pulse rate of 120 beats/min, respiratory rate of 23 breaths/min, and blood pressure of 158/72 mm Hg. (Source: The Journal of Emergency Medicine)


Fibrous dysplasia of mandible—Report of a case presenting with a rare clinical course
We report here a case of FD of the left mandible which followed a rare clinical course and the initial clinical symptoms and radiographic examination were misinterpreted as indicating CDO. A 28-year-old Japanese male was referred to our hospital due to a dull intermittent pain of the left mandibular molars in April 2002. From the clinical and radiographic examination results, we suspected CDO. Antibiotic treatment produced a remission of these symptoms and periodical follow-up was performed in another hospital. In March 2007 the patient returned with firm swelling in the left cheek region. Panoramic radiographic and CT examination revealed remarkable bony expansion with a thickened cortex and diffuse “smoky mottled” lucent-radiopaque appearance in the left molar region of the mandible....


Florid osseous dysplasia: A case report and literature review
Publication date: October 2014 Source:Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, Volume 26, Issue 4 Author(s): Rieko Doi , Nobuyuki Fujii , Atsuhiro Okamoto , Hideharu Okamoto , Kazunori Kidani , Kazuko Takubo , Isamu Kodani , Kazuo Ryoke Florid osseous dysplasia (FOD) is one of the osseous dysplasias, which are characterized by the replacement of normal bone by fibrous tissue and metaplastic bone. It is particularly common in the jaws of middle-aged black women. In some cases, a familial trend can be observed. FOD is usually asymptomatic and, in such cases, the lesion is detected when radiographs are taken for some other reason. In severe cases, focal expansion may occur owing to infection, which may lead to pain and facial deformity. FOD is often symmetrically ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Is low back pain associated with worse health-related quality of life 6 months later?
Conclusions Low back pain has an impact on future physical HRQoL. Strategies for reducing the effects of LBP on HRQoL should be an important focus for clinicians, researchers, and health policy makers. (Source: European Spine Journal)


The role of central sensitization in shoulder pain: A systematic literature review
Hyperexcitability of the central nervous system has been suggested to play an important role in pain experienced by patients with unilateral shoulder pain. A systematic literature review following the PRISMA guidelines was performed to evaluate the existing evidence related to the presence of central sensitization in patients with unilateral shoulder pain of different etiologies including those with chronic subacromial impingement syndrome. Studies addressing neuropathic pain (e.g. post-stroke shoulder pain) were not considered. (Source: Seminars in Arthritis and Rheumatism)


Comparison Of Baseline Urologic Symptoms In Men And Women In The Multidisciplinary Approach To The Study Of Chronic Pelvic Pain (Mapp) Research Cohort
The clinical features of interstitial cystitis/ bladder pain syndrome (IC/BPS) are similar to those of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, no studies have directly compared the characteristics of these syndromes in men and women. (Source: The Journal of Urology)


Can the painDETECT Questionnaire score and MRI help predict treatment outcome in rheumatoid arthritis: protocol for the Frederiksberg hospital's Rheumatoid Arthritis, pain assessment and Medical Evaluation (FRAME-cohort) study
This study aims at supporting rheumatologists to define strategies to reach optimal treatment outcomes in patients with RA based on chronic pain prognostics. The study has been approved by The Capital region of Denmark's Ethics Committee; identification number H-3-2013-049. The results will be published in international peer-reviewed journals. (Source: BMJ Open)


Gleaning after the European Headache Federation consensus statement on refractory chronic migraine
(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>


Abstract C28: An exploratory study of co-occurrence of breast cancer and diabetes in medically underserved Latinas
Conclusions: This preliminary investigation sheds new light on emerging evidence documenting the negative associations of comorbid chronic conditions such as diabetes on patients' outcomes. More attention to the co-occurrence of cancer and chronic disease is warranted for addressing cancer health disparities. Our descriptive analysis offers support for additional inquiry and attention to the co-occurrence of cancer and chronic disease as a target for action in improvements in quality, patient-centered care and in the reduction of persistent health disparities.Citation Format: Kimlin T. Ashing, Monica Rosales, Raynald Samoa, Lily Lai, Roberto Vargas, Courtney Vito, Arti Hurria, Mayra Serrano. An exploratory study of co-occurrence of breast cancer and diabetes in medically underserved Latina...


Early life inflammatory pain induces long-lasting deficits in hippocampal-dependent spatial memory in male and female rats.
Authors: Henderson YO, Victoria NC, Inoue K, Murphy AZ, Parent MB Abstract The present experiment tested the hypothesis that neonatal injury disrupts adult hippocampal functioning and that normal aging or chronic stress during adulthood, which are known to have a negative impact on hippocampal function, exacerbate these effects. Male and female Sprague-Dawley rats were given an intraplantar injection of the inflammatory agent carrageenan (1%) on the day of birth and their memory was tested in the hippocampal-dependent spatial water maze in adulthood and again in middle age. We found that neonatal injury impaired hippocampal-dependent memory in adulthood, that the effects of injury on memory were more pronounced in middle-aged male rats, and that chronic stress accelerated the onset...


Surgical Pathology of Skeletal Coccidioidomycosis: A Clinical and Histopathologic Analysis of 25 Cases
Skeletal coccidioidomycosis is a rare complication of pulmonary coccidioidomycosis that remains incompletely characterized, and its histopathologic features have not been systematically evaluated. All skeletal coccidioidal infections (2000 to 2012) were retrieved from the University of Arizona and Mayo Clinic in Arizona pathology archives. Clinical history and histologic features were reviewed. Among 25 patients (median age 40 y; 17 men), infections involved bones (2 cases), joints (6), or both (17), usually in the distal extremities (68%), especially the wrist (32%). History included previously documented coccidioidomycosis (13), autoimmune disease (8), diabetes (6), malignancy (4), and iatrogenic immunosuppression (10). Common symptoms (median 3 mo) included pain/arthralgia (21) and swel...


The role of palliative care in the current HIV treatment era in developed countries.
Authors: Merlins JS, Tucker RO, Saag MS, Selwyn PA Abstract The goal of palliative care is to minimize and prevent suffering and maximize physical function and quality of life in patients with serious illness. In the early years of the AIDS epidemic in developed countries, prognosis was poor and palliative care was often inseparable from HIV care. Despite the advent of effective antiretroviral therapy and its availability in developed countries, patients with HIV disease still present many palliative care challenges and opportunities. The cases of 3 HIV-infected patients who embody these challenges will be presented in this article: an older patient with numerous medical comorbidities, chronic pain, and severely impaired physical function; a patient with psychiatric illness and sub...


European Position Paper on Rhinosinusitis and Nasal Polyps 2012.
Authors: Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, Cohen N, Cervin A, Douglas R, Gevaert P, Georgalas C, Goossens H, Harvey R, Hellings P, Hopkins C, Jones N, Joos G, Kalogjera L, Kern B, Kowalski M, Price D, Riechelmann H, Schlosser R, Senior B, Thomas M, Toskala E, Voegels R, Wang de Y, Wormald PJ Abstract The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007.The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the doc...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


European position paper on rhinosinusitis and nasal polyps 2007.
Authors: Fokkens W, Lund V, Mullol J, European Position Paper on Rhinosinusitis and Nasal Polyps group Abstract Rhinosinusitis is a significant and increasing health problem which results in a large financial burden on society. This evidence based position paper describes what is known about rhinosinusitis and nasal polyps, offers evidence based recommendations on diagnosis and treatment, and considers how we can make progress with research in this area. Rhinitis and sinusitis usually coexist and are concurrent in most individuals; thus, the correct terminology is now rhinosinusitis. Rhinosinusitis (including nasal polyps) is defined as inflammation of the nose and the paranasal sinuses characterised by two or more symptoms, one of which should be either nasal blockage/obstruction/...


Characterisation of patients with endoscopy-negative, computer tomography-negative midfacial segment pain using the sino-nasal outcome test.
CONCLUSION: MSP has an adverse impact on both physical and psychological well-being. The subtle differences in the SNOT subscores between MSP and CRS have provided greater insight into the character and disease impact of MSP. We propose that the SNOT may be suitably utilised in MSP to document disease severity and measure response to treatment. PMID: 24618633 [PubMed - in process] (Source: Rhinology)


Serial blood serotonin levels in a randomized controlled trial comparing the efficacy of low-dose amitriptyline, amitriptyline with pindolol and surrogate placebo in patients with chronic tension-type facial pain.
CONCLUSION: When linked to the clinical response this study provides evidence that the serotonergic system is involved in the modulation of chronic MFP. Serotonin levels are sex-dependent and related to treatment response. PMID: 23943730 [PubMed - indexed for MEDLINE] (Source: Rhinology)


Do patients with chronic rhinosinusitis with nasal polyps suffer with facial pain?
CONCLUSION: Significant facial pain is uncommon in patients with CRSwNP. It is important to consider this when counselling patients before surgery. PMID: 23943729 [PubMed - indexed for MEDLINE] (Source: Rhinology)


A Randomized Controlled Trial comparing the efficacy of low-dose amitriptyline, amitriptyline with pindolol and surrogate placebo in the treatment of chronic tension-type facial pain.
CONCLUSION: Low dose amitriptyline is effective in the management of MFP and is enhanced by the addition of pindolol. PMID: 23671895 [PubMed - indexed for MEDLINE] (Source: Rhinology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Neuropsychological profile of a male psychiatric patient with a Morgagni-Stewart-Morel syndrome.
Authors: Hansen A, Engelhardt L, Pleschutznig W, Dammann G, Vietze S Abstract In 1765 Giovanni Morgagni described a syndrome consisting of hyperostosis frontalis interna (HFI), obesity and hirsutism. In 1928 Stewart and in 1930 Morel added neuropsychiatric symptoms, e.g. depression and dementia, which led to the definition of the Morgagni-Stewart-Morel Syndrome (MSM). Although mostly women were characterized in literature no gender specifity is demanded. This case report presents the rare case of a 66 year old male psychiatric patient with Morgagni-Stewart-Morel Syndrome. The patient complained of loss of concentration and difficulties with activities of daily living. Admission diagnosis was an opioid misuse on the basis of a chronic pain syndrome. In this case report we are descri...


Analgesia for Early-Life Pain Prevents Deficits in Adult Anxiety and Stress in Rats
Previous studies in rats have established that inflammatory pain experienced on the day of birth (P0) decreases sensitivity to acute noxious, anxiety- and stress-provoking stimuli. However, to date, the impact of early-life pain on adult responses to chronic stress is not known. Further, the ability of morphine, administered at the time of injury, to mitigate changes in adult behavioral and hormonal responses to acute or chronic stressors has not been examined. P0 male and female Sprague-Dawley rat pups were given an intraplantar injection of 1% carrageenan or handled in an identical manner in the presence or absence of morphine. As adults, rats that experienced early-life pain displayed decreased sensitivity to acute stressors, as indicated by increased time in the inner area of the Open ...


Stomach Pain and Colon Cancer
Although chronic stomach pains are not typically a result of colon cancer, there are many treatable causes that should be investigated by your primary care doctor. (Source: About.com Colon Cancer)


Laparoscopic Repair of Complex Incarcerated Recurrent Hernia with Laparoscopic Biologic Graft
Conclusion Laparoscopic suture repair reinforced with biologic dermal tissue matrix was successfully performed during a complex hernia repair. (Source: International Journal of Surgery Case Reports)


Robot Assisted Thoracoscopic Resection of Giant Esophageal Leiomyoma
Conclusion Use of robot allows for removal of large esophageal leiomyoma. The improved dexterity and patient outcome offered by robot suggests its potential as the mainstay technique for giant esophageal leiomyoma removal. (Source: International Journal of Surgery Case Reports)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pathological changes in the lumbar intervertebral discs among professional field hockey players.
Authors: Ogurkowska M, Kawalek K Abstract Acute injuries or chronic overloading can be the cause of lower back pain. Long--term, highly--specialized training can cause the musculoskeletal system to become overloaded. Field hockey is an example of a sport which, due to the players' non--ergonomic positions, can lead to degenerative changes in the lumbar spine. The aim of this study was to evaluate the condition of the lumbar spine among 20 male players of the Polish national team in field hockey, aging between 24 and 35 years of age, and having trained in the discipline of field hockey for a period of between 14 and 26 years. CT scans were used to determine the height of vertebrae and intervertebral discs. The study showed a number of differences in lumbar discs and vertebrae that a...


Transcutaneous Electrical Nerve Stimulation as an Additional Treatment for Women Suffering from Therapy‐Resistant Provoked Vestibulodynia: A Feasibility Study
ConclusionThe addition of self‐administered TENS to multidimensional treatment significantly reduced the level of vulvar pain and the need for vestibulectomy. The long‐term effect was stable. These results not only support our hypothesis that TENS constitutes a feasible and beneficial addition to multidimensional treatment for therapy‐resistant PVD, but also the notion that PVD can be considered as a chronic pain syndrome. Vallinga MS, Spoelstra SK, Hemel ILM, van de Wiel HBM, and Weijmar Schultz WCM. Transcutaneous electrical nerve stimulation as an additional treatment for women suffering from therapy‐resistant provoked vestibulodynia: A feasibility study. J Sex Med **;**:**–**. (Source: The Journal of Sexual Medicine)


[Review] Pain assessment in elderly adults with dementia
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. (Source: Lancet Neurology)


Rheumatoid Arthritis: New Effective and Cheaper Treatment
Rheumatoid arthritis (RA) is a chronic auto-immune disease that causes pain and stiffness in the joints, fatigue, bone damage and, eventually, loss of mobility. RA afflicts around 1% of people in the western world; in Belgium, 80,000 to 100,000 people currently live with the disease. (Source: Disabled World)


A Prospective Multicenter Clinical Study of Extralevator Abdominoperineal Resection for Locally Advanced Low Rectal Cancer
CONCLUSIONS: Extralevator abdominoperineal resection performed in the prone position for low rectal cancer is a relatively safe approach with acceptable circumferential resection margin involvement, intraoperative perforations, and local recurrences. Reconstruction of the pelvic floor with biological mesh might lower the rate of perineal wound complications (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A161 ). (Source: Diseases of the Colon and Rectum)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Back Pain Quiz: Test Your Back Pain IQ
Title: Back Pain Quiz: Test Your Back Pain IQCategory: MedicineNet QuizCreated: 6/16/2011 3:41:00 PMLast Editorial Review: 11/11/2014 4:06:47 PM (Source: MedicineNet Chronic Pain General)


A Rapid Evidence Assessment of Immersive Virtual Reality as an Adjunct Therapy in Acute Pain Management in Clinical Practice
Discussion:This review found moderate evidence for the reduction of pain and functional impairment after IVR in patients with acute pain. Further high-quality studies are required for the conclusive judgment of its effectiveness in acute pain, to establish potential benefits for chronic pain, and for safety. (Source: The Clinical Journal of Pain)


Motor Imagery in People With a History of Back Pain, Current Back Pain, Both, or Neither
Discussion:Trunk motor imagery performance is reduced in people with a history of back pain when they are in a current episode. This is consistent with disruption of cortical proprioceptive representation of the trunk in this group. On the basis of this result, we propose a conceptual model speculating a role of this measure in understanding the development of chronic back pain, a model that can be tested in future studies. (Source: The Clinical Journal of Pain)


Low Back Pain Patient Subgroups in Primary Care: Pain Characteristics, Psychosocial Determinants, and Health Care Utilization
Discussion:Our study adds substantially to the knowledge of LBP-related case-mix in primary care. Information on differential health care needs may be inferred from our study, enabling decision makers to allocate resources more appropriately and to reduce costs. (Source: The Clinical Journal of Pain)


The Impact of Buprenorphine Transdermal Delivery System on Activities of Daily Living Among Patients With Chronic Low Back Pain: An Application of the International Classification of Functioning, Disability and Health
Discussion:These results suggest that for patients with moderate to severe CLBP, 12 weeks use of BTDS improves the ability to carry out certain ADLs related to sleeping, lifting, bending, and working. (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>


Olfactory Acuity in Chronic Migraine: A Cross‐Sectional Study
ConclusionsWhile chronic migraine patients do not appear to have a significant change in olfactory acuity between migrainous and non‐migrainous periods, they do appear to be more likely to have abnormal olfactory acuity at baseline compared to age‐ and sex‐matched controls. (Source: Headache: The Journal of Head and Face Pain)


The effect of chronic pain on life satisfaction: Evidence from Australian data
Publication date: November 2014 Source:Social Science &amp; Medicine, Volume 121 Author(s): Paul McNamee , Silvia Mendolia Chronic pain is associated with significant costs to individuals directly affected by this condition, their families, the healthcare system, and the society as a whole. This paper investigates the relationship between chronic pain and life satisfaction using a sample of around 90,000 observations from the first ten waves of the Household, Income and Labour Dynamics of Australia Survey (HILDA), which is a representative survey of the Australian population that started in 2000. We estimate the negative impact on life satisfaction and examine the persistence of the effect over multiple years. Chronic pain is associated with poor health conditions, disability, decrea...


Neurophysiological evidence for remediation of reward processing deficits in chronic pain and opioid misuse following treatment with Mindfulness-Oriented Recovery Enhancement: exploratory ERP findings from a pilot RCT
This study examined whether a Mindfulness-Oriented Recovery Enhancement (MORE) intervention could augment natural reward processing through training in savoring as indicated by event-related brain potentials (ERPs). Participants were chronic pain patients at risk for opioid misuse who were randomized to 8 weeks of MORE (n = 11) or a support group control condition (n = 18). ERPs to images representing naturally rewarding stimuli (e.g., beautiful landscapes, intimate couples) and neutral images were measured before and after 8 weeks of treatment. Analyses focused on the late positive potential (LPP)—an ERP response in the 400–1,000 ms time window thought to index allocation of attention to emotional information. Treatment with MORE was associated with significant increases in LPP...


Mast cells: Versatile gatekeepers of pain
Publication date: January 2015 Source:Molecular Immunology, Volume 63, Issue 1 Author(s): Devavani Chatterjea , Tijana Martinov Mast cells are important first responders in protective pain responses that provoke withdrawal from intense, noxious environmental stimuli, in part because of their sentinel location in tissue–environment interfaces. In chronic pain disorders, the proximity of mast cells to nerves potentiates critical molecular cross-talk between these two cell types that results in their synergistic contribution to the initiation and propagation of long-term changes in pain responses via intricate signal networks of neurotransmitters, cytokines and adhesion molecules. Both in rodent models of inflammatory pain and chronic pain disorders, as well as in increasing evidence from...


Effect of Pain Induction or Pain Reduction on Conditioned Pain Modulation in Adults: A Systematic Review
ConclusionAnalgesic medication and oral contraceptives might inhibit the CPM response, whereas there is limited evidence that pain‐relieving surgery improves CPM in chronic pain patients. However, the results merely suggest that decreased CPM values (as in chronic pain patients) can improve after elimination of pain. (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>


Cough reduction using capsaicin
Chronic unexplained cough triggered by environmental irritants is characterized by increased cough reflex sensitivity, which can be demonstrated by means of inhaled capsaicin. Topical capsaicin can be used to improve non-allergic rhinitis and intestinal hypersensitivity and to reduce neuropathic pain. (Source: Respiratory Medicine CME)


When Children Die of Cancer
In this study, we used a qualitative method called Grounded Theory to interview 21 Canadian oncologists who treat children about how they feel when their patients die. What we found was surprising. Just like every other griever, pediatric oncologists experienced sadness, crying, sleep loss, exhaustion, and a deep sense of personal loss when their patients died. As one of the oncologists explained, "You feel sad, you think about the patient a lot. You think about the potential that they're going miss out on because they died. You know, you definitely ... I cry, I cry often when my patients die." Unlike everyone else, however, they also reported feelings of guilt, failure, and helplessness when their patients couldn't be cured. This makes sense because unlike most mourners, oncologists ...


Different Perspectives Regarding Quality of Life in Chronically ill and Healthy Individuals
Abstract The areas that were suggested as most important with regard to Quality of Life (QoL) were examined in groups of individuals who were healthy, and those with a chronic condition. An electronic survey was completed by 892 participants (261 healthy and 631 with a chronic condition). They answered three questions relating to QoL: what is most important to you; what areas most impact your QoL; and an open question what does QoL mean to you. Across the three questions both groups highlighted physical functioning, independence and mobility as key areas for QoL. However, the group with a chronic condition tended to find issues of functioning such as pain, fatigue, and sleep as more important to their QoL than the healthy participants. In contrast, the healthy participants tended...


Activation of Extracellular Signal-Regulated Kinase1/2 in the Medial Prefrontal Cortex Contributes to Stress-Induced Hyperalgesia
Abstract Stressful stimuli can exacerbate persistent pain disorder. However, the underlying mechanism is still unknown. Here, to reveal the underlying mechanism for stressful stimuli-induced hyperalgesia in chronic pain, we investigated the effect of extracellular signal-regulated kinase1/2 (ERK1/2) activation on pain hypersensitivity using single-prolonged stress (SPS) model, complete Freund’s adjuvant (CFA) model and SPS + CFA model. The experimental results revealed significantly reduced paw withdrawal threshold in the SPS, CFA, and SPS + CFA group compared with the control group. However, the increased phosphorylation of ERK1/2 in the medial prefrontal cortex (mPFC) was observed in the SPS- or SPS + CFA-exposed group but not the CFA group compared with control g...


An Army Sergeant With Mysterious Pain: Crack the CaseAn Army Sergeant With Mysterious Pain: Crack the Case
What should be done to assess and treat chronic, multifocal pain in a 44-year-old retired Army sergeant? Medscape Internal Medicine (Source: Medscape Today 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>


Recommendations for Improved Opioid Use for Chronic Pain from NIH-Convened Panel
No abstract available (Source: Oncology Times - Current Table Of Contents)


Pain severity and the economic burden of neuropathic pain in the United States: BEAT Neuropathic Pain Observational Study.
CONCLUSION: Subjects with NeP, mainly those showing moderate or severe pain, had significant associations between pain severity and NeP-related health care resource utilization, productivity, and costs. The economic burden, particularly indirect costs, was highest among those with severe pain and higher than previously reported in studies of specific NeP conditions. PMID: 25378940 [PubMed] (Source: Pain Physician)


Can a back pain screening tool help classify patients with acute pain into risk levels for chronic pain?
ConclusionsA risk classification schema using the recommended cut‐off scores with items similar to the STarT‐Back in a primary care population with strictly defined acute LBP had limited ability to identify persons who progressed to chronic pain. The results suggest caution when applying the STarT‐Back in patients with acute LBP and a need to consider a modification of its cut‐offs. (Source: European Journal of Pain)


Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioral therapy for the treatment and management of chronic pain disorders: protocol for a systematic review and meta-analysis with indirect comparisons
The objective of this systematic review and meta-analysis is to compare MBSR to CBT in their relative ability to reduce pain-related disability and intensity, to alleviate emotional distress, and to improve global functioning in chronic pain patients. Methods: We will conduct a systematic review with meta-analyses to compare MBSR to CBT in the treatment of chronic pain disorders in adults. We will report our review according to the recommendations provided by the PRISMA statement. Randomized studies will be included and the literature search will comprise Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Embase Classic + Embase, PsycINFO, the Cochrane Library on Wiley, including CENTRAL, Cochrane Database of Systematic Reviews, DARE, and HTA. Study selection and da...


Characterization of osteoarthritis in cats and meloxicam efficacy using objective chronic pain evaluation tools
This study aimed to characterize osteoarthritis (OA)-related chronic pain and disability in experimental cats with naturally occurring OA. Peak vertical ground reaction force (PVF), accelerometer-based motor activity (MA) and the von Frey anesthesiometer-induced paw withdrawal threshold were used to define OA and to test the efficacy of meloxicam. A diagnosis of OA was based on radiographic and orthopedic examinations. Cats with OA (n =39) and classified as non-OA (n =6) were used to assess the reliability and sensitivity of the parameters to assess OA over 3weeks while being administered placebo medication. A randomised parallel design study was then used to investigate the effects on OA of daily oral meloxicam treatment for 4weeks at different dose rates (0.025mg/kg, n =10mg/kg; 0.04mg/k...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A preliminary RCT of a mind body skills based intervention addressing mood and coping strategies in patients with acute orthopedic trauma
Objective To test the acceptability and feasibility of a mind body skills-based intervention (RRCB) and estimate its preliminary effect in reducing disability and pain intensity as compared to standard care (SC) in patients with acute musculoskeletal trauma.Design Randomized controlled trialSetting Level I trauma centerPatients Adult patients with acute fractures at risk for chronic pain and disability based on scores on two coping with pain measures who presented to an orthopedic trauma center and met inclusion and exclusion criteria. (Source: Injury)


'Beware of the deep': the deep posterior compartment in complex/chronic leg pain
Michael Winkes and his colleagues1 do an admirable job of performing a systematic review on a controversial topic for those of us who care for athletes with leg pain. Like these authors, most of us have come to the frustrating realisation that patients with deep posterior exertional compartment syndromes do less well than those with the more classic anterior or lateral exertional compartment syndrome. The authors validate the clinical experience of many through a comprehensive, systematic review. Through this review, the authors also expose several key issues that limit our ability to definitively conclude why the deep posterior compartment is more commonly associated with poor outcomes. While some of the literature available for this systematic review was graded at evidence level III, mos...


The Role of Synthetic and Biologic Materials in the Treatment of Pelvic Organ Prolapse
Clinics in Colon and Rectal Surgery 2014; 27: 182-190DOI: 10.1055/s-0034-1394157Pelvic organ prolapse is a significant medical problem that poses a diagnostic and management dilemma. These diseases cause serious morbidity in those affected and treatment is sought for relief of pelvic pain, rectal bleeding, chronic constipation, obstructed defecation, and fecal incontinence. Numerous procedures have been proposed to treat these conditions; however, the search continues as colorectal surgeons attempt to find the procedure that would optimally treat these conditions. The use of prosthetics in the repair of pelvic organ prolapse has become prevalent as the benefits of their use are realized. While advances in biologic mesh and new surgical techniques promise improved functional outcomes with d...


