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Medworm: Chronic Pain - Recent Medical Updates

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Bariatric Surgery Patients’ Response to a Chronic Pain Rehabilitation Program
Conclusions These results suggest that bariatric patients may be at risk for treatment non-adherence and have difficulty reducing medication use in the treatment of chronic pain. (Source: Obesity Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


The PREEMPT study - evaluating smartphone-assisted n-of-1 trials in patients with chronic pain: study protocol for a randomized controlled trial
DiscussionTrialist will allow patients and clinicians to conduct personalized n-of-1 trials. In prior studies, n-of-1 trials have been shown to encourage greater patient involvement with care, which has in turn been associated with better health outcomes. mHealth technology implemented using smartphones may offer an efficient means of facilitating n-of-1 trials so that more patients can benefit from this approach.Trial registrationClinicalTrials.gov: NCT02116621, first registered 15 April 2014. (Source: Trials)


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


Trigeminal neuralgia: pain, pricks, and anxiety.
Authors: Puskar KR, Droppa M Abstract Trigeminal neuralgia (TN) is one of the most common forms of neuralgia experienced by older adults. Early in the course of the illness, individuals may be misdiagnosed, with associated delays in treatment. The current article uses an individual example to provide a framework for assessment and clinical management. Because pain associated with TN may be chronic, specific quality of life issues and related management approaches are presented, as well as guidelines for monitoring response to treatment. Targeted strategies to prevent pain triggers and suggestions for supportive coaching provide direction for health providers caring for older adults with TN. [Journal of Gerontological Nursing, 41(3), 8-12.]. PMID: 25710263 [PubMed - in process]...


Association of care practices with suicide attempts in US veterans prescribed opioid medications for chronic pain management - Im JJ, Shachter RD, Oliva EM, Henderson PT, Paik MC, Trafton JA.
IMPORTANCE: Patients receiving opioid therapy are at elevated risk of attempting suicide. Guidelines recommend practices to mitigate risk, but it is not known whether these are effective. OBJECTIVE: Our aim was to examine associations between the r... (Source: SafetyLit: All (Unduplicated))<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Look Behind the Bedroom Door at What's Causing Your Low Libido
In today's pop culture, sex appears to be everywhere, especially as the 50 Shades of Grey books and movie continue to spur conversation about sexual desires and fantasies. But while our society seems more comfortable with women talking about sex, wanting sex and having sex, many still squirm at the idea of having a conversation with their partners, friends and health care providers. In my practice, many women bring up their sexual problems with "oh by the way..." when their hand is on the doorknob as they leave my office. What these women may not know is sexual health can have a serious impact on overall health, relationships and mental wellbeing, which is why it shouldn't be an afterthought when talking to your health care provider. They can help you find solutions! There are different...


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


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


Evaluation and Management of Back Pain in the Elderly
Abstract Back pain is common in the elderly. Most back pain is uncomplicated but identifying back pain due to serious systemic disease is essential. History and physical exam are critical to this distinction and guide further diagnostic evaluation. There are numerous treatments available for acute and chronic back pain, yet there are special considerations when treating the elderly. Treatment is comprehensive with pharmacotherapy, physical therapy, and alternative methods. Pharmacologic therapy for back pain is targeted at reducing inflammation and providing analgesia. Physical therapy is a necessary part of any treatment plan. Non-pharmacologic treatments are broad in scope and consist of activity-based modalities and alternative therapies. Acute back pain generally has a good pr...


Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial
Conclusion: Subxyphoid pleural drainage in severe Chronic obstructive pulmonary disease patients determined better preservation and recovery of pulmonary capacity and volumes with lower pulmonary shunt fraction and better clinical outcomes on early postoperative off-pump coronary artery bypass grafting. Objetivo: Avaliar a função pulmonar e os resultados clínicos em pacientes com doença pulmonar obstrutiva crônica grave submetidos à cirurgia de revascularização do miocárdio sem circulação extracorpórea, com enxerto da artéria torácica interna esquerda, comparando a inserção do dreno pleural intercostal versus subxifoide. Métodos: Estudo clínico, controlado e randomizado. Pacientes com doença pulmonar obstrutiva crônica foram randomizados em dois grupos de acordo com a p...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


May-Thurner syndrome and other obstructive iliac vein lesions: Meaning, myth, and mystery
This article seeks to improve the knowledge base of vascular practitioners who make clinical decisions about the diagnosis and treatment of obstructive iliac vein lesions. (Source: Vascular Medicine)


Promethazine use among chronic pain patients
Concomitant use of opioids and promethazine has been reported in various subpopulations, including methadone maintenance patients, injection drug users, and at-risk teenagers. Promethazine is thought to potentiate the “high” from opioids. However, to date, the prevalence of promethazine use has not been determined among patients prescribed opioids for chronic pain. (Source: Drug and Alcohol Dependence)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Interdisciplinary pain management is beneficial for refractory orchialgia in children
Idiopathic testicular/groin pain can be a difficult entity for children, their families, and caregivers. The role of interdisciplinary pain management has previously been demonstrated in treating chronic orchialgia at the present pediatric pain clinic. (Source: Journal of Pediatric Urology)


PROMIS ® pediatric self-report scales distinguish subgroups of children within and across six common pediatric chronic health conditions
Conclusions PROMIS measures discriminate between different clinically meaningful subgroups within several chronic illnesses. Further research is needed to determine the responsiveness of the PROMIS pediatric scales to change over time. (Source: Quality of Life Research)


ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, and others)
Title: ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, and others)Category: MedicationsCreated: 12/31/1997 12:00:00 AMLast Editorial Review: 2/25/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Health Tip: Avoid Overdosing on Pain Medication
Title: Health Tip: Avoid Overdosing on Pain MedicationCategory: Health NewsCreated: 2/25/2015 12:00:00 AMLast Editorial Review: 2/25/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


oxycodone, OxyContin, Roxicodone, Oxecta
Title: oxycodone, OxyContin, Roxicodone, OxectaCategory: MedicationsCreated: 5/11/1998 12:00:00 AMLast Editorial Review: 2/25/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


FDA clears Bioness' StimRouter device for chronic pain
The FDA has granted market clearance to Bioness' StimRouter device for the treatment of chronic peripheral pain. The FDA has granted market clearance for Bioness&#39; Stimrouter for the treatment of chronic peripheral pain. The company describes StimRouter as a minimally invasive, implanted neuromodulation device that sends electrical signals to the pain&#39;s point of origin. The device is controlled by a wireless, hand-held unit. Bioness Inc., Food & Drug Administration (FDA)News Well, Neuromodulation/Neurostimulation, Regulatoryread more (Source: Mass Device)


One in 3 women could potentially be spared chronic pain after breast cancer surgery
(St. Michael's Hospital) One in every three women undergoing a mastectomy could potentially be spared chronic post-operative pain if anesthesiologists used a regional anesthetic technique in combination with standard care, according to a new study. (Source: EurekAlert! - Cancer)


Risk of Associated Conditions in Relatives of Subjects With Interstitial Cystitis
Conclusions: These results suggest that myalgia and myositis/unspecified (fibromyalgia) as well as constipation are likely to share underlying genetic factors with IC/PBS. (Source: Female Pelvic Medicine and Reconstructive Surgery)


Pneumatosis Intestinalis in a Corticosteroid-Dependent Child
A 12-year-old boy with pseudohypoaldosteronism, chronic lung disease, hypopituitarism, gastrostomy button, and corticosteroid-dependence presented with 1 day of crampy periumbilical and left upper-quadrant abdominal pain that did not radiate. He was afebrile and had no nausea, vomiting, diarrhea, or constipation. The family had not vented the gastrostomy tube, but he had been tolerating feeds well. On arrival, his vital signs demonstrated a temperature of 98.1°F, pulse of 86 beats/min, respiration was 24 breaths/min, blood pressure 112/71 mm Hg, and oxygen saturations of 95% in ambient air. (Source: The Journal of Emergency Medicine)


Quality of life assessment among HIV‐positive persons entering the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial
ConclusionsIn this primarily healthy population, QOL was mostly favourable, emphasizing that it is important that HIV treatments do not negatively impact QOL. Self‐assessed physical health summary scores were higher than mental health scores. Factors such as older age and geographical region had different effects on perceived physical and mental health. (Source: HIV 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>


How Effective Is Melatonin as a Preventive Treatment for Hemicrania Continua? A Clinic‐Based Study
ConclusionFrom this single clinic investigation, only a small percent of subjects with hemicrania continua (less than 20%) will achieve pain freedom on melatonin, thus clearly not matching the effectiveness of indomethacin. However, the addition of melatonin to indomethacin may allow around 45% of patients to have complete or partial relief of their headache with the subsequent ability to reduce or eliminate their indomethacin dosage, which may lead to a decrease in medical morbidity over time secondary to less exposure to indomethacin. (Source: Headache: The Journal of Head and Face Pain)


Study protocol: a randomised controlled trial comparing the long term effects of isolated hip strengthening, quadriceps-based training and free physical activity for patellofemoral pain syndrome (anterior knee pain)
DiscussionThis trial will help to elucidate the role of hip and quadriceps strengthening in the treatment of PFPS. Information as to the role of anxiety and depression, kinesiophobia and self-efficacy will be collected, also as regards prognosis and response to exercise therapy.Trial registrationClinicalTrials.gov reference: NCT02114294. (Source: BMC Musculoskeletal Disorders)


Effectiveness and cost-effectiveness of a health coaching intervention to improve the lifestyle of patients with knee osteoarthritis: cluster randomized clinical trial
DiscussionIf the analyses show the cost-effectiveness and cost-utility of the intervention the results can be incorporated into the clinical guidelines for the management of knee osteoarthritis in primary care.Trial registrationISRCTN57405925. Registred 20 June 2014. (Source: BMC Musculoskeletal Disorders)


Pharmacologic Modulation of Hand Pain in Osteoarthritis: A Double‐Blind Placebo‐Controlled Functional Magnetic Resonance Imaging Study Using Naproxen
ConclusionThis study demonstrates the sensitivity of fMRI to detect the mechanisms underlying treatments of known efficacy. The data illustrate the enticing potential of fMRI as an adjunct to self‐report for detecting early signals of efficacy of novel therapies, both pharmacologic and nonpharmacologic, in small numbers of individuals with persistent pain. (Source: Arthritis and Rheumatism)


The Role of Radiology in Central Nervous System Stimulation.
This article will address the expanding role of radiology and highlight issues, including MRI safety concerns, that radiologists may encounter when confronted with a patient with CNS stimulation equipment in situ. PMID: 25715044 [PubMed - as supplied by publisher] (Source: The British Journal 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 Role of Multimodality Imaging After Cesarean Delivery
This article reviews the range of normal imaging findings after cesarean delivery, as well as the imaging manifestations of complications, both acute and chronic. (Source: Ultrasound Quarterly)


Pathophysiology of Pain: Implications for Perioperative Nursing
This article provides a brief description of the pathophysiology of pain and the components of nociceptive and neuropathic pain pathways to aid the perioperative nurse in pain management. (Source: AORN Journal)


Pro‐protein convertase subtilisin/kexin 9 concentrations correlate with coronary artery disease atheroma burden in a Pakistani cohort with chronic chest pain
ConclusionsProprotein convertase subtilisin kexin 9 concentrations are correlated with atheroma burden in Indian Asian populations from the sub‐continent, not taking statin therapy, independent of LDL‐C or other CVD risk factors. (Source: International Journal of Clinical Practice)


Drugs used to treat joint and muscle disease
Publication date: Available online 19 February 2015 Source:Anaesthesia &amp; Intensive Care Medicine Author(s): David G. Lambert Joint disease: Arthritis can be simply broken into osteoarthritis and rheumatoid arthritis (RA). Osteoarthritis is treated with symptomatic pain relief and surgery. RA is a chronic autoimmune disease that causes inflammation of joints (leading to their destruction), tissues around joints and other organ systems. Treatment (for pain) of RA in the first instance is with non-steroidal anti-inflammatory drugs, with second-line treatment using disease-modifying antirheumatic drugs (DMARDs). DMARDs are a disparate group and include methotrexate, d-penicillamine, sulphasalazine, gold salts, antimalarial drugs and immunosuppressant drugs. The newer class of ‘biol...


Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline
ConclusionChronic prostatitis can present with a wide variety of signs and symptoms.Identification of individual symptom patterns and a symptom‐based treatment approach are recommended.Further research is required to evaluate management options for CBP and CP/CPPS.This article is protected by copyright. All rights reserved. (Source: BJU 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>


Changes in Disability, Physical/Mental Health States and Quality of Life during an 8-Week Multimodal Physiotherapy Programme in Patients with Chronic Non-Specific Neck Pain: A Prospective Cohort Study
Conclusion After 8 weeks of a MPP that integrated land-based physical TE, health education and adapted swimming, clinically-relevant and statistically-significant improvements were observed for disability, physical and mental health states and quality of life in patients who suffer CNSNP. The clinical efficacy requires verification using a randomised controlled study design. Trial Registration ClinicalTrials.gov NCT02046876 (Source: PLoS One)


Chronic Pelvic Pain Syndrome: Reduction of Medication Use After Pelvic Floor Physical Therapy with an Internal Myofascial Trigger Point Wand
This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1–10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient’s discretion. Changes in medication use were assessed by McNemar’s test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, ...


Efficacy and cost‐effectiveness: A study of different treatment approaches in a tertiary pain centre
ConclusionsThis clinical report demonstrates the relevance of biopsychosocial approaches in the improvement of pain and psychological factors in chronic pain patients. The study further reveals the larger impact of self‐hypnosis/self‐care learning treatment, in addition to a cost‐effectiveness benefit of this treatment comparative to other interventions. (Source: European Journal of Pain)


Carvedilol-Induced Hyperkalemia in a Patient With Chronic Kidney Disease
A 69-year-old male was admitted to the hospital with a chief complaint of abdominal pain, nausea, and vomiting. He had an extensive past medical history, including diabetes mellitus type 2 and chronic kidney disease stage III. Prior to admission, the patient was taking carvedilol 3.125 mg twice daily with no abnormality in his serum potassium. During hospitalization, his carvedilol was increased to 6.25 mg twice daily. The patient&rsquo;s serum potassium then rose from 4.8 to 6.7 mEq/L, with no improvement following administration of sodium polystyrene sulfonate. Nephrology concluded the carvedilol could be contributing to the hyperkalemia. The dose was decreased back to 3.125 mg twice daily, leading to the potassium normalizing to 4.4 mEq/L. The reported incidence of beta-blocker&ndash;in...


Photoplethysmography variability as an alternative approach to obtain heart rate variability information in chronic pain patient
This study investigated the correlation coefficient (by Pearson correlation) and agreement (by Bland–Altman analysis) between PRV and HRV in chronic pain patients in the clinical setting. The results showed high significant correlations (p &lt; 0.001, r &gt; 0.86) between all the HRV and PRV parameters and good agreements (ratio &lt; 0.1) between the parameters in terms of HR, mean RR, VLF, LF, nLF, nHF, and SD1/SD2. Our study suggests that HRV can also be reliably estimated using the photoplethysmography-based PP interval in elderly patients with chronic pain. (Source: Journal of Clinical Monitoring and Computing)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective
The intent of this paper is to discuss the evolving role of the myofascial trigger point (MTrP) in myofascial pain syndrome (MPS) from both a historical and scientific perspective. MTrPs are hard, discrete, palpable nodules in a taut band of skeletal muscle that may be spontaneously painful (i.e. active), or painful only on compression (i.e. latent). MPS is a term used to describe a pain condition which can be acute or, more commonly, chronic and involves the muscle and its surrounding connective tissue (e.g. (Source: PM and R)


Chronic Pelvic Pain Syndrome: Reduction of Medication Use After Pelvic Floor Physical Therapy with an Internal Myofascial Trigger Point Wand.
This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion. Changes in medication use were assessed by McNemar's test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median...


Reduction of blood nitric oxide levels is associated with clinical improvement of the chronic pelvic pain related to endometriosis.
The objective of this prospective study was to determine the plasma levels of nitric oxide (NO) in women with chronic pelvic pain secondary to endometriosis (n=24) and abdominal myofascial pain syndrome (n=16). NO levels were measured in plasma collected before and 1 month after treatment. Pretreatment NO levels (μM) were lower in healthy volunteers (47.0±12.7) than in women with myofascial pain (64.2±5.0, P=0.01) or endometriosis (99.5±12.9, P&lt;0.0001). After treatment, plasma NO levels were reduced only in the endometriosis group (99.5±12.9 vs 61.6±5.9, P=0.002). A correlation between reduction of pain intensity and reduction of NO level was observed in the endometriosis group [correlation = 0.67 (95%CI = 0.35 to 0.85), P&lt;0.0001]. Reduction of NO levels was associated with an ...


[Different Health Impairments at the Beginning of Medical Rehab: Possibilities of More Flexibility Using the Example of Rehab Aftercare.]
Conclusion: Rehabilitation patients, who begin rehabilitation with rather low impairments perpetuate their rehabilitation effects with an even reduced aftercare. Aftercare-programs should therefore be adapted to the individual needs. Rehabilitation patient, who start the rehabilitation with relative good health, seem not to have an added value from an intensive aftercare-program. PMID: 25710303 [PubMed - as supplied by publisher] (Source: Die Rehabilitation)


CYP2B6*6 allele and age substantially reduce steady‐state ketamine clearance in chronic pain patients: impact on adverse effects
ConclusionsThe CYP2B6*6 allele is associated with a substantial decrease in steady‐state ketamine plasma clearance in chronic pain patients. The decreased clearance and resultant higher plasma concentrations may be associated with a higher incidence of ketamine adverse effects. (Source: British Journal of Clinical Pharmacology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


'My daughter's relentless pain was so bad she committed suicide'
Like Jennifer Aniston's character in the new film Cake, David Kelly's daughter Julia (left with David) had been battling chronic pain after two car accidents. The condition affects 1.5 billion people. (Source: the Mail online | Health)


Calcitonin gene‐related peptide expressing sensory neurons and spinal microglial reactivity contribute to pain states in collagen‐induced arthritis
Conclusions Sensory neuron derived CGRP sustains mechanical hypersensitivity and spinal microglial reactivity in CIA suggesting that central mechanisms play critical roles in chronic inflammatory pain. Blockade of these central events may provide pain relief in RA patients. This article is protected by copyright. All rights reserved. (Source: Arthritis and Rheumatism)


The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: a randomized controlled trial
Chronic low back pain is one of the most common problematic health conditions worldwide and is highly associated with disability, quality of life, emotional changes, and work absenteeism. Graded activity programs, based on cognitive behavioral therapy, and exercises are common treatments for patients with low back pain. However, recent evidence has shown that there is no evidence to support graded activity for patients with chronic nonspecific low back pain. (Source: Manual Therapy)


Quantitative meta‐analysis of grey matter anomalies in neuropathic pain
ConclusionsThis meta‐analysis shows strong evidence of brain GM anomalies within the pain matrix in patients with neuropathic pain compared with healthy subjects. Further studies are needed to determine whether the reported changes are specific to neuropathic pain or whether they may be common to other chronic pain. (Source: European Journal of Pain)


Evidence for brain glial activation in chronic pain patients
Although substantial evidence has established that microglia and astrocytes play a key role in the establishment and maintenance of persistent pain in animal models, the role of glial cells in human pain disorders remains unknown. Here, using the novel technology of integrated positron emission tomography-magnetic resonance imaging and the recently developed radioligand 11C-PBR28, we show increased brain levels of the translocator protein (TSPO), a marker of glial activation, in patients with chronic low back pain. As the Ala147Thr polymorphism in the TSPO gene affects binding affinity for 11C-PBR28, nine patient&ndash;control pairs were identified from a larger sample of subjects screened and genotyped, and compared in a matched-pairs design, in which each patient was matched to a TSPO po...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Detection of Significant Coronary Artery Disease by Noninvasive Anatomical and Functional Imaging [Coronary Artery Disease]
Conclusions&mdash; In a multicenter European population of patients with stable chest pain and low prevalence of CAD, coronary computed tomographic angiography is more accurate than noninvasive functional testing for detecting significant CAD defined invasively. Clinical Trial Registration&mdash; URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979199. (Source: Circulation: Cardiovascular Imaging)


Surgery for deep venous incompetence.
CONCLUSIONS: No evidence was found for benefit or harm of valvuloplasty in the treatment of patients with DVI secondary to primary valvular incompetence. The individual trials included in this review were small; they used different methods of assessment and overall were of poor quality. They did not include participants with severe DVI. Trials investigating the effects of other surgical procedures on deep veins are needed. Until the findings of such trials become available, the benefit of valvuloplasty remains uncertain. PMID: 25702915 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Quality of life scales for patients with gastroesophageal reflux disease: A literature review
Publication date: Available online 21 February 2015 Source:International Journal of Nursing Sciences Author(s): Xiao-Li Guan , Hui Wang Gastroesophageal reflux disease (GERD) is a common chronic disease of the gastrointestinal tract that occurs in 3.1% of the Chinese population [1]. Heartburn, acid regurgitation and epigastric pain are typical clinical symptoms of GERD. These symptoms can affect patients' work productivity, sleep, diet and daily activities, thus resulting in a reduced quality of life (QOL) [2]. Although patient QOL is increasingly being considered as a medical outcome index in the evaluation of the impact of GERD symptoms on patients' health status, measuring patient QOL in clinical trials can be challenging due to the lack of a standard assessment tool. Therefore, we ai...


Chronic joint pain in a child
Publication date: Available online 19 February 2015 Source:Diagnostic and Interventional Imaging Author(s): I. Ract , J. Storey , J.Y. Travers , G. Pastural , P. Gayon , M. Balu (Source: Diagnostic and Interventional Imaging)


Anesthesiology and anesthesiologists in the era of value-driven health care
Publication date: Available online 12 February 2015 Source:Healthcare Author(s): Lee A. Fleisher , Thomas H. Lee Anesthesiologists, as experts in perioperative, critical care and pain management can demonstrate value by being part of teams focusing on outcomes shared by hospitals, surgeons and themselves. This perspective outlines ways in which anesthesiologists can provide leadership in preoperative care, determining the site of surgical care associated with the best outcomes at the lowest cost and treating both in-hospital and chronic care. Providing value for our patients will be our ability to coordinate and to collaborate with other medical professionals throughout the entire care continuum with the goal of improving patient outcome. (Source: Healthcare)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Transforaminal interbody fusion of the lumbar spine - unilateral approach with contralateral percutaneous transfacet-tranpedicular screw fixation is it enough to secure positive outcome of minimal approach fusion?
The results of conservative surgical interventions on lumbar spine were presented in numerous studies. The main indication for surgical intervention was chronic symptoms of back pain and leg pain with clear radicular component on clinical examination confirmed with radiological findings. In our experience patients following conservative posterior approaches for fusion required longer time of recovery, more intense postoperative pain control, more significant blood loss perioperatively. (Source: The Spine Journal)


Lidocaine Preferentially Inhibits the Function of Purinergic P2X7 Receptors Expressed in Xenopus Oocytes.
CONCLUSIONS: Lidocaine selectively inhibited the function of the P2X7 receptor expressed in Xenopus oocytes. This effect may be caused by acting on sites in the ion channel pore both extracellularly and intracellularly. These results help to understand the mechanisms underlying the analgesic effects of lidocaine when it is administered locally at least. PMID: 25695577 [PubMed - in process] (Source: Anesthesia and Analgesia)


Transcranial Magnetic Stimulation in the Treatment of Chronic Widespread Pain: A Randomized Controlled Study
Discussion: Although some previous clinical studies and basic science studies of TMS in treating pain are promising, this study found no difference in the analgesic effect of TMS and sham stimulation. Future studies should use a sham condition that attempts to simulate the sound and sensation of the TMS stimulation. Stimulus location and other stimulus parameters should be explored in future studies. (Source: The Journal of ECT)


Palliative Care in the Ambulatory Geriatric Practice
This article focuses on 2 areas where the disciplines may differ in their approach. The first is planning for extreme illness and death, with explicit acknowledgment that limiting therapy might be a good idea. This situation is likely to have a different impact in the course of a routine geriatrics visit than in a palliative care context. The second is pain management, especially chronic pain. In patients with sharply limited life expectancy, the risk/benefit equation tilts easily toward narcotic use. In frail elders working to remain independent, the calculus may be quite different. (Source: Clinics in Geriatric Medicine)


Pathophysiology of Pain: Implications for Perioperative Nursing
This article provides a brief description of the pathophysiology of pain and the components of nociceptive and neuropathic pain pathways to aid the perioperative nurse in pain management. (Source: AORN Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Exercise Therapy for Chronic Pain
The benefit of exercise for pain control likely comes from the impact of exercise on the endogenous opioid system and on central pain modulatory systems. Patients with some chronic pain conditions seem to have a dysfunctional endogenous pain modulatory system, which should be considered when prescribing exercise. The prescription of exercise for chronic pain must address the biomechanical issues and the psychosocial factors that contribute to the patient’s pain and disability. Patient education, coordination of care within the health care team, and selecting an exercise regimen that is meaningful to and achievable by the patient are all important components to promote a successful rehabilitation program. (Source: Physical Medicine and Rehabilitation Clinics of North America)


Health Related Quality of Life in Rheumatoid Arthritis, Osteoarthritis, Diabetes Mellitus, End Stage Renal Disease and Geriatric Subjects. Experience From a General Hospital in Mexico
Conclusions The HRQoL in RA patients is poor and comparable to that of other chronic diseases (end-stage renal disease and diabetes mellitus). Rheumatic diseases should be considered as high impact diseases and therefore should receive more attention. (Source: Reumatologia Clinica)


Experimental low-level jaw clenching inhibits temporal summation evoked by electrical stimulation in healthy human volunteers
Temporomandibular disorders (TMD) have been reported to have a multifactorial etiology. Parafunctions are one of the proposed risk factors for TMD(1-3) Indeed, low level jaw muscle activity has been implicated in the pathophysiology of painful TMD conditions. Several studies have reported that a limited increase of jaw muscle activity, e.g., tooth contacting habit (TCH)1–3 or elevated sleep background activity,4 may be a contributing factor to chronic pain in TMD patients. Meanwhile, in experimental conditions, voluntary low-level jaw clenching can cause transient jaw muscle pain symptoms in healthy subjects. (Source: Archives of Oral Biology)


Pneumomediastinum after Nose Blowing
A 16-year-old boy had a sudden onset of chest and neck pain after repetitive forceful nose blowing. He had a medical history of allergic rhinitis and chronic sinusitis. On examination, he had diffuse crepitus felt from his neck to bilateral axillary regions. The radiograph showed lucent streaks of gas that outlined mediastinal structures and the lateral margin of the descending aorta with extension of subcutaneous emphysema in the neck and bilateral axillary regions (Figure 1). Computed tomography of the chest showed severe subcutaneous emphysema with pneumomediastinum and much gas surrounding the aortic arch and the descending aorta (Figure 2; available at www.jpeds.com). (Source: The Journal of Pediatrics)


Brain white matter abnormalities in female interstitial cystitis/bladder pain syndrome: A MAPP Network neuroimaging study
Several chronic pain conditions may be distinguished by condition-specific brain anatomical and functional abnormalities observed by imaging suggestive of underlying disease processes. Here we present the first characterization of IC/BPS-associated white matter (axonal) abnormalities based on multi-center neuroimaging from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. (Source: The Journal of Urology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Successful treatment of classic Kaposi sarcoma with topical timolol: report of two cases.
This article is protected by copyright. All rights reserved. PMID: 25704866 [PubMed - as supplied by publisher] (Source: The British Journal of Dermatology)


Phenotype, symptom severity and treatment in a 'cured' cohort of chronic pelvic pain syndrome patients.
CONCLUSIONS: Many men with CPPS can reach a subjective cure, however, the majority do not reach a CPSI score of 0. This group of "cured" patients is similar to our typical tertiary referral cohort in terms of age and phenotype but differs in having slightly lower pre-treatment CPSI scores. PMID: 25694009 [PubMed - in process] (Source: Canadian Journal of Urology)


Patient Heal Thyself: Engaging in a Team Approach
Abstract Interstitial cystitis/bladder pain syndrome is a chronic condition for which conventional treatment is highly individualistic, may have a limited effect if any, and is often a question of trial and error. The impact on the patient’s life is far-reaching and often greatly underestimated. The limitations of effectiveness, availability, reimbursement and affordability of conventional treatments mean that desperate patients actively seek alternative solutions, with or without professional guidance. Emotional support, empathy and understanding as well as practical support are needed from all players in the equation: the family doctor, the specialist, the physiotherapist, the patient’s family and partner and the patient support group, with the patient also being encouraged ...


Why You Should Give Your Doctor Access To Your Fitness Tracking Data
HACKENSACK, N.J. (AP) — That phone app keeping track of your exercise and meals might keep you out of the hospital one day. Why give your doctors permission to incorporate data from fitness trackers and health apps into electronic patient records? Well, they might spot signs of an ailment sooner and suggest behavioral changes or medication before you land in the emergency room. They also might be able to monitor how you're healing from surgery or whether you're following a treatment regimen. "Right now we only see our patients for about a 15-minute visit in the office, and it's a very constricted view," said Dr. Lauren Koniaris, a specialist in pulmonary critical care at Hackensack University Medical Center in New Jersey. "This really globalizes the view of their health sta...


Five hematologic tests and treatments to question.
Authors: Hicks LK, Bering H, Carson KR, Haynes AE, Kleinerman J, Kukreti V, Ma A, Mueller BU, O'Brien SH, Panepinto JA, Pasquini MC, Rajasekhar A, Sarode R, Wood WA Abstract Choosing Wisely® 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® 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® recommendations include: (1) do not anticoagulate for more than 3 months in patients experiencing a first 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>


Smoothing the crescent curve: sickle cell disease.
Authors: Talano JA, Cairo MS Abstract Sickle cell disease (SCD) is an inherited disorder secondary to a point mutation at the sixth position of the beta chain of human hemoglobin that results in the replacement of valine for glutamic acid. This recessive genetic abnormality precipitates the polymerization of the deoxygenated form of hemoglobin S that induces a major distortion of red blood cells (sickle red blood cells), which decreases sickle red blood cell deformability, leading to chronic hemolysis and vasoocclusion. These processes can result in severe complications, including chronic pain, end organ dysfunction, stroke, and early mortality. The only proven curative therapy for patients with SCD is myeloablative conditioning and allogeneic stem cell transplantation from HLA-mat...


Single‐ or multiple‐session viscosupplementation protocols for temporomandibular joint degenerative disorders: a randomized clinical trial
In conclusion, in a population of age‐, sex‐, and psychosocial aspects‐matched study groups, the standard of reference five‐session protocol proved to be superior at 6 months as far as the decrease in pain levels was concerned, whilst there were no differences between the two single‐session interventions. The absence of differences in treatment effect as for some other secondary clinical outcome variables may suggest that there is further space for future investigations attempting to reduce the number of multiple interventions for TMJ viscosupplementation. (Source: Journal of Oral Rehabilitation)


Celiac symptoms in patients with fibromyalgia: a cross-sectional study
The objective of the present study was to evaluate the presence of celiac-type symptoms among patients with fibromyalgia in comparison with healthy subjects and with those experienced by adult celiac patients and subjects with gluten sensitivity. A list of typical celiac-type symptoms was developed, comparing the frequency of presentation of these symptoms between patients with fibromyalgia (N = 178) and healthy subjects (N = 131), in addition to those of celiac patients and gluten-sensitive patients reported in the literature. The frequency of presentation of every celiac-type symptom, excepting anemia, was significantly higher among patients with fibromyalgia compared to controls (p &lt; 0.0001). Regarding the existing data in the literature, the prevalence of fatigue, depression, ...


Reference Values for the SF-36 in Canadian Injured Workers Undergoing Rehabilitation
Conclusions Claimant scores on the SF-36 were below population norms across all health scales and differed depending on age, employment status and type of rehabilitation. These data will be useful for assessing the health status of injured workers and evaluating the effect of rehabilitation interventions. (Source: Journal of Occupational Rehabilitation)


Comparison of machine classification algorithms for fibromyalgia: Neuroimages versus self-report
This study used commonly reported ML algorithms to measure differences between “objective” neuroimaging data and “subjective” self-report (i.e., mood and pain intensity) in their ability to discriminate between individuals with and without chronic pain. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Endometriosis of the lumbosacral plexus: report of a case with foot drop and chronic pelvic pain
(Source: Acta Neurologica Belgica)


Changing views on diverticular disease: impact of aging, obesity, diet, and microbiota
Abstract The development of colonic diverticulosis is a common aging change in industrialized nations. While most patients have asymptomatic diverticulosis, around one in five develops symptomatic diverticular disease. This is characterized by recurrent abdominal pain and disturbed bowel habit. Some of the pain episodes are prolonged and are due to acute diverticulitis, which itself may be complicated by abscess, perforation, fistulation, or stricture formation. Risk factors favouring the development of symptomatic diverticular disease include obesity, smoking and diets low in fiber but high in red meat and animal fat. What determines the transition from asymptomatic diverticulosis to symptomatic diverticular disease is unclear but neuromuscular changes following acute diverticulitis may b...


Temperament and character profiles of patients with burning mouth syndrome
Burning mouth syndrome (BMS) is a chronic disease in which patients feel a burning sensation and pain in the oral cavity. Although personality traits have been suggested to influence the development and course of BMS, they have not yet been examined in detail. We therefore investigated the personality traits of BMS patients. (Source: Journal of Psychosomatic Research)


Multimodal Compared to Pharmacologic Treatments for Chronic Tension-type Headache in Adolescents
Chronic tension-type headache (CTTH) in children and adolescents is a serious medical condition, with considerable morbidity and few effective, evidence-based treatments. We performed a chart review of 83 adolescents (age range = 13-18 years; 67 girls and 16 boys) diagnosed with CTTH. Two treatment protocols were compared: multimodal (osteopathic manipulative treatments, mindfulness, and qi gong) and pharmacologic (amitriptyline or gabapentin). Four outcomes (headache frequency, pain intensity, general health, and health interference) were assessed at three time points (baseline, 3 months, and 6 months). (Source: Journal of Bodywork and Movement Therapies)


Chronic Pain and Analgesic Use in CKD: Implications for Patient Safety.
CONCLUSIONS: Chronic pain is common in CKD with a significant relationship between the severity of pain and both proper and improper analgesic usage. Screening for chronic pain may help in understanding the role of DRPs in the delivery of safe CKD care. PMID: 25710806 [PubMed - as supplied by publisher] (Source: Clinical Journal of the American Society of Nephrology : CJASN)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Questions to Ask For Cultivating a Joyful Legal Career
Last year, I gave a talk at Golden Gate University School of Law on Cultivating a Joyful Legal Career. When the dean for law career services invited me, I secretly panicked. "What do YOU know about joyful legal practice?" said my inner critic. I felt tremendous amount of pressure to come up with the "right answer." Oh, and I had 30 minutes to do this. I shared my dilemma with my friend, Linda Alvarez. In Linda's typical wisdom, she suggested that I shouldn't be focusing on giving "the answer" but rather, suggesting questions for the audience to consider. Of course! I thought. That makes perfect sense. Each of us has our own idea and definition of a joyful legal career. For most lawyers, misery is the default. I was no exception. So, how did I go from misery to joy? It was pain. The pain...


U.S. Physicians Finally Growing Wary of Opioids for Chronic Pain
No abstract available (Source: The Back Letter)


Quality of Life in Patients With Venous Stasis Ulcers and Others With Advanced Venous Insufficiency
The quality of life (QoL) in patients with advanced venous insufficiency (including venous stasis ulcers, skin discoloration, stasis eczema, and lipodermatosclerosis) assessed using the Clinical Etiological Anatomical Pathophysiological (CEAP) and Venous Clinical Severity Score (VCSS) classifications is presented. Also, disease features such as: intensity of pain, edema and inflammatory response that exerted the most profound effect on different domains of QoL are reported. The global QoL in patients with lower leg venous ulcerations was relatively similar to that observed in other patients with chronic venous insufficiency. The presence of venous ulcerations was associated with lower QoL in a Physical domain. Significant correlations were found between pain intensity and the values of Phy...


Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults.
This article is facilitated by the Australian Cochrane Musculoskeletal Group (CMSG) editorial base. The CMSG is one of the largest Cochrane review groups and produces reliable, up-to-date systematic reviews of interventions for the prevention, treat-ment or rehabilitation of musculoskeletal disorders. OBJECTIVE: Our aim is to place the findings of recent Cochrane musculoskeletal reviews in a context immediately relevant to general practi-tioners (GPs) by summarising the findings of a review of interventions to improve adherence to exercise for adults with chronic musculoskeletal pain (CMP). DISCUSSION: The findings indicate that there are various strategies that may be effective in increasing adherence to exercise and physical activity in patients suffering from CMP. These strategi...


New scoring system helps predict risk of chronic pain after surgery
There are many variables that contribute to a patient’s risk of chronic pain after surgery; however, until recently, physicians had no way to systematically identify those variables prior to surgery. (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>


Thoracic Paravertebral Block and Its Effects on Chronic Pain and Health-Related Quality of Life After Modified Radical Mastectomy
No abstract available (Source: Regional Anesthesia and Pain Medicine)


Obesity and Chronic Pain: Systematic Review of Prevalence and Implications for Pain Practice
This article examines specific pain management approaches for obese patients and reviews novel interventional techniques for treatment of obesity. The infrastructure for simultaneous treatment of obesity and pain already exists in pain medicine (eg, patient education, behavioral medicine approaches, physical rehabilitation, medications, and interventional treatment). Screening for obesity, pain-related disability, and behavioral disorders as well as monitoring of functional performance should become routine in pain medicine practices. Such an approach requires additional physician and staff training. Further research should focus on better understanding the interplay between these 2 very common conditions and the development of effective treatment strategies. (Source: Regional Anesthesia a...


Neck pain can be changed through altered visual feedback
Using virtual reality to misrepresent how far the neck is turned can actually change pain experiences in individuals who suffer from chronic neck pain, according to research. (Source: ScienceDaily Headlines)


Myofascial Pain Syndrome
Title: Myofascial Pain SyndromeCategory: Diseases and ConditionsCreated: 2/4/2005 12:00:00 AMLast Editorial Review: 2/19/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Neck pain can be changed through altered visual feedback
(Association for Psychological Science) Using virtual reality to misrepresent how far the neck is turned can actually change pain experiences in individuals who suffer from chronic neck pain, according to research published in Psychological Science, a journal of the Association for Psychological Science. (Source: EurekAlert! - Social and Behavioral Science)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Association of Care Practices with Suicide Attempts in US Veterans Prescribed Opioid Medications for Chronic Pain Management
CONCLUSIONS AND RELEVANCE Encouraging facilities to make more consistent use of drug screening, provide follow-up within 4 weeks for patients initiating new opioid prescriptions, and avoid sedative co-prescription in combination with long-acting opioids may help prevent suicide attempts. Some clinicians may selectively employ guideline-recommended practices with at-risk patients. (Source: Journal of General Internal Medicine)


Recurrence rate after absorbable tack fixation of mesh in laparoscopic incisional hernia repair
ConclusionAbsorbable tack fixation of the mesh was associated with a higher risk of recurrence than non‐absorbable tacks for laparoscopic mesh repair of incisional hernia, but did not influence chronic pain. (Source: British Journal of Surgery)


A critical evaluation of the trigger point phenomenon
The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) seeks to explain the phenomena of muscle pain and tenderness in the absence of evidence for local nociception. Although it lacks external validity, many practitioners have uncritically accepted the diagnosis of MPS and its system of treatment. Furthermore, rheumatologists have implicated TrPs in the pathogenesis of chronic widespread pain (FM syndrome). We have critically examined the evidence for the existence of myofascial TrPs as putative pathological entities and for the vicious cycles that are said to maintain them. We find that both are inventions that have no scientific basis, whether from experimental approaches that interrogate the suspect tissue or empirical approaches that assess the outcome of treatmen...


Psychological distress over time in early rheumatoid arthritis: results from a longitudinal study in an early arthritis cohort
Conclusion. Psychological distress in very early RA is frequent and the HAQ-DI score is a predictor of depression and anxiety in these patients. A psychological evaluation in patients with early RA is important for further individual psychiatric diagnosis and management. (Source: Rheumatology)


The prevalence and correlates of chronic pain and suicidality in a nationally representative sample.
CONCLUSIONS: Health care professionals need to be aware of the risk of suicidality in patients with chronic pain, even in the absence of mental health problems. PMID: 25698809 [PubMed - as supplied by publisher] (Source: The 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>


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


Rates and Correlates of Unemployment Across Four Common Chronic Pain Diagnostic Categories
Conclusions Depressive symptoms are associated with unemployment across a number of common chronic pain conditions, even when controlling for other factors that are associated with unemployment in these patients. Depressive symptoms, as a modifiable factor, may thus be an important target of intervention for unemployed patients with chronic pain. (Source: Journal of Occupational Rehabilitation)


Acupuncture Less Effective for Skeptics
Title: Acupuncture Less Effective for SkepticsCategory: Health NewsCreated: 2/18/2015 12:00:00 AMLast Editorial Review: 2/18/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Peroneal nerve palsy
This article reviews the anatomy of the peroneal nerve; the clinical findings, etiology, and evaluation of suspected peroneal nerve injury; and treatment options. (Source: Current Orthopaedic Practice)


Nonhematologic Toxicity of Imatinib Mesylate in Pediatric Patients With Chronic Myelogenous Leukemia: A Predominance of Musculoskeletal Pain
Therapy with the tyrosine kinase inhibitor imatinib mesylate has become standard initial treatment for adult and pediatric patients with chronic myelogenous leukemia. Long-term follow-up data are now available in the adult population, and the toxicity profile of imatinib mesylate among adults has been extensively studied and reported. Despite its increasing use in the pediatric population, there are limited data regarding adverse event profiles of imatinib mesylate in children, and few reports exist in the literature focusing on nonhematologic toxicity in this population. We reviewed our institutional experience with imatinib therapy for chronic myelogenous leukemia over an 8-year period of time. Nine pediatric patients began therapy with imatinib mesylate and were included in this 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>


Rhabdomyolysis in the Setting of Induced Hypothyroidism and Statin Therapy: A Case Report
We describe a case of rhabdomyolysis attributable to induced hypothyroidism in a patient on chronic statin medication who was anticipating adjuvant radioiodine (131I) therapy for a thyroid carcinomaEur Thyroid J (Source: European Thyroid Journal)


Distribution and clinical significance of tumour-associated macrophages in pancreatic ductal adenocarcinoma: a retrospective analysis in China.
CONCLUSIONS: The tam count might be associated with neural invasion in pdac, and M2 macrophages might play an important role in lymph node metastasis. Higher counts of either macrophage type were associated with increased risk of lymph node metastasis, and the M2 macrophage count could potentially be a marker for evaluating prognosis. PMID: 25684992 [PubMed] (Source: Current Oncology)


Minimize the risk of chronic pain after cardiac surgery by treating acute postoperative pain
Abstract In patients who have undergone cardiac surgery, treating acute postoperative pain appears to be the most effective method of reducing the risk of developing chronic pain. A combination of opioids and paracetamol (acetaminophen) is the most commonly used analgesic regimen. However, treatment should be individualized and take a stepwise approach, with dosages increased and more medications added when necessary. (Source: Drugs and Therapy Perspectives)


Cost-effectiveness analysis of interventions for migraine in four low- and middle-income countries
Conclusions Self-management with simple analgesics was by far the most cost-effective strategy for migraine treatment in low- and middle-income countries and represents a highly efficient use of health resources. Consumer education and provider training are expected to accelerate progress towards desired levels of coverage and adherence, cost relatively little to implement, and can therefore be considered also economically attractive. Evidence-based interventions for migraine should have as much a claim on scarce health resources as those for other chronic, non-communicable conditions that impose a significant burden on societies. (Source: The Journal of Headache and Pain)


Work-related Musculoskeletal Injury During Sonography: Reducing the Risk Through Education and Biofeedback
Healthcare workers have one of the highest rates of WRMSD. Sonographers are a subset of the healthcare workforce and their claims significantly contribute to this problem. Sonographers provide health care to patients but nationally reported an increased rate of injury and illness cases (N=653,900) when compared to other occupations. An Ohio survey sample of sonographers, self-reported that 59% were working in pain at least 50% of their shift. Interestingly, mind-body interventions were shown to reduce stress in a cohort of 63 college students as well as a systematic review of 20 published studies demonstrated that mind-body interventions reduced chronic pain in adults. (Source: Ultrasound in Medicine and 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>


Ultrasound Evaluation of Peripheral Nerve Injury and Postoperative Treatment
In a level 1 trauma center, 2-3% of patients are diagnosed with traumatic peripheral nerve injuries with a reported incidence of 14 nerve injuries per 100,000 person-years. In most cases, the injury occurs from a sharp object, either by domestic or industrial accidents, and is frequently associated with skeletal fracture or dislocation. Peripheral nerve injuries often lead to sensory and motor disability and may result in chronic neuropathic pain in as many as 50% of patients. Without surgical intervention, nerve retraction, nerve degeneration and traumatic neuroma may occur. (Source: Ultrasound in Medicine and Biology)


2070151 20 Khz, Ultrasound Assisted Treatment of Chronic Wounds With Concurrent Optic Monitoring: A Human Study
The objective of this work was to verify that low energy, tens of kHz frequency ultrasound was clinically viable in promoting chronic venous ulcer (VLU) wounds healing with concurrent optic monitoring of the healing process. Over 500,000 patients are treated for venous ulcers annually and constitute approximately 1% of total health care costs in the western world. The direct wound care costs associated with venous ulcers exceeds $2,400 per month, before factoring in indirect costs due to pain and limited productivity. (Source: Ultrasound in Medicine and Biology)


2092355 Platelet-Rich Plasma and Hyperosmolar Dextrose (Prolotherapy) for Lateral Epicondylosis: Power Doppler Sonographic Assessment of Tendon Neovascularity as a Measure of Healing Response
Chronic lateral epicondylosis (CLE) is a non-inflammatory chronic degenerative condition of the common extensor tendon (CET) that can cause debilitating pain and decreased function. While often a self-limited condition, CLE symptoms may persist for more than 6 months with up to 20% of cases refractory to conservative measures. Platelet-rich plasma (PRP) and prolotherapy (PrT) therapeutic injections into the CET have been proposed as alternative treatments for CLE. In animal models both PRP and PrT have been shown to promote tendon healing. (Source: Ultrasound in Medicine and Biology)


2083973 Ultrasound-Guided Corticosteroid Injection: Efficacy of Treatment in Patients with Moderate To Severe Plantar Fasciitis who have Failed Conservative Therapies
Plantar fasciitis (PF) is the most common cause of chronic heel pain, affecting 2 million Americans a year. The primary OBJECTIVES: was to investigate the efficacy of ultrasound (US)-guided corticosteroid injection for treatment of refractory moderate to severe PF that had previously failed conservative therapy, including blind corticosteroid injection. Secondary OBJECTIVES:s were to report the morphologic changes of the PF following injection and to describe an injection technique that has not been previously reported. (Source: Ultrasound in Medicine and Biology)


2079077 Ultrasound Guided Hydrodissection of Peripheral Nerves as a Treatment Option For Chronic Musculoskeletal Pain Failed Manual Therapy, Using Different Solutions Including Platelet Rick Plasma
To compare the efficacy of different solutions in Ultrasound Guided Hydrodissection of Peripheral Nerves Entrapment or Neurogenic Inflammation as a Treatment Option for Chronic Musculoskeletal Pain Failed Manual Therapy: 1). Diluted Steroid in Normal Saline, 2). 5% Dextrose only, 3). 5% Dextrose followed by RBC positive PRP, 4). 5% Dextrose followed by RBC Free PRP. (Source: Ultrasound in Medicine and 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>


Collegium Pharmaceutical Secures FDA Acceptance for Filing of NDA for XTAMPZA ER(TM) (Oxycodone Extended-Release Capsules), an Abuse-Deterrent Analgesic for Chronic Pain
(Source: Medical News (via PRIMEZONE))


Some Jobs Are a Pain in the Back
Title: Some Jobs Are a Pain in the BackCategory: Health NewsCreated: 2/16/2015 12:00:00 AMLast Editorial Review: 2/17/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


The Neuropsychology of Cluster Headache: Cognition, Mood, Disability, and Quality of Life of Patients With Chronic and Episodic Cluster Headache
ConclusionPatients with CH show worse working memory, disturbance of mood, and poorer quality of life compared with healthy controls. The differences between patients with ECH and CCH, and the implications of these findings for the management of CH are discussed. (Source: Headache: The Journal of Head and Face Pain)


Barriers to Chronic Pain Measurement: A Qualitative Study of Patient Perspectives
ConclusionsThe themes discovered suggest that patients include sensations and experiences other than pain intensity in their ratings, experience the rating of pain as a comparative task, and do not use the scale in a linear manner. These themes are relevant to understanding the validity and scale properties of commonly used pain intensity measures. (Source: Pain Medicine)


Pain Can Produce Systematic Distortions of Autobiographical Memory
ConclusionsThe present data demonstrate that current pain but not chronic pain per se can exert specific influences on remembering in participants with chronic pain. This memory bias could be a predisposition for the development of chronic pain but could also be a pain‐maintaining consequence of painful experiences. This should be addressed in longitudinal studies. (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>


Intended and unintended (sensory‐)motor coupling between the affected and unaffected upper limb in complex regional pain syndrome
ConclusionsImpaired motor control of the affected limb interfered with bimanual coordination, in particular for tasks involving voluntary (intended) as opposed to automatic (unintended) interlimb coupling. Our findings suggest inappropriate functioning of higher order centres involved in motor control of the affected limb, probably due to pain‐related processes and impaired processing of proprioceptive information. Motor function of the affected limb may benefit from intended synchronization with movements of the unaffected contralateral limb, suggesting that bilateral training may be useful in patients with unilateral CRPS. (Source: European Journal of Pain)


Injury of primary afferent neurons may contribute to osteoarthritis induced pain: an experimental study using the collagenase model in rats
Pain exacerbated by movement and loading on the joint is the major symptom of osteoarthritis (OA), but the mechanisms of chronic pain in this pathology are still poorly understood. Using the intra-articular injection of collagenase in the knee of rats as a model of OA, we aimed at evaluating whether injury of sensory neurons may contribute to the development of OA-associated nociception. (Source: Osteoarthritis and Cartilage)


Patterns of dietary behaviours identified by latent class analysis are associated with chronic uninvestigated dyspepsia.
In conclusion, the 'irregular meal pattern' and the 'moderate-to-fast eating rate' were significantly associated with a greater odds of CUD. Further prospective investigations are warranted to confirm this association. PMID: 25686505 [PubMed - as supplied by publisher] (Source: The British Journal of Nutrition)


Longitudinal Analysis of Pain and Illicit Drug Use Behaviors in Outpatients on Methadone Maintenance
Surveys suggest that 37%-80% of the 301,551 (SAMHSA, 2013) patients receiving methadone maintenance treatment (MMT) in the U.S. have clinically significant chronic pain (Barry et al., 2009a; Dhingra et al., 2013; Jamison et al., 2000; Nielsen et al., 2013; Peles et al., 2011, 2005; Pud et al., 2012; Rosenblum et al., 2007, 2003; Trafton et al., 2004). Studies in these and other populations with substance use disorders (SUDs) suggest that unrelieved pain may be linked to poorer addiction-related outcomes (Brennan et al., 2005; Caldeiro et al., 2008; Larson et al., 2007; Peles et al., 2005; Potter et al., 2008; Pud et al., 2012; Rosenblum et al., 2003; Sheu et al., 2008; Trafton et al., 2004; Weiss et al., 2014). (Source: Drug and Alcohol Dependence)


Primary laryngeal cryptococcosis resembling laryngeal carcinoma
A case of an 82-year-old female with primary laryngeal cryptococcosis who had undergone long-term corticosteroid therapy for chronic obstructive pulmonary disease and rheumatoid arthritis is reported. She complained hoarseness with swallowing pain and irritability of the larynx for over a month. Endoscopic examination revealed a white, exudative irregular region on right arytenoid that mimicked a laryngeal carcinoma. Histological examination showed pseudoepitheliomatous hyperplasia and severe submucosal inflammation with ovoid budding yeasts by Grocott's stain. (Source: Auris, Nasus, Larynx)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Epidemiological Study on Chronic Venous Disease in Belgium and Luxembourg: Prevalence, Risk Factors, and Symptomatology.
CONCLUSION: CVD is a very common disease, which is underestimated. The prevalence increases with age, generates incapacity to work, and worsens the patients' quality of life. PMID: 25701071 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)


Revascularization of Hibernating Myocardium Uneven Reflorescence After the Drought ∗
In a review paper published 3 decades ago, Dr. Rahimtoola first defined hibernating myocardium as the “…prolonged subacute or chronic stage of myocardial ischemia that is frequently not accompanied by pain and in which myocardial contractility and metabolism and ventricular function are reduced to match the reduced blood supply” (1). Severe coronary artery stenosis is the primary cause of hibernation, which can be partially or completely reversed by interventions of revascularization (2). An approximate PubMed search on the topic “hibernating myocardium” yields about 500 research papers published since 1985, not including many prior and subsequent clinical and experimental studies that defined and explored the peculiar changes occurring in chronically-hypoperfused myocardium. Des...


Athletic tape may have limited benefit for pain
Reuters Health - Therapeutic tape reduces chronic muscle pain better than no treatment at all but isn’t better than other methods, according to a new analysis. (Source: Reuters: Health)


Long-term efficacy, safety and tolerability of Remoxy for the management of chronic pain
Expert Review of Neurotherapeutics, Ahead of Print. (Source: Expert Review of Neurotherapeutics)


Abnormal Movements in Children With Migraine
The cause and treatment of functional movement disorders and nonepileptic spells in children is poorly understood, and an association with migraine has not previously been reported. We retrospectively reviewed children diagnosed with chronic or episodic migraine at our institution from 2006 to 2013 to determine the proportion with nonorganic movement disorders, their phenomenology, provoking factors, and natural history. Thirty-two patients were identified, representing 4.3% of patients with chronic migraine and 0.9% of patients with episodic migraine. Twenty-four of the 32 (75%) had chronic migraine, whereas 8 (25%) had episodic migraine. Nonepileptic spells was the most common phenomenon in both cohorts, followed by tremor and functional gait disorders. Severe migraine attacks preceded 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>


Mitigating the Dangers of Opioids
JAMA Internal Medicine has run a series of articles on the dangers of prescription opioids for the treatment of chronic pain. The best solution is to avoid prescribing opioids for chronic pain because there is no high-quality evidence that they are effective for this indication, and the risk of adverse effects, including death from unintentional overdose, is great. But when patients are in pain, and nonopioid methods have proven ineffective, it can be difficult to send patients out of the office without an opioid prescription. (Source: JAMA Internal Medicine)


A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: Outcome domains, design quality, and efficacy
Publication date: October 2014 Source:Journal of Contextual Behavioral Science, Volume 3, Issue 4 Author(s): Katie E.J. Hann , Lance M. McCracken Acceptance and Commitment Therapy (ACT) is a form of Cognitive Behavioral Therapy that includes a specific therapeutic process, “psychological flexibility,” and focuses on behavior change rather than symptom reduction. One relatively well-developed research area includes ACT applied to chronic pain. The current systematic review examines outcome domains included as primary, secondary and process variables in controlled trials of ACT-based pain treatment studies, and also summarizes evidence for efficacy. The review of outcome domains is to establish whether these are in-line with recommendations, consistent with the theory underlying ACT, a...


Acceptance and Commitment Therapy for chronic pain: A diary study of treatment process in relation to reliable change in disability
Publication date: April 2014 Source:Journal of Contextual Behavioral Science, Volume 3, Issue 2 Author(s): Kevin E. Vowles , Brandi C. Fink , Lindsey L. Cohen In chronic pain treatment, a primary goal is reduced disability. It is often assumed that a central process by which disability reduction occurs is pain reduction. Conversely, approaches such as Acceptance and Commitment Therapy (ACT) posit that pain reduction is not necessary for reduced disability. Instead, disability reduction occurs when responses to pain are changed, such that as unsuccessful struggles for pain control decreases and engagement in personally-valued activities increases. Treatment outcome studies have supported ACT׳s effectiveness; however, less work has examined how within-treatment patterns of change relate t...


Health, Healthcare Access, and Use of Traditional Versus Modern Medicine in Remote Peruvian Amazon Communities: A Descriptive Study of Knowledge, Attitudes, and Practices.
Authors: Williamson J, Ramirez R, Wingfield T Abstract There is an urgent need for healthcare research, funding, and infrastructure in the Peruvian Amazon. We performed a descriptive study of health, health knowledge and practice, and healthcare access of 13 remote communities of the Manatí and Amazon Rivers in northeastern Peru. Eighty-five adults attending a medical boat service were interviewed to collect data on socioeconomic position, health, diagnosed illnesses, pain, healthcare access, and traditional versus modern medicine use. In this setting, poverty and gender inequality were prevalent, and healthcare access was limited by long distances to the health post and long waiting times. There was a high burden of reported pain (mainly head and musculoskeletal) and chronic non-...


Sex-specific alterations in behavioral and cognitive functions in a "three hit" animal model of schizophrenia.
Sex-specific alterations in behavioral and cognitive functions in a "three hit" animal model of schizophrenia. Behav Brain Res. 2015 Feb 16; Authors: Kekesi G, Petrovszki Z, Benedek G, Horvath G Abstract Whereas schizophrenia affects both human sexes, there are known sex-dependent disparities. We developed a chronic animal model that shows some schizophrenia-related deficits in rats by applying selective breeding after subchronic ketamine administration connected with postweaning social isolation (complex treatment). Our aim was to determine the sex-specific effects of these interventions on several processes. Sensory gating to acoustic stimulation, pain sensitivity, motor behavior, spatial learning and memory deficits on the hole-board test were assessed in the 17th g...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Postoperative Oxycodone Toxicity in a Patient with Chronic Pain and End-Stage Renal Disease
We present this case to review the metabolism of oxycodone and the effects of end-stage renal disease on the elimination of oxycodone and its metabolites. A 42-year-old female with end-stage renal disease who was dependent on hemodialysis presented for left hamstring posterior capsule release. She had been receiving methadone for 2 years for chronic leg pain. On postoperative day 1, the patient’s medication was changed from IV hydromorphone to oral oxycodone to treat breakthrough pain. By the next day, the patient was unarousable with notable respiratory depression. She did not fully recover after urgent hemodialysis but did have full recovery after receiving an IV naloxone infusion for 22 hours. Further study of the safety of oxycodone in hemodialysis patients is warranted. (Source: A&A...


New insights into protease-activated receptor 4 signaling pathways in the pathogenesis of inflammation and neuropathic pain: a literature review.
Authors: Bao Y, Gao Y, Yang L, Kong X, Zheng H, Hou W, Hua B Abstract Abstract Pain is an unpleasant sensory and emotional experience that is commonly associated with actual or potential tissue damage. Despite decades of pain research, many patients continue to suffer from chronic pain that is refractory to current treatments. Accumulating evidence has indicated an important role of protease-activated receptor 4 (PAR4) in the pathogenesis of inflammation and neuropathic pain. Here we reviewed PAR4 expression and activation via intracellular signaling pathways and the role of PAR4 signaling pathways in the development and maintenance of pain. Understanding PAR4 and its corresponding signaling pathways will provide insight to further explore the molecular basis of pain, which will al...


Pharmacological management of chronic low back pain in older patients: a randomized controlled trial of the effect of pregabalin and opioid administration
Conclusions Aside from screening tests, consideration of neuropathic pain and lower extremity symptoms may be an integral component in the selection of the appropriate medication for chronic LBP. Moreover, the therapeutic objectives, including pain relief and/or improvement of ADL, should be specified. (Source: European Spine Journal)


Spinal pain
Publication date: Available online 13 February 2015 Source:European Journal of Radiology Author(s): R. Izzo , T. Popolizio , P. D’Aprile , M. Muto The spinal pain represents the second cause for a medical consultation in primary care setting, especially the low back pain (LBP). LBP is more often idiopathic, the so-called discogenic pain having as common cause an internal disc disruption (IDD) which refers to annular fissures and plate fractures with disc collapse and mechanical failure with no modification of external disc shape. In little percentage of cases dthe IDD is due to underlying evolving pathologies and it is a separate clinical entity respect to disc herniation, segmental instability and asymptomatic degenerative disc desease (DDD). The radicular pain has as most frequent ca...


Effect of pulsed radiofrequency on rat sciatic nerve chronic constriction injury: a preliminary study.
CONCLUSIONS: Hyperalgesia is relieved, and ultrastructural damage ameliorated after direct PRF treatment to the SN in the CCI rat model of NP. PMID: 25673460 [PubMed - in process] (Source: Chinese Medical Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Variation in US Hospital Emergency Department Admission Rates by Clinical Condition
Background: Variation in hospitalization rates have been described for decades, yet little is known about variation in emergency department (ED) admission rates across clinical conditions. We sought to describe variation in ED risk-standardized admission rates (RSAR) and the consistency between condition-specific ED admission rates within hospitals. Methods: Cross-sectional analysis of the 2009 National Emergency Department Sample, an all-payer administrative, claims dataset. We identify the 15 most frequently admitted conditions using Clinical Classification Software. To identify conditions with the highest ED RSAR variation, we compared both the ratio of the 75th percentile to the 25th percentile hospital and coefficient of variation between conditions. We calculate Spearman correlation ...


Posterior symphyseal spurs - an unusual differential diagnosis in athletes with groin pain.
Authors: Hopp SJ, Ojodu I, Pohlemann T, Kelm J Abstract Abstract We set out to highlight the significance of posterior symphyseal spurs as an unusual diagnostic possibility in athletes with chronic groin pain and to demonstrate that operative resection was successful in quickly and safely returning the patients to sporting activities. Five competitive nonprofessional male athletes, three soccer players, and two marathon runners (median age: 30 [26/33] years), who presented to us with significant groin and central pubic pain with duration of at least 12 months, and who had failed conservative or surgical interventions (symphyseal plating), were evaluated. Physical examination as well as pelvic radiographs confirmed the diagnosis of posterior symphyseal spurs. Four out of five athlet...


Routine vs. expert-guided transvaginal ultrasound in the diagnosis of endometriosis: A retrospective review
Conclusions ETVUS is more sensitive than routine TVUS to diagnose endometriosis, identifying lesions other than endometrioma and is of assistance in surgical planning and patient counseling. (Source: Abdominal Imaging)


Effects of Nuclear Factor Kappa B Signaling Pathway in Human Intervertebral Disc Degeneration
Conclusion. These findings demonstrate that the NF-κB signaling pathway is a key mediator of IDD and represents a therapeutic target for mitigating disc degenerative diseases. Level of Evidence: N/A (Source: Spine)


Laser-capture microdissection for analysis of cell type-specific gene expression of muscarinic receptor subtypes in the rat bladder with cyclophosphamide-induced cystitis
Conclusions The LCM could be useful for tissue collection of detrusor muscle and different layers of urothelial cells with minimal contamination of other cell types, and cell type-specific changes in molecular expression could accurately be analyzed. Increased expression of urothelial MR might enhance urothelial–afferent interactions to induce bladder overactivity/pain conditions associated with bladder inflammation. (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>


Depression and pain: an appraisal of cost effectiveness and cost utility of antidepressants
Conclusions For depressed patients without PPS, SSRIs are likely to be cost-effective in improving remission rates and QALYs compared to TCAs and SNRIs. However, to improve cost-utility in those with comorbid PPS, people need to choose between SSRIs and TCAs according to threshold willingness-to-pay levels. Future research is warranted to clarify the impacts of different pain conditions on the economic evaluations of pharmacological treatments in patients with depression. (Source: Journal of Psychiatric Research)


Adherence to treatment in patient with severe cancer pain: A qualitative enquiry through illness narratives
Pain is a common symptom in cancer patients and often the most tangible sign of disease they and their families perceive. Despite currently available treatments, cancer pain frequently remains underrated and undertreated because of lack of adherence to the prescribed drug regimen. With this study we sought to identify elements that could facilitate pain management by exploring through narrative interviews the lived experiences of patients with severe chronic cancer pain in relation to their adherence to pain therapy. (Source: European Journal of Oncology Nursing)


Mindfulness-based stress reduction teachers, practice characteristics, cancer incidence, and health: a nationwide ecological description
Conclusions: Our analyses might suggest that a relationship exists between the total number of MBSR teachers per state and the total number of years of general meditation practice per state, and colorectal and cervical cancer incidence. Positive correlations were observed with overall health rankings. Despite this study?s limitations, its findings could serve to generate hypotheses and to inform and motivate a new focus on meditation and stress reduction in relation to cancer incidence, with specific relevance to colorectal and cervical cancer. (Source: BMC Complementary and Alternative Medicine)


[Health services research in psycho-oncology.]
Authors: Mehnert A, Hartung TJ Abstract Given the increasing incidence of cancer and improved diagnostics and cancer treatments, the number of cancer patients in industrialized nations is increasing worldwide. Multimodal treatment regimens, which contribute to a tumor-free survival or extend patients life expectancy can, however, alone or in combination increase the risk of physical and psychosocial long-term problems or late complications. For many patients cancer has become a chronic disease and is associated with significant physical and psychosocial problems that affect the quality of life in the medium and longer-term perspective. Common problems of cancer patients in the longer course of the disease include chronic and post-cancer pain, cancer-specific fatigue, psychosocial d...


Adherence to treatment in patient with severe cancer pain: A qualitative enquiry through illness narratives.
CONCLUSION: Probing into the significance of the pain experience and its treatment through these narrative interviews revealed several core constituents of adherence. Healthcare providers can use this better understanding to build a trusting relationship with patients and foster adherence to treatment throughout the care pathway. PMID: 25691299 [PubMed - as supplied by publisher] (Source: European Journal of Oncology 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>


Fecal Microbial Transplant Effect on Clinical Outcomes and Fecal Microbiome in Active Crohn's Disease
Conclusions: This is the first study to demonstrate that FMT for CD may be a possible therapeutic option for CD. Further prospective studies are required to fully assess the safety and efficacy of the FMT in patients with CD. (Source: Inflammatory Bowel Diseases)


Approach to Patients With Suspected Chronic Pancreatitis: A Comprehensive Review
We present a review of the current diagnostic tests available for making an early diagnosis of CP. We further report our approach to patients suspected of having CP based on the available literature. (Source: Pancreas)


Deep dry needling of trigger points located in the lateral pterygoid muscle: Efficacy and safety of treatment for management of myofascial pain and temporomandibular dysfunction.
Conclusions: DDN of TPs in the LPM showed better efficacy in reducing pain and improving maximum mouth opening, laterality, and protrusion movements compared with methocarbamol/paracetamol treatment. No adverse events were observed with respect to DDN. PMID: 25662558 [PubMed - as supplied by publisher] (Source: Medicina Oral, Patologia Oral y Cirugia Bucal)


Efficacy and toxicity of radiotherapy for Graves’ ophthalmopathy: the University of Athens experience.
Conclusion:Orbital radiotherapy for Graves&rsquo; disease is a well-established treatment option, even if patients have failed previously with other treatment modalities such as corticosteroids and surgical decompression. (Source: Head and Neck Oncology)


Higher opioid doses associated with increase in depression
Patients who increased doses of opioid medicines to manage chronic pain were more likely to experience an increase in depression, according to new findings. (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>


Relationships and Chronic Illness: Can it still be a happy Valentine’s Day?
Sourced from The Hysterectomy Association: Hysterectomy Association - Hysterectomy Association - hysterectomy, menopause and hormone replacement therapy (hrt) information and support for women. Chronic illness can take many different forms, and it is not uncommon even for two patients with the same condition to experience different symptoms from one another. However, some common symptoms which affect many people who are chronically ill include fatigue, pain and depression, and these symptoms can have a profound effect not only on the sufferer, but also the sufferer’s partner and their relationship with each other. Chronic illness changes the balance of even the most stable relationships. Pain and fatigue are both incredibly debilitating, and will often lead to the unwell partner becoming...


Days out of role due to mental and physical illness in the South African stress and health study
Conclusions Comorbidity is common in both mental and physical disorders, and both are associated with substantial days out of role in South Africa. These data indicate substantial social and economic loss associated with these conditions, and emphasize the need to integrate health services to include common mental disorders in all basic packages of care and to assess for and manage comorbid conditions. (Source: Social Psychiatry and Psychiatric Epidemiology)


New Recommendations For Pain Management Among Active Military And Veterans
Much of the conversation&nbsp;around managing chronic pain has been directed toward the general U.S. population. One specific group deserves a little more attention: active military and veterans. (Source: Forbes.com Healthcare News)


SLU scientist finds higher opioid doses associated with increase in depression
(Saint Louis University) Patients who increased doses of opioid medicines to manage chronic pain were more likely to experience an increase in depression. (Source: EurekAlert! - Medicine and Health)


Involvement of trigeminal astrocyte activation in masseter hyperalgesia under stress
Publication date: 1 April 2015 Source:Physiology &amp; Behavior, Volume 142 Author(s): Ya-Juan Zhao , Yang Liu , Qiang Li , Yin-Hua Zhao , Jian Wang , Min Zhang , Yong-Jin Chen It is commonly accepted that psychological stress contributes to the development of temporomandibular joint disorders, in which chronic orofacial pain is the main symptom. However, the central mechanism underlying the development of these disorders has remained unclear. The current study was performed to determine the involvement of the glia in the trigeminal spinal subnucleus caudalis in stress-induced increases in masseter muscle hyperalgesia in rats. After being subjected to chronic restraint stress, the animals showed decreased body weight gain, behavioral changes and marked masseter allodynia. We also fou...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic Low Back Pain: Restoration of Dynamic Stability
ConclusionsEpisodic stimulation to induce LM contraction can reduce CLBP and disability, improve quality of life and enable return to work. A dedicated lead design to reduce risk of migration is required. (Source: Neuromodulation: Technology at the Neural Interface)


Effective connectivity predicts future placebo analgesic response: A dynamic causal modeling study of pain processing in healthy controls
Publication date: 15 April 2015 Source:NeuroImage, Volume 110 Author(s): Landrew S. Sevel , Andrew M. O'Shea , Janelle E. Letzen , Jason G. Craggs , Donald D. Price , Michael E. Robinson A better understanding of the neural mechanisms underlying pain processing and analgesia may aid in the development and personalization of effective treatments for chronic pain. Clarification of the neural predictors of individual variability in placebo analgesia (PA) could aid in this process. The present study examined whether the strength of effective connectivity (EC) among pain-related brain regions could predict future placebo analgesic response in healthy individuals. In Visit 1, fMRI data were collected from 24 healthy subjects (13 females, mean age=22.56, SD=2.94) while experiencing painful ther...


Urinary trypsin inhibitor attenuates the development of neuropathic pain following spinal nerve ligation
This study evaluated the effect of ulinastatin in a rat model of spinal nerve ligation (SNL). Neuropathic pain was induced by L5 and L6 SNL in male Sprague–Dawley rats. Rats were divided into three groups: group N (control) received normal saline through the tail vein for three days immediately following SNL, group Upre received ulinastatin (50,000U/kg) intravenously for three days immediately following SNL, and group Upost received ulinastatin (50,000U/kg) intravenously for three days from the 3rd day following SNL. The paw withdrawal threshold was examined and the development of mechanical allodynia was confirmed with a behavioral test using a von Frey filament three days following SNL. On the 3rd, 5th, 7th, 14th, and 28th day following SNL, the paw withdrawal threshold was examined an...


