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Medworm: Chronic Pain - Recent Medical Updates

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Increased Cerebral Cannabinoid-1 Receptor Availability Is a Stable Feature of Functional Dyspepsia: A [18F]MK-9470 PET Study
Conclusions: Although these findings need replication in larger samples, they suggest that the abnormal brain activity in several of these regions, previously demonstrated in FD, may be due to a sustained endocannabinoid system dysfunction, identifying it as a potential novel target for treatment and warranting further studies to elucidate whether it is also a feature of other FGIDs or FSSs.Psychother Psychosom 2015;84:149-158 (Source: Psychotherapy and Psychosomatics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Understanding and treating painful diabetic neuropathy: time for a paradigm shift
This article is protected by copyright. All rights reserved. (Source: Diabetic Medicine)


Antidepressant Drugs for Prevention of Acute and Chronic Postsurgical Pain: Early Evidence and Recommended Future Directions
No abstract available (Source: Survey of Anesthesiology)


(105) The influence of familial pain models and ethnicity on the rating of experienced and imagined painful events
Numerous studies have indicated racial/ethnic differences in both clinical and experimental pain. Similarly, the presence of a parental pain model is associated with altered pain behavior, greater frequency of pain complaints, and greater likelihood of developing chronic pain. However, to our knowledge, the potential interaction of race/ethnicity and presence of parental pain models on the evaluation of experienced and imagined painful events has not been examined, nor whether the presence of a same-sex parental pain model might have different effects than a parental pain model of either sex. (Source: The Journal of Pain)


(111) An evidence-informed approach to the identification and assessment of chronic pain in children with cerebral palsy
Chronic pain is common for children with disabilities, most notably cerebral palsy (CP). Due to the complex heterogeneity of the disability, chronic pain is often unrecognized and thereby undertreated. Through an integrated knowledge translation strategy, a need for a Chronic Pain Assessment Toolbox for Children with Disabilities was recognized, to assist clinicians in the identification and assessment of chronic pain in a population for which very little support exists. A structured review of clinical practice guideline clearinghouses and scientific databases (Medline, CINAHL, Embase) retrieved 1,243 documents, from which 3 guidelines met eligibility criteria: (i) available in English; (ii) recommendations for ages 1-18 years; (iii) published between 2001- 2013. (Source: The Journal of Pa...


(115) Validity and reliability of the Patient-Reported Outcomes Measurement Information System (PROMIS) for pain interference and quality of life in women with fibromyalgia
The Patient-Reported Outcomes Measurement Information System (PROMIS) is a system of measurement tools developed to standardize reporting of patient-centered health related outcomes in various domains across a spectrum of chronic conditions. The purpose of this study was to determine validity and reliability of the PROMIS measurement tools for pain interference and quality of life in women with fibromyalgia. The current study is part of a larger randomized control trial evaluating the effect of TENS on movement pain in women with fibromyalgia. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(116) Assessment of anxiety as mediator of the relationship between sleep disturbance and pain catastrophizing in chronic pain
One of the most commonly reported issues of chronic pain sufferers is sleep disturbance, which causes decreases in productivity and quality of life for 70-88% of the chronic pain population.3 These patients also often suffer from anxiety and pain catastrophizing (PC), a negative emotional and cognitive state regarding actual or anticipated pain; however, it is unclear how these psychological conditions contribute to their disrupted sleep. Thus, we conducted the largest known retrospective review of sleep disturbance, anxiety, and PC scores using the Stanford-NIH Collaborative Health Outcomes Measurement Information Registry (CHOIR),1 including measures from the Patient Reported Outcomes Measurement Information System (PROMIS). (Source: The Journal of Pain)


(118) Differentiating among veterans who evidence clinically meaningful improvement in pain and those who don’t: a longitudinal analysis
We examined two waves of survey data from a cohort of recently returning veterans to identify demographic and clinical variables that differentiate those who evidence clinically meaningful improvement in pain intensity from those who don’t. (Source: The Journal of Pain)


(120) Toward clinical decision support for chronic pain: integrating patient reported outcomes in an electronic health record
This study describes the technical design and implementation of a novel system for integrating PROs with an EHR to provide pain-related clinical decision support. (Source: The Journal of Pain)


(121) Individual predictors of physical function and pain interference in chronic pain syndromes
There has been an effort to determine how the impact of chronic pain on daily life and well-being is altered by other factors. Through Stanford’s Collaborative Health Outcomes Information Registry (CHOIR) patients use the NIH Patient Reported Outcomes Measurement Information System (PROMIS) measures to inform doctors of the impact that chronic pain has on their life – biologically, socially and physiologically. In this retrospective analysis, we analyzed CHOIR data to determine individual predictors of physical function and pain interference in the chronic pain population. (Source: The Journal of Pain)


(122) Differentiating mild versus clinically meaningful chronic pain among recent service veterans
The Institute of Medicine reported that over 100 million Americans suffer from pain. Some have criticized this estimate as failing to distinguish clinically meaningful chronic pain from pain that is mild in severity with minimal functional interference. The present investigation utilized a cohort of returning service veterans and applied stringent chronicity and severity definitions to identify demographic and clinical variables differentiating those with mild versus clinically meaningful chronic pain. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(123) Differing responses to functional tests among LBP and KOA populations
This study aimed to use true, quantitative functional testing to assess elements of daily living in both models, and correlate this with pain before and after these functional tests. 48 subjects with KOA and 50 subjects with CLBP completed a six minute treadmill walk, timed stair climb, finger-to-floor forward bend, and a one minute sit-to-stand test. (Source: The Journal of Pain)


(131) Transitions among chronic pain and fibromyalgia patients: results from a two-year observational fibromyalgia study in the United States
This study followed a cohort of 226 subjects recruited online to assess transitions into and out of FM over 2 years. At enrollment (Year 1) subjects completed a brief online questionnaire to screen for CWP (bilateral pain, above/below waist lasting ≥1 week) based on the 4 pain questions of the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFESSQ), site visit for physician evaluation of FM, and another online questionnaire with several validated patient-reported outcome instruments. (Source: The Journal of Pain)


(133) Adrenocorticotropin hormone as a biomarker of uncontrolled severe, chronic pain
Adrenocorticotropin (ACTH) is the major pituitary stress hormone that stimulates adrenal hormones to be secreted into the serum in an effort to eliminate or heal injured tissue that may cause pain. When pain occurs, signals are transmitted to the thalamus which stimulates the corticotropin releasing hormone in the hypothalamus to cause the pituitary to hyper-secrete ACTH into the serum. Given this physiologic mechanism, ACTH should be elevated in uncontrolled pain, and, if pain is uncontrolled for an extensive time period, pituitary reserve and production of ACTH may not be able to meet the stress demand of pain, and it, therefore, will drop in the serum. (Source: The Journal of Pain)


(132) Use of a depression biomarker panel to diagnose depression in chronic pain patients
In this study we determined MDDScores and investigated the depression related alterations in biomarker expression in a series of CIP patients. The CIP group consisted of 35 patients with documented centralized intractable pain. (Source: The Journal of Pain)


(134) Pituitary-adrenal failure in severe, chronic pain patients
Hormone testing is a new entry into pain management. Recent technological and logistical advances now make it possible to obtain immediate access to hormone profile testing so that complete hormone information is available to outpatient pain care. As a result, profound hormone abnormalities are now being identified in pain patients. Reported here are 61 chronic pain patients who were referred for evaluation and treatment after failing standard pain therapies. All described their pain as constant, uncontrolled, and with flares that were “excruciating and unbearable.” Patients were weak, fatigued, and bed or house-bound. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(135) Cytochrome P450 defects in pain treatment failures
A long-time question in pain treatment is why patients with similar, painful injuries or conditions may require great differences in dosages of opioids and other drugs. Cytochrome P450 enzymes are principally found in the liver and intestine and they metabolize almost 75% of pharmaceuticals used in pain treatment. Cytochrome P450 (CYP450) enzyme testing capability is now widely accessible to pain practitioners. Reported here is a series of 101 severe, chronic pain patients who had failed standard pain treatments including a minimal daily dosage of 100 mg equivalence of morphine. (Source: The Journal of Pain)


(137) Association of multiple cytochrome P450 defects and opioid malabsorption
Cytochrome P450 (CYP450) enzyme testing has recently entered pain care. One of the main uses of CYP450 testing is to evaluate chronic pain patients who fail standard pain treatments. A surprising finding has been that some patients who have failed standard treatments have multiple CYP450 defects. The CYP450 enzymes that are involved in opioid metabolism are primarily found in the liver and intestine. Those in the intestine facilitate transport of opioids from the intestinal lumen into the serum. (Source: The Journal of Pain)


(138) Modelling oral fluid test results for hydrocodone: assisting with assessment of dose compliance
Oral fluid testing to assist in the assessment of dose compliance for chronic pain patients is growing (1,2). This work reports a retrospective approach to determine the important parameters for assisting a clinician with assessing whether a patient is compliant or not with his or her prescribed dose of hydrocodone via oral fluid testing results. Data from patients who were both prescribed hydrocodone and tested positive (reporting cutoff < X < ULOL) by LC/MSMS were used to determine a “normal” representation of expected results. (Source: The Journal of Pain)


(140) Chronic pain and the risk of death: findings from the 1999-2004 NHANES Mortality Follow-up Study
Chronic widespread pain (CWP) is associated with decreased physical activity and limitations in physical function, well-established risk factors for mortality. We sought to (1) determine whether chronic pain is associated with mortality in the general population of the United States and (2) assess the role that physical function plays in the chronic pain-mortality relationship. Data from the 1999-2004 National Health and Nutrition Examination Survey were analyzed. A total of 15,311 adults ages >=20 years were interviewed and followed over 7.7 years (total number of deaths=1,318). (Source: The Journal of Pain)


(142) Correlates of pain among high-risk patients on methadone maintenance treatment
The complex epidemiology of concurrent pain and drug dependency among many patients treated with methadone remains poorly understood. Recent guidelines published by the American Pain Society have called for increased research on the use and safety of methadone among chronic pain patients. To help inform pain management strategies among high-risk methadone-maintained patients, this study explored the prevalence and correlates of pain among a prospective cohort of people who have used illicit drugs in Vancouver, Canada, who reported active enrollment in methadone maintenance treatment (MMT) between 2011 and 2013. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(144) Chronic pain and prescription opioid use in rural bariatric surgery patients
An estimated 100 million Americans experience chronic pain. Obesity is a risk factor for chronic pain and is also a major contributor to morbidity. Previous research has shown that for every point increase in BMI, there is an associated increase in the number of pain origins reported by patients. These pain origins are not limited to lower limb pain, but all types of pain measured. Bariatric surgery and the weight loss associated with the surgery have been associated with reductions in pain severity and disability, particularly knee and back pain. (Source: The Journal of Pain)


(146) Pain comorbidity and the transition from episodic to chronic migraine: results from the CaMEO (Chronic Migraine Epidemiology & Outcomes) study
Several pain disorders are comorbid with migraine, especially chronic migraine (CM). Herein, we examine the influence of extra-cephalic pain on the progression of episodic migraine (EM) to CM and on the persistence of CM over a 3-month period. Participants were recruited from a US web-panel using quota sampling, and completed web-based questionnaires at baseline and 3 months. Respondents who met ICHD-3 beta criteria for migraine were classified into EM ( (Source: The Journal of Pain)


(150) Prevalance of chronic pain and associated risk factors: intake data from a rehabilitation center in Kuwait
This study looks at intake data from 2,101 patients treated at a private rehabilitation center in Kuwait. Most of the subjects were female (55.4%) and ranged in age between 18 and 88 (average age 41). Sixty nine percent were Kuwaiti citizens and 57.9% were employed. (Source: The Journal of Pain)


(153) Chronic pain management in the acute care setting
Chronic pain is a major problem and its management can be difficult under the best of circumstances. When an individual has suffered with chronic pain for a period of time, sometimes years, they utilize many methods for relieving their discomfort, or at least holding it at bay, through both pharmacological and non-pharmacological therapies. When these individuals enter the acute care setting, whether planned or unplanned, their normal chronic pain management regimen may become disrupted and difficult to continue, potentially leading to the exacerbation of their chronic pain symptoms or an inability to adequately meet their current pain relief needs. (Source: The Journal of Pain)


(155) Can thoracotomy patients be “immune” to developing chronic pain? Examination of the role of immune and inflammatory markers in the post-surgical trajectory
Recent evidence reveals that approximately 60% of patients who undergo thoracotomy for lung cancer report chronic pain lasting up to 5 years. However, little evidence exists regarding what factors may protect or place one at-risk for developing chronic post-thoracotomy pain. As part of a larger prospective, longitudinal project, this study identified patterns of immune changes and inflammatory markers and examined associations with temporal patterns of and risk for transition to post-thoracotomy chronic pain. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(158) Sex moderates the relationship between positive affect and pain severity among knee osteoarthritis patients
Research suggests that women show increased risk for chronic pain disorders, and greater sensitivity to pain, relative to men. Psychological factors, such as positive affect (PA) and negative affect (NA) also show marked effects on pain, with NA largely associated with enhanced pain, and PA having pain-reducing effects. Evidence suggests that affect may modulate pain severity differentially between sexes. However, few studies have directly tested for sex-specific relationships between affect and pain in clinical samples of patients with chronic pain. (Source: The Journal of Pain)


(160) Extracting unstructured data from electronic health records (EHR) to enhance opioid risk assessment in patients with chronic non-cancer pain
Clinical guidelines for the use of opioids in chronic non-cancer pain recommend assessing risk for aberrant drug-related behaviors (ADRBs) prior to initiating opioid therapy. Despite recent drastic increases in prescription opioid misuse and abuse, the use of screening tools in assessing risk of ADRB by clinicians continues to be underutilized. We hypothesized that Natural Language Processing (NLP) techniques may support clinicians in risk assessment of patients considered for opioid therapy. Using a retrospective cohort of 3,672 chronic non-cancer pain patients with at least one Opioid Agreement (OA) between 1/1/2007 and 12/31/2012, we examined the availability of EHR structured and unstructured data to populate three ADRB risk tools, which varied in length, complexity and assessed patien...