Impact of locomotion training with a neurologic controlled hybrid assistive limb (HAL) exoskeleton on neuropathic pain and health related quality of life (HRQoL) in chronic SCI: a case study.
This report presents two cases of severe chronic and therapy resistant neuropathic pain due to chronic SCI and demonstrates the beneficial effects of neurologic controlled exoskeletal intervention on pain severity and health-related quality of life (HRQoL). Both of these patients were engaged in a 12 weeks period of daily HAL®-supported locomotion training. In addition to improvements in motor functions and walking abilities, both show significant reduction in pain severity and improvements in all HRQoL domains. Although various causal factors likely contribute to abatement of CNP, the reported results occurred due to a new approach in the rehabilitation of chronic spinal cord injury patients. These findings suggest not only the feasibility of this new approach but in conclusion, demonstr...


Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioral therapy for the treatment and management of chronic pain disorders: protocol for a systematic review and meta-analysis with indirect comparisons
The objective of this systematic review and meta-analysis is to compare MBSR to CBT in their relative ability to reduce pain-related disability and intensity, to alleviate emotional distress, and to improve global functioning in chronic pain patients. Methods/design We will conduct a systematic review with meta-analyses to compare MBSR to CBT in the treatment of chronic pain disorders in adults. We will report our review according to the recommendations provided by the PRISMA statement. Randomized studies will be included and the literature search will comprise Ovid MEDLINE®, Ovid MEDLINE® In-Process & Other Non-Indexed Citations, Embase Classic + Embase, PsycINFO, the Cochrane Library on Wiley, including CENTRAL, Cochrane Database of 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>


Stress-induced hyperalgesia
Publication date: October 2014 Source:Progress in Neurobiology, Volume 121 Author(s): Elaine M. Jennings , Bright N. Okine , Michelle Roche , David P. Finn The importance of the modulation of pain by emotion is now widely recognised. In particular, stress and anxiety, depending on their nature, duration and intensity, can exert potent, but complex, modulatory influences typified by either a reduction or exacerbation of the pain state. Exposure to either acute or chronic stress can increase pain responding under experimental conditions and exacerbate clinical pain disorders. There is evidence that exposure to chronic or repeated stress can produce maladaptive neurobiological changes in pathways associated with pain processing, resulting in stress-induced hyperalgesia (SIH). Preclinical st...


Preclinical research on pain comorbidity with affective disorders and cognitive deficits: Challenges and perspectives
Publication date: May 2014 Source:Progress in Neurobiology, Volume 116 Author(s): Ming-Gang Liu , Jun Chen Affective disorders and cognitive deficits are common comorbidities of chronic pain in the clinical setting, which severely affect the quality of life of pain patients and impose a great difficulty upon clinical pain therapy. Despite large numbers of human studies examining this issue, there are surprisingly few reports investigating the comorbidities of chronic pain in animal models. This review summarizes and integrates previous reports of animal studies on pain and comorbidity, covering pain-evoked anxiety, depression, attentional deficits, cognitive impairment and locomotor dysfunction in rodents. Moreover, pain-induced alterations in synaptic plasticity are also discussed in te...


Stromal cell-derived CCL2 drives neuropathic pain states through myeloid cell infiltration in injured nerve
Publication date: Available online 4 November 2014 Source:Brain, Behavior, and Immunity Author(s): Juliette Van Steenwinckel , Constance Auvynet , Anaïs Sapienza , Annabelle Reaux-Le Goazigo , Christophe Combadière , Stéphane Melik Parsadaniantz Neuropathic pain resulting from peripheral nerve injury involves many persistent neuroinflammatory processes including inflammatory chemokines that control leukocyte trafficking and activate resident cells. Several studies have shown that CCL2 chemokine, a potent attractant of monocytes, and its cognate receptor, CCR2, play a critical role in regulating nociceptive processes during neuropathic pain. However, the role of CCL2 in peripheral leukocyte infiltration-associated neuropathic pain remains poorly understood. In particular, the contribut...


Minocycline modulates neuropathic pain behaviour and cortical M1–M2 microglial gene expression in a rat model of depression
Publication date: November 2014 Source:Brain, Behavior, and Immunity, Volume 42 Author(s): Nikita N. Burke , Daniel M. Kerr , Orla Moriarty , David P. Finn , Michelle Roche There is a paucity of data on the role of microglia and neuroinflammatory processes in the association between chronic pain and depression. The current study examined the effect of the microglial inhibitor minocycline on depressive-like behaviour, spinal nerve ligation (SNL)-induced mechanical and cold allodynia and associated changes in the expression of genes encoding microglial markers (M1 vs. M2 polarisation) and inflammatory mediators in the prefrontal cortex in the olfactory bulbectomised (OB) rat model of depression. Acute minocycline administration did not alter OB-induced depressive-like behaviour but prevent...


Identification of a functional interaction of HMGB1 with Receptor for Advanced Glycation End-products in a model of neuropathic pain
Publication date: November 2014 Source:Brain, Behavior, and Immunity, Volume 42 Author(s): Yohance M. Allette , Michael R. Due , Sarah M. Wilson , Polina Feldman , Matthew S. Ripsch , Rajesh Khanna , Fletcher A. White Recent studies indicate that the release of high mobility group box 1 (HMGB1) following nerve injury may play a central role in the pathogenesis of neuropathic pain. HMGB1 is known to influence cellular responses within the nervous system via two distinct receptor families; the Receptor for Advanced Glycation End-products (RAGE) and Toll-like receptors (TLRs). The degree to which HMGB1 activates a receptor is thought to be dependent upon the oxidative state of the ligand, resulting in the functional isoforms of all-thiol HMGB1 (at-HMGB1) acting through RAGE, and disufide HM...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 increases in intramuscular inflammatory cytokines are necessary for the development of mechanical hypersensitivity in a mouse model of musculoskeletal sensitization
Publication date: Available online 22 October 2014 Source:Brain, Behavior, and Immunity Author(s): Blair C. Sutton , Mark R. Opp Musculoskeletal pain is a widespread health problem in the United States. Back pain, neck pain, and facial pain are three of the most prevalent types of chronic pain, and each is characterized as musculoskeletal in origin. Despite its prevalence, preclinical research investigating musculoskeletal pain is limited. Musculoskeletal sensitization is a preclinical model of muscle pain that produces mechanical hypersensitivity. In a rodent model of musculoskeletal sensitization, mechanical hypersensitivity develops at the hind paws after injection of acidified saline (pH 4.0) into the gastrocnemius muscle. Inflammatory cytokines contribute to pain during a variety of...


[Physical training for neurological and mental diseases.]
CONCLUSION: The concerted integration of physical exercise into prophylactic and therapeutic interventions can lower the burden of neurological and mental diseases; however, scientific evidence is still lacking concerning the optimal duration, type, and intensity as well as potential risks of physical exercise. PMID: 25380564 [PubMed - as supplied by publisher] (Source: Der Nervenarzt)


Potential risk factors of re‐intervention after endovascular repair for type B aortic dissections
Conclusions: we concluded that chronic phase, smoking and too big oversizing were potential risk factors of re‐intervention. © 2014 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Helicobacter pylori Infection in Children. Antimicrobial Resistance and Treatment Response
ConclusionTreated patients often failed to meet the criteria established in the guidelines for H. pylori diagnostic screening and treatment because most of them had only recurrent abdominal pain, but remission of their symptoms was associated with H. pylori eradication. (Source: Helicobacter)


Effects of Early Childhood Trauma on Hypothalamic-Pituitary-Adrenal (HPA) Axis Function in Patients with Chronic Fatigue Syndrome
Chronic Fatigue Syndrome (CFS) is characterized by chronic, medically unexplained fatigue and physical and/or mental fatigability in response to exertion in particular (Fukuda et al., 1994; Carruthers et al., 2011). It is a highly debilitating condition that most often affects women (Jason et al., 1999) and that is associated with high psychosocial and economic costs (Collin et al., 2011). A considerable proportion of CFS patients also suffers from chronic pain symptoms, and studies increasingly suggest that CFS may be part of a broader spectrum of chronic pain and fatigue disorders (Kanaan et al., 2007; Van Houdenhove et al., 2010; Ablin et al., 2012). (Source: Psychoneuroendocrinology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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-opioid substance use disorders and opioid dose predict therapeutic opioid addiction
This study examined TOA among 199 patients undergoing chronic opioid therapy at the time of admission to a pain rehabilitation program. It was hypothesized that non-opioid substance use disorders and opioid dosage would predict TOA. Daily mean opioid dose was 132.85mg ±175.39. Patients with non-opioid substance use disorders had 28x the odds (OR = 28.58; 95% CI = 10.86, 75.27) of having TOA. (Source: The Journal of Pain)


[Perioperative pain management: what is evidence based?]
CONCLUSION: Regional anesthesia is currently the predominant method of choice for post-operative acute pain management. Neuraxial blockage is especially important when considering all spinal procedures. PMID: 25380683 [PubMed - as supplied by publisher] (Source: Pain Physician)


[Opioids in chronic neuropathic pain : A systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks duration.]
CONCLUSION: In short-term studies (4-12 weeks) in CNP, 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. The conclusion relating to the safety of opioids compared to placebo in CNP is limited by the low number of SAE and deaths. Short-term opioid therapy may be considered in selected CNP patients. The English full-text version of this article is freely available at SpringerLink (under "Supplementary Material"). PMID: 25376548 [PubMed - as supplied by publisher] (Source: Schmerz)


[Opioids in chronic osteoarthritis 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. The effect sizes of average reduction in pain intensity and physical disability were small. Opioids and placebo did not differ in terms of safety. The conclusion on the safety of opioids compared to placebo is limited by the low number of SAE and deaths. Short-term opioid therapy may be considered in selected chronic OA pain patients. No current evidence-based guideline recommends opioids as first-line treatment option for chronic OA pain. To provide superior evidence for future treatment guidelines, RCTs must directly compare existing pharmacological and nonpharmacological therapies and administer these in various combinations and sequences. The English full-text version of this articl...


[Opioids in chronic noncancer pain-are opioids superior to nonopioid analgesics? : A systematic review and meta-analysis of efficacy, tolerability and safety in randomized head-to-head comparisons of opioids versus nonopioid analgesics of at least four week's duration.]
CONCLUSION: Nonopioid analgesics are superior to opioids in terms of improvement of physical function and tolerability in short-term (4-12 weeks) therapy of neuropathic, low back and osteoarthritis pain. Our results do not support the concept of an"opioid-requiring" CNCP. The English full-text version of this article is freely available at SpringerLink (under "Supplemental"). PMID: 25376546 [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>


[Opioids in chronic noncancer pain-are opioids different? : A systematic review and meta-analysis of efficacy, tolerability and safety in randomized head-to-head comparisons of opioids of at least four week's duration.]
CONCLUSION: Pooled head-to-head comparisons of opioids (opioid of the sponsor of the study versus standard opioid) provide no rational for preferring one opioid and/or administration route over another in the therapy of patients with CNCP. The English full-text version of this article is freely available at SpringerLink (under "Supplemental"). PMID: 25376545 [PubMed - as supplied by publisher] (Source: Schmerz)


The management of sportsman’s groin hernia in professional and amateur soccer players: a revised concept
Conclusion Selective surgical hernia repair, based on meticulous anamnesis and physical examination is effective in the management of chronic groin pain in athletes. (Source: Hernia)


Effects of early childhood trauma on hypothalamic–pituitary–adrenal (HPA) axis function in patients with Chronic Fatigue Syndrome
Chronic Fatigue Syndrome (CFS) is characterized by chronic, medically unexplained fatigue and physical and/or mental fatigability in response to exertion in particular (Fukuda et al., 1994; Carruthers et al., 2011). It is a highly debilitating condition that most often affects women (Jason et al., 1999) and that is associated with high psychosocial and economic costs (Collin et al., 2011). A considerable proportion of CFS patients also suffers from chronic pain symptoms, and studies increasingly suggest that CFS may be part of a broader spectrum of chronic pain and fatigue disorders (Kanaan et al., 2007; Van Houdenhove et al., 2010; Ablin et al., 2012). (Source: Psychoneuroendocrinology)


Kineta wants to change biotech investing from 'a black box' to shorter, transparent model
Kineta, a Seattle-based company founded in 2008, is a different type of biotech. Its co-founders, CEO Charles Magness and Chief Scientific Officer Shawn Iadonato, aren't just focusing on developing their drugs for chronic pain, infectious diseases and autoimmune diseases. They want to transform the risky world of biotech investing to help make innovative products, especially those being made in the Seattle area, more successful in the long-term. I chatted with Magness and Iadonato about why there's… (Source: bizjournals.com Health Care:Pharmaceuticals headlines)


Can epidemiological factors affect the 2-year outcomes after surgery for degenerative lumbar disease in terms of quality of life, disability and post-surgical pain?
Conclusion Based on our findings, age and permanent sick leave have to be considered as negative epidemiologic predictive factors of the outcome of degenerative lumbar disease surgery. (Source: Revista Espanola de Cirugia Ortopedica y Traumatologia)


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)


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)


Gait characteristics of women with fibromyalgia: a premature aging pattern
Conclusion Middle-aged women with fibromyalgia showed gait pattern resemblances to elderly, women, which is characterized by reduced lower limb ROM, stride length and walking speed. (Source: Revista Brasileira de Reumatologia)


Nonspecific low back pain in young adults: Associated risk factors
Conclusion Some variables related to chronic diffuse pain and lower quality of life might be associated to chronic low back pain in young adults. However, longitudinal studies are necessary. (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>


The analgesic effect of intravenous lidocaine in the treatment of chronic pain: a literature review
Conclusions Based on the literature review, it is not possible to uniformly specify the most effective and safe dose of lidocaine administered intravenously for the treatment of neuropathic or musculoskeletal pain. As for effectiveness, the intravenous infusion of lidocaine as an alternative for the treatment of chronic pain of various etiologies seems very promising, but further studies need to be conducted. (Source: Revista Brasileira de Reumatologia)


Legionella pneumonia after infliximab in a patient with Rheumatoid Arthritis
We report a case of a female patient with previous diagnosis of RA for 16 years that used several disease-modifying anti-rheumatic drugs (DMARDs) that resulted in treatment failure, and then was treated with infliximab. After fifteen days of the second dose, the patient developed ventilatory-dependent chest pain, dry cough and dyspnea. She was hospitalized, and the diagnosis of pneumonia by Legionella pneumophila was confirmed by the presence of Legionella antigen in an urine test. TNF is an inflammatory cytokine that also acts inhibiting the bacterial growth of intracellular pathogens, and its inhibition seems to increase susceptibility to these infections in some patients. (Source: Revista Brasileira de Reumatologia)


Characterization of the pain, sleep and alexithymia patterns of patients with fibromyalgia treated in a Brazilian tertiary center
Conclusion Studies have disclosed the presence of important and frequently underdiagnosed symptoms beyond pain complaints in FM, such as sleep complaints and alexithymia, and a better knowledge of such disturbances might improve FM patients’ approach and treatment. (Source: Revista Brasileira de Reumatologia)


Effects of Mindfulness Meditation on Chronic Pain: A Randomized Controlled Trial
ConclusionA standardized mindfulness program (MBSR) contributes positively to pain management and can exert clinically relevant effects on several important dimensions in patients with long‐lasting chronic pain. (Source: Pain Medicine)


Satellite glial cells in sensory ganglia: its role in pain
Conclusions Satellite glial cells are important in the establishment of physiological pain, in addition to being a potential target for the development of new pain treatments. (Source: Brazilian Journal of Anesthesiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Bilateral optic neuritis related to chronic inflammatory demyelinating polyneuropathy
Publication date: Available online 23 June 2014 Source:Taiwan Journal of Ophthalmology Author(s): Kui-Yueh Lin , I-Hua Wang , Jieh-Ren Jou , Hai-Jui Chu , William Wei , Shwu-Huey Lee , Szu-Yuan Lin Chronic inflammatory demyelinating polyneuropathy (CIDP) is a condition that mainly affects the peripheral nervous system; however, the central nervous system has also been involved in rare cases. Herein, we describe the case of a 33-year-old man with CIDP who presented with progressively blurred vision and pain with eye movement in both eyes for 1 month. Ocular examination revealed reduced visual acuities of 0.15 (oculus unitas or OU) and unremarkable fundi (OU). Furthermore, bitemporal visual field defects and prolonged visually evoked potentials were evident. Brain magnetic resonance imagi...


Using MBCT in a Chronic Pain Setting: A Qualitative Analysis of Participants’ Experiences
Abstract An estimated 20 % of the global population experiences chronic pain, and comorbidity with emotional disorders such as depression is high. While the use of mindfulness-based cognitive therapy (MBCT) as an intervention for recurrent depression is escalating in both popularity and evidence-based success, MBCT is being increasingly utilised in a range of areas including chronic pain management. The current study was designed to conceptualise chronic pain patients’ perceived benefits of an MBCT programme. Semi-structured interviews were conducted with 17 chronic pain patients who had participated in MBCT group training within a public hospital pain unit between 8 and 50 months previously. The recorded interviews were transcribed and interpreted using thematic analysis to i...


Arthritis among veterans - United States, 2011-2013.
This report summarizes the results of these analyses, which found that one in four veterans reported that they had arthritis (25.6%) and that prevalence was higher among veterans than nonveterans across most sociodemographic categories, including sex (prevalence among male and female veterans was 25.0% and 31.3%, respectively). State-specific, age-standardized arthritis prevalence among veterans ranged from 18.8% in Hawaii to 32.7% in West Virginia. Veterans comprise a large and important target group for reducing the growing burden of arthritis. Those interested in veterans' health can help to improve the quality of life of veterans by ensuring that they have access to affordable, evidence-based, physical activity and self-management education classes that reduce the adverse effects of ar...


Spreading and sustaining best practices for home care of older adults: a grounded theory study
Conclusions: Spread of best practices is optimized through the application of the phases of spread, allocation of resources to support spread, and implementing strategies for ongoing sustainability that address potential barriers. Further research will help to understand how best practices are spread externally to other organizations. (Source: Implementation Science)


Do fibromyalgia patients benefit from cognitive restructuring and acceptance? An experimental study
Conclusion: Results show that both, cognitive restructuring and acceptance instructions, enhance pain tolerance in fibromyalgia patients. (Source: Journal of Behavior Therapy and Experimental 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>


Effect of experimental jaw muscle pain on dynamic bite force during mastication
Temporomandibular disorders (TMDs) are chronic pain conditions in the musculoskeletal structures in the craniofacial region with a higher prevalence in women (6.3 - 15%) than men (3.2 - 10%).1 Patients with myofascial TMD pain may have impaired masticatory function due to limited jaw movements and the awareness of muscle pain may also impede and perturb mastication.2 Though the effect of experimental muscle pain or fatigue on static bite force, like maximum voluntary contraction, is well studied,3,4 the relationship between pain and the control of dynamic bite force during mastication still remains unclear. (Source: Archives of Oral Biology)


Pharmacological interventions for somatoform disorders in adults.
CONCLUSIONS: The current review found very low-quality evidence for NGAs and low-quality evidence for NPs being effective in treating somatoform symptoms in adults when compared with placebo. There was some evidence that different classes of antidepressants did not differ in efficacy; however, this was limited and of low to very low quality. These results had serious shortcomings such as the high risk of bias, strong heterogeneity in the data, and small sample sizes. Furthermore, the significant effects of antidepressant treatment have to be balanced against the relatively high rates of adverse effects. Adverse effects produced by medication can have amplifying effects on symptom perceptions, particularly in people focusing on somatic symptoms without medical causes. We can only draw concl...


Using the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) Model in Clinical Research: Application to Refine a Practice-based Research Network (PBRN) Study
Conclusions: The study was not as pragmatic as expected. The exercise results seem to be useful in identifying necessary refinements to the study methodology that may benefit future study design and increase generalizability. Readers can identify how the PRECIS model may be used to provide clarity and transparency for proposed or existing studies and may wish to replicate our exercise in planning their own studies. (Source: Journal of the American Board of Family Medicine)


Autoimmune Hepatitis with Multiple Sclerosis and Graves Disease: Coincidence or Association
We report the case of a 61-year-old woman with MS (untreated) and a history of Graves disease who presented with fatigue and right upper quadrant abdominal pain. She was admitted to our hospital for evaluation. Clinical and laboratory workup revealed AIH. She was successfully treated with prednisone and azathioprine, with complete clinical and laboratory improvement. However, to our knowledge there have been only a few reports of a possible association between AIH and untreated MS.Case Rep Gastroenterol 2014;8:319-323 (Source: Case Reports in Gastroenterology)


Clinical Study on Chronic Pain in Parkinson's Disease Patients in Shanghai, China
Conclusion: Chronic PD-related pain is a frequent complaint and complex in PD. The challenge of managing pain in PD patients will hopefully someday result in specific and effective treatment strategies.Integr Med Int 2014;1:93-101 (Source: Integrative Medicine 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>


Opioid Therapy for Chronic Low Back Pain: Prescribing Considerations for Advanced Practice Registered Nurses
No abstract available (Source: Journal of Neuroscience Nursing)


Treatment of Chronic Pain: Diffusion Tensor Imaging Identification of the Ventroposterolateral Nucleus Confirmed with Successful Deep Brain Stimulation
Conclusion: DTI has the potential to identify the thalamic nuclei in individuals, which would be more accurate than anatomical localization and likely identical to intraoperative physiological testing. Postoperative DBS electrode placement and the affected cortical areas can be confirmed with coregistration of CT and FT using the electrode as a seed ROI.Stereotact Funct Neurosurg 2014;92:365-371 (Source: Stereotactic and Functional Neurosurgery)


Does having a hobby help you live longer?
ConclusionThis is an interesting paper on the important issue of wellbeing and its potential effect on health and survival. However, as the authors point out, it does not prove that wellbeing protects health and increases the chance of living longer. The association they found could be a result of both measured and unmeasured confounders, such as ill health. Wellbeing could be a marker for underlying biological processes that are responsible for the effect on survival. There are likely to be bidirectional effects at work. Some people with poor health become unhappy, while others who are unhappy become physically unwell. That said, it's sensible for people to stay active as they grow older, and maintain their social activities and relationships. Eating well, exercising regularly and mai...


Long term effect of cupping for chronic neck pain
Publication date: Available online 14 October 2014 Source:Integrative Medicine Research Author(s): Jungtae Leem Aim To investigate long-term effects of cupping therapy in patients with chronic neck pain. Design Three 2-armed randomized waitlist-controlled trials (RCTs) were followed up 2 years after completion of each of the 3 studies. Assessments were conducted by researchers before and after the cupping therapy. Setting Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Germany. Participants Study subjects included patients aged 18–75 years who had experienced nonspecific neck pain with a pain intensity of more than 40mm on a 100mm visual analogue scale (VAS) for at least 3 months for a minimum of 5 days a week...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Histamine in the locus coeruleus promotes descending noradrenergic inhibition of neuropathic hypersensitivity
Publication date: December 2014 Source:Pharmacological Research, Volume 90 Author(s): Hong Wei , Cong-Yu Jin , Hanna Viisanen , Hao-Jun You , Antti Pertovaara Among brain structures receiving efferent projections from the histaminergic tuberomammillary nucleus is the pontine locus coeruleus (LC) involved in descending noradrenergic control of pain. Here we studied whether histamine in the LC is involved in descending regulation of neuropathic hypersensitivity. Peripheral neuropathy was induced by unilateral spinal nerve ligation in the rat with a chronic intracerebral and intrathecal catheter for drug administrations. Mechanical hypersensitivity in the injured limb was assessed by monofilaments. Heat nociception was assessed by determining radiant heat-induced paw flick. Histamine in the...


JZL184 is anti-hyperalgesic in a murine model of cisplatin-induced peripheral neuropathy
Publication date: December 2014 Source:Pharmacological Research, Volume 90 Author(s): Iryna A. Khasabova , Xu Yao , Justin Paz , Cutler T. Lewandowski , Amy E. Lindberg , Lia Coicou , Natasha Burlakova , Don A. Simone , Virginia S. Seybold Cisplatin has been used effectively to treat a variety of cancers but its use is limited by the development of painful peripheral neuropathy. Because the endocannabinoid 2-arachidonoyl-sn-glycerol (2-AG) is anti-hyperalgesic in several preclinical models of chronic pain, the anti-hyperalgesic effect of JZL184, an inhibitor of 2-AG hydrolysis, was tested in a murine model of cisplatin-induced hyperalgesia. Systemic injection of cisplatin (1mg/kg) produced mechanical hyperalgesia when administered daily for 7 days. Daily peripheral administration of a lo...


Hydrocodone Extended-Release: Pharmacodynamics, Pharmacokinetics and Behavioral Pharmacology of a Controversy
Publication date: Available online 6 October 2014 Source:Pharmacological Research Author(s): Harry J. Gould III , Dennis Paul Recently, the U.S. Food and Drug Administration (FDA) approved Zohydro®, an extended release formulation of the opioid analgesic hydrocodone that contains no acetaminophen. This approval was against the recommendation of the FDA's Expert Panel. Subsequently, both chronic pain advocates and anti-drug abuse advocates have steadfastly expressed their support of, or astonishment at this decision. Here, we review the pharmacokinetics, pharmacodynamics, safety and abuse liability of this hydrocodone formulation and how it relates to Expert Panel's opinion and the FDA decision. We discuss the important issues, risk mitigation, potential use of abuse deterrents, and how ...


Glycine transport inhibitors for the treatment of pain
Publication date: August 2014 Source:Trends in Pharmacological Sciences, Volume 35, Issue 8 Author(s): Robert J. Vandenberg , Renae M. Ryan , Jane E. Carland , Wendy L. Imlach , Macdonald J. Christie Opioids, local anesthetics, anticonvulsant drugs, antidepressants, and non-steroidal anti-inflammatory drugs (NSAIDs) are used to provide pain relief but they do not provide adequate pain relief in a large proportion of chronic pain patients and are often associated with unacceptable side effects. Inhibitory glycinergic neurotransmission is impaired in chronic pain states, and this provides a novel target for drug development. Inhibitors of the glycine transporter 2 (GlyT2) enhance inhibitory neurotransmission and show particular promise for the treatment of neuropathic pain. N-arachidonyl-g...


