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Technical refinement of mini-laparoscopic hernia repair in infants and children
Conclusions Our refined laparoscopic technique is a safe and effective method in the management of groin hernias in infants and children with a minimal early recurrence rate. (Source: Hernia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Misplaced central venous catheter in the vertebral artery: endovascular treatment of foreseen hemorrhage during catheter withdrawal.
CONCLUSION: Central venous catheterization (CVC) is not a risk-free procedure and arterial injuries are in a wide spectrum from a simple puncture to rupture of the artery. Inadvertent VA cannulation is a rare and serious complication necessitating prompt diagnosis and early treatment. If an arterial injury with a large-caliber catheter occurs, endovascular treatment with stent-graft seems to be a safe and effective option in terms of achieving hemostasis and preserving arterial patency. Recent findings suggest that endovascular management of inadvertent cervical arterial injury secondary to CVC seems to be the safest strategy. PMID: 25041914 [PubMed - in process] (Source: The Journal of Vascular Access)


Using tunneled femoral vein catheters for "urgent start" dialysis patients: a preliminary report.
CONCLUSIONS: Femoral vein tunneled catheters appear to be a safe, well tolerated, and effective temporary access in urgent start dialysis patients while they await more appropriate long-term access. PMID: 24817465 [PubMed - in process] (Source: The Journal of Vascular Access)


Peripheral nerve blocks in the treatment of migraine in pregnancy.
CONCLUSION: Peripheral nerve blocks for treatment-refractory migraine may be an effective therapeutic option in pregnancy. LEVEL OF EVIDENCE: : III. PMID: 25415168 [PubMed - in process] (Source: Obstetrics and Gynecology)


Pharmacokinetics of oral amantadine in greyhound dogs
This study reports the pharmacokinetics of amantadine in greyhound dogs after oral administration. Five healthy greyhound dogs were used. A single oral dose of 100 mg amantadine hydrochloride (mean dose 2.8 mg/kg as amantadine hydrochloride) was administered to nonfasted subjects. Blood samples were collected at predetermined time points from 0 to 24 h after administration, and plasma concentrations of amantadine were measured by liquid chromatography with triple quadrupole mass spectrometry. Noncompartmental pharmacokinetic analyses were performed. Amantadine was well tolerated in all dogs with no adverse effects observed. The mean (range) amantadine CMAX was 275 ng/mL (225–351 ng/mL) at 2.6 h (1–4 h) with a terminal half‐life of 4.96 h (4.11–6.59 h). The results of this ...


The involvement of norepinephrine in pain modulation in the nucleus accumbens of morphine-dependent rats
In this study, we examined the role of NE on the evoked discharges of pain-excitation neurons (PENs) and pain-inhibition neurons (PINs) in the nucleus accumbens (NAc) of rats, following the development of morphine dependence. Our results revealed that NE inhibited the evoked discharges of PENs and attenuated the inhibition of PINs, while phentolamine enhanced the evoked discharges of PENs and facilitated the inhibition of PINs. These results indicate that the inhibitory action of NE on pain modulation acts via alpha adrenoceptors in the NAc of morphine-dependent rats. (Source: Neuroscience Letters)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Intra-articular administration of an antibody against CSF-1 receptor reduces pain-related behaviors and inflammation in CFA-induced knee arthritis
Publication date: 1 January 2015 Source:Neuroscience Letters, Volume 584 Author(s): P.A. Alvarado-Vazquez , C.E. Morado-Urbina , G. Castañeda-Corral , R.I. Acosta-Gonzalez , H. Kitaura , K. Kimura , T. Takano-Yamamoto , J.M. Jiménez-Andrade Several studies have shown that blockade of colony stimulating factor-1 (CSF-1) or its receptor (CSF-1R) inhibits disease progression in rodent models of rheumatoid arthritis (RA); however, the role of the CSF-1/CSF-1R pathway in RA-induced pain and functional deficits has not been studied. Thus, we examined the effect of chronic intra-articular administration of a monoclonal anti-CSF-1R antibody (AFS98) on spontaneous pain, knee edema and functional disabilities in mice with arthritis. Unilateral arthritis was produced by multiple injections of com...


Antiallodynic effect through spinal endothelin-B receptor antagonism in rat models of complex regional pain syndrome
Publication date: 1 January 2015 Source:Neuroscience Letters, Volume 584 Author(s): Yeo Ok Kim , In Ji Kim , Myung Ha Yoon Complex regional pain syndrome (CRPS) is a very complicated chronic pain disorder that has been classified into two types (I and II). Endothelin (ET) receptors are involved in pain conditions at the spinal level. We investigated the role of spinal ET receptors in CRPS. Chronic post-ischemia pain (CPIP) was induced in male Sprague–Dawley rats as a model for CRPS-I by placing a tourniquet (O-ring) at the ankle joint for 3h, and removing it to allow reperfusion. Ligation of L5 and L6 spinal nerves to induce neuropathic pain was performed as a model for CRPS-II. After O-ring application and spinal nerve ligation, the paw withdrawal threshold was significantly decreased...


Spanish consensus on the physical health of patients with depressive disorders
Publication date: Available online 26 November 2014 Source:Revista de Psiquiatría y Salud Mental (English Edition) Author(s): José Giner , Jerónimo Saiz Ruiz , Julio Bobes , Enric Zamorano , Francisco López , Teresa Hernando , Fernando Rico-Villademoros , Cecilio Álamo , Jorge A. Cervilla , Ángela Ibáñez Cuadrado , Elena Ibáñez Guerra , Silvia López , Pedro Morán , Diego J. Palao , Montserrat Romacho Comorbidity between depression and physical illnesses is very common and has a significant impact on the health and management of the patient. With the support of the Sociedades Españolas de Psiquiatría y Psiquiatría Biológica and Sociedad Española de Médicos de Atención Primaria (SEMERGEN) a consensus was prepared on physical health in patients with depression and it is s...


Intramuscular pain modulatory substances before and after exercise in women with chronic neck pain
ConclusionsThe findings at baseline indicated algesic and analgesic alterations in the painful trapezius muscles. The findings for CNSP after the exercise intervention, with changes in peripheral substances and decreased pain intensity and sensitivity, could reflect a long‐term physiological effect of the exercise. (Source: European Journal of Pain)


Temporomandibular disorders in fibromyalgia syndrome: a short-communication
Publication date: Available online 26 November 2014 Source:Revista Brasileira de Reumatologia (English Edition) Author(s): Maísa Soares Gui , Marcele Jardim Pimentel , Célia Marisa Rizzatti Barbosa Fibromyalgia syndrome (FMS) is a chronic painful syndrome and the coexistence of a painful condition caused by Temporomandibular Disorders (TMD) and FMS has been frequently raised for several studies; however, a more likely hypothesis is that a set of FMS characteristics may lead to the onset of TMD symptoms and they are not merely coexisting conditions. Therefore, our aim is presenting a review of literature about the relation between fibromyalgia and the signs and symptoms of temporomandibular disorders. For this purpose, a bibliographic search was performed for the period of 1990–2013, ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Kinematic effect of Chinese herbal fomentation on patients with chronic neck pain
Conclusions Chinese herbal fomentation could improve abnormal mobility in terms of ROM and ICR. Chinese herbal fomentation might be an effective treatment for chronic neck pain. (Source: Chinese Journal of Integrative Medicine)


Anesthesia-free procedures for benign prostate obstruction: worth it?
Purpose of review: Perhaps, 30% of patients with benign prostate obstruction experience no symptom relief with drug therapy, necessitating surgical intervention. General anesthesia can be too dangerous for elderly or frail men, making local anesthesia desirable. Such minimally invasive procedures may offer time-saving, effective, gentle, and well tolerated alternatives. Recent findings: Recent interest has focused on the mechanical devices and intraprostatic injections. The commercially available UroLift system demonstrates promising short-term data in randomized multicenter trials. Rezum steam injection therapy is intriguing, although currently study-based with limited data. NX1207 and PRX302 are new intraprostatic injection drugs demonstrating interesting results in phase I and II studie...


'Off switch' for pain discovered: Activating the adenosine A3 receptor subtype is key to powerful pain relief
A way to block a pain pathway in animal models of chronic neuropathic pain has been discovered by researchers, suggesting a promising new approach to pain relief. (Source: ScienceDaily Headlines)


Uneven or large breasts can cause teen angst
ConclusionThis study found young females with macromastia report lower quality of life and physical health, as well as more pain and poorer mental health than females with asymmetrical breasts or those with average breasts. However, in this study, females with asymmetrical breasts of more than a cup size difference did report lower self-esteem. Contrary to the media reporting, the study did not assess the impact of any treatment or surgical interventions on self-esteem, physical or mental health.The study also did not find that females developed eating disorders because of their breasts. The researchers found women with asymmetrical breasts scored higher on a questionnaire about disordered attitudes to eating than controls, but this was no longer significant if BMI was taken into account. ...


Chronic physical illness: a psychophysiological approach for chronic physical illness.
Authors: Purdy J Abstract Growing evidence demonstrates that psychological risk variables can contribute to physical disease. In an effort to thoroughly investigate potential etiological origins and optimal interventions, this broad review is divided into five sections: the stress response, chronic diseases, mind-body theoretical models, psychophysiological interventions, and integrated health care solutions. The stress response and its correlation to chronic disorders such as cardiovascular, gastrointestinal, autoimmune, metabolic syndrome, and chronic pain are comprehensively explored. Current mind-body theoretical models, including peripheral nerve pathway, neurophysiological, and integrative theories, are reviewed to elucidate the biological mechanisms behind psychophysiologica...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


FDA Panel Says Steroid Shots for Back Pain Can Continue
Title: FDA Panel Says Steroid Shots for Back Pain Can ContinueCategory: Health NewsCreated: 11/25/2014 12:00:00 AMLast Editorial Review: 11/26/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


SLU researcher finds an off switch for pain
(Saint Louis University) Researchers have discovered a way to block a pain pathway in animal models of chronic neuropathic pain suggesting a promising new approach to pain relief. (Source: EurekAlert! - Medicine and Health)


Delayed diagnosis of subacute angle closure glaucoma in patients presenting with headaches
This study characterizes the medical course and symptoms of patients with SACG in whom headache was the major symptom. This retrospective observational study consisted of 30 consecutive patients, suffering from headaches and diagnosed with SACG, collected from the Glaucoma Service at the Ophthalmology Department of Meir Medical Center, Kfar Saba, Israel, a tertiary care referral facility. The primary study outcomes were reasons for referral, number of specialists visited and number of imaging studies performed before diagnosing SACG and headache characteristics. The majority of the patients experienced headaches once or twice a week. Four patients suffered a classic SACG pain involving the eye and frontal or hemicranial area. The mean time from onset of headaches to diagnosis was 2.6 year...