Increased Alcohol Consumption in Urocortin 3 Knockout Mice Is Unaffected by Chronic Inflammatory Pain
Conclusion: The increased drinking in Ucn3 KO supports a role for this peptide in alcohol-related behavior. These data suggest the necessity for more research exploring the relationship between alcohol drinking, chronic pain and the CRF system in rodent models. (Source: Alcohol and Alcoholism)


Intestinal lymphoid nodular hyperplasia in children: The relationship to food allergy
ConclusionsIntestinal LNH should be considered a benign finding in children without red flags, because the symptoms are largely self‐limiting. The use of mesalamine or elimination diet does not modify the clinical outcome compared to symptomatic therapy. The presence of food allergy was not predicted by allergy skin testing and was found in a minority of patients. (Source: Pediatric Allergy and Immunology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Subjective wellbeing, health, and ageing
Publication date: 14–20 February 2015 Source:The Lancet, Volume 385, Issue 9968 Author(s): Andrew Steptoe , Angus Deaton , Arthur A Stone Subjective wellbeing and health are closely linked to age. Three aspects of subjective wellbeing can be distinguished—evaluative wellbeing (or life satisfaction), hedonic wellbeing (feelings of happiness, sadness, anger, stress, and pain), and eudemonic wellbeing (sense of purpose and meaning in life). We review recent advances in the specialty of psychological wellbeing, and present new analyses about the pattern of wellbeing across ages and the association between wellbeing and survival at older ages. The Gallup World Poll, a continuing survey in more than 160 countries, shows a U-shaped relation between evaluative wellbeing and age in high-incom...


Walking away from back pain: one step at a time ¿ a community-based randomised controlled trial
DiscussionThis paper describes the design of a community-based RCT to determine the effectiveness of a pedometer-driven walking programme in the management of CLBP.Trial registrationUnited States National Institutes of Health Clinical Trails registry (http://ClinicalTrails.gov/) No. NCT02284958. Registered on 27th October 2014). (Source: BMC Public Health)


Reconstruction of Chronic Foveal TFCC Tears with an Autologous Tendon Graft
Conclusions This technique provides stability of the distal ulna to the radius and carpus, with potential for biologic healing through osseous integration. It is a robust, anatomically based reconstruction of the TFCC to the fovea that stabilizes the DRUJ and the ulnar-carpal sag.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Journal of Wrist Surgery)


Anatomical Reattachment of the TFCC to the Ulnar Fovea Using an ECU Half-Slip
Conclusions Anatomic reattachment of the TFCC to the ulnar fovea using an ECU half-slip tendon is a promising procedure. This technique is effective for severe DRUJ instability due to chronic foveal avulsion of the TFCC.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Journal of Wrist Surgery)


Bilateral Symptomatic Os Epilunatum: A Case Report
We report the case of a patient suffering with chronic, bilateral wrist pain without history of trauma. Sonographic examination showed a bilateral symptomatic os epilunatum, both of which were surgically resected, resulting in pain relief. Literature Review Os epilunatum is a rare entity that has been reported only in few cadaveric specimen. Clinical Relevance Os epilunatum is a rare accessory ossicle of the carpus that can cause this aggravating pain. Sonography enabled accurate diagnosis of this anomaly. Because of possible associated tear of the scapholunate ligament, we recommend intraoperative testing of the stability of the scapholunate joint.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  | ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Active immunization with myelin-derived altered peptide ligand reduces mechanical pain hypersensitivity following peripheral nerve injury
Conclusions: These results suggest that immune deviation by active immunization with a non-encephalitogenic MBP-derived APL mediates an analgesic effect in animals with peripheral nerve injury. Thus, T cell immunomodulation warrants further investigation as a possible therapeutic strategy for the treatment of peripheral neuropathic pain. (Source: Journal of Neuroinflammation)


Re: Richard A. Deyo, Samuel F. Dworkin, Dagmar Amtmann, et al. Report of the NIH Task Force on Research Standards for Chronic Low Back Pain. Spine J. 2014;14:1375–91
John Carrino's name should have had his middle initial “A.”. The correct citation should have read John A. Carrino. (Source: The Spine Journal)


Interdisciplinary Rehabilitation
Interdisciplinary pain rehabilitation programs are infrequently used in the United States in the treatment of chronic pain. Comprehensively addressing the contributors to chronic pain, which include behavioral, psychological, and physical dimensions, has shown evidence-based efficacy in improving functioning and reducing pain-related distress. This approach also holds the potential for reducing the escalating costs of chronic pain care. (Source: Physical Medicine and Rehabilitation Clinics of North America)


Opioid Therapy in Chronic Pain
This article presents how opioids should be used to treat chronic pain considering recent concerns about their efficacy and safety. (Source: Physical Medicine and Rehabilitation Clinics of North America)


Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine
CONCLUSION Many buprenorphine patients are receiving over-the-counter or prescribed pain medications, as well as antidepressants, and yet continue to have significant and disabling pain and depressive symptoms. There is a clear need to address the pain–depression nexus in novel ways. (Source: Journal of General Internal Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials.
CONCLUSIONS: Our results found a beneficial effect for strength/resistance and coordination/stabilisation exercise programs over other interventions in the treatment of chronic low back pain and that cardiorespiratory and combined exercise programs are ineffective. PMID: 25681408 [PubMed - as supplied by publisher] (Source: Clinical Rehabilitation)


Pain management at the end of life: A comparative study of cancer, dementia, and chronic obstructive pulmonary disease patients.
CONCLUSIONS: Despite the fact that pain is the most common complaint at the end of life, pain management may be suboptimal for some primary diagnoses. Admission diagnosis is the strongest predictor of pain control. Patient with cancer achieve the best pain control, and chronic obstructive pulmonary disease patients are the least likely to have their pain adequately treated. PMID: 25680377 [PubMed - as supplied by publisher] (Source: Palliative Medicine)


Chronic Fatigue Finally Gets The Name It Deserves
WASHINGTON (AP) — Doctors are getting a new way to diagnose chronic fatigue syndrome — and influential government advisers say it's time to replace that hated name, too, to show it's a real and debilitating disease. The Institute of Medicine on Tuesday called on doctors to do a better job diagnosing an illness that may affect up to 2.5 million Americans, and it set five main symptoms as the criteria. And the IOM's choice of a new name — Systemic Exertion Intolerance Disease, or SEID — reflects a core symptom, that exertion can wipe patients out. "This is not a figment of their imagination," said Dr. Ellen Wright Clayton of Vanderbilt University's Center for Biomedical Ethics and Society, who chaired the IOM panel. "These patients have real symptoms. They deserve real care." Her...


Carbamazepine in bipolar disorder with pain: reviewing treatment guidelines.
CONCLUSIONS: Carbamazepine was found to have strong preclinical data for the treatment of comorbid bipolar mood disorder and chronic pain disorders. While requiring more studies in this population, we propose that this treatment modality may benefit patients. PMID: 25667814 [PubMed] (Source: The Primary Care Companion for CNS Disorders)


Impact of invalidation and trust in physicians on health outcomes in fibromyalgia patients.
CONCLUSIONS: Invalidation, trust in physician, and use of complementary medicine can have significant impact on QoL and pain in fibromyalgia. Further research in more representative fibromyalgia samples may help confirm findings. PMID: 25667809 [PubMed] (Source: The Primary Care Companion for CNS 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>


A double-blind, placebo-controlled, parallel-group pilot study of milnacipran for chronic radicular pain (sciatica) associated with lumbosacral disc disease.
CONCLUSIONS: In this small pilot study, milnacipran treatment was associated with reduction in radicular and nociceptive low back pain in patients with lumbosacral disc disease. Larger studies of milnacipran in this population are warranted. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01777581. PMID: 25664215 [PubMed] (Source: The Primary Care Companion for CNS Disorders)


Associations Between Cigarette Smoking and Pain Among Veterans
Individuals with chronic pain often report using cigarettes to cope, and smoking and chronic pain appear prevalent among US veterans. Pain may be a barrier to cigarette cessation and abstinence in this population. Because of physiological effects, smoking cigarettes may also interfere with pain management. A better understanding of how cigarette use relates to pain may assist in veteran cigarette cessation and pain management efforts. To assist these efforts, we searched the literature using keywords, such as "pain," "smoking," and "veteran," to identify 23 journal articles published from 1993 to 2013 that reported on studies examining pain and smoking variables among military or veteran populations. Studies found that veterans reported using cigarettes to cope with pain, there was greater...


Molecules, Vol. 20, Pages 3067-3088: Novel Orally Active Analgesic and Anti-Inflammatory Cyclohexyl-N-Acylhydrazone Derivatives
The N-acylhydrazone (NAH) moiety is considered a privileged structure, being present in many compounds with diverse pharmacological activities. Among the activities attributed to NAH derivatives anti-inflammatory and analgesic ones are recurrent. As part of a research program aiming at the design of new analgesic and anti-inflammatory lead-candidates, a series of cyclohexyl-N-acylhydrazones 10–26 were structurally designed from molecular modification on the prototype LASSBio-294, representing a new class of cycloalkyl analogues. Compounds 10–26 and their conformationally restricted analogue 9 were synthetized and evaluated as analgesic and anti-inflammatory agents in classical pharmacologic protocols. The cyclohexyl-N-acylhydrazones 10–26 and the cyclohexenyl analogue 9 showed great ...


Analgesia for neuropathic pain by dorsal root ganglion transplantation of genetically engineered mesenchymal stem cells: initial results
Conclusions: These data indicate that genetically modified MSCs secreting analgesic peptides could potentially be developed as a novel DRG-targeted cell therapy for treating neuropathic pain. However, further work is needed to address the challenges of MSC survival and excess proliferation, possibly with trials of autologous MSCs, evaluation of clonally selected populations of MSCs, and investigation of regulation of MSC proliferation. (Source: Molecular Pain)


Recovery Sleep Does Not Mitigate the Effects of Prior Sleep Loss on Paclitaxel-Induced Mechanical Hypersensitivity in Sprague-Dawley Rats
Society has a rapidly growing accumulative sleep debt due to employment obligations and lifestyle choices that limit sleep opportunities. The degree to which poor sleep may set the stage for adverse symptom outcomes among more than 1.7 million persons who will be diagnosed with cancer is not entirely understood. Paclitaxel (PAC), a commonly used chemotherapy agent, is associated with painful, debilitating peripheral neuropathy of the hands and feet, which may persist long after adjuvant therapy is completed. The aims of this preclinical study were to determine the accumulative and sustained effects of sleep restriction on PAC-induced mechanical sensitivity in animals and whether there are male&ndash;female differences in mechanical sensitivity in PAC-injected animals. Sixty-two adult Sprag...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Identification of novel mechanisms involved in generating localized vulvodynia pain
Our goal was to gain a better understanding of the inflammatory pathways affected during localized vulvodynia, a poorly understood, common, and debilitating condition characterized by chronic pain of the vulvar vestibule. (Source: American Journal of Obstetrics and Gynecology)


Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders?
DiscussionIncreasing evidence reveals structural and functional changes within the Central Nervous System (CNS) of people with chronic MSD that appear to play a prominent role in the pathophysiology of these disorders. These neuroplastic changes are reflective of adaptive neurophysiological processes occurring as the result of altered afferent stimuli including nociceptive and neuropathic transmission to spinal, subcortical and cortical areas with MSD that are initially beneficial but may persist in a chronic state, may be part and parcel in the pathophysiology of the condition and the development and maintenance of chronic signs and symptoms. Neuroplastic changes within different areas of the CNS may help to explain the transition from acute to chronic conditions, sensory-motor findings, ...


An observational study of buprenorphine treatment of the prescription opioid dependent pain patient.
CONCLUSIONS: Patients often improved with much less preoccupation with pain, expressing great satisfaction with buprenorphine treatment. SCIENTIFIC SIGNIFICANCE: Buprenorphine is an effective tool when treating the opioid-dependent chronic pain patient. (Am J Addict 2015;XX:1-5). PMID: 25675861 [PubMed - as supplied by publisher] (Source: American Journal on Addictions)


[Chronic pain after surgery: State of the art.]
Authors: Lavand'homme P Abstract Any type of surgery can lead to persistent pain (Chronic Post-Surgical Pain, CPSP), including minor or less invasive procedures. CPSP often but not always includes neuropathic pain features; when a neuropathic component is present, CPSP is more severe. The major risk factors for the development of CPSP are well known but not selective. New tools to target high-risk patients preoperatively are currently being assessed (e.g. the risk index from Althaus and colleagues) but remains not specific enough. Today, the prevention of CPSP might be improved by a better management of the patients, specifically by a better control of severe acute postoperative pain (i.e. early diagnosis of a neuropathic component involved, judicious utilization of peri-operative ...


Episodic and chronic migraine headache: breaking down barriers to optimal treatment and prevention.
Authors: Lipton RB, Silberstein SD Abstract Migraine is a common disabling primary headache disorder that affects an estimated 36 million Americans. Migraine headaches often occur over many years or over an individual's lifetime. By definition, episodic migraine is characterized by headaches that occur on fewer than 15 days per month. According to the recent International Classification of Headache Disorders (third revision) beta diagnostic criteria, chronic migraine is defined as "headaches on at least 15 days per month for at least 3 months, with the features of migraine on at least 8 days per month." However, diagnostic criteria distinguishing episodic from chronic migraine continue to evolve. Persons with episodic migraine can remit, not change, or progress to high-frequency ep...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Extreme mechano-sensitive neurons of tactile-foraging ducks fit the bill for touch research
Mechanosensation is one of our fundamental physiological processes, on par with sight and smell, but how it works on a cellular level remains poorly understood, holding back development of effective treatments for mechanosensory disorders like chronic pain. Now, a team of researchers has identified a new model organism that may help elucidate the cellular mechanisms behind mechanosensation: the ordinary duck. (Source: ScienceDaily Headlines)


New Name, New Criteria for Chronic Fatigue Syndrome?
Title: New Name, New Criteria for Chronic Fatigue Syndrome?Category: Health NewsCreated: 2/10/2015 12:00:00 AMLast Editorial Review: 2/11/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Exogenously induced brain activation regulates neuronal activity by top-down modulation: conceptualized model for electrical brain stimulation.
Authors: Spezia Adachi LN, Quevedo AS, de Souza A, Scarabelot VL, Rozisky JR, de Oliveira C, Marques Filho PR, Medeiros LF, Fregni F, Caumo W, Torres IL Abstract Physiological and exogenous factors are able to adjust sensory processing by modulating activity at different levels of the nervous system hierarchy. Accordingly, transcranial direct current stimulation (tDCS) may use top-down mechanisms to control the access for incoming information along the neuroaxis. To test the hypothesis that brain activation induced by tCDS is able to initiate top-down modulation and that chronic stress disrupts this effect, 60-day-old male Wistar rats (n = 78) were divided into control; control + tDCS; control + sham-tDCS; stress; stress + tDCS; and stress + sham-tDCS. Chronic stress was ...


[Focus] fMRI in analgesic drug discovery
Functional magnetic resonance imaging offers an unprecedented opportunity to evaluate and compare drug effects on human brain activity and to provide systems-level predictions for how new drugs for chronic pain will affect the brain, thus accelerating drug discovery and repurposing (Duff et al., this issue). (Source: Science Translational Medicine)


Identifying prognostic factors predicting outcome in patients with chronic neck pain after multimodal treatment: a retrospective study
this study was conducted to identify possible prognostic factors to predict drop-out and favorable outcome in patients following a multimodal treatment program at an outpatient rehabilitation clinic. (Source: Manual Therapy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The Inflammatory Milieu of the Degenerate Disc: is Mesenchymal Stem Cell-Based Therapy for Intervertebral Disc Repair a Feasible Approach?
Authors: Krock E, Rosenzweig DH, Haglund L Abstract Intervertebral disc degeneration is directly linked to chronic low back pain, a condition that affects multitudes of people worldwide and presents tremendous direct and indirect health costs. Water-loss, inflammation and disruption of the extracellular matrix ultimately result in loss of tissue function and associated pain. Cytokines present in degenerate tissue can upregulate protease activity and directly causes pain. Non-invasive therapies provide limited efficacy for pain management, and surgical intervention is therefore often required to treat chronic low back pain. Disc removal can offer immediate pain-relief, however degeneration of adjacent segments can occur and pain can return. To circumvent the caveats of recurring pai...


Intracellular residency of within mast cells in nasal polyps: A novel observation
Chronic rhinosinusitis (CRS) with or without nasal polyps (NPs) (CRSwNP and CRSsNP, respectively) is one of the most common conditions encountered in medicine.1 CRS is a disease of the mucosa lining the sinonasal cavity characterized by recurrent episodes of inflammation resulting in chronic symptoms such as nasal obstruction, facial pain, rhinorrhea, and reduction in sense of smell.1 CRS affects up to 15% of the general population in Europe and the United States, ranking it second in prevalence among chronic conditions,1 and significantly affecting quality of life and health care resources. (Source: Journal of Allergy and Clinical Immunology)


Intraosseous ganglion cysts of the carpus: current practice
Abstract Intraosseous cysts of the carpal bones are an infrequent cause of chronic wrist pain. The main body of work has investigated their occurrence in the proximal carpus, with limited incidence in the distal row. We review the current literature on the treatment of symptomatic carpal cysts following the report of a 17-year-old male with a 12-month history of progressive right wrist pain due to an intraosseous ganglion of the trapezoid. This review explores the pathology of carpal cysts, their varying presentation and current treatments. (Source: Hand)


Panel Asks: What Defines Chronic Fatigue Syndrome?
Title: Panel Asks: What Defines Chronic Fatigue Syndrome?Category: Health NewsCreated: 2/9/2015 12:00:00 AMLast Editorial Review: 2/10/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Intraprostatic injection of botulinum toxin-A in patients with refractory chronic pelvic pain syndrome: The transurethral vs. transrectal approach
Conclusion BTX-A is an available treatment option for patients with refractory CP/CPPS. It is more effective in patients with a small prostate and short symptom duration. The transrectal route provided better results than the transurethral route. More prospective longer term studies are needed. (Source: Arab 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>


Oxidative stress, mitochondrial dysfunction and, inflammation common events in skin of patients with Fibromyalgia
Publication date: Available online 7 February 2015 Source:Mitochondrion Author(s): Benito Sánchez-Domínguez , Pedro Bullón , Lourdes Román-Malo , Fabiola Marín-Aguilar , Elísabet Alcocer-Gómez , Angel M. Carrión , José Antonio Sánchez-Alcazar , Mario D. Cordero Fibromyalgia is a chronic pain syndrome with unknown etiology. Recent studies have shown some evidence demonstrating that oxidative stress, mitochondrial dysfunction and inflammation may have a role in the pathophysiology of fibromyalgia. Despite several skin-related symptoms accompanied by small fiber neuropathy have been studied in FM, these mitochondrial changes have not been yet studied in this tissue. Skin biopsies from patients showed a significant mitochondrial dysfunction with reduced mitochondrial chain activiti...


Pain in patients attending outpatient rehabilitation: results of a pilot study
Abstract The aim of the study was to investigate pain occurrence, characteristics and correlations in an outpatient rehabilitation setting. This was an observational pilot study. The setting was an outpatient rehabilitation facility. The subjects included all patients attending physiotherapy in the week 25th to 29th September 2010 and the interventions were made using self-administered questionnaire. Ongoing pain was assessed by a yes–no question, pain intensity by a numeric rating scale (NRS) ranging 0–10. Pain-related medication was investigated, along with pain characteristics, patient treatment expectations, life satisfaction, and catastrophism. Of the 201 patients, 12 were excluded and 189 enrolled (age 63.6 ± 15.6; 70.4 % women). Pain (mean NRS = 5.6 ± 2.4) was ...


Treating Chronic Knee Pain With Acupuncture
To the Editor In the randomized clinical trial of acupuncture for chronic knee pain, the acupuncture treatment design appeared flawed. Specifically, the acupuncture points were nonstandardized and the study lacked the details necessary to ascertain whether the provided interventions were representative of acupuncture sessions appropriate for chronic knee pain. (Source: JAMA)


Treating Chronic Knee Pain With Acupuncture—Reply
In Reply Our study found no benefit of needle or laser acupuncture compared with sham laser and small clinically irrelevant benefits compared with no acupuncture for chronic knee pain. We took a pragmatic approach, permitting 8 acupuncturists (each with at least 10 years of acupuncture experience) flexibility to choose acupuncture points and treatment frequency (8-12 visits over 12 weeks). Consistent with clinical practice and acupuncture training in Australia, acupuncturists aimed for deqi with needle acupuncture. (Source: JAMA)


Serum levels of the pro-inflammatory interleukins 6 (IL-6) and -8 (IL-8) in patients with lumbar radicular pain due to disc herniation: A 12-month prospective study
Publication date: Available online 31 January 2015 Source:Brain, Behavior, and Immunity Author(s): Linda Margareth Pedersen , Elina Schistad , Line Melå Jacobsen , Cecile Røe , Johannes Gjerstad Earlier studies indicate that lumbar radicular pain after disc herniation may be associated with a local inflammation induced by leakage of nucleus pulposus (NP) into the spinal canal and neuroforamen. In the present study we addressed the role of two interleukins, IL-6 and IL-8 in such long-lasting lumbar radicular pain. All 127 patients were recruited from Oslo University Hospital, Ullevål, Norway. At inclusion, 6weeks and 12months, serum concentrations of IL-6 and IL-8 were analyzed by enzyme-linked immunosorbent assay (ELISA) and pain intensity was reported on a 0–10cm visual analog scal...


Peripheral indoleamine 2,3-dioxygenase 1 is required for comorbid depression-like behavior but does not contribute to neuropathic pain in mice
In conclusion, our findings show for the first time that neuropathic pain is associated with an increase of Ido1 in liver, but not brain, downstream of spinal cord IL-1β signaling and that Ido1 mediates comorbid depression. Moreover, comorbidity of neuropathic pain and depression are only partially mediated by a common mechanism because mechanical hyperalgesia develops independently of Ido1. (Source: Brain, Behavior, and Immunity)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Disability After Deployment Injury: Are Women and Men Service Members Different?
CONCLUSIONS: After deployment-related injury, women have higher rates of arthritis, lower rates of pain disorders, and more severely rated PTSD compared with men. Women are unable to return to duty more often than men injured in combat. These results suggest some difference between men's and women's outcomes after deployment injury, important information for military and Veterans Administration providers seeking to minimize postdeployment disability. LEVEL OF EVIDENCE: Level III, prognostic study. PMID: 25666145 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)


Physical Activity, Fear Avoidance, and Chronic Non-Specific Pain: A Narrative Review
Chronic non-specific pain (CNSP) and physical inactivity have become increasingly prevalent in the United States; however, the associations between the two remain unclear. The lack of clarity may be due to the presence of a third variable, the individual’s pain coping strategy. (Source: Journal of Bodywork and Movement Therapies)


Exercise therapy for chronic fatigue syndrome.
CONCLUSIONS: Patients with CFS may generally benefit and feel less fatigued following exercise therapy, and no evidence suggests that exercise therapy may worsen outcomes. A positive effect with respect to sleep, physical function and self-perceived general health has been observed, but no conclusions for the outcomes of pain, quality of life, anxiety, depression, drop-out rate and health service resources were possible. The effectiveness of exercise therapy seems greater than that of pacing but similar to that of CBT. Randomised trials with low risk of bias are needed to investigate the type, duration and intensity of the most beneficial exercise intervention. PMID: 25674924 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Ameliorative potential of Ocimum sanctum in chronic constriction injury-induced neuropathic pain in rats.
Authors: Kaur G, Bali A, Singh N, Jaggi AS Abstract The present study was designed to investigate the ameliorative potential of Ocimum sanctum and its saponin rich fraction in chronic constriction injury-induced neuropathic pain in rats. The chronic constriction injury was induced by placing four loose ligatures around the sciatic nerve, proximal to its trifurcation. The mechanical hyperalgesia, cold allodynia, paw heat hyperalgesia and cold tail hyperalgesia were assessed by performing the pinprick, acetone, hot plate and cold tail immersion tests, respectively. Biochemically, the tissue thio-barbituric acid reactive species, super-oxide anion content (markers of oxidative stress) and total calcium levels were measured. Chronic constriction injury was associated with the developme...


[Neurosurgical treatment of chronic pain.]
Authors: Fontaine D, Blond S, Mertens P, Lanteri-Minet M Abstract Neurosurgical treatment of pain used two kind of techniques: 1) Lesional techniques interrupt the transmission of nociceptive neural input by lesionning the nociceptive pathways (drezotomy, cordotomy, tractotomy…). They are indicated to treat morphine-resistant cancer pain and few cases of selected neuropathic pain. 2) Neuromodulation techniques try to decrease pain by reinforcing inhibitory and/or to limit activatory mechanisms. Chronic electrical stimulation of the nervous system (peripheral nerve stimulation, spinal cord stimulation, motor cortex stimulation…) is used to treat chronic neuropathic pain. Intrathecal infusion of analgesics (morphine, ziconotide…), using implantable pumps, allows to increase 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>


Life With a Traumatic Brain Injury
As I near the one-year mark since my accident, I have thought a lot about writing a blog post on it. Actually, the entire past year I have thought a lot about it. But I didn't. I didn't have the courage. I've been scared. Scared of what people might think. Scared that people will be snarky or rude. Scared of what I might feel. Scared of reliving the fall. Scared that no one will read it. Then I heard a voice in my head say "Screw it! Writing is your therapy, Amy. It's time to write it down and get it out of your head!" If my story can inspire even just one person, it is so worth getting past my fear, so here goes!! It's been almost one year since that cold February day that I slipped on a patch of sheer ice in my building's driveway and landed smack on my head. I can still feel my feet sl...


Optimization Of Combinational Intranasal Drug Delivery System For The Management Of Migraine By Using Statistical Design.
This study uses Box-Behnken design for the first time to develop, optimize the TMISG and assess factors affecting the critical quality attributes. Histopathological study of the nasal mucosa suggested that the formulation was safe for nasal administration. The statistical difference in absolute bioavailability between oral and intranasal route suggested that intranasal route had almost 21% increases in bioavailability for ZT and for KT there was 16% increase over oral formulations. Optimized formulation would help mitigate migraine associated symptoms much better over the currently available formulations. PMID: 25676136 [PubMed - as supplied by publisher] (Source: European Journal of Pharmaceutical Sciences)


The inimitable kynurenic acid: the roles of different ionotropic receptors in the action of kynurenic acid at a spinal level.
Authors: Tuboly G, Tar L, Bohar Z, Safrany-Fark A, Petrovszki Z, Kekesi G, Vecsei L, Pardutz A, Horvath G Abstract Kynurenic acid (KYNA) is a neuroactive metabolite that interacts with NMDA, AMPA/kainate and alpha 7 nicotinic receptors. The goal of this study was to clarify the roles of these receptors in the action of KYNA at a spinal level by using highly specific receptor antagonists alone or in triple combinations. Chronic osteoarthritis-like joint pain was induced with monosodium-iodoacetate in male Wistar rats. Mechanical allodynia and motor function were quantified. In the first series we determined the dose-response and time course effects of intrathecally administered KYNA (10-100μg), D-(-)-2-amino-5-phosphonopentanoic acid (AP5; an NMDA receptor antagonist; 10-200μg), m...


Commentary on the influence of gender on the management of chronic pelvic pain.
Authors: Curran N PMID: 25683661 [PubMed - as supplied by publisher] (Source: BJOG : An International Journal of Obstetrics and Gynaecology)


Chronic Pain: Cytokines, Lymphocytes and Chemokines
(Source: Inflammation and Allergy Drug Targets)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Occupational Respiratory and Musculoskeletal Symptoms among Egyptian Female Hairdressers
This study aimed to identify respiratory and musculoskeletal disorders in hairdressers compared to office workers. A cross-sectional study was conducted on 80 female hairdressers and 50 matched controls. A structured questionnaire was used to collect information on personal and occupational data, hairdressing activities, the presence of respiratory symptoms and the prevalence of musculoskeletal pain in the past 12 months. Reported symptoms were compared between hairdressers and controls. The associations between self-reported symptoms and hairdressing activities were investigated. Hairdressers were more likely to report symptoms than controls particularly for those who were older, with higher body mass index and longer duration of work as hairdresser. There were significant associations b...


Advances in surgical treatment of chronic pancreatitis
The incidence of chronic pancreatitis (CP) is between 2 and 200 per 100,000 persons and shows an increasing trend year by year. India has the highest incidence of CP in the world at approximately 114 to 200 per 100,000 persons. The incidence of CP in China is approximately 13 per 100,000 persons. The aim of this review is to assist surgeons in managing patients with CP in surgical treatment. We conducted a PubMed search for ?chronic pancreatitis? and ?surgical treatment? and reviewed relevant articles. On the basis of our review of the literature, we found that CP cannot be completely cured. The purpose of surgical therapy for CP is to relieve symptoms, especially pain; to improve the patient?s quality of life; and to treat complications. Decompression (drainage), resection, neuroablation ...


Incidence of abdominal pain due to the anterior cutaneous nerve entrapment syndrome in an emergency department
Conclusions: In an ED setting of a Dutch teaching hospital, approximately 2% of patients presenting with acute abdominal pain suffered from ACNES. ED physicians should consider ACNES in abdominal pain patients with normal laboratory or imaging tests. (Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)


Tackling Chronic Amputee Pain for Veterans and Civilians
New DoD Funded Study to Tackle Chronic Amputee Pain for Veterans and Civilians. (Source: Disabled World)


Sleep Fragmentation Has Differential Effects on Obese and Lean Mice
Abstract Chronic sleep fragmentation (SF), common in patients with sleep apnea, correlates with the development of obesity. We hypothesized that SF differentially affects neurobehavior in lean wild-type (WT) and obese pan-leptin receptor knockout (POKO) mice fed the same normal diet. First, we established an SF paradigm by interrupting sleep every 2 min during the inactive light span. The maneuver was effective in decreasing sleep duration and bout length, and in increasing sleep state transition and waking, without significant rebound sleep in the dark span. Changes of sleep architecture were evident in the light span and consistent across days 1–10 of SF. There was reduced NREM, shortened sleep latency, and increased state transitions. During the light span of the first day ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Four steps to curing Hashimoto's disease plus many other autoimmune conditions
(NaturalNews) Common symptoms of Hashimoto's disease plus nearly 100 other autoimmune conditions include fatigue, low-grade fever, inability to stay mentally focused, and (usually) an "unexplainable" feeling of chronic sickness or pain. Sadly, conventional medicine would have you... (Source: NaturalNews.com)


Open-label milnacipran for patients with persistent knee pain 1 year or longer after total knee arthroplasty: a pilot study.
CONCLUSIONS: Open-label milnacipran demonstrated reduced pain and some evidence of functional improvement in this small sample of patients with chronic persistent pain 1 year or more after total knee arthroplasty such that well-powered studies are warranted. PMID: 24392250 [PubMed] (Source: The Primary Care Companion for CNS Disorders)


'I've been walking on eggshells all my life': fibromyalgia patients' narratives about experienced violence and abuse - Sallinen M, Kukkurainen ML.
According to earlier research, the prevalence of violence and abuse in the life history of patients with chronic widespread pain and fibromyalgia seems to be high in comparison with other pain patients and healthy controls. The purpose of the present study... (Source: SafetyLit: All (Unduplicated))


Revolutionary Way to Be Healthy #8: Minimize Symptom Suppression
So, the guy says to his doctor, "Doc, it hurts when I do this." And the doctor says to the guy, "Then don't do that." OK, it's silly, old-fashioned humor (attributed alternately to Henny Youngman and to the 1920s vaudeville duo Smith and Dale). But you know what's even sillier, and arguably more old-fashioned? The exchanges that happen in many real-life doctors' offices today. Too often, in response to all sorts of health complaints, we're likely to be given the same pat advice: "Take this drug. Carry on as usual, and then come back when it gets worse." The result? According to a 2013 Mayo Clinic report, about 70 percent of Americans are on at least one prescription drug. More than half take two. And 20 percent of patients take five or more. The vast majority of those prescriptions ar...


Confirmatory factor analysis of the Korean version of the short-form McGill pain questionnaire with chronic pain patients: a comparison of alternative models
Conclusions: The results showed the KSF-MPQ is cross-culturally equivalent to the original questionnaire. Thus, the KSF-MPQ is valid measurement for assessing the quality and intensity of pain to chronic pain patients and may be helpful in clinical and research settings in Korea. (Source: Health and Quality of Life Outcomes)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Outcome prediction in chronic unilateral lumbar radiculopathy: prospective cohort study
Background: Identification of prognostic factors for persistent pain and disability are important for better understanding of the clinical course of chronic unilateral lumbar radiculopathy and to assist clinical decision-making. There is a lack of scientific evidence concerning prognostic factors. The aim of this study was to identify clinically relevant predictors for outcome at 52 weeks. Methods: 116 patients were included in a sham controlled clinical trial on epidural injection of glucocorticoids in patients with chronic unilateral lumbar radiculopathy. Success at follow-up was ?17.5 for visual analogue scale (VAS) leg pain, ?22.5 for VAS back pain and ?20 for Oswestry Disability Index (ODI). Fifteen clinically relevant variables included demographic, psychosocial, clinical and radiolo...


Responsiveness and minimal important changes for the Neck Disability Index and the Neck Pain Disability Scale in Italian subjects with chronic neck pain
Conclusions The Italian NDI and NPDS were equally sensitive in detecting clinical changes in subjects with chronic NP undergoing rehabilitation. We recommend taking the MICs into account when assessing patient improvement or planning studies in this clinical context. (Source: European Spine Journal)


Biologic Enhancement of Cartilage Repair: The Role of Platelet-Rich Plasma and Other Commercially Available Growth Factors
In part, people's quality of life depends on the “health” of their cartilage because its damage or deterioration causes pain that limits mobility and reduces autonomy. Predisposing genetic factors and modern-life environmental factors, such as diet, excessive physical exercise, or the absence of any physical exercise, in addition to injuries that can occur, all contribute to the onset and development of chronic degenerative diseases such as osteoarthritis. Regenerative medicine focuses on the repair, replacement, or regeneration of cells, tissues, or organs to restore impaired function from any cause, including congenital defects, disease, and trauma. (Source: Arthroscopy - Journal of Arthroscopic and Related Surgery)


Pancreaticopleural fistula: a review.
Authors: Aswani Y, Hira P Abstract Pancreaticopleural fistula is a rare complication of chronic pancreatitis consequent to posterior disruption of the pancreatic duct. The fistulous track ascends into the pleural cavity and gives rise to large volumes of pleural fluid. Pancreaticopleural fistula thus poses a diagnostic problem since the source of pleural fluid is extrathoracic. To further complicate the matter, abdominal pain is seldom the presenting or significant feature. The pleural effusion is typically rapidly accumulating, recurrent and exudative in nature. Pleural fluid amylase in the correct clinical setting virtually clinches the diagnosis. Magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography and computed tomography may delineate the ...