Intravenous Lipid Emulsion Therapy Does Not Improve Hypotension Compared to Sodium Bicarbonate for Tricyclic Antidepressant Toxicity: A Randomized, Controlled Pilot Study in a Swine Model / El Tratamiento con Emulsión Lipídica Intravenosa No Mejora la Hipotensión en comparación con el Bicarbonato Sódico para la Toxicidad por Antidepresivos Tricíclicos: Estudio Piloto Controlado Aleatorizado en un Modelo de Porcino
ConclusionsIntravenous lipid emulsion treatment failed to improve amitriptyline‐induced hypotension when compared to the standard treatment of sodium bicarbonate in a large animal model of severe TCA overdose. Larger groups with better survival may yield different results from the high mortality observed in this pilot study. Similar amounts of amitriptyline were found in the aqueous and lipid layers. These conclusions are limited to a single ILE regimen. Resumen ObjetivosLos antidepresivos tricíclicos (ATC) son medicaciones altamente lipofílicas utilizadas para tratar el trastorno de estrés postraumático y el dolor crónico. La emulsión lipídica intravenosa (ELI) es un antídoto reciente para la sobredosis de drogas lipofílicas con un efectividad no evidente. La ELI se ha estudia...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Dorsal horn suction – A DREZ lesioning technique based on intrinsic cord tissue elasticity
Conclusion Our results confirmed the dorsal horn suction as a feasible DREZ lesioning method. (Source: The Indian Journal of Neurotrauma)


Case-control study on regular Ba Duan Jin practice for patients with chronic neck pain
Conclusion Regular Ba Duan Jin practice reduces suffering and pain, and increases health satisfaction in individuals with chronic neck pain. (Source: International Journal of Nursing Sciences)


Postherpetic neuralgia is associated with an increased risk of coronary heart disease: A population-based cohort study
Postherpetic neuralgia (PHN), a type of chronic neuropathic pain, is the most frequent complication of herpes zoster [1]. Cell-mediated immunity plays an essential role in the development of herpes zoster and its complications such as PHN [2]. Inflammation and innate immunity also play central roles in the pathophysiological mechanisms of atherosclerosis and coronary heart disease (CHD) [3]. Studies using animal models have found that statins, widely used for treating hypercholesterolemia and for preventing CHD, could mitigate neuropathic pain by mediating nerve injury-associated inflammatory responses [4,5]. (Source: International Journal of Cardiology)


Conceptualising time before surgery: The experience of patients waiting for hip replacement
This article explores how 24 patients with osteoarthritis experience time during the lead up to hip replacement surgery. We draw on data collected during longitudinal in-depth interviews with patients a median of 9.5 days before surgery and at two to four weeks post-operatively. Transcripts of audio-recorded interviews were imported into Atlas.ti® and inductive thematic analysis undertaken. Increasing pain and deterioration in function altered the experience of time during the journey towards hip replacement. Patients made essential changes to how they filled their days. They experienced lost and wasted time and faced disruption to the temporal order of their lives. A surgical date marked in the calendar became their focus. However, this date was not static, moving because of changing per...


Are patients with chronic pain and fibromyalgia correctly classified by MMPI-2 validity scales and indexes?
Publication date: July 2013 Source:The European Journal of Psychology Applied to Legal Context, Volume 5, Issue 2 Author(s): Alfonso Palmer , Carmen Borrás , Javier Pérez-Pareja , Albert Sesé , Manuel Vilariño A study was designed to find out whether MMPI-2 validity scales and indexes differentiate between true fibromyalgia sufferers, patients with chronic organic pain and normal people, as well as whether they are correctly classified. 105 subjects participated in the study, 27 diagnosed with fibromyalgia and 44 with chronic organic pain and 34 were healthy people, who answered the MMPI-2 following standard instructions. The results showed that fibromyalgia patients scored higher than the control group in the F, Fb, F-K, Fp, Ds, and FBS scales and indexes and that patients with chro...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome
Publication date: 2014 Source:NeuroImage: Clinical, Volume 6 Author(s): Lino Becerra , Simona Sava , Laura E. Simons , Athena M. Drosos , Navil Sethna , Charles Berde , Alyssa A. Lebel , David Borsook Pediatric complex regional pain syndrome (P-CRPS) offers a unique model of chronic neuropathic pain as it either resolves spontaneously or through therapeutic interventions in most patients. Here we evaluated brain changes in well-characterized children and adolescents with P-CRPS by measuring resting state networks before and following a brief (median = 3 weeks) but intensive physical and psychological treatment program, and compared them to matched healthy controls. Differences in intrinsic brain networks were observed in P-CRPS compared to controls before treatment (disease state) wit...


Evaluation of lesions of the internal ligaments of the wrist; conventional magnetic resonance imaging versus MR arthrography (MRA)
Conclusion MR arthrography is a potent additional tool facilitating the diagnosis of different pathologic entities affecting the major internal ligaments of the wrist joint and helps to reduce arthroscopic interventions. (Source: The Egyptian Journal of Radiology and Nuclear Medicine)


Reccomendations for the Detection, Study and Referral of Inflammatory Low-back Pain in Primary Care
Conclusions The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments. (Source: Reumatologia Clinica)


White tumor of the wrist: A rare localization of tuberculosis
Conclusion This case highlights that TB should be taken into consideration when dealing with nonspecific chronic wrist arthritis, especially if the patient is immunocompromised HIV infected. (Source: The Egyptian Rheumatologist)


Clinical significance of bone mineral density in Ankylosing Spondylitis patients: Relation to disease activity and physical function
Conclusion The BMD was remarkably decreased at all measurement sites in AS patients. The BMD at the spine significantly negatively correlated with the disease activity and physical function. Bone loss in AS can be explained partly by the role of inflammatory mediators and partly as a consequence of reduced physical activity. (Source: The Egyptian Rheumatologist)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 graft-versus-host disease following simultaneous pancreas-kidney transplantation: report of a case
Abstract Acute graft-versus-host-disease (aGVHD) is a rare complication in the setting of pancreas-kidney transplantation (PKT). We herein describe the case of a 37-year-old male with severe type 1 diabetes with chronic renal failure who received simultaneous PKT from a female donor. Diarrhea developed on postoperative day (POD) 10. Subsequently, fever and liver dysfunction occurred on POD 32. Skin rashes appeared with pain and itching on his trunk and extremities on POD 40. As pancytopenia occurred on POD 63, bone marrow biopsies demonstrated profound hypoplastic marrow. On POD 69, we eventually made a definitive diagnosis of aGVHD because skin biopsies revealed the XX chromosome signal in a fluorescence in situ hybridization analysis. Thereafter, 100 mg of prednisolone was admi...


Antihyperalgesic effect of 5-HT7 receptor activation on the midbrain periaqueductal gray in a rat model of neuropathic pain
This study examined the antihyperalgesic effect of the 5-HT7 receptors in the ventrolateral midbrain periaqueductal gray (vlPAG), a crucial site for endogenous pain inhibition. This study also explored the importance of the interactions between the 5-HT7 and P2X3 receptors in this effect. To address this issue, neuropathic pain was induced through chronic constriction injury (CCI) of the sciatic nerve in Sprague–Dawley (SD) rats. The expression level and distribution of the 5-HT7 receptor were evaluated through Western blot and immunohistochemistry. The mechanical withdrawal threshold (MWT) was measured by using an electronic pressure meter test. Different doses (3, 6, and 12μmol) of AS-19, a selective agonist of the 5-HT7 receptor, were administered in the vlPAG of CCI rats. The effect...


Polysaccharide glucomannan isolated from Heterodermia obscurata attenuates acute and chronic pain in mice
Publication date: 15 February 2013 Source:Carbohydrate Polymers, Volume 92, Issue 2 Author(s): Marina M. Córdova , Daniel F. Martins , Morgana D. Silva , Cristiane H. Baggio , Elaine R. Carbonero , Andrea C. Ruthes , Marcello Iacomini , Adair R.S. Santos Glucomannan (GM) is a polysaccharide obtained from Heterodermia obscurata lichens. The present study was conducted to elucidate the antinociceptive effect of GM in behavioural models of acute and chronic pain in mice. GM reduced mechanical allodynia and the levels of interleukin 1-β (IL-1β) in spinal cord and nerve in the partial sciatic nerve ligation (PSNL) model. Systemic treatment with GM inhibited the nociception induced by intraplantar injection of glutamate and by intrathecal injection of N-methyl-d-aspartic acid (NMDA), (±)-1...


Restless leg syndrome exacerbated by amytriptiline in a patient with Duchenne Muscular Dystrophy
We report an unusual case of a Duchenne Muscular Dystrophy(DMD) patient who initiated a restless leg syndrome after the use of amytriptiline. The prescription and use of this medication for patients with persistent neuropathic pain is relatively common, especially for patients with DMD. Normally, this medication is well tolerated, however, we now report the occurrence of an induction or intensification of a restless leg syndrome case in a young patient with DMD, treated with amytriptiline for his chronic pain. (Source: Sleep Science)


Psychophysiology of pain and opioid use: Implications for managing pain in patients with an opioid use disorder
Approximately 40% of Americans experience non-malignant chronic or persistent pain (Tsang et al., 2008) and opioid therapy has been a major component of pain management with a historical trend of increased rates of prescribing (Crum, 2006; Gilson et al., 2004). With greater access to opioids there has been a parallel rise in reported cases of misuse and abuse of opioid analgesics (Crum, 2006; Compton and Volkow, 2006) and opioid-related overdose fatalities (Jones et al., 2010). In 2012 it was estimated that 4.9 million individuals 12 years or older were current nonmedical users of pain relievers (SAMHSA, NSDUH, 2013), there were 488,004 emergency department visits related to nonmedical use of opioids in 2011 (SAMHSA, DAWN, 2013) and there were186,986 admissions to treatment facilities 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>


Increased Pain Sensitivity in Chronic Pain Subjects on Opioid Therapy: A Cross‐Sectional Study Using Quantitative Sensory Testing
ConclusionThese findings suggest that a subset of QST parameters can reflect opioid‐associated thermal pain sensitivity alteration, including decreased heat pain threshold, decreased cold and heat pain tolerance, diminished DNIC, and/or exacerbated temporal summation. (Source: Pain Medicine)


Growth Failure and Nutrition Considerations in Chronic Childhood Wasting Diseases.
This article is an overview of the most common causes of growth failure/growth retardation that affect children with a number of chronic diseases. We also briefly review the nutrition considerations and treatment goals. Growth failure is multifactorial in children with chronic conditions, including patients with cystic fibrosis, chronic kidney disease, chronic liver disease, congenital heart disease, human immunodeficiency virus, inflammatory bowel disease, short bowel syndrome, and muscular dystrophies. Important contributory factors to growth failure include increased energy needs, increased energy loss, malabsorption, decreased energy intake, anorexia, pain, vomiting, intestinal obstruction, and inflammatory cytokines. Various metabolic and pathologic abnormalities that are characterist...


Spasticity in disorders of consciousness: A behavioral study.
CONCLUSION: A large proportion of patients with disorders of consciousness develop severe spasticity, possibly affecting their functional recovery and their quality of life. The observed correlation between degrees of spasticity and pain scores highlights the importance of pain management in these patients with altered states of consciousness. Finally, the relationship between spasticity and treatment (i.e., pharmacological and physical therapy) should be further investigated in order to improve clinical care. CLINICAL REHABILITATION IMPACT: Managing spasticity at first signs could improve rehabilitation of patients with disorders of consciousness and maximize their chances of recovery. In addition, decreasing this trouble could allow a better quality of life for these non-communicativ...


Importance of Abdominal Ultrasound in 17 Patients with Histologically Confirmed Autoimmune Pancreatitis (AIP).
Conclusion: Ultrasound can be diagnostically useful if the clinical manifestations of AIP are known. While the diffuse form allows an ad-hoc suspected diagnosis, the focal form can only be suspected in the case of additional extrapancreatic involvement. Contrast-enhanced ultrasound (CEUS) contributes greatly to the differentiation from ductal adenocarcinoma in the case of focal AIP. PMID: 25377446 [PubMed - as supplied by publisher] (Source: Ultraschall in der Medizin)


Smoking 'increases risk of chronic back pain'
Conclusion This longitudinal study found sub-acute back pain was three times more likely to progress to persistent back pain in smokers. The researchers presented functional MRI findings, which indicated brain pathways that could be involved in this process. But further research will be required to fully understand the mechanisms at play. The study did not find that smoking provided any pain relief, and indeed the pain intensity did not increase for those people who stopped smoking. The study sample was quite small, meaning the results may not be applicable to larger and more diverse groups of people. As such, the results are not conclusive and should not be taken at face value. The general advice for the early management of lower back pain is: to continue normal activities as far as...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Health status profiles in community-dwelling elderly using self-reported health indicators: a latent class analysis
Conclusion Using LCA, we identified two distinct health status profiles which accounted for the heterogeneity of the elderly population. Selected socio-demographic characteristics were associated with different profiles and provide implications for the structuring of future public health interventions targeting the older population. (Source: Quality of Life Research)


Gait characteristics of women with fibromyalgia: a premature aging pattern
Conclusion: Middle-aged women with fibromyalgia showed gait pattern resemblances to elderly, women, which is characterized by reduced lower limb ROM, stride length and walking speed. (Source: Revista Brasileira de Reumatologia)


Nonspecific low back pain in young adults: Associated risk factors
Conclusion: Some variables related to chronic diffuse pain and lower quality of life might be associated to chronic low back pain in young adults. However, longitudinal studies are necessary. (Source: Revista Brasileira de Reumatologia)


The analgesic effect of intravenous lidocaine in the treatment of chronic pain: a literature review
Conclusions: Based on the literature review, it is not possible to uniformly specify the most effective and safe dose of lidocaine administered intravenously for the treatment of neuropathic or musculoskeletal pain. As for effectiveness, the intravenous infusion of lidocaine as an alternative for the treatment of chronic pain of various etiologies seems very promising, but further studies need to be conducted. (Source: Revista Brasileira de Reumatologia)


Legionella pneumonia after infliximab in a patient with Rheumatoid Arthritis
We report a case of a female patient with previous diagnosis of RA for 16 years that used several disease-modifying anti-rheumatic drugs (DMARDs) that resulted in treatment failure, and then was treated with infliximab. After fifteen days of the second dose, the patient developed ventilatory-dependent chest pain, dry cough and dyspnea. She was hospitalized, and the diagnosis of pneumonia by Legionella pneumophila was confirmed by the presence of Legionella antigen in an urine test. TNF is an inflammatory cytokine that also acts inhibiting the bacterial growth of intracellular pathogens, and its inhibition seems to increase susceptibility to these infections in some patients. (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>


Characterization of the pain, sleep and alexithymia patterns of patients with fibromyalgia treated in a Brazilian tertiary center
Conclusion: Studies have disclosed the presence of important and frequently underdiagnosed symptoms beyond pain complaints in FM, such as sleep complaints and alexithymia, and a better knowledge of such disturbances might improve FM patients' approach and treatment. (Source: Revista Brasileira de Reumatologia)


The G Protein-Coupled Receptor-Transient Receptor Potential Channel Axis: Molecular Insights for Targeting Disorders of Sensation and Inflammation.
Authors: Veldhuis NA, Poole DP, Grace M, McIntyre P, Bunnett NW Abstract Sensory nerves are equipped with receptors and ion channels that allow them to detect and respond to diverse chemical, mechanical, and thermal stimuli. These sensory proteins include G protein-coupled receptors (GPCRs) and transient receptor potential (TRP) ion channels. A subclass of peptidergic sensory nerves express GPCRs and TRP channels that detect noxious, irritant, and inflammatory stimuli. Activation of these nerves triggers protective mechanisms that lead to withdrawal from danger (pain), removal of irritants (itch, cough), and resolution of infection (neurogenic inflammation). The GPCR-TRP axis is central to these mechanisms. Signals that emanate from the GPCR superfamily converge on the small TRP fa...


Genitofemoral neuralgia: A review
Genitofemoral neuralgia is a cause of neuropathic pain that is often debilitating in nature. It is characterized by chronic neuropathic groin pain that is localized along the distribution of the genitofemoral nerve. The symptoms include groin pain, paresthesias, and burning sensation spreading from the lower abdomen to the medial aspect of the thigh. It may present with scrotal pain in male, while females experience symptoms radiating to the labia majora and mons pubis. Genitofemoral neuropathy has been attributed to iatrogenic nerve injury occurring during inguinal and femoral herniorrhaphy, with cases developing after both open and laparoscopic techniques. Diagnosis of genitofemoral neuralgia can be challenging, due to the overlap in sensory distribution the nerve shares with the ilioing...


CGRP receptor blockade by MK‐8825 alleviates allodynia in infraorbital nerve‐ligated rats
ConclusionsThese data further support the idea that CGRP receptor blockade might be a valuable approach to alleviate trigeminal, but not spinal, neuropathic pain through, at least partly, an inhibitory effect on neuropathic pain‐associated increase in NO production in trigeminal ganglion. (Source: European Journal of Pain)


Efficacy of epidural methylprednisolone in radicular pain
Conclusions When radicular pain is refractory to conservative treatment based on pharmacological and physical therapy, epidural methylprednisolone is an effective and safe method in our setting. (Source: Colombian Journal of Anesthesiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A Systematic Review of the Prevalence and Measurement of Chronic Pain in Asian Adults
There are limited epidemiologic studies on chronic pain in Asian populations. The aim of this review was to gather all epidemiologic studies of chronic pain in Asian countries and systematically describe the measurement and prevalence of chronic pain in Asian adults. A systematic review was performed using PubMed, MEDLINE, EMBASE, Psych INFO, Cochrane Database for Systematic Review, and CINAHL. Additional studies were identified manually by searching bibliographies. We identified 19 relevant articles for this review. (Source: Pain Management Nursing)


[Characteristics of Health-Care Provision for Patients in Out-of-Hours Care and Regular Care.]
Conclusion: With the help of the data, requirements, occupation, resulting diagnoses and care processes in regular and out of hours care can be compared and described in detail. We could document major differences between the provision in OOHC and regular care. The results encourage initiating further studies to ensure the supply of primary care in OOHC. PMID: 25372654 [PubMed - as supplied by publisher] (Source: Pain Physician)


Alberta Breakthrough Pain Assessment Tool: A validation multicentre study in cancer patients with breakthrough pain.
CONCLUSIONS: In this study, ABPAT resulted to be a well-accepted tool for BTP assessment and characterization in a relatively large cohort of cancer patients. It is effective in discovering the unmet needs of cancer patients and in exploring the outcomes of BTP treatment. PMID: 25370838 [PubMed - as supplied by publisher] (Source: Pain Physician)


Gastric endometriosis associated with transverse colon endometriosis: a case report of a very rare event
We report here a very rare case of gastric endometriosis associated with transverse colon endometriosis. (Source: Archives of Gynecology and Obstetrics)


CoQ10 Helps Veterans Relieve Symptoms of Gulf War Illness
Disabled World: Roughly one-third of the 700,000 United States troops who fought in the 1990-1991 Persian Gulf War have subsequently developed a distinct set of chronic health problems, dubbed Gulf War illness. Their symptoms, from fatigue, muscle pain and weakness to decreased cognitive function and gastrointestinal and skin problems, persist decades after the conflict. (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>


Patients with chronic pain and dysphagia (CPD): unmet medical needs and pharmacologic treatment options
Current Medical Research and Opinion, Ahead of Print. (Source: Current Medical Research and Opinion)


Clinical evaluation of the first oxycodone once daily prolonged release tablet in moderate to severe chronic pain: a randomized, double-blind, multicenter, cross-over, non-inferiority study to investigate efficacy and safety in comparison with an established oxycodone twice daily prolonged release tablet
Current Medical Research and Opinion, Volume 30, Issue 11, Page 2365-2375, November 2014. (Source: Current Medical Research and Opinion)


Mindfulness intervention in the management of chronic pain and psychological comorbidity: A meta-analysis
Conclusion There is insufficient evidence that mindfulness intervention relieves pain intensity. However, it improves depression and trait anxiety in patients with chronic pain. Further research in larger, properly powered, and better-designed studies is warranted. (Source: International Journal of Nursing Sciences)


Emborrhoid: A New Concept for the Treatment of Hemorrhoids with Arterial Embolization: The First 14 Cases
Conclusion Our case studies suggest that coil embolization of the superior rectal arteries is technically feasible, safe and well tolerated. Additional studies are needed to evaluate the efficacy of this new ‘emborrhoid’ technique in the management of hemorrhoidal disease. (Source: CardioVascular and Interventional Radiology)


Low Back Pain in the ED – are the ACR Appropriateness Criteria being followed?
Conclusion The majority of patients presenting to the ED with low back pain did not undergo imaging. The vast majority of those who underwent imaging were appropriately imaged based on the ACR Appropriateness Criteria. Teaser We conducted a retrospective study of ED imaging for low back pain which demonstrated that the majority of our patient cohort was appropriately imaged based on the ACR Appropriateness Criteria. (Source: Journal of the American College of Radiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The association between spinal cord trauma-sensitive miRNAs and pain sensitivity, and their regulation by morphine
Publication date: November 2014 Source:Neurochemistry International, Volume 77 Author(s): Eric R. Strickland , Sarah A. Woller , Michelle A. Hook , James W. Grau , Rajesh C. Miranda Increased pain sensitivity is a common sequela to spinal cord injury (SCI). Moreover, drugs like morphine, though critical for pain management, elicit pro-inflammatory effects that exacerbate chronic pain symptoms. Previous reports showed that SCI results in the induction and suppression of several microRNAs (miRNAs), both at the site of injury, as well as in segments of the spinal cord distal to the injury site. We hypothesized that morphine would modulate the expression of these miRNAs, and that expression of these SCI-sensitive miRNAs may predict adaptation of distal nociceptive circuitry following SCI. To...


Emerging roles of microRNAs in chronic pain
Publication date: November 2014 Source:Neurochemistry International, Volume 77 Author(s): Atsushi Sakai , Hidenori Suzuki Chronic pain is a debilitating syndrome caused by a variety of disorders, and represents a major clinical problem because of the lack of adequate medication. In chronic pain, massive changes in gene expression are observed in a variety of cells, including neurons and glia, in the overall somatosensory system from the sensory ganglia to the higher central nervous system. The protein expressions of hundreds of genes are thought to be post-transcriptionally regulated by a single type of microRNA in a sequence-specific manner. Recently, critical roles of microRNAs in the pathophysiology of chronic pain have been emerging. Genome-wide screenings of microRNA expression chan...


Spinal presynaptic inhibition in pain control
Publication date: Available online 22 September 2014 Source:Neuroscience Author(s): D. Guo , J. Hu The gate control theory proposed that the nociceptive sensory information transmitted to the brain relies on an interplay between the inputs from nociceptive and non-nociceptive primary afferent fibers. Both inputs are normally under strong inhibitory control in the spinal cord. Under healthy conditions, presynaptic inhibition activated by non-nociceptive fibers modulates the afferent input from nociceptive fibers onto spinal cord neurons, while postsynaptic inhibition controls the excitability of dorsal horn neurons, and silences the non-nociceptive information flow to nociceptive-specific (NS) projection neurons. However, under pathological conditions, this spinal inhibition may be altere...


Chronic tooth pulp inflammation induces persistent expression of phosphorylated ERK (pERK) and phosphorylated p38 (pp38) in trigeminal subnucleus caudalis
Conclusions This study provides the first demonstration that chronic inflammation of tooth pulp induces persistent bilateral activation of ERK and p38 within Vc, and that this activation is further increased by acute stimulation. This altered activity in intracellular signaling is likely to be linked to the sensitization that is seen in our animal model and in patients with pulpitis. Our data indicate that pERK and pp38 are more accurate markers of central change than Fos expression. In our model, localization of pERK and pp38 within specific cell types differs from that seen following acute stimulation. This may indicate specific roles for different cell types in the induction and maintenance of pulpitic and other types of pain. (Source: Neuroscience)


Metabolomics uncovers dietary omega-3 fatty acid-derived metabolites implicated in anti-nociceptive responses after experimental spinal cord injury
Publication date: 26 December 2013 Source:Neuroscience, Volume 255 Author(s): J.D. Figueroa , K. Cordero , M. Serrano-Illan , A. Almeyda , K. Baldeosingh , F.G. Almaguel , M. De Leon Chronic neuropathic pain is a frequent comorbidity following spinal cord injury (SCI) and often fails to respond to conventional pain management strategies. Preventive administration of docosahexaenoic acid (DHA) or the consumption of a diet rich in omega-3 polyunsaturated fatty acids (O3PUFAs) confers potent prophylaxis against SCI and improves functional recovery. The present study examines whether this novel dietary strategy provides significant antinociceptive benefits in rats experiencing SCI-induced pain. Rats were fed control chow or chow enriched with O3PUFAs for 8weeks before being subjected to sham...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


HCN4 subunit expression in fast-spiking interneurons of the rat spinal cord and hippocampus
Publication date: 1 May 2013 Source:Neuroscience, Volume 237 Author(s): D.I. Hughes , K.A. Boyle , C.M. Kinnon , C. Bilsland , J.A. Quayle , R.J. Callister , B.A. Graham Hyperpolarisation-activated (Ih ) currents are considered important for dendritic integration, synaptic transmission, setting membrane potential and rhythmic action potential (AP) discharge in neurons of the central nervous system. Hyperpolarisation-activated cyclic nucleotide-gated (HCN) channels underlie these currents and are composed of homo- and hetero-tetramers of HCN channel subunits (HCN1–4), which confer distinct biophysical properties on the channel. Despite understanding the structure–function relationships of HCN channels with different subunit stoichiometry, our knowledge of their expression in defined n...