Opioid-induced constipation: pathophysiology, clinical consequences, and management.
Authors: Kumar L, Barker C, Emmanuel A Abstract Although opioids offer potent analgesia for severe acute and chronic noncancer pain, adverse gastrointestinal effects potentially undermine their clinical utility. In particular, between 40% and 95% of patients develop opioid-induced constipation (OIC). Therefore, there is a consensus that patients should commence laxatives at the start of opioid therapy and continue throughout treatment. Nevertheless, laxatives are not routinely coprescribed with opioids. Even when concurrent laxatives are prescribed, approximately half the patients treated for OIC do not achieve the desired improvement. Moreover, laxatives do not target the underlying cause of OIC (opioid binding to the μ -receptors in the enteric system) and as such are not very e...


Sleep problems, exercise and obesity and risk of chronic musculoskeletal pain: The Norwegian HUNT study
Conclusion: Sleep problems are associated with an increased risk of chronic pain in the low back and neck/shoulders. Regular exercise and maintenance of normal body weight may reduce the adverse effect of mild sleep problems on risk of chronic pain. (Source: The European Journal of Public Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Task-Specificity of Bilateral Anticipatory Activation of the Deep Abdominal Muscles in Healthy and Chronic Low Back Pain Populations
The deep abdominal muscles, and in particular the transversus abdominis (TrA), have received substantial attention for their role in lumbo-pelvic motor control [1–3]. This is first because TrA is thought to provide stiffness to the lumbosacral spine during a bilaterally symmetrical contraction [4,5] [6] through its attachments to the pelvis [7] and the thoracolumbar fascia [8]. Then, a series of studies on healthy individuals in the mid-1990s suggested that TrA was always activated in anticipation to rapid unilateral limb movements and independently of the direction of movement whereas the activation of other trunk muscles was direction-specific [1–3]. (Source: Gait and Posture)


The effect of a self-determination theory-based communication skills training program on physiotherapists’ psychological support for their patients with chronic low back pain: A randomized controlled trial
To examine communication skills training effects on physiotherapists’ supportive behavior during clinical practice. (Source: Archives of Physical Medicine and Rehabilitation)


In Vivo Phenotypic Screening for Treating Chronic Neuropathic Pain: Modification of C2-Arylethynyl Group of Conformationally Constrained A3 Adenosine Receptor Agonists
Journal of Medicinal ChemistryDOI: 10.1021/jm501021n (Source: Journal of Medicinal Chemistry)


Referral Patterns, Diagnosis, and Disease Management of Patients With Axial Spondyloarthritis: Results of an International Survey
Conclusions: Referral patterns, diagnosis, and disease management for axial SpA were similar among WE, North America, and RoW rheumatologists and in academic/community practices, although more WE and RoW rheumatologists referred to Assessment of SpondyloArthritis International Society criteria in clinical practice. Disease-modifying antirheumatic drugs were commonly prescribed for axial SpA patients, although it was unclear whether these were prescribed for axial or peripheral symptoms. (Source: JCR: Journal of Clinical Rheumatology)


Does presence of anterior greater tuberosity cysts change the function in patients with chronic rotator cuff tear?
CONCLUSION: Our findings demonstrated that decreased function, larger cuff tears and muscle atrophy can be observed patients with anterior greater tuberosity cysts. Anterior greater tuberosity cysts can be detected by plain X-rays. The presence of these cysts should warn the physician regarding the possibility of decreased shoulder function, muscle atrophy and larger cuff tear before ordering a magnetic resonance imaging. PMID: 25413458 [PubMed - in process] (Source: Pain Physician)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Effectiveness of pulsed radiofrequency with multifunctional epidural electrode in chronic lumbosacral radicular pain with neuropathic features.
CONCLUSIONS: PRF of dorsal root ganglion performed with a multifunctional electrode for &gt; 240 seconds appears to be safe and might be more effective than the classic 120 seconds needle-mediated approach. Therefore, it may be considered as a valuable tool for the treatment of lumbosacral radicular pain with neuropathic features. PMID: 25415772 [PubMed - in process] (Source: Pain Physician)


A survey on teaching ultrasound-guided chronic pain procedures in pain medicine fellowship programs.
CONCLUSION: The teaching of ultrasound guided chronic pain procedures varies significantly between individual programs. Though many program directors do require that fellows demonstrate competency in the technique before graduation, as of today there is no ACGME guideline regarding this. The advancement in ultrasound technology and the increase in number of trained faculty may significantly impact the use of USG in training fellows to perform chronic pain procedures. PMID: 25415783 [PubMed - in process] (Source: Pain Physician)


Lumbar interlaminar epidural injections are superior to caudal epidural injections in managing lumbar central spinal stenosis.
CONCLUSIONS: The results of this assessment showed significant improvement in patients suffering with chronic lumbar spinal stenosis with caudal and interlaminar epidural approaches with local anesthetic only, or with steroids in a long-term follow-up of up to 2 years, in contemporary interventional pain management setting, with the interlaminar approach providing significantly better results. PMID: 25415784 [PubMed - in process] (Source: Pain Physician)


Pulsed radiofrequency for occipital neuralgia.
CONCLUSION: Clinical studies to date examining the efficacy of PRF as a treatment for occipital neuralgia have yielded promising results, demonstrating sustained improvement in pain, quality of life, and adjuvant pain medication usage. Despite these encouraging clinical studies, conclusive evidence in support of PRF as an interventional treatment option for occipital neuralgia awaits to be seen. PMID: 25415786 [PubMed - in process] (Source: Pain Physician)


Development of an Effective Topical Liposomal Formulation for Localized Analgesia and Anti-inflammatory Actions in the Complete Freund's Adjuvant Rodent Model of Acute Inflammatory Pain.
CONCLUSIONS: The study demonstrates that topically applied loperamide encapsulated within liposomal systems has improved therapeutic efficacy over conventional formulations for the local treatment of acute peripheral inflammatory pain conditions where the skin has remained intact. Once in the inflamed peripheral tissue, loperamide provides analgesic and anti-inflammatory effects in a similar manner to peripheral endogenous opioids. This preparation optimises the retention of drug at the site where action is required. PMID: 25415787 [PubMed - in process] (Source: Pain Physician)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Hemiparesis and Facial Sensory Loss following Cervical Epidural Steroid Injection.
Authors: Maddela R, Wahezi SE, Sparr S, Brook A Abstract Interlaminar cervical epidural steroid injections (ic-ESI) are safe and effective treatment options for the management of acute and chronic radiculopathy, spinal stenosis, and other causes of neck pain not responding to more conservative measures. However, the procedure inherently lends itself to possible spinal cord injury (SCI). Though reports of such events have been documented, the clinical presentation of patients with needle puncture SCI varies. In part, this may be due to anatomic considerations, as symptoms may be dependent on the cervical level intruded, as well as the volume and type of injectate used. Many cases go unreported and therefore the true incidence of cord injections during ic-ESI is not known. Cervical e...


Greater trochanteric pain syndrome due to tumoral calcinosis in a patient with chronic kidney disease.
We report our experience of symptomatic improvement following the repeated ultrasound-guided aspiration of calcific fluid and the injection of a mixture of local anesthetic and steroid. PMID: 25415793 [PubMed - in process] (Source: Pain Physician)


Neuromodulation of the suprascapular nerve.
Authors: Elahi F, Reddy CG Abstract The shoulder joint is an enarthrodial or ball-and-socket joint. A complex network of anatomic structures endows the human shoulder with tremendous mobility, greater than any other joint in the body. Many pathologies can been found in those patients with chronic shoulder pain. The painful limitation of shoulder motion affects hand and arm motion as well; therefore, it significantly influences work performance and everyday activities as well as the quality of life. Therefore, the treatment of patients with chronic shoulder pain has major social and health economic implications. In this article we present a patient with a complex history of shoulder pathology including 7 surgeries that left the patient with chronic debilitating shoulder pain. She wa...


Tryptamine levels are low in plasma of chronic migraine and chronic tension-type headache
Abstract The primary aim of this study (TA-CH, Tryptophan Amine in Chronic Headache) was to investigate a possible role of tryptophan (TRP) metabolism in chronic migraine (CM) and chronic tension-type headache (CTTH). It is not known if TRP metabolism plays any role in CM and/or CTTH. Plasma levels of serotonin (5-HT), 5-hydroxyindolacetic acid (5-HIAA), metabolite of 5-HT, and tryptamine (TRY) were tested in 73 patients with CM, 15 patients with CTTH and 37 control subjects. Of these, plasmatic TRY was significantly lower in CM (p &lt; 0.001) and in CTTH (p &lt; 0.002) patients with respect to control subjects, while 5-HIAA levels in plasma were within the same range in all groups. 5-HT was undetectable in the plasma of almost all subjects. Our results support the hypothesis...


Central antalgic activity of resveratrol.
In this study, the response to painful stimuli of the animals treated with resveratrol had a bimodal profile with hypoalgesia or hyperalgesia. In the selected experimental conditions, resveratrol had a definite analgesic effect; the increase in time to reaction ranged from 100-120% (8 rats) to 600-700% (9 rats). In this experiment resveratrol exerts evident central antalgic effects in the majority of rats, which are related to the individual level of excitation and vigilance at baseline. Antinociceptive induced by resveratrol icv injection was maximal at 4-10 min and lasted no longer than 15 min. The effect of resveratrol to produce analgesia after a single icv injection may be interesting for preventing chronic pain. PMID: 21308652 [PubMed - indexed for MEDLINE] (Source: Archives Ital...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Metabolomics insights into pathophysiological mechanisms of interstitial cystitis.
Authors: Fiehn O, Kim J Abstract Interstitial cystitis (IC), also known as painful bladder syndrome or bladder pain syndrome, is a chronic lower urinary tract syndrome characterized by pelvic pain, urinary urgency, and increased urinary frequency in the absence of bacterial infection or identifiable clinicopathology. IC can lead to long-term adverse effects on the patient's quality of life. Therefore, early diagnosis and better understanding of the mechanisms underlying IC are needed. Metabolomic studies of biofluids have become a powerful method for assessing disease mechanisms and biomarker discovery, which potentially address these important clinical needs. However, limited intensive metabolic profiles have been elucidated in IC. The article is a short review on metabolomic anal...