Altered bone metabolism and bone density in patients with chronic pancreatitis and pancreatic exocrine insufficiency.
CONCLUSIONS: Patients with chronic pancreatitis have osteoporosis, along with abnormal bone metabolism and reduced bone mineral density as measured by DXA and X-ray. PERT is associated with less osteopathy. PMID: 25640785 [PubMed - in process] (Source: JOP)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Relationship between Pain and Plasma Amino Acid Levels in Chronic Pancreatitis.
CONCLUSION: These amino acid levels and pancreatic pain were improved by the elemental diet. The pancreatic pain may be related to these amino acid imbalances. PMID: 25640784 [PubMed - in process] (Source: JOP)


Migraine Mimics
The symptoms of migraine are non‐specific and can be present in many other primary and secondary headache disorders, which are reviewed. Even experienced headache specialists may be challenged at times when diagnosing what appears to be first or worst, new type, migraine status, and chronic migraine. (Source: Headache: The Journal of Head and Face Pain)


Chronic Fatigue Syndrome Linked to Early MenopauseChronic Fatigue Syndrome Linked to Early Menopause
The disorder is also associated with other menstrual problems and pelvic pain, a study finds. WebMD Health News (Source: Medscape Medical News Headlines)


Juvenile Chronic Mandibular Osteomyelitis: Histological and Immunohistochemical Findings from an Enigmatic Inflammatory Condition
Juvenile chronic mandibular osteomyelitis (JCMO) is a paediatric inflammatory condition of unknown aetiology. Patients present with pain, soft tissue swelling and unilateral mandibular enlargement without an identifiable inflammatory trigger. Existing case series lack detailed description of microscopic features. (Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics)


Natural Stress-Buster that Lets You Live Longer
As you know, one of the main areas of focus at my wellness clinic is non-invasive, natural therapies for anti-aging. That&#8217;s why when patients come to me with what they call the &#8220;symptoms of old age,&#8221; I feel compelled to set them on the right course. And I can tell you that the literally thousands of patients I&#8217;ve seen with these &#8220;symptoms&#8221; over the years have left my clinic – some even as skeptics – and returned renewed and rejuvenated. But, I confess, the cure was easy. Because usually their problems were not &#8220;symptoms&#8221; at all. They were the side-effects of our pill-pushing mainstream medical establishment! If the goal in prescribing this mountain of high-priced medication is to make sure you don&#8217;t miss any of the great experiences...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Focus Article Report of the NIH Task Force on Research Standards for Chronic Low Back Pain: Erratum
No abstract available (Source: The Clinical Journal of Pain)


Modeling the Predictive Value of Pain Intensity on Costs and Resources Utilization in Patients With Peripheral Neuropathic Pain
Objective: The aim of the present analysis was to model the association and predictive value of pain intensity on cost and resource utilization in patients with chronic peripheral neuropathic pain (PNP) treated in routine clinical practice settings in Spain. Methods: We performed a secondary economic analysis based on data from a multicenter, observational, and prospective cost-of-illness study in patients with chronic PNP that is refractory to prior treatment. Pain intensity was measured using the Short-Form McGill Pain Questionnaire. Univariate and multivariate linear regression models were fitted to identify independent predictors of cost and health care/non–health care resource utilization. Results: A total of 1703 patients were included in the current analysis. Pain intensity was an...


Total pancreatectomy and islet cell autotransplantation: outcomes, controversies and new techniques.
Authors: Radomski M, Zureikat AH Abstract Chronic pancreatitis is a challenging disease; the constellation of chronic abdominal pain and metabolic derangements present unique difficulties to the treating physician. Initial treatment revolves around lifestyle modification, pain control, and management of exocrine insufficiency. In refractory cases, total pancreatectomy with islet cell auto transplantation (TP-IAT) is an option for patients with diffuse disease not amenable to subtotal pancreatectomy or a decompressive (drainage) operation. This procedure aspires to alleviate pain and avoid surgically induced brittle diabetes, a morbid complication of total pancreatectomy alone. Herein, we review the indications, optimal timing, surgical outcomes and controversies for TP-IAT, focusin...


An update on oxycodone: lessons for death investigators in Australia
This study investigated deaths involving oxycodone in Australia to explore potentially inappropriate prescribing and the coroner’s investigation. The National Coronial Information System identified cases from 2001 to 2011 where oxycodone was detected by toxicological analysis. There were 806 oxycodone-related deaths, with a significant increase in the 11-year period, from 21 deaths in 2001, up almost sevenfold in 2011 (139 deaths). Most deaths were caused by combined drug toxicity (63.4 %) or oxycodone toxicity alone (11.8 %). Most individuals were male (59.1 %), aged 35–44 years (26.7 %), who died unintentionally (56.4 %), with mental illness (52.1 %) and/or a history of acute or chronic pain (46.2 %). 312 cases (39 %) described a legitimate prescription for oxycodone, of whi...


Patient-centered mental health care for female veterans.
CONCLUSIONS: Female veterans are a diverse population whose needs and preferences for mental health services vary along demographic and clinical factors. These stakeholder perspectives can help prioritize structural and clinical aspects of designated women's mental health care in the VHA. PMID: 25642611 [PubMed - in process] (Source: Psychiatric Services)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


UC Davis researchers identify new compound that takes aim at neuropathic pain
(University of California - Davis Health System) A new compound discovered by a team of UC Davis investigators has potent actions against production of a chemical that which is implicated in the development of chronic pain following a peripheral nerve injury in the spinal cord. (Source: EurekAlert! - Medicine and Health)


Optical Coherence Tomography Findings in Recurrent Corneal Erosion Syndrome
Conclusions: Corneal OCT can be useful to study and manage RCES. Specific OCT findings may clarify etiology, confirm a suspected diagnosis, and give advice on the decision to treat patients. (Source: Cornea)


A new integrated clinical-biohumoral model to predict functionally significant coronary artery disease in patients with chronic chest pain
Conclusions The Genders’ model has a low accuracy to predict functionally significant CAD. A new model integrating HDL cholesterol, AST and hs-CRP with common clinical variables has higher predictive accuracy for functionally significant CAD and allows to reclassify patients from intermediate/high to low pre-test likelihood. Teaser This study demonstrates that, in a European population of patients with stable chest pain, a new model which integrates clinical data with a few bio-humoral markers outperforms currently available clinical models in predicting a significant CAD. These results could have implications on cost-containment and effectiveness of the diagnostic process in patients with suspected CAD allowing to better select subjects with an increased likelihood of high risk disease ...


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 NSAID-induced adverse reactions and their implications in dentistry are also discussed. (Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology)


The Pharmacological Treatment of Migraine in Brazil
Background/ObjectivesMigraine is a chronic, disabling, and recurrent illness. Despite its burden, preventive medications are often underused, while acute strategies are frequently used injudiciously. Patients may benefit from comprehensive approaches with general informative orientation and formal medication strategies. In developing countries like Brazil, the access to comprehensive tertiary headache centers or updated specialists is somewhat limited, as are the resources available out of some private specialty care clinics. In addition, centers from the public system may not deliver effective care. The aim of this review is to perform a general description of the pharmacological treatments of migraine in tertiary headache centers of Brazil. MethodsThe data of 4 public and 6 private terti...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The Prevalence and Impact of Headache in Brazil
ConclusionsThe mean prevalence of headache in Brazil, and some of its subtypes, is similar to the rates described in other countries of the world. Disability is higher in females, in patients with migraine, in individuals with headaches ≥15 days per month, and in those with severe head pain. (Source: Headache: The Journal of Head and Face Pain)


Episodic and Chronic Migraine Headache: Breaking Down Barriers to Optimal Treatment and Prevention
(Source: Headache: The Journal of Head and Face Pain)


Salinomycin Inhibits Scar-forming Myofibroblast Formation [Glycobiology and Extracellular Matrices]
Although scarring is a component of wound healing, excessive scar formation is a debilitating condition that results in pain, loss of tissue function, and even death. Many tissues, including the lungs, heart, skin, and eyes, can develop excessive scar tissue as a result of tissue injury, chronic inflammation, or autoimmune disease. Unfortunately, there are few, if any, effective treatments to prevent excess scarring, and new treatment strategies are needed. Using HEK293FT cells stably transfected with a TGFβ-dependent luciferase reporter, we performed a small molecule screen to identify novel compounds with antiscarring activity. We discovered that the polyether ionophore salinomycin potently inhibited the formation of scar-forming myofibroblasts. Salinomycin (250 nm) blocked TGFβ-depend...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Low back pain affects trunk as well as lower limb movements during walking and running
Up to now, most gait analyses on low back pain concentrate on changes in trunk coordination during walking on a treadmill. Locomotion on uneven ground as well as lower limb changes receives little attention in association with low back pain. The present study focuses on how chronic non-specific low back pain causes modifications in lower limb and trunk movements, in level and uneven walking and running.We found that trunk as well as lower limb movement was influenced by chronic non-specific low back pain. (Source: Journal of Biomechanics)


Biogen Idec bets on chronic pain
Nature Biotechnology 33, 116 (2015). doi:10.1038/nbt0215-116b (Source: Nature Biotechnology)


Daylight photodynamic therapy: The Southern California experience
ConclusionIn this case series, daylight PDT achieved obvious improvement in photodamage, specifically precancerous lesions, and in photoaging with a reduction in lentigenes and other signs of aging. Patients reported significantly less pain than with conventional PDT and enjoyed the convenience of treatment generally in their backyard. It was noted to be a safe procedure with no significant adverse events such as scarring. Additionally, the cost of the procedure was significantly reduced, with ALA and its application being the only expenses. Lasers Surg. Med. © 2015 Wiley Periodicals, Inc. (Source: Lasers in Surgery and Medicine)


Polyneuropathy in POEMS syndrome: alterations in nerve function and morphology
For clinicians who work outside neurology, a diagnosis of peripheral neuropathy rarely elicits much concern. While most recognise that the condition could lead to sensory dysaethesiae, pain and possibly weakness, the general consensus nevertheless appears to be that it is chronic, benign and generally untreatable. Those who work within the neurosciences would see it rather differently. The diagnosis of peripheral neuropathy is merely a starting point. Inevitably, a detailed history is required often followed by a long list of investigations, aimed at elucidating an underlying cause. (Source: Clinical Neurophysiology)


Treatment of chronic facial pain including cluster headache by repetitive transcranial magnetic stimulation of the motor cortex with maintenance sessions: a naturalistic study
To assess the long-term maintenance of analgesia induced by high-frequency repetitive transcranial magnetic stimulation (rTMS) of the motor cortex contralateral to pain in a naturalistic study of patients with chronic refractory facial pain. (Source: BRAIN STIMULATION: Basic, Translational, and Clinical Research in Neuromodulation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic non-orthopedic conditions more common in patients with less severe degenerative changes that have elected to undergo total knee arthroplasty
The purpose of this study was to determine whether the prevalence of chronic non-orthopedic conditions that may play a role in an abnormal pain response differ between patients based on the severity of degenerative changes at the time of surgery. Of 1,020 OA knees that had undergone primary TKA with a minimum 2year follow-up, we identified 117 (11.5%) that had less severe degenerative changes. The prevalence of dissatisfaction was significantly greater in less severe group compared to those with moderate or severe changes (18.8% vs. (Source: The Journal of Arthroplasty)


The Prevalence and Impact of Headache in Brazil.
CONCLUSIONS: The mean prevalence of headache in Brazil, and some of its subtypes, is similar to the rates described in other countries of the world. Disability is higher in females, in patients with migraine, in individuals with headaches ≥15 days per month, and in those with severe head pain. PMID: 25659407 [PubMed - as supplied by publisher] (Source: Headache)


Efficacy and Safety of Sublingual Fentanyl Tablets for the Management of Breakthrough Pain in Patients with Chronic Musculoskeletal Pain with Neuropathic Component: Multicenter Prospective Study
Conclusion SLF provides significant reductions in BTP intensity. The results of the BPI and EQ-5D assessments indicate that pain relief is associated with improvement of functioning and enhancement of QoL. (Source: Clinical Drug Investigation)


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


Microglia are Involved in Pruritus Induced by DNFB via the CX3CR1/p38 MAPK Pathway
Conclusion: Our results suggest that microglia are involved in pruritus induced by DNFB via FKN/CX3CR1/p38MAPK pathways similar to those participating in the development of neuropathic pain.Cell Physiol Biochem 2015;35:1023-1033 (Source: Cellular Physiology and Biochemistry)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic Fatigue Syndrome Linked to Early Menopause: CDC
Disorder also associated with other menstrual problems and pelvic pain, study finds (Source: WebMD Health)


Percutaneous endoscopic caecostomy for severe constipation in adults: feasibility, durability, functional and quality of life results at 1 year follow-up
Conclusion PEC placement achieves satisfying functional and quality of life results, and allows approximately 3/4 of patients to suspend laxatives and retrograde enemas. Nevertheless, 1/4 of the patients ask for the PEC removal because of chronic wound pain. In order to improve long-term durability of the device, a better prevention of pain is required. (Source: Surgical Endoscopy)


Course of disability reduction during a pain rehabilitation program: a prospective clinical study
The aim of this study was to analyze the course of reduction of disability during a pain rehabilitation program (PRP) and factors influencing this course. A prospective cohort study was carried out. All patients with chronic musculoskeletal pain treated in a PRP between March 2010 and December 2010 were eligible for this study. All patients were treated at a University-based rehabilitation center and received an outpatient multidisciplinary PRP. Main outcome measures, Pain Disability Index (PDI), and average pain measured with a numeric rating scale were measured every 2 weeks during the PRP. To analyze the course of disability, a linear mixed-effect model was applied. One hundred and twenty-eight patients participated in the study, of whom 20% dropped out during the PRP. Initial PDI (β=0...


Study Suggests Early Intervention to Prevent Progression from Acute to Chronic Migraine Pain
No abstract available (Source: Neurology Today)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Prospective randomized clinical trial of Jean Rives technique versus laparoscopic TEP repair for primary inguinal hernia: 10-year follow-up
Conclusion Jean Rives technique is a relatively easy technique to perform, requires shorter operating time when compared to laparoscopic TEP technique. JR technique should be taken into consideration while planning surgical treatment of inguinal hernia. (Source: Hernia)


Results of treatment for chronic pancreatitis by the combined Frey and Beger procedure
Conclusions The combined Frey and Beger procedure provides good antalgic control while preserving pancreatic function, with acceptable morbidity and mortality. (Source: Journal of Visceral Surgery)


High‐Frequency Electrical Nerve Block for Postamputation Pain: A Pilot Study
ConclusionThis pilot study generated preliminary evidence on the efficacy and safety of kilohertz electrical nerve block for postamputation pain, justifying a pivotal study for regulatory approval. (Source: Neuromodulation: Technology at the Neural Interface)


Protectins and maresins: New pro-resolving families of mediators in acute inflammation and resolution bioactive metabolome
This article is part of a Special Issue entitled “Oxygenated metabolism of PUFA: analysis and biological relevance”. (Source: Biochimica et Biophysica Acta (BBA) Molecular and Cell Biology of Lipids)


Mild renal dysfunction and long-term adverse outcomes in women with chest pain: Results from the National Heart, Lung, and Blood Institute–sponsored Women’s Ischemia Syndrome Evaluation (WISE)
Conclusions Even mild CKD is a strong independent predictor of all-cause and cardiac mortality in women with symptoms/signs of ischemia, regardless of underlying obstructive CAD severity, underscoring the need to better understand the interactions between ischemic heart disease and CKD. (Source: American Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 store‐operated calcium channel inhibitor attenuates collagen‐induced arthritis
Conclusions and ImplicationsThis study provides the first evidence that inhibition of SOCE prevents and relieves rheumatoid arthritis and arthritic pain, and that these effects are likely mediated by reduction of cytokine levels in the periphery and activation of ERK and CaMKIIα in the spinal cord. These results suggest that SOC channels are potential drug targets for the treatment of RA. (Source: British Journal of Pharmacology)


The Efficacy of Laparoscopic Surgical Treatment of Ovarian Remnant and Ovarian Retention Syndromes
Conclusion Surgical treatment for ovarian remnant or ovarian retention syndrome is effective but is most effective in patients with no other pain-related diagnoses. Thus, it is important to thoroughly evaluate women with ovarian remnant or ovarian retention syndrome for other pelvic pain–related disorders. In almost all cases, surgery can be done laparoscopically in patients with these syndromes. (Source: Journal of Minimally Invasive Gynecology)


Does the Uterine Cervix Become Abnormally Reinnervated After Subtotal Hysterectomy and What Is the Association With Future Trachelectomy?
Conclusion Nerve fibers in the cervical stump after supracervical hysterectomy are significantly increased in women undergoing trachelectomy for pain indications compared with those who underwent trachelectomy for nonpain indications and controls. Although not statistically significant, endometriosis may be an independent risk factor for increased nerve fibers. These histopathologic observations may support the idea that the cervix should be removed in women undergoing hysterectomy for chronic pelvic pain or endometriosis. (Source: Journal of Minimally Invasive Gynecology)


Anti-TNF response rates in radiographic and non-radiographic axial spondyloarthropathy
With recent evolution of classification systems for axial spondyloarthropathy to include non-radiographic disease, there has been an increasing emphasis to treat inflammatory back pain early, potentially aiming to halt disease progression and prevent chronic damage. Current National Institute of Health and Care Excellence (NICE) criteria for commencement of anti-tumour necrosis factor (TNF) therapy in spondyloarthropathy are based on the modified New York criteria of 1984. As such, this requires radiographic changes based on plain film X-ray rather than allowing for the more sensitive modality of MRI. This criterion, therefore, excludes a group of patients that may potentially benefit from biological therapy. Published studies by Song et al (ESTHER1) and Sieper et al (ABILITY-12) as well a...


A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies
Conclusions: The shift in treatment expectations to greater acceptance of pain and the need for continued self-care suggests that future research should explore how CAM practitioners can capitalize on these shifts to encourage feelings of empowerment rather than disappointment surrounding realizations of the need for continued engagement with self-care. (Source: BMC Complementary and Alternative Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pain and its clinical associations in individuals with chronic obstructive pulmonary disease (COPD): a systematic review.
Conclusions: In people with COPD, pain has negative clinical associations with symptoms and quality of life measures. Further research exploring the measurement properties of instruments assessing pain is required. PMID: 25654647 [PubMed - as supplied by publisher] (Source: Chest)


Analysis of chronic low back pain with magnetic resonance imaging T2 mapping of lumbar intervertebral disc
Conclusions The results indicated a correlation between posterior AF degeneration and CLBP. This study suggests that MRI T2 mapping could be used as a quantitative method for diagnosing discogenic pain. (Source: Journal of Orthopaedic Science)


Link between early menopause, chronic fatigue syndrome discovered
A newfound link between chronic fatigue syndrome (CFS) and early menopause has been reported by researchers. This link, as well as links with other gynecologic problems and with pelvic pain, may help explain why CFS is two to four times more common in women than in men and is most prevalent in women in their 40s. (Source: ScienceDaily Headlines)


New DoD funded study to tackle chronic amputee pain for veterans and civilians
(Northwestern Memorial Hospital) Northwestern Medicine researchers are leading a new multi-center clinical trial to evaluate a unique surgical method, known as targeted muscle reinnervation, to treat chronic pain that can result from limb amputation. Around a quarter of all amputees develop chronic pain in the remaining portion of their amputated limb, which can include phantom limb syndrome (pain that is perceived in the portion of the limb that is gone), and prevents many patients from using prostheses. (Source: EurekAlert! - Medicine and Health)


Study finds link between early menopause and CFS
(The North American Menopause Society (NAMS)) A newfound link between chronic fatigue syndrome (CFS) and early menopause was reported online today in Menopause, the journal of the North American Menopause Society. This link, as well as links with other gynecologic problems and with pelvic pain, may help explain why CFS is two to four times more common in women than in men and is most prevalent in women in their 40s. (Source: EurekAlert! - Social and Behavioral Science)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


D-aspartate modulates nociceptive-specific neuron activity and pain threshold in inflammatory and neuropathic pain condition in mice.
Authors: Boccella S, Vacca V, Errico F, Marinelli S, Squillace M, Guida F, Di Maio A, Vitucci D, Palazzo E, De Novellis V, Maione S, Pavone F, Usiello A Abstract D-Aspartate (D-Asp) is a free D-amino acid found in the mammalian brain with a temporal-dependent concentration based on the postnatal expression of its metabolizing enzyme D-aspartate oxidase (DDO). D-Asp acts as an agonist on NMDA receptors (NMDARs). Accordingly, high levels of D-Asp in knockout mice for Ddo gene (Ddo (-/-)) or in mice treated with D-Asp increase NMDAR-dependent processes. We have here evaluated in Ddo (-/-) mice the effect of high levels of free D-Asp on the long-term plastic changes along the nociceptive pathway occurring in chronic and acute pain condition. We found that Ddo (-/-) mice show an increas...


A multi-center, double-blind, randomized, placebo-controlled trial protocol to assess Traumeel injection vs dexamethasone injection in rotator cuff syndrome: the TRAumeel in ROtator cuff syndrome (TRARO) study protocol
DiscussionIt is hoped that the results of this trial will expand the treatment options and evidence base available for the management of rotator cuff disease.Trial registrationClinicalTrials.gov: NCT01702233. EudraCT number: 2012-003393-12. (Source: BMC Musculoskeletal Disorders)


Central Hypersensitivity in Chronic Musculoskeletal Pain
Clinical research has consistently detected alteration in central pain processing leading to hypersensitivity. Most methods used in humans are reliable and have face validity to detect widespread central hypersensitivity. However, construct validity is difficult to investigate due to lack of gold standards. Reference values in the pain-free population have been generated, but need replication. Research on pain biomarkers that reflect specific central hypersensitivity processes is warranted. Few studies have analyzed the prognostic value of central hypersensitivity. Most medications acting at central level and some non-pharmacological approaches, including psychological interventions, are likely to attenuate central hypersensitivity. (Source: Physical Medicine and Rehabilitation Clinics of ...


“Dry Needling Alters Trigger Points in the Upper Trapezius Muscle and Reduces Pain in Subjects with Chronic Myofascial Pain”
To determine whether dry needling of an active myofascial trigger point (MTrP) reduces pain and alters the status of the trigger point to either a non-spontaneously tender nodule or its resolution. (Source: PM and R)


Relationship between blood- and CSF-bound neurotransmitter concentrations and conditioned pain modulation in pain-free and chronic pain subjects
Descending pain inhibition is an endogenous pain control system thought to depend partially on the activation of bulbo-spinal monoaminergic pathways. Deficits in descending pain inhibition have been reported in numerous human chronic pain conditions, but there is currently no consensus regarding the neurochemical correlates responsible for this deficit. The aims of this study were to: [1] assess the efficacy of descending pain inhibition in pain-free (PF) and chronic pain (CP) subjects, [2] screen for changes in centrally (i.e. (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>


Prevalence of chronic pain and its association with the sociodemographic situation and physical activity in leisure of elderly in Florianópolis, Santa Catarina: population-based study
CONCLUSIONS: Therefore, it is clear that chronic pain affects a considerable amount of elderly individuals. Social inequalities are a harmful influence in these individuals' quality of life, inasmuch as those inequalities increase the frequency with which chronic pain afflicts them. At the same time, physical activity during leisure time decreases chronic pain frequency. It is fundamental that public health policies subsidize multidisciplinary pain management programs, which should include health targeted physical activity for the elderly, thus preventing the decrease in quality of life that chronic pain brings to this population. (Source: Revista Brasileira de Epidemiologia)


The Science Behind Why You Say 'Ow' When You're In Pain
When you stub your toe or bang your head, why is the initial response always to yell "ouch" (or something less printable)? Scientists may have the answer. New research from the National University of Singapore suggests that vocalizing may interfere with pain signals traveling to the brain, distracting you from the uncomfortable sensations you're feeling. The researchers gathered 56 test participants and had each person submerge his or her hand into painfully cold water four separate times. In each case, participants were asked either to say "ow," to listen to a recording of a person saying "ow," to press a button or to remain passive and silent. Both saying "ow" and pressing the button were found to have a positive effect on pain tolerance. When participants said "ow" or pushed a butt...


Exercises for mechanical neck disorders.
CONCLUSIONS: No high quality evidence was found, indicating that there is still uncertainty about the effectiveness of exercise for neck pain. Using specific strengthening exercises as a part of routine practice for chronic neck pain, cervicogenic headache and radiculopathy may be beneficial. Research showed the use of strengthening and endurance exercises for the cervico-scapulothoracic and shoulder may be beneficial in reducing pain and improving function. However, when only stretching exercises were used no beneficial effects may be expected. Future research should explore optimal dosage. PMID: 25629215 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)


Narcotic Analgesics
Title: Narcotic AnalgesicsCategory: MedicationsCreated: 3/2/2005 12:00:00 AMLast Editorial Review: 2/3/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Successful medical treatment of emphysematous pyelonephritis in chronic hemodialysis
We report the case of a 77‐year‐old woman with diabetes and end‐stage renal disease on chronic hemodialysis that presented with fever and left flank pain. A bubbly gas pattern inside the left kidney was demonstrated on abdominal computed tomography scan and blood cultures grew Escherichia coli. She was successfully treated solely with systemic antibiotics. This highlights the fact that prompt recognition of imaging findings associated with benign prognosis is essential for a favorable outcome. It allows for an effective management avoiding high‐risk interventions, especially in frail patients with multiple comorbidities. Finally, we review all published cases of EPN in chronic dialysis patients. (Source: Hemodialysis 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>


Onabotulinum Toxin A for the Treatment of Headache in Service Members With a History of Mild Traumatic Brain Injury: A Cohort Study
ConclusionsWe demonstrate that active duty military patients with headaches related to concussions may benefit from treatment with OBA. Further studies are indicated. (Source: Headache: The Journal of Head and Face Pain)


The Prevalence, Burden, and Treatment of Severe, Frequent, and Migraine Headaches in US Minority Populations: Statistics From National Survey Studies
ConclusionsIn the United States, migraine prevalence is highest among Native Americans, then Whites, followed closely by Hispanics and Blacks. Asians have the lowest prevalence of severe, frequent headache or migraine of the major racial or ethnic groups. Differences in diagnosis and treatment of headache and migraine may indicate racial and ethnic disparities in access and quality of care for minority patients. (Source: Headache: The Journal of Head and Face Pain)


No Microstructural White Matter Alterations in Chronic and Episodic Migraineurs: A Case–Control Diffusion Tensor Magnetic Resonance Imaging Study
ConclusionsNo microstructural white matter changes could be observed in middle‐aged chronic and episodic migraineurs using DTI. CM does not seem to be a risk factor for progressive microstructural changes in DTI. (Source: Headache: The Journal of Head and Face Pain)


Temporomandibular Dysfunction and Headache Disorder
It has been well established that primary headaches (especially migraine, chronic migraine, and tension‐type headache) and temporomandibular dysfunction (TMD) are comorbid diseases, with the presence of one of them in a patient increasing the prevalence of the others. The relationship between the 2 diseases may involve the sharing of common physiopathological aspects. Studies about the treatment of this disease association have shown that a simultaneous therapeutic approach to the 2 diseases is more effective than the separate treatment of each. As a consequence, specialists in orofacial pain are now required to know the criteria for the diagnosis of headaches, and headache physicians are required to know the semiologic aspects of orofacial pain. Nevertheless, a headache may be attribute...


Varicocele anatomy during subinguinal microsurgical varicocelectomy in Chinese men
Summary Knowledge of subinguinal microsurgical varicocelectomy is of fundamental importance to ensure that varicocele is resolved and testicular function is preserved. Our study aimed to describe the number of veins, arteries and lymphatics in the subinguinal spermatic cord and to clarify their differences between two sides, between patients with different complaints and between varicoceles with different clinical grades. A total of 102 consecutive patients underwent 162 primary subinguinal microsurgical varicocelectomies, during which the number of vessels with different diameters was recorded. A mean number of 12.9 internal spermatic veins, 0.9 external spermatic veins, 1.8 internal spermatic arteries and 2.9 lymphatics were identified per cord. 88.2% of the internal spermatic arteries 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>


Epidural spinal cord stimulation for neuropathic pain: a neurosurgical multicentric Italian data collection and analysis
Conclusions No relevant differences in long-term outcomes were observed in previously tested patients compared with patients implanted at once. Through this analysis we hope to recruit new centres, to give more scientific value to our results. (Source: Acta Neurochirurgica)


The QTc Effect of Low‐Dose Methadone for Chronic Pain: A Prospective Pilot Study
ConclusionData from our chronic pain clinic support a potential association of QTc prolongation during the initiation of methadone, but this effect is small and short lived. We believe larger scale studies to further characterize the safety profile of low‐dose methadone are warranted. (Source: Pain Medicine)


Economic Analysis of a Comprehensive Pain Rehabilitation Program: A Collaboration Between Florida Blue and Mayo Clinic Florida.
ConclusionsThe appropriate use of a comprehensive outpatient rehabilitation program for chronic pain patients can result in a significant reduction in medical costs. (Source: Pain Medicine)


Pain Self‐Management in HIV‐Infected Individuals with Chronic Pain: A Qualitative Study
ConclusionsSome of these strategies may be viewed as beneficial and overlap with known HIV self‐management strategies (cognitive strategies), whereas others may have negative health consequences (substance use). Interventions that incorporate healthy self‐management strategies may be particularly effective in improving both HIV and pain outcomes. (Source: Pain Medicine)


Effect of enzymatic debridement with two different collagenases versus mechanical debridement on chronic hard‐to‐heal wounds
This study was designed in order to compare two types of collagenases with mechanical debridement alone. It was thus possible to evaluate their differences in terms of pain and debridement efficacy. Patients were divided into three groups: 30 patients were daily dressed using an ointment based on collagenase produced by Vibrio alginolyticus (B group), 30 patients were daily dressed using an ointment based on a collagenase preparation derived from Clostridium histolyticum (N group) and 30 patients underwent classical mechanical debridement (M group). Complete wound healing over a period of 8 weeks occurred in 24 patients (27%) out of 90;10 patients belonging to the B group, 8 patients to the N group and 6 patients to the M group. This study was performed in order to highlight the differen...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Prevalence of Pain With Advancing Age Brief Report
We present longitudinal data from age 70 to 90 years concerning chronic musculoskeletal/joint pain, abdominal pain, and headache. (Source: Journal of the American Medical Directors Association)


Symptom trends in the last year of life from 1998 to 2010: a cohort study.
CONCLUSION: Despite national efforts to improve end-of-life care, proxy reports of pain and other alarming symptoms in the last year of life increased from 1998 to 2010. PRIMARY FUNDING SOURCE: National Institute of Nursing Research. PMID: 25643305 [PubMed - in process] (Source: Annals of Internal Medicine)


Obesity and Chronic Pain: Systematic Review of Prevalence and Implications for Pain Practice.
This article examines specific pain management approaches for obese patients and reviews novel interventional techniques for treatment of obesity. The infrastructure for simultaneous treatment of obesity and pain already exists in pain medicine (eg, patient education, behavioral medicine approaches, physical rehabilitation, medications, and interventional treatment). Screening for obesity, pain-related disability, and behavioral disorders as well as monitoring of functional performance should become routine in pain medicine practices. Such an approach requires additional physician and staff training. Further research should focus on better understanding the interplay between these 2 very common conditions and the development of effective treatment strategies. PMID: 25650632 [PubMed - a...


The use of autologous platelet-rich plasma in the orthopedic setting.
CONCLUSIONS: Despite its popularity, there are no standardized criteria that define aPRP. Different techniques yield wide variability in terms of platelet count and concentration. These variations make it difficult to compare clinical trials that use aPRP or draw conclusions concerning its clinical efficacy in orthopedic procedures. Blood bankers have experience in the production of standardized blood components. This expertise may be used to develop and implement protocols for the production and administration of aPRP, as well as quality control measures. PMID: 25646697 [PubMed - as supplied by publisher] (Source: Transfusion)


Temporomandibular Dysfunction and Headache Disorder.
Authors: Speciali JG, Dach F Abstract It has been well established that primary headaches (especially migraine, chronic migraine, and tension-type headache) and temporomandibular dysfunction (TMD) are comorbid diseases, with the presence of one of them in a patient increasing the prevalence of the others. The relationship between the 2 diseases may involve the sharing of common physiopathological aspects. Studies about the treatment of this disease association have shown that a simultaneous therapeutic approach to the 2 diseases is more effective than the separate treatment of each. As a consequence, specialists in orofacial pain are now required to know the criteria for the diagnosis of headaches, and headache physicians are required to know the semiologic aspects of orofacial pai...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


No Microstructural White Matter Alterations in Chronic and Episodic Migraineurs: A Case-Control Diffusion Tensor Magnetic Resonance Imaging Study.
CONCLUSIONS: No microstructural white matter changes could be observed in middle-aged chronic and episodic migraineurs using DTI. CM does not seem to be a risk factor for progressive microstructural changes in DTI. PMID: 25644380 [PubMed - as supplied by publisher] (Source: Headache)


Onabotulinum Toxin A for the Treatment of Headache in Service Members With a History of Mild Traumatic Brain Injury: A Cohort Study.
CONCLUSIONS: We demonstrate that active duty military patients with headaches related to concussions may benefit from treatment with OBA. Further studies are indicated. PMID: 25644249 [PubMed - as supplied by publisher] (Source: Headache)


Restoring the Spinal Pain Gate: GABAA Receptors as Targets for Novel Analgesics.
Authors: Zeilhofer HU, Ralvenius WT, Acuña MA Abstract GABAA receptors (GABAARs) and glycine receptors are key elements of the spinal control of nociception and pain. Compromised functioning of these two transmitter systems contributes to chronic pain states. Restoring their proper function through positive allosteric modulators should constitute a rational approach to the treatment of chronic pain syndromes involving diminished inhibitory spinal pain control. Although classical benzodiazepines (i.e., full agonists at the benzodiazepine binding site of GABAARs) potentiate synaptic inhibition in spinal pain controlling circuits, they lack clinically relevant analgesic activity in humans. Recent data obtained from experiments in GABAAR point-mutated mice suggests dose-limiting sedat...


Efficacy of tramadol–acetaminophen tablets in low back pain patients with depression
Conclusions This investigation found that tramadol–acetaminophen is effective for reducing LBP and provided a prophylactic antidepressant effect in chronic LBP patients with depression. (Source: Journal of Orthopaedic Science)


Primary Care Physicians' Attitudes and Beliefs towards Chronic Low Back Pain: An Asian Study.
CONCLUSION: The lack of concordance in the pain explanatory models used by private and public sector may have a detrimental effect on patients who are under the care of both parties. The uncertain treatment orientation may have a negative influence on patients' attitudes and beliefs, thus contributing to the tension and, perhaps, even ailing mental state of a person with chronic LBP. PMID: 25635919 [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>


PKCγ-Positive Neurons Gate Light Tactile Inputs to Pain Pathway Through pERK1/2 Neuronal Network in Trigeminal Neuropathic Pain Model.
Conclusion: PKCγ cells in the medullary dorsal horn may be involved in DMA following CCI-IoN through the activation of pERK1/2-expressing cells, which then may relay nonnociceptive information to lamina I cells in the medullary dorsal horn. PMID: 25635962 [PubMed - as supplied by publisher] (Source: Journal of Orofacial Pain)


The Effectiveness of Cannabinoids in the Management of Chronic Nonmalignant Neuropathic Pain: A Systematic Review.
Conclusion: Cannabisbased medicinal extracts used in different populations of chronic nonmalignant neuropathic pain patients may provide effective analgesia in conditions that are refractory to other treatments. Further high-quality studies are needed to assess the impact of the duration of the treatment as well as the best form of drug delivery. PMID: 25635955 [PubMed - as supplied by publisher] (Source: Journal of Orofacial Pain)


Tapentadol Toxicity in Children
Tapentadol is used in the treatment of chronic pain, specifically diabetic neuropathy. It has known action on the &mu;-opioid receptor leading to drowsiness and apneas. There is no published information on the effects of tapentadol in small children. After an accidental overdose in a child, tapentadol may be expected to cause &mu;-opioid clinical effects similar to other opioids. While the opioid effects predominate sympathomimetic effects are also seen. The risk of respiratory depression and dyspnea should be acknowledged. (Read the full article) (Source: PEDIATRICS)


Short-term consolidation of articular cartilage in the long-term context of osteoarthritis
Publication date: 7 March 2015 Source:Journal of Theoretical Biology, Volume 368 Author(s): Francis G. Woodhouse , Bruce S. Gardiner , David W. Smith Over ten percent of the population are afflicted by osteoarthritis, a chronic disease of diarthrodial joints such as the knees and hips, costing hundreds of billions of dollars every year. In this condition, the thin layers of articular cartilage on the bones degrade and weaken over years, causing pain, stiffness and eventual immobility. The biggest controllable risk factor is long-term mechanical overloading of the cartilage, but the disparity in time scales makes this process a challenge to model: loading events can take place every second, whereas degradation occurs over many months. Therefore, a suitable model must be sufficiently simpl...