(163) Sub-clinical range of pain catastrophizing moderates the effect of pain intensity on opioid prescription
Pain catastrophizing (PC) can predict pain severity, duration, and opioid craving, but its associations with opioid prescription are inconsistent. We aimed to elucidate the association between PC, opioid prescription, and average VAS pain in chronic pain patients. PC data were obtained from the Pain Catastrophizing Scale (PCS) along with VAS from within the Collaborative Health Outcomes Information Registry (CHOIR) for 636 patients. Opioid prescription data were obtained via retrospective chart review. (Source: The Journal of Pain)


(167) Contributions of physical function and satisfaction with social roles in chronic pain: a Stanford-NIH CHOIR study
Chronic pain contributes to a variety of emotional difficulties, including increased rates of depression and greater feelings and expression of anger. Individuals with chronic pain who exhibit more severe depression or anger tend to show difficulties with functioning in many domains, including poorer interpersonal functioning and greater physical disability. The current study sought to characterize the process by which pain influences both anger and depression through decreased physical and social functioning. (Source: The Journal of Pain)


(169) Development of the Sensory Hypersensitivity Scale (SHS): a self-report tool for assessing sensitivity to sensory stimuli
Sensory hypersensitivity is one manifestation of the central sensitization that may underlie conditions such as fibromyalgia and chronic fatigue syndrome. We conducted four studies designed to develop and validate the Sensory Hypersensitive Scale (SHS); a 25-item self-report measure of sensory hypersensitivity. The SHS assesses both general sensitivity and modality specific sensitivity (e.g. touch, taste, and hearing). 1202 participants (157 individuals with chronic pain) completed the SHS and demonstrated an overall internal reliability (Cronbach’s alpha) of 0.81, suggesting the tool can be used as a cross-modality assessment of sensitivity. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(170) Physical and psychological correlates of fatigue and physical function: a Stanford-NIH CHOIR study
Fatigue is a multidimensional construct that has significant implications for physical function in chronic non-cancer pain populations but remains relatively understudied. The current study characterized the independent contributions of self-reported ratings of pain intensity, sleep disturbance, depression, and fatigue to ratings of physical function and pain-related interference in a diverse sample of treatment-seeking individuals with chronic pain. These relationships were examined as a path modeling analysis of self-report scores obtained from 2,487 individuals with chronic pain from a tertiary care outpatient pain clinic, administered through Stanford University’s Collaborative Health Outcomes Information Registry (CHOIR). (Source: The Journal of Pain)


(171) Cognitive-motivational influences on health behavior change in chronic pain
Behavioral therapy for pain offers an effective adjunct to biomedical interventions. However, treatment non-adherence and dropout is common. Assessment of the influences on health behavior change in chronic pain may help identify those at risk for treatment dropout and can themselves serve as targets of intervention to increase motivation for behavioral engagement. Eighty-six adults with chronic musculoskeletal pain were given a newly created self-report measure [The Behavioral Engagement Test for Chronic Pain (BET-CP)] to assess the cognitive-motivational influences on health behavior change in chronic pain. (Source: The Journal of Pain)


(173) Executive function and suicidal risk in complex regional pain syndrome: preliminary study
Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by extremely severe pain, swelling, and changes in the skin, and causes psychological sequelae such as depression, anxiety, and deteriorated quality of life. CRPS patients’ risk for suicide has been reported to be considerably higher than that not only of general populations but also of other chronic pain populations. Considering that conceiving, planning, and committing suicide is closely related to the decline of executive function that regulates cognitive flexibility, planning and organizing, and response inhibition ability, this preliminary study aimed to examine the relationship between CRPS patients’ executive function and their risk for suicide. (Source: The Journal of Pain)


(172) Perceived injustice as a risk factor in Chronic Disabling Occupational Musculoskeletal Disorder (CDOMD) population: its association with psychosocial distress and sedatives use
Perceived injustice refers to perception of undeserved loss or suffering as a consequence of injury or negligence. Previous studies have found that perceived injustice plays a role in the trajectory of recovery following musculoskeletal injury. High levels of perceived injustice are associated with persistent pain, greater disability, severe depression, and being less likely to return to work after injury. Perceived injustice has not been studied in Chronic Disabling Occupational Musculoskeletal Disorder (CDOMD), a subgroup of chronic musculoskeletal disorder in which occupational injury is the leading cause. (Source: The Journal of Pain)


(174) Risky business: an actuarial approach to predicting opioid misuse in a chronic-pain population
In the medical management of chronic pain, long-term opioid treatment has been a controversial topic. Much of the concern regarding this approach has been due to the risk of misuse by the patient, addiction, and even death. There have been calls in the literature for assessing risk of opioid misuse before treating a patient with opioids (Robinson et al., Clinical Journal of Pain, 2001), a task that is often assigned to a health psychologist. In recent years, strides have been made in developing measures that assist a psychologist in identifying individuals at risk for opioid misuse (Butler et al., Pain, 2004; Adams et al., Journal of Pain and Symptom Management, 2004; Moore et al., Pain Medicine, 2009); these measures have not, however, led to a “gold standard.” The current article exp...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(175) Examination of pain drawing utility, responsiveness, and one-year outcomes prediction in a chronic disabling occupational spinal disorder (CDOSD) population
Pain drawings are a common tool for pain assessment. They are brief to administer and score, are non-verbal, and provide a graphic representation of multidimensional pain experience. Previous studies show that pain drawings are associated with patient-reported disability, pain severity, physical symptoms, return to work, and personality factors when rated for non-organic pain (pain for which no biological cause is delineated); however, no studies have been done in a chronic disabling occupational spinal disorder (CDOSD) population. (Source: The Journal of Pain)


(176) Opioid craving among chronic pain patients prescribed long-term opioid therapy: a within-person analysis
Recent research indicates that opioid craving is one of the strongest determinants of prescription opioid misuse among patients with chronic pain prescribed long-term opioid therapy. To date, however, little is known on how craving unfolds in everyday life, and on the factors that are associated with opioid craving among patients with pain. In this longitudinal diary study, patients with chronic pain prescribed long-term opioid therapy were asked to provide, once a day for a period of 14 days, self-reports of pain intensity and opioid craving. (Source: The Journal of Pain)


(177) Pain interference mediates the relationship between pain and happiness
Research has extensively explored the relationship between chronic pain and depression; however, less is known about the relationship between chronic pain and happiness. Our first objective was to explore differences in self-reported happiness in individuals with chronic pain versus individuals without. Our second objective was to understand the relationship between pain and happiness, taking into account various factors. We recruited and enrolled 5 groups of participants: healthy volunteers, individuals recovered from low back pain, two groups of patients with current low back pain (one group on opioids and one group opioid-naïve), and individuals in a methadone maintenance treatment program. (Source: The Journal of Pain)


(178) MMPI-2 validity scale code-types in chronic headache and orofacial pain
The MMPI-2 has been widely used to classify chronic pain patients into clinically meaningful code-types based on cluster analysis of its clinical scales. These code-types have often been used to assess a patient’s psychological status, to design treatment interventions and to predict treatment outcome. A major strength of the MMPI-2 is its validity scales designed to measure test-taking approaches that may impact MMPI-2 test validity. The primary validity scales are: L (Lie Scale), F (False Item Scale) and K (Defensiveness Scale). (Source: The Journal of Pain)


(180) Quantitative sensory testing: a population based study of adolescents with and without chronic pain
Quantitative sensory testing (QST) has emerged as a modality for examining responses to somatosensory stimuli. However, little data is available in pediatric populations to understand whether youth demonstrate a differential response to QST when they have chronic pain. Data on QST may extend our understanding of the pathophysiology underlying the persistence of pediatric pain. Using a population-based sample, this study compared QST values in adolescents with and without chronic pain. We hypothesized that adolescents with chronic pain would have altered QST compared to adolescents without chronic pain. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(182) Central inhibition and excitability measures are independent of each other
Central pain modulation consists of a balance between central inhibition and central excitability. Central inhibition is commonly assessed using conditioned pain modulation (CPM) while central excitability is commonly assessed using temporal summation of pain (TS). Clinically, people with chronic pain have exhibited higher clinical pain ratings with either reduced CPM or higher TS. However it is unclear if CPM and TS are related or independent measures. Pain-free adults (n=93, 44F, 49M; 18-49 yr) were assessed for pressure TS by applying pressure to the dorsal forearm (custom apparatus, 1 cm2 tip, individualized pressure) for 30 sec at 0.5 Hz. (Source: The Journal of Pain)


(183) Ethnic differences in pain facilitation across the adult lifespan
The risk of developing chronic pain conditions generally increases with age, and this appears to be particularly relevant for older African Americans (AAs). One explanation for increased pain in older populations of AAs has been that minority aging is associated with greater sensitivity to painful stimuli. However, reviews have reported an increase, a decrease, or stability of pain thresholds associated with aging, as well as a lack of consistent pain threshold differences between AAs and non-Hispanic Whites (NHWs). (Source: The Journal of Pain)


(185) Reducing the respondent burden of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): an approach using curtailment and stochastic curtailment
The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), an empirically derived self-report questionnaire, is widely used in clinical practice to screen patients with chronic pain for potential aberrant medication-related behaviors. Some patients might be reluctant to take the SOAPP-R due to its length of 24 items; therefore, shorter versions are needed. Two methods to reduce respondent burden, curtailment and stochastic curtailment, have been shown to lower average test lengths in computer-based administration of other instruments. (Source: The Journal of Pain)


(187) Use of a risk-stratification tool in identification of potential adrenal suppression preceding steroid injection therapy in chronic pain patients
Patients who present for steroid injections are not adequately screened for potential hypothalamic-pituitary-adrenal (HPA) axis suppression from previous steroid exposure. Chronic pain patients often have multiple providers leading to the risk of redundant or contradictory treatments. Patients often receive oral or inhaled steroids, or joint/peri-spinal injections that are not reported by the patient or recorded in the available medical records. Yet, HPA suppression has been reported with a single intra-articular injection. (Source: The Journal of Pain)


(195) Bertolotti’s syndrome: a lesser known cause of chronic low back pain
We report a 43-year-old male, diagnosed with rectal adenocarcinoma complicated by metastasis to the lungs, liver, and bone. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(196) Implications for assessments with the treatment as usual condition within comparative effectiveness research with an underserved population
Addressing health disparities has become a major focus in research, policy, and practice especially for a patient population burdened with additional psychosocial factors that may negatively impact health outcomes. As with pain management, communities with limited resources may not be equipped to fulfill the pain management needs of their patients. In an ongoing randomized-comparative effectiveness trial of behavioral health interventions for chronic pain, participants in the treatment as usual (TAU) comparison groups are assessed alongside participants who have been randomized to either a cognitive-behavioral coping skills or pain education group. (Source: The Journal of Pain)


(197) The experiences of people living with chronic pain while receiving opioids to manage their pain in the primary care setting
The purpose of this qualitative study is to examine the narratives of people who experience chronic pain and receive opioids for the treatment of chronic pain through a primary care clinic. The purposefully selected sample was composed of 12 patients who experienced pain for more than 6 months, were receiving opioids for the treatment of pain in a primary care clinic in the Midwest metropolitan area, and were willing to tell the story of their experiences. Participants were asked to describe their healthcare experiences living with chronic pain and receiving opioids for their pain. (Source: The Journal of Pain)


(202) Explaining group differences in clinical pain among knee osteoarthritis patients: a moderated mediation model involving pain catastrophizing and sleep disturbance
Pain catastrophizing and sleep disturbance are important factors prevalent in the chronic pain experience, and may help better understand the underlying processes through which these factors exert effects, due to their strong associations with pain. In the present study we examine pain catastrophizing as a mediator in the relationship between group status and clinical pain in older individuals diagnosed with chronic knee osteoarthritis (K-OA). We used a bootstrapped conditional process model to test whether this specific mediation, including both the direct and indirect effects, is also moderated by sleep disturbance. (Source: The Journal of Pain)


(203) The role of diet in the etiology and severity of rheumatoid arthritis: a prospective analysis of the NHANES I Epidemiological Follow-up Study (NHEFS) cohort
Rheumatoid arthritis (RA) is a chronic, disabling disease that affects approximately 1.3 million US adults. Due to their anti-inflammatory properties, fruit and vegetable (F&V) consumption could mitigate the risk of developing RA. Evidence from European studies supports this hypothesis; however, it has not been tested in a representative US sample. The current prospective cohort study included data from 6,707 participants in the NHANES I Epidemiological Follow-up Study (NHEFS) to examine dietary risk factors for RA. (Source: The Journal of Pain)


(211) Modulation of experimental and clinical pain by distraction in fibromyalgia patients and controls
In this study, 53 patients with FM and 17 control subjects without FM underwent quantitative sensory testing (QST), including an exposure to a sustained, moderately-painful mechanical stimulus under conditions of distraction (subjects trained to use visual imagery) and pain-focused attention. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(212) Sleep disturbance in chronic low back pain: an age- and gender-matched case-control study
Sleep disturbance is often reported by individuals with chronic low back pain (cLBP). However, studies have only begun to comprehensively investigate sleep quality in this population. This ongoing study seeks to examine both subjective and objective measures of sleep among cLBP participants, and compare them to age- and gender-matched controls. Thus far, a total of 30 participants (15 cLBP, 15 matched controls) aged 45-88 years have completed the Insomnia Severity Index, the Center for Epidemiological Studies – Depression Scale, and seven consecutive nights of actigraphic measurement in the home environment. (Source: The Journal of Pain)


(215) Pre-pregnancy and first trimester menstrual and pain characteristics of pregnant women
Chronic vulvar pain is common among reproductive-aged women and potentially associated with hormonal triggers yet little is known about fertility and pregnancy in these women, thus limiting clinical guidance on pregnancy. A national sample of pregnant women was followed prospectively to establish a cohort of 169 (93 with no history of chronic vulvar pain, 76 with vulvodynia). Surveys inquiring about reproductive characteristics and pain were completed each trimester of pregnancy. In the 3 months prior to pregnancy we found that menstrual characteristics (regularity, length, flow) did not differ between those with or without vulvodynia. (Source: The Journal of Pain)


(217) Daily peer victimization experiences of adolescents with and without chronic pain: preliminary results of a prospective diary study
This study utilizes a novel prospective diary methodology to assess peer victimization among youth with chronic pain. We compared daily peer victimization experiences over 7 days of youth with chronic pain to a healthy comparison group, and examined associations among peer victimization and daily pain intensity, activity limitations, mood, and sleep quality. (Source: The Journal of Pain)


(218) The lived experience of pain in adolescents diagnosed with cystic fibrosis
Cystic Fibrosis (CF) is the most common life-shortening inherited disease in Caucasians. It is characterized by a genetic defect leading to excessively viscous mucus. Individuals with CF develop chronic sinus and chest infections as well as problems with malnutrition. Pain (headache, chest, back, GI, musculoskeletal) in CF, has been well documented. Quantitative studies of pain self-reports in adolescents with CF show that pain negatively impacts quality of life, but little is known about the lived experience of pain in adolescents with CF. (Source: The Journal of Pain)


(220) Central pain processing measures are associated with movement-evoked pain report among older adults with chronic axial low back pain
Research has elucidated age-related neuroplastic changes in pain sensitivity and central pain processing. However, the association of such changes to musculoskeletal pain conditions is less understood, as research has been predominantly performed in asymptomatic individuals. We employed a comprehensive experimental pain battery to compare correlates of pain sensitivity and central pain processing among younger (18-39 years; n=20), middle-aged (40-56 years; n=20) and older (57-76 years; n=20) adults with chronic axial low back pain (CLBP). (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(223) Identifying central sensitization in adults with sickle cell disease: differences in clinical features and psychobehavioral factors
Central sensitization (CS) has been identified as a leading culprit responsible for maintaining pain in several chronic pain conditions. It may explain differences in the symptom experience of individuals with Sickle Cell Disease (SCD). Quantitative sensory testing (QST) can be used to examine CS and identify individuals that may have a heightened CS profile. The present study identified and categorized SCD patients based on QST into a high or low CS phenotype and examined clinical pain, vaso-occlusive crises, psychosocial factors, and sleep continuity (i.e. (Source: The Journal of Pain)


(225) Differences in Mexican Americans’ prevalence of chronic pain and co-occurring analgesic medication and substance use relative to Non-Hispanic White and Black Americans: Results from NHANES 1999-2004
Little is known about the pain experience of the burgeoning Mexican American (MA) population. Using data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES), prevalence of chronic pain (>3 months), analgesic medication use, and substance use were examined among MA, Non-Hispanic White (NHW), and Non-Hispanic Black (NHB) respondents. Logistic and linear regression models adjusted for age, sex, and sampling design examined racial/ethnic differences in: 1) chronic pain prevalence among all respondents (n=14,036), 2) location and number of pain sites among respondents with chronic pain (n=2,005), and 3) analgesic medication and substance use among respondents with chronic pain. (Source: The Journal of Pain)