Pain, catastrophizing, and depression in chronic prostatitis/chronic pelvic pain syndrome.
Authors: Kwon JK, Chang IH Abstract Persistent and disabling pain is the hallmark of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, disease severity (as measured by objective indexes such as those that use radiography or serology) is only marginally related to patients' reports of pain severity, and pain-related presentation can differ widely among individuals with CP/CPPS. Increasing evidence in support of the biopsychosocial model of pain suggests that cognitive and emotional processes are crucial contributors to inter-individual differences in the perception and impact of pain. This review describes the growing body of literature relating depression and catastrophizing to the experience of pain and pain-related sequelae in CP/CPPS. Depression and catastroph...


Effects of a Short Course of Oral Prednisolone in Patients with Bladder Pain Syndrome with Fluctuating, Worsening Pain despite Low-Dose Triple Therapy.
CONCLUSIONS: In patients with BPS/IC who show transient, fluctuating, worsening pain as flare-up symptoms despite undergoing low-dose triple therapy, a short course of oral prednisolone therapy was sufficiently effective. However, large-scale studies should be performed to verify our findings. PMID: 23346483 [PubMed] (Source: International Neurourology Journal)


'Omics' approaches to understanding interstitial cystitis/painful bladder syndrome/bladder pain syndrome.
Authors: You S, Yang W, Anger JT, Freeman MR, Kim J Abstract Recent efforts in the generation of large genomics, transcriptomics, proteomics, metabolomics and other types of 'omics' data sets have provided an unprecedentedly detailed view of certain diseases, however to date most of this literature has been focused on malignancy and other lethal pathological conditions. Very little intensive work on global profiles has been performed to understand the molecular mechanism of interstitial cystitis/painful bladder syndrome/bladder pain syndrome (IC/PBS/BPS), a chronic lower urinary tract disorder characterized by pelvic pain, urinary urgency and frequency, which can lead to long lasting adverse effects on quality of life. A lack of understanding of molecular mechanism has been a chall...


The prevalence of sacroiliitis and spondyloarthritis in patients with sarcoidosis.
Conclusion. We found spondyloarthritis in patients with sarcoidosis at a higher percentage rate than in the general population (1-1.9%). Controlled trials involving large series of patients are required for the confirmation of the data. PMID: 24899899 [PubMed] (Source: International Journal of Rheumatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The Relationship between Mechanical Hyperalgesia Assessed by Manual Tender Point Examination and Disease Severity in Patients with Chronic Widespread Pain: A Cross-Sectional Study.
The objective of this study was to assess the relationship between mechanical hyperalgesia assessed by manual TP examination and clinical disease severity. 271 women with CWP were recruited from a clinical setting. Data collection included patient-reported symptoms, health-related quality of life variables, and observation-based measures of functional ability, muscle strength, 6-minute walk, and pressure pain thresholds measured by cuff algometry. TP examination was conducted according to ACR-guidelines. Relationships between disease variables and TP count (TPC) were analyzed with logistic regression in a continuum model, allowing the TPC to depend on the included disease variables and two regression models carried out for a TPC threshold level, varying between 1 and 17. The threshold anal...


Quantitative sensory testing in painful hand osteoarthritis demonstrates features of peripheral sensitisation.
Authors: Wajed J, Ejindu V, Heron C, Hermansson M, Kiely P, Sofat N Abstract Hand osteoarthritis (HOA) is a prevalent condition for which treatments are based on analgesia and physical therapies. Our primary objective was to evaluate pain perception in participants with HOA by assessing the characteristics of nodal involvement, pain threshold in each hand joint, and radiological severity. We hypothesised that inflammation in hand osteoarthritis joints enhances sensitivity and firing of peripheral nociceptors, thereby causing chronic pain. Participants with proximal and distal interphalangeal (PIP and DIP) joint HOA and non-OA controls were recruited. Clinical parameters of joint involvement were measured including clinical nodes, VAS (visual analogue score) for pain (0-100 mm sca...


23-year-old female with dyspnea, hematuria, and seizure progressing to respiratory failure.
We report a 23-year old female who presented with fever, shortness of breath and abdominal pain. Shortly thereafter the patient developed hematuria, hemoptysis and seizure progressing to respiratory failure. She was found to have aortitis and alveolar hemorrhage. We discuss the clinical manifestations and the diagnostic work up of Takayasu arteritis. The patient's response to therapy and a discussion on treatment modalities of the disease are also included in the report. PMID: 24003540 [PubMed - indexed for MEDLINE] (Source: Sarcoidosis Vasculitis and Diffuse Lung Diseases)


Two-Dimensional Ultrasound and Ultrasound Elastography Imaging of Trigger Points in Women with Myofascial Pain Syndrome Treated by Acupuncture and Electroacupuncture: A Double-Blinded Randomized Controlled Pilot Study.
Authors: Müller CE, Aranha MF, Gavião MB Abstract Chronic pain has been often associated with myofascial pain syndrome (MPS), which is determined by myofascial trigger points (MTrP). New features have been tested for MTrP diagnosis. The aim of this study was to evaluate two-dimensional ultrasonography (2D US) and ultrasound elastography (UE) images and elastograms of upper trapezius MTrP during electroacupuncture (EA) and acupuncture (AC) treatment. 24 women participated, aged between 20 and 40 years (M ± SD = 27.33 ± 5.05) with a body mass index ranging from 18.03 to 27.59 kg/m2 (22.59 ± 3.11), a regular menstrual cycle, at least one active MTrP at both right (RTPz) and left trapezius (LTPz) and local or referred pain for up to six months. Subjects were randomized into EA and...


Ultrasonic characterization of the upper trapezius muscle in patients with chronic neck pain.
Authors: Turo D, Otto P, Shah JP, Heimur J, Gebreab T, Zaazhoa M, Armstrong K, Gerber LH, Sikdar S Abstract Myofascial trigger points (MTrPs) are palpable, tender nodules in taut bands of skeletal muscle that are painful on compression. MTrPs are characteristic findings in myofascial pain syndrome (MPS). The role of MTrPs in the pathophysiology of MPS is unknown. Localization, diagnosis, and clinical outcome measures of painful MTrPs can be improved by objectively characterizing and quantitatively measuring their properties. The goal of this study was to evaluate whether ultrasound imaging and elastography can differentiate symptomatic (active) MTrPs from normal muscle. Patients with chronic (&gt;3 months) neck pain with spontaneously painful, palpable (i.e., active) MTrPs and heal...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


P2X(7) Receptors in Neurological and Cardiovascular Disorders.
Authors: Skaper SD, Debetto P, Giusti P Abstract P2X receptors are ATP-gated cation channels that mediate fast excitatory transmission in diverse regions of the brain and spinal cord. Several P2X receptor subtypes, including P2X(7), have the unusual property of changing their ion selectivity during prolonged exposure to ATP, which results in a channel pore permeable to molecules as large as 900 daltons. The P2X(7) receptor was originally described in cells of hematopoietic origin, and mediates the influx of Ca(2+) and Na(+) and Ca(2+) and Na(+) ions as well as the release of proinflammatory cytokines. P2X(7) receptors may affect neuronal cell death through their ability to regulate the processing and release of interleukin-1beta, a key mediator in neurodegeneration, chronic inflamm...


P2X(7) Receptors as a Transducer in the Co-Occurrence of Neurological/Psychiatric and Cardiovascular Disorders: A Hypothesis.
Authors: Skaper SD, Giusti P Abstract Background. Over-stimulation of the purinergic P2X(7) receptor may bring about cellular dysfunction and injury in settings of neurodegeneration, chronic inflammation, as well as in psychiatric and cardiovascular diseases. Here we speculate how P2X(7) receptor over-activation may lead to the co-occurrence of neurological and psychiatric disorders with cardiovascular disorders. Presentation. We hypothesize that proinflammatory cytokines, in particular interleukin-1beta, are key players in the pathophysiology of neurological, psychiatric, and cardiovascular diseases. Critically, this premise is based on a role for the P2X(7) receptor in triggering a rise in these cytokines. Given the broad distribution of P2X(7) receptors in nervous, immune, and v...


Revision of infected total knee arthroplasty: two-stage reimplantation using an antibiotic-impregnated static spacer.
CONCLUSIONS: This technique is a reasonable procedure to eradicate chronic infection in knee arthroplasty and provides proper functional and clinical results. However, it sometimes requires extensile surgical approaches that could imply arduous surgeries. Metallic augments with cementless stems available in most of the knee revision systems are a suitable alternative to handle bone deficiencies, avoiding the use of bone allografts with its complications. PMID: 24009903 [PubMed - indexed for MEDLINE] (Source: Clinics in Orthopedic Surgery)


Clinical and radiological predictive factors to be related with the degree of lumbar back muscle degeneration: difference by gender.
CONCLUSIONS: The PT was the important predictive factor for lumbar back muscle degeneration in both, the male and the female group. However, age and BMI were predictive factors in the female group only. PMID: 25177458 [PubMed - in process] (Source: Clinics in Orthopedic Surgery)


Randomized controlled study on resistive vibration exercise (EVE study): protocol, implementation and feasibility.
CONCLUSIONS: These data suggest positive effects of resistance exercise upon cardiovascular health and vascular responsiveness and a further beneficial effect of superimposed vibrations in decreasing resting diastolic blood pressure. Finally, development of back pain may be fostered by superimposed vibrations to high training loads, particularly at higher frequencies. PMID: 23728101 [PubMed - indexed for MEDLINE] (Source: Journal of Musculoskeletal Neuronal Interactions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


A Comparative Pilot Study to Evaluate the Adjunctive Role of Levosulpride with Trigger Point Injection Therapy in the Management of Myofascial Pain Syndrome of Orofacial Region
Conclusions The combined therapy with conventional trigger point injection and levosulpride as antidepressant significantly reduce pain and depression in the study subjects suffering from chronic myofascial pain with moderate to severe depression in the orofacial region. (Source: Journal of Maxillofacial and Oral Surgery)


A comparative analysis of magnetic resonance imaging and radiographic examinations of patients with atypical odontalgia.
CONCLUSION: MRI examination revealed no changes in the painful region in a majority of patients with AO, suggesting that inflammation was not present. MRI findings were significantly correlated to radiographic findings. PMID: 25068217 [PubMed - indexed for MEDLINE] (Source: Journal of Orofacial Pain)