Spinal autophagy is differently modulated in distinct mouse models of neuropathic pain
In this study, we characterized the main autophagic markers in two other common experimental models of neuropathic pain, the chronic constriction injury (CCI) and the spared nerve injury (SNI). The different modulation of LC3-I, Beclin 1 and p62 suggested that autophagy is differentially affected in the spinal dorsal horn depending on the type of peripheral injury. Confocal analysis of p62 distribution in the spinal dorsal horn indicated its presence mainly in NeuN-positive cell bodies and occasionally in glial processes, thus suggesting a predominant expression in the neuronal compartment. Finally, we investigated the consequences of autophagy impairment on pain behaviour by using the autophagy blocker cloroquine. Intrathecal chloroquine injection in naive mice induced spinal accumulation...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Anterior Cutaneous Nerve Entrapment Syndrome in Children
The purpose of this manuscript is to report on an entity known as Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) and its relevance to chronic abdominal pain encountered in children. (Source: Journal of Pediatric Surgery)


Electrical Stimulation and Motor Recovery.
Authors: Young W Abstract In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people and &gt;90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as "neurons th...


Non-Celiac Gluten Sensitivity Triggers Gut Dysbiosis, Neuroinflammation, Gut-Brain Axis Dysfunction, and Vulnerability for Dementia.
Authors: Daulatzai MA Abstract The non-celiac gluten sensitivity (NCGS) is a chronic functional gastrointestinal disorder which is very common worldwide. The human gut harbors microbiota which has a wide variety of microbial organisms; they are mainly symbiotic and important for well being. However, "dysbiosis" - i.e. an alteration in normal commensal gut microbiome with an increase in pathogenic microbes, impacts homeostasis/health. Dysbiosis in NCGS causes gut inflammation, diarrhea, constipation, visceral hypersensitivity, abdominal pain, dysfunctional metabolic state, and peripheral immune and neuro-immune communication. Thus, immune-mediated gut and extra-gut dysfunctions, due to gluten sensitivity with comorbid diarrhea, may last for decades. A significant proportion of NCGS ...


Urinary Tract Infection in Infancy Is a Risk Factor for Chronic Abdominal Pain in Childhood
Conclusions: We show for the first time that UTI is associated with CAP in childhood. We speculate that pelvic organ sensory convergence explains our findings. (Source: Journal of Pediatric Gastroenterology and Nutrition)


Management of Chronic Spinal Cord Dysfunction
This article highlights key issues associated with chronic spinal cord dysfunction. Recent Findings:: Advances in symptomatic management for chronic spinal cord dysfunction include use of botulinum toxin to manage detrusor hyperreflexia, pregabalin for management of neuropathic pain, and intensive locomotor training for improved walking ability in incomplete spinal cord injuries. Summary:: The care of spinal cord dysfunction has advanced significantly over the past 2 decades. Management and treatment of neurologic and non-neurologic complications of chronic myelopathies ensure that each patient will be able to maximize their functional independence and quality of life. (Source: CONTINUUM)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Improving Pain Outcomes in Home Health Patients Through Implementation of an Evidence-Based Guideline Bundle
Abstract: Pain is often undertreated and underreported in the elderly. Many of these individuals receive home healthcare services for management of their conditions. Home healthcare agencies (HHAs) have outcome measures that are publicly reported. The purpose of this project was to implement an evidence-based (EB) guideline bundle to improve the outcome measure “Improvement in Pain Interfering With Activity.” This quality improvement (QI) project used a pre-/posttest design. The setting was a hospital-based HHA in Arizona. The target sample included Medicare patients with chronic pain and pain that interfered with activity. The approach included a review of published clinical practice guidelines addressing pain management, and identification of relevant interventions for the home healt...


For What Illnesses Is a Disease Management Program Most Effective?
Conclusions: Employers should focus on those conditions that generate savings when purchasing DM programs. Clinical Significance: This study suggests that the University of Minnesota's DM program reduces hospitalizations for individuals with asthma, cardiovascular disease, depression, musculoskeletal problems, low back pain, and migraines. The program also reduced avoidable hospitalizations for individuals with asthma, depression, and low back pain. (Source: Journal of Occupational and Environmental Medicine)


Body composition in lipoedema of the legs using Dual‐Energy‐X‐Ray‐Absorptiometry – a case control study
This article is protected by copyright. All rights reserved. (Source: British Journal of Dermatology)


History and Present State of Targeted Intrathecal Drug Delivery
Abstract Nearly 50 years ago, the seminal experiments of Melzack and Wall, culminating in the gate control theory, coupled with the discovery of endogenous opioid receptors, helped shape modern understandings of pain and provided interventionalists a potent therapeutic gateway to neuraxial analgesia. This paper emphasizes the historical antecedents, present state, and emerging future of the neuromodulatory technique of targeted intrathecal drug delivery (TIDD) for chronic pain. The strengths of TIDD are its customizability, reversibility, programmability, and low risk profile. Its benefits are evidenced by improved pain relief and quality of life and reduced demand for health-care resources. (Source: Current Pain and Headache Reports)


Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process
Conclusion Motor weakness, male sex, morphological stenotic grade, and the amount of disability are critical factors leading to a surgical decision for LSS when using a preference-based shared decision-making process. (Source: European Spine Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The Value of Pharmacogenetic Testing—Reply
In Reply We thank Dr Pocinki for sharing his experience with pharmacogenetic testing over the past year. He notes that “with the exception of specific warfarin testing,” pharmacogenetic testing in his patient population has improved clinical decision making and patient outcomes. He cites his experience treating a young woman with chronic pain and “NSAID [nonsteroidal anti-inflammatory drug] intolerance” in whom pharmacogenetic testing showed to be a poor metabolizer of almost all NSAIDs, but suggested she could be treated with naproxen, which is metabolized by a different pathway. Dr Pocinki concludes that “waiting for the results of future, well-designed, adequately powered studies needlessly condemns countless patients to experience avoidable adverse reactions and treatment fai...


Centrally targeted pharmacotherapy for chronic abdominal pain
Abstract BackgroundChronic abdominal pain in the context of the functional gastrointestinal disorders departs from a more traditional approach to treating gastrointestinal symptoms. Chronic abdominal pain involves a dysregulation of brain‐gut modulation of afferent signaling, so treatments directed toward the gut are not usually sufficient to achieve a clinical response. Rather the methods of treatment depend on re‐establishing central pain regulation. PurposeA conceptual model of predisposing, precipitating, and perpetuating factors is used to explain how a situation of chronic pain develops and it provides the evidence for central neuron degeneration as relevant to this chain of events. The rationale for centrally targeted medications, in particular antidepressants, is discussed with...


Partial recovery of abnormal insula and dorsolateral prefrontal connectivity to cognitive networks in chronic low back pain after treatment
Abstract We previously reported that effective treatment of chronic low back pain (CLBP) reversed abnormal brain structure and functional MRI (fMRI) activity during cognitive task performance, particularly in the left dorsolateral prefrontal cortex (DLPFC). Here, we used resting‐state fMRI to examine how chronic pain affects connectivity of brain networks supporting cognitive functioning and the effect of treatment in 14 CLBP patients and 16 healthy, pain‐free controls (scans were acquired at baseline for all subjects and at 6‐months post‐treatment for patients and a matched time‐point for 10 controls). The main networks activated during cognitive task performance, task‐positive network (TPN) and task‐negative network (TNN) (aka default mode) network, were identified in subje...


Use of acellular dermal matrix combined with a component separation technique for repair of contaminated large ventral hernias: a possible ideal solution for this clinical challenge.
This study reviewed retrospectively data of 35 patients with contaminated large ventral hernias who received repair using acellular dermal matrix combined with a component separation technique from 2009 to 2011. Twenty-one males and 14 females were identified with a mean age of 45.5 ± 12.5 years and a mean body mass index of 22.5 ± 5.8 kg/m(2). Simultaneously, nine patients underwent bowel fistula resection, 13 patients underwent ostomy takedown, five patients underwent recurrent colon cancer dissection, and eight patients underwent infectious permanent mesh removal and wound débridement. Mean defect size was 125.0 ± 23.5 cm(2). The aponeurosis of the external oblique muscle was transected and separated from internal oblique muscle to reach abdominal closure. Acellular dermal matrix wa...


Dermal flap advancement combined with conservative sphincterotomy in the treatment of chronic anal fissure.
Authors: Theodoropoulos GE, Spiropoulos V, Bramis K, Plastiras A, Zografos G Abstract Lateral internal sphincterotomy (LIS) is considered the surgical treatment of choice for chronic anal fissure (CAF). Flap techniques for fissure coverage have the advantage of primary wound healing, potentially providing better functional results and faster pain relief. The standard surgical strategy for CAF consisting of conventional LIS (CLIS) up to the dentate line was modified by "tailoring" the LIS to the apex of the CAF, but never greater than 1 cm, and by advancing a dermal flap for coverage of the CAF (LIS + flap) after fissurectomy. Thirty consecutive patients who underwent "LIS + flap" were compared with 32 patients who had been previously treated by CLIS. A modified, trapezoid-like Y-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>


Central failures of lightweight monofilament polyester mesh causing hernia recurrence: a cautionary note
Conclusion Lightweight monofilament polyester mesh (Parietex TCM) appears to have a high incidence of mechanical failure in the context of open incisional hernia repair. While this limitation may ultimately be revealed as a weakness of all lightweight mesh, surgeons should be aware that these failures have already been documented. (Source: Hernia)


Biomechanical evaluation of fixation properties of fibrin glue for ventral incisional hernia repair
Conclusions With mesh in the onlay position, fixation to the abdominal wall occurs quickly. Though sutures were stronger at 24 h, as early as 1 week, the strength of the fixation exceeded the tissue or the mesh strength in our testing configuration for both glue and suture groups. Fixation strength is independent of technique at the latter time points. There are potential clinical advantages to the exclusive use of fibrin glue for fixation including acute post-operative pain, chronic post-operative pain, and recurrence for ventral incisional hernia repair. (Source: Hernia)


Role of orchiectomy in severe testicular pain after inguinal hernia surgery: audit of the Finnish Patient Insurance Centre
Conclusion Urological injuries form one-fifth of the major complications after inguinal hernioplasty. Orchiectomy appears to help the majority of patients with severe testicular pain syndrome. (Source: Hernia)


PedsQL™ Gastrointestinal Symptoms Scales and Gastrointestinal Worry Scales in pediatric patients with functional and organic gastrointestinal diseases in comparison to healthy controls
Conclusions The PedsQL™ Gastrointestinal Symptoms and Worry Scales may be utilized as common metrics across pediatric patient groups with FGIDs and organic GI diseases and healthy samples to measure GI-specific symptoms in clinical research and practice. (Source: Quality of Life Research)


Effect of herbal-partitioned moxibustion at Tianshu (ST 25) and Qihai (CV 6) on pain-related behavior and emotion in rats with chronic inflammatory visceral pain
Conclusion HPM has analgesic effect on chronic inflammatory visceral pain. It can reduce the visceral and somatic pain in rats and markedly improve the emotions such as anxiety and depression induced by chronic visceral pain. (Source: Journal of Acupuncture and Tuina Science)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


February 2015 erratum.
Authors: Abstract Correction to an article published in November 2014 of JOSPT: Llamas-Ramos R, Pecos-Martín D, Gallego-Izquierdo T, Llamas-Ramos I, Plaza-Manzano G, Ortega-Santiago R, Cleland J, Fernández-de-Las-Peñas C. Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 2014;44(11):852-861. doi:10.2519/jospt.2014.5229 J Orthop Sports Phys Ther 2015;45(2):147. doi:10.2519/jospt.2015.45.2.147. PMID: 25641312 [PubMed - in process] (Source: Physical Therapy)


Report of the NIH Task Force on Research Standards for Chronic Low Back Pain.
Authors: Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, Delitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner DK Abstract UNLABELLED: Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to ...


A detailed analysis of outcome reporting from randomised controlled trials and meta-analyses of inguinal hernia repair
Conclusions Outcome reporting from RCTs concerning inguinal hernia repair is inconsistent and poorly defined, limiting meta-analyses, which themselves do not control for the differing definitions of assessed outcomes. This study justifies investment in a standardised core outcome set for inguinal hernia surgery, to improve outcome reporting and evidence synthesis. (Source: Hernia)


Body composition in lipoedema of the legs using Dual-Energy-X-Ray-Absorptiometry - a case control study.
This article is protected by copyright. All rights reserved. PMID: 25641018 [PubMed - as supplied by publisher] (Source: The British Journal of Dermatology)


Commentary on the influence of gender on the management of chronic pelvic pain
(Source: BJOG: An International Journal of Obstetrics and Gynaecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group].
Authors: Takács T, Czakó L, Dubravcsik Z, Farkas G, Hegyi P, Hritz I, Kelemen D, Lásztity N, Morvay Z, Oláh A, Pap Á, Párniczky A, Patai Á, Sahin-Tóth M, Szentkereszti Z, Szmola R, Tiszlavicz L, Szücs Á, Magyar Hasnyálmirigy Munkacsoport Abstract Chronic pancreatitis is an inflammatory disease associated with structural and functional damage of the pancreas. In most cases pain, maldigestion and weight loss are the leading sympthoms, which significantly worsen the quality of life. Correct diagnosis and differential diagnosis of chronic pancreatitis and treatment of these patients requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines a...


Stacked-blade, single-cut, ulnar-shortening osteotomy.
Authors: Renfree KJ, Odgers RA Abstract The authors reviewed a 10-year consecutive series of ulnar-shortening osteotomies using a freehand, single oblique cut with 2 or 3 stacked saw blades. Twenty-one patients (23 wrists) with chronic ulnar impaction syndrome (mean age, 45 years; range, 16 to 73 years) demonstrated an average preoperative ulnar variance of +2.1 mm (range, 0.0 to 4.0 mm). An oblique osteotomy was performed in the distal one-third of the ulnar diaphysis at an estimated 45° or 60° angle, relative to the ulnar axis, and was fixed with a 7-hole, 2.7- or 3.5-mm dynamic compression plate placed dorsally. Using a previously described formula, the authors estimated ulnar shortening on the basis of intraoperative measurement of kerf width and osteotomy angle as 3.3 mm (ra...


Biologics in the treatment of chronic pain: a new era of therapy?
Authors: Bannwarth B, Kostine M Abstract Existing analgesics fail to provide adequate pain relief in a significant proportion of patients complaining of chronic pain. Furthermore, their use is limited by tolerability and safety concerns. Thus, there is a huge unmet need for effective and safe innovative painkillers. Considering the major role of nerve growth factor (NGF) in the generation and maintenance of a wide range of pain states, the issue is whether anti-NGF biologics under development might offer such an opportunity. PMID: 25670514 [PubMed - in process] (Source: Clinical Pharmacology and Therapeutics)


Opioids for chronic noncancer pain: still no evidence for superiority of sustained-release opioids.
Authors: Pedersen L, Fredheim O Abstract Opioids are controversial in the treatment of chronic pain due to the risk of addiction, misuse, and death. Long-acting formulations of opioids have been hypothesized to improve pain relief, sleep quality, and lower the risk of side effects and addiction compared to short-acting formulations of opioids. Thus, several guidelines have recommended the use of long-acting opioid formulations over short-acting ones in the treatment of chronic noncancer pain. However, is there really evidence of their superiority? PMID: 25670511 [PubMed - in process] (Source: Clinical Pharmacology and Therapeutics)


Pharmacological treatment of pain: future trends and novel insights.
Authors: Cascorbi I Abstract The pharmacological treatment of chronic pain is generally hampered by a limited clinical outcome. Hence, there is a strong need for new therapeutic concepts considering the identification of novel targets and related drugs, but also optimization of established therapeutic regimes through individualization. In this issue, focused on "Pain," we discuss some of the recent new concepts in pain treatment, understanding of pain heterogeneity, and subsequent optimization of analgesic treatment, but also novel insights into interactions of nonopioids. PMID: 25670508 [PubMed - in process] (Source: Clinical 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>


[Postherpetic neuralgia].
Authors: Goßrau G Abstract Postherpetic neuralgia is considered to be a neuropathic pain syndrome. Typically, patients experience pain in the dermatomes of skin lesions persisting for more than 3 months after skin restitution. About 10 % of patients with herpes zoster develop postherpetic neuralgia. Its prevalence increases with age. Common clinical symptoms include continuous burning pain, sharp pain attacks, and allodynia. Additionally, sensory hyperactivation or loss in the affected skin area is present. Pathophysiology includes mechanisms of peripheral and central sensitization, based on damaged nerve fibers as the main mechanisms for pain generation and its maintenance. Clinical studies did show pain relief in postherpetic neuralgia after administration of antidepressants,...


Social work in health care when conventional meets complementary: nonspecific back pain and massage therapy.
This article offers information relevant to social workers in practice about the complex and multifactoral condition of chronic nonspecific back pain and the integration of complementary and alternative medicine, in particular, massage therapy, as an effective evidence-based integrated approach. PMID: 25665287 [PubMed - in process] (Source: Health and Social Work)


Local and distant acupuncture points stimulation for chronic musculoskeletal pain: A systematic review on the comparative effects
Abstract One in four people suffers from chronic musculoskeletal pain (CMP). Acupuncture points stimulation is increasingly used for pain relief for CMP. Commonly, a combination of local and distant points is used. However, the difference between the effects of local and distant point stimulation is unknown. This systematic review aimed to determine if there was a difference in effects between stimulating local and distant points, and the combination of both when compared with either alone. English and Chinese electronic databases were searched to identify randomized controlled trials, where local or distant points were stimulated in adults with CMP. Pain intensity was the primary outcome measure. Nineteen were included in the qualitative analysis and 15 in the meta‐analysis. Local and d...


Successful treatment of classic Kaposi sarcoma with topical timolol: report of two cases
This article is protected by copyright. All rights reserved. (Source: British Journal of Dermatology)


Osteomalacia and Fanconi's syndrome caused by long‐term low‐dose adefovir dipivoxil
We report a case of low‐dose ADV‐induced hypophosphatemic osteomalacia that initially presented as diffuse musculoskeletal pain. Case summaryA 59‐year‐old Chinese man reported an 18‐month history of severe chest wall pain and multiple bone pain during the previous 4 months with no antecedent trauma. There was no clinical evidence of an infectious, inflammatory or malignant process. Medical history showed that the patient had a history of chronic hepatitis B infection, and receiving lamivudine at a daily dose of 100 mg for 70 months. Lamivudine was changed to adefovir (10 mg/day) for the past 42 months. His serum inorganic phosphorus concentration was significantly low (0·4 mmol/l; 0·81–1·5 mmol/L), and the result of a urine routine test was abnormal. Combined with unb...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Serum MicroRNA Signatures in Migraineurs During Attacks and in Pain-Free Periods
In conclusion, migraine manifestation is reflected in serum miRNA aberrations, both during attacks and pain-free periods. This finding sheds light on the potential role of microRNAs in the pathophysiology of migraine and adds a new approach towards potential identification of much sought-after serum biomarkers of migraine. (Source: Molecular Neurobiology)


The Fear-Avoidance Model of Chronic Pain: Assessing the Role of Neuroticism and Negative Affect in Pain Catastrophizing Using Structural Equation Modeling
Conclusion The results offer preliminary evidence that patients presenting with more neurotic symptom and heightened NA probably elicit more catastrophic thoughts about pain. (Source: International Journal of Behavioral Medicine)


Volume: 22 Issue: 1
This study investigated whether the Chronic Respiratory Disease Questionnaire could be used as a screening tool to identify individuals with depression or anxiety, and to explore relationships between psychological status and clinical outcomes. Effectiveness of phosphodiesterase-5 inhibitor therapy for portopulmonary hypertensionPortopulmonary hypertension (PoPH), a serious complication of chronic liver disease, is associated with significant morbidity and mortality. Prompted, in part, by a lack of data from the PoPH population, this single-centre, retrospective study investigated the efficacy of phosphodiesterase-5 inhibitor therapy with respect to hemodynamic measures, including pulmonary vascular resistance and Fick cardiac output, in 25 PoPH patients at the University Health Network in...


Protective effects of the flavonoid hesperidin methyl chalcone in inflammation and pain in mice: Role of TRPV1, oxidative stress, cytokines and NF-κB
Publication date: 25 February 2015 Source:Chemico-Biological Interactions, Volume 228 Author(s): Felipe A. Pinho-Ribeiro , Miriam S.N. Hohmann , Sergio M. Borghi , Ana C. Zarpelon , Carla F.S. Guazelli , Marilia F. Manchope , Rubia Casagrande , Waldiceu A. Verri Jr. Cytokines and reactive oxygen species are inflammatory mediators that lead to increased sensitivity to painful stimuli, and their inhibition represents a therapeutic approach in controlling acute and chronic pain. The water-soluble flavonone hesperidin methyl chalcone (HMC) is used in the treatment of venous diseases, but its bioactivity as anti-inflammatory and analgesic is poorly understood. The present study evaluated the protective effects of HMC in widely used mouse models of acute and prolonged inflammation and pain. Ma...


Relationship between serotonin transporter occupancies and analgesic effects of AS1069562, the (+)-isomer of indeloxazine, and duloxetine in reserpine-induced myalgia rats
Publication date: 19 March 2015 Source:Neuroscience, Volume 289 Author(s): N. Murai , H. Fushiki , S. Honda , Y. Murakami , A. Iwashita , M. Irie , S. Tamura , Y. Nagakura , T. Aoki Serotonin (5-HT) and norepinephrine (NE) have been implicated in the mediation of endogenous analgesic mechanisms via the descending inhibitory pain pathway in the brain, and dysfunction in both the 5-HT and NE systems has been suggested as an etiology of fibromyalgia (FM). Given that 5-HT reuptake inhibition in the brain appears to be associated with pain reduction, this mechanism might exert an analgesic effect also on pain associated with FM. In this case, it would be of interest to investigate the correlation of 5-HT transporter (SERT) occupancy with in vivo analgesic effect on pain associated with FM. He...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Efficacy and safety of sublingual fentanyl orally disintegrating tablet at doses determined from oral morphine rescue doses in the treatment of breakthrough cancer pain
Conclusions Patients treated with strong opioid analgesics at fixed intervals for chronic cancer pain and with oral morphine at doses up to 20 mg as rescue medication were investigated. The doses of sublingual fentanyl to treat breakthrough pain were determined from rescue morphine doses by use of conversion ratios. In these patients, administration of sublingual fentanyl at doses determined by a conversion ratio of 1/50 was effective and safe. Further studies are needed to validate the use of this conversion method. (Source: Japanese Journal of Clinical Oncology)


Analgesic efficacy of cerebral and peripheral electrical stimulation in chronic nonspecific low back pain: a randomized, double-blind, factorial clinical trial
DiscussionThe results of this study may assist in clinical decision-making about the combined use of cerebral and peripheral electrical stimulation for pain relief in patients with chronic low back pain.Trial registrationNCT01896453 (Source: BMC Musculoskeletal Disorders)


Predicting falls in elderly patients with chronic pain and other chronic conditions.
CONCLUSION: Fall history, dependency in daily activities, age ≥75 and living alone are independent fall predictors in CP, AF and T2DM patients. PMID: 25637513 [PubMed - as supplied by publisher] (Source: Aging Clinical and Experimental Research)


Serum levels of the pro-inflammatory interleukins 6 (IL-6) and -8 (IL-8) in patients with lumbar radicular pain due to disc herniation: a 12-month prospective study.
Authors: Pedersen LM, Schistad E, Jacobsen LM, Røe C, Gjerstad J Abstract Earlier studies indicate that lumbar radicular pain after disc herniation may be associated with a local inflammation induced by leakage of nucleus pulposus (NP) into the spinal canal and neuroforamen. In the present study we addressed the role of two interleukins, IL-6 and IL-8 in such long-lasting lumbar radicular pain. All 127 patients were recruited from Oslo University Hospital, Ullevål, Norway. At inclusion, 6 weeks and 12 months, serum concentrations of IL-6 and IL-8 were analyzed by enzyme-linked immunosorbent assay (ELISA) and pain intensity was reported on a 0 to 10 cm visual analog scale (VAS). Significantly higher levels of IL-6 and IL-8 in serum were found in patients with VAS⩾3 at 12 months,...


The efficacy of traditional Thai massage for the treatment of chronic pain: A systematic review.
Authors: Keeratitanont K, Jensen MP, Chatchawan U, Auvichayapat P Abstract RATIONAL AND BACKGROUND: Traditional Thai massage (TTM) is an alternative medicine treatment used for pain relief. The purpose of this paper is to provide a systematic review of the research about the effects of TTM on pain intensity and other important outcomes in individuals with chronic pain. METHODS: We performed a systematic review of the controlled trials of the effects of TTM, using the keywords "Traditional Thai massage" or "Thai massage" with the keyword "Chronic pain." RESULTS: Six research articles met the inclusion criteria. All of the studies found a pre- to post-treatment pain reductions, varying from 25% to 80% and was also associated with improvements in disability, perceived muscle t...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A systematic review of the efficacy and tolerability of hydroxyethylrutosides for improvement of the signs and symptoms of chronic venous insufficiency
Summary What is known and objectiveRutoside (rutin; quercetin rutinoside) is a glycoside found in various plant products, including apples, citrus fruits and cranberries. Hydroxyethylrutosides (HR) are semisynthetic derivatives sold as standardized products for the treatment of chronic venous insufficiency (CVI). Commercially available products include Relvène® (France), Venoruton® (Switzerland) and Paroven® (United Kingdom). However, the evidence for their efficacy is inconclusive. The aim of this systematic review was to evaluate the evidence of efficacy and tolerability of hydroxyethylrutosides for CVI. MethodsWe searched electronic databases such as the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL, and publisher databases, conference proceedi...


‘I've Been Walking on Eggshells All My Life’: Fibromyalgia Patients' Narratives About Experienced Violence and Abuse
In conclusion, the narrated life stories indicated that violence is still hidden behind a wall of silence and non‐interference in our society. The devastating mental and physical consequences of violence in different forms may be carried by the individual for years, even decades. Understanding any exposure to violence that a patient has endured may help healthcare professionals to understand the individual's health behaviour and any possible reluctance to undergo treatment and rehabilitation. Copyright © 2015 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)


Long lasting activity of nociceptive muscular afferents facilitates bilateral flexion reflex pattern in the feline spinal cord
Publication date: Available online 20 January 2015 Source:Neuroscience Research Author(s): E.D. Schomburg , H. Steffens , A.I. Pilyavskii , V.A. Maisky , W. Brück , P. Dibaj , T.A. Sears Chronic muscular limb pain requires the adoption of motor patterns distinct from the classic ipsilateral flexion, crossed extension and corresponding reciprocal inhibitions to acute exteroceptive stimulation. Using selective chemical activation of group III/IV afferents in gastrocnemius-soleus (GS) muscles we investigated bilaterally their reflex responses conditioned by (a) acute ‘myositis’ induced either by intramuscular carrageenan; and (b) sub-acute ‘myositis’ induced by infusion of complete Freund's adjuvant (CFA). Reflex transmission was detected by monosynaptic testing and c-fos staining ...


European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa
Abstract Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually presents after puberty with painful, deep‐seated, inflamed lesions in the apocrine gland‐bearing areas of the body, most commonly the axillae, inguinal and anogenital regions. A mean disease incidence of 6.0 per 100 000 person‐years and an average prevalence of 1% has been reported in Europe. HS has the highest impact on patients' quality of life among all assessed dermatological diseases. HS is associated with a variety of concomitant and secondary diseases, such as obesity, metabolic syndrome, inflammatory bowel disease, e.g. Crohn's disease, spondyloarthropathy, follicular occlusion syndrome and other hyperergic diseases. The centr...


The importance of three-dimensional anorectal ultrasound in the study of patients with anal pain
Conclusion The three-dimensional anorectal ultrasound is a simple, economical, fast and useful test for the study of anorectal diseases and should be included in the examination of patients with anal pain, to exclude organic causes. (Source: Journal of Coloproctology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Disrupted resting‐state functional connectivity and its changing trend in migraine suffers
Abstract Chronic pain has been linked with learning and memory processes and functional changes in brain plasticity in its development and maintenance via neuroimaging studies. However, the principle of reorganization of the migraine brain network as the brain progresses into chronic pain remain poorly understood. Here, using resting‐state functional magnetic resonance imaging (rs‐fMRI) and graph theory approaches, we aimed to investigate the dynamic dysfunctional connectivity in 108 patients with migraine without aura (MWoA) and 30 gender‐matched healthy controls (HC). All patients were divided into 40 groups using a sliding boxcar grouping of subjects in disease duration order. As compared with HC, nonparametric permutation tests were applied for between‐group comparisons of func...


A novel comparative effectiveness study of Tai Chi versus aerobic exercise for fibromyalgia: study protocol for a randomized controlled trial
This study is the first comparative effectiveness randomized trial of Tai Chi versus aerobic exercise in a large fibromyalgia population with long-term follow up. We present here a robust and well-designed trial to determine the optimal frequency and duration of a supervised Tai Chi intervention with regard to short- and long-term effectiveness. The trial also explores multiple outcomes to elucidate the potential mechanisms of Tai Chi and aerobic exercise and the generalizability of these interventions across instructors. Results of this study are expected to have important public health implications for patients with a major disabling disease that incurs substantial health burdens and economic costs.Trial registrationClinicalTrials.gov identifier: NCT01420640, registered 18 August 2011. (...


Analysis of scapular muscle EMG activity in patients with idiopathic neck pain: a systematic review
It is proposed that altered scapular muscle function can contribute to abnormal loading of the cervical spine. However, it is not clear if patients with idiopathic neck pain show altered activity of the scapular muscles. The aim of this paper was to systematically review the literature regarding the differences or similarities in scapular muscle activity, measured by electromyography (=EMG), between patients with chronic idiopathic neck pain compared to pain-free controls. Case-control (neck pain/healthy) studies investigating scapular muscle EMG activity (amplitude, timing and fatigue parameters) were searched in Pubmed and Web of Science. (Source: Journal of Electromyography and Kinesiology)


Interactions of early adversity with stress-related gene polymorphisms impact regional brain structure in females.
Authors: Gupta A, Labus J, Kilpatrick LA, Bonyadi M, Ashe-McNalley C, Heendeniya N, Bradesi S, Chang L, Mayer EA Abstract Early adverse life events (EALs) have been associated with regional thinning of the subgenual cingulate cortex (sgACC), a brain region implicated in the development of disorders of mood and affect, and often comorbid functional pain disorders, such as irritable bowel syndrome (IBS). Regional neuroinflammation related to chronic stress system activation has been suggested as a possible mechanism underlying these neuroplastic changes. However, the interaction of genetic and environmental factors in these changes is poorly understood. The current study aimed to evaluate the interactions of EALs and candidate gene polymorphisms in influencing thickness of the sgACC....


[Value of whole-body MRI in vertebral fractures.]
We describe the case of a 14-year-old boy, with no significant past medical history, who had a sudden dorsal pain after carrying a friend on his back. Plain radiographs and MRI showed fractures of the superior endplate of T5 and T6 associated with a mild degree of kyphosis. MRI allowed ruling out discitis. The diagnostic hypotheses raised were cancer (lymphoma, leukemia), Langerhans cell histiocytosis, osteogenesis imperfecta, and CRMO. A whole-body MRI (wbMRI) was performed and disclosed several clinically silent signal abnormalities in key sites of CRMO (pelvic bone and tibial metaphyses). We point out that CRMO should be systematically added to the list of possible diseases in case of vertebral fracture. In this perspective, wbMRI is a major noninvasive tool to assess the diagnosis of C...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Long-term safety and efficacy of oxycodone/naloxone prolonged-release tablets in patients with moderate-to-severe chronic cancer pain
Conclusions In patients with moderate-to-severe cancer pain, long-term use of OXN PR is well tolerated and effective, resulting in sustained analgesia, improved bowel function and improved symptoms of constipation. (Source: Supportive Care in Cancer)


Late effects of oxaliplatin-induced peripheral neuropathy (LEON)—cross-sectional cohort study of patients with colorectal cancer surviving at least 2 years
Conclusion Many patients objectively demonstrated mild to moderate oxaliplatin neuropathy &gt;2 years post-treatment. The majority of patients did not recall being warned of the risks of chronic peripheral neuropathy. Many of those who recall being warned did not feel sufficient emphasis was placed on the issue. Despite a varying burden of neuropathic symptoms, the majority of patients were highly satisfied with their decision to receive oxaliplatin. (Source: Supportive Care in Cancer)


Interactions of early adversity with stress-related gene polymorphisms impact regional brain structure in females
Abstract Early adverse life events (EALs) have been associated with regional thinning of the subgenual cingulate cortex (sgACC), a brain region implicated in the development of disorders of mood and affect, and often comorbid functional pain disorders, such as irritable bowel syndrome (IBS). Regional neuroinflammation related to chronic stress system activation has been suggested as a possible mechanism underlying these neuroplastic changes. However, the interaction of genetic and environmental factors in these changes is poorly understood. The current study aimed to evaluate the interactions of EALs and candidate gene polymorphisms in influencing thickness of the sgACC. 210 female subjects (137 healthy controls; 73 IBS) were genotyped for stress and inflammation-related gene poly...


Deaths Higher With Methadone vs Morphine in Chronic PainDeaths Higher With Methadone vs Morphine in Chronic Pain
Out-of-hospital deaths were higher with methadone even at low doses. Researchers stress that methadone should not be first-line therapy to patients with noncancer pain. Medscape Medical News (Source: Medscape Neurology and Neurosurgery Headlines)


Palliative care issues in heart transplant candidates
Purpose of review: Heart failure is a serious condition and equivalent to malignant disease in terms of symptoms burden and mortality. Presently, only a comparatively small number of heart failure patients receive specialized palliative care. A literature search was conducted with the terms, palliative care and heart failure, using the electronic databases of PubMed and MEDLINE. Recent findings: Nine-hundred and five articles were reviewed and of those, 78 articles discussed clinical trials in palliative care and heart failure. A complex set of management tools and strategies were used and recommended, including but not limited to lifestyle modification, exercise programs, pain and sleep disorder management, and support in end-of-life care. Limited data are available of using palliative ca...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Informal carers, paramedics, chronic pain, and Twitter.
Authors: Rashid A PMID: 25624290 [PubMed - in process] (Source: The British Journal of General Practice)


MRI features of the anterolateral ligament of the knee
Conclusions Magnetic resonance imaging clearly identifies the anterolateral ligament of the knee in slightly more than half of cases, being partially visible in most of them. In all cases, a tibial insertion is characterized. (Source: Skeletal Radiology)


Extended-Release Opioid Returns to Market
* Embeda (a combination of morphine and naltrexone) is an extended-release opioid analgesic used around the clock to treat severe, chronic pain. New labeling describes features that make the drug less likely to be abused. * The particles of naltrexone are kept separate from those of morphine. The opioid antagonist is released only if the pellets containing the naltrexone are crushed or dissolved. It's important to swallow the drug whole in order to prevent the release of naltrexone. (Source: AJN)


Chronic post stroke central pain: Increased success rate of chronic epidural motor cortex stimulation using somatotopic, navigated repetitive TMS for patient selection and implant placement
Neuromodulation for severe central pain using repetitive stimulation of motor cortices has been used for more than two decades, first via direct cortical stimulation (DCS) by implanted electrodes, later non-invasively mainly by repetitive transcranial magnetic stimulation (rTMS). The outcome at group level has been limited, though for some, the effects have been of large value. There is a need for selection of patients that are likely to benefit from this procedure. Based on a preliminary report indicating that rTMS could contribute to this, we aimed to address this problem. (Source: BRAIN STIMULATION: Basic, Translational, and Clinical Research in Neuromodulation)


Neurochemical properties of the synapses between the parabrachial nucleus-derived CGRP-positive axonal terminals and the GABAergic neurons in the lateral capsular division of central nucleus of amygdala
This study provides direct ultrastructural evidences for the synaptic contacts between CGRP-positive terminals and GABAergic neurons within the CeC, which may underlie the pain-related neural pathway from PBN to CeC and be involved in the chronic pain modulation. (Source: Molecular Neurobiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Nocturia in men is a chaotic condition dominated by nocturnal polyuria
ConclusionsNocturia in men is a chaotic condition dominated by nocturnal polyuria, and related to multiple factors including age, renal function, urgency, bladder pain, insomnia and bladder volume. (Source: International Journal of Urology)


Associative fear learning and perceptual discrimination: A perceptual pathway in the development of chronic pain
Publication date: Available online 17 January 2015 Source:Neuroscience &amp; Biobehavioral Reviews Author(s): Jonas Zaman , Johan W.S. Vlaeyen , Lukas Van Oudenhove , Katja Wiech , Ilse Van Diest Recent neuropsychological theories emphasize the influence of maladaptive learning and memory processes on pain perception. However, the precise relationship between these processes as well as the underlying mechanisms remain poorly understood; especially the role of perceptual discrimination and its modulation by associative fear learning has received little attention so far. Experimental work with exteroceptive stimuli consistently points to effects of fear learning on perceptual discrimination acuity. In addition, clinical observations have revealed that in individuals with chronic pain p...