(226) How do women deal with dysmenorrhea?
Approximately 25-90% of women of reproductive age experience dysmenorrhea characterized by pelvic pain occurring before or during menstruation. As the leading cause of absence from school and work among women, dysmenorrhea poses a great socioeconomic burden on society. Dysmenorrhea commonly co-occurs with other chronic pain conditions (e.g., irritable bowel syndrome, fibromyalgia). Not only can it exacerbate existing pain conditions, it can even increase a woman’s risk of developing other pain conditions later in life. (Source: The Journal of Pain)


(227) Evaluating musculoskeletal pain pathogenesis in the aftermath of motor vehicle collision in a multi-dimensional context
In this study we evaluated how trajectories of pain symptoms, depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and somatic symptoms (often termed “post-concussive” (PC)) cluster over time after motor vehicle collision (MVC) in a large cohort of adult European Americans who presented to the ED within 24 hours of MVC. (Source: The Journal of Pain)


(231) Temporal role of yeast infections prior to the onset of vulvodynia and after pain development
Vulvovaginal yeast infection has been hypothesized to trigger unexplained chronic vulvar pain (vulvodynia). Yet most studies have failed to describe its temporal role as occurring before or after vulvodynia onset, which if different, may delineate the biological mechanism(s). Using a population-based clinically-confirmed case-control study, we estimated risks of having a history of yeast infection (categorized as: none, 1-4, 5-10, 11-20, 21+) before and after vulvodynia onset for 170 cases who reported age of vulvar pain onset (reference age) and 171 vulvar pain-free controls whose reference age was set to that of a case. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(233) Temporal summation testing provides evidence for increased pain sensitivity and central sensitization in sickle cell anemia
In this study, 30 SCA adults and 30 age and sex matched normal volunteers (NVs) underwent thermal windup and mechanical pinprick summation testing. Pain was reported on a 0-20 scale. For random thermal windup (slow temporal summation), SCA adults reported higher pain scores than NVs at the lowest testing temperature (mean 1.3±1.9 vs. (Source: The Journal of Pain)


(234) Chronic opioid therapy is more strongly associated with central sensitization in sickle cell disease than clinical pain
Central nervous system sensitization (CS) is common to a number of chronic pain conditions. Adult patients with sickle cell disease (SCD) often have chronic pain. Both animal and human evidence suggests that central sensitization is a factor in its development or maintenance. Patients with SCD are often treated with opioids, which can produce paradoxical pain facilitation through central mechanisms. This analysis examined the relationship of chronic opioid therapy (COT, those prescribed daily long-acting opioids) to central sensitization with SCD. (Source: The Journal of Pain)


(235) Regional cerebral blood flow abnormalities in patients with chronic fatigue after a fatiguing task using arterial spin labeling
Chronic fatigue syndrome (CFS) has been associated with activation of nociceptors, the HPA-axis, and pain pathways. Unfortunately, little is known about the underlying neural mechanisms of CFS. Compared to other imaging modalities, arterial spin labeling (ASL) can quantify changes in regional cerebral blood flow (rCBF) over time. For this study, we acquired ASL data from 32 women, 16 with CFS, and 16 age-matched healthy controls (HC), to investigate the relationship between fatigue and temporal changes in rCBF. (Source: The Journal of Pain)


(236) Resting regional cerebral blood flow abnormalities of fronto-parietal brain areas in patients with chronic fatigue using arterial spin labeling
Chronic fatigue syndrome (CFS) has been associated with activation of metaboreceptors, the HPA-axis, and pain pathways. Little is known about the underlying neural mechanisms of CFS but hypoperfusion of fatigue related brain areas has been suggested. Compared to other imaging modalities, arterial spin labeling (ASL) can quantify changes in regional cerebral blood flow (rCBF). The purpose of this study was to measure cerebral blood flow in CFS patients at rest and compare them to and healthy controls (HC). (Source: The Journal of Pain)


(237) The integration of healthcare provider and patient education with a standardized chronic pain assessment
Pain is among the most common reasons that patients seek medical attention in the United States, and significant educational and procedural gaps continue to exist with respect to pain assessment, treatment planning, management, and follow-up. Healthcare provider education about chronic pain and its treatment is often lacking, with the burden of patient education being the responsibility of healthcare providers, and it can be difficult to have pertinent educational materials readily available for patient distribution that is valuable based on the specific medical circumstances. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(238) Estimates of national healthcare expenditures associated with pediatric chronic pain
Pediatric chronic pain, with estimated prevalence rates of 15-25%, is increasingly being recognized as a major cause of morbidity in children, and data are emerging on the associated economic costs to families. However associated national healthcare expenditures are unknown. The primary objective of this study was to assess the impact of pediatric chronic pain on national healthcare expenditures in comparison to healthcare expenditures for other common childhood conditions including asthma, attention deficit hyperactivity disorder (ADHD), and obesity. (Source: The Journal of Pain)


(240) Poor, scared, and hurting: the experiences of Black elders managing chronic pain
Pain is a challenging stressor that can affect every facet of a person’s life and significantly diminish their quality of life. Those at greatest risk for diminished quality of life secondary to pain are older adults. Older adults have an increased likelihood to have chronic end-stage diseases that cause moderate to severe pain. Unfortunately, the management of pain amongst the older adult population has been consistently poor. Of particular concern within the older adult and chronically ill populations are Black Americans. (Source: The Journal of Pain)


(242) Prescriber attitudes regarding treating patients with extended release/long acting opioids
Provider attitudes and beliefs may influence how they perceive and treat people with chronic pain. As part of the PainEDU REMS (Risk Evaluation and Mitigation Strategy) Education Program for extended-release and long-acting (ER/LA) opioid analgesics, we evaluated factors that contributed to provider’s decision- making when it came to decisions about managing pain with ER/LA opioids. Healthcare providers (N=825 to date) were asked a series multiple choice questions while completing the course that evaluated: 1) common challenges associated with treating chronic pain patients, 2) challenges with treating patients with chronic opioids, 3) factors that influence the prescribing chronic opioid therapy, 4) view of family involvement when caring for patients with chronic pain, 5) concerns about...


(245) Establishment of a controlled substance advisory review consult process for patients on chronic opioid therapy
In a system where primary care providers prescribe the majority of opioids for chronic pain, there can be significant benefit in terms of continuity of care. However, there are also outsized challenges posed by the subset of patients who struggle with aberrant behaviors. To help providers address these challenges, the William S. Middleton Memorial Veterans Hospital established an Opioid Pain Care Agreement in May 2012 for all patients who are starting chronic opioid therapy. This was superseded in May 2014 by the nationally mandated VA Consent for Long Term Opioid Therapy for Pain. (Source: The Journal of Pain)


(246) Racial and ethnic disparities in pain care at a statewide federally qualified health center
To date most research on racial/ethnic disparities in chronic nonmalignant pain management has evaluated care in settings such as emergency departments, academic primary care, and post-operative settings. However, community health centers, organizations with a specific mission to provide culturally appropriate care and reduce disparities, have not been examined in this context. We hypothesized that there will be less evidence for pain care disparities in such settings. We retrospectively examined the extent to which racial/ethnic disparities occur in pain care at a statewide, Federally Qualified Health Center in Connecticut for the years 2011-2014. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(247) Attitudes and beliefs about pain management among providers treating an economically-disadvantaged primary care population
Chronic pain is common in economically-disadvantaged, community-dwelling populations. Although most pain care is provided by primary care practitioners, little is known about their attitudes and beliefs towards pain management. We evaluated baseline data from 55 physicians, 4 nurse practitioners and 1 physician assistant participating in a study of a decision support tool for pain management in six Federally Qualified Health Centers in New York State. The sample had a mean (SD) age of 39.3 (11.0) years, 62.0% were women, and had a mean (SD) of 8.8 (9.7) years in practice. (Source: The Journal of Pain)


(248) Technology use in low income chronic pain patients
Many future advances in chronic pain management are reliant on innovations in technology. These innovations are often proposed as ways to reduce the gap in access to behavioral pain management services. As part of an ongoing comparative efficacy trial of chronic pain management groups, participants were asked questions about their ownership and use of electronics that are often used in providing behavioral healthcare. The participants are primarily low income and many live in rural locations in Alabama, thus primary targets for innovative delivery of behavioral health services. (Source: The Journal of Pain)


(251) Opioids and microglia: a murine-derived microglia stable cell line study
The development of opioid hyperalgesia following long-term opioid use is a critical impediment in treating chronic pain. Activated microglia has been identified as a critical mediator in the development of opioid hyperalgesia. The mechanism by which opioids activate microglia remains unknown. To explore this question, we used a stable cell line of mouse-derived microglial cells, which allowed us to isolate the direct effect of opioids on microglia in the absence of neurons. The BV-2 microglial cell line, derived from mouse microglial cells, was cultured in vitro. (Source: The Journal of Pain)


(252) Broad and highly organized changes in DNA methylation in prefrontal cortex and T cells in a model of chronic neuropathic pain in rats
In this study, neuropathic pain (or sham surgery controls) was induced in rats using the spared nerve injury (SNI). (Source: The Journal of Pain)


(254) Gene expression factor analysis differentiates pathways linked to pain, fatigue, and depression in a diverse patient sample
Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FMS) are complex and often debilitating disorders with a range of co-morbidities. Previous research using quantitative mRNA leukocyte gene expression has demonstrated CFS and FMS showed markedly different expression in a large number of individual genes in response to a moderate exercise task compared to healthy people, but differences at resting baseline were few. The major goal of this exploratory study was to examine if we could group baseline expression of genes into meaningful biological factors and if these factors were associated pain and/or depression, which is a common mood co-morbidity in CFS and FMS. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(255) Induction of a M2 phenotype in human macrophages via CD163 gene induction using nanotechnology
Major surgeries are associated with a higher risk of developing chronic postoperative pain (CPS). We hypothesize that a more efficient wound healing process will reduce the risk of developing CPS following major surgeries. Alternatively activated macrophages (M2) are essential in the promotion of wound healing and the resolution of inflammation via CD163. We propose to use nanotechnology for CD163 gene induction in human macrophages. We used THP-1 human macrophages stimulated with lipopolysaccharide (LPS, 1 μg/ml) or interleukin (IL)-6 (50 ng/ml). (Source: The Journal of Pain)


(257) microRNA 320a is a potential mediator of chronic widespread hyperalgesia development after stress exposure
In a well-explicated animal model, widespread hyperalgesia (WH) induced by unpredictable sound stress (USS) has been shown to be mediated by increased glucocorticoid and catecholamine levels acting at the level of the peripheral nerve.1 A recent study found that circulating levels of miRNA 320a are associated with fibromyalgia,2 and in silico analyses suggest that miR-320a targets multiple transcripts associated with glucocorticoid synthesis/regulation. Based on these data, we evaluated whether (1) circulating miR-320a levels predict chronic widespread pain (CWP) and fibromyalgia development after motor vehicle collision (MVC) stress exposure in humans, (2) miR-320a is expressed in tissues relevant to identified mechanisms mediating WH induced by induced by USS (3) miR-320a regulates gluco...


(259) Exercise attenuates LPS-induced musculoskeletal hyperalgesia in mice by preventing excessive macrophage activation
Exercise is an effective method for alleviating pain symptoms in people with chronic musculoskeletal pain conditions. Macrophages are plastic mononuclear phagocytes that change their phenotype in response to the immunological microenvironment of the tissue, and release cytokines based on their phenotype. M1 macrophages release proinflammatory cytokines that promote tissue damage and hyperalgesia, whereas M2 macrophages release anti-inflammatory cytokines that promote wound healing and analgesia. (Source: The Journal of Pain)


(260) Vitamin D deficiency is associated with worse overall pain outcomes over time among African Americans experiencing motor vehicle collision
More than four million Americans present to the emergency department (ED) each year for evaluation after MVC. More than 90% of these individuals are discharged to home; evidence suggests that chronic musculoskeletal pain is common in this population and that rates of chronic pain development are increased in African Americans (AAs). Biological mechanisms responsible for elevated risk in AAs remain poorly understood. Vitamin D deficiency (VDD, defined as 25[OH]D plasma levels (Source: The Journal of Pain)


(261) Reduction of cytokine levels in human macrophages over-expressing CD163
Extended levels of inflammation after major surgeries contribute to the development of chronic pain. In normal wound healing, inflammatory macrophages (M1 phenotype) transition to antiinflammatory macrophages (M2 phenotype). CD163 is highly expressed in M2 macrophages, whereby CD163 seems to play a major role in the induction of M2 macrophages. We hypothesize that the genetic overexpression of CD163 in M1 macrophages will induce an earlier and efficient M2 phenotypic shift. THP-1 macrophages were stimulated with lipopolysaccharide (LPS, 1μg/mL) or interleukin-6 (IL-6, 50ng/mL) in the presence or absence of either CD163 plasmid or an empty plasmid, both conjugated with the nanoparticle polyethylenimine grafted with a mannose receptor ligand (mPEI). (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(262) Persistent changes in pain behaviors and K channel physiology in rats chronically exposed to gulf war neurotoxicants
Following their return from deployment, Gulf War (GW) veterans reported widespread joint and muscle pain at rates that far exceeded those of soldiers returning from other conflicts. The Research Advisory Committee on Gulf War Veterans’ Illnesses (GWI) identified neuroactive insecticides, repellants and nerve agent prophylactics used during the war that might have contributed to the development of GWI. In our previous work, we identified a distinction between membrane nociceptor proteins affected by acute exposure to neurotoxicants (Nav1.8) and those affected by chronic exposure (Nav1.9, Kv7). (Source: The Journal of Pain)


(264) AMPA glutamate receptors containing the GluA4 subunit are expressed in epidermal keratinocytes and may be involved in chronic itch and painful peripheral neuropathies
Epidermal keratinocytes express numerous neurosignaling molecules that were only thought to regulate cell differentiation prior to the discovery of extensive intraepidermal innervation by c- and Aδ-fibers implicated in thermal, pain, and itch sensation. Immunocytochemical and pharmacological evidence indicates that excitatory and inhibitory mechanisms are expressed in differentially stratified epidermal patterns indicating that they may transduce or modulate tactile stimuli including those implicated in pain. (Source: The Journal of Pain)


(266) TLR2 activation induces NGF gene and protein expression via NF-κB in human intervertebral disc cells
Intervertebral disc degeneration is a leading cause of chronic low back pain (LBP), but how degeneration contributes to LBP is poorly understood. Nerve growth factor (NGF) is upregulated in disc degeneration. The presence of NGF may promote disc innervation, neuronal sensitization and low back pain, making NGF a possible therapeutic target. However, the mechanisms underlying the dysregulation of NGF during degeneration are poorly understood. During disc degeneration proteoglycans and other extra-cellular matrix (ECM) proteins are degraded and fragmented. (Source: The Journal of Pain)


(268) Female-specific effects of a serotonin 2A receptor genetic variant on TMD pain and psychological phenotypes
Temporomandibular disorders (TMD) represent a major source of chronic orofacial pain, but their etiology is not well understood. In order to identify genetic risk factors for chronic TMD, we have examined genetic polymorphisms in two large candidate gene association studies that used case-control designs. The discovery cohort, the UNC-TMD study, included 200 chronic TMD cases and 198 pain-free controls, all of which were white females. For replication we used the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study; association analyses included 166 chronic TMD cases and 1442 healthy controls, of both sexes and varied racial backgrounds. (Source: The Journal of Pain)


(271) Behavioral and physiological effects of poor diet in mice
Obesity rates in the United States are climbing rapidly, and obesity is often comorbid with chronic pain. In many instances, obesity is a result of poor diet choices. Therefore, we utilized a cafeteria diet (CAF) and a total western diet (TWD) in separate experiments to investigate the functional and physiological consequences of poor diet in mice. The CAF was used to model human-like nutrient intake from junk foods. During ten weeks on the CAF, the mice had elevated mechanical and thermal thresholds when compared to regular diet-fed controls. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