Emotional consequences of neuropathic pain: Insight from preclinical studies
We present an overview of rodent models of these consequences and we discuss the challenges and parameters to consider for generating these models. We then discuss the possible mechanism(s) underlying anxiodepressive consequences by describing morphological and functional changes. Information is provided concerning neuroanatomical changes and plasticity, including LTP and LTD, in the anterior cingulate cortex, the insula, the hippocampus, the amygdala and the mesolimbic system, neuroendocrine parameters concerning the hypothalamo-pituitary-adrenal axis, neuroimmune response including the role of glial cells and cytokines, monoamine systems and changes in locus coeruleus noradrenergic system, and neurotrophic factors such as BDNF. (Source: Neuroscience and Biobehavioral Reviews)


Morfometrical and morphological analysis of the suprascapular notch with multidetector computerized tomography
This study was conducted on 100 patients (35 females–65 males). Average age of individuals included into the study was 17–87 years. Results The morphological study of the suprascapular notch revealed six different types of notches. Discussion The data we have obtained in our study are important to constitute a reference space of Turkish society. Furthermore, the fact that the differences between genders and right-left are exhibited will be helpful for surgeons who perform surgery in this region. Therefore, we conclude that the exhibited results will provide a better detail of information regarding morphometry of suprascapular notch and will aid in diagnosing and surgical treatment for shoulder pain. (Source: Journal of the Anatomical Society of India)


Close‐range blast exposure is associated with altered functional connectivity in Veterans independent of concussion symptoms at time of exposure
This article is a U.S. Government work and is in the public domain in the USA. (Source: Human Brain Mapping)


Randomised clinical trial: conventional Lichtenstein vs. hernioplasty with self-adhesive mesh in bilateral inguinal hernia surgery
Conclusions Although hernioplasty with self-adhesive mesh reduced early postoperative pain, this reduction was clinically irrelevant and it had no influence on chronic pain. There was a trend towards a higher recurrence rate when self-adhesive meshes were used, and although in this study differences were not statistically significant they should be confirmed in later studies using larger samples. Surgical procedures that do not need fixing sutures are promising, but further studies are needed before they become the gold standard of inguinal hernia repair. (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>


Plasma Membrane Mechanisms in a Preclinical Rat Model of Chronic Pain
We have recently shown that the prolongation of prostaglandin E2 (PGE2) hyperalgesia in a preclinical model of chronic pain – hyperalgesic priming – is mediated by release of cAMP from IB4-positive nociceptors and its metabolism by ectonucleotidases to produce adenosine. The adenosine, in turn, acts in an autocrine mechanism at an A1 adenosine receptor whose downstream signaling mechanisms in the nociceptor are altered to produce nociceptor sensitization. We previously showed that antisense against an extracellular matrix (ECM) molecule, versican, which defines the population of nociceptors involved in hyperalgesic priming, eliminated the prolongation of PGE2 hyperalgesia. (Source: The Journal of Pain)


Regional Lumbar Motion and Patient-Rated Outcomes: A Secondary Analysis of Data From a Randomized Clinical Trial
The purpose of this study was to examine the relationship in change scores between regional lumbar motion and patient-rated pain of the previous week and back-related function in chronic low back pain patients enrolled in a randomized clinical trial and treated with either exercise therapy or spinal manipulation using 6 different motion parameters. (Source: Journal of Manipulative and Physiological Therapeutics)


Interaction of the adenosine A1 receptor agonist N6-cyclopentyladenosine and κ-opioid receptors in rat spinal cord nociceptive reflexes
Antinociception induced by the adenosine A1 receptor agonist N6-cyclopentyladenosine (CPA) is linked to opioid receptors. We studied the subtype of receptors to which CPA action is related, as well as a possible enhancement of antinociception when CPA is coadministered with opioid receptor agonists. Spinal cord neuronal nociceptive responses of male Wistar rats with inflammation were recorded using the single motor unit technique. CPA antinociception was challenged with naloxone or norbinaltorphimine. The antinociceptive activity of fentanyl and U-50488H was studied alone and combined with CPA. Reversal of CPA antinociception was observed with norbinaltorphimine (82.9±13% of control) but not with low doses of naloxone (27±8% of control), indicating an involvement of κ-opioid but not µ-...


Method Validation of a Tricyclic Antidepressant Drug Panel in Urine by UPLC-MS/MS.
Authors: Lin CN, Juenke JM, Johnson-Davis KL Abstract UNLABELLED: Tricyclic antidepressant (TCA) drugs are also used as adjunctive therapy to treat chronic pain. To monitor patient compliance to therapy, urine specimens may be preferred since collection is non-invasive, and the specimen can provide a longer detection window. TCA drugs are frequently monitored by immunoassay; however, poor antibody specificity may compromise results. The purpose for this study was to develop a confirmation method for determining TCA in urine specimens by ultra-pressure liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Our method can quantify 9 TCA drugs in less than 5 min. Method validation experiments were performed, and the coefficient variation for inter- and intra-day precision was wi...


Why Do Dogs Have Such Short Lives?
Why do dogs have such short lives?: originally appeared on Quora: The best answer to any question. Ask a question, get a great answer. Learn from experts and access insider knowledge. You can follow Quora on Twitter, Facebook, and Google+. Answer by Suzanne Sadedin, Evolutionary Biologist Lifespan in general is determined by trade-offs between survival and reproduction. Wolves, the ancestors of dogs, can live 15-20 years*, roughly twice as long as comparable-sized dogs. They start breeding in the wild no younger than 2 years. They need to form pairs and establish a territory before breeding. Older wolves will often have help raising their pups from older juveniles who have not managed to mate or find territories. In contrast, most dogs can breed from 6-12 months of age, and they don't ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Smoking is a pain in the back
Smokers are three times more likely than nonsmokers to develop chronic back pain, and dropping the habit may cut their chances of developing this often debilitating condition, researchers report. (Source: ScienceDaily Headlines)


Caeco-peritoneal band as a potential cause of right iliac fossa pain in children
Conclusions CPB is a potential cause of chronic RIF pain in patients with unremarkable examination findings and negative serological and radiological investigations. Laparoscopic identification and division of the CPB has produced symptom resolution in this cohort of patients. (Source: Pediatric Surgery International)


Spinal Surgery Varies by Region in U.S.: Study
Title: Spinal Surgery Varies by Region in U.S.: StudyCategory: Health NewsCreated: 10/31/2014 12:00:00 AMLast Editorial Review: 11/3/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Smoking is a pain in the back
(Northwestern University) A new Northwestern Medicine study has found that smokers are three times more likely than nonsmokers to develop chronic back pain, and dropping the habit may cut your chances of developing this often debilitating condition. (Source: EurekAlert! - Medicine and Health)


Is This Bursitis?
Discussion Bursa are the body&#8217;s bumper pads for tendons. They are a small synovial fluid-filled sac that lies between tendon and a bone or skin. There are more than 150 of them in the body. With bursitis there can be thickening and proliferation of the synovial lining, bursal adhesions, chalky deposits and villus formation. Trauma, repetitive stress, infection and autoimmune usually are the reasons for bursitis but idiopathic etiology also occurs. The differential diagnosis includes infection, arthritis, tendonitis, tendon or ligament injury, fracture or neoplasm. The usual signs and symptoms are localized pain and tenderness over a bursa, and if the bursa is superficial edema can be seen. Other specific signs and symptoms occur because of location. Bursitis is described as septic or...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Alemtuzumab induced ST-segment elevation and acute myocardial dysfunction
Publication date: November 2014 Source:Journal of Cardiology Cases, Volume 10, Issue 5 Author(s): Shirin Attarian , Cindy Y. Wang , Jorge Romero , Stefan K. Barta , Santiago Aparo , Mark A. Menegus Cardiac toxicity as a side effect of chemotherapeutic agents has been well reported in the literature. Cardiac toxicity secondary to alemtuzumab has been reported, presenting as congestive heart failure and arrhythmias. Here we report a case of acute myocardial dysfunction after administration of a test dose of alemtuzumab. Our patient was a 66-year-old man with a history of small lymphocytic lymphoma/chronic lymphocytic lymphoma who received a test dose of alemtuzumab. Twenty minutes post administration, the patient developed nausea, vomiting, rigors, and tachycardia. Electrocardiography (ECG...


Evaluation of Heat Transfer in Acupuncture Needles: Convection and Conduction Approaches
This article analyzes the significance of heat transfer through needles via convection and conduction, approached by means of computational analysis. The needle is a cylindrical body, and an axis symmetrical steady-state heat-transfer model that viscosity and static pressure was not applied. This article evaluates heat transfer via acupuncture needles by using five metal materials: silver, copper, brass, iron, and stainless steel. A silver needle of the type extensively applied in acupuncture can dissipate more than seven times as much heat as a stainless steel needle of the same type. Heat transfer through such a needle is significant, compared to natural body-energy consumption over a range of ambient temperatures. The mechanism by which heat flows in or out of the body through the needl...


Hand self-Shiatsu for sleep problems in persons with chronic pain: a pilot study
Conclusion These preliminary findings are promising and future studies exploring the mechanism of action and with stronger control of treatment fidelity are indicated. (Source: Journal of Integrative Medicine)


Ketamine: An Update on Its Abuse
Ketamine is a dissociative anesthetic and substance of abuse. Numerous effects can result from the abuse of ketamine. Death from acute direct toxicity is rare. Ketamine can alter numerous functions in the brain including color perception, memory, attention, cognition, reaction time, and sense of time and can produce psychological addiction. Chronic ketamine abuse can produce toxicity to the gastrointestinal and urinary tract. Gastrointestinal changes include epigastric pain, hepatic dysfunction, and impaired gallbladder activity. The most common urological condition from ketamine is cystitis but renal failure has been reported. (Source: Journal of Pharmacy Practice)


Mesenteric Venous Thrombosis
Publication date: September 2014 Source:Journal of Clinical and Experimental Hepatology, Volume 4, Issue 3 Author(s): Bashar Hmoud , Ashwani K. Singal , Patrick S. Kamath Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Acute thrombosis commonly presents with abdominal pain and chronic type with features of portal hypertension. Contrast enhanced CT scan of abdomen is quite accurate for diagnosing and differentiating two types of mesenteric venous thrombosis. Prothrombotic state, hematological malignancy, and local abdominal inflammatory conditions are common predisposing conditions. Over the last decade, JAK-2 (janus kinase 2) mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenter...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


New surgical approach of retrorectal cystic hamartoma using transanal minimally invasive surgery (TAMIS)
Publication date: Available online 6 September 2014 Source:Journal of Coloproctology Author(s): Pablo Colsa Gutiérrez , Mahgol Kharazmi Taghavi , Rocío Daniela Sosa , Angel Pelayo Salas , Victor Jacinto Ovejero , Jose Luis Ruiz , Jose Manuel Gutiérrez Cabezas , Alfredo Ingelmo Setién Introduction Tailgut cysts or cystic hamartomas are rare developmental tumors of the presacral space. Their true incidence is not well known but we must think on it when we have a patient with a multicystic uncapsulated tumor at presacral space. Tailgut cysts are often asymptomatic, and in other cases present with chronic perineal pain, constipation or rectal tenesmus. They must be treated to avoid complications such as infections (perianal fistula or abscess) and malignant degenerations (usually adenoca...


Successful endoscopic treatment of fecalith blocking sinus in a patient with ileal pouch-anal anastomosis
Conclusion Fecalith blocking pouch anastomotic sinus is a rare complication in patients with restorative proctocolectomy. In our case, this surgical complication was successfully treated with a carefully planned, stepwise endoscopy approach. (Source: Journal of Coloproctology)


Mucinous adenocarcinoma arising from recurrent perianal fistula in patient with Crohn's disease: case report
This study aims to report a case of mucinous adenocarcinoma originating from recurrent perianal fistula in patients with CD. Case report A man of 43 years, with melanoderma, complaining of perianal tumors, anal pain and mucopurulent secretion, the patient was diagnosed with fistulae. Colonoscopy revealed a chronic inflammatory process associated with villous polypoid lesion in the colonic and rectal mucosa. In a new episode, where it was diagnosed, chronic colitis of rectum and sigmoid was being prescribed sulfasalazine with improvement. There were relapses and the patient underwent repeated fistulectomias. After investigation, CD was diagnosed. Computed tomography (CT) of abdomen and pelvis showed multiple perineal and gluteal collections, and the patient underwent abdominoperineal resec...


Functional decline and mortality in long-term care settings: Static and dynamic approach
Conclusion Physical function decline within 6 months predicted the subsequent 1-year mortality, whereas increased sum of RAP triggers and positive trigger for cognitive loss and mood were associated with functional decline. (Source: Journal of Clinical Gerontology and Geriatrics)


Infiltration of Bupivacaine Local Anesthetic to Trocar Insertion Sites After Laparoscopy: A Randomized, Double-blind, Stratified, and Controlled Trial
Conclusion The postoperative injection of bupivacaine in trocar port sites did not significantly improve pain scores after laparoscopic gynecologic surgery. (Source: Journal of Minimally Invasive Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Modified hemi-hamate replacement arthroplasty
Conclusions The modified HHRA for neglected PIP fracture dislocation appears to augment the PIP joint stability following the HHRA procedure and prevents late deformity in chronic cases. (Source: Journal of Arthroscopy and Joint Surgery)


Bicipitoradial Bursitis: A Review of Clinical Presentation and Treatment
Publication date: June 2014 Source:Journal of Orthopaedics, Trauma and Rehabilitation, Volume 18, Issue 1 Author(s): Tsz-Lung Choi , Tun-Hing Lui The bicipitoradial bursa lies at the insertion of the biceps tendon on the radial tuberosity. It is an unusual site for chronic bursitis and most often results from repetitive mechanical trauma or overuse. Other causes include tuberculosis, immunological complications of rheumatological disease and synovial chondromatosis. Accurate diagnosis requires imaging studies and sometimes histological study. It can be treated conservatively with aspiration and steroid injection. Surgical excision of the bursa is indicated in the case of infection cause, failed conservative treatment with recurrence of the enlarged bursa and pain after aspiration, presen...


Associations between aspects of pain and cognitive performance and the contribution of depressive symptoms in mid-life women: A cross-sectional analysis
Chronic pain has been associated with cognitive problems in the domains of memory, concentration, problem solving, abstract thinking, and cognitive efficiency [1–3]. Most evidence related to the adverse effect of pain on cognitive functioning is derived from chronic pain patients, including those with fibromyalgia, whiplash, arthritis and other chronic pain conditions [4–7]. It is unclear whether general pain experiences affect cognitive function in the middle-aged and older adult population. This question is important because general pain experiences occur in a substantial proportion of middle-aged and older adults [8]. (Source: Maturitas)


Disrupted functional connectivity of the periaqueductal gray in chronic low back pain
In this study, we investigated brain resting state PAG functional connectivity (FC) differences between patients with chronic low back pain (cLBP) in low pain or high pain condition and matched healthy controls (HCs). PAG seed based functional connectivity (FC) analysis of the functional MR imaging data was performed to investigate the difference among the connectivity maps in the cLBP in the low or high pain condition and HC groups as well as within the cLBP at differing endogenous back pain intensities. Results showed that FC between the PAG and the ventral medial prefrontal cortex (vmPFC)/rostral anterior cingulate cortex (rACC) increased in cLBP patients compared to matched controls. In addition, we also found significant negative correlations between pain ratings and PAG–vmPFC/rACC ...


Resting state connectivity correlates with drug and placebo response in fibromyalgia patients
This study indicates that ACC–IC connectivity might play a role in the mechanism of action of MLN, and perhaps more importantly fcMRI might be a useful tool to predict pharmacological treatment response. (Source: NeuroImage: Clinical)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Familial Jejuno-Ileal Diverticulitis: A Case Report and Review of the Literature
Conclusion Familial JID is a rare entity, without an identified genetic abnormality. Treatment of chronic symptoms currently focuses on non-operative management. While most case reports involve individual patients, this cohort may possess a genetic mutation with an autosomal dominant pattern of inheritance. Further study into patients with JID may reveal an underlying genetic abnormality associated with development of the disease. (Source: International Journal of Surgery Case Reports)


Appendiceal diverticulum associated with chronic appendicitis
CONCLUSION We present a case in which both diagnoses concurred in the same patient. The relevance of this case relies on the importance of the adequate knowledge of these pathologies, so we can approach them correctly. Although it does not represent an absolute surgical emergency, appendectomy represents the first therapeutic option. (Source: International Journal of Surgery Case Reports)


Herlyn-Werner-Wunderlich syndrome: 3D ultrasonographic diagnosis in premenarche
We report a case with premenarche diagnosis and treatment and make a review of the illness. Case report A premenarche 11year old female was referred for pediatric nephrology and neurodevelopment consultation due to prenatal diagnosis of left renal agenesis. A pelvic ultrasound was performed and an anomalous uterus and a cystic pelvic mass was incidentally discovered. A 3D trans-rectal ultrasound identified a bicolis didelfus uterus and mucocolpos. A unidigital vaginal exam revealed a single cervix with soft bulging of the left apical vaginal wall. Using monopolar knife, an incision was done allowing drainage of the cavity. A part of the apical vaginal septum was removed and a normal cervix was seen. Comments A high degree of clinical suspicion is important for the diagnoses. 3D ultrasoun...


The frequency and reliability of cortical activity using a novel strategy to present pressure pain stimulus over the lumbar spine
Conclusions This strategy could be used for evaluating pressure stimuli related central sensitization associated with back pain. (Source: Journal of Neuroscience Methods)


Erythropoietin attenuates loss of potassium chloride co-transporters following prenatal brain injury
Publication date: July 2014 Source:Molecular and Cellular Neuroscience, Volume 61 Author(s): L.L. Jantzie , P.M. Getsy , D.J. Firl , C.G. Wilson , R.H. Miller , S. Robinson Therapeutic agents that restore the inhibitory actions of γ-amino butyric acid (GABA) by modulating intracellular chloride concentrations will provide novel avenues to treat stroke, chronic pain, epilepsy, autism, and neurodegenerative and cognitive disorders. During development, upregulation of the potassium-chloride co-transporter KCC2, and the resultant switch from excitatory to inhibitory responses to GABA guide the formation of essential inhibitory circuits. Importantly, maturation of inhibitory mechanisms is also central to the development of excitatory circuits and proper balance between excitatory and inhibit...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 jyoti meditation for patients with chronic neck pain and psychological distress - a randomized controlled clinical trial
This article presents the results of a randomized controlled trial on the clinical effects of an 8-week meditation program or self-care exercise in patients with chronic neck pain. Meditation reduced pain at rest but not disability and might be a useful treatment option for pain management of chronic neck pain. (Source: The Journal of Pain)


Associations Between Serum Biomarkers and Pain and Pain‐Related Function in Older Adults with Low Back Pain: A Pilot Study
ConclusionSerum biomarkers may be a metric for assessment of active disease in older adults, in whom imaging changes are ubiquitous. In addition, changing levels of biomarkers in response to activity suggests that they may be useful as metrics to measure treatment responses in future studies and may reflect potential targets for use in designing personalized treatment for older adults with low back pain. (Source: Journal of the American Geriatrics Society)


Psychological Factors and Personality Traits Associated With Patients in Chronic Foot and Ankle Pain
Conclusion: The study showed a significant association of anxiety, depression, and neuroticism in patients presenting with chronic foot and ankle pain. Clinicians should recognize the influence of these specific psychological issues to provide a more holistic approach to the clinical problem. Level of Evidence: Level III, case control study. (Source: Foot and Ankle International)


Nicotine smoking: Influences on perioperative pain management
Conclusions Chronic nicotine smoking increases the incidence of perioperative pain. Heavy smokers need more perioperative analgesia than nonsmokers. (Source: Egyptian Journal of Anaesthesia)


The Effect of Iloprost on Renal Function in Patients with Critical Limb Ischemia
Conclusions The use of iloprost in critical limb ischemia can slow down the progress of early stage renal damage. GFRcyc and cystatin C, which are indicators of early stage chronic renal dysfunction, can be used for the evaluation of treatment response. (Source: Current Therapeutic 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>


Curcumin Could Prevent the Development of Chronic Neuropathic Pain in Rats with Peripheral Nerve Injury
Conclusions Treatment with curcumin during the early stages of peripheral neuropathy can prevent the development of chronic neuropathic pain. (Source: Current Therapeutic Research)


Preoperatıve Ultrasound-Guıded Suprascapular Nerve Block for Postthoracotomy Shoulder Paın
Conclusion Postthoracotomy shoulder pain reduces patient function and postsurgical rehabilitation potential after thoracotomy, and various studies on explaining the etiology and management of postthoracotomy shoulder pain have been conducted. Theories of the etiology involved either musculoskeletal origin or referred pain. In this study, we concluded that preoperative ultrasound-guided suprascapular nerve block with thoracic epidural analgesia could achieve effective shoulder pain relief for 72 hours postoperatively, both at rest and coughing. (Source: Current Therapeutic Research)


Evaluating mobile apps for breathing training: The effectiveness of visualization
Publication date: November 2014 Source:Computers in Human Behavior, Volume 40 Author(s): Luca Chittaro , Riccardo Sioni Deep and slow breathing exercises can be an effective adjunct in the treatment of stress, anxiety, post-traumatic stress disorder, chronic pain and depression. Breathing techniques are traditionally learned in courses with trainers and/or with materials such as audio CDs for home practice. Recently, mobile apps have been proposed as novel breathing training tools, but to the best of our knowledge no research has focused on their evaluation so far. In this paper, we study three different designs for breathing training apps. The first employs audio instructions as in traditional training based on audio CDs, while the other two include visualizations of the breathing proce...


Functional results of arthroscopic triangular fibrocartilage complex reconstruction in chronic distal radioulnar joint instability
Conclusions The results of this study suggest that arthroscopic TFCC reconstruction using the PL tendon is an effective method for treating chronic and irreparable TFCC tears with DRUJ instability. (Source: Formosan Journal of Musculoskeletal Disorders)


Pediatric Chronic Pain Eased by Early Intervention, Parental Involvement
Comfort Ability program provides psychological strategies to help children self-manage symptoms (Source: The Rheumatologist)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Canadian Occupational Performance Measure performance scale: Validity and responsiveness in chronic pain.
Authors: Nieuwenhuizen MG, de Groot S, Janssen TW, van der Maas LC, Beckerman H Abstract The construct validity and construct responsiveness of the performance scale of the Canadian Occupational Performance Measure (COPM) was measured in 87 newly admitted patients with chronic pain attending an outpatient rehabilitation clinic. At admission and after 12 wk, patients completed a COPM interview, the Pain Disability Index (PDI), and the RAND 36-Item Health Survey (RAND-36). We determined the construct validity of the COPM by correlations between the COPM performance scale (COPM-P), the PDI, and the RAND-36 at admission. Construct responsiveness was assessed by calculating the correlations between the change scores (n = 57). The COPM-P did not significantly correlate with the PDI (r = ...


Reverse total shoulder arthroplasty: a comprehensive review of biomechanics, surgical technique, and potential complications
The indications and use of reverse total shoulder arthroplasty (rTSA) have expanded because of the significantly predictable outcomes compared with other operative procedures for similar conditions. While relatively new in the United States with long-term outcome data not yet available, the use of rTSA in Europe over the past 2 decades has resulted in better overall function and pain relief in patients with difficult to treat disorders of the shoulder that result in chronic pain and dysfunction. Originally indicated for rotator cuff arthropathy, rTSA is proving to be a viable option for other disorders, including failed total shoulder arthroplasty, proximal humeral fracture (either complicated or sequelae from), tumor resection, and other bone-loss related pathologies. The following review...


Anatomical Analysis of Medial Branches of Dorsal Rami of Cervical Nerves for Radiofrequency Thermocoagulation
Conclusions: The present anatomical study may help improve accuracy and safety during radiofrequency denervation of the cervical medial branches. (Source: Regional Anesthesia and Pain Medicine)


The Short-FormMcGill Pain Questionnaire-Revised to Evaluate Persistent Pain and Surgery-Related Symptoms in Healthy Women Undergoing a Planned Cesarean Delivery
Conclusions: The incidence of chronic pain at 12 months after planned CD is low (0.6%) and if present symptoms are mostly mild and not interfering with common daily activities. Using Short-Form McGill Pain Questionnaire–Revised, this study provides a comprehensive evaluation of pain quality that can be used as a basis in future post-CD pain trials. (Source: Regional Anesthesia and Pain Medicine)


Reverse total shoulder arthroplasty: a comprehensive review of biomechanics, surgical technique, and potential complications
The indications and use of reverse total shoulder arthroplasty (rTSA) have expanded because of the significantly predictable outcomes compared with other operative procedures for similar conditions. While relatively new in the United States with long-term outcome data not yet available, the use of rTSA in Europe over the past 2 decades has resulted in better overall function and pain relief in patients with difficult to treat disorders of the shoulder that result in chronic pain and dysfunction. Originally indicated for rotator cuff arthropathy, rTSA is proving to be a viable option for other disorders, including failed total shoulder arthroplasty, proximal humeral fracture (either complicated or sequelae from), tumor resection, and other bone-loss related pathologies. The following review...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Clinical Pearls for Irritable Bowel Syndrome: Management of the Diarrhea-Predominant Subtype
This article reviews the disease state of IBS, answers questions about the condition, and discusses the evidence supporting current management options. (Source: Gastroenterology Nursing)


One-year follow-up of patients with long-lasting post-herpetic neuralgia
Conclusions: Patients who six months after acute zoster still have significant neuropathic pain, have a high probability of suffering from chronic pain in the subsequent months/years. The initial antiviral treatment has a significant impact on the pain. Current strategies of analgesic therapy are effective to achieve relief of pain in PHN patients, but they are burdened with heavy and undesirable side effects. (Source: Epidemiologic Perspectives and Innovations)


Thermoregulatory vasomotor tone of the rat tail and paws in thermoneutral conditions and its impact on a behavioral model of acute pain
We describe the fluctuations of vasomotor tone in the tail and paws in conditions of thermal neutrality and the constraints of these physiological processes on the responses to thermal nociceptive stimuli, commonly used as an index of pain. Skin temperatures were recorded with a calibrated thermal camera to monitor changes of vasomotor tone in the tail and paws of awake and anesthetized rats. In thermoneutral conditions, the sympathetic tone fluctuated at a rate of two to seven cycles/h. Increased mean arterial blood pressure (MAP; ~46 mmHg) was followed by increased heart rate (HR; ~45 beats/min) within 30 s, vasoconstriction of extremities (3.5&ndash;7&deg;C range) within 3&ndash;5 min, and increased Tcore (~0.7&deg;C) within 6 min. Decreased MAP was followed by opposite events. There wa...