Beliefs and distress about orofacial pain: patient journey through a specialist pain consultation.
CONCLUSION: Patients' fears and beliefs about chronic orofacial pain are dominated by worrying and searching for meaning before consultation. Information about their chronic pain condition counters feelings of helplessness and supports sense-making around pain when explanations are clear, are delivered sensitively from a trusted source, and take into account the patient's existing health beliefs; this promotes self-management. These findings underline the important functions of specialist consultation in achieving a shared accurate understanding of pain and options for treatment. PMID: 25068216 [PubMed - indexed for MEDLINE] (Source: Journal of Orofacial Pain)


Masticatory and cervical muscle tenderness and pain sensitivity in a remote area in subjects with a temporomandibular disorder and neck disability.
CONCLUSION: The results of this study have highlighted the importance of assessing TMD patients not only in the craniofacial region but also in the neck and other parts of the body. Future studies should focus on testing the effectiveness of treatments addressing the neck and the pain sensitivity in the hand in patients with TMD. PMID: 24829929 [PubMed - indexed for MEDLINE] (Source: Journal of Orofacial Pain)


Bilateral stellate ganglion blockade for recalcitrant oral pain from Burning Mouth Syndrome: a case report.
This article presents a case report of stellate ganglion blockade as a treatment for recalcitrant pain from BMS. PMID: 24822241 [PubMed - indexed for MEDLINE] (Source: Journal of Orofacial Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Topical review: the enigma of fibromyalgia.
This article reviews the epidemiology, etiology, pathophysiology, and clinical presentation of fibromyalgia, as well as therapeutic advances. Also highlighted are issues that are important to the oral health care provider, including orofacial manifestations and oral health care considerations for patients with fibromyalgia. PMID: 24822234 [PubMed - indexed for MEDLINE] (Source: Journal of Orofacial Pain)


Antinociceptive effects of mirtazapine, pregabalin, and gabapentin after chronic constriction injury of the infraorbital nerve in rats.
CONCLUSION: Intraspinal administration of either mirtazapine, gabapentin, or pregabalin reverses the lowered facial mechanical thresholds produced in a rat model of trigeminal neuropathic pain. PMID: 24482789 [PubMed - indexed for MEDLINE] (Source: Journal of Orofacial Pain)


Search for antisickling agents from plants.
Authors: Dash BP, Archana Y, Satapathy N, Naik SK Abstract The sickle cell disease is fatal in nature. Thousands of children are dying off due to this health problem throughout the globe. Due to the rapid development of diagnosis and clinical managements such patients are living up to a respectable age. But as there is no permanent cure the patients are suffering from bone and joint pain, jaundice, hepato-splenomegaly, chronic infections etc. The main physiological complicacy is due to the polymerization of sickle hemoglobin (HbS), (sickling process) inside the red blood cell (RBC) of these patients during deoxygenating state. The change of RBC from spherical to sickle shape is due to the polymerization of mutant hemoglobin (HbS) inside the RBC and membrane distortion during anoxic...


Pain-related worry in patients with chronic orofacial pain.
CONCLUSIONS: Participants with chronic orofacial pain reported experiencing substantial levels of trait worry, anxiety, PC and worry about pain that related to pain ratings directly and indirectly. PRACTICAL IMPLICATIONS: Clinicians should assess pain-related worry in patients with chronic orofacial pain to understand the effects of worry on pain and functioning. Clinicians could treat these patients more effectively by helping them reduce their levels of pain-related worry and focusing on improved coping. PMID: 24982278 [PubMed - in process] (Source: Journal of the American Dental Association)


Clitoral Reconstruction after Female Genital Mutilation/Cutting: Case Studies
ConclusionWe show a positive outcome in pain reduction and improved sexual function, self body image, and gender after psychosexual therapy and clitoral reconstruction. More evidence is needed about clitoral reconstruction to develop guidelines on best practices. Until research is conducted that rigorously evaluates clitoral reconstruction for its impact on pain and sexuality, we advise always offering a multidisciplinary care, including sexual therapy before and after the surgery. Abdulcadir J, Rodriguez MI, Petignat P, and Say L. Clitoral reconstruction after female genital mutilation/cutting: Case studies. J Sex Med **;**:**–**. (Source: The Journal of Sexual Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Blowing Away the Pain: A Technique for Pediatric Pain Management
We describe a distraction technique for pediatric pain management that involves “blowing away the pain.” This technique may be used for acute pediatric procedures as well as for patients with chronic pain. (Source: Pediatric Dermatology)


Laparoscopic ventral mesh rectopexy in male patients with internal or external rectal prolapse
ConclusionLVMR is an effective treatment for external and symptomatic internal rectal prolapse in men, leading to significant improvement in QoL and function. (Source: Colorectal Disease)


Association of neutrophil extracellular traps with endometriosis-related chronic inflammation
Conclusion This is the first study, which evaluated and described the presence of NETs in the PF of endometriosis patients. Our study shows, that NETs may be involved in the complex pathophysiology of endometriosis. (Source: European Journal of Obstetrics and Gynecology and Reproductive Biology)


Spinal cord infarction as a complication of hemodialysis
A 76-year-old man with past history of hypertension, hyperlipidemia, diabetes mellitus and chronic kidney disease was referred because of acute onset paraplegia occurring shortly after hemodialysis. He experienced severe hypotension in the middle of dialysis session and acute onset low back pain afterwards. On examination he had a T9-T10 sensory level. MR Imaging revealed a longitudinal T2 hyperintense lesion extending from T8 to L1 in the center of the cord without gadolinium enhancement (Figure 1). (Source: The Spine Journal)


Association Between Experimental Pain Biomarkers and Serologic Markers in Patients With Different Degrees of Painful Knee Osteoarthritis
ConclusionA platform of mechanistic pain biomarkers in combination with structure‐related serologic biomarkers provides new possibilities for understanding how osteoarthritis‐related structural features may be associated with pain and pain sensitization. This study showed significant correlations between central pain sensitization and CRPM as a possible measure for chronic inflammation. Future pain association studies should include biomarkers representing the local joint environment more specifically. (Source: Arthritis and Rheumatism)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Chronic Pain and Health Care Spending: An Analysis of Longitudinal Data from the Medical Expenditure Panel Survey
ConclusionsChronic pain limitations are associated with higher health care expenditures. Results underscore the substantial cost of pain to the health care system. (Source: Health Services Research)


Targeting C5aR for pain relief [Pharmacology]
Chronic pain resulting from inflammatory and neuropathic disorders causes considerable economic and social burden. Pharmacological therapies currently available for certain types of pain are only partially effective and may cause severe adverse side effects. The C5a anaphylatoxin acting on its cognate G protein-coupled receptor (GPCR), C5aR, is a potent pronociceptive... (Source: Proceedings of the National Academy of Sciences)


Tapentadol Potentiates Descending Pain Inhibition in Chronic Pain Patients With Diabetic Polyneuropathy
No abstract available (Source: Survey of Anesthesiology)


Type 2 Diabetes: Not Invisible, but Misunderstood
Sourced from The Hysterectomy Association: Hysterectomy Association - Hysterectomy Association - hysterectomy, menopause and hormone replacement therapy (hrt) information and support for women. Type 2 diabetes is a rapidly growing global health concern. It is estimated to affect more than 300 million people worldwide, and around 90% of all diabetics have this form of the condition. However, despite type 2 being well and truly in the spotlight, it is still frequently misunderstood. Much has been said in the media about the connection between type 2 diabetes, obesity and a sedentary lifestyle – so much so that perhaps we’re inclined to feel unsympathetic towards type 2 patients? But even while it’s true that Type 2 diabetes can be prevented in many cases, it remains a serious and incur...


Sickle Cell Anemia Treatment So Successful in Kids That Trial Is Halted
Title: Sickle Cell Anemia Treatment So Successful in Kids That Trial Is HaltedCategory: Health NewsCreated: 11/21/2014 12:00:00 AMLast Editorial Review: 11/24/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


What Types of Patients Can Be Referred for Palliative Care Services?
Discussion Pediatric pallative care (PPC) is care for patients who have life-threatening conditions or need end of life care. The main stakeholders receiving PPC are the patients and all members of the family which may include siblings, grandparents and other members. Other stakeholders are the medical care team including ancillary staff at the hospital and other venues where the patient receives care. PPC is provided by an interdisciplinary team including physicians, nurses, social workers, pharmacists, psychologists, chaplains/faith workers and others who assist families in four main areas: &#8220;&#8230;relieve suffering, improve quality of life, facilitate informed decision-making and assist in care coordination between clinicians and across sites of care.&#8221; PPC providers can hel...


Perspectives in Pain Research 2014: Neuroinflammation and glial cell activation: The cause of transition from acute to chronic pain?
Conclusions The present perspective paper indicates that neuroinflammation and the associated release of pro-inflammatory cytokines in dorsal root ganglion and at the spinal cord contribute to the transition from acute to chronic pain. Neuroinflammatory changes have not only been identified in the spinal cord and brainstem, but more recently, in the sensory ganglia and in the nerves as well. The glial cell activation may be responsible for contralateral spreading and possible widespread sensitisation. Implications Communication between glia and neurons is proposed to be a critical component of neuroinflammatory changes that may lead to chronic pain. Sensory ganglia neurons are surrounded by satellite glial cells but how communication between the cells contributes to altered pain sensitivi...


Stereotactic body radiation therapy for abdominal and pelvic oligometastases: Dosimetric targets for safe and effective local control
Conclusions Our results suggest that SBRT doses 40-50 Gy in 5 fractions (biological effective dose 72-100 Gy10) with bowel V20Gy ≤20 mL are efficacious and associated with minimal toxicity for abdominal pelvic nodal and soft-tissue oligometastases. Palliation of symptoms is achievable in most patients with symptomatic lesions. SBRT for oligometastases may be a good alternative to systemic therapy in selected patients. (Source: Practical Radiation Oncology)


σ1 receptors activate astrocytes via p38 MAPK phosphorylation leading to the development of mechanical allodynia in a mouse model of neuropathic pain
Conclusions and ImplicationsSpinal σ1 receptors are localized in astrocytes and blockade of σ1 receptors inhibits the pathological activation of astrocytes via modulation of p‐p38, which ultimately prevents the development of MA in neuropathic mice. (Source: British Journal of Pharmacology)


The non‐peptide GLP‐1 receptor agonist WB4‐24 blocks inflammatory nociception by stimulating β‐endorphin release from spinal microglia
Conclusions and ImplicationsOur results suggest that WB4‐24 inhibits inflammatory nociception by releasing analgesic β‐endorphin rather than inhibiting the expression of proalgesic pro‐inflammatory cytokines in spinal microglia, and that the spinal GLP‐1 receptor is a potential target molecule for the treatment of pain hypersensitivity including inflammatory nociception. (Source: British Journal of Pharmacology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


In vivo properties of KNT‐127, a novel δ opioid receptor agonist: receptor internalization, antihyperalgesia and antidepressant effects in mice
Conclusions and ImplicationsThe DOP receptor agonist KNT‐127 induced agonist‐specific acute and chronic responses, at both behavioural and cellular levels. It displays activities similar to the other recently reported DOP agonists, AR‐M1000390, ADL5747 and ADL5859, and differs from SNC80. SNC80 differs from the other DOP receptor agonists including KNT‐127, by exhibiting ligand‐biased tolerance at this receptor. (Source: British Journal of Pharmacology)


Gender Differences in Acute and Chronic Pain in the Emergency Department: Results of the 2014 Academic Emergency Medicine Consensus Conference Pain Section
Abstract Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were r...