Skin Matters: A Review of Topical Treatments for Chronic Pain. Part Two: Treatments and Applications
Abstract In Part One of this two-part series, we discussed skin physiology and anatomy as well as generalities concerning topical analgesics. This modality of therapy has lesser side effects and drug–drug interactions, and patients tolerate this form of therapy better than many oral options. Unfortunately, this modality is not used as often as it could be in chronic pain states, such as that from neuropathic pain. Part Two discusses specific therapies, local anesthetics, and other drugs, as well as how a clinician might use specific aspects of a patient’s neuropathic pain presentation to help guide them in the selection of a topical agent. (Source: Pain and Therapy)


Phenotypic changes in dorsal root ganglion and spinal cord in the collagen antibody‐induced arthritis mouse model
In conclusion, this study suggests that long‐term joint inflammation has an impact on DRG neurons that resembles both inflammation and nerve‐injury induced pain states. Thus, antibody‐driven inflammation generates a pain state with a unique neurochemical profile. This article is protected by copyright. All rights reserved. This study shows that some pain‐related molecules, e.g. galanin, α2δ1, P2X3 and GAP‐43, are upregulated in mouse DRGs after induction of collagen antibody‐induced arthritis. They resemble some, but not all, of the changes seen in rodent neuropathic pain models and may contribute to chronic joint pain caused by rheumatoid arthritis. (Source: The Journal of Comparative Neurology)


Intramuscular Compartment Pressure Measurement in Chronic Exertional Compartment Syndrome: New and Improved Diagnostic Criteria
Conclusion: Anterior compartment IMCP is elevated immediately upon standing at rest in subjects with CECS. In patients with symptoms consistent with CECS, diagnostic utility of IMCP measurement is improved when measured continuously during exercise. A cutoff of 105 mm Hg in phase 2 provides better diagnostic accuracy than do the Pedowitz criteria of 30 mm Hg and 20 mm Hg at 1 and 5 minutes after exercise, respectively. (Source: The American Journal of Sports Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Therapeutic abdominoplasty: Report of a case
Conclusion Wide abdominal rectus plication abdominoplasty should be considered to be performed for therapeutic purposes when major health problems occur. (Source: International Journal of Surgery Case Reports)


Adult intussusception caused by myoepithelial hamartoma in the small bowel: A case report
Conclusion Intussusception caused by MEH is a rare but serious cause of mechanical bowel obstruction. We propose that surgeons should consider this diagnosis in atypical cases of bowel obstruction and expedite laparotomy when it is suspected. (Source: International Journal of Surgery Case Reports)


Pravastatin-induced rhabdomyolysis and purpura fulminans in a patient with chronic renal failure
Conclusion We report an extremely rare case of pravastatin-induced rhabdomyolysis and purpura fulminans with DIC in a patient with CRF. (Source: International Journal of Surgery Case Reports)


Validation of the Short-form McGill Pain Questionnaire-2 (SF-MPQ-2) in Acute Low Back Pain
The Short-form McGill Pain Questionnaire (SF-MPQ-2) assesses the major symptoms of both neuropathic and non-neuropathic pain and can be used in studies of epidemiology, natural history, pathophysiologic mechanisms, and treatment response. Previous research has demonstrated its reliability, validity, and responsiveness in diverse samples of patients with chronic pain. However, the SF-MPQ-2 has not been evaluated for use in patients with acute pain. Data were examined from a double-blind, randomized clinical trial of immediate-release tapentadol vs. (Source: The Journal of Pain)


Automated Prediction of Risk of Problem Opioid Use in a Primary Care Setting
Identification of patients at increased risk for problem opioid use is recommended by chronic opioid therapy (COT) guidelines but clinical assessment of risks often does not occur on a timely basis. This research assessed whether structured electronic healthcare record (EHR) data could accurately predict subsequent problem opioid use. This research was conducted among 2,752 chronic non-cancer pain patients initiating COT (> 70 days’ supply of an opioid in a calendar quarter) during 2008-10. Patients were followed through the end of 2012 or until disenrollment from the health plan, whichever was earlier. (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>


Enhanced non-peptidergic intraepidermal fiber density and an expanded subset of chloroquine-responsive trigeminal neurons in a mouse model of dry skin itch
In this study, repeated application of acetone and ether, followed by water (AEW) to the cheek skin of mice produced persistent scratching behavior with no increase in pain-related forelimb wiping, indicating the generation of itch without pain. Cheek skin immunohistochemistry showed a 64.5% increase in total epidermal innervation in AEW-treated mice compared to water-treated controls. This increase was independent of scratching, because mice prevented from scratching by Elizabethan collars showed similar hyperinnervation. (Source: The Journal of Pain)


Adrenergic signaling mediates mechanical hyperalgesia through activation of P2X3 receptors in primary sensory neurons of rats with chronic pancreatitis.
Authors: Wang S, Zhu HY, Jin Y, Zhou Y, Hu S, Liu T, Jiang X, Xu GY Abstract The mechanism of pain in chronic pancreatitis (CP) is poorly understood. The aim of this study was designed to investigate roles of norepinephrine (NE) and P2X receptor signaling pathway in the pathogenesis of hyperalgesia in a rat model of CP. CP was induced in male adult rats by intraductal injection of trinitrobenzene sulfonic acid (TNBS). Mechanical hyperalgesia was assessed by referred somatic behaviors to mechanical stimulation of rat abdomen. P2X receptor-mediated responses of pancreatic DRG neurons were measured utilizing calcium-imaging and whole cell patch clamp recording techniques. Western blot analysis and immunofluorescence were performed to examine protein expression. TNBS injection produced...


Screening for Neuropathic Pain, Anxiety and other Associated Chronic Pain Condition in Vulvodynia: A Pilot Study.
Authors: Tersiguel AC, Bodéré C, Schollhammer M, Postec E, Tandéo P, Quinio B, Brenaut E, Misery L Abstract Abstract is missing (Short communication). PMID: 25634661 [PubMed - as supplied by publisher] (Source: Acta Dermato-Venereologica)


Role of Transient Receptor Potential Channels in Intestinal Inflammation and Visceral Pain: Novel Targets in Inflammatory Bowel Diseases
Abstract: Transient receptor potential (TRP) channels are a large group of ion channels that are prevalent in mammalian tissues. They are widely distributed in the central and peripheral nervous systems, and in nonneuronal cells, where they are implicated in sensing temperature, noxious substances, and pain. TRPs play an important role in immune response and nociception and, therefore, may be involved in the pathogenesis of inflammatory bowel diseases, whose major symptoms include chronic inflammatory state and abdominal pain. In this review, we summarize what is known on TRP channels in inflammatory bowel disease and visceral pain; we focus in particular on TRPV1, TRPV4, TRPA1, and TRPM. We also analyze scientific reports that evidence potential use of TRP regulators in future inflammator...


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


[Painful ischemic neuropathy.]
Authors: Lang PM Abstract Chronic ischemia in patients with peripheral arterial disease (PAD) represents a common medical problem. Neuropathic changes and pain caused by chronic ischemia are often found in the lower extremities of these patients. Pain in patients with chronic critical limb ischemia fulfill the criteria of neuropathic pain. Diagnostic tools besides medical history and examination are questionnaires, quantitative sensory testing (QST) and measuring intraepidermal nerve fiber density (IENFD) when indicated. A pharmacological approach with non-opioids and opioids as well as antidepressive and anticonvulsive drugs (according to the recommendations for the therapy of neuropathic pain) seems to be indicated for treating painful ischemic neuropathy. Spinal cord stimulation...


Presentation and endoscopic management of sigmoid volvulus in children
Conclusion: Although rare in children, sigmoid volvulus should be advocated when abdominal pain is associated with dilated sigmoid loops. Sigmoidoscopic exsufflation can be considered as the first-line management in the absence of perforation. However, sigmoidectomy is often required for prevention of recurrence. What is Known: • Sigmoid volvulus is uncommon in childhood. • Diagnosis is often missed or delayed. What is New: • This is the first pediatric series showing that endoscopic exsufflation is an efficient and ...


The Prevalence of Fibromyalgia in the General Population: A Comparison of the American College of Rheumatology 1990, 2010, and Modified 2010 Classification Criteria
ConclusionFibromyalgia prevalence varies with the different sets of classification criteria applied. In particular, prevalence is higher and a greater proportion of men are identified with the modified 2010 criteria as compared to the criteria sets requiring clinician input. This has important implications for the use of the new criteria, both in research and in clinical practice. (Source: Arthritis and Rheumatism)


Perspectives of cardiac care unit nursing staff about developing hospice services in iran for terminally ill cardiovascular patients: A qualitative study
Conclusion: Growing load of chronic diseases has made the need for Hospice as a necessary issue in Iran. In order to provide these services, studying the viewpoints of health service providers is inevitable. Therefore using and applying the results of this study in planning and policy making about designing and providing these services in Iran for cardiovascular patients in their final stages of lives could be helpful. (Source: Indian Journal of Palliative Care)


Long-term high-dose oral morphine in phantom limb pain with no addiction risk
We report a case where a patient receiving high-dose oral morphine for chronic cancer pain did not demonstrate signs of addiction. (Source: Indian Journal of Palliative Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Application of low frequency and medium frequency currents in the management of acute and chronic pain-A narrative review
Stephen Rajan Samuel, G Arun MaiyaIndian Journal of Palliative Care 2015 21(1):116-120Trancutaneous electrical nerve stimulation (TENS) and interferential therapy (IFT) have been a regular line of treatment for various types of acute and chronic pain. This review aims to compile the latest literature in pain management using these modalities which use low-frequency and medium-frequency currents. The Cochrane Library, Scopus, PubMed, MEDLINE, and CINAHL were searched and studies were examined from their inception till October 2013. After title and abstract screening the relevant studies were included for this review. We found through this review that even though TENS and IFT are used in management of pain, there is limited amount of high quality research available in this area. Most of the ...


Skin Matters: A Review of Topical Treatments for Chronic Pain. Part One: Skin Physiology and Delivery Systems
Abstract Chronic pain is a complex disorder with multiple etiologies for which the pathologic mechanisms are still largely unknown, making effective treatment a difficult clinical task. Achieving pain relief along with improved function and quality of life is the primary goal of pain clinicians; however, most patients and healthcare professionals consider 30% pain improvement to be clinically significant—a success level that would be unacceptable in other areas of medicine. Furthermore, patients with chronic pain frequently have multiple comorbidities, including depression and sleep apnea, and most have seen several physicians prior to being seen by a pain specialist, have more than three specific pain generators, and are taking multiple medications. The addition of further oral...


Peripheral indoleamine 2,3-dioxygenase 1 is required for comorbid depression-like behavior but does not contribute to neuropathic pain in mice.
In conclusion, our findings show for the first time that neuropathic pain is associated with an increase of Ido1 in liver, but not brain, downstream of spinal cord IL-1β signaling and that Ido1 mediates co-morbid depression. Moreover, comorbidity of neuropathic pain and depression are only partially mediated by a common mechanism because mechanical hyperalgesia develops independently of Ido1. PMID: 25637485 [PubMed - as supplied by publisher] (Source: Brain, Behavior, and Immunity)


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


Comparative pilot study of implantation techniques for pudendal neuromodulation: technical and clinical outcome in first 20 patients with chronic pelvic pain
Conclusions The STAR approach appears to achieve technical standardisation and optimized reproducibility in pudendal lead placement resulting into an increased feasibility of PNM. (Source: World Journal of Urology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Obesity and sleepiness in women with fibromyalgia
The objective of the present study was to investigate the relationship between obesity and sleepiness in women with FM. A total of 100 adult female patients with a prior medical diagnosis of FM participated in the study. Body mass, height and waist circumference were measured, and body mass index (BMI) was calculated. The diet quality was evaluated by the Healthy Eating Index. Subjective analyses of daytime sleepiness [Epworth Sleepiness Scale (ESS)] and sleep quality (Pittsburgh Sleep Quality) were performed. An obesity rate of 41 % was found in all women (56.1 % were sleepy and 43.9 % were not, p = 0.04). Obese women showed a greater level of sleepiness when compared with non-obese (10.2 and 7.0, respectively, p = 0.004). Sleepy women showed a greater weight gain after the diagnos...


Multiple Sclerosis – Why a hug might be the last thing you need
Sourced from The Hysterectomy Association: Hysterectomy Association - Hysterectomy Association - hysterectomy, menopause and hormone replacement therapy (hrt) information and support for women. Multiple Sclerosis is an autoimmune disease, and another prime example of an invisible illness. Physically, an MS patient may look well for most of the time, and might be able to go about normal daily activities like work and family life. However, what’s happening below the surface tells a very different story. The immune system attacks the myelin sheathing which protects the body’s nervous system, leaving the nerve exposed. To visualise this, you might like to think of an electrical wire with its casing worn away. Like that wire, the exposed nerve becomes dangerous and unpredictable. The sympto...


Elevation of plasma 1‐deoxy‐sphingolipids in type 2 diabetes mellitus: a susceptibility to neuropathy?
Conclusion1‐deoxy‐sphingolipid plasma levels are significantly elevated in DSPN. They are already detectable in early disease stages but do not correlate with the clinical course. Further knowledge on 1‐deoxy‐sphingolipids might lead to a better pathophysiological understanding and future treatment options in DSPN. (Source: European Journal of Neurology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


Nevro Receives Approvable Letter From U.S. Food And Drug Administration For Senza® Spinal Cord Stimulation System
Nevro Corp. (NYSE:NVRO), a medical device company that has developed and commercialized an innovative, evidence-based neuromodulation platform for the treatment of chronic pain, today announced that it has received a letter from the U.S. Food and Drug Administration (FDA) informing the company of the approvability of its Premarket Approval Application (PMA) for the Senza spinal cord stimulation (SCS) system. (Source: Medical Design Online News)


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


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


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


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


Biologic Response of Inguinal Hernia Prosthetics: A Comparative Study of Conventional Static Meshes Versus 3D Dynamic Implants
Abstract Despite improvements in prosthetics and surgical techniques, the rate of complications following inguinal hernia repair remains high. Among these, discomfort and chronic pain have become a source of increasing concern among surgeons. Poor quality of tissue ingrowth, such as thin scar plates or shrinking scars—typical results with conventional static implants and plugs—may contribute to these adverse events. Recently, a new type of 3D dynamically responsive implant was introduced to the market. This device, designed to be placed fixation‐free, seems to induce ingrowth of viable and structured tissue instead of regressive fibrotic scarring. To elucidate the differences in biologic response between the conventional static meshes and this 3D dynamically responsive implant, a his...


Comparison of Cervical Spine Stiffness in Individuals With Chronic Nonspecific Neck Pain and an Asymptomatic Comparison Group.
Conclusion These preliminary results suggest that cervical spine stiffness may be greater in the presence of non-specific neck pain. However, judgements regarding pain intensity and level of disability should not be inferred from examinations of spinal joint stiffness. J Orthop Sports Phys Ther, Epub 27 Jan 2015. doi:10.2519/jospt.2015.5711. PMID: 25627153 [PubMed - as supplied by publisher] (Source: Physical Therapy)


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


How I've learnt to take my dodgy hip in my stride
Since a road accident as a child, Liz Hunt has suffered chronic pain - so could learning to 'Walkactive' be the answer? (Source: The Telegraph : Health Advice)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic pain, activity restriction and flourishing mental health.
This study uses a measure of mental health (flourishing), rather than mental illness to examine associations between pain and activity restrictions. DATA AND METHODS: Data from the 2011/2012 Canadian Community Health Survey were used to study the relationship between pain intensity, pain-related activity prevention, and flourishing mental health in people aged 18 or older. Multivariate logistic regression was used in a sample of 26,429 people with chronic pain to identify significant relationships, while adjusting for potential confounders. RESULTS: In 2011/2012, an estimated 6 million Canadians aged 18 or older (22%) reported chronic pain. They were less likely to be in flourishing mental health than were people without chronic pain (69% versus 79%). The prevalence of flourishing ...


Diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome
Chronic prostatitis is a poorly understood and difficult‐to‐treat condition. The authors discuss a guideline produced by the Prostatitis Expert Reference Group (PERG), which provides a framework for initial assessment and effective management in the community. Roger Kirby and Culley Carson comment from a secondary‐care perspective on page 17. (Source: Trends in Urology, Gynaecology and Sexual Health)


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


The somatosensory link: S1 functional connectivity is altered by sustained pain and associated with clinical/autonomic dysfunction in fibromyalgia
Conclusion: Our study demonstrates that both somatic and non‐somatic dysfunction in FM, including clinical pain, pain catastrophizing, autonomic dysfunction, and amplified temporal summation, are all closely linked with the degree to which evoked deep‐tissue pain alters S1 connectivity to salience/affective pain processing regions. Additionally, diminished connectivity between S1 subregions at REST in FM may result from ongoing widespread clinical pain. This article is protected by copyright. All rights reserved. (Source: Arthritis and Rheumatism)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


A Health Plan’s Innovative Telephonic Case Management Model to Provide Palliative Care (TH303)
SCAN Health Plan is a Medicare Advantage Plan in California and Arizona serving 170,000 members. In 2013, SCAN launched a case management program to assist members with multiple chronic health conditions manage their symptoms and medications. The Program for Advanced Illness (PAI) is designed to manage the sickest patients in the last months and years of life. The goals of the program are to better manage symptoms, improve member and family/caregiver satisfaction, and improve overall quality of care, while reducing inpatient/ER utilization. (Source: Journal of Pain and Symptom Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


De“liver”ing Palliative Care to Patients with Advanced Liver Diease: Creating Collaborative Models Between GI and Palliative Medicine (FR462)
End-stage liver disease (ESLD) is defined as chronic liver disease with a decompensating event, such as ascites formation, variceal bleeding, or hepatic encephalopathy, and is a leading cause of morbidity and mortality. Though its disease manifestations, symptoms, and effects on psychosocial distress are frequent and burdensome, few cooperative models between gastroenterology and palliative care have been reported. Further collaboration would provide an extra layer of support to this population through better understanding of unmet needs and unique perspectives for symptom management that leverages the expertise and resources of each service. (Source: Journal of Pain and Symptom Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Expressions of Teenagers Under Palliative Care on Facebook: A Fresh Approach for Healthcare Professionals (S714)
Children with long-term chronic illnesses need broad types of support that can be offered in creative ways by the palliative care team. An increasing number of health related communities on the Internet show that people who use virtual socialization are also looking for support. (Source: Journal of Pain and Symptom Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Events Preceding Final Hospitalizations or Deaths and End-Of-Life Decisions in Patients on Chronic Dialysis (S768)
Healthcare intensity at end-of-life in chronic dialysis patients is high. However, the medical events leading to final hospitalizations or imminent deaths and end-of-life decisions in these patients have not been well described. (Source: Journal of Pain and Symptom Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Sinomenine alleviates mechanical hypersensitivity in mice with experimentally induced rheumatoid arthritis
Conclusions We have shown that sinomenine is effective in alleviating localized and spread hypersensitivities in CAIA mice both during acute inflammation and in post-inflammatory phase. Further, repeated sinomenine administration has elevated the baseline mechanical threshold without producing tolerance. Implications Sinomenine may be clinically useful to treat chronic pain in RA, including wide-spread pain which appears to be a difficult clinical problem despite the improvement in the acute treatment of RA by disease modifying agents. (Source: Scandinavian Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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: An Energy/Trauma Model
Publication date: November–December 2014 Source:EXPLORE: The Journal of Science and Healing, Volume 10, Issue 6 Author(s): Eric Leskowitz Phantom limb pain (PLP) is a form of chronic neuropathic pain that responds poorly to treatment interventions derived from the neuroanatomic understanding of pain and analgesia. Several new psychological and behavioral treatments that have proven more effective have been explained by invoking neural plasticity as their mechanism of action. Other novel treatments that are based on an “energy medicine” model also appear to be quite effective, especially when addressing the psychological trauma of the amputation itself, a factor that is generally overlooked in the standard surgical approach to limb amputation. A speculative trauma/energy model for t...


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


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


[Multimodal therapy programs for chronic pain.]
Authors: Kopf A, Gjoni E Abstract Chronic pain is a common and disabling disorder with major consequences for patient quality of life and it is also a major economic burden to society. The management of chronic pain comprises a large range of different intervention strategies including pharmacological therapy, non-medicinal and invasive therapeutic options. While non-pharmacological and multimodal options are underused, monomodal options, especially pharmacotherapy and invasive therapies are overused. The effectiveness of multidisciplinary and multimodal treatment programs including physical and rehabilitation interventions and psychological treatment has been extensively studied in the last two decades. Evidence from randomized controlled trials demonstrates that there is low qual...


[Recommendations of the updated LONTS guidelines : Long-term opioid therapy for chronic noncancer pain.]
CONCLUSION: Responsible application of opioid-containing analgesics requires consideration of possible indications and contraindications, as well as regular assessment of efficacy and adverse effects. Neither an uncritical increase in opioid application, nor the global rejection of opioid-containing analgesics is justified in patients with CNCP. PMID: 25616996 [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>


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


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


Postoperative Pain Control
Prevention and control of postoperative pain are essential. Inadequate treatment of postoperative pain continues to be a major problem after many surgeries and leads to worse outcomes, including chronic postsurgical pain. Optimal management of postoperative pain requires an understanding of the pathophysiology of pain, methods available to reduce pain, invasiveness of the procedure, and patient factors associated with increased pain, such as anxiety, depression, catastrophizing, and neuroticism. Use of a procedure-specific, multimodal perioperative pain management provides a rational basis for enhanced postoperative pain control, optimization of analgesia, decrease in adverse effects, and improved patient satisfaction. (Source: Surgical Clinics of North America)


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


Genome-wide enrichment analysis between endometriosis and obesity-related traits reveals novel susceptibility loci
Endometriosis is a chronic inflammatory condition in women that results in pelvic pain and subfertility, and has been associated with decreased body mass index (BMI). Genetic variants contributing to the heritable component have started to emerge from genome-wide association studies (GWAS), although the majority remain unknown. Unexpectedly, we observed an intergenic locus on 7p15.2 that was genome-wide significantly associated with both endometriosis and fat distribution (waist-to-hip ratio adjusted for BMI; WHRadjBMI) in an independent meta-GWAS of European ancestry individuals. This led us to investigate the potential overlap in genetic variants underlying the aetiology of endometriosis, WHRadjBMI and BMI using GWAS data. Our analyses demonstrated significant enrichment of common varian...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 CCN2, substance P and tissue fibrosis are associated with sensorimotor declines in a rat model of repetitive overuse injury.
Authors: Fisher PW, Zhao Y, Rico MC, Massicotte VS, Wade CK, Litvin J, Bove GM, Popoff SN, Barbe MF Abstract Key clinical features of cumulative trauma disorders include pain, muscle weakness, and tissue fibrosis, although the etiology is still under investigation. Here, we characterized the temporal pattern of altered sensorimotor behaviors and inflammatory and fibrogenic processes occurring in forearm muscles and serum of young adult, female rats performing an operant, high repetition high force (HRHF) reaching and grasping task for 6, 12, or 18 weeks. Palmar mechanical sensitivity, cold temperature avoidance and spontaneous behavioral changes increased, while grip strength declined, in 18-week HRHF rats, compared to controls. Flexor digitorum muscles had increased MCP-1 levels ...


Synthesis and biological evaluation of aryl isoxazole derivatives as metabotropic glutamate receptor 1 antagonists: A potential treatment for neuropathic pain.
In this study, we have developed mGluR1 antagonists with an aryl isoxazole scaffold, and identify several compounds that are orally active in vivo. We believe that these compounds can serve as a useful tool for the investigation of the role of mGluR1 and a promising lead for the potential treatment of neuropathic pain. PMID: 25677662 [PubMed - as supplied by publisher] (Source: Bioorganic and Medicinal Chemistry Letters)


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


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


Intrathecal siRNA Against GPNMB Attenuates Nociception in a Rat Model of Neuropathic Pain
Abstract Neuropathic pain is characterized by hyperalgesia, allodynia, and spontaneous pain. Recent studies have shown that glycoprotein nonmetastatic melanoma B (GPNMB) plays a pivotal role in neuronal survival and neuroprotection. However, the role of GPNMB in neuropathic pain remains unknown. The aim of the present study was to assess the role of GPNMB in neuropathic pain. In cultured spinal cord neurons, we used two small interfering RNAs (siRNAs) targeting the complementary DNA (cDNA) sequence of rat GPNMB that had potent inhibitory effects on GPNMB, and siRNA1-GPNMB was selected for further in vivo study as it had the higher inhibitory effect. After sciatic nerve injury in rats, the endogenous level of GPNMB was increased in a time-dependent manner in the spinal cord. Furth...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 hybrid approach to urine drug testing using high-resolution mass spectrometry and select immunoassays.
CONCLUSIONS: The hybrid approach to urine drug testing provides a simplified and analytically specific testing process that minimizes the need for secondary confirmation. PMID: 25596249 [PubMed - in process] (Source: American Journal of Clinical Pathology)


The Fragility of Life and Lung: My Dad's Severe Pneumonia Story
The first message arrived midday on a Sunday, picking up the latest in the long paper and electronic trail that chronicles our family's health. Mom, Jan. 4, 12:49 p.m.: Yesterday morning Dad woke up very sick. He has a terrible cough. Mom, Jan. 5, 2:52 p.m.: Dad has the flu. Mom, Jan. 6, 3:40 p.m.: Doc said Dad has to get down fluid. He spit up water twice. If he can't, I have to take him to an urgent care clinic. Don't come home! This is highly contagious. Dad, Jan. 7, 2:15 p.m.: I will be visiting the doctor again today. I had a very bad night last night and I am very weak. You must stay away from the house. When I was 4 years old, my dad lived on red meat and his total cholesterol reached 300. His doctor began him on Lipitor -- a cholesterol-reducing medication -- and told him he mu...


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


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


Celiac Artery Decompression for Median Arcuate Ligament Syndrome: A United States National Inpatient Sample Study
The objective of this study was to evaluate the outcomes of MALS after celiac artery decompression (CAD). (Source: Journal of Vascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


The influence of personality traits on perception of pain in older adults – Findings from the Swedish National Study on Aging and Care – Blekinge study
Conclusions Personality traits and pain were related among the older adults but there were gender differences. The relationship between pain and neuroticism in women was about the same in strength as the relation between pain and neuroticism/openness in men. Both sexes suffer from insomnia. The relationship between personality traits and pain was only affected to a minor extent by insomnia. Implications There is a need to increase awareness of the impact of personality as well as to provide improved treatment for pain and insomnia in older people. (Source: Scandinavian Journal of Pain)


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


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


Patient-Clinician Communication About End-of-Life Care in Patients with Advanced Chronic Organ Failure During One Year
Patient-clinician communication is an important prerequisite to delivering high-quality end-of-life care. However, discussions about end-of-life care are uncommon in patients with advanced chronic organ failure. (Source: Journal of Pain and Symptom Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Evaluation of Health Plan Interventions to Influence Chronic Opioid Therapy Prescribing.
DISCUSSION:: Following initiatives implemented to alter physician prescribing practices and norms, mean opioid dose prescribed to COT patients declined more in intervention than control practices. Physicians reported more conservative beliefs regarding opioid prescribing immediately after completing an online course in 2011, but the course was not associated with additional reductions in mean daily opioid dose prescribed by physicians completing the course. PMID: 25621426 [PubMed - as supplied by publisher] (Source: Pain Physician)


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


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


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


Influence of chronic back pain on kinematic reactions to unpredictable arm pulls
Observed reflex delays and identified kinematic differences inside and outside the region of pain during impaired movement indicated that chronic low back pain patients have an altered motor control that is not restricted to the lumbo-pelvic region. This applied paradigm of external perturbations can be used to detect chronic low back pain patients and also persons without chronic low back pain but with an altered motor control. Further investigations are essential to reveal whether healthy persons with changes in motor function have an increased potential to develop chronic back pain. (Source: Clinical Biomechanics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Examination of Anatomic Variants and Incidental Peroneal Tendon Pathologic Features: A Comprehensive MRI Review of Asymptomatic Lateral Ankles
Publication date: Available online 22 January 2015 Source:The Journal of Foot and Ankle Surgery Author(s): Melissa M. Galli , Nicole M. Protzman , Eiran M. Mandelker , Amit D. Malhotra , Edward Schwartz , Stephen A. Brigido Intraoperatively, foot and ankle surgeons will encounter peroneal pathologic features in patients with asymptomatic lateral ankles. The purpose of the present study was to review the ankle magnetic resonance imaging (MRI) scans of patients without a history of ankle trauma or lateral ankle pain to determine which anatomic variants correlate with peroneal tendon pathologic features and noted pathophysiology. A total of 500 MRI scans were screened, 108 (41.90 ± 20.42) of which met the inclusion criteria. The peroneus brevis tendon was intact in 104 MRI scans (96.30%)...


Sensory manifestations of diabetic neuropathies: Anatomical and clinical correlations
Conclusions: Diabetic neuropathies can involve any segment of peripheral nerves from nerve roots to the nerve endings giving different patterns of abnormal sensation. It is the involvement of small fibers that causes positive sensory symptoms like pain early during the course of disease, bringing subjects to physician&rsquo;s care. Clinical Relevance This article emphasizes on the fact that diabetic neuropathies are not a single entity. They are rather different varieties of conditions with more or less separate pathophysiological mechanisms and anatomical localization. Clinicians should keep this in mind when assessing patients with diabetes on the first visit or follow-up. (Source: Prosthetics and Orthotics International)


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


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


Could low grade bacterial infection contribute to low back pain? A systematic review
Evidence from a systematic review suggests the presence of bacteria in spinal discs could be associated with low back pain and disc herniation, but more research is needed to determine whether low-grade infection contributes to chronic pain. (Source: BMC Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


[Heterozygote forms of familial Mediterranean fever can be manifested in adults as myofacial pain syndrome.]
This article presents evidence that 9 out of 12 Mediterranean patients with recurrent myofascial pain syndrome and mild inflammation revealed heterozygote mutations in the MEFV gene and 7 of these patients benefitted from treatment with colchicine. DISCUSSION: As colchicine treatment not only improved the myofascial pain but also prevented FMF-associated amyloidosis and nephropathy, differential diagnosis of fibromyalgia in patients of Mediterranean origin should include FMF and a genetic screening of the MEFV locus. PMID: 25604326 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Rheumatologie)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


Zonisamide for neuropathic pain in adults.
CONCLUSIONS: The review found a lack of evidence suggesting that zonisamide provides pain relief in any neuropathic pain condition. Effective medicines with much greater supportive evidence are available. PMID: 25612256 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


An Examination of Anatomic Variants and Incidental Peroneal Tendon Pathologic Features: A Comprehensive MRI Review of Asymptomatic Lateral Ankles.
Authors: Galli MM, Protzman NM, Mandelker EM, Malhotra AD, Schwartz E, Brigido SA Abstract Intraoperatively, foot and ankle surgeons will encounter peroneal pathologic features in patients with asymptomatic lateral ankles. The purpose of the present study was to review the ankle magnetic resonance imaging (MRI) scans of patients without a history of ankle trauma or lateral ankle pain to determine which anatomic variants correlate with peroneal tendon pathologic features and noted pathophysiology. A total of 500 MRI scans were screened, 108 (41.90 ± 20.42) of which met the inclusion criteria. The peroneus brevis tendon was intact in 104 MRI scans (96.30%), and the peroneus longus tendon was intact in 108 (100.00%). The results of the present study have confirmed statistically sig...


Smoking cessation and bone healing: optimal cessation timing


Product/Study: Chronic pain, activity restriction and flourishing mental health , Health Reports
Catalogue number 82-003-X201500114130 (Source: Statistics Canada, The Daily: Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Protective effects of the flavonoid hesperidin methyl chalcone in inflammation and pain in mice: role of TRPV1, oxidative stress, cytokines and NF-κB.
Authors: Pinho-Ribeiro FA, Hohmann MS, Borghi SM, Zarpelon AC, Guazelli CF, Manchope MF, Casagrande R, Verri WA Abstract Cytokines and reactive oxygen species are inflammatory mediators that lead to increased sensitivity to painful stimuli, and their inhibition represents a therapeutic approach in controlling acute and chronic pain. The water-soluble flavonone hesperidin methyl chalcone (HMC) is used in the treatment of venous diseases, but its bioactivity as anti-inflammatory and analgesic is poorly understood. The present study evaluated the protective effects of HMC in widely used mouse models of acute and prolonged inflammation and pain. Male Swiss mice were treated with HMC (3-100 or 30 mg/kg, intraperitoneally) or vehicle (saline) 1 h before inflammatory stimuli. In overt pai...


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


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


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


Seattle Pain Relief Now Finding Success With Laser Therapy for Over a...
Seattle Pain Relief, one of the top pain clinics in Seatte, is now offering laser therapy for a dozen pain conditions. The treatment has shown effectiveness for all types of acute and chronic pain...(PRWeb January 19, 2015)Read the full story at http://www.prweb.com/releases/seattle-pain-center/laser-therapy/prweb12454827.htm (Source: PRWeb: Medical Pharmaceuticals)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Surgery Not Better for Spine Narrowing, Study Finds
Title: Surgery Not Better for Spine Narrowing, Study FindsCategory: Health NewsCreated: 1/19/2015 12:00:00 AMLast Editorial Review: 1/20/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Transcutaneous electrical nerve stimulation for chronic post‐herpetic neuralgia
Abstract Postherpetic neuralgia remains a therapeutic challenge for the clinician. Many modalities have been utilized with limited success. In this pilot randomized study of patients who were refractory to previous medicinal treatment, the patients were treated with transcutaneous nerve stimulation with a biofeedback capability. After every two treatments with the sham and true device, the patients were required to fill out a standard neuropathic pain scale score. The patients were allowed to select the other device after three consecutive treatments if they felt an inadequate decrease in their pain. The true device was chosen over the sham device by all patients. The majority of these patients treated by the true device reported a statistically significant decrease in pain scores (P &lt;...