Randomized placebo-controlled clinical trial showed cold atmospheric argon plasma relieved acute pain and accelerated healing in herpes zoster
In this study, weekday 5min plasma treatments with the MicroPlaSter ß device was assessed for safety, pain reduction and healing rates of herpes zoster. 37 inpatients with herpes zoster were treated in a prospective randomized placebo-controlled phase II study with either weekday 5min of cold atmospheric argon plasma (19, active) or with 5min of argon gas (18, placebo), in addition to a standard treatment regime. Pain was assessed by visual analogue scale before and after active or placebo application. Digital images of lesions were evaluated independently by three blinded clinicians, with regard to vesicles, erythema and general impression. Analysis revealed a significantly greater (p&lt;0.01) reduction in pain in plasma-treated patients compared to controls over the course of treatm...


Aeroportia and Pneumatosis Intestinalis in a Hemodialysis Patient
We report a case of HPVG in an 84-year-old man who was on hemodialysis. He experienced abdominal pain, nausea, and vomiting during the dialysis session. Abdominal tomodensitometry revealed the presence of HPVG and numerous air-fluid levels with pneumatosis intestinalis in the context of severe mesenteric atherosclerosis. The patient's condition gradually worsened, and he died soon afterwards. Early detection of HPVG and pneumatosis intestinalis signs is crucial for prompt diagnosis and management of acute mesenteric infarction. (Source: Hong Kong Journal of 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>


Anti-arthritic activity profile of methanolic extract of Ficus bengalensis: Comparison with some clinically effective drugs
Conclusion The antioxidant property of MEFB may largely be responsible for its anti-arthritic activity, and can be a feasible therapeutic candidate for the treatment of chronic arthritis. (Source: Biomedicine and Aging Pathology)


Antifibromyalgic activity of standardized extracts of Phyllanthus amarus and Phyllanthus fraternus in acidic saline induced chronic muscle pain
Conclusion The results of the present study suggest that in the present model, muscle-mediated pain can be alleviated by standardized extracts of Phyllanthus species and suggest that these can be useful in treatment of chronic musculoskeletal pain syndromes such as fibromyalgia. (Source: Biomedicine and Aging Pathology)


The effectiveness of physiotherapist-delivered group education and exercise interventions to promote self-management for people with osteoarthritis and chronic low back pain: A rapid review part I
Osteoarthritis (OA) and chronic low back pain (CLBP) are two of the most common and costly musculoskeletal conditions globally. Healthcare service demands mean that multiple condition group-based interventions are of increasing clinical interest, but no reviews have evaluated the effectiveness of group-based physiotherapy-led self-management interventions (GPSMI) for both conditions. (Source: Manual Therapy)


Cyclical strain modulates metalloprotease and matrix gene expression in human tenocytes via activation of TGFβ
Publication date: December 2013 Source:Biochimica et Biophysica Acta (BBA) - Molecular Cell Research, Volume 1833, Issue 12 Author(s): Eleanor R. Jones , Gavin C. Jones , Kirsten Legerlotz , Graham P. Riley Tendinopathies are a range of diseases characterised by degeneration and chronic tendon pain and represent a significant cause of morbidity. Relatively little is known about the underlying mechanisms; however onset is often associated with physical activity. A number of molecular changes have been documented in tendinopathy such as a decrease in overall collagen content, increased extracellular matrix turnover and protease activity. Metalloproteinases are involved in the homeostasis of the extracellular matrix and expression is regulated by mechanical strain. The aims of this study we...


Materials considerations of implantable neuroengineering devices for clinical use
Publication date: Available online 16 September 2014 Source:Current Opinion in Solid State and Materials Science Author(s): Daniel R. Merrill Implantable devices for recording and stimulation of the human nervous system offer promise for the treatment of disorders including spinal cord injury, stroke, traumatic brain injury, sensory and motor deficits, chronic pain, epilepsy, Parkinson’s disease and amputation. While advances in neuroengineering devices have been impressive, often the expectations and desires for a chronically implantable device remain unrealized. In the face of engineering approaches which perform well on the bench or in acute implantations is an immune response which is well-tuned to recognize foreign bodies, including the materials chosen for our innovations. Recent...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 analgesia: Ever-changing technology and pharmacology
Publication date: March 2014 Source:Best Practice &amp; Research Clinical Anaesthesiology, Volume 28, Issue 1 Author(s): Alan David Kaye , Syed Irfan Q. Ali , Richard D. Urman Our understanding of pain and its long-term implications have dramatically changed with the advent of advancements in molecular mechanisms involved in acute or postoperative pain and chronic pain. This better understanding has led to multiple pharmacologic advancements to better treat pain with minimal side effects. Currently, we are still struggling to find the right balance between all of the different modalities that we have at our leisure. In order to best take care of postoperative pain, we are improving patient satisfaction, decreasing hospital stays, and decreasing the development of long-term pain and i...


Sphenopalatine ganglion pulsed radiofrequency treatment in patients suffering from chronic face and head pain
Conclusion Pulsed radiofrequency of the sphenopalatine ganglion is effective in treating the patients suffering from intractable chronic facial and head pain as shown by our findings. There is a need for prospective, randomized, controlled trials in order to confirm the efficacy and safety of this new treatment modality in chronic head and face pain. (Source: Brazilian Journal of Anesthesiology)


Tongue Piercing and Chronic Abdominal Pain with Nausea and Vomiting-2 Cases
Conclusions 1.Tongue scars from tongue rings may be causes of chronic upper gastrointestinal symptoms. 2. Neural therapy and acupuncture may be helpful in the treatment of chronic upper GI symptoms related to tongue scars. (Source: EXPLORE: The Journal of Science and Healing)


Chronic abdominal pain with a difficult diagnosis
Publication date: May–June 2014 Source:GE Jornal Português de Gastrenterologia, Volume 21, Issue 3 Author(s): Ana Maria Oliveira , Catarina Rodrigues , Liliana Santos , Alexandra Martins , João Ramos de Deus (Source: GE Jornal Portugues de Gastrenterologia)


Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults.
CONCLUSIONS: When all psychological therapies included this review were combined they were superior to usual care or waiting list in terms of reduction of symptom severity, but effect sizes were small. As a single treatment, only CBT has been adequately studied to allow tentative conclusions for practice to be drawn. Compared with usual care or waiting list conditions, CBT reduced somatic symptoms, with a small effect and substantial differences in effects between CBT studies. The effects were durable within and after one year of follow-up. Compared with enhanced or structured care, psychological therapies generally were not more effective for most of the outcomes. Compared with enhanced care, CBT was not more effective. The overall quality of evidence contributing to this review was rated...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Alberta Breakthrough Pain Assessment Tool: A validation multicentre study in cancer patients with breakthrough pain
ConclusionsIn this study, ABPAT resulted to be a well‐accepted tool for BTP assessment and characterization in a relatively large cohort of cancer patients. It is effective in discovering the unmet needs of cancer patients and in exploring the outcomes of BTP treatment. (Source: European Journal of Pain)


Acute pediatric leg compartment syndrome in chronic myeloid leukemia.
This report adds another unique case to the growing literature on compartment syndrome in the pediatric population and reinforces the need to consider compartment syndrome, even in unlikely clinical scenarios. PMID: 25361367 [PubMed - in process] (Source: Orthopedics)


Acute pancreatitis.
Authors: Quinlan JD Abstract Acute pancreatitis is most commonly caused by gallstones or chronic alcohol use, and accounts for more than 200,000 hospital admissions annually. Using the Atlanta criteria, acute pancreatitis is diagnosed when a patient presents with two of three findings, including abdominal pain suggestive of pancreatitis, serum amylase and/or lipase levels at least three times the normal level, and characteristic findings on imaging. It is important to distinguish mild from severe disease because severe pancreatitis has a mortality rate of up to 30%. Contrast-enhanced computed tomography is considered the diagnostic standard for radiologic evaluation of acute pancreatitis because of its success in predicting disease severity and prognosis. The BALI and computed tomo...


Ultrasound Evaluation of Pelvic Pain
This article reviews the ultrasound imaging technique and provides a thorough differential of gynecologic and nongynecologic causes of both acute and chronic pelvic pain. (Source: Radiologic Clinics of North America)


Serum Soluble Bone Turnover Biomarkers in Psoriatic Arthritis and Psoriatic Spondyloarthropathy.
The objectives of our systematic review were to determine whether serum soluble bone and cartilage turnover biomarkers are (1) associated with PsA or psoriatic spondyloarthropathy; and (2) associated with disease activity, disease severity, or clinical phenotype. Ten studies met eligibility criteria. Matrix metalloproteinase (MMP)-3, Dickkopf (DKK)-1, macrophage colony-stimulating factor (M-CSF), crosslinked telopeptide of collagen-1, and tumor necrosis factor-related apoptosis-inducing ligand were associated with PsA, with equivocal results for osteoprotegerin (OPG) and bone alkaline phosphatase (ALP). MMP-3, DKK-1, M-CSF, CPII:C2C (ratio of cartilage degradation vs byproduct formation), and possibly OPG were associated with PsA independently of psoriasis. C1-2C (a neoepitope released whe...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 pain‐related anxiety in adolescents' disability and social impairment: ALSPAC data
ConclusionsPain‐related anxiety was associated with greater pain‐related disability and impaired social functioning. Social functioning should be explored as an integral part of fear‐avoidance models of adolescent chronic pain. (Source: European Journal of Pain)


Lunate intraosseous ganglion cysts and chronic wrist pain- reporting six cases.
CONCLUSION: Diagnosis of intraosseous ganglion was based on the imaging features and clinical presentation. Although most cases of the lunate bone IOGs are symptom free and found incidentally after wrist imaging performed for other reasons, these lytic lesions should be included in differential diagnosis list of chronic wrist pain especially in the presence of increased uptake in bone scan located on the lunate area. PMID: 25365617 [PubMed - in process] (Source: Archives of Iranian Medicine)


Survey of Primary-Care Providers on Perceived Benefits of and Barriers to PainTracker
Management of chronic pain is a common and complex challenge in primary care. Patient-reported outcomes surveys can help assist the patient with chronic pain to communicate the symptoms to their provider and engage the patient in treatment planning and evaluation to improve both quality of care and patient outcomes. A web survey was used to assess clinic providers’ perceived ease of use, barriers to use, and clinical benefits of a patient-reported outcomes survey, termed PainTracker. More than half the respondents were satisfied with PainTracker and 76% of respondents agreed that PainTracker helps patients participate in their pain management. (Source: The Journal for Nurse Practitioners)


Efficacy and safety of oral ketamine for the relief of intractable chronic pain: A retrospective 5‐year study of 51 patients
ConclusionsPain was reduced or abolished in two‐thirds of patients under ketamine therapy; ketamine was effective for patients taking opioids and resulted in few adverse effects. (Source: European Journal of Pain)


Intravenous Lipid Emulsion Therapy Does Not Improve Hypotension Compared to Sodium Bicarbonate for Tricyclic Antidepressant Toxicity: A Randomized, Controlled Pilot Study in a Swine Model.
CONCLUSIONS: Intravenous lipid emulsion treatment failed to improve amitriptyline-induced hypotension when compared to the standard treatment of sodium bicarbonate in a large animal model of severe TCA overdose. Larger groups with better survival may yield different results from the high mortality observed in this pilot study. Similar amounts of amitriptyline were found in the aqueous and lipid layers. These conclusions are limited to a single ILE regimen. PMID: 25377397 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Measuring health‐related quality of life with EQ‐5D‐Y instrument in children with asthma
ConclusionThe EQ‐5D‐Y instrument seemed to provide feasiblity and convergent validity for measuring health‐related quality of life in children and adolescents with asthma.This article is protected by copyright. All rights reserved. (Source: Acta Paediatrica)


Misuse, Abuse, and Diversion of instanyl® (Fentanyl Nasal Spray) in France
Instanyl® (fentanyl nasal spray) received European market authorisation in July 2009 for the management of breakthrough pain in adults already receiving maintenance opioid therapy for chronic cancer pain, with precise instructions on indications for use and dosage. The study objectives were to evaluate patient-reported misuse, abuse, and diversion of Instanyl® in real-life in France. (Source: Value in Health)


A Systematic Search and Methodological Review of Economic Models of Analgesics for Chronic Pain
Economic modelling of analgesics for chronic pain (including the chronic pain sub-populations of musculoskeletal, neuropathic and malignant pain) is well established but characterised by methodological heterogeneity. The methods used to model pain vary substantially between and within the sub-populations and this variability inhibits comparability across the evidence base. This research aims to facilitate increased consensus for future development of pain models, by summarising existing published economic models and identifying key model characteristics. (Source: Value in Health)


Endpoints in Pain: the Suitability for Health Economic Evaluation of Endpoint Designs in Chronic Pain Studies
A wide range of instruments are used to measure outcomes in clinical studies of chronic pain. However, the suitability of study outcomes for economic evaluations in chronic pain is limited by variability in the instruments used and the failure of those that are in common use to adequately capture the dimensions of a patient’s experience of pain, including function, quality of life and tolerability. The current study aims to identify the pain instruments and study endpoints most commonly used in the clinical trial setting. (Source: Value in Health)


Predictors of Functional Disability in Patients With Chronic Lumbosacral Radicular Pain
The objective of this study was to assess the functional disability and factors affecting it in patients with chronic lumbosacral radicular pain. (Source: Value in Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Impacts of Lower Back Pain: Refinement of the Pain Assessment for Lower Back-Impacts Questionnaire (Pal-I) Using a Mixed Methods Approach
The Pain Assessment for Lower Back-Impacts (PAL-I) is a patient-reported outcome (PRO) instrument being developed to assess key impacts, e. g. walking, sitting, standing, etc. associated with chronic low back pain (cLBP). Following a mixed methods approach, the PAL-I development included qualitative work (both concept elicitation and cognitive interviews) and now a quantitative “pilot study” evaluation for further content validity. (Source: Value in Health)


The Pain Assessment for Lower Back Symptoms (Pal-S): Refinement of A New Pro Instrument Through A Mixed Methods Approach
The Pain Assessment for Lower Back Symptoms (PAL-S) is a Patient Reported Outcome (PRO) instrument being developed to assess the key symptoms of chronic low back pain (cLBP). Qualitative development included both concept elicitation and cognitive interviews. As part of the ongoing development of the instrument, we further evaluated and refined the PAL-S using a mixed methods approach. (Source: Value in Health)


Cost-Minimization Analysis of Methadona Opioid Analgesic for Mexican Patients With Acute and Chronic Secondary Cancer As Rotation Option In Severe Pain
Perform a full economic evaluation of cost minimization of the use of Methadone versus oxycodone (extended release), buprenorphine (transdermal patches), fentanyl (transdermal patches) and hydromorphone in opioid rotation for patients with acute severe pain secondary to cancer and chronic type as rotation option in Mexico, from the point of view of public health. (Source: Value in Health)


Cost-Effectiveness Analysis of Celecoxib In the Treatment of Patients With Chronic Pain In Japan
To evaluate the cost-effectiveness of celecoxib compared with loxoprofen for the treatment of patients with chronic pain caused by osteoarthritis, rheumatoid arthritis and low back pain in Japan. (Source: Value in Health)


Direct Health Care Costs Associated With Opioid-Induced Constipation
Opioid-induced constipation (OIC) is the most common and distressing side effect of opioid treatment in patients with chronic pain. There are limited data to estimate the occurrence of OIC; however, estimates in non-cancer patients range from 40-50% and can be as high as 90% in cancer patients. Increased resource utilisation is associated with the diagnosis and management of OIC; however, the economic burden of OIC remains under-reported. (Source: Value in Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Racial Disparities in Type 2 Diabetes Health Care Utilization in Medicaid Adults With Developmental Disabilities
The objective of this study was to examine the association of race, and medication adherence, and their interaction with health care utilization and health care costs in Medicaid enrollees with developmental disabilities (DD) and type 2 diabetes. (Source: Value in Health)


The Socioeconomic Costs of the Undertreatment of Pain
To investigate the scale and socioeconomic cost of untreated/uncontrolled chronic pain. (Source: Value in Health)


Prescribing Patterns and Treatment Outcomes in North Indian Female Patients with Chronic Low Back Pain
This observational study was designed to determine the prescribing pattern, improvement of pain intensity, and disability in female patients with CLBP. (Source: Value in Health)


Examining Opioid-Dependent Chronic Pain Patients Experiences On Buprenorphine Maintenance Therapy In The Texas Workers Compensation System: Pilot Study - Part 2
The objective of this pilot study was to examine opioid analgesic (OA) use and patient reported outcomes (PRO) among opioid-dependent chronic nonmalignant pain (CNMP) patients placed on buprenorphine therapy in the Functional Restoration and Pain Management (FRPM) program. (Source: Value in Health)


[Water-filtered infrared-A (wIRA) promotes wound healing].
Authors: Winkel R, Hoffmann G, Hoffmann R Abstract Water-filtered infrared-A (wIRA) is a special form of heat radiation with high tissue penetration and low thermal load to the skin surface which promotes the healing of acute and chronic wounds both by thermal and thermic as well as by non-thermal and non-thermic effects. Water-filtered infrared-A increases tissue temperature (+ 2.7 °C at a tissue depth of 2 cm), tissue oxygen partial pressure (+ 32 % at a tissue depth of 2 cm) and tissue perfusion. These three factors are decisive for a sufficient supply of tissue with energy and oxygen and consequently also for wound healing and infection defense. Water-filtered infrared-A promotes normal as well as disturbed wound healing by diminishing inflammation and exudation, by ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Curcumin loaded solid lipid nanoparticles ameliorate adjuvant‐induced arthritis in rats
ConclusionsThe current findings suggest the protective potential of curcumin‐SLNs in ameliorating CFA‐induced arthritis in rats through attenuation of oxido‐inflammatory and immunomodulatory cascade. Further, the results emphasize that SLNs are a novel approach to deliver curcumin into the inflamed joints and improve its biopharmaceutical performance. (Source: European Journal of Pain)


How to monitor opioid use for your patients with chronic pain.
Authors: Hudson S, Wimsatt LA PMID: 25403045 [PubMed - in process] (Source: Family Practice Management)


Effects of curcumin on pain threshold and on the expression of nuclear factor κ B and CX3C receptor 1 after sciatic nerve chronic constrictive injury in rats
Conclusion Our study suggests that curcumin could ameliorate the CCI-induced neuropathic pain, probably through inhibiting CX3CR1 expression by the activation of NF-κ B p65 in spinal cord and DRG. (Source: Chinese Journal of Integrative Medicine)


Single‐ and multiple‐dose study to evaluate pharmacokinetics, safety and tolerability in healthy volunteers: A comparison of extended‐release oxycodone with sequestered naltrexone 40 mg twice daily to oxycontin 40 mg twice daily and extended‐release oxycodone with sequestered naltrexone 80 mg once daily
This article is protected by copyright. All rights reserved (Source: Clinical Pharmacology in Drug Development)


Pharmacological management of chronic neuropathic pain: Revised consensus statement from the Canadian Pain Society.
CONCLUSIONS: These guidelines provide an updated, stepwise approach to the pharmacological management of NeP. Treatment should be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Additional studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes and treatment of pediatric, geriatric and central NeP. PMID: 25479151 [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>


Ultrasound Evaluation of Pelvic Pain.
This article reviews the ultrasound imaging technique and provides a thorough differential of gynecologic and nongynecologic causes of both acute and chronic pelvic pain. PMID: 25444102 [PubMed - as supplied by publisher] (Source: Radiologic Clinics of North America)


Tweeting about pain experiences
Pain is reported to affect 100 million adults and costs $560 to $635 billion each year. Orofacial pain may be responsible for up to 40% of the annual costs associated with chronic pain. Toothaches are the most prevalent dental problem and are experienced by 26% of US adults. Even though toothaches are described as painful and having negative effects on the quality of life, between 30% and 54% of people who report toothaches do not seek dental care. Cost-related reasons account for about a third of unmet dental care needs in persons who have toothaches. (Source: Dental Abstracts)


Codeine
has been used for over 200 years and is available in many over-the-counter remedies for cough and for acute and chronic mild to moderate pain. This narcotic analgesic is a weak opioid that has been used for pediatric purposes, giving it a reputation for safety. The World Health Organization (WHO) formulated a three-step analgesic ladder in 1986 that listed codeine as the second step for the treatment of increasing pain. It was recommended for the treatment of breakthrough pain when nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen were ineffective. (Source: Dental Abstracts)


Early childhood caries restorations
Early childhood caries (ECC) is perhaps the most common chronic disease in those age birth to 6 years. It rapidly causes extensive destruction of the primary teeth and often requires prompt and comprehensive treatment to prevent pain and further damage to tooth tissues. Dental treatment must often include advanced behavior guidance techniques and/or anesthesiology interventions to manage these young patients who may lack the ability to cooperate appropriately during the invasive treatment required. (Source: Dental Abstracts)


Multidimensional Approach to Classifying Chronic Pain Conditions—Less Is More
Our team received with enthusiasm the proposal from the ACTTION-APS Pain Taxonomy (AAPT),1 which claims an evidence-based and multidimensional approach to classifying chronic pain conditions. Attempting to approach an ideal diagnostic system that aims to systematize, organize, and standardize the biopsychosocial assessment of chronic pain patients, a 5-dimension taxonomy was proposed. This perspective drew inspiration from the Diagnostic and Statistical Manual of Mental Disorders (DSM), Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), and International Classification of Headache Disorders diagnostic systems. (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>


Brain differences linked to chronic fatigue syndrome
Conclusion This study used a specialised type of MRI to examine whether there were any differences in the brain volume and structure of 15 people with CFS, compared with 14 people without. They found the volume of white matter (nerve fibres) appeared to be lower, on average, in the people with CFS. There were also differences in the magnitude of water diffusion (a measure known as fractional anisotropy) in one particular white matter tract on the right side of the brain, which connects the temporal with the frontal brain regions. These are interesting developments in furthering our understanding of CFS. But there are points to bear in mind when considering the meaning of these findings. It must be remembered this research only used a very small sample of 15 people with CFS from the US, ...


Brain Scans Yield Clues to Chronic Fatigue Syndrome
Title: Brain Scans Yield Clues to Chronic Fatigue SyndromeCategory: Health NewsCreated: 10/30/2014 12:00:00 AMLast Editorial Review: 10/31/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Almost 1 in 5 Americans Plagued by Constant Pain, Survey Suggests
Title: Almost 1 in 5 Americans Plagued by Constant Pain, Survey SuggestsCategory: Health NewsCreated: 10/30/2014 12:00:00 AMLast Editorial Review: 10/31/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Comment on Nakamura et al.: Investigation of chronic musculoskeletal pain (third report): with special reference to the importance of neuropathic pain and psychogenic pain
(Source: Journal of Orthopaedic Science)


Histamine antagonism and postinflammatory visceral hypersensitivity
Abdominal pain is one of the most difficult to treat symptoms in patients suffering from IBS. Recent evidence shows that abnormal perception of visceral stimuli, or visceral hypersensitivity, represents an important underlying mechanism. Of interest, similar mechanisms may be involved in abdominal pain reported by UC and Crohn's disease patients in remission. Although the underlying mechanisms are not fully understood, it becomes increasingly clear that intestinal inflammation may provide an initial stimulus for a persistent state of visceral hypersensitivity. Most insight in the role of inflammation in chronic abdominal pain comes from studies evaluating patients with postinfectious (PI)-IBS. Colonic biopsies of patients with PI-IBS reveal no signs of overt inflammation but show persisten...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Postsynaptic insertion of AMPA receptor onto cortical pyramidal neurons in the anterior cingulate cortex after peripheral nerve injury
Long-term potentiation (LTP) is the key cellular mechanism for physiological learning and pathological chronic pain. Postsynaptic accumulation of AMPA receptor (AMPAR) GluA1 plays an important role for injury-related cortical LTP. However, there is no direct evidence for postsynaptic GluA1 insertion or accumulation after peripheral injury. Here we report nerve injury increased the postsynaptic expression of AMPAR GluA1 in pyramidal neurons in the layer V of the anterior cingulate cortex (ACC), including the corticospinal projecting neurons. Electrophysiological recordings show that potentiation of postsynaptic responses was reversed by Ca2+ permeable AMPAR antagonist NASPM. Finally, behavioral studies show that microinjection of NASPM into the ACC inhibited behavioral sensitization caused ...