Mobile Pharmacy: An Innovative Community Pharmacy Primary Care Collaboration for Complex Co-Morbid and Chronic Pain Patients (Scott Vincent Monte PharmD)
Power point presentation outlining clinical and operational collaboration opportunities between primary care and community pharmacy. (Source: Family Medicine Digital Resources Library (FMDRL) Recently Uploaded)


High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency - a prospective study.
Conclusion: Even in educated patients with chronic adrenal insufficiency AC occurs in a substantial proportion of cases. Furthermore, we identified AC associated mortality in about 6% of AC. Our findings further emphasize the need for improved management of AC in patients with chronic AI. PMID: 25419882 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)


Advances in Diagnosis and Treatment of Interstitial Cystitis/Painful Bladder Syndrome
Abstract Interstitial cystitis/bladder pain syndrome (IC/BPS) is a prevalent chronic condition that can be challenging not only to diagnose but also to treat. We review recent diagnostic markers and therapies for IC/BPS from non-medication-based therapies, oral therapies, intravesical therapies, and surgical treatments. (Source: Current Infectious Disease Reports)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Neuroinflammation and glial cell activation in pathogenesis of chronic pain
Publication date: Available online 23 November 2014 Source:Scandinavian Journal of Pain Author(s): Elisabeth Hansson (Source: Scandinavian Journal of Pain)


Erratum
In the article by Malay S and Chung KC in the November 2014 issue of the Journal (“Testing the Validity of Preventing Chronic Regional Pain Syndrome With Vitamin C After Distal Radius Fracture”, Vol. 39A, No. 11, pp 2251–2257), the title is incorrect. The article title should be “Testing the Validity of Preventing Complex Regional Pain Syndrome With Vitamin C After Distal Radius Fracture.” (Source: The Journal of Hand Surgery)


Cervicobrachial Polymyositis
Conclusions:Cervicobrachial polymyositis presents with predominant or isolated proximal upper limb and neck weakness. It has marked female preponderance and affects neck flexors and extensors and trapezius and deltoid muscles severely. Wrist and finger extensors are also weakened. In a proportion of patients, it is associated with serological markers of autoimmune disorders and interstitial lung disease. In addition to serum creatine kinase, electromyography, and muscle biopsy, magnetic resonance imaging forms a noninvasive adjunct test in the diagnostic process. Because of the pattern of weakness, cervicobrachial polymyositis tends to be confused with other common neurological conditions having upper girdle weakness, leading to delay in the diagnosis of this potentially treatable conditio...


Mast Cell Activation Syndrome as a Significant Comorbidity in Sickle Cell Disease
Abstract:Some sickle cell anemia (SCA) patients suffer significantly worse phenotypes than others. Causes of such disparities are incompletely understood. Comorbid chronic inflammation likely is a factor. Recently, mast cell (MC) activation (creating an inflammatory state) was found to be a significant factor in sickle pathobiology and pain in a murine SCA model. Also, a new realm of relatively noncytoproliferative MC disease termed MC activation syndrome (MCAS) has been identified recently. MCAS has not previously been described in SCA. Some SCA patients experience pain patterns and other morbidities more congruent with MCAS than traditional SCA pathobiology (eg, vasoocclusion). Presented here are 32 poor-phenotype SCA patients who met MCAS diagnostic criteria; all improved with MCAS-targ...


Do silver-based wound dressings reduce pain? A prospective study and review of the literature
Silver-containing dressings are a mainstay in the management of burn injury and acute and chronic wounds. In addition to antimicrobial activity, there is anecdotal evidence that silver dressings may modulate or reduce wound pain. Pain is subjective and difficult to quantify, and most studies of silver-containing dressings evaluate pain as a secondary rather than a primary outcome. Nevertheless, a dressing with a proven ability to reduce pain independent of systemic analgesics would have great utility. (Source: Burns : Journal of the International Society for Burn Injuries)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


[Case Report] A pregnant woman with chronic meningococcaemia from Neisseria meningitidis with lpxL1-mutations
In February, 2014, a 29-year-old woman at 17 weeks' gestation was referred to our hospital with a 7 day history of maculopapular rash, joint pain, and swelling of her fingers and toes. Medical history was unremarkable apart from 4 months of chronic sinusitis. On examination she looked well, with temperature 36·6°C, pulse 80 beats per min, and blood pressure 110/60 mm Hg. She had disseminated maculopapular blanching lesions on her arms and legs (), and swollen fingers and toes which were tender to palpation. (Source: LANCET)


Risk Factors of Chronic Daily Headache or Chronic Migraine
Abstract Chronic daily headache (CDH) is a common neurological condition that affects 1–4 % of the general population. Most individuals with CDH originally suffered from episodic headaches, but over time, this developed into CDH. Although the pathophysiology of CDH is not fully understood, recent clinical and epidemiological studies suggest some risk factors that are associated with an increased risk of transformation from episodic headaches. If risk factors can be identified, they could provide a base for aggressive preventive intervention and thus decrease the transformation from episodic headaches to eventual CDH. In this article, we review and summarize the current data on risk factors for CDH. (Source: Current Pain and Headache Reports)


Sleep and Chronic Daily Headache
Abstract Sleep and headache have a complex and extensive interrelationship. This review focuses on the relationship between sleep and chronic daily headache, examining recent advances in the epidemiology and insights into possible mechanisms of this relationship as well as reviewing advances in treatment. There is a clear relationship between obstructive sleep apnoea (OSA) and snoring and morning headache, but the relationship between OSA and snoring and other primary headaches requires clarification. OSA and chronic migraine share both obesity and patent foramen ovale (PFO) as possible co-morbidities. Hypoxia does not clearly predispose to morning headache. Continuous positive airway pressure (CPAP) is an established treatment for OSA, and mixed results have been reported with r...


Update of Chronic Tension-Type Headache
Abstract Tension-type headache (TTH) is the most common type of primary headaches, and its chronic form, chronic tension-type headache (CTTH), is affecting 0.5 to 4.8 % of the worldwide population. Although the mechanism underlying CTTH remains unclear, the role of central versus peripheral mechanisms has always been discussed while explaining the pathogenesis of CTTH. There is always a debate on differential diagnosis between CTTH and chronic migraine without aura which are regarded as different aspects of chronic daily headache spectrum because of many similarities and fuzzy boundaries. Compared with pharmacological treatments, non-pharmacological treatments have been popular as alternative interventions for CTTH in recent years. This review summaries the update knowledge on C...


Animal Models of Chronic Migraine
Abstract Many animal models of migraine have been described. Some of them have been useful in the development of new therapies. All of them have their shortcomings. Animal models of chronic migraine have been relatively less frequently described. Whether a rigid distinction between episodic and chronic migraine is useful when their underlying pathophysiology is likely to be the same and that migraine frequency probably depends on complex polygenic influences remains to be determined. Any model of chronic migraine must reflect the chronicity of the disorder and be reliable and validated with pharmacological interventions. Future animal models of chronic migraine are likely to involve recurrent activation of the trigeminal nociceptive system. Valid models would provide a means for ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Non-healing gastro-duodenal ulcer: a rare presentation of primary abdominal tuberculosis
Conclusion This case has illustrated the difficulties associated with a prompt diagnosis of an unusual case of primary duodenal tuberculosis from chronic peptic ulcer disease in an immunocompetent patient. (Source: International Journal of Surgery Case Reports)


Movement coaching: study protocol of a randomized controlled trial evaluating effects on physical activity and participation in low back pain patients
DiscussionDue to the burden of physical inactivity, there is a need to develop, evaluate and disseminate approaches that are effective in promoting physical activity and especially promoting the maintenance of physical activity in relevant target groups. Considering the high prevalence and socioeconomic impact of low back pain and its multifactorial etiology, low back pain patients seem to be a relevant target group for physical activity promotion. A multilevel approach to bridge the interface of (inpatient) rehabilitation and self-directed physical activity will help to target group-specific PA promotion.Trial registration: German Clinical Trials Register (DRKS)-ID: DRKS00004878. (Source: Epidemiologic Perspectives and Innovations)


Narcotic induced pain
A man in his 40s with a history of Diabetes mellitus type 1, hypertension, neuropathy on chronic opioids and end stage renal disease was referred to our hospital for management of chronic abdominal pain, nausea, vomiting and anorexia of two years duration. (Source: The American Journal of Medicine)


Acupuncture for chronic pain? Clinical wisdom undecided despite over 4000 years of practice
While healers and practitioners have used acupuncture to relieve pain for millennia, modern clinical trials assessing the efficacy of this approach yield seemingly inconsistent and contradictory results. For example, in multiple rigorous studies focusing on chronic lower back pain, acupuncture outperformed standard-of-care (e.g., combination of drugs, physical therapy, and exercise); surprisingly, sham acupuncture and placebo controls similarly outperformed conventional treatment.1,2 Zetetics sometimes discount this conundrum by dismissing the formidable psychosocial influence of both actual and sham acupuncture treatments. (Source: The American Journal of Medicine)


Dienogest in women with persistent endometriosis-related pelvic pain during norethisterone acetate treatment
Conclusions This study confirms the efficacy of DNG in treating symptomatic women with rectovaginal endometriosis even in a particular endometriotic subpopulation of NETA “resistant” patients. Further randomized clinical trials comparing these two progestins both in first than second line are warranted. (Source: European Journal of Obstetrics and Gynecology and Reproductive Biology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Expression of AKR1B1, AKR1C3 and other genes of prostaglandin F2α biosynthesis and action in ovarian endometriosis tissue and in model cell lines
Publication date: Available online 22 November 2014 Source:Chemico-Biological Interactions Author(s): Maša Sinreih , Maja Anko , Neli Hevir Kene , Vida Kocbek , Tea Lanišnik Rižner Endometriosis is a frequent benign gynecological disease characterized by endometrial tissue outside the uterine cavity. The estimated prevalence in the general population is 6%-10%, but this reaches 30%-50% in women with infertility and/or pain. As ectopic tissue within the pelvic cavity provokes inflammation, endometriosis is also considered a chronic inflammatory disease, and is characterized by increased peritoneal fluid levels of prostaglandin (PG)E2 and PGF2α. The AKR1B1 and AKR1C3 enzymes act as PG synthases and catalyze reduction of PGH2 to PGF2α, and PGD2 to 9α,11β-PGF2α, respectively. AKR1B1 ...