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


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


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


The spinal anti-inflammatory mechanism of motor cortex stimulation: cause of success and refractoriness in neuropathic pain?
Conclusions: These results indicate that MCS induces analgesia through a spinal anti-neuroinflammatory effect and the activation of the cannabinoid and opioid systems via descending inhibitory pathways. As a possible explanation for MCS refractoriness, we propose that CB2 activation is compromised, leading to cannabinoid resistance and consequently to the perpetuation of neuroinflammation and opioid inefficacy. (Source: Journal of Neuroinflammation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Footwear experiences of people with chronic musculoskeletal diseases
Conclusion: Key categories describing the important issues surrounding the footwear experiences of respondents with chronic musculoskeletal diseases were identified which may provide important targets for improving footwear and foot care services, and self‐management strategies. This article is protected by copyright. All rights reserved. (Source: Arthritis Care and Research)


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


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


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


Testing Before Seeing the Patient
Practice varies around the United States and across each institution, but I would bet that every reader could give multiple examples of situations in which tests are ordered automatically before talking to or examining a patient. There are situations in which ordering tests before examining a patient is reasonable and promotes efficiency. Primary care physicians often order tests before sending a patient to a specialist. These tests are based on the primary care physician’s history and examination, sometimes with advice from the specialist, and tailored to the individual patient’s case. It would not make sense to send a patient to a pulmonologist for a chronic cough without first obtaining a chest x-ray. It is also reasonable for clinic protocols to include specific tests based in inta...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A prospective evaluation of the Chronic Pain Self-Management Programme in a Danish population of chronic pain patients
Chronic pain is pain which persists beyond normal tissue healing time, which is defined as 3 months [1]. The estimated prevalence of chronic pain in the European Union is 27% [2] with human costs such as a reduced quality of life [3], and an increased risk of developing common mental disorders [4]. Waiting lists for specialized pain clinics are often long with deterioration in health as an unacceptable consequence [5]. Therefore, low cost interventions have great individual and societal relevance. (Source: Patient Education and Counseling)


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


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


Pain affects depression through anxiety, fatigue, and sleep in multiple sclerosis.
Conclusion: Individuals living with MS who report high levels of chronic pain and depressive symptoms may benefit from treatment approaches that can address sleep, fatigue, and anxiety. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (Source: Rehabilitation Psychology)


AS1069562, the (+)-isomer of indeloxazine, exerts analgesic effects in rat models of nociceptive pain.
Discussion: AS1069562 exerts analgesic effects on inflammatory and noninflammatory nociceptive pain in rat models of arthritis pain, and repeated administration of AS1069562 exerts a more persistent analgesic effect on arthritis pain than duloxetine. These findings suggest that AS1069562 has an attractive analgesic profile for the treatment of nociceptive pain. PMID: 25591424 [PubMed - as supplied by publisher] (Source: Neurological Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 evidence on clitoral reconstruction after female genital mutilation/cutting
Conclusions Women who request clitoral reconstruction should be informed about the scarcity of evidence available. Additional research is needed on the safety and efficacy of the procedure to identify both long-term outcomes and which women might benefit. (Source: International Journal of Gynecology and Obstetrics)


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


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


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


Sex Differences in Predicting Chronicity of Low-Back Pain After Acute Trauma Using Lumbar Muscle Area
ConclusionsIn the men, the cross-sectional area of the multifidus and erector spinae muscles at the lower lumbar level can be considered to be prognostic factors for the chronic low-back pain after acute trauma. The authors thus suggest that strengthening of lumbar paraspinal muscles could be helpful for preventing chronicity of low-back pain. (Source: American Journal of Physical Medicine and Rehabilitation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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: Berg S, Tullberg T. Letter to the editor regarding Mannion, Brox, Fairbank. Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials. Spine J 2014;14:1087
We follow with great interest the ongoing debate on the role of lumbar fusion in the treatment of chronic nonspecific low back pain (LBP). Since evidence from randomized clinical trials (RCTs) comparing conservative and surgical treatments for this condition is rare, meticulous interpretation of all available data is certainly essential [1]. However, delaying the reversal of ineffective or harmful medical practices has its own obvious consequences [2]. (Source: The Spine Journal)


Reply to letter to the editor from Berg S, Tullberg T. Letter to the editor regarding Mannion, Brox, Fairbank. Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials. Spine J 2014;14:1087
We thank Berg and Tulberg [1] for their interest in our article [2] and would like to respond to their criticisms of our work. They find it questionable whether intention to treat (ITT) analyses—the recommended method for analyzing randomized controlled trial data—should have been applied to our data and instead plead for removal from the analysis of the patients who crossed over. They will be aware that with ITT, patients are analyzed in the group to which they were randomly allocated (regardless of what happens afterwards), otherwise the benefit of randomization will be lost. (Source: The Spine Journal)


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


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


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


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


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


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


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


Is there a gender bias in the recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment?
Conclusion: Our findings indicate that the interdisciplinary teams in specialist healthcare may discriminate against women with chronic pain when physiotherapy and radiological investigation are recommended. The team's choice of recommendations might be influenced by gendered attitudes, but this field of research needs to be studied further. PMID: 25587848 [PubMed - as supplied by publisher] (Source: Journal of Rehabilitation Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


Approach to diagnosis and management of optic neuropathy
This article briefly describes the important causes of optic neuropathy in the Indian context and outlines a practical approach to management. (Source: Neurology India)


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


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


Theory of Mind and Emotional Functioning in Fibromyalgia Syndrome: An Investigation of the Relationship between Social Cognition and Executive Function
Conclusions The results show the presence of several impairments in social cognition skills in patients with FM, which are largely independent of both executive function deficits and symptoms of psychological distress. The impairments reported highlight the importance of adequately assessing ToM and emotional functioning in clinical practice. (Source: PLoS One)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Cake Rings True
It often really concerns me that many people get their medical information from watching movies and television. That's because most shows are wildly medically inaccurate and truly misinform, especially in the arena of mental health. So I was particularly intrigued to watch Cake with Jennifer Aniston, which would be dealing with the subject of addiction. Besides being touchingly absorbing, Cake spells out that in reality ANYONE can develop a drug addiction, which is a painfully horrible way to live, often deadly and that it most often goes untreated. When we think of a drug addict, we tend not to think about young mothers, upstanding citizens or those with means. Cake's main character, Claire, is all of these. This is accurate because addiction cuts across ALL demographics. That is because...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


Laparoscopic hernia repair with adductor tenotomy for athletic pubalgia: an established procedure for an obscure entity
Conclusion Athletic pubalgia is a disease with a multifactorial etiology that can be treated surgically by a laparoscopic totally extraperitoneal hernia repair with synthetic mesh accompanied with an ipsilateral adductor longus tenotomy allowing patients to return to sports-related activity early with minimal complications. (Source: Surgical Endoscopy)


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


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


Report highlights the dangers of opioid painkillers
Whenever I read or write about the overuse of so-called opioid painkillers it is with mixed feelings. As a lifelong back-pain patient who once depended on them for pain relief, I appreciate the challenge posed by opioids to people in pain and their doctors. People in agonizing pain want it to stop, but opioids are often a poor long-term solution. Doctors want to help their patients, so they may prescribe opioids for extended periods despite well-founded reservations. At the same time, the epidemic of abuse of these painkillers has led to numerous deaths. Like many Americans, I know people whose lives were destroyed—who ended up in rehab, the legal system, or the grave—because of prescription painkiller abuse. An article this week in the New England Journal of Medicine pegs the toll at ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Study reveals lack of data on opioid drugs for chronic pain
(University of Connecticut) A National Institutes of Health white paper that was released today finds little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain, despite the explosive recent growth in the use of the drugs. (Source: EurekAlert! - Medicine and Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Chinese medicinal formulation ameliorates dextran sulfate sodium-induced experimental colitis by suppressing the activity of nuclear factor-kappaB signaling
Conclusions Our findings suggest that MZWD is a potential remedy for treating IBD, and the mechanism of its efficacy is an anti-inflammatory effect associated with the suppression of the NF-κB pathway. Graphical abstract (Source: Journal of Ethnopharmacology)


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


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


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


A New Version of The Impairment and Functioning Inventory for Chronic Pain Patients (IFI-R)
Conclusions The IFI-R appears to be a valid and reliable measurement tool for the assessment of perceived daily functioning and impairment in people with chronic pain. (Source: PMandR)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Tuning In to Music May Ease Kids' Post-Op Pain, Study Finds
Title: Tuning In to Music May Ease Kids' Post-Op Pain, Study FindsCategory: Health NewsCreated: 1/13/2015 12:00:00 AMLast Editorial Review: 1/14/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Benefits of Reiki in older individuals with chronic pain
In conclusion, this therapeutic practice significantly improves chronic pain complaints, in addition to contributing to the balance of the physical, mental, emotional and spiritual needs of older people. Reiki se caracteriza por ser una terapia complementar llevado a cabo a través de la imposición de manos en el ser humano con la intención de restablecer el equilibrio físico, mental y espiritual. El objetivo de esta investigación fue identificar y analizar los beneficios experimentados con la práctica de Reiki, en sujetos ancianos con dolor crónico no oncológica. Se trata de un estudio cualitativo, descriptivo y exploratorio. Para la recolección se utilizó la entrevista semiestructurada, con cuestiones abiertas y cerradas. Los datos fueron recogidos entre julio y agosto de 2012. ...


A Meta-Analysis Examining the Use of Fibrin Glue Mesh Fixation versus Suture Mesh Fixation in Open Inguinal Hernia Repair
Conclusions: During the 6-15 months follow-up, fibrin glue mesh fixation is a feasible alternative for mesh fixation with sutures in open inguinal hernia repair. However, the poor quality of the included trials limits the evidence; rigorously designed trials are warranted to confirm this conclusion.Dig Surg 2014;31:444-451 (Source: Digestive Surgery)


Pancreatitis in dogs and cats: definitions and pathophysiology
This article reviews histological and clinical definitions and current understanding of the pathophysiology and causes in small animals by comparison with the much more extensive literature in humans, and suggests many areas that need further study in dogs and cats. (Source: The Journal of Small Animal Practice)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


From "mechanical" to "neuropathic" back pain concept in FBSS patients. A systematic review based on factors leading to the chronification of pain (part C).
CONCLUSION: A clear understanding of the factors leading to the chronification of back pain should help us to move to the choice of mechanism related pain treatments to improve outcomes in FBSS chronic condition. PMID: 25596973 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Chronic Pain Associated with Activation of Brain's Glial Cells
Patients with chronic pain show signs of glial activation in brain centers that modulate pain, according to results from a PET-MRI study -- Read more on ScientificAmerican.com (Source: Scientific American - Official RSS Feed)


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


Expert Panel Final Report on Opioids in Chronic PainExpert Panel Final Report on Opioids in Chronic Pain
An independent expert panel convened by NIH has published a final report identifying knowledge gaps and calling for more research into various aspects of chronic pain management and long-term opioid use. Medscape Medical News (Source: Medscape Neurology and Neurosurgery Headlines)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Brain Scans Give New Clues to Chronic Pain
Title: Brain Scans Give New Clues to Chronic PainCategory: Health NewsCreated: 1/12/2015 12:00:00 AMLast Editorial Review: 1/13/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


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


Idiopathic Vitritis in the Setting of Boston Keratoprosthesis
Conclusions:The current paradigm for idiopathic vitritis after keratoprosthesis implantation includes sudden painless loss of vision with full recovery of vision on treatment with periocular corticosteroids. However, idiopathic vitritis after keratoprosthesis can also mimic infectious endophthalmitis with pain and external signs of inflammation. Visual loss can be gradual. Vision may not recover to baseline despite treatment. Vitritis may be a part of a common pathway of chronic inflammation after keratoprosthesis. (Source: Cornea)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


The Pain—Suffering Association, A Review
ConclusionsThe above results indicate a consistent association between suffering and pain in some patient groups. Studies addressing suffering are needed in CNPM patients. (Source: Pain Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain.
This article is an abridged version of the panel's report, the full version of which is available at at https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/opioids-chronic-pain/workshop-resources#finalreport. PMID: 25581341 [PubMed - as supplied by publisher] (Source: Annals of Internal Medicine)


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


Failed back surgery syndrome: Who has failed?
CONCLUSION: The initial pejorative connotation of FBSS suggesting failure or blame must now be replaced to direct the patient and therapists towards a temporal concept focusing on the future rather than the past. In addition to the redefinition of an optimised care pathway, a consensus based on consultation would allow redefinition and renaming of this syndrome in order to ensure a more positive approach centered on the patient. PMID: 25595592 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Scant Evidence for Opioids in Chronic Pain (CME/CE)
(MedPage Today) -- A two-day NIH workshop concludes there's little evidence for opioids in chronic pain. (Source: MedPage Today Geriatrics)


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


Brain Scans Give New Clues to Chronic Pain
In patients with back pain, certain cells produced a protein that might someday be treatment targetSource: HealthDay Related MedlinePlus Page: Chronic Pain (Source: MedlinePlus Health News)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


How Well Do Medical Oncologists Manage Chronic Cancer Pain?: A National Survey.
CONCLUSION: These data suggest that oncologists and other medical specialists who manage cancer pain have knowledge deficiencies in cancer pain management. These gaps help clarify the need for pain management education. PMID: 25582140 [PubMed - as supplied by publisher] (Source: The Oncologist)


The up-regulation of spinal Toll-like receptor 4 in rats with inflammatory pain induced by complete Freund's adjuvant.
Authors: Zhao XH, Zhang T Abstract Peripheral inflammation induces central sensitization that displays the features by the development of pain hypersensitivity to the stimuli. It has been shown that activation of glia contributes to the development of behavioral hypersensitivity after peripheral inflammation. It has been suggested that Toll-like receptor 4 (TLR4) primarily expressed on microglia affects central pain response. The present study was designed to examine the expressions of TLR4 and microglia in the spinal cord in different time points of inflammatory pain induced by complete Freund's adjuvant (CFA). The results show that CFA induces significant pain hypersensitivity and paw edema as well as spinal dorsal horn (SDH) microglia activation with the increased expressions of...


Mechanisms of morphine-venlafaxine interactions in diabetic neuropathic pain model.
CONCLUSIONS: The results of our study show that single administration of VFX potentiates antinociceptive action of morphine in DNPM. This effect is probably mediated by both, noradrenergic and serotonergic systems. On the other hand, 21-days administration of VFX significantly decreases analgesic action of MRF. Moreover, there is a possibility that VFX acts as an antagonist of N-methyl-d-aspartate receptors. PMID: 25560581 [PubMed - in process] (Source: Pharmacological Reports)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Increased risks of healthcare-seeking behaviors of anxiety, depression and insomnia among patients with bladder pain syndrome/interstitial cystitis: a nationwide population-based study
Conclusion Patients with BPS/IC are at risk of development of anxiety, depression, and insomnia. These findings can help guide urologists, urogynecologists, and psychiatrists toward early identification and treatment of psychological complications that may develop in BPS/IC patients. (Source: International Urology and Nephrology)


Intravenous immunoglobulin for chronic residual peripheral neuropathy in eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome): a multicenter, double-blind trial
This study indicates that IVIg treatment for EGPA patients with residual peripheral neuropathy should be considered even when laboratory indices suggest remission of the disease. (Source: Journal of Neurology)


[Behavioral concepts in the treatment of chronic pain.]
Authors: Kaiser U, Nilges P Abstract In recent decades there has been much work on cognitive behavioral approaches to chronic pain. Now there is a considerable variety of concepts and interventions which share the same roots but differ in theoretical issues and application. Psychotherapeutic interventions are ideally embedded into an interdisciplinary setting and base on a bio-psycho-social perspective. Starting from a classical operant model we will describe the model of fear avoidance and the model of acceptance in the therapy of chronic pain. The latter have been influencing therapy and theory in recent years. The cognitive behavioral perspective on chronic pain has, therefore, not only become more differentiated and complex but also more complicated. PMID: 25576181 [PubMed ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


3 Tips for Love & Pain
Couples in hot romantic love feel fantastic! They glow. And, it turns out that love has a surprising protective effect against pain. Intense romantic love brings euphoric pleasure and it also confers analgesic benefit, according to two separate Stanford studies.read more (Source: Psychology Today Relationships Center)


Altered cognition-related brain activity and interactions with acute pain in migraine
Publication date: Available online 10 January 2015 Source:NeuroImage: Clinical Author(s): Vani A. Mathur , Shariq A. Khan , Michael L. Keaser , Catherine S. Hubbard , Madhav Goyal , David A. Seminowicz Little is known about the effect of migraine on neural cognitive networks. However, cognitive dysfunction is increasingly being recognized as a comorbidity of chronic pain. Pain appears to affect cognitive ability and the function of cognitive networks over time, and decrements in cognitive function can exacerbate affective and sensory components of pain. We investigated differences in cognitive processing and pain-cognition interactions between 14 migraine patients and 14 matched healthy controls using an fMRI block-design with two levels of task difficulty and concurrent heat (painful an...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


Gene Therapy for Chronic Pain: How to Manipulate and Unravel Pain Control Circuits from the Brain?
The increasing prevalence of chronic pain imposes to search for new therapeutic approaches. Despite the increase in basic and clinical pain research during the last decades, the available analgesic drugs remained considerably unchanged. Gene therapy emerged as an important tool in the pain field. Studies in experimental pain models consisted on blockade of nociceptive transmission at the spinal cord by peripheral delivery of viral vectors (mainly replication-defective forms of herpes simplex virus type 1, HSV-1). Based on these results, clinical trials using gene therapy were successfully implemented in cancer patients with intractable pain. (Source: Springer protocols feed by Neuroscience)


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


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


Measuring Lumbar Reposition Accuracy in Patients With Unspecific Low Back Pain: Systematic Review and Meta-analysis
Conclusion. Although patients with NSCLBP seemed to produce a larger lumbar RE compared with healthy controls, study limitations render firm conclusions unsafe. Future studies should pay closer attention to power, precision, and reliability of the measurement approach, definition of outcome measures, and patient selection. We recommend a large, well-powered, prospective randomized control study that uses a standardized measurement approach and definitions for absolute error, CE, and variable error to address the hypothesis that proprioception may be impaired with CLBP. Level of Evidence: 1 (Source: Spine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Welcome to Chronic Pain 360: Real Hope for Recovery
We need to rethink the way we treat chronic pain.read more (Source: Psychology Today Addiction Center)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


GDNF‐mediated enhancement of noradrenergic descending inhibition in the locus coeruleus exerts a prolonged analgesic effect on neuropathic pain
Conclusions and ImplicationsGDNF injection into the LC exerts prolonged analgesic effects on neuropathic pain in rats by enhancing descending noradrenergic inhibition. (Source: British Journal of Pharmacology)


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


Exercise for osteoarthritis of the knee.
CONCLUSIONS: High-quality evidence indicates that land-based therapeutic exercise provides short-term benefit that is sustained for at least two to six months after cessation of formal treatment in terms of reduced knee pain, and moderate-quality evidence shows improvement in physical function among people with knee OA. The magnitude of the treatment effect would be considered moderate (immediate) to small (two to six months) but comparable with estimates reported for non-steroidal anti-inflammatory drugs. Confidence intervals around demonstrated pooled results for pain reduction and improvement in physical function do not exclude a minimal clinically important treatment effect. Since the participants in most trials were aware of their treatment, this may have contributed to their improvem...


ASICs as therapeutic targets for migraine.
Authors: Dussor G Abstract Migraine is the most common neurological disorder and one of the most common chronic pain conditions. Despite its prevalence, the pathophysiology leading to migraine is poorly understood and the identification of new therapeutic targets has been slow. Several processes are currently thought to contribute to migraine including altered activity in the hypothalamus, cortical-spreading depression (CSD), and afferent sensory input from the cranial meninges. Decreased extracellular pH and subsequent activation of acid-sensing ion channels (ASICs) may contribute to each of these processes and may thus play a role in migraine pathophysiology. Although few studies have directly examined a role of ASICs in migraine, studies directly examining a connection have gene...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 dichotomized role for acid sensing ion channels in musculoskeletal pain and inflammation.
Authors: Sluka KA, Gregory NS Abstract Chronic muscle pain affects between 11-24% of the world's population with the majority of people experiencing musculoskeletal pain at some time in their life. Acid sensing ion channels (ASICs) are important sensors of modest decreases in extracellular pH that occur within the physiological range. These decreases in extracellular pH occur in response to inflammation, fatiguing exercise,, and ischemia. Further, injection of acidic saline into muscle produces enhanced nociceptive behaviors in animals and pain in human subjects. Of the different types of ASICs, ASIC3 and ASIC1 have been implicated in transmission of nociceptive information from the musculoskeletal system. The current review will provide an overview of the evidence for ASIC3 and AS...


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


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


Outcome Measures in Randomized-controlled Trials of Neuropathic Pain Conditions: A Systematic Review of Systematic Reviews and Recommendations for Practice
Discussion: These results demonstrate that measures of pain are predominantly used in trials of NeP conditions and highlight the scant usage of functional outcome measures. The lack of standardization for the diagnostic criteria in NeP trials is also an issue that needs to be considered for future research and guideline development. (Source: The Clinical Journal of Pain)


Attachment and Adjustment in Adolescents and Young Adults With a History of Pediatric Functional Abdominal Pain
This study tested predictions of the Attachment-Diathesis Model (ADM) of Chronic Pain in a cross-sectional sample of adolescents and young adults with a history of childhood functional abdominal pain (FAP). ADM posits that attachment anxiety is a diathesis for poor adjustment (physical health, mental health, and functioning) in the context of chronic pain and that pain self-efficacy, pain threat appraisal, and passive coping mediate this effect. Methods: Participants (N=261) were recruited from a database of consecutive new patients evaluated for abdominal pain at a pediatric gastroenterology clinic. Participants’ mean age at the follow-up assessment was 21 years. Structural equation modeling was used to test the fit of our conceptual model to the data. Results: Model fit was good (compa...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Self-efficacy Mediates the Relationship Between Depressive Symptoms and Pain Severity
We examined the relationships between depressive symptoms, pain severity, and pain self-efficacy (PSE) in patients with chronic low back pain (CLBP). We hypothesized that change in depressive symptoms would significantly influence change in pain severity, and that PSE indirectly affects this relationship. Materials and Methods: Participants were 109 CLBP patients in a 4-week multidisciplinary rehabilitation program for CLBP. They completed measures of PSE, depression, and pain severity at admission and discharge. Structural equation modeling was used to test the significant direct and indirect effects from pretreatment to posttreatment. Results: Change in depressive symptoms significantly predicted change in pain severity in affective (β=0.358; 95% confidence interval [CI], 0.206-0.480; P...


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


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


Exercise, Not to Exercise, or How to Exercise in Patients With Chronic Pain? Applying Science to Practice
Conclusion: Exercise therapy has found to be beneficial in CP, but it should be appropriately and individually tailored with emphasis on prevention of symptom flares and applying adequate recovery strategies. (Source: The Clinical Journal of Pain)


Pain among institutionalized stroke patients and its relation to emotional distress and social engagement
ConclusionsPain is a serious and multidimensional problem among institutionalized stroke patients. It is related to increased ED, which in turn can be a pathway to low SE as an indicator of social vulnerability. Future research should reveal how pain management in nursing homes can be tailored to the needs of this patient group. Copyright © 2014 John Wiley & Sons, Ltd. (Source: International Journal of Geriatric Psychiatry)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Topical sodium nitrite for chronic leg ulcers in patients with sickle cell anaemia: a phase 1 dose-finding safety and tolerability trial
This study is registered with ClinicalTrials.gov, number NCT01316796. Findings Between April 4, 2011, and March 19, 2013, we enrolled 18 adult patients with sickle cell anaemia and leg ulcers into our trial. We assigned three patients into each cohort, and each cohort was treated with a different concentration of sodium nitrite cream (cohort 1: 0·5%, cohort 2: 1·0%, cohort 3: 1·5%, and cohort 4: 2·0%). Patients were not enrolled into the next cohort dose until we were able to establish that no dose-limiting toxicities were observed. An additional six patients were enrolled to cohort 3a: 1·8%, after two patients in cohort 4 had asymptomatic drops in diastolic blood pressure. No grade 3–4 adverse events were observed, and there were no serious adverse events or dose-limiting side-eff...


The common link between functional somatic syndromes may be central sensitisation
Functional somatic syndromes are common and disabling conditions that all include chronic pain, and which may be related to central nervous system sensitisation. Here, we address the concept of central sensitisation as a physiological basis for the functional somatic syndromes. (Source: Journal of Psychosomatic Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


A 10-year experience of totally extraperitoneal endoscopic repair for adult inguinal hernia
Conclusions The results obtained for TEP over 10 years support this as a promising procedure for the treatment of adult inguinal hernia. (Source: Surgery Today)


Viral vectors encoding endomorphins and serine histogranin attenuate neuropathic pain symptoms after spinal cord injury in rats
Conclusions: Findings from this study support the potential for direct gene therapy to provide a robust and sustained alleviation of chronic neuropathic pain following SCI. The combination strategy utilizing potent mu-opioid peptides with a naturally-derived NMDA antagonist may produce additive or synergistic analgesic effects without the tolerance development for long-term management of persistent pain. (Source: Epidemiologic Perspectives and Innovations)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Twelve‐Month Follow‐Up of a Randomized Trial Assessing Cooled Radiofrequency Denervation as a Treatment for Sacroiliac Region Pain
ConclusionsThese favorable 12‐month results illustrate the durability of effective CRF/LBN‐mediated treatment of SI region pain for selected patients. Furthermore, successful CRF/LBN treatments in unblinded crossover study subjects demonstrate the unlikelihood that such positive outcomes are attributable to a “placebo” effect, and suggest that CRF/LBN is an effective therapeutic option for alleviating pain, and improving physical function and quality of life, with few complications. (Source: Pain Practice)


Interdisciplinary expert consensus on management of type B intramural haematoma and penetrating aortic ulcer [REVIEWS]
An expert panel on the treatment of type B intramural haematoma (IMH) and penetrating atherosclerotic ulcer (PAU) consisting of cardiologists, cardiothoracic surgeons, vascular surgeons and interventional radiologists reviewed the literature to develop treatment algorithms using a consensus method. Data from 46 studies considered relevant were retrieved for a total of 1386 patients consisting of 925 with IMH, and 461 with PAU. The weighted mean 30-day mortality from IMH was 3.9%, 3-year aortic event-related mortality with medical treatment 5.4%, open surgery 23.2% and endovascular therapy 7.1%. In patients with PAU early and 3-year aortic event-mortality rates with open surgery were 15.9 and 25.0%, respectively, and with TEVAR were 7.2 and 10.4%, respectively. According to panel consensus ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Smiling Again with Laughing Gas
And so, maybe it is time to look at what we already have: Although ketamine has gained interest in recent years as a rapidly acting potential therapy for treatment refractory depression, researchers say an even better option may lie in another well-known agent with a similar mechanism of action ― nitrous oxide, better known as laughing gas. (Image from Google.)read more (Source: Psychology Today Depression Center)


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


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


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


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


Endogenous adenosine A3 receptor activation selectively alleviates persistent pain states
Chronic pain is a global burden that promotes disability and unnecessary suffering. To date, efficacious treatment of chronic pain has not been achieved. Thus, new therapeutic targets are needed. Here, we demonstrate that increasing endogenous adenosine levels through selective adenosine kinase inhibition produces powerful analgesic effects in rodent models of experimental neuropathic pain through the A3 adenosine receptor (A3AR, now known as ADORA3) signalling pathway. Similar results were obtained by the administration of a novel and highly selective A3AR agonist. These effects were prevented by blockade of spinal and supraspinal A3AR, lost in A3AR knock-out mice, and independent of opioid and endocannabinoid mechanisms. A3AR activation also relieved non-evoked spontaneous pain behaviour...


Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes
Treatment-induced neuropathy in diabetes (also referred to as insulin neuritis) is considered a rare iatrogenic small fibre neuropathy caused by an abrupt improvement in glycaemic control in the setting of chronic hyperglycaemia. The prevalence and risk factors of this disorder are not known. In a retrospective review of all individuals referred to a tertiary care diabetic neuropathy clinic over 5 years, we define the proportion of individuals that present with and the risk factors for development of treatment-induced neuropathy in diabetes. Nine hundred and fifty-four individuals were evaluated for a possible diabetic neuropathy. Treatment-induced neuropathy in diabetes was defined as the acute onset of neuropathic pain and/or autonomic dysfunction within 8 weeks of a large improvement in...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Adhesion prevention agents for gynaecological surgery: an overview of Cochrane reviews.
CONCLUSIONS: There is insufficient evidence to allow us to draw any conclusions about the effectiveness and safety of anti-adhesion agents in gynaecological surgery, due to the lack of data on pelvic pain, fertility outcomes, quality of life or safety. A substantial proportion of research in this field has been funded by private companies that manufacture these agents, and further high powered, independent trials will be needed before definitive conclusions can be made. PMID: 25561409 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 terbinafine and itraconazole on the pharmacokinetics of orally administered tramadol
Conclusions Terbinafine may reduce the opioid effect of tramadol and increase the risk of its monoaminergic adverse effects. Itraconazole has no meaningful interaction with tramadol in subjects who have functional CYP2D6 enzyme. (Source: European Journal of Clinical Pharmacology)


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


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


Item-level informant discrepancies between children and their parents on the PROMIS ® pediatric scales
Conclusions Parent–child item-level discrepancies were lower for more objective or visible items than for items measuring internal states or less observable items measuring latent variables such as peer relationships and fatigue. Future research should focus on the child and parent characteristics that influence domain-specific item-level discrepancies, and under what conditions item-level parent–child discrepancies predict child health outcomes. (Source: Quality of Life Research)


Investigation of the Relationship between Increased Vertical Overlap with Minimum Horizontal Overlap and the Signs of Temporomandibular Disorders
ConclusionWithin the limitations of this study, deviation upon maximum opening, tenderness of lateral pterygoid muscles (upon palpation), and opening‐closing joint sounds occurred more often in the increased vertical overlap occlusions with minimum horizontal overlap compared to the control groups. These results indicated that clinicians should pay special attention to the tempormandibuar joint status of patients with significant vertical overlap anteriorly and position of the incisors when performing dental treatments that require reestablishment of incisor relationships. (Source: Journal of Prosthodontics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Chronic pelvic allodynia is mediated by CCL2 through mast cells in an experimental autoimmune cystitis model
The cause of chronic pelvic pain in interstitial cystitis/painful bladder syndrome (IC/PBS) remains unclear; autoimmunity is a possible etiology. We have recently shown that injection of a single immunogenic peptide of uroplakin 3A (UPK3A 65-84) induces experimental autoimmune cystitis (EAC) in female BALB/cJ mice that is unique among experimental models in accurately reflecting both the urinary symptoms and pelvic pain of IC/PBS. The aim of this project was to identify the roles of mast cells and mast cell chemoattractant/activator monocyte chemoattractant protein-1 [chemokine (C-C motif) ligand 2 (CCL2)] in the allodynia in this model. We immunized 6- to 8-wk-old female BALB/cJ mice with UPK3A 65-84 peptide and, 5&ndash;40 days later, observed increased responses to stimulation of the su...


Chronic low back pain, chronic disability at work, chronic management issues.
Authors: Petit A PMID: 25561278 [PubMed - as supplied by publisher] (Source: Scandinavian Journal of Work, Environment and Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


A multicenter, randomized, double-blind clinical study on Wufuxinnaoqing Soft Capsule (五福心脑清胶囊) in treatment of chronic stable angina patients with blood stasis syndrome
Conclusion In treatment of chronic stable angina (blood stasis syndrome), WSC can reduce angina attacks and consumption of nitroglycerin, decrease angina severity degree, effectively relieve the blood stasis syndromes, such as chest pain, chest tightness, palpitations, dark purple tongue and other symptoms. Besides, adverse events and cardiovascular adverse events in the treatment group and the control group showed no difference. All shows that the drug is safe and effective. [This study was registered in Chinese Clinical Trial Registry (ChiCTR), with registration number: ChiCTR-TRC-14005158.] (Source: Chinese Journal of Integrative Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Changing trends in use of laparoscopy: a clinical audit.
Conclusion. Over the years, there has been a rise in the rate of operative laparoscopy. Though the indications for laparoscopy have remained almost similar during the years, laparoscopy for diagnosis and treatment of CPP and AUB has now increased. PMID: 25548664 [PubMed] (Source: Minimally Invasive Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Creating an Interdisciplinary Medical Home for Survivors of Human Trafficking
ABSTRACT: Human trafficking refers to situations of forced labor and/or sexual servitude. At any given time, millions of individuals are trafficked worldwide. It is estimated that up to 17,500 individuals are trafficked into the United States annually; more than 20% are involved in sexual trafficking. Survivors of human trafficking are victims of psychological, physical, and sexual abuse that leave them vulnerable to a variety of medical conditions. Moreover, these patients are often fearful, distrust medical providers, and may resist attempts to evaluate them. In May 2012, an article published in Obstetrics & Gynecology (Obstet Gynecol 2012;119:1045) called for action by obstetrician-gynecologists and other health care providers to address the health-delivery needs of victims of human tra...


Effects of Pilates Exercise Programs in People With Chronic Low Back Pain: A Systematic Review
The objective of this study is to describe and provide an extensive overview of the scientific literature comparing the effectiveness of the Pilates method on pain and disability in patients with chronic nonspecific LBP. The study is based on the data from the following sources: MEDLINE-NLM, MEDLINE-EBSCO, Scopus Elsevier, Cochrane, DOAJ, SciELO, and PLOSONE. Original articles and systematic reviews of adults with chronic nonspecific LBP that evaluated pain and/or disability were included in this study; studies in which the primary treatment was based on Pilates method exercises compared with no treatment, minimal intervention, other types of intervention, or other types of exercises. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were adopted. The literatu...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Sex Differences Among Opioid-Abusing Patients With Chronic Pain in a Clinical Trial
Conclusions: The demographic profile of opioid-abusing patients with chronic pain presenting for treatment in a clinical trial was similar between sexes; however, some important differences were observed. Women reported more psychiatric comorbidity and endorsed greater pain-related physical and social impairment. Men reported more aberrant behaviors. These differences suggest that men with chronic pain and opioid abuse/dependence may benefit by closer monitoring of aberrant behaviors whereas women may benefit from closer attention paid to physical and psychological effects of pain. (Source: Journal of Addiction Medicine)


The Relationship Between Nonsurgical Pain and Interference With Activity in Patients Undergoing a Total Knee Arthroplasty
This study explores the severity and ways in which NSP interferes with activities 48 hours and 6–7 weeks post surgery. ANALYSIS: Univariate and multivariate analyses were used. The mean score for intensity at 48 hours was 1.78, and at 6–7 weeks it was 1.15. The mean score for interference with activities at 48 hours was 1.62 and at 6–7 weeks it was 0.91. Highest NSP pain interference at 48 hours was for “activity,” “sleep,” and “enjoyment of life.” At 6–7 weeks, the highest scores were for “activity,” “sleep,” and “walking.” No significant differences were noted for age, race, education, or gender. IMPLICATIONS: Although rated “mild,” this pain should be addressed. The NSP indicates a baseline of chronic and persistent pain, which is an opportunity to wo...


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


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


Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years
This study evaluates clinical and ultrasound (US) outcomes after surgical repair of acute and chronic PM tendon rupture. Materials and methods Twelve men with PM tendon rupture (9 right and 3 left shoulders) were enrolled. Mean age was 34.6 years, and mean follow-up was 60 months (range 12–108). Rupture was diagnosed by magnetic resonance imaging. Eight patients underwent direct tendon repair (acute group) and 4 had allograft reconstruction (chronic group). Pain, range of motion, strength recovery and return to sports were assessed. Postoperative X-ray and US scans were obtained in all patients. Final outcomes were graded as excellent, good, fair or poor. Isometric strength in adduction/abduction, flexion, internal rotation (IR) and external ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


60-Year-Old Man With Chronic Diarrhea and Peptic Ulcer Disease
A 60-year-old man was transferred to our hospital with a 5-year history of worsening daily watery, nonbloody, nongreasy diarrhea. One year previously, recurrent vomiting had developed. Over the month preceding the current admission, he experienced 4 episodes of intractable, large-volume diarrhea with abdominal pain, upper and lower extremity muscle cramping, and orthostatic light-headedness. His diarrhea did not improve with fasting, and each of these episodes required hospitalization for intravenous fluid and electrolyte replacement. (Source: Mayo Clinic Proceedings)


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


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


Postoperative pain outcomes after transvaginal mesh revision
Conclusions Excision or revision of vaginal mesh appears to be effective in improving patients’ pain symptoms most of the time. Patients with a history of chronic pelvic pain are at an increased risk of no improvement or of worsening pain. (Source: International Urogynecology Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


Treatment efficacy for pain complaints in women with endometriosis of the lesser pelvis after laparoscopic electroablation vs. CO 2 laser ablation
Abstract Endometriosis is a chronic disease affecting mainly women of the reproductive age. Its most common manifestations include impaired fecundity, pelvic pain, and dyschezia. Laparoscopic removal of endometriotic foci remains to be the gold standard for the treatment of endometriosis. More effective techniques of endoscopic approach—among others, laser application—are continually being developed. The aim of the study was to evaluate the efficacy of laparoscopic treatment with the use of CO2 laser ablation vs. electroablation with regard to pain complaints in the affected patients. The study included 48 women (aged 22–42) with varying degrees of endometriosis of the lesser pelvis. The Numeric Rating Scale (NRS) was used to evaluate pain intensity before the surgery in al...