The Fentanyl Story
Fentanyl, introduced more than 50 years ago, has become the most often used opioid for intraoperative analgesia. Since the early 1990s the fentanyl patch has been available for management of chronic pain of all forms of cancer as well as the persistent, intense pain from many noncancerous maladies. More than a half dozen rapid-onset transmucosal fentanyl preparations have been developed, approved, launched, and popularized for “breakthrough” pain syndromes in the past 20 years. The purpose of this article is to describe why this opioid has become so important in the treatment of pain in modern clinical practice. (Source: The Journal of Pain)


Prevalence of Radiographic Findings in Individuals With Chronic Low Back Pain Screened for a Randomized Controlled Trial: Secondary Analysis and Clinical Implications
The purpose of this study is to measure the prevalence of graded disc degeneration, spondylolisthesis, transitional segmentation, and the distribution of sacral slope in patients 21 to 65 years of age with chronic low back pain (CLBP). (Source: Journal of Manipulative and Physiological Therapeutics)


Aromatherapy Hand Massage for Older Adults With Chronic Pain Living in Long-Term Care
Conclusions: M technique hand massage with or without aromatherapy significantly decreased chronic pain intensity compared to nurse presence visits. M technique hand massage is a safe, simple, but effective intervention. Caregivers using it could improve chronic pain management in this population. (Source: Journal of Holistic Nursing)


Role of Self-Care in Sickle Cell Disease
Self-care is an important aspect of managing a chronic disease. In sickle cell disease (SCD), home self-care contributes to individual pain management and thus pain crisis prevention. A better understanding of self-care can help health care providers equip patients with the resources and skills necessary to participate in their disease management. The aim of this study was to examine factors that influence self-care among young adults with SCD. A descriptive, cross-sectional study was conducted using secondary data analysis. (Source: Pain Management Nursing)


Percutaneous Iliosacral Fixation in External Rotational Pelvic Fractures. A Biomechanical Analysis
Although the gold standard in open book pelvic fractures remains the pubic symphysis (PS) plate fixation, the clinical outcomes are not satisfactory, despite the excellent anatomical reduction assessed radiologically. Some authors suggest that residual instability of the posterior pelvic elements may be responsible for the chronic pain and the early osteoarthritic changes in the sacroiliac joint (SIJ). (Source: Injury)


Sleep quality, BDNF genotype and gene expression in individuals with chronic abdominal pain
Conclusions: Participants with CAP reported poor sleep quality compared to healthy controls. The role of the BDNF Met allele on differential gene expression was not distinct as main factor, but impacted interactions with sleep quality and CAP. Down-regulation of IGF1, SPATS2L, and IGHG1 expression may be related to the etiology of poor sleep quality and CAP. Trial registration: Clinicaltrial.gov#NCT00824941 (Source: BMC Medical Genomics)


Adherence Barriers to Chronic Dialysis in the United States
In conclusion, poor adherence to hemodialysis treatments may be a substantial roadblock to achieving better patient outcomes. Addressing systemic and patient barriers that impede access to hemodialysis care may decrease missed appointments and reduce patient morbidity. (Source: Journal of the American Society of Nephrology : JASN)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Almost 1 in 5 Americans Plagued by Constant Pain, Survey Suggests
Older people, women more likely to struggle on daily basis, researchers note Source: HealthDay Related MedlinePlus Pages: Chronic Pain, Health Statistics (Source: MedlinePlus Health News)


Impact of a Multidisciplinary Vulvodynia Program on Sexual Functioning and Dyspareunia
ConclusionThis study provides strong support for the efficacy of a multidisciplinary approach (psychological, pelvic floor physiotherapy, and medical management) for improving dyspareunia and all domains of sexual functioning among women with PVD. The study also highlights the benefits of incorporating sexual health education into general pain management strategies for this population. Brotto LA, Yong P, Smith KB, and Sadownik LA. Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia. J Sex Med **;**:**–**. (Source: The Journal of Sexual Medicine)


Chronic fatigue syndrome is real, researchers say
People with chronic fatigue syndrome are exhausted, no matter how much rest they get, for more than six months at a time. They suffer from muscle and joint pain and may experience short-term memory loss. (Source: CNN.com - Health)


Scientists Find Differences In The Brains Of People With Chronic Fatigue Syndrome
By Nathan Collins Chronic fatigue syndrome affects as many as four in a thousand people in the United States -- perhaps more. Despite that, there's been slow progress in understanding the disease, and researchers still aren't exactly sure what causes it. Now, a small new study hints that subtle differences in the brain's white matter might have something to do with the disease. CFS has a controversial past. For years, health officials denied it even existed, ironically dismissing it as a sign of mental illness. But in the last few years, more and more researchers are taking it seriously. The latest research points to mold-produced toxins as a likely cause -- or at least trigger -- of CFS, the symptoms of which include impaired memory and concentration, extreme fatigue after exercise, mus...


Chronobiology of chronic pain: focus on diurnal rhythmicity of neuropathic pain
Purpose of reviewAlthough 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 findingsSecondary 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. SummaryThe observation of clinica...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Gaining the Patient Reported Outcomes Measurement Information System (PROMIS) perspective in chronic kidney disease: a Midwest Pediatric Nephrology Consortium study
Conclusions The PROMIS pediatric domains of depression, anxiety, social-peer relationships, pain interference, and mobility were sensitive to the clinical status of children with chronic kidney disease in this multi-center cross sectional study. We demonstrated that a number of important clinical characteristics including recent history of hospitalization and edema, affected patient perceptions of depression, anxiety, pain interference, fatigue and mobility. The PROMIS instruments provide a potentially valuable tool to study the impact of chronic kidney disease. Additional studies will be required to assess responsiveness in PROMIS score with changes in disease status over time. (Source: Pediatric Nephrology)


Gradual Medicalization of Chronic Pain
No abstract available (Source: The Back Letter)


Has the United States Fundamentally Misinterpreted The Evidence on Chronic Pain?
No abstract available (Source: The Back Letter)


Percutaneous Tibial Nerve Stimulation as an Off-label Treatment of Clitoral Pain
ConclusionsThe findings of this report suggest that PTNS may be a therapeutic option in patients with idiopathic clitoral pain. (Source: Female Pelvic Medicine and Reconstructive Surgery)


Micturition Problems After Bladder Distension During Hospitalization in Sweden: “I’m Not Ill, Just Damaged for the Rest of My Life”
DiscussionBladder distension is a healthcare-related injury that can cause suffering and practical, emotional, and psychosocial problems with a great impact on the life of the person affected and anxiety for the future. The healthcare system must, therefore, raise awareness and improve preventive routines. (Source: Nursing 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>


New Extended-Release Narcotic Approved
* Targiniq ER is a new combination opioid analgesic for treating severe chronic pain. The drug combines the narcotic oxycodone with naloxone, an opioid receptor blocker. The goal of this combination is to reduce the risk of drug abuse by blocking the euphoric effects of oxycodone. * Targiniq ER carries the same risks as all other opioid analgesics. Overdosage of Targiniq ER can be fatal. (Source: AJN)


Hypogammaglobulinemia-associated gastrointestinal disease–A case series
Abstract Hypogammaglobulinemia, a form of primary immunodeficiency, is an uncommon condition. Gastrointestinal (GI) symptoms may be the only presentation. A series of 22 patients who presented with GI symptoms and were diagnosed with hypogammaglobulinemia is presented. Chronic diarrhea was the presentation in majority (90.9 %) of patients. Malabsorption was identified in 87.5 % of patients followed by weight loss (59.0 %), abdominal pain (27.2 %), and oral ulcers (4.5 %). The median duration of symptoms prior to diagnosis was 4 years, range being 6 months to 23 years. Evaluation revealed opportunistic infections including Giardia lamblia in 31.8 % and Cryptosporidium parvum, Isospora belli, Cytomegalovirus and Aeromonas in 4.5 % each. Serum globulins were low in all pati...


A review on how meditation could be used to comfort the terminally ill.
Authors: Ball MS, Vernon B Abstract Objective: Our objective was to review how meditation could comfort the terminally ill. Method: Our methodology was a literature search, which included books, journals, papers in collections, and online databases. The main search engines employed were Google Scholar and the Durham University Library. The main databases consulted were the Christian Meditation Centre, Project Meditation, and Stress-Related Facts and Well-Being at Monash. We were specifically interested in data acquired from clinical and nonclinical trials. The arguments needed to be based on qualitative and quantitative scientific data. Papers were published between 1985 and 2014. We then subdivided the review into three subcategories: physical, emotional, and self-awareness. When ...


Effectiveness of the Godelieve Denys-Struyf (GDS) Method in Patients With Low Back Pain: A Cluster Randomized Controlled Trial.
CONCLUSIONS: Disability improvement was slightly higher with Group GDS sessions than with the program routinely used in PT Units within the SNHS. Adding individualized GDS sessions eliminates this advantage. Further studies should compare GDS with other types of exercise. PMID: 25359444 [PubMed - as supplied by publisher] (Source: Physical Therapy)


Antinociceptive effect of botulinum toxin type A on experimental abdominal pain.
Authors: Drinovac V, Bach-Rojecky L, Babić A, Lacković Z Abstract Visceral pain, especially in the abdominal region, represents one of the most common types of pain. Its chronic form is usually very hard to treat by conventional analgesic agents and adjuvants. We investigated the antinociceptive effect of botulinum toxin type A (BTX-A) in male Wistar rats in two models of visceral pain: peritonitis induced by intraperitoneal injection of 1% acetic acid and colitis induced by intracolonic instillation of 0.1% capsaicin. Pain was measured as the number of abdominal writhes. Additionally, referred mechanical sensitivity in the ventral abdominal area was evaluated by von Frey test and the extent of spinal c-Fos expression was immunohistochemically examined. BTX-A significantly reduce...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Ghost of Pregnancies Past
For centuries, theologians have grappled with that line in Exodus 20:5, which states: “For I, the Lord your God, am a jealous God, visiting the iniquity of the fathers on the children to the third and fourth generations of those who hate Me.” From a genetic viewpoint, the iniquity of the fathers might occasionally miss its target, only to hit that innocent bystander, Mom.read more (Source: Psychology Today Sex Center)


Effectiveness of Chinese massage therapy (Tui Na) for chronic low back pain: study protocol for a randomized controlled trial
DiscussionThe design and methodological rigor of this trial will allow for collection of valuable data to evaluate the efficacy of a specific tuina protocol for treating CLBP. This trial will therefore contribute to providing a solid foundation for clinical treatment of CLBP, as well as future research in massage therapy.Trial registration: This trial was registered with ClinicalTrials.gov of the National Institute of Health on 22 October 2013 (NCT01973010, http://clinicaltrials.gov/ct2/show/NCT01973010?term=massage+for+low+back+pain&rank=2). (Source: Trials)


The Dorsal Root Ganglion in Chronic Pain and as a Target for Neuromodulation: A Review
ConclusionsThe DRG is an active participant in the development of NP. DRG stimulation has multiple effects on the abnormal changes that occur within the DRG as a result of peripheral afferent fiber injury. The sum total of these stimulation effects is to stabilize and decrease hyperexcitability of DRG neurons and thereby decrease NP. (Source: Neuromodulation)


A Review of the Clinical Value of Isolated Lumbar Extension Resistance Training for Chronic Low Back Pain
Chronic low back pain (CLBP) is prevalent, costly, and acknowledged as multifactorial in nature. However, deconditioning of the lumbar extensor musculature may be a common factor. Thus specific resistance exercise is often recommended. Many resistance exercises for the lumbar extensors exist though recent evidence suggests isolated lumbar extension (ILEX) resistance training may best condition these muscles. Thus this review aimed to examine use of ILEX resistance training in participants with CLBP to provide a best evidence synthesis for practitioners and clinicians. (Source: PM and R)


A Pain Research Agenda for the 21st Century
Chronic pain represents an immense clinical problem. With tens of millions of people in the United States alone suffering from the burden of debilitating chronic pain, there is a moral obligation to reduce this burden by improving the understanding of pain and treatment mechanisms, developing new therapies, optimizing and testing existing therapies, and improving access to evidence-based pain care. Here, we present a goal-oriented research agenda describing the American Pain Society's vision for the pain research aimed at tackling the most pressing issues in the field. (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>


A Review of the Use of the Number Needed to Treat to Evaluate the Efficacy of Analgesics
Standardized measures of efficacy are needed to compare analgesic efficacy across trials. The number needed to treat (NNT) is considered a statistically robust and readily interpretable measure to rank the efficacy of treatments, including analgesics. The NNT has become widely utilized to compare the efficacy of chronic pain treatments, helping physicians make treatment decisions and informing decisions for market access, reimbursement, and treatment guidelines. However, the NNT is associated with specific weaknesses in calculation and interpretation not associated with other methods for integrating trial data. (Source: The Journal of Pain)


Cerebrospinal Fluid Cytokines and Neurotrophic Factors in Human Chronic Pain Populations: A Comprehensive Review
Abstract Chronic pain is a prevalent and debilitating condition, conveying immense human burden. Suffering is caused not only by painful symptoms, but also through psychopathological and detrimental physical consequences, generating enormous societal costs. The current treatment armamentarium often fails to achieve satisfying pain relief; thus, research directed toward elucidating the complex pathophysiological mechanisms underlying chronic pain syndromes is imperative. Central neuroimmune activation and neuroinflammation have emerged as driving forces in the transition from acute to chronic pain, leading to central sensitization and decreased opioid efficacy, through processes in which glia have been highlighted as key contributors. Under normal conditions, glia exert a protective role, b...


Chronic Pain and Neurodegenerative Processes in Elderly People
(Source: Pain Practice)


Spanish version of the screening Örebro Musculoskeletal Pain Questionnaire: a cross-cultural adaptation and validation
Conclusions: The Spanish version of the screening questionnaire OMPQ can be used to identify Spanish patients with musculoskeletal pain at risk of developing a chronic disability. (Source: Health and Quality of Life Outcomes)


Why You Should Never Ask 'Have You Tried...?'
One day I walked into the doctor's office and I came out with a diagnosis. At first the diagnosis gave me relief, even joy. At last I have an answer. I know what the problem is, and surely I can therefore find the solution. I can get better. I can feel better. I will be whole again. It's all good from here. You'd think that incurable, life-long stuff would hit you immediately, right in the cerebral cortex and wham! a solution would process. Sadly, it doesn't work like that. Incurable and life-long are concepts that are beyond the human ability to process immediately. In my case, it was beyond my human ability to process them for years. Incurable. Life-long. This is big stuff. So, as I'm processing, I'm also jumping on and off the medical merry-go-round. Like all merry-go-rounds, ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Provocation and Low Gallbladder Ejection Fraction with CCK Cholescintigraphy Are Not Predictive of Chronic Acalculous Gallbladder Disease Symptom Relief After Cholecystectomy
Conclusion Provocation of pain by CCK-CS and low GBEF are unreliable predictors of postoperative relief of symptoms following cholecystectomy for biliary dyskinesia or chronic acalculous gallbladder disease. (Source: Digestive Diseases and Sciences)


Damned If You Do, Dead If You Don’t
If heroin use increases, death from heroin increases (as does the spread of HIV and viral hepatitis). And we should all wonder what the crackdown on prescription opioid abuse is accomplishing.read more (Source: Psychology Today Addiction Center)


Demographic and Health Characteristics of Rural- and Urban-Dwelling Canadians With Chronic Back Disorders: A Population-Based Comparison
Conclusion. There are significant sociodemographic and lifestyle differences between rural and urban Canadians with CBD. These differences may have implications for the design and delivery of more equitable and appropriate health services as well as health promotion and prevention efforts. Level of Evidence: 2 (Source: Spine)


Implementation fidelity of physiotherapist-delivered group education and exercise interventions to promote self-management in people with osteoarthritis and chronic low back pain: A rapid review Part II
Implementation fidelity is the extent to which an intervention is delivered as intended by intervention developers, and is extremely important as it increases confidence that changes in study outcomes are due to the effect of the intervention itself and not due to variability in implementation. A paucity of literature exists concerning implementation fidelity in physiotherapy research. (Source: Manual Therapy)


Somatosensory and Affective Contributions to Emotional, Social, and Daily Functioning in Chronic Pain Patients
ConclusionsResults suggest that both intensity and unpleasantness contribute unique variance to functional outcomes. The results highlight the importance of interventions that not only try to reduce pain levels but also reduce levels of pain unpleasantness. (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>


Encouraging Couples to Change: A Motivational Assessment to Promote Well‐Being in People with Chronic Pain and Their Partners
ConclusionsThis article provides a guide to clinicians for using a motivational assessment to help patients with a chronic illness achieve immediate benefits. (Source: Pain Medicine)


Hip and Groin Pain in the Child Athlete
Semin Musculoskelet Radiol 2014; 18: 478-488DOI: 10.1055/s-0034-1389265An increasing number of children are taking up sporting activities and at more competitive levels. For this reason (pediatric) radiologists should expect to receive greater numbers of requests from their orthopedic colleagues to image the athletic child who presents with hip or groin pain: “athletic pubalgia.”Lower limb sports-related pathology is particularly common in sports such as ballet, football, hockey, rugby, and running. Injuries to the hip and groin may account for up to a quarter of injuries seen in athletic children and may be acute or chronic, osseous, cartilaginous, ligamentous, or muscular. The radiologist should also bear in mind the possibility of non–sports-related pathology such as inflammation ...


Charity head discovers he does not have cerebral palsy - after 50 years
David Hayes, the former head of the charity Scope, had to retire from his job due to chronic pain (Source: Telegraph Health)


Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report
Conclusion: This case shows that the manifestations of intestinal tuberculosis can be very difficult to diagnose and mimic those of Chron's disease. Total body computed tomography and laparotomy with an intestinal biopsy for the detection of Mycobacterium tuberculosis are the means of avoid the risks of a misdiagnosis in children with unexplained chronic abdominal problems. (Source: BioMed Central)


Co-morbid pain and opioid addiction: Long term effect of opioid maintenance on acute pain
Recent years have seen increasing recognition of the critical intersection between opioid addiction and chronic (non-malignant) pain. However, despite the increased interest in this topic, there is little known about the psycho-physiological links between opioid addiction and pain and extremely few empirically validated treatments (Wachholtz et al., 2011a, 2011b). (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>


A Case of Confusion
Question: A 59-year-old man with a history of hypertension, hyperlipidemia, diabetes mellitus type 2, chronic kidney disease, and chronic right foot osteomyelitis was found confused in his car by a passerby and was admitted for altered mental status and new memory deficits. He was only oriented to himself. He had anterograde amnesia and could not recall information for >1–2 hours at a time. He had diarrhea that was believed to be overflow related. He denied abdominal pain, bright red blood per rectum, nausea, vomiting, loss of appetite, and was unsure of weight loss. (Source: Gastroenterology)


Oxytocin - A Multifunctional Analgesic for Chronic Deep Tissue Pain.
Authors: Goodin BR, Ness TJ, Robbins MT Abstract The treatment of chronic pain arising from deep tissues is currently inadequate and there is need for new pharmacological agents to provide analgesia. The endogenous paracrine hormone/neurotransmitter oxytocin is intimately involved in the modulation of multiple physiological and psychological functions. Recent experiments have given clear evidence for a role of oxytocin in the modulation of nociception. The present article reviews the existent human and basic science data related to the direct and indirect effects of oxytocin on pain. Due to its analgesic, anxiolytic, antidepressant and other central nervous system effects, there is strong evidence that oxytocin and other drugs acting through the oxytocin receptor could act as multi...


Can Modulating Inflammatory Response Be a Good Strategy to Treat Neuropathic Pain?
Authors: Zhang J, Echeverry S, Lim T, Lee SH, Shi XQ, Huang H Abstract Neuronal injury not only results in severe alteration in the function of primary sensory neurons and their central projection pathway, but is also associated with a robust immune response at almost every level of the somatosensory system. Studies in animal studies suggest undoubtedly that bi-directional signalling between the immune system and the nervous system contribute to the development and maintenance of chronic neuropathic pain. Non-neuronal cells, including peripheral immune cells, CNS/PNS glial cells and endothelial cells play important roles in the neuroimmune interaction and subsequent persistent hypersensitivity. Various cytokines and chemokines have been identified as key signalling molecules in the...


The Roles of Neurotensin and its Analogues in Pain.
Authors: Feng YP, Wang J, Dong YL, Wang YY, Li YQ Abstract Neurotensin (NT) is an endogenous 13 amino acid neuropeptide with profound opioid-independent analgesic effects. This role of NT is thought to be mediated by both neurotensin receptor subtype 1 (NTS1) and neurotensin receptor subtype 2 (NTS2). NT and its receptors are widely distributed in the pain circuits in central nervous system. Thus NT might modulate pain in many structures of pain pathway, such as spinal cord, rostroventral medulla (RVM) and periaqueductal gray (PAG). Actually either intrathecal application of NT or direct injection of NT into RVM or PAG or intracerebroventricular injection of NT showed analgesic effects. NT exerted its antinociceptive effects in both acute pain and chronic pain models. The analgesic...


Targeting injury-related synaptic Plasticity for the Treatment of Chronic Pain.
Authors: Zhuo M Abstract Recent investigations of the cellular and molecular mechanisms of pain provide new hopes for more effective treatments for patients with chronic pain. At the molecular and genetic levels, new proteins and genes related to sensory sensation have been identified. However, many of these new discoveries have not resulted in better and more effective treatments for chronic pain. This disconnect between discovery and better treatment options is due, in part to the negative side effects associated with new treatment options, and also as a result of the ineffectiveness of these new drugs for inhibiting chronic pain. In this review, I will explore this disconnect between discovery and treatment, and propose that the failure of previous medicines can be due to their ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report
Conclusion: This case shows that the manifestations of intestinal tuberculosis can be very difficult to diagnose and mimic those of Chron’s disease. Total body computed tomography and laparotomy with an intestinal biopsy for the detection of Mycobacterium tuberculosis are the means of avoid the risks of a misdiagnosis in children with unexplained chronic abdominal problems. (Source: BMC Research Notes)


[Epileptic seizures complicated by Takotsubo syndrome].
CONCLUSIONS. Cardiac complications are one of the causes of morbidity and mortality in epilepsy, and Takotsubo syndrome is an example of them. The real incidence of this syndrome is unknown, but given its involvement in mortality caused by heart problems in epilepsy it is important to suspect it in the presence of cardiac dysfunction following epileptic seizures. PMID: 25342054 [PubMed - in process] (Source: Revista de Neurologia)


Skin manifestations associated with chronic recurrent multifocal osteomyelitis in a 9-year-old girl
To the Editor: A 9-year-old girl presented with a 15-month history of severe joint pain limited to the right ankle. She had been treated for fatigue fracture and epiphysitis, but continued to require the use of crutches. The patient had pronounced muscular atrophy of the right leg, swelling and hyperthermia at the heel, and plantar pustulosis. She had mild paronychia on most fingers of the right hand and progressive changes in the fingernails, which were characteristic of nail psoriasis (Fig 1). (Source: Journal of the American Academy of Dermatology)


Short- and Long-term Results of Modified Frey's Procedure in Patients with Chronic Pancreatitis: A Retrospective Japanese Single-Center Study.
CONCLUSIONS: Modified Frey's procedure is safe, feasible, and effective to manage chronic pancreatitis. The technique prevents further exacerbations and maintains appropriate pancreatic endocrine and exocrine function. PMID: 25339257 [PubMed - in process] (Source: Kobe J Med Sci)


Altered Functional Magnetic Resonance Imaging Responses to Nonpainful Sensory Stimulation in Fibromyalgia Patients
ConclusionFM patients showed strong attenuation of brain responses to nonpainful events in early sensory cortices, accompanied by an amplified response at later stages of sensory integration in the insula. These abnormalities are associated with core FM symptoms, suggesting that they may be part of the pathophysiology of the disease. (Source: Arthritis and Rheumatism)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Predisposing effects of neonatal visceral pain on abuse-related effects of morphine in adult male Sprague Dawley rats
Conclusions NVP-induced changes in brain opioid systems have persistent pharmacological consequences into adulthood and may increase sensitivity to abuse-related effects of opioids across development. (Source: Psychopharmacology)


Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia
Abstract Fibromyalgia (FM) syndrome is a disabling clinical condition of unknown cause, and only symptomatic treatment with limited benefit is available. Gluten sensitivity that does not fulfill the diagnostic criteria for celiac disease (CD) is increasingly recognized as a frequent and treatable condition with a wide spectrum of manifestations that overlap with the manifestations of FM, including chronic musculoskeletal pain, asthenia, and irritable bowel syndrome. The aim of this report was to describe 20 selected patients with FM without CD who improved when placed on a gluten-free diet. An anti-transglutaminase assay, duodenal biopsy, and HLA typing were performed in all cases. CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy...


Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial
Abstract Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that affects mainly the axial skeleton and causes significant pain and disability. Aquatic (water-based) exercise may have a beneficial effect in various musculoskeletal conditions. The aim of this study was to compare the effectiveness of aquatic exercise interventions with land-based exercises (home-based exercise) in the treatment of AS. Patients with AS were randomly assigned to receive either home-based exercise or aquatic exercise treatment protocol. Home-based exercise program was demonstrated by a physiotherapist on one occasion and then, exercise manual booklet was given to all patients in this group. Aquatic exercise program consisted of 20 sessions, 5× per week for 4 weeks in a swimming p...


Using item response theory to enrich and expand the PROMIS ® pediatric self report banks
Conclusions: The present study expanded PROMIS pediatric item banks to add new content and to increase the range of measurement. Using item response theory, the banks were revised and expanded without changing the underlying scale of measurement. For Anger, Anxiety, and Depressive Symptoms, we successfully added new content that may render those banks more robust and flexible. (Source: Health and Quality of Life Outcomes)


Unexpected Cause of Acute Recurrent Vomiting
Question: A 70-year-old woman who was visiting our city presented to the emergency department with a 24-hour history of nausea, voluminous, recurrent vomiting, and epigastric pain. Medical history disclosed gastroesophageal reflux disease, osteoporosis, and chronic cognitive impairment. There was no antecedent of trauma or surgical interventions. She was taking omeprazole and raloxifene hydrochloride as regular medications. At presentation, vital signs were unexceptional and she did not look seriously ill. (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>


Assessing Cognitive and Psychomotor Performance in Patients with Fibromyalgia Syndrome
Conclusion The results of the present study demonstrate that, in general, the driving ability of patients with FMS was not inferior to that of healthy volunteers based on a standardized computer-based test battery. However, variables, such as younger age, depression, anxiety, fatigue, pain, and poor motor coordination, likely contribute to the subjective perception of cognitive dysfunction in FMS. (Source: Pain and Therapy)


Yoga for Health
This issue of the digest summarizes current scientific evidence about yoga for health conditions, including chronic low-back pain, asthma, and&nbsp;arthritis. The scientific evidence to date suggests that a carefully adapted set of yoga poses may help reduce pain and improve function in people with chronic low-back pain. Studies also suggest that practicing yoga (as well as other forms of regular exercise) might confer other health benefits such as reducing heart rate and blood pressure, and may also help alleviate anxiety and depression. Other research suggests yoga&rsquo;s deep breathing is not helpful for asthma, and studies looking at yoga and arthritis have had mixed&nbsp;results. (Source: NCCAM Featured Content)


Vaginal Mesh Lawsuit News: Boston Scientific Loses Bid for Summary...
The Firm is representing hundreds of women who suffered mesh erosion, chronic pain, organ damage, and other serious vaginal mesh complications, allegedly due to products manufactured by Boston...(PRWeb October 23, 2014)Read the full story at http://www.prweb.com/releases/vaginal-mesh-lawsuit/boston-scientific-mesh/prweb12273695.htm (Source: PRWeb: Medical Pharmaceuticals)


American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: Evidence-Based Report on Diagnostic Guidelines
This report defines the diagnostic criteria useful in the assessment of patients with suspected and established chronic pancreatitis. All current diagnostic procedures are reviewed, and evidence-based statements are provided about their utility and limitations. Diagnostic criteria for chronic pancreatitis are classified as definitive, probable, or insufficient evidence. A diagnostic (STEP-wise; survey, tomography, endoscopy, and pancreas function testing) algorithm is proposed that proceeds from a noninvasive to a more invasive approach. This algorithm maximizes specificity (low false-positive rate) in subjects with chronic abdominal pain and equivocal imaging changes. Furthermore, a nomenclature is suggested to further characterize patients with established chronic pancreatitis based on T...