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


The economic impact of chronic pain: a nationwide population-based cost-of-illness study in Portugal
Abstract In addition to its high frequency and relevant individual and social impact, chronic pain (CP) has been shown to be a major contributor to increased healthcare utilisation, reduced labour productivity, and consequently large direct and indirect costs. In the context of a larger nationwide study, we aimed to assess the total annual direct and indirect costs associated with CP in Portugal. A population-based study was conducted in a representative sample of the Portuguese adult population. The 5,094 participants were selected using random digit dialling and contacted by computer-assisted telephone interviews. Questionnaires included the brief pain inventory and pain disability index. Estimates were adequately weighted for the population. From all CP subjects identified, a s...


A Partnered Approach to Opioid Management, Guideline Concordant Care and the Stepped Care Model of Pain Management
CONCLUSIONS We demonstrate improvements in the management of veterans receiving OT that are consistent with the SCM-PM and published practice guidelines. We highlight how partnerships among funders, researchers, clinicians, and administrators contributed to the project’s design and implementation, and to the dissemination strategy and future directions for improving opioid management and pain care. (Source: Journal of General Internal Medicine)


Measuring the Symptoms of Pediatric Constipation and Irritable Bowel Syndrome with Constipation: Expert Commentary and Literature Review
Conclusion Findings demonstrate consistency in the literature on key CIC/IBS symptoms to measure in pediatric trials, but existing COAs do not meet regulatory standards. (Source: The Patient - Patient-Centered Outcomes Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


CKD: Exercise May Improve Pain, Physical Function CKD: Exercise May Improve Pain, Physical Function
Patients with chronic kidney disease improved on fitness tests and quality-of-life measures after completing a 12-week exercise program. Medscape Medical News (Source: Medscape Nephrology Headlines)


[Deep Brain Stimulation: New Frontier in the Treatment of CNS Disorders.]
Conclusions: In most of these clinical situations, deep brain stimulation is a safe and useful therapeutic resource that must be considered whenever the usual therapies are useless or not enough; in the other cases a greater experience is needed to make it a regular indication. PMID: 25409221 [PubMed - as supplied by publisher] (Source: Acta Medica Portuguesa)


Abuse-Resistant Prescription Painkiller Approved
Title: Abuse-Resistant Prescription Painkiller ApprovedCategory: Health NewsCreated: 11/20/2014 12:00:00 AMLast Editorial Review: 11/21/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Clinical characteristics and in-hospital outcome of patients with acute coronary syndromes and systemic lupus erythematosus
Conclusions Despite the small number of patients, our findings were similar to those in the literature, showing coronary artery disease in young people with SLE due to premature atherosclerosis and a high mortality rate. (Source: Revista Portuguesa de Cardiologia)


FDA Approves Harder-to-Abuse Hydrocodone (FREE)
By Kristin J. Kelley Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS Hydrocodone bitartrate (marketed as Hysingla ER) has been approved by the FDA for treating chronic, "around-the-clock" pain in … (Source: Physician's First Watch current issue)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Assessment of function in patients with rotator cuff tears: Functional test versus self-reported questionnaire
Conclusions: In addition to the weak association between WORC and 9PEG, the difference between the parameters related to each method suggests that they should not be used interchangeably to determine the upper extremity function. We recommend the utilization of 9PEG instead of WORC in assessing the upper extremity function in the setting of loss of muscle strength. Level of Evidence: Level IV, Therapeutic study. (Source: Table of Contents : International Journal of Shoulder Surgery : 2007 - 1(1))


On high heels and short muscles: A multiscale model for sarcomere loss in the gastrocnemius muscle
Publication date: 21 January 2015 Source:Journal of Theoretical Biology, Volume 365 Author(s): Alexander M. Zöllner , Jacquelynn M. Pok , Emily J. McWalter , Garry E. Gold , Ellen Kuhl High heels are a major source of chronic lower limb pain. Yet, more than one third of all women compromise health for looks and wear high heels on a daily basis. Changing from flat footwear to high heels induces chronic muscle shortening associated with discomfort, fatigue, reduced shock absorption, and increased injury risk. However, the long-term effects of high-heeled footwear on the musculoskeletal kinematics of the lower extremities remain poorly understood. Here we create a multiscale computational model for chronic muscle adaptation to characterize the acute and chronic effects of global muscle sho...


The antinociceptive effect of reversible monoamine oxidase-A inhibitors in a mouse neuropathic pain model
Publication date: 1 July 2013 Source:Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 44 Author(s): Jardel Gomes Villarinho , Kelly de Vargas Pinheiro , Francielle de Vargas Pinheiro , Sara Marchesan Oliveira , Pablo Machado , Marcos Antônio Pinto Martins , Helio Gauze Bonacorso , Nilo Zanatta , Roselei Fachinetto , Juliano Ferreira Neuropathic pain is a debilitating condition that is often resistant to common analgesics, such as opioids, but is sensitive to some antidepressants, an effect that seems to be mediated by spinal cord 5-HT3 receptors. Because the analgesic potential of monoamine oxidase-A (MAO-A) inhibitors is understudied, we evaluated the potential antinociceptive effect of the reversible MAO-A inhibitors moclobemide and 2-(3,4-dimethoxy-phenyl)-4,5-d...


Tongue Piercing and Chronic Abdominal Pain With Nausea and Vomiting—Two Cases
The objectives of the study were as follows: (1) To demonstrate the usefulness of an integrative medicine treatment approach in two cases of patients with chronic abdominal pain, nausea, and vomiting of unclear etiology who had failed standard medical management. (2) To identify scars from tongue piercings as a possible contributing factor in chronic upper GI symptoms of unclear etiology. Two retrospective case studies are presented of young adult females who were seen in a private multi-physician integrative medicine practice in the US. The patients were treated with neural therapy and acupuncture. The desired outcome was the cessation or reduction of the frequency of abdominal pain, nausea, and vomiting. Both patients had resolution of their symptoms. From this study, we have concluded t...


Long-term effect of cupping for chronic neck pain
Publication date: Available online 14 October 2014 Source:Integrative Medicine Research Author(s): Jungtae Leem (Source: Integrative Medicine Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


A Challenging Cause of Chronic Diarrhea
Question: An 88-year-old man with no significant past medical history presented with nine months history of diarrhea and weight loss of 40 pounds. There was no associated abdominal pain or blood in stools. On examination the patient looked cachectic; the remaining physical examination was unremarkable. Complete blood count with differential and comprehensive metabolic panel were unremarkable except for a high alkaline phosphatase of 248 U/L. Abdominal computed tomography revealed a discrete, circumscribed, 5 × 5-cm solid mass in the inferior part of spleen (FigureA). (Source: Gastroenterology)


Neuroscience Education in Addition to Trigger Point Dry Needling for The Management of Patients with Mechanical Chronic Low Back Pain: A Preliminary Clinical Trial
The objective of the current study was to determine the short-term effects of trigger point dry needling (TrP-DN) alone or combined with neuroscience education on pain, disability, kinesiophobia and widespread pressure sensitivity in patients with mechanical low back pain (LBP). Twelve patients with LBP were randomly assigned to receive either TrP-DN (TrP-DN) or TrP-DN plus neuroscience education (TrP-DN+EDU). Pain intensity (Numerical Pain Rating Scale, 0-10), disability (Roland-Morris Disability Questionnaire-RMQ-, Oswestry Low Back Pain Disability Index-ODI), kinesiophobia (Tampa Scale of Kinesiophobia-TSK), and pressure pain thresholds (PPT) over the C5-C6 zygapophyseal joint, transverse process of L3 vertebra, second metacarpal, and tibialis anterior muscle were collected at baseline ...


Opioid Prescribing Patterns for Non-Malignant Chronic Pain for Rural Versus Non-Rural U.S. Adults: A Population-Based Study Using 2010 NAMCS Data
Discusses the results of a survey comparing rural and non-rural prescribing patterns of opioid drugs for non-malignant chronic pain management. Rurality was indicated to be a factor in the over-prescribing of opioids. -- (Source: Rural publications via the Rural Assistance Center)


Modulation of the TRPV1 channel: current clinical trials and recent patents with focus on neurological conditions.
Authors: De Petrocellis L, Moriello AS Abstract The transient receptor potential vanilloid-1 cat ion channel (TRPV1) is a nonspecific cation channel that can be activated by multiple endogenous stimuli and is expressed predominantly in sensory neurons, where it serves as a key nodal point in pain transmission pathways. In mammals, TRPV1 displays a wide tissue and cellular expression including both the peripheral and central nervous system, and in the latter it is now recognized to have a broader distribution and function. The pharmacological modulation of TRPV1 represents a strategy for the treatment of a variety of disease states, particularly those requiring chronic pain management. The validation of the TRPV1 channel as a therapeutic target for the control of pain and inflammato...


A survey of recent patents on CB2 agonists in the management of pain.
Authors: Murineddu G, Asproni B, Pinna GA Abstract Pain, a homeostatic and protective mechanism which can go awry in disease states and therefore needs treatment, is a complex and differentiated sensorial perception which may be classified as physiological, inflammatory and neuropathic. Chronic pain represents a major health problem throughout the world, thus several companies and researchers have embarked on the search for new drugs and targets to treat the disease. The different types of receptors in the CNS involved in the mediation of analgesia include the cannabinoid receptors: in particular, CB2 modulators seem to represent a new potential class of analgesic. This review covers recent patents and advances in CB2 agonist studies in the management of pain. PMID: 22280338 [P...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Analgesic and antineuropathic drugs acting through central cholinergic mechanisms.
Authors: Bartolini A, Di Cesare Mannelli L, Ghelardini C Abstract The role of muscarinic and nicotinic cholinergic receptors in analgesia and neuropathic pain relief is relatively unknown. This review describes how such drugs induce analgesia or alleviate neuropathic pain by acting on the central cholinergic system. Several pharmacological strategies are discussed which increase synthesis and release of acetylcholine (ACh) from cholinergic neurons. The effects of their acute and chronic administration are described. The pharmacological strategies which facilitate the physiological functions of the cholinergic system without altering the normal modulation of cholinergic signals are highlighted. It is proposed that full agonists of muscarinic or nicotinic receptors should be avoided....