(272) Behavioral and physiological effects of a newly-developed Sub-optimal American Diet (SAD) in rats
Approximately two thirds of the United States population is considered overweight or obese. Chronic pain and inflammation have been shown to be highly comorbid with obesity. Our previous work has shown that a cafeteria diet including typical “junk foods” and a commercially available “total western diet” caused both physiological and behavioral changes in mice. These animals showed higher levels of pro-inflammatory cytokines, higher mechanical and thermal thresholds, and a prolonged recovery period after induction of chronic inflammatory pain with Complete Freund’s Adjuvant. (Source: The Journal of Pain)


(278) GLYX-13, an N-methyl-D-aspartate functional glycine site partial agonist, is efficacious in rat surgical models of neuropathic pain
GLYX-13 is an amidated tetrapeptide (Thre-Pro-Pro-Thre-NH2) that has been shown to be a robust cognitive enhancer and antidepressant. Currently GLYX-13 is entering Phase III clinical trials for major depressive disorder. GLYX-13 was evaluated in two rat surgical models of the neuropathic pain: Chung (spinal nerve ligation) and Bennett (chronic nerve constriction). Pain responses were measured using Von Frey filaments and the Dixon up-down method. At its optimal dose level (5mg/kg, IV), GLYX-13 produced a robust analgesic effect (compared to saline vehicle) in these models 1 hr, 24 hr and 1 week following a single dose without any adverse effects. (Source: The Journal of Pain)


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


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


(282) The development of mechanical allodynia after spinal cord injury is associated with higher respiratory rate
Chronic neuropathic pain and impaired autonomic signaling are major consequences of spinal cord injury (SCI). Despite the prevalence of these maladaptive conditions, the underlying mechanisms are poorly understood. C low threshold mechanoreceptors (C-LTMRs; CT afferents in human) are unmyelinated cutaneous afferents that were recently shown to normally encode pleasant touch, although under painful conditions, they can signal mechanical allodynia. In rodents, C-LTMRs innervating hairy skin can be selectively identified by their expression of tyrosine hydroxylase (TH). (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(291) Pain catastrophizing and cytomegalovirus antibody titers in adults with chronic pain
Chronic pain is physically and psychologically stressful. Individuals with chronic pain who tend to catastrophize often report more intense pain and emotional distress. It has been suggested that catastrophizing might be related to altered immunological responses to stress and pain; however, relatively little is currently understood regarding the relationships among catastrophizing, pain, and stress-related immune function. Latent herpesvirus reactivation, which is reflected by elevated herpesvirus antibody titers, provides a window into immune function/dysregulation. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(305) The pain and interoception imaging network (PAIN) repository: towards big data approaches to chronic pain
The PAIN repository (painrepository.org) is a newly created NIH (NIDA/NCCAM) funded neuroimaging data repository that aims to accelerate scientific discovery regarding brain mechanisms in pain and provide more rapid benefits to pain patients through the harmonization of efforts and data sharing. The PAIN Repository consists of two components, an Archived Repository and a Standardized Repository. Similar to other ‘open’ imaging repositories, neuroimaging researchers can deposit any dataset of chronic pain patients and healthy controls into the Archived Repository. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(316) Elucidating brain regions engaged in strategies for real-time fMRI neurofeedback pain modulation
Real-time fMRI (rtfMRI) neurofeedback for pain modulation is still in an early developing phase. Cognitive and attention strategies can be helpful for pain coping, and strategy effectiveness can be enhanced through training. For patients with chronic low back pain, our overall goal is to effectively combine rtfMRI neurofeedback with Cognitive Regulation (CR) and Attention Regulation (AR) strategies. A preliminary step is to elucidate brain regions involved with these strategies to identify targets for feedback control of neural activity. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(321) Role of microglia and P2X7 receptors in arthritis pain
Joint pain associated with arthritis is among the most common and debilitating chronic pain conditions. Although joint pathology is an underlying factor, some patients with severe joint degeneration report little to no pain, while others with minor joint pathology experience debilitating and unremitting pain. The discordance between pain severity and peripheral pathology of the arthritic joint suggests joint damage is not necessarily a direct predictor of ensuing chronic pain. Rather, new evidence suggests altered pain processing within the spinal cord as being a key determinant of joint pain. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(338) Human sensory neurons: cellular excitability, sensitization, and ion channel conductances
Biological differences in sensory processing between human and model organisms may present significant obstacles to translational approaches in treating chronic pain. Such obstacles may include functional differences in target receptor pharmacology and signaling or fundamental differences in neuronal physiology. While cultures of rodent dorsal root ganglion (rDRG) neurons have proven useful for identifying new analgesic targets and elucidating signaling pathways, notable translational failures have recently raised questions about the wisdom of developing drugs for pain relief in rodents for eventual use in humans. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(353) A direct role of the sympathetic nervous system in chronic pain? An optogenetic approach
Despite various etiologies, common features can be found between different types of chronic pain. Among them, involvement of the sympathetic system has been shown in humans as well as in animal models of chronic pain. Interestingly, we described a robust sprouting of sympathetic fibers in the skin following neuropathy or inflammation in rodent models. These ectopic sympathetic fibers wrap around the peptidergic nociceptive fibers in the upper dermis, a region in which they are normally absent, providing a morphological substrate for autonomic/sensory interactions. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(360) Pudendal nerve stimulation inhibits visceromotor responses to urinary bladder distension during concurrent treatment with acute or chronic morphine
Bilateral electrical pudendal nerve stimulation (bPNS) anecdotally reduces pain in humans with pain due to interstitial cystitis (IC) and we have reported that it reduces bladder hypersensitivity in rat models. Concomitant medication use can alter responses to neuromodulation and so prior to the development of a clinical trial, the interaction between opioid medication use and acute bPNS was examined. Bladder hypersensitivity was produced by neonatal bladder inflammation in rats pups coupled with a second inflammatory insult as an adult. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(376) The effect of LFTMS on TENS related neuronal functional changes
After peripheral nerve injury fast conducting large myelinated A-beta afferent firing diminished over time, whereas smaller pain transmitting fibers including A-delta and C-fibers firing enhanced. This aberrant afferent neuronal behavior is thought to be one of the main neuronal mechanisms leading to the development of chronic post-traumatic peripheral neuropathic pain (PTP-NP). Recently the use of non-invasive dynamic magnetic flux stimulation has been implicated in treating PTP-NP, a condition currently not being adequately addressed by other means of non-invasive but skin contact required peripheral electrical stimulation such as transcutaneous electrical stimulation (TENS). (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(395) Patient-reported outcomes of disease impact and change experienced with pregabalin treatment in patients with fibromyalgia and moderate or severe baseline pain
Fibromyalgia is generally associated with widespread chronic pain. In this analysis, we used patient-reported outcomes (Patient Global Impression of Change [PGIC], Fibromyalgia Impact Questionnaire [FIQ]) to evaluate management of fibromyalgia with pregabalin. Data were pooled from five randomized, placebo-controlled clinical trials of pregabalin (8-15 weeks at 300 mg/day, 450 mg/day, or flexible dosing [300-450 mg/day]) in patients with fibromyalgia. Patients were subgrouped by moderate (mean baseline pain scores ≥4- (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(409) Chromocell's Compounds A: a novel, orally active, selective NaV1.7 inhibitor
Compound A is a novel, orally bioavailable, peripherally restrictive, selective inhibitor of NaV1.7 that is 1000x selective for the inactivated state of the channel over the resting state. Compound A is active in numerous rat and mouse models of pain and itch including the formalin model of induced pain, acetic acid writhing model, complete Freund’s adjuvant model, chronic constriction injury model, partial sciatic nerve ligation model, streptozotocin induced diabetic neuropathy model and histamine and serotonin induced itch models. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(426) Genetics and drug response: study on the role of genetics in analgesic response variations in chronic pain patients taking hydrocodone
This study included 1219 pain subjects (males 509, females 710) across 30 Clinical research sites in the US. The analgesic effect of the hydrocodone was recorded using the Proove Medication Efficacy Differentiation (MED) Scale (A scale of 1-5 to measure efficacy of a drug). (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(433) Polypharmacy, opioid use, and chronic widespread pain: a secondary analysis of clinical trial data
Fibromyalgia (FMS), a chronic widespread pain syndrome that has no known etiology, coincides with other life-altering symptoms that include fatigue, mood disturbances, non-restorative sleep and muscle stiffness. Despite multiple medication classes typically used for the treatment of FMS, there few studies assessing the efficacy of polypharmacy on symptoms of pain in this patient population. While analgesic medications, including opioid or opioid-like medications, are commonly prescribed, the use of these medications for FMS has not been fully described, including potential incidence of analgesic overuse. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(439) Efficacy and tolerability of BEMA buprenorphine in opioid-naive patients with moderate-to-severe chronic low back pain: primary results from a phase 3, enriched-enrollment, randomized withdrawal study
BEMA®, BioErodible MucoAdhesive Buprenorphine, a buccal film form of buprenorphine, was evaluated for the management of chronic pain in a multicenter, double-blind, placebo-controlled, enriched-enrollment, randomized withdrawal study in opioid-naive patients with moderate-to-severe chronic low back pain (CLBP) requiring around-the-clock analgesia. Patients were titrated to a dose of buprenorphine buccal film (range, 150–450 ug q12h) that was generally well tolerated and provided adequate analgesia for ≥14 days. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(445) Efficacy and safety of oxycodone DETERx: results of a randomized, double-blind, placebo-controlled phase III study
Oxycodone DETERx (DETERx) is an extended-release (ER), microsphere-in-capsule, abuse-deterrent analgesic formulation designed to retain its ER properties following common tampering methods such as crushing, chewing, and preparation for intravenous (IV) injection. In a multicenter, double-blind, enriched enrollment, randomized withdrawal study, safety, tolerability, and efficacy of DETERx were compared with placebo in opioid-experienced and -naïve subjects with moderate-to-severe chronic low back pain (CLBP), requiring continuous around-the-clock (ATC) opioid analgesia. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(453) Ganglion impar block for chronic vulvar pain syndrome
Although chronic vulvar pain syndrome or vulvodynia is not rare, it has no known effective treatment. Vulvodynia may be a common pathway in or the ultimate outcome of several pathological processes; therefore, given the heterogeneous etiology of the disorder, one management strategy may not be adequate for all women with vulvar pain. Although the role of the sympathetic nervous system (SNS) in neuropathic pain is a controversial issue, selective sympathetic nerve blocks have been a standard treatment for chronic pain. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(467) Complete relief of chronic abdominal pain after rapid detoxification of oral and intravenous opiates: a case report
We present the case of a 27 year-old female that had chronic abdominal pain since 2010 from autoimmune hepatitis, primary sclerosing cholangitis and gastroparesis. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(477) Duration of analgesia induced by a 15 or 30-minute application of acupuncture-like TENS on a population of patients suffering from chronic non-specific low back pain
Electrotherapy can be used as an add-on modality for patients with chronic low back pain (CLBP), where it can temporarily alleviate painful symptoms. Acupuncture-like TENS (AL-TENS) has been shown to alleviate clinical pain, but no study has yet investigated the duration and magnitude of analgesia induced by AL-TENS on population suffering from CLPB. We initially hypothesize that a 30-minutes application would induce a greater duration and magnitude of AL-TENS analgesia than a 15-minute application. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(489) Reducing disparities with literacy-adapted psychosocial treatments for chronic pain: initial exploration of feasibiity/acceptability
Cognitive behavioral therapy (CBT) has been found to be both efficacious and effective for treating chronic pain. Nevertheless, CBT and other psychosocial treatments remain underutilized, particularly among disadvantaged populations. Recent efforts have sought to increase the accessibility of psychosocial treatments by reducing literacy and cognitive load barriers. To investigate the value of these efforts, we compared patients currently enrolled in an ongoing trial (N = 64) who participated in one of two literacy–adapted 10-week psychosocial treatments. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(495) Pain self-management in HIV-infected individuals with chronic pain: a qualitative study
Chronic pain in individuals with HIV is a common, impairing condition. Behavioral interventions for chronic pain specifically tailored to this population have yet to be developed. We assert that understanding self-management strategies already used by persons living with these conditions is an essential first step, and is the objective of this investigation. We conducted a thematic analysis of qualitative data from 25 in-depth interviews with individuals with HIV and chronic pain. The primary pain self-management strategies articulated by participants were: physical activity; cognitive and spiritual strategies; spending time with family and friends and social support; avoidance of physical/social activity; medication-centric pain management; and substance use. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(505) A case study of response to group CBT or a potent pain education group for minority patients with chronic pain
Chronic pain is a large and growing problem facing U.S. health care in the 21st century. Current practice relies on biomedical interventions (e.g., medication/surgery), which may have severe side effects and discouraging outcomes. Psychosocial interventions are low-cost and effective with few side effects. However, uncertainty about when to use an intervention or how it may look in vivo presents difficulty to clinicians when selecting a treatment approach. In response, this poster presents a case study (n = 13) of two groups drawn from a clinical trial evaluating two novel psychosocial group treatments: Cognitive-Behavioral Therapy for chronic pain (CBT) and a potency-enhanced pain education (EDU). (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(514) The relative utility of pacing and committed action for predicting adjustment to chronic pain
Pacing is defined as doing a work by diving it into pieces, or slowly or with taking breaks and controlling the pace. Pacing has not shown a consistently positive impact on adjustment to chronic pain. Recently, a psychological flexibility model of acceptance and commitment therapy was proposed as theoretical framework for supplementing such variations. Among the elements of the model, committed action indicates acting flexibly and continuing or stopping the action according to the person’s value or goal. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(520) Immediate benefits of a multidisciplinary educational program for fibromyalgia on patients’ pain related self-efficacy and health locus of control
Patients who suffer from fibromyalgia (FMS), a chronic biopsychosocial pain syndrome, and are uneducated about their condition have increased risk for poor outcomes. No studies have looked at the impact of brief intervention on self-efficacy and locus of control specific self-management constructs. We evaluated the effect of an intensive, brief, multidisciplinary educational program on these constructs in managing FMS. Patients and family actively participated in a 3.5 hour program involving discussion about clinical, pathophysiologic, and therapeutic aspects of FMS; exercise instruction, orientation on the cognitive behavioral model of pain and stress, review of psychosocial contributors to chronic pain, family education, and introduction to relaxation techniques. (Source: The Journal of ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(525) Efficacy and prediction of pain, mood, and function outcomes upon completion of an interdisciplinary chronic pain rehabilitation program.
Chronic pain renders many individuals incapacitated and increases the risk of opioid dependence throughout the lifetime course of treatment. The efficacy of an intensive non-opioid interdisciplinary chronic pain rehabilitation program (CPRP) was previously established in headache patients1 and was expanded to include a broader range of primary pain conditions in this study. Assessments of pain intensity (0-10), Depression Anxiety Stress Scale (DASS) and Perceived Stress Scale (PSS) scores (measuring mood), Pain Disability Index scores (PDI; measuring function), and coping styles, utilizing the brief COPE questionnaire were compared in 133 patients at admission versus discharge. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(534) A novel strategy to improve opioid prescribing safety in chronic pain patients: evaluation by addiction psychiatry fellow rotators
The goal of the evaluation was to assist pain providers with safe opioid prescribing. 95% of the consultations were requested by the pain fellows and NPs. Seven addiction Psychiatry fellows evaluated opioid prescribing risk in chronic pain patients at the Pain Clinic, Beth Israel Medical Center, an academic center. This one time evaluation was performed as part of their training in a once a week ½ a day session. The Chief of the Pain Division and the Director of the Addiction Psychiatry Fellowship supervised the evaluations. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