Total Pancreatectomy With Islet Autotransplantation: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop
AbstractA 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 (CP). 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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Vulvodynia: integrating current knowledge into clinical practice
Key content Vulvodynia is a chronic gynaecological condition that results in significant distress to women and management can be challenging to the clinician. The 2003 International Society for the Study of Vulvovaginal Disease (ISSVD) defines vulvodynia as vulval discomfort that is described as burning, stinging or irritation, in the absence of relevant visible findings or specific signs of a clinically identifiable neurological condition. The condition can be localised (vestibule) or generalised and the discomfort can be spontaneous or provoked by physical contact. The diagnosis of vulvodynia is one of exclusion after inflammatory, infectious, dermatological, neoplastic, neurological and psychosexual conditions have been ruled out. A multidisciplinary approach to tackle the different...


The Alexander Technique and musicians: a systematic review of controlled trials
Conclusions: A variety of outcome measures have been used to investigate the effectiveness of AT sessions in musicians. Evidence from RCTs and CTs suggests that AT sessions may improve performance anxiety in musicians. Effects on music performance, respiratory function and posture yet remain inconclusive. Future trials with well-established study designs are warranted to further and more reliably explore the potential of AT in the interest of musicians. (Source: BMC Complementary and Alternative Medicine)


Chronic Pancreatitis Pain Pattern and Severity are Independent of Abdominal Imaging Findings
Chronic pancreatitis is characterized by inflammation, atrophy, fibrosis with progressive ductal changes, and functional changes that include variable exocrine and endocrine insufficiency and multiple patterns of pain. We investigated whether abdominal imaging features accurately predict patterns of pain. (Source: Clinical Gastroenterology and Hepatology)


Improving the primary care physicians¿ decision making for fibromyalgia in clinical practice: development and validation of the Fibromyalgia Detection (FibroDetect®) screening tool
Conclusions: The FibroDetect is a self-administered tool that can be used as a screening classification surrogate to the ACR criteria in primary care settings to help PCPs detect potential fibromyalgia patients among a population complaining of chronic widespread pain. (Source: Health and Quality of Life Outcomes)


Primary spinal epidural cavernous hemangioma: clinical features and surgical outcome in 14 cases.
CONCLUSIONS Total surgical removal of spine epidural cavernous hemangiomas with a chronic course is the optimum treatment and carries a good prognosis. Secondary surgery for recurrent epidural cavernous hemangioma is technically more challenging. In patients with profound myelopathy from acute hemorrhage, even prompt surgical decompression can rarely reverse all symptoms. PMID: 25343406 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Effectiveness and safety of serial endoscopic ultrasound–guided celiac plexus block for chronic pancreatitis
Conclusions: Repeated EUS-CPB procedures in a single patient appear to be safe. Response to the first EUS-CPB is associated with response to subsequent blocks. [...]© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents  |  Abstract  |  open access Full text (Source: Endoscopy International Open)


A prospective randomized controlled trial to compare single-port endo-laparoscopic surgery versus conventional TEP inguinal hernia repair
Discussion The outcomes after laparoscopic TEP inguinal hernia repair with a single-port device are comparable to the standard three-port technique. (Source: Surgical Endoscopy)


Quartet Medicine Launches with $17 Million Series A Financing
Company to explore broad applications for modulators of tetrahydrobiopterin (BH4) synthesis in the treatment of chronic pain and inflammation CAMBRIDGE, Mass.--(Healthcare Sales & Marketing Network)--Quartet Medicine, a biotechnology company focused on ... Biopharmaceuticals, Venture CapitalQuartet Medicine, tetrahydrobiopterin (Source: HSMN NewsFeed)


Are there sex differences in placebo analgesia during visceral pain processing? A fMRI study in healthy subjects
Conclusions & InferencesOur data provide first evidence supporting sex differences in pain‐induced neural modulation during visceral placebo analgesia despite similar placebo‐induced reductions in perceived pain intensity. These preliminary findings might contribute to elucidating mechanisms mediating placebo effects in clinical conditions associated with chronic abdominal pain such as in irritable bowel syndrome. Our study is the first to address sex differences in placebo analgesia in a visceral pain model. To do so, we compared healthy men and women with respect to the behavioral and neural responses to painful rectal distensions in an established placebo analgesia paradigm. In summary, women and men showed comparable placebo‐induced reductions in pain ratings. Analysis of fM...


Health Tip: Coping With Chronic Pain
Title: Health Tip: Coping With Chronic PainCategory: Health NewsCreated: 10/23/2014 12:00:00 AMLast Editorial Review: 10/23/2014 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>


Chronic Neck Pain and Episodic Vertigo and Tinnitus
(Source: Pain Medicine)


Chronic Unexplained Thigh Pain from Saphenous Nerve Entrapment due to a Leiomyoma
(Source: Pain Medicine)


Report on a case series investigating a neurostimulation device for the treatment of pain and improvement of mobility and function following elbow surgery
Conclusion It appears that the neurostimulation (Stimpod) has the capacity to improve acute post-surgical pain and reduce pain, improve mobility, function and stimulate wound healing once the splint was removed. This treatment is relatively cost effective, is non-invasive and of short duration. Positive effects were all maintained at 6 months. (Source: Acupuncture and Related Therapies)


Spinal mediation of descending pain inhibitory mechanisms activated by 2/100-Hz electroacupuncture in the rat tail-flick test
Publication date: May–June 2013 Source:Acupuncture and Related Therapies, Volume 1, Issues 2–3 Author(s): Josie Resende Torres da Silva , Marcelo Lourenço da Silva , Wiliam Alves Prado Electroacupuncture (EA) has been widely used for the management of chronic pain, but the mechanism of EA-induced analgesia is not yet fully understood. The present study evaluated the effectiveness of intrathecal antagonists of serotonergic (methysergide), α1- (WB4101) and α2- (idazoxan) adrenoceptors, opioid (naloxone), muscarinic (atropine), GABAA (bicuculline) and GABAB (phaclofen) receptors in blocking 2/100-Hz electroacupuncture-induced analgesia (EAIA) in the rat tail-flick test. Rats were taken for determination of baseline tail-flick latency (TFL). Vehicle or drug was then injected intrathec...


Amitriptyline prolongs the antihyperalgesic effect of 2Hz electroacupuncture in mononeuropathic rats
This study examines whether the use of an intraperitoneal injection of amitriptyline changes the effectiveness of EA to reduce neuropathic pain in rats. Changes in the nociceptive threshold of intraperitoneal saline (0.8ml/kg)- or amitriptyline (0.8mg/kg)-treated rats were evaluated using the tail-flick test and a model of neuropathic pain before, during and after a 20-min period of 2Hz EA applied to the Zusanli and Sanynjiao acupoints. The experiments were conducted two or seven days after a sham or chronic constriction injury (CCI) of the sciatic nerve. Amitriptyline had no effect against thermal or neuropathic pain in sham EA-stimulated rats. Two Hz EA increased the tail-flick latency and reduced the mechanical hyperalgesia evoked by the CCI and was more effective against mechanical hyp...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Neural therapy—A review of the therapeutic use of local anesthetics
Publication date: 2012 Source:Acupuncture and Related Therapies, Volume 1, Issue 1 Author(s): Stefan Weinschenk Neural therapy, or therapeutic local anesthesia (TLA), is the diagnostic and therapeutic use of local anesthetics. This review summarizes the scientific and clinical evidence, indications, methods of application, and possible future research. In the literature, there is a gap between the multitude of data supporting a number of different molecular effects and the few clinical trials that are available. The available clinical studies and case reports, however, show effectiveness in acute and chronic pain, functional disorders, vegetative diseases such as the complex regional pain syndrome (CRPS), and chronic inflammation. Five administration methods are described: local, segment...


Is compassion a part of the non-specific effects of acupuncture?
Publication date: 2012 Source:Acupuncture and Related Therapies, Volume 1, Issue 1 Author(s): Thomas Lundeberg , Iréne Lund , Jan Näslund Acupuncture is widely used for the treatment of chronic (long-term) pain. In a recent study, Vickers et al. characterized the analgesic effect of acupuncture in four different chronic pain conditions, back and neck pain, osteoarthritis, headache, and shoulder pain, and concluded that acupuncture is an effective type of treatment for these chronic pain states. Significant differences between true and sham acupuncture indicate that acupuncture induces superior effects. However, these differences were reported to be relatively modest, suggesting that non-specific effects, in addition to the specific effects of the needle stimulation, are important contr...


Long‐term evaluation of combined prolonged‐release oxycodone and naloxone in patients with moderate‐to‐severe chronic pain: pooled analysis of extension phases of two Phase III trials
Conclusions & InferencesPooled data demonstrate OXN PR is an effective long‐term therapy for patients with chronic non‐cancer pain, and can address symptoms of OIC. No new safety issues were observed which were attributable to the long‐term administration of OXN PR. Pooled data from the 12‐month extension phases of two Phase III trials demonstrate combined oxycodone/naloxone prolonged‐release tablets (OXN PR) are an effective long‐term therapy for patients with chronic non‐cancer pain, and can address symptoms of opioid‐induced constipation. Comparable pain control but with improved bowel function was observed with OXN PR vs oxycodone PR and was maintained during the open‐label, long‐term treatment. No new safety issues were observed which were attributable to the ...


Methodological Issues in Studying Trigger Factors and Premonitory Features of Migraine
ConclusionEstablishing the relationship between antecedent events and headaches is a formidable challenge. Successfully addressing this challenge should provide insights into disease mechanisms and lead to new strategies for treatment. In the second paper in this series, we review the available literature on trigger factors and premonitory features. (Source: Headache: The Journal of Head and Face Pain)


A Double‐Blind, Placebo‐Controlled Study of Repetitive Transnasal Sphenopalatine Ganglion Blockade With Tx360® as Acute Treatment for Chronic Migraine
ConclusionSPG blockade with bupivacaine delivered repetitively for 6 weeks with the Tx360® device demonstrates promise as an acute treatment of headache in some subjects with CM. Statistically significant headache relief is noted at 15 and 30 minutes and sustained at 24 hours for SPG blockade with bupivacaine vs saline. The Tx360® device was simple to use and not associated with any significant or lasting adverse events. Further research on sphenopalatine ganglion blockade is warranted. (Source: Headache: The Journal of Head and Face Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Diagnosis and Treatment of Lateral Patellar Compression Syndrome
This report describes a surgical technique developed in response to lateral pressure in flexion and the shortcomings of traditional arthroscopic lateral release procedures. The technique is performed open with the knee in flexion, and the lateral release is repaired with a rotation flap of iliotibial band to close the defect and prevent patellar subluxation. The technique effectively decreases lateral patellar pressure and centers the patella correctly in the trochlear groove with minimal risk of iatrogenic patellar instability. (Source: Arthroscopy Techniques)


Anatomic Reconstruction of Chronic Coracoclavicular Ligament Tears: Arthroscopic-Assisted Approach With Nonrigid Mechanical Fixation and Graft Augmentation
Publication date: Available online 15 September 2014 Source:Arthroscopy Techniques Author(s): Luis Natera , Juan Sarasquete Reiriz , Ferran Abat It has recently been suggested that all coracoclavicular ligament tears could be considered for surgery because nonoperative management might result in irreversible changes in the scapular position that could lead to muscle kinematic alterations that would perturb the shoulder girdle function and result in pain. In this technical note we describe an anatomic technique for the treatment of chronic coracoclavicular ligament tears that overcomes the issues related to open surgery, metal hardware, the inferior resistance to secondary displacement of only grafting and nonanatomic techniques, and the saw effect and anterior loop translation that can b...


Bilateral spermatic cord en bloc ligation by laparoendoscopic single-site surgery: preliminary experience compared to conventional laparoscopy
Conclusions: Bilateral spermatic cord ligation with LESS is an alternative to conventional laparoscopy. The procedure was successfully performed in all patients. The trans-umbilical approach offers the advantage of a better cosmetic result, shorter hospital stay and less postoperative pain. (Source: BMC Urology)


Current views on the etiopathogenesis, clinical manifestation, diagnostics, treatment and correlation with other nosological entities of SIBO
Publication date: Available online 6 October 2014 Source:Advances in Medical Sciences Author(s): Angelika Miazga , Maciej Osiński , Wojciech Cichy , Ryszard Żaba Small intestinal bacterial overgrowth (SIBO) is a disease of great clinical and socioeconomic importance caused by an excessive amount of bacteria in the upper alimentary tract. Physiological microbiota are replaced by pathogenic bacteria mainly from large intestine, which is called dysbacteriosis. SIBO disturbs digestion and absorption in the alimentary tract, which seems to cause inflammation. SIBO affects the morphology and function of the digestive system and causes systemic complications (e.g. osteoporosis, macrocytic anemia). Inflammation interferes with gene expression responsible for producing and secreting mucus, ther...


Diabetes Symptoms and Self-Management Behaviors in Rural Older Adults
Type 2 diabetes mellitus is common among older adults and is associated with numerous co-morbidities. A myriad of complications is associated with diabetes; some of these complications can be monitored by recognition and response to the common symptoms of the disease. Both acute and chronic symptoms may be experienced by patients, including the classic symptoms of thirst, hunger, and frequent urination, as well as other common symptoms, including visual blurring, numbness and tingling in the extremities, calf pain on walking, and fatigue [1,2]. (Source: Diabetes Research and Clinical Practice)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A Double-Blind, Placebo-Controlled Study of Repetitive Transnasal Sphenopalatine Ganglion Blockade With Tx360(®) as Acute Treatment for Chronic Migraine.
CONCLUSION: SPG blockade with bupivacaine delivered repetitively for 6 weeks with the Tx360(®) device demonstrates promise as an acute treatment of headache in some subjects with CM. Statistically significant headache relief is noted at 15 and 30 minutes and sustained at 24 hours for SPG blockade with bupivacaine vs saline. The Tx360(®) device was simple to use and not associated with any significant or lasting adverse events. Further research on sphenopalatine ganglion blockade is warranted. PMID: 25338927 [PubMed - as supplied by publisher] (Source: Headache)


[Key messages in nail disease.]
Authors: Goettmann S Abstract Nail diseases are varied, and their diagnosis is often difficult. Misdiagnosis can result in failure to recognize a severe disease in urgent need of treatment and in the prescription of treatments that are inappropriate, long, ineffective, and expensive. Acute paronychia must be managed rapidly, treated with antiseptics several times a day, and closely monitored. Nail lichen must be recognized early and treated rapidly and appropriately to prevent permanent scarring. All chronic pain (to shocks or cold) of the tip of a finger or toe should suggest a glomus tumor. Any unexplained persistent single-finger onychopathy should in principle cause the physician to suspect a tumor, carcinoma, or melanoma and to order a histologic examination. An onychopathy mu...


Combined trochleoplasty and MPFL reconstruction for treatment of chronic patellofemoral instability: a prospective minimum 2-year follow-up study
Conclusions Combined treatment for trochleoplasty with MPFLR serves as a successful therapy for chronic PFI. This combinatory treatment concept is a reliable option not only as salvage therapy but also as primary procedure regarding treatment for excessive PFI. Level of evidence Prospective case series, Level IV. (Source: Knee Surgery, Sports Traumatology, Arthroscopy)


Short‐ and long‐term results of the Frey procedure for chronic pancreatitis
ConclusionsThe Frey procedure for painful chronic pancreatitis may be safe and pancreatic endocrine function is preserved. Complete decompression of the pancreatic ducts in the head of pancreas and full length drainage of the main pancreatic duct from the head of pancreas to the tail may be important in the Frey procedure to prevent recurrence of acute inflammation. (Source: Journal of Hepato-Biliary-Pancreatic Sciences)


Surgical anatomy of greater occipital nerve and its relation to occipital artery
Conclusion The knowledge of the anatomy of greater occipital nerve and its relation to occipital artery is important for the surgeon. Blockage or surgical release of greater occipital nerve is clinically effective in eliminating chronic migraine headache. (Source: Alexandria Journal of Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Prevalence and risk factors of pelvic pain
Conclusions High prevalence of CPP symptoms in Málaga (22.8%); this is related to several significant risk factors. (Source: Actas Urologicas Espanolas)


Adult attachment and approaches to activity engagement in chronic pain.
Authors: Andrews NE, Meredith PJ, Strong J, Donohue GF PMID: 25337857 [PubMed - as supplied by publisher] (Source: Pain Research and Management)


Peripheral field stimulation for thoracic post herpetic neuropathic pain
Post herpetic neuralgic (PHN) pain is a prevalent chronic neuropathic pain. It follows the eruption of varicella herpes zoster virus (VZV, chickenpox). It is estimated that 1 million new cases of VZV are reported annually in the United States alone [1]. Of those approximately 20–30% will develop PHN. The disorder is defined by three distinctive groups. Acute herpetic neuralgia that develops within 30 days of rash onset, sub-acute herpetic neuralgia which develops within 30–120 days after rash onset and post herpetic neuralgia which is defined as pain lasting at least 120 days following rash onset [2,3]. (Source: Clinical Neurology and Neurosurgery)


Cross-cultural translation and validation of the Greek version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in patients with total knee replacement.
Conclusion: The Greek KOOS was found to be a practical and comprehensible self-reported measure for TKR patients with acceptable psychometric properties. It is therefore, recommendable for usage in future clinical trials and clinical practice. Implications for Rehabilitation The Greek version of KOOS is an essential assessment scale to evaluate not only acute injuries but also chronic knee associated conditions in a holistic perspective. The Greek KOOS has been found to be a practical and comprehensible self-reported measure for TKR patients with acceptable psychometric properties, recommendable for usage in future clinical trials and clinical practice. KOOS Greek version (downloadable at the official site http://www.koos.nu/koosgreek.pdf ) was used in the validity study. PMID: 2533555...


Tongue Piercing and Chronic Abdominal Pain with Nausea and Vomiting-2 Cases
Chronic upper gastrointestinal (GI) symptoms of unclear etiology are frustrating to patients and physicians alike. The integrative medicine procedures of acupuncture and neural therapy may provide treatment options. Tongue piercing which is prevalent in 5.6 percent of the adolescent population,1 may be a contributing factor in upper gastrointestinal symptoms. (Source: Explore)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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. (Source: Explore)


AMPAkines Have Novel Analgesic Properties in Rat Models of Persistent Neuropathic and Inflammatory Pain
Conclusions: AMPAkines alleviate pain hypersensitivity as well as depression-like behavior associated with long-lasting nerve injury and inflammatory insult. (Source: Anesthesiology)


Modeling Individual Recovery after Peripheral Nerve Injury in Rats and the Effects of Parturition
Conclusions: The authors describe a method of analysis to quantify recovery from hypersensitivity after surgery in rats with several distinct advantages over traditionally used methods. Study results do not support a sex difference in trajectory of recovery but confirm and extend previous observations that injury at the time of obstetric delivery is associated with an abnormally rapid recovery. (Source: Anesthesiology)


More attention to pain management in community-dwelling older persons with chronic musculoskeletal pain
Conclusion: physicians need to take a more active role in the process of recognising, assessing and controlling persistent pain in older people. (Source: Age and Ageing)


Chronic unilateral chemosis following the use of amlodipine besylate
Conclusion: Prior to invasive evaluation including biopsy, specific drugs should be considered as possible causes of idiopathic longstanding conjunctival chemosis. (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>


Assessment and Management of Pain in Juvenile Idiopathic Arthritis
Abstract Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. Persistent pain is the most common and distressing symptom of JIA, and pain in childhood arthritis is multifactorial. Children and adolescents with persistent pain due to JIA experience significantly more problems with physical, emotional, social, and school functioning than healthy individuals. Assessment of pain at each office visit is the cornerstone of effective pain management and should include an evaluation of pain intensity, interference, and coping. Following the biopsychosocial model of pain management, a multi-modal approach is recommended for pain control in children with arthritis. Pharmacologic strategies for the treatment of pain in JIA include aggressive treatmen...


Correlates of Complementary and Alternative Medicine Use in a Pediatric Tertiary Pain Center
Conclusions In a pediatric chronic pain center, CAM users tended to have higher pain intensity and greater functional disability. Exposure to biobehavioral CAM techniques was associated with adaptive coping skills. (Source: Academic Pediatrics)


Synchronous gallbladder and pancreatic cancer associated with pancreaticobiliary maljunction.
We report the case of a 46-year-old woman who presented with chronic intermittent abdominal pain without jaundice; abdominal ultrasonography showed thickening of the gallbladder wall and dilatation of the bile duct. Endoscopic retrograde cholangiopancreaticography showed pancreatobiliary maljunction with proximal common bile duct dilatation. Pancreatobiliary maljunction was diagnosed. A computed tomography scan of the abdomen showed suspected gallbladder cancer and distal common bile duct obstruction. A pancreatic head mass was incidentally found intraoperative. Radical cholecystectomy with pancreatoduodenectomy was performed. The pathological report showed gallbladder cancer that was synchronous with pancreatic head cancer. In the pancreatobiliary maljunction with pancreatobiliary reflux ...


Therapeutic Ultrasound Suppresses Neuropathic Pain and Upregulation of Substance P and Neurokinin-1 Receptor in Rats after Peripheral Nerve Injury
We studied the mechanisms and impact of therapeutic ultrasound (TU) for pain caused by nerve injury. TU began on post-operative day 5 (POD5) and then continued daily for the next 22 d. Sensitivity to thermal and mechanical stimuli and levels of neurokinin-1 receptor, substance P, tumor necrosis factor-α and interleukin-6 in the sciatic nerve were examined. On POD7, chronic constriction injury rats undergoing TU at an intensity of 1 W/cm2, but not 0.25 or 0.5 W/cm2, had increases in both the mechanical withdrawal threshold and the thermal withdrawal latency compared with the chronic constriction injury group. (Source: Ultrasound in Medicine and Biology)


Assessment and Management of Pain in Juvenile Idiopathic Arthritis.
Authors: Weiss JE, Luca NJ, Boneparth A, Stinson J Abstract Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. Persistent pain is the most common and distressing symptom of JIA, and pain in childhood arthritis is multifactorial. Children and adolescents with persistent pain due to JIA experience significantly more problems with physical, emotional, social, and school functioning than healthy individuals. Assessment of pain at each office visit is the cornerstone of effective pain management and should include an evaluation of pain intensity, interference, and coping. Following the biopsychosocial model of pain management, a multi-modal approach is recommended for pain control in children with arthritis. Pharmacologic strategies for the tr...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Developmental Analysis of the Factorial Validity of the Parent-report Version of the Adult Responses to Children’s Symptoms (ARCS) in Children versus Adolescents with Chronic Pain or Pain-related Chronic Illness
The widely used Adult Responses to Children’s Symptoms (ARCS) measures parental responses to child symptom complaints among youth aged 7-18 years with recurrent/chronic pain. Given developmental differences between children and adolescents and the impact of developmental stage on parenting, the factorial validity of the parent-report version of the ARCS with a pain-specific stem was examined separately in 743 parents of 281 children (7-11 years) and 462 adolescents (12-18 years) with chronic pain or pain-related chronic illness. (Source: The Journal of Pain)


The associations between pre-existing mental disorders and subsequent onset of chronic headaches: A worldwide epidemiological perspective
We report global data from the WHO’s World Mental Health surveys (N=52,095), in which, by means of the Composite International Diagnostic Interview-3.0 (CIDI-3.0), 16 DSM-IV mental disorders were retrospectively assessed in terms of lifetime prevalence and age-of-onset. (Source: The Journal of Pain)


Pain: OnabotulinumtoxinA to treat chronic scrotal pain
Nature Reviews Urology 11, 660 (2014). doi:10.1038/nrurol.2014.298 In a pilot open-label study, 18 patients with chronic scrotal pain who had failed other treatment but had temporary symptom relief after standard cord block received 100 U of onabotulinumtoxinA to asses long-term pain relief. Decreases in pain measured by 10-point analogue scale pain score, (Source: Nature Reviews Urology)


Children Who Go to School in Pain
Imagine pain like an ice pick through your head, vertigo, and nausea. Imagine that a cat's footpad sounded so loud your eardrums felt like they were being sandpapered and the overhead lights felt like a harsh flashlight in your eyes when you've been hiding in the dark. Now imagine yourself in the middle of a high school corridor when classes are changing.read more (Source: Psychology Today Parenting Center)


The response of patients with bile acid diarrhoea to the farnesoid X receptor agonist obeticholic acid
ConclusionsThis proof‐of‐concept study indicates that obeticholic acid stimulates FGF19, reduces bile acid synthesis and produces clinical benefits in bile acid diarrhoea. FXR agonists have therapeutic potential in chronic diarrhoea. EudraCT 2011‐003777‐28; Clinical Trials: NCT01585025 (Source: Alimentary Pharmacology 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>


Risky monetary behavior in chronic back pain is associated with altered modular connectivity of the nucleus accumbens
Conclusions: Our results support previous findings that chronic back pain is accompanied by altered connectivity of the NAc. This lends itself to riskier behavior in these patients, a finding which establishes a potential cognitive consequence or co-morbidity of long-term pain and provides a behavioral link to growing research showing that chronic pain is related to abnormal changes in the dopaminergic system. (Source: BMC Research Notes)


Works of Illness and the Challenges of Social Risk and the Specter of Pain in the Lived Experience of TMD
Temporomandibular Disorders (TMD) represent a particular form of chronic pain that, while not outwardly debilitating, profoundly impacts interactions as fundamental to human existence as smiling, laughing, speaking, eating, and intimacy. Our analysis, informed by an expanded “works of illness” assessment, draws attention to work surrounding social and physical risk. We refer to these as the work of stoicism and the work of vigilance and identify double binds created in contexts that call for both. Conflicting authorial stances in informants’ narratives are shown to be essential in maintaining a positive identity in the face of illness. While earlier ethnographic studies report TMD sufferers’ experience of stigma and search for diagnosis and legitimacy, we present a group of individ...