From antidepressant drugs to beta-mimetics: preclinical insights on potential new treatments for neuropathic pain.
This article reviews the findings leading to propose beta-mimetics for neuropathic pain treatment and other recent patents on the topic. PMID: 19538157 [PubMed - indexed for MEDLINE] (Source: Recent Patents on CNS Drug Discovery)


Health Tip: Seek Treatment for a Broken Toe
Title: Health Tip: Seek Treatment for a Broken ToeCategory: Health NewsCreated: 11/20/2014 12:00:00 AMLast Editorial Review: 11/20/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


3 natural pain relievers that are as powerful as drugs, without the side effects
(NaturalNews) Unfortunately, acute or chronic pain is something that everyone in their life experiences at one time or another. Even though this is a powerful reminder from the body that something is either healing or going terribly wrong, a way to manage the pain is often required... (Source: NaturalNews.com)


Muscle progenitor cell regenerative capacity in the torn rotator cuff
This article is protected by copyright. All rights reserved (Source: Journal of Orthopaedic Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Histopathological classification criteria of rat model of chronic prostatitis/chronic pelvic pain syndrome
Conclusion The histopathological classification criteria of rat model of CP/CPPS will serve for further research of the pathogenesis and treatment strategies of the disease. (Source: International Urology and Nephrology)


Hyperbaric oxygenation treatment alleviates CCI‐induced neuropathic pain and decreases spinal apoptosis
ConclusionsOverly expressed proapoptosis genes, and subsequent increase in spinal apoptotic cells, seem to contribute to the development of CCI‐induced neuropathic pain. The inhibitory role of HBO on spinal proapoptosis genes and apoptotic changes may contribute to its beneficial effect on CCI‐induced neuropathic pain. (Source: European Journal of Pain)


Intravenous dextromethorphan/quinidine inhibits activity of dura‐sensitive spinal trigeminal neurons in rats
ConclusionsIt is evident that the observed DM/Q‐induced suppression of trigeminal neuron excitability can lead to a reduction in nociceptive transmission from meninges to higher centres of the brain. Since the same mechanism is believed to underlie the pharmacodynamics of many well‐known antimigraine drugs, results of the present study enable us to anticipate the potential efficacy of DM/Q in migraine. (Source: European Journal of Pain)


Applying the Gender Lens to Emergency Care: From Bench to Bedside
This article outlines the history, need, and evolution of gender medicine in emergency care research. Clinical examples are used where sex and gender play a role in diagnosis, management, or prognosis of patients in the emergency department (ED). The ED serves as an ideal setting to advance sex‐ and gender‐specific research as the primary access point for health care for much of the U.S. population, with more than 136 million annual visits. Gender medicine provides the biologic and social framework to provide high‐quality, safe, equitable, and cost‐effective sex‐ and gender‐specific care in the ED. With a 24‐hour hospital presence, and with access to high‐acuity patients, emergency physicians are well positioned to lead sex‐ and gender‐specific clinical studies for time...


Fluoroscope-guided celiac plexus block in a pregnant patient: a case report
A 28-weeks gestation pregnant patient with chronic pacreatitis and severe abdominal pain leading to impaired nutrition is presented. After detailed consideration of the case, fluoroscopic-guided celiac plexus neurolysis was performed. The block was performed using the transaortic approach as it reduces radiation exposure. (Source: Journal of Clinical Anesthesia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Management of chronic neuropathic pain: a protocol for a multiple treatment comparison meta-analysis of randomised controlled trials
Introduction Chronic neuropathic pain is associated with reduced health-related quality of life and substantial socioeconomic costs. Current research addressing management of chronic neuropathic pain is limited. No review has evaluated all interventional studies for chronic neuropathic pain, which limits attempts to make inferences regarding the relative effectiveness of treatments. Methods and analysis We will conduct a systematic review of all randomised controlled trials evaluating therapies for chronic neuropathic pain. We will identify eligible trials, in any language, by a systematic search of CINAHL, EMBASE, MEDLINE, AMED, HealthSTAR, DARE, PsychINFO and the Cochrane Central Registry of Controlled Trials. Eligible trials will be: (1) enrol patients presenting with chronic neuropath...


Serotonergic System and Its Role in Epilepsy and Neuropathic Pain Treatment: a Review Based on Receptor Ligands.
Authors: Pańczyk K, Gołda S, Waszkielewicz A, Zelaszczyk D, Gunia-Krzyżak A, Marona H Abstract The serotonergic system is involved in pathomechanisms of both epilepsy and neuropathic pain. So far, participation in the epileptogenesis and maintenance of epilepsy was proved for 5-HT1A, 5-HT2C, 5-HT3, 5-HT4 and 5-HT7 receptors as well as 5-HTT serotonin transporter. Depending on the receptor type or its localization, its stimulation may increase or decrease neuronal excitability. According to the available data, neuropathic pain mechanisms involve 5-HT1A/1B/1D, 5-HT2A/2B/2C, 5-HT3, 5-HT4, 5-HT6, 5-HT7 receptors and 5-HTT serotonin transporter. Changes in their expression modulate pain mainly by affecting the transmission through serotonergic descending pathways. Several compounds, ...


Applying the Gender Lens to Emergency Care: From Bench to Bedside.
This article outlines the history, need, and evolution of gender medicine in emergency care research. Clinical examples are used where sex and gender play a role in diagnosis, management, or prognosis of patients in the emergency department (ED). The ED serves as an ideal setting to advance sex- and gender-specific research as the primary access point for health care for much of the U.S. population, with more than 136 million annual visits. Gender medicine provides the biologic and social framework to provide high-quality, safe, equitable, and cost-effective sex- and gender-specific care in the ED. With a 24-hour hospital presence, and with access to high-acuity patients, emergency physicians are well positioned to lead sex- and gender-specific clinical studies for time-sensitive condition...


[Conversion to tapentadol PR improves analgesia and quality of life in patients with severe and chronic pain despite using tramadol > 300 mg/d.]
CONCLUSIONS: Data analysis shows a clinically relevant benefit in patients unsuccessfully pretreated with tramadol by consecutive conversion to the potent analgesic tapentadol PR. PMID: 25409951 [PubMed - as supplied by publisher] (Source: Wiener Klinische Wochenschrift)


Abdominal Pain and the Neurotrophic System in Ulcerative Colitis
Conclusions:We did not observe changes in mucosal innervation and did not see a significant relationship between nerve fiber density, inflammatory mediators, neurotrophic factors, or mucosal ion channel expression and pain. In contrast, the importance of depression as the only independent predictor of pain ratings mirrors functional disorders, where central processes significantly contribute to symptom development and/or perpetuation. (Source: Inflammatory Bowel Diseases)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Significance of the Epithelioid Granuloma in Biopsies of Crohn's Colitis
Conclusions:In colonic biopsies from patients with Crohn's disease, granulomas constitute a rare finding. Presence of granulomas is associated with younger patient age, more severe histopathologic expression of the underlying disease, and more clinical symptoms. (Source: Inflammatory Bowel Diseases)


Distraction Analgesia in Chronic Pain Patients: The Impact of Catastrophizing
Conclusion: Distraction produced greater analgesia among chronic pain patients with higher catastrophizing, suggesting that catastrophizing’s pain-amplifying effects may be due in part to greater attention to pain, and these patients may benefit from distraction-based pain management approaches. Furthermore, these data suggest that distraction analgesia and conditioned pain modulation may involve separate underlying mechanisms. (Source: Anesthesiology)


PTSD Symptoms Mediate the Effect of Attachment on Pain and Somatisation after Whiplash Injury.
CONCLUSION: Acknowledging that PTSD is part of the aetiology involved in explaining persistent symptoms after whiplash, may help sufferers to gain early and more suited treatment, which in turn may prevent the condition from becoming chronic. PMID: 23802016 [PubMed] (Source: Clinical Practice and Epidemiology in Mental Health)


Vitamin D and autoimmune thyroid diseases: facts and unresolved questions
Abstract Vitamin D deficiency (levels lower than 20 ng/ml) is becoming a global health problem, since it is increasingly represented even among healthy subjects. Vitamin D, as an environmental factor, is involved in many biological processes, like perception of chronic pain and response to infections. In recent years, evidence has emerged pointing to an involvement of vitamin D in the development of many autoimmune diseases, and a severe vitamin D deficiency has been especially demonstrated in patients affected with autoimmune thyroid disease (AITD). Low levels of vitamin D were found associated with antithyroid antibody presence, abnormal thyroid function, increased thyroid volume, increased TSH levels, and adverse pregnancy outcome in women with AITD. Vitamin D mediates its eff...


Predicting Postcesarean Delivery Pain
Abstract Poorly treated acute pain after cesarean delivery is associated with significant short-term and long-term morbidity in young women. Due to the importance of treating perioperative pain, more emphasis has been placed on improving postoperative pain management. However, individual differences in pain perception make postoperative pain management challenging after cesarean delivery. In this review, we will identify recent studies that have utilized a variety of preoperative tests to predict acute and/or chronic postoperative pain scores after cesarean delivery. (Source: Current Anesthesiology Reports)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Chronic pelvic floor dysfunction
Publication date: October 2014 Source:Best Practice &amp; Research Clinical Obstetrics &amp; Gynaecology, Volume 28, Issue 7 Author(s): Dee Hartmann , Julie Sarton The successful treatment of women with vestibulodynia and its associated chronic pelvic floor dysfunctions requires interventions that address a broad field of possible pain contributors. Pelvic floor muscle hypertonicity was implicated in the mid-1990s as a trigger of major chronic vulvar pain. Painful bladder syndrome, irritable bowel syndrome, fibromyalgia, and temporomandibular jaw disorder are known common comorbidities that can cause a host of associated muscular, visceral, bony, and fascial dysfunctions. It appears that normalizing all of those disorders plays a pivotal role in reducing complaints of chronic vul...