(550) Feldenkrais method-based exercise improves quality of life in individuals with Parkinson's disease: a controlled, randomized clinical trial
This study intended to assess changes in QoL and depression in older adults with Parkinson's disease through use of the Feldenkrais method-based exercise. The study was a controlled, blinded and randomized clinical trial. The study was performed at the University Hospital of the Federal University of Sergipe in Aracaju, Sergipe, Brazil. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Single-incision Laparoscopic Cholecystectomy with an Additional Needle Grasper: A Novel Technique.
CONCLUSIONS: SILCAN is a safe and feasible alternative to SILC which does not compromise the qualities of CLC. It is less technically challenging, and postoperative pain and cosmesis are comparable to those of conventional SILC. PMID: 25797875 [PubMed - in process] (Source: Journal of Nippon Medical School)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Functional gastrointestinal disorders are associated with the joint hypermobility syndrome in secondary care: a case–control study
Conclusions & InferencesJHS is significantly associated with FGID, and this subgroup of patients have increased comorbidity and decreased QOL. Further research is required to understand the pathophysiological basis of this association. The prevalence of joint hypermobility syndrome (JHS) in patients with Functional gastrointestinal disorders (FGID) has not been studied prospectively. In patients presenting to secondary care GI clinics, JHS is more common in patients with FGID in comparison to those with organic GI disorders; JHS is most‐significantly associated with functional gastroduodenal disorders, specifically postprandial distress syndrome. Patients with overlapping JHS and FGID have a phenotype characterized by increased chronic pain, somatic sensitivity, autonomic symptoms, ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Take a multidisciplinary approach when managing chronic noncancer pain in paediatric patients
Abstract Optimal management of chronic noncancer pain in paediatric patients requires a multidisciplinary approach, with medications forming an important part of therapy. There is limited clinical evidence to support the use of specific medications in children with chronic pain, with most drugs being used off-label. (Source: Drugs and Therapy Perspectives)


A Randomized Controlled Trial Comparing Transforaminal Lumbar Interbody Fusion and Uninstrumented Posterolateral Fusion in the Degenerative Lumbar Spine
Conclusions The results of the current study support the use of TLIF rather than uninstrumented PLF in the surgical treatment of the degenerative lumbar spine. The less optimal outcome after uninstrumented PLF may be explained by the much higher reoperation rate.[...]Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents  |  Abstract  |  open access Full text (Source: Global Spine Journal)


Modulation of cervical facet joint nociception and pain attenuates physical and psychological features of chronic whiplash: a prospective study
To investigate changes in clinical (physical and psychological) features of individuals with chronic whiplash associated disorder who had previously underwent cervical radiofrequency neurotomy at the time point when the effects of radiofrequency neurotomy had dissipated and pain returned. (Source: PM and R)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Obstructive Pulmonary Disease and sexual functioning among Women in Egypt
Conclusion Significant dysfunction in sexual life as attributed to symptoms of breathing difficulties and difficult sexual positions were found in a majority of the studied Egyptian female group with Chronic Obstructive Pulmonary Disease. Comparatively the healthy women group demonstrated significantly less sexual dysfunction. (Source: Egyptian Journal of Chest Diseases and Tuberculosis)


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


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


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


Pfizer, Lilly to Resume Phase 3 Chronic Pain Program
Pfizer expects to receive a $200 million upfront payment from Lilly in accordance with their collaboration agreement (Source: PharmaManufacturing.com)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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


High-Frequency SCS Raises Bar on Chronic Pain ReliefHigh-Frequency SCS Raises Bar on Chronic Pain Relief
Randomized trial results show double the pain relief and remission with an investigational high-frequency spinal cord stimulation device of those with conventional, lower-frequency SCS. Medscape Medical News (Source: Medscape Neurology and Neurosurgery Headlines)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Deep Brain Stimulation of the Subthalamic Nucleus Taking the Ouch Out of Parkinson Disease
Parkinson disease (PD) is known to affect multiple neurotransmitter systems, resulting in both motor and nonmotor symptoms. Pain is an underrecognized but important nonmotor symptom of PD that may be very disabling and is known to impair quality of life. While significant progress has been made in ameliorating motor symptoms using pharmacological, rehabilitative, and surgical treatments, the treatment of pain in this context has not received sufficient attention. A literature review noted a reported prevalence of pain in PD of 40% to 85%, yet only about half of patients with PD who felt pain took analgesics. Classifying PD-related pain into its subtypes is important for rational treatment, and the most common subtypes of pain in PD are musculoskeletal and dystonic, with central neuropathic...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


A study to evaluate the safety of platelet-derived growth factor for treatment of osteochondral defects of the talus
Conclusion This new procedure may offer a promising alternative for the treatment of osteochondral defects. Further high-quality studies are needed to confirm these results and to analyse the long-term effects of the procedure. The clinical relevance of this study is that the procedure may provide a less invasive option with improved bone healing compared to standard techniques . Level of evidence IV. (Source: Knee Surgery, Sports Traumatology, Arthroscopy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Why Loneliness Is A Growing Public Health Concern -- And What We Can Do About It
Our time has been called the "age of loneliness." It's estimated that one in five Americans suffers from persistent loneliness, and while we're more connected than ever before, social media may actually be exacerbating the problem. A new wave of research is shedding light on some of the causes and consequences of chronic loneliness, a condition that significantly raises the risk of a number of physical and psychological health problems, including heart disease and depression. For a condition that has such an enormous impact on our health and well-being, loneliness has been relatively neglected by psychologists -- but that's beginning to change. In a special section of the March 2015 issue of the journal Perspectives on Psychological Science, psychologists took stock of some of the po...


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


Gynaecological causes of abdominal pain
This article addresses causes of abdominal pain in pregnancy such as miscarriage, ectopic pregnancy, fibroids and urinary tract infection. In the non-pregnant female, cyclical causes of pain include primary dysmenorrhoea, endometriosis and mittelschmerz; and non-cyclical causes include pelvic inflammatory disease, ovarian cyst accidents and adhesions. An ovarian cyst accident occurs when an ovarian cyst undergoes torsion, bleeds internally or ruptures. Timely diagnosis is prudent in order to avoid ovarian infarction and hence loss of ovarian tissue, especially in a young woman. Pelvic inflammatory disease is the reason for 1 in 60 visits to GPs by women under 45 years. It has long-term consequences which include chronic pelvic pain and infertility making timely management crucial. In the U...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Fibromyalgia and nutrition: what news?
Authors: Rossi A, Di Lollo AC, Guzzo MP, Giacomelli C, Atzeni F, Bazzichi L, Di Franco M Abstract Fibromyalgia syndrome (FM) is a chronic, generalised pain condition usually accompanied by several associated symptoms, such as fatigue, sleep disturbance, headache, irritable bowel syndrome and mood disorders. Different medical treatments are used to treat fibromyalgia and the recent guidelines suggest that the optimal treatment consists in a multidisciplinary approach with a combination of pharmacological and non-pharmacological treatment modalities. Among non-pharmacological treatment, nutrition is a promising tool for FM patients. The aim of this review is to update the present knowledge about fibromyalgia and nutrition by means of a systematic search performed on Medline from Janu...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 randomised controlled trial comparing duloxetine and acetyl L-carnitine in fibromyalgic patients: preliminary data.
CONCLUSIONS: Although they need to be confirmed by further studies, these preliminary findings confirm the efficacy of duloxetine, and suggest that acetyl L-carnitine is also efficacious in improving depressive symptoms, pain, and the quality of life of FMS patients. PMID: 25786048 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Rheumatology)


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


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


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


A comparison of the attitudes toward chronic low back pain in Saudi, Australian and Brazilian physical therapy students
Conclusion This is the first study to translate HC-PAIRS into Arabic language. Compared with Brazilian and Australian students, Saudi physical therapy students agreed more strongly with the notion that chronic LBP leads to impairment and disability. (Source: Journal of Taibah University Medical Sciences)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Sensing the body in chronic pain: A review of psychophysical studies implicating altered body representation
Publication date: Available online 14 March 2015 Source:Neuroscience &amp; Biobehavioral Reviews Author(s): A. Tsay , T.J. Allen , U. Proske , M. Giummarra There is growing evidence that chronic pain conditions can have an associated central pathology, involving both cortical reorganisation and an incongruence between expected and actual sensory–motor feedback. While such findings are primarily driven by the recent proliferation of neuroimaging studies, the psychophysical tasks that complement those investigations have received little attention. In this review, we discuss the literature that involves the subjective appraisal of body representation in patients with chronic pain. We do so by examining three broad sensory systems that form the foundations of the sense of physical self...


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


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


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


Basal Pain Sensitivity does not Predict the Outcome of Multidisciplinary Chronic Pain Treatment
This study investigated if basal pain sensitivity predicted the outcome of a 4‐week outpatient multidisciplinary pain management program. DesignCohort study. SettingChronic pain outpatient clinic at the Department of Anesthesiology, Intensive Care Medicine and Pain Therapy of the University of Münster. MethodsBasal pain sensitivity was measured at treatment onset, using comprehensive experimental pain testing (thermal, pressure, and pinprick pain) and the pain sensitivity questionnaire. Primary (clinical pain intensity) and secondary (depression, anxiety, pain‐related disability) outcome parameters were assessed at treatment start, at discharge and 6 months later. SubjectsSixty five adult chronic pain patients with mixed pain diagnoses. ResultsThere were significant improvements in cl...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Relief due to Transsacrococcygeal Ganglion Impar Block in Chronic Coccygodynia: A Pilot Study
ConclusionsGanglion impar block appears to be effective in patients who have coccygodynia resistant to conservative therapy, with high success rates and prolonged duration of effect. Controlled studies are required to reveal the mechanism of this effect. (Source: Pain Medicine)


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


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


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


N-acetyl-cysteine, a drug that enhances the endogenous activation of group-II metabotropic glutamate receptors, inhibits nociceptive transmission in humans
Conclusions: Our findings show for the first time that NAC inhibits nociceptive transmission in humans, and does the same in mice by activating mGlu2/3 receptors. These data lay the groundwork for investigating the therapeutic potential of NAC in patients with chronic pain. (Source: Molecular Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Here to Stay -- Living With Sickle Cell Disease
My name is Noah Alexander Williams and I am living with sickle cell anemia disease. Sickle cell isn't really a widely talked-about disease but it's so real and epic that it should be. Sickle cell anemia disease is a grasping chronic sickness that doesn't let go. Unfortunately I have it and have had it since I was born. I don't know life without sickle cell disease and therefore I don't know life without pain -- the daily aches, the crucial crises that come out of nowhere. Sickle cell is never predictable. Of course this disease has impacted my life beyond words. I've learned to cope with it. Just to be clear, sickle cell is a genetic trait. Sickle cell disease is a severe illness that occurs in people who inherit the sickle cell gene from both parents. When I was a few months old, my pe...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Physical Activity and Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Purpose: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent urologic disorder among men, but its etiology is still poorly understood. Our objective was to examine the relation between physical activity and incidence of CP/CPPS in a large cohort of male health professionals. Methods: We conducted a prospective cohort study among men in the Health Professionals Follow-up Study followed from 1986 to 2008. The study population included 20,918 men who completed all CP/CPPS questions on the 2008 questionnaire. Leisure-time physical activity, including type and intensity of activity, was measured by questionnaire in 1986. A National Institute of Health Chronic Prostatitis Symptom Index pain score was calculated on the basis of the responses on the 2008 questionnaire. Partic...


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


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


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


Pericarditis
Publication date: April 2015 Source:Hospital Medicine Clinics, Volume 4, Issue 2 Author(s): Florian Foerg , Zechariah GardnerTeaser Pericarditis is acute or chronic inflammation of the pericardium. Pericarditis is a common cause of chest pain and its recognition has important clinical implications. Viral pathogens are thought to be the leading cause of pericarditis. Complications of acute pericarditis include cardiac tamponade, recurrent or chronic pericarditis, and constrictive or constrictive-effusive pericarditis. Subspecialty consultation should be considered when the diagnosis remains uncertain following initial evaluation or based on a failure to respond to treatment. Surgery may be required for recurrent symptomatic effusions or recurrent pericardial tamponade. The causes, differe...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life
This study examined 250 Veterans Affairs primary care patients with moderate to severe chronic musculoskeletal pain who participated in a randomized controlled pain treatment trial. Baseline data were analyzed to examine the independent associations of PTSD and major depression with multiple domains of pain, psychological status, quality of life, and disability. PTSD was strongly associated with these variables and in multivariate models, PTSD and major depression each had strong independent associations with these domains. PTSD demonstrated similar relationships as major depression with psychological, quality of life, and disability outcomes and significant but somewhat smaller associations with pain. Because PTSD and major depression have independent negative associations with pain, psyc...


A Honeycomb-Like Structure in Chronic Total Occlusion Demonstrated by Frequency-Domain Optical Coherence Tomography
A 68year-old male with a history of hypertension and current smoking was admitted due to exertional chest pain. Coronary angiography (CAG) showed a chronic total occlusion (CTO) in the left circumflex artery with collateral supply from the right coronary artery (Fig. 1). PCI was performed in this lesion as patient has normal left ventricular function. After crossing the lesion with guide wire (Gaia 2nd) and micro catheter, frequency-domain optical coherence tomography (FD-OCT) (ILUMIEN™ OCT Imaging System, St Jude Medical, Inc, St Paul, Minnesota) was performed. (Source: International Journal of Cardiology)


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


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


Synthesis of a Series of Novel 3,9-Disubstituted Phenanthrenes as Analogues of Known N-Methyl-d-aspartate Receptor Allosteric Modulators
SynthesisDOI: 10.1055/s-0034-13801149-Substituted phenanthrene-3-carboxylic acids have been reported to have allosteric modulatory activity at the N-methyl-d-aspartate (NMDA) receptor. This receptor is activated by the excitatory neurotransmitter l-glutamate and has been implicated in a range of neurological disorders such as schizophrenia, epilepsy and chronic pain, and in neurodegenerative disorders such as Alzheimer’s disease. Herein, the convenient synthesis of a wide range of novel 3,9-disubstituted phenanthrene derivatives starting from a few common intermediates is described. These new phenanthrene derivatives will help to clarify the structural requirements for allosteric modulation of the NMDA receptor.[...]© Georg Thieme Verlag Stuttgart · New YorkArticle in Thieme eJournals...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Caring for Tube-Fed Children: A Review of Management, Tube Weaning, and Emotional Considerations.
Authors: Edwards S, Davis AM, Bruce A, Mousa H, Lyman B, Cocjin J, Dean K, Ernst L, Almadhoun O, Hyman P Abstract Enteral nutrition is the practice of delivering nutrition to the gut either orally or through a tube or other device. Many children are reliant on enteral feedings to either supplement their nutrition or as a complete source of their nutrition. Managing children on tube feedings requires a team of providers to work through such dilemmas as feeding schedules, weaning from tube feeding, sensory implications of tube feeding, treatment of pain or nausea associated with eating, oral-motor issues, and behavioral issues in the child and family. The purpose of the current review is to summarize the multidisciplinary aspects of enteral feeding. The multidisciplinary team consist...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 novel analgesic approach to optogenetically and specifically inhibit pain transmission using TRPV1 promoter.
In conclusion, we have established a novel analgesic approach that can noninvasively and selectively inhibit pain transmission using an acute and controllable optogenetics method. This study may shed light on the application of a novel optogenetic strategy for the treatment of pain. PMID: 25797803 [PubMed - as supplied by publisher] (Source: Brain Research)