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


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


A Multicentre Prospective Evaluation of the Impact of Renal Insufficiency on In-hospital and Long-term Mortality of Patients with Acute ST-elevation Myocardial Infarction.
CONCLUSIONS: RI is very common in STEMI patients. RI evaluated by eGFR is an important independent predictor of short-term and long-term outcome in patients with acute STEMI. PMID: 25563305 [PubMed - in process] (Source: Chinese Medical Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


A 65-year-old man with persistent cough and large nodular opacity.
Authors: Grimes BS, Albores J, Barjaktarevic I Abstract A 65-year-old Asian man with a history of chronic hepatitis B infection presented to our pulmonary clinic for second opinion of his chronic, persistent, nonproductive cough. He was evaluated 10 months earlier with chest CT scan, which revealed a large lingular nodular opacity that was diagnosed as nodular cryptogenic organizing pneumonia by CT scan-guided percutaneous lung biopsy. Systemic corticosteroids were initiated and continued over the next 10 months. The dry cough persisted, and he developed intermittent left-sided pleuritic chest pain. He denied fevers, night sweats, hemoptysis, weight loss, or dyspnea. He was a lifelong nonsmoker and moved to the United States from China during childhood. PMID: 25560867 [PubMed ...


Chronic Pain: The Psychiatric Perspective
Why rheumatic pain is more than a joint issue (Source: The Rheumatologist)


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


Association between Cardiovascular Drugs and Chronic Kidney Disease in Non‐Institutionalized elderly patients
ConclusionRenal safety of cardiovascular drugs in the elderly appears acceptable and should not be a barrier to their use.This article is protected by copyright. All rights reserved. (Source: Basic and Clinical Pharmacology and Toxicology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


Placebo effect in burning mouth syndrome
Stomatodynia or burning mouth syndrome (BMS) manifests as a burning dysesthesia of the oral cavity that usually affects the tongue but also occurs on the inner aspect of the lips and anterior hard palate. This chronic pain condition has no definable local or systemic causes, but can also cause xerostomia, dysgeusia, and other oral dysesthesias. BMS is more common with increasing age and in postmenopausal women. Prevalence rates vary from 0.7% to 15%, but the epidemiology of BMS is unclear. Although it is probable that the pathophysiology of BMS includes interactions between local, systemic, and/or psychogenic factors, a neuropathic mechanism has been suggested. (Source: Dental Abstracts)


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


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


A successful treatment for a lesion of chronic total occlusion with contralateral angiography in a single radial access
Abstract A 50-year-old man was admitted due to effort chest pain. Coronary angiogram showed a total occlusion of LAD. The 5-French JL 3.5 was engaged into the left coronary artery. The XT-A guidewire was advanced to the distal of the occluded lesion. Contralateral angiography was performed using JL 3.5. The guiding catheter was pullback from the left coronary orifice leaving the guidewire at LAD, and the catheter tip was rotated clockwise to right coronary cusp for right coronary angiography. We could confirm that the guidewire was in the true lumen vessel. (Source: Cardiovascular Intervention and Therapeutics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


Systemic Opioid Elimination After Implantation of an Intrathecal Drug Delivery System Significantly Reduced Health‐Care Expenditures
ConclusionsFifty‐one percent of patients completely eliminated systemic opioids in the year after IDDS implant. This elimination resulted in a 10% to 17% reduction in yearly inpatient, outpatient, and drug expenditures. (Source: Neuromodulation)


The 12 Leads of Christmas: aVR
Conclusion to 83 Year Old Male: Shortness of Breath (My earlier primer on diffuse subendocardial ischemia) A Non STEMI That Needs the Cath Lab Now (Post by Dr. Smith that covers the management of emergent NSTEMI&#8217;s) Five Primary Patterns of Ischemic ST depression, without ST elevation. (Amazing post by Dr. Smith on patterns of ST-depression) Marked ST depression refractory to maximal medical therapy (More NSTEMI goodness from Dr. Smith) ST elevation in aVR, with widespread ST depression (Another NSTEMI that needs the cath lab) Deep and widespread ST depression signifies high risk coronary lesion (One final NSTEMI that needs the cath lab) &nbsp; I hope you’re enjoying our 12 Leads of Christmas series. You can check out the rest of the posts below (updated as new posts come out): 12 L...


The Forgotten Ones: Challenges and Needs of Children Living with Disabling Parental Chronic Pain
A qualitative study explored the challenges and needs of children living with parental chronic pain. Young adult children (n=30) of parents with chronic pain were interviewed. Parents (n=20) with chronic pain participated in four focus groups. Content analysis yielded five categories of child challenges: (a) understanding the big picture; (b) enduring hardships; (c) grieving losses; (d) communicating with parent, and; (e) isolating self from peers. Three categories of child needs emerged: (a) knowledge; (b) skills, and; (c) supervised interaction. (Source: Journal of Pediatric Nursing)


Ankle Syndesmosis: A Qualitative and Quantitative Anatomic Analysis
Conclusion: The qualitative and quantitative anatomy of the syndesmotic ligaments was reproducibly described and defined with respect to surgically identifiable bony prominences. Clinical Relevance: Data regarding anatomic attachment sites and distances to bony prominences can optimize current surgical fixation techniques, improve anatomic restoration, and reduce the risk of iatrogenic injury from malreduction or misplaced implants. Quantitative data also provide the consistency required for the development of anatomic reconstructions. (Source: The American Journal of Sports Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 validation of a questionnaire to measure the severity of functional limitations and reduction of sports ability in German-speaking patients with exercise-induced leg pain
Conclusions EILP-G questionnaire is a valid and reliable self-administered and disease-related outcome tool to measure the severity of symptoms that impact on function and sports ability in patients with exercise-induced leg pain. It can be recommended as a robust tool for measuring the subjectively perceived severity in German-speaking patients with exercise-induced leg pain. (Source: British Journal of Sports Medicine)


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


Immunomodulatory Effects of Endogenous and Synthetic Peptides Activating Opioid Receptors.
Authors: Pomorska DK, Gach K, Janecka A Abstract The main role of endogenous opioid peptides is the modulation of pain. Opioid peptides exert their analgesic activity by binding to the opioid receptors distributed widely in the central nervous system (CNS). However, opioid receptors are also found on tissues and organs outside the CNS, including the cells of the immune system, indicating that opioids are capable of exerting additional effects in periphery. Morphine, which is a gold standard in the treatment of chronic pain, is well-known for its immunosuppressive effects. Much less is known about the immunomodulatory effects exerted by endogenous (enkephalins, endorphins, dynorphins and endomorphins) and synthetic peptides activating opioid receptors. In this review we tried to sum...


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


Case studies of long-acting, extended-release, and sustained-release opioids for the treatment of chronic nonmalignant pain.
Authors: Sloan PA PMID: 25539291 [PubMed - in process] (Source: Journal of Opioid Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Extended-release and long-acting opioids for chronic pain management.
Authors: Sloan PA, Davis MP PMID: 25539288 [PubMed - in process] (Source: Journal of Opioid Management)


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


Chronic noncancer pain management in primary care: family medicine physicians' risk assessment of opioid misuse.
Conclusion: Knowledge and competency of the family physicians in managing CNCP were improved as was expected. Although the rate of eagerness about risk assessment of opioid misuse was increased, expected increase in the rate of using risk assessment was not achieved. Further studies are needed to identify the reasons of the difficulties on changing the attitudes and practices of primary care physicians about this subject. PMID: 25539797 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


New Treatment for Opioid-Induced Constipation
* The opioid antagonist naloxegol (Movantik) is now approved to treat opioid-induced constipation in adults with chronic noncancer pain. * The most common adverse effects are abdominal pain, diarrhea, nausea, flatulence, vomiting, and headache. (Source: AJN)


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


An unusual cause of right heart failure
A 48year old woman was admitted to our department for cardiac catheterization. She was complaining of dyspnea on light exertion and chest pain for 3months and increasing headaches for about 4weeks. The symptoms started acutely after microsurgical nucleotomy at L5/S1. Acute pulmonary embolism was excluded shortly after the onset of symptoms in a CT scan of the lung. A pulmonary consultant saw no signs of pulmonary failure. During the 3months before admittance to our department, our patient had also been seen by a cardiologist who saw signs of chronic right heart failure and a mild tricuspid insufficiency. (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Ulnar Collateral Ligament Injuries of the Thumb
Injuries to the thumb ulnar collateral ligament (UCL) are common. Failure to address the ensuing laxity of the metacarpophalangeal joint can lead to compromised grip and pinch, pain, and ultimately osteoarthritis. Instability to valgus stress with the lack of a firm end point is a strong indicator of complete rupture of the UCL. Nonoperative treatment is reserved for incomplete ruptures of the thumb UCL. Operative intervention is typically performed for complete ruptures. Repair of acute ruptures and reconstruction for chronic injuries yield excellent results. Complications are rare and most patients show preservation of motion, key pinch, and grip strength. (Source: Orthopedic Clinics of North America)


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


Neural circuitry of abdominal pain‐related fear learning and reinstatement in irritable bowel syndrome
Conclusions & InferencesAbdominal pain‐related fear learning and memory processes are altered in IBS, mediated by amygdala, cingulate cortex, prefrontal areas, and hippocampus. Enhanced reinstatement may contribute to hypervigilance and central pain amplification, especially in anxious patients. Preventing a ‘relapse’ of learned fear utilizing extinction‐based interventions may be a promising treatment goal in IBS. The response to abdominal pain is shaped by expectations, likely resulting from learning processes affecting brain responses in anticipation of pain. In a differential fear conditioning model of abdominal pain‐related fear with painful rectal distensions as unconditioned stimuli, we investigated the neural circuitry underlying acquisition, extinction, and reinstat...


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


Advanced Pain Medical Group Now Offering New Chronic Pain Treatment...
The top pain management clinics in the San Fernando Valley, Advanced Pain Medical Group, are now offering a new chronic pain treatment with spinal cord stimulator implants. The implants have been...(PRWeb December 28, 2014)Read the full story at http://www.prweb.com/releases/sanfernandopainclinic/spinal-cord-stimulator/prweb12416011.htm (Source: PRWeb: Medical Pharmaceuticals)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Purified Type I Collagen Wound Matrix Improves Chronic Wound Healing in Patients with Recessive Dystrophic Epidermolysis Bullosa
Abstract Recessive dystrophic epidermolysis bullosa is a severe genetic blistering skin condition resulting in chronic wounds. Nonhealing wounds were treated over 8 weeks using a reconstituted natural purified type I collagen skin substitute. Chronic wounds were defined as nonhealing wounds present for longer than 6 months. For each patient, two chronic wounds were identified and randomized into a control or treatment group. Both groups received standard‐of‐care wound dressings. The treatment group received an additional type I collagen skin substitute. Wound size was measured at baseline and weeks 1, 4, and 8. Pain, pruritus, and burning and stinging were assessed. Wound cultures were obtained at baseline and thereafter as was considered clinically relevant. Ten subjects were enroll...


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


The relationship between drug use, drug-related arrests, and chronic pain among adults on probation
This study examined whether chronic pain was associated with opiate use, other illicit drug use, and drug-related arrests in a sample of substance-using probationers. We expected that probationers with chronic pain-related diagnoses would report more opiate use and drug-related arrests. This study used baseline data from 250 adults on probation in Baltimore, Maryland and Dallas, Texas who were participating in a larger clinical trial. (Source: Journal of Substance Abuse Treatment)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Beliefs and Perceptions Inventory: A Cross-Sectional Study in Chronic and Episodic Migraine.
This study aims to compare differences in pain beliefs according to headache type, chronic vs episodic migraine, in a large cohort of patients, using the Pain Beliefs and Perceptions Inventory (PBPI), and to identify possible predictive factors of the same pain beliefs. METHODS: All patients referring for the first time at our center in 2011 were screened using PBPI and the Hamilton Anxiety and Depression Scale (a total of 1032 patients). PBPI is a 4-subscale questionnaire that explores a patient's personal beliefs on their subjective experience of pain. Headache patients also completed the Headache Impact Test (HIT-6) and a 30-day headache diary. For all participants, age, gender, duration of pain were collected. The sample was narrowed down to 899 as we experienced a nonresponse rate...


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


Complex regional pain syndrome: An optimistic perspective
Complex regional pain syndrome (CRPS) presents with clinical symptoms that can no longer be explained by the initial trauma, including pain, sensory, motor, and trophic symptoms, and impairment of autonomic control of the limb. These symptoms spread distally and go beyond single nerve innervation territories. Typically, the symptoms change through the course of CRPS as a result of the varying pathophysiology. Diagnosis is made clinically after the rigorous elimination of other possible causes, and 3-phase bone scintigraphy can be a useful tool for confirming CRPS. In acute stages, inflammatory symptoms prevail and should be treated with anti-inflammatory agents (steroids), bisphosphonates, or topical application of dimethyl sulfoxide. In chronic stages, many symptoms are related to so-call...


The effectiveness of lumbar extensor training: local stabilization or dynamic strengthening exercises. A review of literature.
Conclusions. 1. The lumbar low load specific stabilization exercises would be more efficient than muscle strengthening in the improvement of chronic low back pain. 2. Conditioning and strengthening exercises are considered valuable in effectively 'pre-habilitating' and reducing injury risk for athletes. PMID: 25694371 [PubMed - in process] (Source: Ortopedia, Traumatologia, Rehabilitacja)


Perioperative Factors Associated with HCAHPS Responses of 2,758 Surgical Patients
ConclusionsThese data suggest that demographic factors, preadmission medications, and PACU pain scores but not analgesic medications are associated with patient satisfaction with regards to both pain management and overall satisfaction. (Source: Pain Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Evaluation of the usefulness of the MRI jelly method for diagnosing complete cul-de-sac obliteration.
CONCLUSION: The MRI jelly method is a potentially useful, beneficial, and simple approach for diagnosing Pouch of Douglas adhesions. PMID: 24812616 [PubMed - indexed for MEDLINE] (Source: Biomed Res)


Prevalence of pelvic adhesions on ultrasound examination in women with a history of Cesarean section
ConclusionsPelvic adhesions are present in more than a third of women with a history of Cesarean section and they are associated with chronic pelvic pain. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. (Source: Ultrasound in Obstetrics and Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


[Sexual dysfunction in migraine patients who receive preventive treatment: identification by means of two screening tests].
CONCLUSIONS. Simple sexual dysfunction screening tests often detect sexual dysfunctions in patients with migraine on preventive treatment and changes in their sex life that can be attributed to these drugs. PMID: 25522859 [PubMed - in process] (Source: Revista de Neurologia)


Factors Predictive of Treatment-Emergent Adverse Events of Prucalopride: An Integrated Analysis of Four Randomized, Double-Blind, Placebo- Controlled Trials.
Conclusions: Prucalopride treatment was positively associated with diarrhea, headache, and nausea. Asian patients tended to have a higher frequency of diarrhea but lower frequencies of headache, abdominal pain, and nausea compared with non- Asians. PMID: 25534573 [PubMed - as supplied by publisher] (Source: Gut and Liver)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


For this drug developer, 2014 was 'best year in company history'
Mark Sirgo, the BioDelivery Sciences International CEO who has been described as a "street fighter," called 2014 the "best year in company history," and predicted 2015 would be "another positive year." It's hard to argue. On Wednesday, BioDelivery Sciences (Nasdaq: BDSI) submitted a new drug application to the U.S. Food and Drug Administration for a new chronic pain treatment that could hit $500 million in peak annual sales. Although BioDelivery's partner, Endo Pharmaceuticals, owns most of the… (Source: bizjournals.com Health Care:Physician Practices headlines)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


The Effect of Arm Support Combined With Rehabilitation Games on Upper-Extremity Function in Subacute Stroke: A Randomized Controlled Trial
Conclusions. AS training with computerized exercises is as effective as conventional therapy dedicated to the arm to improve arm function and activity in subacute stroke rehabilitation, when applied at the same dose. (Source: Neurorehabilitation and Neural Repair)


The role of the dorsolateral funiculi in the pain relieving effect of spinal cord stimulation: a study in a rat model of neuropathic pain.
Authors: Saadé NE, Barchini J, Tchachaghian S, Chamaa F, Jabbur SJ, Song Z, Meyerson BA, Linderoth B Abstract Activation of the dorsal columns is relayed to supraspinal centers, involved in pain modulation, probably via the descending fibers in the dorsolateral funiculi (DLF). The present study examines the role of the DLF in the attenuation of pain-related signs by spinal cord stimulation (SCS). Several groups of rats were subjected to nerve injury and to chronic bilateral DLF lesions at C5-7 level. In each animal, two sets of miniature electrodes were implanted, a caudal system placed in the dorsal epidural space at low thoracic level and another implanted over the dorsal column nuclei, rostral to the lesions. Stimulation (50 Hz, 0.2 ms; 70 % of motor threshold) was applied f...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Beliefs and attitudes about opioid prescribing and chronic pain management: Survey of primary care providers.
CONCLUSION: This study indicates a general concern and reluctance of primary care physicians to manage the prescribing of opioids among their patients with chronic pain and younger providers expressed more concern about opioids than older providers. PMID: 25531955 [PubMed - as supplied by publisher] (Source: Journal of Opioid Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Health Tip: Take Back Strain Out of Work
Title: Health Tip: Take Back Strain Out of WorkCategory: Health NewsCreated: 12/23/2014 12:00:00 AMLast Editorial Review: 12/23/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Sutured Repair of Primary Small Umbilical and Epigastric Hernias: Concomitant Rectus Diastasis Is a Significant Risk Factor for Recurrence
Conclusion We strongly recommend preoperatively checking for rectus diastasis and using nonabsorbable sutures as an alternative to mesh repair only when repairing small umbilical or epigastric hernias (&lt;2 cm) and there is no concomitant rectus diastasis. Patients with coexistent rectus diastasis definitely benefit from mesh-based repair of the midline to decrease the recurrence rate. (Source: World Journal of Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Laparoscopic Discoid Anterior Rectal Excision with the Circular Stapler for Rectosigmoid Endometriosis, Performed by the Gynecologic Surgeon
Conclusion Laparoscopic discoid excision of an anterior rectal nodule using the circular stapler is an effective option for treating selected cases of rectosigmoid endometriosis. The technique might be reproducible by gynecologic surgeons after proper training. (Source: Journal of Minimally Invasive Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Clinical Outcomes Following Resectoscopic Endometrial Ablation of Non-Atypical Endometrial Hyperplasia in Women With Abnormal Uterine Bleeding
Conclusion When performed by surgeons experienced in hysteroscopy, resectoscopic endometrial ablation is feasible, safe, and effective for treatment of SH and CH without atypia in women with AUB. (Source: Journal of Minimally Invasive Gynecology)


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


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


Inhaled hydrogen sulfide prevents neuropathic pain after peripheral nerve injury in mice
In this study, we examined the effects of hydrogen sulfide breathing on neuropathic pain in mice. C57BL/6J mice were subjected to chronic constriction injury (CCI) of the sciatic nerve. After CCI, mice breathed air alone or air mixed with hydrogen sulfide at 40 ppm for 8 h on 7 consecutive days. The expression levels of inflammatory cytokines including interleukin 6 (IL-6) were measured in the spinal cord. Effects of hydrogen sulfide on IL-6-induced activation of microglia were examined in primary rat microglia. Mice that breathed air alone exhibited the neuropathic pain behavior including mechanical allodynia and thermal hyperalgesia and increased mRNA levels of IL-6 and chemokine CC motif ligand 2 (CCL2) after CCI. Inhaled hydrogen sulfide prevented the neuropathic pain behavior and ...


Discovering the Truth Beyond the Truth
The question "What is truth?" is one of the oldest questions in philosophy. Truth within the field of medicine has gained relevance because of its fundamental relationship to the principle of patient autonomy. In order to fully participate in their medical care, patients must be told the truth – even in the most difficult of situations. Palliative care emphasizes patient autonomy and a patient-centered approach, and it is precisely among patients with chronic, life-threatening, or terminal illnesses that truth plays a particularly crucial role. (Source: Journal of Pain and Symptom Management)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Clinical outcomes of bilateral lung transplantation for cystic fibrosis in frame of the european multicentric COLT study
The objective of the study is to describe clinical outcomes of cystic fibrosis (CF) patients in COLT, with at least one year follow up post transplantation.From september 2009 to june 2012, 156 CF patients underwent bilateral lung transplantation. 48% were men, with mean age 27,5 and 18 IMC. 65% lung transplant recipients (LTR) with CF were infected with Pseudomonas aeruginosa, 33% with Staphylococcus Aureus. Before transplantation, 38% patients were colonizated with Aspergillus Fumigatus. The median time on waiting list was 123+/- 418 days with 27% High Emergency (HE) transplanted patients (waiting time: 7 +/- 5 days). 38% were transplanted with a miss-match of CMV, 12% for EBV. Patients required invasive ventilation during 9 days (median: 2 days) in intensive care unit. The post-transpla...


Evaluation of medical thoracoscopy (MT) service at Basildon Hospital, UK
Conclusion:MT is a relatively safe procedure for the diagnosis of patient with an exudative pleural effusion.Serious complications are rare,however,complications led to prolonged hospital stay,and therefore cost. (Source: European Respiratory Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Mindfulness-based stress reduction in patients with interstitial lung disease: A pilot study
Interstitial lung diseases (ILDs) are characterized by a chronic and progressive course with reduced quality of life (QoL). Depressive symptoms are common and persistent in patients with ILD.Mindfulness-based stress reduction (MBSR) is a protocol integrating Buddhist meditation with contemporary clinical and psychological practice; MBSR has already proven to reduce negative moods related to chronic symptoms.Nineteen ILD patients (M=11, mean age &plusmn; SD: 65 &plusmn; 8 years; 12 affected by idiopathic pulmonary fibrosis) were enrolled in a prospective, open-label, observational study evaluating feasibility, safety, and effect on QoL and lung function of a MBSR program. The intervention consisted of 8 weekly group meetings and 45 minutes-long daily home training. Three quarterly group mee...


Cytological types of lung cancer in a referral population in Western Greece during the past decade
Discussion: The most common type of malignancy in the population that was investigated was squamous cell carcinoma with a rate of 36,8%, followed by adenocarcinoma 34,3%. The patients that were found to have small cell lung carcinoma (SCLC) were fewer (16,0%), while there are patients reported with other types of endobronchial lesions (12,9%) such as large cell carcinoma, benign tumors etc. About 60% of the male patients were smokers and 75% of them were heavy smokers (over 40 packs/year). About 45% of female patients were smokers and 20% of those were heavy smokers. The ratio between men:women was 3,6:1. (Source: European Respiratory Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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


Antinocieptive effects of lacosamide on spinal neuronal and behavioural measures of pain in a rat model of osteoarthritis
Conclusions: Our in vivo electrophysiological results show that the inhibitory effects of LCM were MIA dependent. This suggests that if used in OA patients, LCM may allow physiological transmission yet suppress secondary hyperlagesia and allodynia. The inhibitory effect on spinal neuronal firing aligned with analgesic efficacy on nociceptive behaviours and suggests that LCM may still prove worthwhile for OA pain treatment and merits further clinical investigation. (Source: Arthritis Research and Therapy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Effectiveness of balneotherapy and spa therapy for the treatment of chronic low back pain: a review on latest evidence
Abstract In most European countries, balneotherapy and spa therapy are widely prescribed by physicians and preferred by European citizens for the treatment of musculoskeletal problems including chronic low back pain (LBP). We aimed to review and evaluate the recent evidence on the effectiveness of balneotherapy and spa therapy for patients with LBP. We comprehensively searched data bases for randomized controlled trials (RCTs) published in English between July 2005 and December 2013. We identified all trials testing balneotherapy or spa therapy for LBP that reported that the sequence of allocation was randomized. We finally included total of eight RCTs: two on balneotherapy and six on spa therapy. All reviewed trials reported that balneotherapy was superior in long term to tap wat...


Therapeutic Affordances of Social Media: Emergent Themes From a Global Online Survey of People With Chronic Pain
Conclusions: Much of the efficacy of social media may be explicable via a closer examination of therapeutic affordances. Particular areas that warrant attention include social media&#8217;s ability to filter and guide people to useful information, connect individuals, and share experiences. Further research into a variety of chronic conditions is warranted. Coupled with the results of the present study, a greater theoretical basis detailing how social media may foster health outcomes may lead to an improved evidence base for conducting research and may inform recommendations for social media use in chronic disease management. (Source: Journal of Medical Internet Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Investigating the size and dynamics of voltage-gated sodium channel fenestrations.
Investigating the size and dynamics of voltage-gated sodium channel fenestrations. Channels (Austin). 2014;8(3):264-77 Authors: Kaczmarski JA, Corry B Abstract Eukaryotic voltage-gated sodium channels (VGSCs) are essential for the initiation and propagation of action potentials in electrically excitable cells, and are important pharmaceutical targets for the treatment of neurological disorders such as epilepsy, cardiac arrhythmias, and chronic pain. Evidence suggests that small, hydrophobic, VGSC-blocking drugs can gain access to binding residues within the central cavity of these channels by passing through lateral, lipid-filled “fenestrations” which run between the exterior of the protein and its central pore. Here, we use molecular dynamics simulations to invest...


Eight principles for safer opioid prescribing and cautions with benzodiazepines.
Authors: Webster LR, Reisfield GM, Dasgupta N Abstract Abstract The provision of long-term opioid analgesic therapy for chronic pain requires a careful risk/benefit analysis followed by clinical safety measures to identify and reduce misuse, abuse, and addiction and their associated morbidity and mortality. Multiple data sources show that benzodiazepines, prescribed for comorbid insomnia, anxiety, and mood disorders, heighten the risk of respiratory depression and other adverse outcomes when combined with opioid therapy. Evidence is presented for hazards associated with coadministration of opioids and benzodiazepines and the need for caution when initiating opioid therapy for chronic pain. Clinical recommendations follow, as drawn from 2 previously published literature reviews, one...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


A rare complication: misdirection of an indwelling urethral catheter into the ureter.
We report 3 patients with the rare complication of an indwelling urethral catheter misdirected into the ureter. This is the largest series to date. Patients were referred to us for a variety of reasons following exchange of their chronic indwelling urinary catheters. CT in all cases demonstrated the urinary catheters residing in the left ureter. The ages of the patients were 37, 67 and 81 years old. All patients suffered from neurogenic bladder. Two patients were female, one was male, and 2 of the 3 had a sensory disorder inhibiting their pain response. The catheters were replaced with open-end Foley catheters. Extensive follow-up CT scans were obtained in one case, demonstrating improvement of hydronephrosis and no evidence of ureteral stenosis. Cystoscopy in this patient demonstrated nor...


In Reply:
Administration of vitamin C for preventing complex regional pain syndrome (CRPS) after a distal radius fracture (DRF) is an intriguing possibility. CRPS is a devastating syndrome that has no clear etiology other than the hypothesis of sympathetic overtone that can cause chronic pain after a trauma. Owing to the absence of a case definition and an identifiable unified etiology, the diagnosis of CRPS is based on subjective criteria defined by the International Association for the Study of Pain (IASP). (Source: The Journal of Hand Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Select steroid hormone glucuronide metabolites can cause toll-like receptor 4 activation and enhanced pain
Publication date: February 2015 Source:Brain, Behavior, and Immunity, Volume 44 Author(s): Susannah S. Lewis , Mark R. Hutchinson , Morin M. Frick , Yingning Zhang , Steven F. Maier , Tarek Sammakia , Kenner C. Rice , Linda R. Watkins We have recently shown that several classes of glucuronide metabolites, including the morphine metabolite morphine-3-glucuronide and the ethanol metabolite ethyl glucuronide, cause toll like receptor 4 (TLR4)-dependent signaling in vitro and enhanced pain in vivo. Steroid hormones, including estrogens and corticosterone, are also metabolized through glucuronidation. Here we demonstrate that in silico docking predicts that corticosterone, corticosterone-21-glucuronide, estradiol, estradiol-3-glucuronide and estradiol-17-glucuronide all dock with the MD-2 com...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


Physical and Psychological Correlates of Fatigue and Physical Function: A Stanford-NIH Open Source Pain Registry Study
Fatigue is a multidimensional construct that has significant implications for physical function in chronic non-cancer pain populations but remains relatively understudied. The current study characterized the independent contributions of self-reported ratings of pain intensity, sleep disturbance, depression, and fatigue to ratings of physical function and pain-related interference in a diverse sample of treatment-seeking individuals with chronic pain. Methods: These relationships were examined as a path modeling analysis of self-report scores obtained from 2,487 individuals with chronic pain from a tertiary care outpatient pain clinic. (Source: The Journal of Pain)


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


New and Lower Estimate of the Prevalence of Chronic Pain in the United States
No abstract available (Source: The Back Letter)


Should Physicians Simply No Longer Offer Opioids As a Treatment Option for Chronic Low Back Pain?
No abstract available (Source: The Back Letter)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Attenuation of neuropathic pain by sodium butyrate in an experimental model of chronic constriction injury in rats
Conclusion It may be concluded that the anti-inflammatory actions mediated by sodium butyrate are responsible for its beneficial effects in neuropathic pain in rats. (Source: Journal of the Formosan Medical Association)


Clinical Trials Update 2014: Year in Review
This section of Headache annually reviews the status of recently completed and ongoing major clinical trials involving common headache disorders. The review will focus on multicenter trials of new therapies as well as novel formulations of previously approved therapeutics. Table 1 summarizes the major therapeutic headache trials that were ongoing at the end of 2014, according to data obtained from both the “ClinicalTrials.Gov” website and from corporate press releases and presentations. Title Conditions Interventions Phases Single‐ascending dose study of AMG 333 in healthy subjects and subjects with migraines Migraine AMG 333 Phase 1 TI‐001 (intranasal oxytocin) for treatment of chronic migraine Chronic migraine TI‐001 Phase 2 Study to determine the effica...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Treatment of Chronic Lumbosacral Radicular Pain Using Adjuvant Pulsed Radiofrequency: A Randomized Controlled Study
ConclusionThe TFEI provided significant short‐term pain relief and PRF can be applied in conjunction with TFEI to achieve higher treatment efficacy compared with TFEI alone. (Source: Pain Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Root Ganglion Pulsed Radiofrequency for the Management of Intractable Vertebral Metastatic Pain: A Case Series
ConclusionDRG pulsed RF procedure provided sound pain relief for patients with intractable vertebral metastatic pain. Metastatic bone pain is characteristic of cancer pain and is a form of refractory cancer pain, as the pain includes not only nociceptive but also neuropathic pain. Although some drugs are effective in the management of painful bone metastases, pain while moving is one of the most refractory forms of pain. DRG pulsed RF procedure provided sound pain relief for patients with intractable vertebral metastatic pain. (Source: Pain Medicine)


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


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


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


Dose Escalation During the First Year of Long‐Term Opioid Therapy for Chronic Pain
ConclusionsDose escalation during the first year of long‐term opioid therapy is associated with higher rates of substance use disorders and more frequent outpatient encounters, especially non face‐to‐face encounters. (Source: Pain Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Management of Pain in Autosomal Dominant Polycystic Kidney Disease and Anatomy of Renal Innervation
Chronic pain is a prominent feature of autosomal dominant polycystic kidney disease that is difficult to treat and manage, often resulting in a decrease in quality of life. Understanding the underlying anatomy of renal innervation and the various etiologies of pain that occur in autosomal dominant polycystic kidney disease can help guide proper treatments to manage pain. Reviewing previously studied treatments for pain in autosomal dominant polycystic kidney disease can help characterize treatment in a stepwise fashion. (Source: The Journal of Urology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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


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


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


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


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


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


"Change is possible": Patients' experience of a multimodal chronic pain rehabilitation programme.
Conclusion: Individuals living with disabling chronic pain can create a better life by integrating their illness. A prerequisite is that healthcare professionals empower patients to develop the strength to take responsibility for their daily lives. This process is facilitated by skills to reduce pain and handle life, plus support from significant others. PMID: 25502883 [PubMed - as supplied by publisher] (Source: Journal of Rehabilitation Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Modeling pain in a dish: Nociceptors made from skin recreate pain physiology
We report and comment on medical innovations and advances &ndash; from bench to bedside &ndash; touching on scientific, business and policy issues. Our ranks include science writers, physicians, lab researchers, market analysts and others inside and outside the hospital. Neurons from patients could lead researchers to better drugs for chronic pain. By Nancy Fliesler Chronic pain, affecting tens of millions of Americans alone, is debilitating and demoralizing. It has many causes, and in the worst cases, people become "hypersensitized" &ndash; their nervous systems fire off pain signals in response to very minor triggers. Boston Children&#039;s HospitalNews Well, Vector Blog, Big Data, Blogread more (Source: Mass Device)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Effectiveness of app-based relaxation for patients with chronic low back pain (Relaxback) and chronic neck pain (Relaxneck): study protocol for two randomized pragmatic trials
DiscussionThe designed studies reflect a usual self-care setting and will provide evidence on a pragmatic self-care intervention that is easy to combine with care provided by medical professionals.Trial registration: ClinicalTrials.gov identifier Relaxback NCT02019498, Relaxneck NCT02019134 registered on 18 December 2013. (Source: Trials)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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


Clinical implications of Prescribing Nonsteroidal Anti-inflammatory Drugs in Oral Health Care – A Review
This article reviews therapeutic and analgesic uses of NSAIDs in dentistry. The various issues surrounding NSAIDs-induced adverse reactions and its implications in dentistry are also discussed. Teaser Acute pain is the most common complaint that causes patients to seek help from oral healthcare professionals. NSAIDs are routinely prescribed drugs but they have been associated with adverse reactions. Therefore, medical history and analgesic requirement of patient is essential. (Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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


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


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


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


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


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


A study of respiratory function among the workers engaged in ginning processes
Conclusions: Studies on cotton textile workers have shown both cross-shift and chronic decline of values. In this study on ginning workers, chronic effect only is observed. This difference of observation may be explained by different nature of exposure in case of ginning. This study recommends regular periodic clinical examination, lung function test and monitoring of dust, gram-negative bacteria and endotoxins in such workplaces. (Source: Indian Journal of Occupational and Environmental Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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


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


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


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


The Role of Parent Psychological Flexibility in Relation to Adolescent Chronic Pain: Further Instrument Development
Parental responses to their child's pain are associated with the young person's functioning. Psychological flexibility, defined as the capacity to persist with or change behavior, depending on one’s values and the current situation, while recognizing cognitive and non-cognitive influences on behavior, may provide a basis for further investigating the role of these responses. The Parent Psychological Flexibility Questionnaire (PPFQ) is a promising but preliminary measure of this construct. Parents of 332 young people with pain (301 mothers, 99 fathers, 68 dyads) completed the PPFQ during appointments in a pediatric pain clinic. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


Chronic multisite pain in major depression and bipolar disorder: cross-sectional study of 149,611 participants in UK Biobank
Individuals who report chronic pain and multiple sites of pain are more likely to have depression and are at higher risk of bipolar disorder, highlighting an important aspect of comorbidity between these two disorders. (Source: BMC Psychiatry)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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


Age-related cutoffs for cervical movement behaviour to distinguish chronic idiopathic neck pain patients from unimpaired subjects
Conclusions By including such classifications, the present findings expand actual research stating an age-related decrease in kinematic behaviour only using categorising span widths across decades. Future study is warranted to reveal our results’ potential applicability for intervention onset decision making for idiopathic neck pain patients. (Source: European Spine Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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