Relationship between Chronic Non-Urological Associated Somatic Syndromes (NUAS) and Symptom Severity in Urological Chronic Pelvic Pain Syndromes: Baseline Evaluation of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Study
We report data from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) network to: (1) identify participants having either (a) urologic chronic pelvic pain syndromes (UCPPS) only or (b) chronic functional non-urological associated somatic syndromes (NUAS) in addition to UCPPS, (2) characterize these two subgroups, and (3) explore these two subgroups using three criteria: (a) the MAPP eligibility criteria, (b) self-reported medical history, or (c) RAND interstitial cystitis epidemiologic (RICE) criteria. (Source: The Journal of Urology)


Revising the negative meaning of chronic pain - A phenomenological study.
CONCLUSIONS: Pain is an aversive sensation, which leads to the conclusion that the meaning of the experience is also negative, but it can be reversed. In clinical practice, the focus should be on revising the subjective meaning of pain in order to manage pain and to restore positivity in personal life. PMID: 25330917 [PubMed - as supplied by publisher] (Source: Chronic Illness)


Patient quality of life and pain improve after autologous islet transplantation (AIT) for treatment of chronic pancreatitis: 53 patient series at the University of Arizona
Pancreatectomy with autologous islet transplantation has slowly been proving to be an effective way of treating chronic pancreatitis while lessening the effects of the concomitant surgical diabetes of pancreatectomy alone. Assessing patient quality of life and pain after the procedure is particularly important as intractable pain is the main complaint for which patients undergo total pancreatectomy. (Source: Pancreatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic Pelvic Pain from Mesh Anchors Used in Pelvic Floor Repairs
This video describes the technique and relevant anatomic landmarks for removing mesh anchors placed during a pelvic floor mesh kit (Elevate). A case is presented, as well as a study describing the locations of the nerves in the vicinity of the sacrospinous ligament. (Source: The Journal of Minimally Invasive Gynecology)


Application of Dienogest in Chronic Pelvic Pain Associated with the Diffuse Form of External Endometriosis
Endometriosis is one of the most common and “mysterious” gynecological diseases in women of reproductive age. (Source: The Journal of Minimally Invasive Gynecology)


Anatomy of the Pudendal Nerve Seen during a Laparoscopic Pudendal Nerve Release
Pudendal neuralgia is not that uncommon of a diagnosis associated with chronic pelvic pain. Laparoscopic pudendal nerve release is a challenging procedure that can provide relief in patients who fail conservative management of an entrapped pudendal nerve resulting in pudendal neuralgia. The video will demonstrate technique and pertinent anatomy encountered during a laparoscopic pudendal nerve release. (Source: The Journal of Minimally Invasive Gynecology)


Bladder Base Tenderness in Chronic Pelvic Pain: Prevalence and Associations
The objective of this study is to determine the prevalence of BBT in a CPP population and to demonstrate potential associations between BBT and patient characteristics, pain symptoms, and exam findings. (Source: The Journal of Minimally Invasive Gynecology)


Inguinal Hernia as a Cause of Chronic Pelvic Pain: A Key Sign to Make the Diagnosis
To identify key presenting characteristics for inguinal hernia in women as a primary source of chronic pelvic pain. (Source: The Journal of Minimally Invasive Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Complex Robotic Trachelectomy for Chronic Pelvic Pain after Failed Laparotomic Trachelectomy
We present a case of robotic trachelectomy in a 45 year old female who underwent multiple failed laparotomies after a supra-cervical hysterectomy in an attempt to remove her cervix. In spite of successfully removing her ovaries during these surgeries, her cervix was never successfully identified. MRI demonstrated the cervix to be contiguous with residual uterine corpus adherent to the lower anterior abdominal wall and bladder. (Source: The Journal of Minimally Invasive Gynecology)


Hospital-Associated Costs of Chronic Pelvic Pain in Canada
To determine the hospital-related costs associated with women requiring surgery or inpatient admission for chronic pelvic pain in Canada. (Source: The Journal of Minimally Invasive Gynecology)


Complete Excision of Full-Thickness Bladder Endometriosis
This video demonstrates the safe and complete resection of a full-thickness endometriotic nodule of the left superior posterior dome of the bladder. A 35-year-old nulligravida Caucasian female presents with a history of severe, chronic bladder pain, nocturia, cyclic dysuria and macroscopic hematuria, and the bladder is found to be tender on exam. During cystoscopy a nodule measuring approximately 4cm in diameter is visualized, with evident infiltration of the bladder mucosa. At laparoscopy the nodule is circumscribed and carefully excised using the Carbon 13 CO2 laser, inevitably leading into the lumen of the bladder. (Source: The Journal of Minimally Invasive Gynecology)


Use of Fluorescence Imaging Technology in Robotic Surgery to Improve Identification of Peritoneal Endometriosis
Surgical resection of endometriosis reduces pain symptoms and improves quality of life in women with chronic pelvic pain. Complete resection is contingent upon the accuracy of visual identification of endometriosis, which may be influenced by endometriosis stage, lesion appearance and location, and inter-observer variability. Indocyanine green (ICG) is a water soluble dye that binds to plasma proteins and can be used with the da Vinci Si® near infrared fluorescence imaging system to measure tissue perfusion and for selective vessel identification. (Source: The Journal of Minimally Invasive Gynecology)


Laparoscopic Excision of Endometriosis in a 14 Year-Old Patient with Chronic Pelvic Pain
This video depicts the laparoscopic excision of endometriosis in a 14 year old patient with chronic pelvic pain. The patient underwent menarche at age 11, and developed cyclic pelvic pain 6 months later. Over the past year the pain has progressed to daily, but with more discomfort during meses. She has been seen by many specialists: a pediatrician, gynecologist, reproductive endocrinologist, gastroenterologist, urologist, pain specialist, and a psychiatrist, who recommended various medical management. (Source: The Journal of Minimally Invasive Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A Feasibility Study Evaluating the Role of Transvaginal Ultrasound with Bowel Prep for Deep Endometriosis in the Treatment Algorithm of Patients with Chronic Pelvic Pain and Endometriosis
To evaluate how transvaginal ultrasound with bowel prep (TVUS-BP) for deep endometriosis affects the treatment algorithm of patients with chronic pelvic pain and endometriosis. (Source: The Journal of Minimally Invasive Gynecology)


CA125 and VAS Pain Score Modifications Following GnRH-Analog Administration as Ex Adiuvantibus Criteria to Diagnose Endometriosis as Cause of Chronic Pelvic Pain
To assess the diagnostic accuracy of the combination of two simple parameters for the noninvasive detection of pelvic endometriosis: modifications of serum CA125 and VAS pain score following one dose of GnRH-analog (GnRH-a). (Source: The Journal of Minimally Invasive Gynecology)


Is Chronic Pelvic Pain (CPP) Linked to a Pro-Inflammatory Diet or Vitamin D Deficiency?
To review CPP as a complex, multi-system disorder, develop a possible link between CPP and diet, based on current research which determines a pro-inflammatory diet is responsible for inflammatory conditions occurring in endometriosis patients. Correlate musculoskeletal inflammation in patients with vitamin D deficiencies as a suspected cause of CPP conditions. (Source: The Journal of Minimally Invasive Gynecology)


Para-Ovarian Endomerioma in a Patient with a Congenital Uterine Anomaly
Congenital uterine anomalies are a rare entity and are known to be associated with endometriosis. A 26 year-old woman with chronic pelvic pain was found to have a müllerian anomaly and a large recurrent endometrioma in an uncommon para-ovarian location. She underwent resection of the functional, non-communicating uterine horn, as well as excision of the endometrioma and pelvic endometriosis. This case illustrates several important points. First, surgical management of müllerian anomalies can range from simple to very complex depending on the type of anomaly and severity of endometriosis present. (Source: The Journal of Minimally Invasive Gynecology)


Robotic Stapler for Coincidental Appendectomy
Coincidental appendectomy has been shown to be beneficial in numerous patient populations such as patients with endometriosis and chronic pelvic pain. Previous reports have noted that laparoscopic surgical staplers used at the time of gynecologic surgery allow for simple, rapid removal of the appendix with decreased procedure time and no spillage of appendiceal contents into the peritoneal cavity. The use of a robotic stapler will provide the same benefits and eliminate the need of the surgeon to rely on conventional laparoscopy to complete the appendectomy. (Source: The Journal of Minimally Invasive Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Laparoscopic Supracervical Hysterectomy of Uterine Didelphys with Cervical Atresia and Renal Agenesis
We present the case of a 16 year old nulligravid patient with chronic pelvic pain, hematometra, hematosalpinx and didelphys, bicollis uterus with atretic cervix. (Source: The Journal of Minimally Invasive Gynecology)


Chronic Pelvic Pain & Stress Urinary Incontinence Resolution after Laparoscopic TVT Removal & Burch/Paravaginal Repair
1) Discuss the surgical treatment of pain complications associated with TVT type retropubic slings 2) demonstrate our laparoscopic approach to complete TVT removal 3) demonstrate simultaneous laparoscopic Burch and paravaginal repair for stress urinary incontinence (SUI) and a cystocele. (Source: The Journal of Minimally Invasive Gynecology)


Is there a role for vitamin D in the treatment of chronic pain?
Abstract A brief survey of recent literature was conducted with regard to vitamin D and pain. There is evidence for and against a role for vitamin D in the treatment of chronic pain. The contradictory findings may have to do with study design or perhaps the type and intensity of pain. To answer the question whether there is a role for vitamin D in the treatment of chronic pain, larger and longer duration studies need to be conducted. The design should also be such to assess whether vitamin D might act to increase the effectiveness of existing analgesics and/or reduce the dose and duration of their use, thereby increasing safety. (Source: Inflammopharmacology)


BDNF-trkB-KCC2-GABA pathway may be related to chronic stress-induced hyperalgesia at both the spinal and supraspinal level
Chronic stresses can induce physiological and psychological changes and result in stress-related neuropsychiatry, sometimes they may also contribute to hypersensitivity to pain known as stress-induced hyperalgesia (SIH). Recently it was found that GABAergic disinhibition is closely related to morphine and chronic inflammation pain induced hyperalgesia in the PAG (periaqueductal gray)-RVM (rostral ventromedial medulla) -spinal descending facilitatory system, the changes of potassium-chloride co-transporter 2 (KCC2) function or expression modulated by brain-derived neurotrophic factor (BDNF) are involved in it. (Source: Medical Hypotheses)


Mental health disorders among women victims of conflict-related sexual violence in the Democratic Republic of Congo - Dossa NI, Zunzunegui MV, Hatem M, Fraser WD.
To assess the effects of sexual violence (SV) in armed conflicts on women's mental health, on its own and in conjunction with reproductive health issues such as fistula or chronic pelvic pain (CPP). A cross-sectional population-based study of 320 women liv... (Source: SafetyLit: All (Unduplicated))<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Perception of venipuncture pain in children suffering from chronic diseases
Conclusions: Our study suggests that children with chronic diseases have a lower pain threshold than children of the same sex and age who experience venipuncture for the first time. (Source: BMC Research Notes)


Minimally invasive facet restoration implant for chronic lumbar zygapophysial pain: 1-year outcomes
Conclusions: A minimally invasive facet restoration implant is a promising treatment option in select patients with chronic lumbar zygapophysial pain who have exhausted nonsurgical treatments, with therapeutic benefit persisting at 1?year follow-up. (Source: Annals of Surgical Innovation and Research)


The prevalence of fibromyalgia in the general population – a comparison of the American College of Rheumatology 1990, 2010 and modified 2010 classification criteria
Conclusion Fibromyalgia prevalence varies with the different classification criteria – specifically, prevalence is higher, and a greater proportion of men are identified, with the modified 2010 criteria, compared to those requiring clinician input. This has important implications for the use of the new criteria both in research and in clinical practice. © 2014 American College of Rheumatology. (Source: Arthritis and Rheumatism)


Association between fibromyalgia and adverse perioperative outcomes
Conclusions We found no evidence that the diagnosis of fibromyalgia increased the risk of in-hospital complications. Fibromyalgia seems to be associated with a reduction in in-hospital mortality, but this requires confirmation with a large prospective controlled study. (Source: British Journal of Anaesthesia)


AP pelvis and frog lateral for a limping child
A 5-year-old boy presented to the emergency department with a limp on the left side. The examination was unremarkable, and inflammatory markers were normal. An anteroposterior (AP) pelvic radiograph was arranged (figure 1), and the child was referred to fracture clinic. No lateral radiographs were obtained. Due to a slight irregularity in the articular surface, an MRI scan was organised to investigate the possibility of Legg&ndash;Calv&eacute;&ndash;Perthes disease. The child's symptoms settled; his parents missed his MRI scan appointment. Two years later, the child presented with pain on the opposite side. AP and lateral radiographs showed bilateral slipped upper femoral epiphysis (SUFE) (figures 2 and 3). A CT scan confirmed the diagnosis, with severe chronic slip on the left that was mi...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Commentary: Dennis D. Drotar Distinguished Research Award: Innovations in Pediatric Chronic Pain Research
(Source: Journal of Pediatric Psychology)


Impaired pre-attentive auditory processing in fibromyalgia: A mismatch negativity (MMN) study
Fibromyalgia (FM) is a commonly encountered chronic pain disorder characterized by widespread pain and tenderness, which are often accompanied by affective and cognitive symptoms (Wolfe et al., 1990; Clauw, 2009; Clauw et al., 2011). A high proportion of patients with FM exhibit cognitive deficits in attention (de Melo et al., 2012), executive function (Verdejo-Garcia et al., 2009), and working memory (Luerding et al., 2008). Recently, the American College of Rheumatology included cognitive symptoms among the developing diagnostic criteria for FM (Wolfe et al., 2010). (Source: Clinical Neurophysiology)


Chronic Pain Malpractice Claims on the RiseChronic Pain Malpractice Claims on the Rise
More claims are now associated with chronic pain management, especially for certain procedures, such as cervical neuraxial injections, device implantations, and opioid prescriptions. Medscape Medical News (Source: Medscape Medical News Headlines)


Health Tip: Pain in the Foot?
Title: Health Tip: Pain in the Foot?Category: Health NewsCreated: 10/16/2014 12:00:00 AMLast Editorial Review: 10/16/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


The Ineffectiveness of Opioids for Chronic Pain
Let me first say that I am not a medical doctor. However, as the founder and CEO of a leading addiction treatment center, I sit on the front-lines of the prescription painkiller epidemic. From this vantage point, by working with addicts and their families and the physicians who treat addiction, I have come to learn a great deal about opioids.read more (Source: Psychology Today Addiction 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>


Clinical efficacy of oral risedronate therapy in Japanese patients with Paget’s disease of bone
Abstract Paget’s disease of bone (PDB) is a chronic disorder characterized by localized bone regions with excessive bone turnover. Although oral risedronate (17.5 mg daily for 8 weeks) was recently approved in Japan, its efficacy is not well understood. We retrospectively examined the efficacy of oral risedronate in PDB patients in a clinical setting. Eleven patients whose serum alkaline phosphatase (ALP) level exceeded the upper limit of the normal range were treated. Patients whose ALP levels normalized and remained so for 12 months after therapy initiation were defined as responders. Treatment was repeated if bone pain recurred or if serum ALP levels increased at least 25% above the nadir. Six patients (55%) were responsive to the therapy. A higher prevalence of skull lesi...


[Endoprosthetic treatment of the ankle.]
CONCLUSION: Total ankle replacement is a good option for treating osteoarthritis of the ankle joint in rheumatoid arthritis when attention is paid to the eligibility of the patients. PMID: 25315121 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Rheumatologie)


Post-tonsillectomy complications more likely in children from lower-income families
Removing a child’s tonsils is one of the most common surgeries performed in the United States, with approximately 500,000 children undergoing the procedure each year. New research by doctors at UCLA finds that children from lower-income families are more likely to have complications following the surgery. In the first study of its kind to analyze post-operative complications requiring a doctor’s visit within the first 14 days after tonsillectomy, researchers saw a significant disparity based on income status, race and ethnicity. “Surprisingly, despite all children having a relatively uniform health status before surgery, we found significant differences in the numbers of children requiring revisits after their tonsillectomies,” said co-author Dr. Nina Shapiro, director of pediatri...


Post-Op Pain Management Improves in Past Decade, Survey Shows
Title: Post-Op Pain Management Improves in Past Decade, Survey ShowsCategory: Health NewsCreated: 10/14/2014 12:00:00 AMLast Editorial Review: 10/15/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Risks From Epidural, Spinal Anesthesia Very Low, Study Says
Title: Risks From Epidural, Spinal Anesthesia Very Low, Study SaysCategory: Health NewsCreated: 10/14/2014 12:00:00 AMLast Editorial Review: 10/15/2014 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>


Opioid prescribing by physicians with and without electronic health records.
CONCLUSIONS: We found higher levels of opioid prescribing among physicians with EHRs compared to those without. These results highlight the need to better understand how using EHR systems may influence physician prescribing behavior so that EHRs can be designed to reliably guide physicians toward high quality care. PMID: 25300237 [PubMed - in process] (Source: Pain Physician)


Physician practicing preferences for conventional or homeopathic medicines in elderly subjects with musculoskeletal disorders in the EPI3-MSD cohort.
CONCLUSION: NSAID use was significantly higher in elderly MSD patients consulting a conventional practice general practitioner. In contrast, analgesic use and MSD evolution were similar in the three groups. Consulting a homeopathic physician for MSD management does not appear to represent a loss of therapeutic opportunity, and decreases the use of NSAIDs. PMID: 25298739 [PubMed] (Source: Pain Physician)


Methotrexate in chronic-recurrent calcium pyrophosphate deposition disease: no significant effect in a randomized cross-over trial
Conclusion: The results of this trial with MTX in this elderly population with chronic or recurrent CPPD arthropathy, suggest no strong effect of MTX on disease activity.Trial registrationEudraCT No: 2007-003479-37, registered 2008-03-26 (Source: BioMed Central)


Influence of a new 5‐HT4 receptor partial agonist, YKP10811, on visceral hypersensitivity in rats triggered by stress and inflammation
Conclusions & InferencesYKP10811exhibits antinociceptive activity in inflammation and acute stress‐induced colonic hypersensitivity through 5‐HT4 receptors but unlike tegaserod, YKP10811 maintains its activity after repeated administrations and may represent a new candidate to treat IBS‐C patients. This MS evaluates the influence of a new 5‐HT4 receptor partial agonist on visceral pain in different animal models of colonic hypersenstivity to distension in rats. (Source: Neurogastroenterology and Motility)


Managing chronic pain in adults.
Authors: Barrie J, Loughlin D Abstract The management of chronic pain is complex. Services and support for people living with chronic pain are variable despite the publication of a number of reports highlighting the problem. Due to the epidemiology of pain, nurses deliver care to patients with persistent pain in a variety of settings. It is important that nurses have the knowledge, skills and correct attitude to deliver compassionate, person-centred care, in line with best practice in chronic pain management. PMID: 25315569 [PubMed - in process] (Source: Nursing Standard)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Comparing core stability and general exercise on chronic low back pain patients using three functional lumbopelvic stability tests.
Authors: Shamsi M, Sarrafzadeh J, Jamshidi A Abstract Abstract It is a matter of controversy whether core stability exercise is preferred to other types of exercise for chronic low back pain. Lumbopelvic stability is an important element in low back pain. No study was found using lumbopelvic stability tests in comparing core stability and other exercises. The single leg squat, dip test, and runner pose test appear to be suitable as tests for lumbopelvic stability. The aim of this study was to compare "core stability" and "traditional trunk exercise" using these tests and also the Oswestry disability questionnaire and pain intensity. Twenty-nine non-specific chronic low back pain subjects were alternately allocated in one of the two exercise groups. For both groups, a 16-sessions ex...


Microglia phenotypes in the spinal cords of aging and obese mice: Comorbidity with altered sensory response
In this study, we aimed to characterize the phenotypes of spinal microglia in both obese and aging conditions and to seek whether there is a direct correlation between spinal microglial activation and impaired sensory response. (Source: Journal of Neuroimmunology)


Neuropathic pain-induced depressive-like behavior is associated with myelin remodeling and impaired neurogenesis
Patients suffering from neuropathic pain have a higher incidence of mood disorders such as depression. Increased expression of TNF has been reported in neuropathic pain and depressive-like conditions and most of the pro-inflammatory effects of TNF are mediated by TNF receptor 1. Here we sought to investigate 1) the occurrence of anhedonia in chronic neuropathic pain and the associated forms of hippocampal plasticity and 2) the involvement of TNFR1-mediated TNF signaling as a possible regulator of such events. (Source: Journal of Neuroimmunology)


Analgesic topical capsaicinoid therapy increases somatostatin-like immunoreactivity in the human plasma
• We have determined the capsaicinoid content of EMSPOMA® cream by LC-MS/MS.• Nonivamide (0.01%) was identified as the only capsaicinoid molecule in the cream.• Local nonivamide treatment exerts analgesic action in chronic low back pain.• Nonivamide treatment causes threefold elevation in the plasma level of SST-LI.• Somatostatin may play role in the pain-relieving effect. (Source: Neuropeptides)


Septic Cavernous Sinus Thrombosis Caused by Sinusitis
By Ichwan, Brian MD; Barrie, Michael MD; Neltner, Kurt MD A 37-year-old man with no significant medical history presented to the emergency department with a headache. He described it as an insidious, constant severe pain that was initially localized occipital but progressed to a bitemporal distribution. His neurologic exam, extraocular movements, and visual acuity were all normal. The patient was given symptomatic treatment with compazine and Benadryl. He was responsive to therapy and discharged home after his headache symptoms resolved.   Seven days later, however, he presented to the emergency department with a worsening headache, progressive altered mental status, fever, and bilateral proptosis. His temperature was of 103.9°F, blood pressure was 194/82 mm Hg, pulse rate was 87 bpm,...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Satellite glial cells in dorsal root ganglia are activated in streptozotocin‐treated rodents
Abstract Neuropathic pain is a very common complication in diabetes mellitus (DM), and treatment for it is limited. As DM is becoming a global epidemic it is important to understand and treat this problem. The mechanisms of diabetic neuropathic pain are largely obscure. Recent studies have shown that glial cells are important for a variety of neuropathic pain types, and we investigated what are the changes that satellite glial cells (SGCs) in dorsal root ganglia undergo in a DM type 1 model, induced by streptozotocin (STZ) in mice and rats. We carried out immunohistochemical studies to learn about changes in the activation marker glial fibrillary acidic protein (GFAP) in SGCs. We found that after STZ‐treatment the number of neurons surrounded with GFAP‐positive SGCs in dorsal root gang...


An extended evaluation of a dedicated male chronic pelvic pain clinic within a sexual health service
We performed a follow on service evaluation of the male pelvic pain clinic1 undertaken by PH for patients who attended during 1 October 2012 to 31 March 2013. Notes were available for 24/28 (86%) patients. Patients were managed as detailed in the recent &lsquo;How to&rsquo; article.2 In 2012, the mean age was 36.9&nbsp;years, mean National Institutes of Health &ndash; Chronic Prostatitis Symptom Index score 24.7 at presentation and 15.2 at final review, with 15 (62.5%) having a &gt;25% improvement in symptom score which was similar to our 2010 evaluation. The proportion of patients receiving antibiotics (95.8%), &alpha;-blockers (87.5%) and amitriptyline (29.2%) was also comparable.1 Of the 11 (46%) patients referred to urology, outcome was recorded for eight patients. Of these, only two p...


Gall bladder lymphoid hyperplasia: Masquerading as lymphoma
Safia Rana, Zeeba S Jairajpuri, Sabina Khan, Mohammed Jaseem Hassan, Sujata JetleyJournal of Cancer Research and Therapeutics 2014 10(3):749-751Lymphoid hyperplasia of the gall bladder is an extremely rare condition that may be missed on associated radiological or clinical evaluation but is diagnosed on biopsy. We are reporting hereby, a case of reactive lymphoid hyperplasia masquerading as a lymphoma on histopathology. A 58-year-old male was referred to our hospital with complaints of pain abdomen infrequently since last one year. Ultrasonography revealed the presence of single calculus along with features of chronic cholecystitis. Laparoscopic cholecystectomy was performed and the gall bladder was sent for routine histopathological evaluation. On microscopic examination, there were sheet...


Allopurinol for chronic gout.
CONCLUSIONS: Our review found low- to moderate-quality evidence indicating similar effects on withdrawals due to AEs and SAEs and incidence of acute gout attacks when allopurinol (100 to 600 mg daily) was compared with placebo, benzbromarone (100 to 200 mg daily) or febuxostat (80 mg daily). There was moderate-quality evidence of little or no difference in the proportion of participants achieving target serum urate when allopurinol was compared with benzbromarone. However, allopurinol seemed more successful than placebo and may be less successful than febuxostat (80 mg daily) in achieving a target serum urate level (6 mg/dL or less; 0.36 mmol/L or less) based on moderate- to low-quality evidence. Single studies reported no difference in pain reduction when allopurinol (300 mg daily) was co...