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


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


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


Portal vein thrombosis associated with psoriasis: a case report
Conclusion: This case highlights the importance of having clinical awareness of occurrence of thrombosis in patients with psoriasis. Typical symptoms favoring thrombosis should prompt thorough investigation to exclude this rare yet possible complication in patients with psoriasis, including that of portal vein thrombosis. Prophylaxis with anticoagulation still lacks strength of evidence to be justified in psoriasis. The exact pathogenesis of venous thromboembolism in psoriasis is still unexplained and further studies are needed to clarify the causal association. (Source: BMC Research Notes)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Chronic pain in adults.
Authors: Ponomarenko-Jones R Abstract I was unaware of the full range of treatments available for individuals experiencing chronic pain before reading this CPD article. Many patients on the gynaecology ward where I work are admitted because of chronic pain. PMID: 25783283 [PubMed - in process] (Source: Nursing Standard)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Chronic pain.
Authors: Abstract Essential facts Chronic pain is pain that persists or recurs for more than three months. It may be related to a condition, or may be pain from an injury or operation that continues after healing would usually take place. According to guidance from the Scottish Intercollegiate Guidelines Network (SIGN), around 18 per cent of Europe's population are currently affected by moderate to severe chronic pain. It has a considerable effect on quality of life, and can cause significant suffering and disability. PMID: 25783253 [PubMed - in process] (Source: Nursing Standard)


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


Therapeutic value of spinal cord stimulation in irritable bowel syndrome - a randomized cross-over pilot study.
Authors: Lind G, Winter J, Linderoth B, Hellstrom PM Abstract Irritable bowel syndrome (IBS) is characterized by abdominal pain and changed bowel habits. Spinal cord stimulation (SCS) has been used for treatment of chronic pain syndromes. Animal studies have shown SCS to reduce the reaction to colonic balloon distension, known to be increased in IBS patients. To elucidate the potential for SCS as treatment for IBS, a pilot study was performed. Ten IBS patients (age 26-56 years) were recruited. A SCS system with a 4-polar electrode was implanted at the T5-T8 level. After a two-week run-in, a randomized, crossover design SCS during 6 weeks was compared to no stimulation, with an ensuing stimulation period for 12 weeks; total study period 28 weeks. Patients recorded pain level, pain a...


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


ERK1/2: Function, signaling and implication in pain and pain-related anxio-depressive disorders
Publication date: 3 July 2015 Source:Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 60 Author(s): Gisela Borges , Esther Berrocoso , Juan Antonio Mico , Fani Neto Despite the increasing knowledge regarding pain modulation, the understanding of the mechanisms behind a complex and pathologic chronic pain condition is still insufficient. These knowledge gaps might result in ineffective therapeutic approaches to relieve painful sensations. As a result, severe untreated chronic pain frequently triggers the onset of new disorders such as depression and/or anxiety, and therefore, both the diagnosis and treatment of patients suffering from chronic pain become seriously compromised, prompting a self-perpetuating cycle of symptomatology. The extracellular signal-regulated k...


The use of porcine small intestine submucosa implants might be associated with a high recurrence rate following laparoscopic herniorrhaphy
Conclusion Our data suggest that the use of SIS mesh in endoscopic TEP herniorrhaphy might be associated with a high recurrence rate. The second look laparoscopy in these recurrent cases revealed slow and inadequate integration of host tissue. More evidence is still required to further evaluate the efficacy of SIS mesh in endoscopic TEP herniorrhaphy. (Source: Journal of the Formosan Medical Association)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients.
CONCLUSIONS: This trial indicated that gabapentin treatment had no clinically important reduction in postoperative morphine consumption at 72 hr in patients undergoing THA. Multimodal analgesia may account for the similar primary and secondary outcomes found in the groups. This trial was registered at ClinicalTrials.gov, number: NCT01307202. PMID: 25772701 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Lateral Antebrachial Cutaneous Nerve Entrapment After Shoulder Arthroscopy: A Case Report
Publication date: Available online 13 March 2015 Source:PM&amp;R Author(s): Herbie Yung , Gerritt M. Lagemann , Albert Lin , Steven L. Orebaugh , Megan H. Cortazzo The lateral antebrachial cutaneous nerve (LABCN) is a distal sensory branch of the musculocutaneous nerve. It innervates the radial aspect of the forearm. There have been reported cases of LABCN injury from trauma and chronic compression. There has also been a reported case of musculocutaneous nerve injury after a biceps tenodesis. This is a case report of a LABCN injury and forearm pain following a biceps tenodesis. Using a multifaceted diagnostic approach of electrodiagnostics and MR neurography, the site of compression was appropriately localized. The patient ultimately achieved relief after a surgical decompression. (S...


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


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


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


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


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


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


Transition from acute to chronic pain
(Source: Continuing Education in Anaesthesia, Critical Care and Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


Metformin and caloric restriction induce an AMPK-dependent restoration of mitochondrial dysfunction in fibroblasts from Fibromyalgia patients.
Authors: Alcocer-Gómez E, Garrido-Maraver J, Bullón P, Marín-Aguilar F, Cotán D, Carrión AM, Alvarez-Suarez JM, Giampieri F, Sánchez-Alcazar JA, Battino M, Cordero MD Abstract Impaired AMPK is associated with a wide spectrum of clinical and pathological conditions, ranging from obesity, altered responses to exercise or metabolic syndrome, to inflammation, disturbed mitochondrial biogenesis and defective response to energy stress. Fibromyalgia (FM) is a world-wide diffused musculoskeletal chronic pain condition that affects up to 5% of the general population and comprises all the above mentioned pathophysiological states. Here, we tested the involvement of AMPK activation in fibroblasts derived from FM patients. AMPK was not phosphorylated in fibroblasts from FM patients and w...


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


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


Pfizer pain drug Lyrica fails study in adolescents with fibromyalgia
(Reuters) - Pfizer Inc's pain drug, Lyrica, failed a post-marketing study testing the treatment in adolescents with fibromyalgia, a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. (Source: Reuters: Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Impact of Race and Diagnostic Label on Older Adults' Emotions, Illness Beliefs, and Willingness to Help a Family Member With Osteoarthritis
Discussion: The diagnostic label of OA had little effect on these older adults, but racial differences indicate that cultural values regarding family caregiving are important in arthritis care. (Source: Journal of Applied Gerontology)


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


Effects of β2 agonists on post‐thoracotomy pain incidence
ConclusionsThese data suggest a possible influence of chronic β2‐agonist treatments on neuropathic pain secondary to thoracotomy. This apparent preventive effect of β2‐agonist treatments should warrant controlled clinical trials. (Source: European Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Diagnosis and Management of Intra-articular Causes of Pain After Total Knee Arthroplasty.
Authors: Potty AG, Tzeng TH, Sams JD, Lovell ME, Mihalko WM, Thompson KM, Parke J, Manning BT, Dennis DA, Goodman SB, Saleh KJ Abstract Total knee arthroplasty (TKA) is an effective procedure for decreasing pain, improving functional capability, and increasing the overall quality of life for thousands of people with chronic knee osteoarthritis. Although patient outcomes and satisfaction remain high, a substantial percentage of patients report residual pain after TKA. Sources of postoperative pain include intra- and extra-articular etiologies as well as factors unrelated to the implants themselves. A patient-centered approach to the painful TKA may aid clinicians in diagnosing and treating patients with intra-articular causes of pain after TKA. A thorough understanding of the mechan...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Overlap between Fibromyalgia Syndrome and Myotonia Congenita.
CONCLUSIONS: These two cases are the first report of an overlap of CWP between FMS and MC. PMID: 25749817 [PubMed - as supplied by publisher] (Source: Journal of Clinical Neurology)


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


Paclitaxel induces acute pain via directly activating toll like receptor 4
In this study, we found that paclitaxel causes acute pain in rodents in a dose-dependent manner. The paclitaxel-induced acute pain occurs within 2 hrs after a single intravenous injection of paclitaxel. This is accompanied by low levels of paclitaxel penetrating into the cerebral spinal fluid and spinal dorsal horn. We demonstrated that a intrathecal injection of paclitaxel induces mechanical allodynia in a dose-dependent manner. Paclitaxel causes activation of toll like receptor 4 (TLR4) in the spinal dorsal horn and dorsal root ganglions. Through activating TLR4, paclitaxel increases glutamatergic synaptic activities and reduces glial glutamate transporter activities in the dorsal horn. Activations of TLR4 are necessary in the genesis of paclitaxel-induced acute pain. The cellular and m...


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


Interleukin-10 levels in rat models of nerve damage and neuropathic pain
The objective of the present study was to assess the levels of IL-10 in rat’s dorsal root ganglion (DRG) and the sciatic nerve following four different forms of sciatic nerve injury. The models used to induce the injury included two models of partial nerve injury: partial sciatic ligation (PSL) and chronic constriction injury (CCI), a model of complete sciatic transection (CST) and a model of perineural inflammation with minimal nerve damage (neuritis). Withdrawal responses for mechanical stimulus and withdrawal latency for thermal stimulation were used to measure mechanical and thermal hyperalgesia, respectively, and duration of the nociceptive withdrawal reflex to mechanical stimulus was used to measure mechanical hyperalgesia. The affected and contra-lateral nerves and the affected si...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 quantitative non-invasive assessment of femoroacetabular impingement with CT-based dynamic simulation - cadaveric validation study
Conclusions: The use of this dynamic simulation software to determine the presence of motion limiting deformities of the femoroacetabular is validated. The simulation software is able to non-invasively detect a reduction in achievable ROM, caused by a cam type deformity. (Source: BMC Musculoskeletal Disorders)


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


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


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


Toll-like Receptor 4 and comorbid pain in Interstitial Cystitis/Bladder Pain Syndrome: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain research network study.
CONCLUSIONS: TLR-4 inflammatory responses in PBMCs are a marker of widespread pain in IC/BPS, and should be explored in other conditions characterized by medically unexplained pain. PMID: 25771510 [PubMed - as supplied by publisher] (Source: Brain, Behavior, and Immunity)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 changes following aberrant urine drug test results for patients prescribed chronic opioid therapy.
DISCUSSION: Current methods for optimizing treatment after obtaining aberrant UDT results should be enhanced. To improve the utility of UDT to reduce prescription opioid misuse, additional interventions and support for clinicians need to be developed and tested. PMID: 25750164 [PubMed - in process] (Source: Journal of Opioid Management)


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


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


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


British Scientists Spot Brain's Pain Center
Title: British Scientists Spot Brain's Pain CenterCategory: Health NewsCreated: 3/9/2015 12:00:00 AMLast Editorial Review: 3/10/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Low serum vitamin D levels are not associated with increased postoperative pain and opioid requirements: a historical cohort study
Conclusion We did not find any association between preoperative vitamin D levels and postoperative pain scores/opioid consumption in morbidly obese patients undergoing bariatric surgery. (Source: Canadian Journal of Anesthesia)


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


Active Vitamin D (1,25 Dihydroxyvitamin D) Is Associated With Chronic Pain in Older Australian Men: The Concord Health and Ageing in Men Project
Conclusions. Low serum 1,25D concentrations are associated with chronic pain in older men. This raises the question whether vitamin D metabolites may influence pain states, mediated through different biological mechanisms and pathways. (Source: Journals of Gerontology Series A: Biological Sciences and Medical Sciences)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Extracorporeal shock wave lithotripsy treatment of pancreatic stones complicated with advanced stage autoimmune pancreatitis
Conclusions: Different approaches are needed for the treatment of pancreatic calculi in chronic stage AIP and ordinary CP. Specifically, it appears that intensive ESWL therapy can be avoided or delayed in AIP if the patient displays: (1) advanced age, (2) little or no chronic pain or pancreatitis, and (3) pancreatic duct stenosis proximal to pancreatic stones. In such cases, the benefit of ESWL treatment may be outweighed by the risks involved in this procedure. (Source: BMC Gastroenterology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


The Shared Neuroanatomy and Neurobiology of Comorbid Chronic Pain and PTSD: Therapeutic Implications
This article focuses on neurobiological factors that may contribute to the coprevalence and synergistic interactions of chronic pain and PTSD. First, we outline how circuits that mediate emotional distress and physiological threat, including pain, converge. Secondly, we discuss specific neurobiological mediators and modulators of these circuits that may contribute to chronic pain and PTSD symptoms. For example, neuropeptide Y, and the neuroactive steroids allopregnanolone and pregnanolone (together termed ALLO) have antistress and antinociceptive properties. Reduced levels of neuropeptide Y and ALLO have been implicated in the pathophysiology of both chronic pain and PTSD. The potential contribution of opioid and cannabinoid system factors also will be discussed. Finally, we address potent...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 2-Year Examination of Cognitive and Behavioral Correlates of Provoked Vestibulodynia Outcomes
Discussion: Changes in both cognitive and behavioral variables were significantly associated with improved pain and sexual satisfaction outcomes. However, it was the positive changes in SE that better predicted changes in avoidance behavior, pain, and sexual satisfaction. Cognitive-behavior therapy is often focused on changing negative pain-related cognitions to reduce avoidance and pain, but the present results demonstrate the potential importance of bolstering positive self-beliefs as well. Indeed, before engaging in exposure therapies, SE beliefs should be assessed and potentially targeted to improve adherence to exposure strategies. (Source: The Clinical Journal of Pain)


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


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


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


Intravenous nonopioid analgesic drugs in chronic low back pain patients on chronic opioid treatment: A crossover, randomised, double-blinded, placebo-controlled study: Retraction
No abstract available (Source: European Journal of Anaesthesiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Sexual Function in Patients with Chronic Renal Failure on Hemodialysis and Its Effects on Patients’ Perception of Health and Life Satisfaction
Abstract This descriptive and correlational study was conducted to determine both sexual functions of patients with chronic renal failure on hemodialysis and the relationship between sexual function and “life satisfaction and perception of health”. The study was conducted with 125 patients with chronic renal failure who were treated at dialysis centers. Data were collected with the socio-demographic information form, Arizona Sexual Experience Scale (ASEX), Satisfaction with Life Scale and Nottingham Health Profile questionnaire. Of the participants, 72 % were over the age of 50 and 64.8 % had a chronic illness for six or more years. All the participants were receiving hemodialysis treatment. Of the participants, 85.6 % suffered from sexual dysfunction. There was a moderatel...


Chronic pain, body mass index and cardiovascular disease risk factors: tests of moderation, unique and shared relationships in the Study of Women’s Health Across the Nation (SWAN)
Abstract Chronic pain may be related to cardiovascular disease (CVD) risk. The current study examined whether persistent bodily pain was related to cardiovascular disease risk factors, whether these effects were moderated by body mass index (BMI), and, if not, whether chronic pain accounted for unique variance in CVD risk factors. Participants were women (N = 2,135) in the Study of Women’s Health Across the Nation. A high pain frequency variable (high pain in 0 through 4 assessments) was coded to reflect the frequency of high levels of bodily pain across the first 3 years of the study. Six CVD risk factors and BMI were measured at follow-up year 3. High pain frequency and BMI were correlated significantly with risk factors, although effects for the former were small. Hierarc...


New hope for treating knee injuries
An experimental new surgery could solve the problem of chronic knee pain from wear and tear of the meniscus cartilage (Source: Health News: CBSNews.com)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts A Randomized Clinical Trial
Conclusions and RelevanceA stepped-care intervention that combined analgesics, self-management strategies, and brief cognitive behavioral therapy resulted in statistically significant reductions in pain-related disability, pain interference, and pain severity in veterans with chronic musculoskeletal pain.Trial Registrationclinicaltrials.gov Identifier: NCT00386243 (Source: JAMA Internal Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Evaluation of clinical measurements and development of new diagnostic criteria for Takayasu arteritis in a Chinese population.
CONCLUSIONS: The new diagnostic criteria exhibited high sensitivity and specificity and have demonstrated to be feasible in the diagnosis of TA. PMID: 25738632 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Rheumatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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


Sex differences in depression-like behavior after nerve injury are associated with differential changes in brain-derived neurotrophic factor levels in mice subjected to early life stress - Nishinaka T, Kinoshita M, Nakamoto K, Tokuyama S.
We recently demonstrated that exposure to early life stress exacerbates nerve injury-induced thermal and mechanical hypersensitivity in adult male and female mice. Accumulating evidence suggests that chronic pain causes emotional dysfunction, such as anxie... (Source: SafetyLit: All (Unduplicated))<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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-sampling methodology with a mobile device in fibromyalgia.
Authors: Diana C, Cristina B, Azucena GP, Luis F, Ignacio M Abstract This work describes the usability studies conducted in the development of an experience-sampling methodology (ESM) system running in a mobile device. The goal of the system is to improve the accuracy and ecology in gathering daily self-report data in individuals suffering a chronic pain condition, fibromyalgia. The usability studies showed that the developed software to conduct ESM with mobile devices (smartphones, cell phones) can be successfully used by individuals with fibromyalgia of different ages and with low level of expertise in the use of information and communication technologies. 100% of users completed the tasks successfully, although some have completely illiterate. Also there seems to be a clear diff...


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


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


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


Blockade and reversal of spinal morphine tolerance by P2X3 receptor antagonist
In recent years, studies have substantiated the view that P2X3 receptors play a part in the generation and transmission of purinergic signals in inflammatory and chronic neuropathic pain. Data have also been presented to suggest that the process of P2X3 receptor antagonism inhibits inflammatory hyperalgesia, involving the spinal opioid system. The aim of this study was to investigate the effect of the selective P2X3 receptor antagonist A-317491 on the development of antinociceptive tolerance to chronic morphine administration in mice. Daily systemic injection of A-317491 attenuated the morphine-induced antinociceptive tolerance to von Frey and thermal stimuli. Repeated morphine injections alone led to a significant rightward shift in the morphine dose–response curve compared with that wi...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Local knockdown of the NaV1.6 sodium channel reduces pain behaviors, sensory neuron excitability, and sympathetic sprouting in rat models of neuropathic pain
In this study, we injected small inhibitory (si) RNA directed against the NaV1.6 sodium channel isoform into the DRG before SNL. This isoform can mediate high-frequency repetitive firing, like that seen in spontaneously active neurons. Local knockdown of NaV1.6 markedly reduced mechanical pain behaviors induced by SNL, reduced sympathetic sprouting into the ligated sensory ganglion, and blocked abnormal spontaneous activity and other measures of hyperexcitability in myelinated neurons in the ligated sensory ganglion. Immunohistochemical experiments showed that sympathetic sprouting preferentially targeted NaV1.6-positive neurons. Under these experimental conditions, NaV1.6 knockdown did not prevent or strongly alter single evoked action potentials, unlike previous less specific methods use...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Clinical and 22‐item Sino‐Nasal Outcome Test symptom patterns in primary headache disorder patients presenting to otolaryngologists with “sinus” headaches, pain or pressure
ConclusionProminent rhinologic symptoms can be present in PHD patients in the absence of rhinosinusitis. In particular, high symptom‐burden/SNOT‐22 scores and high psychosocial symptoms should raise suspicion of PHD when endoscopy and/or CT results do not correlate with symptoms. (Source: International Forum of Allergy and Rhinology)


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


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


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


Pro-Nociceptive and Anti-Nociceptive Effects of a Conditioned Pain Modulation Protocol in Participants with Chronic Low Back Pain and Healthy Control Subjects
People with chronic pain may exhibit pro-nociceptive phenotypes characterised partly by reduced conditioned pain modulation (CPM). Characterising variability in CPM in people with chronic low back pain (CLBP) may inform management. (Source: Manual Therapy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


NeuroMetrix tries Indiegogo for Quell OTC chronic pain device
Crowdfunding site Indiegogo is an unconventional marketing tool for the medical device world, but for NeuroMetrix it appears to have paid off. Indiegogo, NeurometrixNews Well, Over-the-counter (OTC), Pain Managementread more (Source: Mass Device)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Study: Interactive, tailored web content may improve patient health, knowledge
Offering interactive web-based content that is personalized for a patient may increase the patient&#8217;s knowledge of their condition and reduce their incidence of negative effects, according to a study conducted by researchers in the Department of Medical Psychology at Germany-based University Medical Center Hamburg-Eppendorf. The study, a randomized control trial of 561 people with either type 2 diabetes or chronic [&#8230;] (Source: mobihealthnews)


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


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


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


The mixed-action delta/mu opioid agonist MMP-2200 does not produce conditioned place preference but does maintain drug self-administration in rats, and induces in vitro markers of tolerance and dependence
This study evaluated the rewarding and reinforcing effects of a lead candidate, mixed-action delta/mu agonist MMP-2200, using a conditioned place preference assay as well as a drug self-administration procedure in rats. In place conditioning studies, rats underwent a 2-week conditioning protocol and were then tested for chamber preference. Rats receiving MMP-2200, at previously determined analgesic doses, could not distinguish between the drug and saline-paired chamber, whereas rats receiving the opioid agonist morphine showed a strong preference for the morphine-paired chamber. In self-administration studies, rats were trained to respond for the high efficacy mu opioid receptor agonist fentanyl on an FR5 schedule of reinforcement. Following complete dose–response determinations for fent...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 occurrence and characteristics of pain in HIV-1 positive persons – A challenge in the aging population
Conclusion Almost 40% of respondents reported chronic pain. We have found a strong correlation between age and chronic pain in the HIV infected population with the 7% increase in the odds of experiencing pain with each year of age. (Source: HIV and AIDS Review)


Acupuncture treatment for chronic knee pain: study by Hinman et al underestimates acupuncture efficacy.
Authors: Zhang Q, Yue J, Lu Y PMID: 25742694 [PubMed - as supplied by publisher] (Source: Acupuncture in Medicine : journal of the British Medical Acupuncture Society)


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


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


A comprehensive approach to glenohumeral arthritis.
This article reviews the basic science and clinical management of osteoarthritis of the glenohumeral joint. PMID: 25188621 [PubMed - indexed for MEDLINE] (Source: Southern Medical Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 mixed-action delta/mu opioid agonst MMP-2200 does not produce conditioned place preference but does maintain drug self-administration in rats, and induces in vitro markers of tolerance and dependence.
This study evaluated the rewarding and reinforcing effects of a lead candidate, mixed-action delta/mu agonist MMP-2200, using a conditioned place preference assay as well as a drug self-administration procedure in rats. In place conditioning studies, rats underwent a 2-week conditioning protocol and were then tested for chamber preference. Rats receiving MMP-2200, at previously determined analgesic doses, could not distinguish between the drug and saline-paired chamber, whereas rats receiving the opioid agonist morphine showed a strong preference for the morphine-paired chamber. In self-administration studies, rats were trained to respond for the high efficacy mu opioid receptor agonist fentanyl on an FR5 schedule of reinforcement. Following complete dose–response determinations for fent...


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


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


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


A missed opportunity: tophaceous gout
Several features of one patient’s case belied the original diagnosis. A 70-year-old Filipino man presented to the clinic, complaining of subacute worsening of chronic hand pain. Two weeks prior, he experienced increasing pain and swelling of the metacarpophalangeal joints and both wrists. Over the past several years, he had similar episodes, each lasting 2-3 weeks; shorter when he received oral nonsteroidal anti-inflammatory drugs or prednisone. Between these periods, minimal joint swelling and stiffness remained. (Source: The American Journal of Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Assessment
This article focuses on the history and examination and emphasizes pitfalls associated with overreliance on medical technology. (Source: Physical Medicine and Rehabilitation Clinics of North America)


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


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


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


Comparative and quantitative proteomic analysis of normal and degenerated human annulus fibrosus cells.
This article is protected by copyright. All rights reserved. PMID: 25739836 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Pharmacology and Physiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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


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


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


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


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


Immune System Changes Tied to Chronic Fatigue Syndrome
Title: Immune System Changes Tied to Chronic Fatigue SyndromeCategory: Health NewsCreated: 2/27/2015 12:00:00 AMLast Editorial Review: 3/2/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Belief in Acupuncture Key to Effect on Back Pain, Study Suggests
Title: Belief in Acupuncture Key to Effect on Back Pain, Study SuggestsCategory: Health NewsCreated: 2/27/2015 12:00:00 AMLast Editorial Review: 3/2/2015 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


The village that helped me face fear: Reflections on the training and early career experiences of the 2014 Donald O. Hebb Award recipient.
In June 2014 I had the honour and privilege of receiving the Donald O. Hebb Award for Distinguished Contributions to Psychology as a Science from the Canadian Psychological Association. Although I was the individual upon whom this award was bestowed, my career contributions to the science of psychology have required the labours of many. In this article I pay homage to the “village” that helped me tackle the complexities of various forms of fear and eventually shape current understanding of chronic and disabling pain and its associations with posttraumatic stress disorder. In the spirit of paying forward some of the wisdom graciously imparted on me by that village, and with hopes that this may in some small way benefit others venturing down the career path of Canadian academic psycholog...


Cav2.2 channels: Therapeutic target for chronic arthritic pain?
(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>


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


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


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


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


The Club-Level Road Cyclist: Injury, Pain, and Performance
Conclusions: Cycling is a sport in which injury risk and prevention need to be further studied. Cyclists are frequently injured but continue to participate in cycling at volumes equal to their healthy peers. Clinical Relevance: This study outlines a clinically reproducible cyclist assessment and discusses behaviors common to the cycling patient. (Source: Clinical Journal of Sport Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 Dynamic Weight Bearing for Measuring Nonevoked Inflammatory Hyperalgesia in Mice
Discussion: Mice with inflammation showed alterations in weight bearing as well as increased thermal hyperalgesia in comparison with control groups. These findings support the use of the DWB test as a tool for measuring nonevoked inflammatory hyperalgesia in a mouse model. (Source: Nursing Research)


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


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


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


Cervical Spondylosis and Hypertension: A Clinical Study of 2 Cases
We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis. (Source: Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Don't Forget Palliative Patients
To the Editor We appreciate the Viewpoint by Dr Schechter recently published in JAMA Pediatrics on the hazards of indiscriminate use of opioids in children. He has made major contributions to pain management for children and his words deserve great respect. We accept that pediatricians have insufficient data about the effectiveness of opioids for chronic pain and even less information about how opioid use contributes to substance abuse and harm in developing brains. Nonetheless, we have concerns about Dr Schechter’s call for caution. At the very least, we need thoughtful consideration of how curtailing opioids might adversely affect subpopulations of children with chronic pain. (Source: JAMA Pediatrics)


Suppression of peripheral pain by blockade of Cav2.2 channels in nociceptors induces RANKL and impairs recovery from inflammatory arthritis
Conclusion. Altogether, our results indicate that alleviation of peripheral pain by blockade of CaV2.2‐ mediated calcium influx and signaling in nociceptor sensory neurons, impairs recovery from induced arthritis and point to the potentially devastating effects of using CaV2.2 channel blockers as analgesics during inflammation. This article is protected by copyright. All rights reserved. (Source: Arthritis and Rheumatism)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Diagnostic imaging of pelvic congestive syndrome.
Authors: Arnoldussen C, de Wolf M, Wittens C Abstract Many female patients are affected by chronic pelvic pain and a significant number of referrals to the gynecology department result in a clinical suspicion of pelvic congestion syndrome. Additionally, patients referred to the vascular surgery department for venous disease can also present with complaints of a persistent dull lower abdominal pain in addition to typically distributed leg varicosities (that extend from the leg through the pelvic floor) which should be evaluated for the presence of pelvic congestion syndrome. In this article, we focus on imaging pelvic vein insufficiency and related (extending) varicosities: how should we evaluate the pelvic veins, what are the signs to look for, and what are the currently establishe...


Pain threshold and intensity in rheumatic patients: correlations with the Hamilton Depression Rating scale
This study aims to investigate the relationship between depression and pain intensity and threshold in a group of rheumatic patients compared to healthy subjects. One hundred twenty-four individuals of whom 50 were affected by rheumatoid arthritis (RA), 23 by psoriatic arthritis (PsA), 23 by ankylosing spondylitis (AS), and 28 age-matched controls without chronic pain underwent quantitative sensory testing to assess pressure pain threshold with pressure algometry. Pain intensity was evaluated through the visual analogue scale (VAS) and depression through the Hamilton Depression Rating scale (HAMD). A significant inverse correlation between HAMD values and pressure pain thresholds was found in the entire group of patients (p &lt; 0.0001), in controls (p = 0.02), and also in RA (p ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 the incidence of haemorrhoidal disease in patients with ankylosing spondylitis
Abstract Haemorrhoidal disease (HD) is one of the most common diseases encountered by the clinicians of general surgery. Chronic constipation, pushing during defecation and increased abdominal pressure play an important role in development of haemorrhoidal disease. Patients with ankylosing spondylitis (AS) frequently use the Valsalva manoeuvre in their daily lives, which may increase the abdominal pressure, leading to formation of haemorrhoids. The purpose of this study was to evaluate the incidence of haemorrhoidal disease in patients with AS. A total of 221 individuals were included in this study in three groups as follows: 72 patients with ankylosing spondylitis (AS), 75 patients with chronic low back pain (LBP) and 74 healthy control subjects. Patients were examined both phys...


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


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


Treatment of a patient with posterior cortical atrophy (PCA) with chiropractic manipulation and Dynamic Neuromuscular Stabilization (DNS): A case report.
CONCLUSION: PCA is a progressive and debilitating condition. Because of poor awareness of PCA by physicians, patients usually receive incomplete care. Additional efforts must be centered on the musculoskeletal features of PCA, aiming enhancement in quality of life and functional improvements (FI). Adjunctive rehabilitative treatment is considered essential for individuals with cognitive and motor disturbances, and manual medicine procedures may be consider a viable option. PMID: 25729084 [PubMed] (Source: Pain Physician)


Cross-cultural adaptation and validation of the Neck Bournemouth Questionnaire in the Italian population
Conclusions The validation process revealed acceptable psychometric properties of the NBQ, whose Italian version can be used for research and clinical purposes. (Source: Quality of Life Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 popliteal entrapment with calcified lesions results in an acute occlusion after blunt knee trauma in a 17-year-old soccer player
A 17-year-old soccer player noticed intermittent claudication after reconvalescence from a severe blunt knee trauma with laceration of the anterior cruciate ligament. Physical examination revealed a pulseless right leg without rest pain. Magnetic resonance imaging documented a short occlusion of the popliteal artery with sparse but visible collaterals (A). Cross-sectional imaging demonstrated an atypical bundle or accessory insertion of the gastrocnemius muscle (popliteal entrapment syndrome type III) (B). (Source: Journal of Vascular Surgery)


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


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


An evaluation of short-stretch compression systems for chronic lower-limb leg ulcers.
Authors: Carr C, Shadwell J, Regan P, Hammett S Abstract An evaluation of a new short-stretch compression system (CoFlex UBZ, TLC and TLC Lite, Aspen Medical Europe Ltd) was undertaken in four leg ulcer clinics. A total of 19 patients aged 42-93 years were treated for up to 4 weeks, or until healed. Collated data included age, underlying diseases, leg ulcer type, ulcer duration and current treatment. The evaluation included quality of life measurements, wear time, slippage, exudate strikethrough and pain using a numerical pain score. Patients were asked to document sleep patterns. Compression was applied according to clinical need. Inclusion criteria were non-healing wounds on the lower limb existing for more than 6 weeks that were suitable for compression. Exclusion criteria inclu...


Predictors of chronic abdominal pain affecting the well-being of children in primary care.
CONCLUSIONS: Chronic abdominal pain sufficient to affect well-being is common among children initially seen for abdominal pain by family physicians. Although the risk of this outcome increases with number of predictors, these predictors are of limited value in identifying children in whom pain will become chronic, suggesting that other, as yet unidentified factors play an important role. PMID: 25755037 [PubMed - in process] (Source: Annals of Family Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Intrathecal analgesia: Time to consider it for your patient?
Authors: Shaparin N, Sim A, Pappagallo M, Gritsenko K, Carullo V, Tsukanov J, Kosharskyy B Abstract When systemic analgesics or antispasmodics fail to control chronic pain or cause intolerable adverse effects, an intrathecal drug delivery system may be the best bet. PMID: 25789343 [PubMed - in process] (Source: The Journal of Family Practice)


The Presence of Is Associated With Increased Leukocyte Counts and Pain Severity in Men With Chronic Pelvic Pain Syndrome
To examine the role of urinary chlamydial infection in patients with chronic prostatitis and/or chronic pelvic pain syndrome (CP-CPPS). (Source: Urology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 pain paradox: borderline personality disorder features, self-harm history, and the experience of pain - Carpenter RW, Trull TJ.
Individuals with borderline personality disorder (BPD), compared to controls, report a relative absence of acute pain. In contrast, BPD is overrepresented among chronic pain patients, suggesting they experience a relative excess of chronic pain. To date, t... (Source: SafetyLit: All (Unduplicated))


Prevalence of low back pain among nurses: predisposing factors and role of work place violence - Rezaee M, Ghasemi M.
BACKGROUND: Ergonomic factors predispose nurses to low back pain (LBP). Few studies have clarified the role of workplace violence in LBP occurrence. OBJECTIVES: The present study was designed to investigate acute and chronic LBP in Iranian nurses a... (Source: SafetyLit: All (Unduplicated))


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


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


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


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


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


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


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


One year in review: novelties in the treatment of rheumatoid arthritis.
Authors: Guidelli GM, Barskova T, Brizi MG, Lepri G, Parma A, Talarico R, Cantarini L, Frediani B Abstract Rheumatoid arthritis (RA) is a chronic disease characterised by inflammation of the synovial tissue in joints, which can lead to joint destruction. The primary aim of the treatment is to control pain and inflammation, reduce joint damage and disability, and maintain or improve physical function and quality of life. In this article, we provide a critical analysis of the recent literature on the novelties in the treatment of RA, with a particular focus on the most relevant studies published over the last two years. PMID: 25719499 [PubMed - as supplied by publisher] (Source: Clinical and Experimental Rheumatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 postoperative day one discharges after implementation of a hysterectomy enhanced recovery pathway: a retrospective cohort study
Conclusion For patients undergoing abdominal hysterectomy, implementation of a HER pathway is associated with a higher POD 1 discharge rate, with no increase in the early return to hospital rate. (Source: Canadian Journal of Anesthesia)


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


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


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


Increased postoperative day one discharges after implementation of a hysterectomy enhanced recovery pathway: a retrospective cohort study.
CONCLUSION: For patients undergoing abdominal hysterectomy, implementation of a HER pathway is associated with a higher POD 1 discharge rate, with no increase in the early return to hospital rate. PMID: 25724789 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


One in every three women could potentially be spared chronic pain after breast cancer surgery
(Source: St. Michael's Hospital News and Media)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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 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)


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


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


[Interdisciplinary Diagnosis and Treatment of Deep Infiltrating Endometriosis.]


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


Association of care practices with suicide attempts in US veterans prescribed opioid medications for chronic pain management - Im JJ, Shachter RD, Oliva EM, Henderson PT, Paik MC, Trafton JA.
IMPORTANCE: Patients receiving opioid therapy are at elevated risk of attempting suicide. Guidelines recommend practices to mitigate risk, but it is not known whether these are effective. OBJECTIVE: Our aim was to examine associations between the r... (Source: SafetyLit: All (Unduplicated))


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


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


A Brief Guide To The Basic Fundamentals Of Art Therapy
The British Association of Art Therapists defines art therapy as "a form of psychotherapy that uses art media as its primary mode of communication." There are no limits on who can participate and no constrictions on what artistic supplies can be incorporated. The field, available to children and adults of all backgrounds and circumstances, opens up avenues of communication that extend beyond verbal language, exploring feelings that cannot be spoken. Over the past few months, we've published a series of articles suggesting relaxation techniques -- inspired by the field of art therapy -- meant to help readers unwind, heal and express these unspoken feelings. We are not art therapists, and although the various artistic methods are based on therapy methods, art therapy can really only be defi...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Evaluation and 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...


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


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)


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)


A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: a randomised controlled trial with one-year follow-up
Exercise is an effective treatment for patients with sub-acute and chronic non-specific low back pain (NSLBP). Previous studies have shown that a subgroup of patients with NSLBP and movement control impairment (MCI) can be diagnosed with substantial reliability. However, which type of exercises are most beneficial to this subgroup is still unknown. (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>


Pain in stroke patients: characteristics and impact on the rehabilitation treatment. A multicenter cross-sectional study.
CONCLUSIONS: The results from this multicenter study showed that in about ¼ of the patients, pain negatively influenced the rehabilitation program delaying the recovery and likely increasing the cost of rehabilitation. CLINICAL REHABILITATION IMPACT: Clinicians should pay more attention to pain, especially neuropathic pain, in post--stroke patients. Tailored pharmacological therapy, to treat and prevent pain, might improve patients' compliance during the rehabilitation process. PMID: 25739508 [PubMed - as supplied by publisher] (Source: European Journal of Physical and Rehabilitation Medicine)


Chronic Pain, Misuse of Pain Meds Common in Kidney DiseaseChronic Pain, Misuse of Pain Meds Common in Kidney Disease
Although chronic pain is common in end-stage renal disease, less is known about pain in predialysis CKD; researchers found safety may be an issue. Medscape Medical News (Source: Medscape Nephrology Headlines)


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>


Role of α5-containing nicotinic receptors in neuropathic pain and response to nicotine.
Authors: Xanthos DN, Beiersdorf JW, Thrun A, Ianosi B, Orr-Urtreger A, Huck S, Scholze P Abstract Nicotinic receptors in the central nervous system (nAChRs) are known to play important roles in pain processing and modulate behavioral responses to analgesic drugs, including nicotine. The presence of the α5-neuronal nicotinic accessory subunit in the nicotinic receptor complex is increasingly understood to modulate reward and aversive states, addiction, and possibly pathological pain. In the current study, using α5-knockout (KO) mice and subunit-specific antibodies, we assess the role of α5-containing neuronal nicotinic receptors in neuropathic pain and in the analgesic response to nicotine. After chronic constriction injury (CCI) or partial sciatic nerve ligation (PSNL), no diffe...


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


Diagnosis and treatment of chronic 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)


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


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)


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


[Feasibility of outpatient laparoscopy in gynaecology. A prospective study about 50 cases.]
CONCLUSION: The outpatient laparoscopy in gynaecology seems feasible with a high level of satisfaction. It can be proposed to patients after good information. PMID: 25724600 [PubMed - as supplied by publisher] (Source: Reproductive Biology)


Structural modeling and patch-clamp analysis of pain-related mutation TRPA1-N855S reveal inter-subunit salt bridges stabilizing the channel open state.
Authors: Zíma V, Witschas K, Hynkova A, Zímová L, Barvík I, Vlachova V Abstract The ankyrin transient receptor potential channel TRPA1 is a polymodal sensor for noxious stimuli, and hence a promising target for treating chronic pain. This tetrameric six-transmembrane segment (S1-S6) channel can be activated by various pungent chemicals, such as allyl isothiocyanate or cinnamaldehyde, but also by intracellular Ca(2+) or depolarizing voltages. Within the S4-S5 linker of human TRPA1, a gain-of-function mutation, N855S, was recently found to underlie familial episodic pain syndrome, manifested by bouts of severe upper body pain, triggered by physical stress, fasting, or cold. To clarify the structural basis for this channelopathy, we derive a structural model of TRPA1 by combining ...


Evaluation of influence of stretching therapy and ergonomic factors on postural control in patients with chronic non-specific low back pain.
CONCLUSIONS: Ergonomic factors are often accompanied by the appearance of LBP. The restrictions within the musculoskeletal system cause disorders in muscle synergies, which is expressed by an increase in the angular velocity of the COG. In patients with chronic back pain syndrome, selected stretching therapy techniques improves the range of motion of the spine and reduces pain. PMID: 25780844 [PubMed - in process] (Source: Annals of Agricultural and Environmental Medicine : AAEM)


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)


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


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...


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


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)


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


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)


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


Health 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)


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


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...


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


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)


Endometriosis of the lumbosacral plexus: report of a case with foot drop and chronic pelvic pain
(Source: Acta Neurologica Belgica)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Changing 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)


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


U.S. 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)


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


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)


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


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)


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


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....


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


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)


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


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)


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


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)


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


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


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...


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


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


New 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)


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


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)


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


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)


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


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)


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


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...


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


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)


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


Walking 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  | ...


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


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


Pain management 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)


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


Associations 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...


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


Is 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...


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


New 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)


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


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)


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


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


Physical Activity, 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...


Childhood functional abdominal pain: mechanisms and management
Nature Reviews Gastroenterology & Hepatology 12, 159 (2015). doi:10.1038/nrgastro.2015.21 Authors: Judith Korterink, Niranga Manjuri Devanarayana, Shaman Rajindrajith, Arine Vlieger & Marc A. Benninga Chronic abdominal pain is one of the most common clinical syndromes encountered in day to day clinical paediatric practice. Although common, its definition is confusing, predisposing factors are poorly understood and the pathophysiological mechanisms are not clear. The prevailing viewpoint in the pathogenesis involves the (Source: Nature Reviews Gastroenterology and Hepatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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>


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 Cerebrospinal Fluid–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 bulbospinal 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 and chronic pain subjects, 2) screen for changes in centrally (ie, cerebrospinal fluid) and peripherally (ie, plasma) acting monoamine concentrations, and 3) explore the relationship between descending pain inhibition and monoamine neurotransmitter concentrations. (Source: The Journal of Pain)


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


Narcotic 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)


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


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...


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


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


The use of 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...


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)


Prostatitis: Acupuncture treatment for chronic prostatitis
Nature Reviews Urology 12, 121 (2015). doi:10.1038/nrurol.2015.11 New research has shown that acupuncture treatment can be a safe and effective treatment in patients with category IIIB chronic prostatitis&#8211;chronic pelvic pain syndrome (CP&#8211;CPPS). K&#252;&#231;&#252;k et al. compared acupuncture treatment (n = 26) and medical treatment with antibiotics and NSAIDs (Source: Nature Reviews 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>


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)


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


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...


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


Non-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)


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


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)


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


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 ...


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


Role of 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)


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


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


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)


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


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...


Unsuccessful Pulsed Radiofrequency of the Sphenopalatine Ganglion in Patients with Chronic Cluster Headache and Subsequent Successful Thermocoagulation
We present the results of pulsed and continuous radiofrequency (CRF) of the sphenopalatine ganglion in a case series of 3 patients with chronic cluster headache (CCH). Three patients were referred to our neurosurgical department because of CCH, which was refractory to pharmacological treatment. They underwent pulsed radiofrequency of the sphenopalatine ganglion (PRF‐SPG), and the procedure was performed through an infrazygomatic approach. In the PRF procedures, we applied 2 cycles of PRF at 42°C and 45 V for 120 seconds, with a pulse frequency of 2 Hz and a pulse width of 20 ms. In those procedures where thermocoagulation was carried out, 2 CRF lesions at 80°C for 90 seconds each were performed. Following corticosteroid and local anesthetic (40 mg of methylprednisolone and 1 mL ...


[Perioperative management of patients with opioid tolerance and misuse].
Authors: Stoetzer C, Leffler A, Filitz J Abstract Patients with opioid pretreatment can be divided into different groups.While patients after successful drug addiction treatment with or without drug replacement therapy usually not require an extensive perioperative pain therapy, patients with persistent chronic pain and patients with an existing opioid addiction regularly are challenging for the anesthetist. Important pathophysiological issues among the patients include opioid tolerance, opioid-induced hyperalgesia (OIH) as well as acute withdrawal symptomes. Pharmakokinetic properties of the opioid seems to be crucial the manifestation of an acute withdrawal syndrome following opioid administration, and thus the use of remifentanil has frequently been reported to induce withdrawal...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://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, Safety, and Predictors of Intradiscal Methylene Blue Injection for Discogenic Low Back Pain: Results of a Multicenter Prospective Clinical Series
ConclusionsOur findings of 40% positive respondents, and no complications, give reason to set up a randomized, double‐blind, placebo‐controlled, trial. (Source: Pain Practice)


Bullying, abuse and family conflict as risk factors for chronic pain among Dutch adolescents
ConclusionsThe results of the present study suggest that bullying, abuse and family conflict may be risk factors for chronic pain in adolescents. Early signalling these stressors might prevent chronic pain. Implications and contributionEarly adversities, i.e. physical and sexual abuse, being bullied and family conflict, might be risk factors for developing chronic pain. In addition, the present study suggests that chronic pain is common among Dutch adolescents and interferes with their daily activities. If future studies confirm our results, this knowledge can be used to improve the signalling and prevention of chronic pain in adolescents. (Source: European Journal of Pain)


The Complexity Model: A Novel Approach to Improve Chronic Pain Care
ConclusionsFrom the perspective of the busy clinician, the treatment of chronic pain can be overwhelming. The scarcity of trained pain practitioners and the burgeoning number of patients with chronic pain necessitate a new approach that values the complex nature of chronic pain and offers a practical blueprint to meet these challenges. (Source: Pain Medicine)


Reversible Late Thoracic Myelopathy and Neurostimulation Tolerance Caused by Fibrous Scar Tissue Formation Around the Spinal Cord Stimulation Electrode
ConclusionCareful surgical removal of the fibrous tissue can be performed to allow decompression of the spinal cord and may help to obtain a more efficient pain management. As large surgical electrodes could be specifically associated with compressive scar tissue formation, they should therefore be considered as a second line of treatment after percutaneous leads. (Source: Neuromodulation: Technology at the Neural Interface)


Development and evaluation of short forms of the Pain Catastrophizing Scale and the Pain Self‐efficacy Questionnaire
ConclusionThe strongest short forms of the PCS and PSEQ could facilitate the assessment of pain catastrophizing and self‐efficacy in situations in which the use of the longer original measures is not feasible. (Source: European Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Reward responsiveness in patients with chronic pain
ConclusionsReward responsiveness is reduced in chronic pain patients of heterogeneous aetiology, and this reduction was associated with nucleus accumbens volume. Reduced reward responsiveness could be a marker of chronic pain vulnerability, and may indicate reduced opioid function. (Source: European Journal of Pain)


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


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


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


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


[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...


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


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


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)


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


Intramuscular 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)


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


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)


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


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)


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


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


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


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


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


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


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


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


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


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


Gender 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...


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


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


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


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


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


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


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


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


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)