Effects of proprioceptive exercises on pain and function in chronic neck- and low back pain rehabilitation: a systematic literature review
Conclusions: There are few relevant good quality studies on proprioceptive exercises. A descriptive summary of the evidence suggests that there is no consistent benefit in adding PrT to neck- and low back pain rehabilitation and functional restoration. (Source: BMC Musculoskeletal Disorders)


Association of Atypical Femoral Fractures with Bisphosphonate Use by Patients with Varus Hip Geometry
Conclusions: Patients on chronic bisphosphonate therapy who presented with atypical femoral fracture(s) had more varus proximal femoral geometry than those who took bisphosphonates without sustaining a fracture. Although no causative effect can be determined, a finding of varus geometry may help to better identify patients at risk for fracture after long-term bisphosphonate use. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: The Journal of Bone and Joint Surgery)


Work related upper limb disorders
Publication date: December 2014 Source:Indian Journal of Rheumatology, Volume 9, Supplement 2 Author(s): Michael Hutson Neuropathic arm pain (NAP), commonly referred to as ‘RSI’, diffuse upper limb disorder or type II work related upper limb disorder (WRULD) is a regional pain syndrome affecting the upper limb(s), characterized by persistent pain and dysaesthesiae. It is commonly associated with long periods of keyboard use, though may also occur in workers engaged in other types of repetitive stereotyped activities of the hands. Adverse ergonomics is commonly present. Sleep pattern is usually disturbed, and depression, headaches, chronic fatigue, and frustration are frequently experienced. The pathogenesis of NAP is probably linked to overloading of sensorineural mechanisms responsi...


Diagnosis and management of neck and back pain
Publication date: December 2014 Source:Indian Journal of Rheumatology, Volume 9, Supplement 2 Author(s): Andrew O. Frank Neck and back pains are features of life worldwide. Few with spinal pain (SP) have serious medical (non-spinal) conditions; significant spinal pathology; or compression of root or cord such as to require surgery. Although the causes of most episodes of SP remain unclear in practice, physical stress and its consequences on discs, facet joints and supporting soft tissue structures at work or leisure activities are thought to trigger many initial attacks. But prognosis usually depends on psychosocial issues. A minority of episodes are prolonged, intractable and disabling, contributing to the high cost for society. Around 10% of those presenting to a rheumatological servic...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Psychological therapies help reduce headache and non-headache pain in children and adolescents
Commentary on: Eccleston C, Palermo TM, Williams AC, et al.. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2014;5:CD003968. Context Chronic and recurrent pain, especially in the head, abdomen and limbs affects up to 30% of children and adolescents.1 Pain can be severely disabling, disrupting school and social activities and if left untreated, may extend towards adulthood. Increasing evidence shows that psychological factors are pivotal in the transition from acute to chronic disabling pain. As a result, psychological interventions have been developed to modify the emotional, cognitive and behavioural processes that are considered to maintain pain, disability and distress. Psychological interventions initiall...


Ledipasvir/Sofosbuvir administration achieves very high rate of viral clearance in patients with HCV genotype 1 infection without cirrhosis, regardless of ribavirin co-administration or length of treatment
Commentary on: Kowdley KV, Gordon SC, Reddy KR, et al.. Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis. N Engl J Med 2014;370:1879&ndash;88. Context Approximately 150 million people worldwide are estimated to be chronic carriers of hepatitis C virus (HCV). Estimates indicate a quarter of HCV carriers will develop liver cirrhosis, which entails a risk of severe complications (hepatocellular carcinoma, decompensation, end-stage liver failure, death).1 Viral clearance significantly decreases disease progression and increases survival rates. Two antiviral approaches are currently available: interferon-based and interferon-free. Interferon-free therapies are the future of HCV treatment thanks to the optimal tolerability and safety, high efficacy and because they c...


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


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


Opioid prescribing patterns for non-malignant chronic pain for rural versus non-rural US adults: a population-based study using 2010 NAMCS data
Conclusions: Our results clearly indicated that rurality is an important factor in opioid prescribing patterns that cannot be ignored and bears further investigation. Further research on the growing concern about the over-prescribing of opioids in the US should now include rurality as a variable in data generation and analysis. Future research should also attempt to document the ecological, sociological and political factors impacting opioid prescribing and care in rural communities. Prescribers and health care policy makers need to critically evaluate the implications of our findings and their relationship to patient needs, best practices in a rural setting, and the overall consequences of increased opioid prescribing on rural communities. (Source: BMC Health Services Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


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


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


Case reports: orthotic treatment of adult scoliosis patients with chronic back pain
This article presents two cases in which individualized torso orthoses were successfully used to treat patients with degenerative diseases and disorders of the sagittal line as well as three dimensional deformities of the spine. Using torso orthoses allows treatment of these patients with as few invasive measures as possible without losing maximal functionality. (Source: Scoliosis)


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


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


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


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


Effect of ω-conotoxin MVIIA and Phα1β on paclitaxel-induced acute and chronic pain
Publication date: December 2013 Source:Pharmacology Biochemistry and Behavior, Volumes 114–115 Author(s): Flávia K. Rigo , Gerusa D. Dalmolin , Gabriela Trevisan , Raquel Tonello , Mariane A. Silva , Mateus F. Rossato , Jonatas Z. Klafke , Marta do N. Cordeiro , Célio J. Castro Junior , Danuza Montijo , Marcus V. Gomez , Juliano Ferreira The treatment with the chemotherapeutic agent paclitaxel produces a painful peripheral neuropathy, and is associated with an acute pain syndrome in a clinically significant number of patients. However, no standard therapy has been established to manage the acute pain or the chronic neuropathic pain related to paclitaxel. In the present study, we evaluated the analgesic potential of two N-type voltage-gated calcium channel (VGCC) blockers, ω-conotoxi...


The long-lasting sensitization of primary afferent nociceptors induced by inflammation involves prostanoid and dopaminergic systems in mice
Publication date: January 2013 Source:Pharmacology Biochemistry and Behavior, Volume 103, Issue 3 Author(s): Cristiane Flora Villarreal , Mani Indiana Funez , Fernando de Queiroz Cunha , Carlos Amílcar Parada , Sérgio Henrique Ferreira In recent years, evidence that sensitization of primary afferent nociceptors is an important event associated with chronic pain has been accumulating. The present study aimed to evaluate the participation of the prostaglandin and sympathetic components in the long-lasting sensitization of nociceptors induced by acute inflammation in mice. The intraplantar administration of carrageenan (100μg) enhanced the nociceptive response to a small dose of PGE2 (9ng/paw) or dopamine (3μg/paw) up to 30days later. This long-lasting sensitization is dependent on dopa...


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


One-year course and predictors of abdominal pain in children with autism spectrum disorders: The role of anxiety and sensory over-responsivity
Conclusions Abdominal pain appears to be common and persistent among children with ASD. The relations among SOR, anxiety and abdominal pain offer information about potential underlying mechanisms. (Source: Research in Autism Spectrum Disorders)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Relationship between chronic pathologies of the supraspinatus tendon and the long head of the biceps tendon: systematic review
Conclusions: The review of literature corroborates an association between the chronic pathology of the supraspinatus tendon and LHBT due to the epidemiological data. In addition, some authors confirm the existence of an anatomical and functional relationship between LHBT and the supraspinatus tendon, the latter being part of the LHBT pulley. (Source: BMC Musculoskeletal Disorders)


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


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


Evaluation of a modified clinical prediction rule for use with spinal manipulative therapy in patients with chronic low back pain: a randomized clinical trial
Conclusions: We found no evidence that a modification of the original CPR can be used to discriminate CLBP patients that would benefit more from SMT. Further studies are needed to further clarify the patient characteristics that moderate treatment responsiveness to specific interventions for CLBP.Trial registrationISRCTN30511490 (Source: Chiropractic and Osteopathy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


Safety and neurological assessments after autologous transplantation of bone marrow mesenchymal stem cells in subjects with chronic spinal cord injury
Conclusion: Intralesional transplantation of autologous mesenchymal stem cells in subjects with chronic, complete spinal cord injury is safe, feasible, and may promote neurological improvements.Trial registration: ClinicalTrials.gov NCT01325103 - Registered 28 March 2011 (Source: BioMed Central)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Headache Following Occipital Brain Lesion: A Case of Migraine Triggered by Occipital Spikes?
This study describes the case of an 8-year-old boy who developed a genuine migraine after the surgical excision, from the right occipital lobe, of brain abscesses due to selective infestation of the cerebrum by Entamoeba histolytica. After the surgical treatment, the boy presented daily headaches with typical migraine features, including right-side parieto-temporal pain, nausea, vomiting, and photophobia. Electroencephalography (EEG) showed epileptiform discharges in the right occipital lobe, although he never presented seizures. Clinical and neurophysiological observations were performed, including video-EEG and polygraphic recordings. EEG showed "interictal" epileptiform discharges in the right occipital lobe. A prolonged video-EEG recording performed before, during, and after an acute a...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


A Case of Codeine Induced Anaphylaxis via Oral Route.
Authors: Yoo HS, Yang EM, Kim MA, Hwang SH, Shin YS, Ye YM, Nahm DH, Park HS Abstract Codeine is widely prescribed in clinical settings for the relief of pain and non-productive coughs. Common adverse drug reactions to codeine include constipation, euphoria, nausea, and drowsiness. However, there have been few reports of serious adverse reactions after codeine ingestion in adults. Here, we present a case of severe anaphylaxis after oral ingestion of a therapeutic dose of codeine. A 30-year-old Korean woman complained of the sudden onset of dyspnea, urticaria, chest tightness, and dizziness 10 minutes after taking a 10-mg dose of codeine to treat a chronic cough following a viral infection. She had previously experienced episodes of asthma exacerbation following upper respiratory in...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The effects of anesthetics on tumor progression.
Authors: Mao L, Lin S, Lin J Abstract More and more cancer patients receive surgery and chronic pain control. Cell-mediated immunosuppression from surgical stress renders perioperative period a vulnerable period for tumor metastasis. Retrospective studies suggest that regional anesthesia reduces the risk of tumor metastasis and recurrence. This benefit may be due to the attenuation of immunosuppression by regional anesthesia. On the other hand, accumulating evidence points to a direct role of anesthetics in tumor progression. A variety of malignancies exhibit increased activity of voltage-gated sodium channels. Blockade of these channels by local anesthetics may help inhibit tumor progression. Opioids promote angiogenesis, cancer cell proliferation and metastasis. It will be intere...


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


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


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


Osteoprotegerin correlates with disease activity and endothelial activation in non-diabetic ankylosing spondylitis patients undergoing TNF-α antagonist therapy.
CONCLUSIONS: OPG shows a correlation with markers of disease activity and endothelial activation in non-diabetic ankylosing spondylitis patients undergoing TNF-α antagonist therapy. PMID: 25190453 [PubMed - in process] (Source: Clinical and Experimental Rheumatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Autoimmune pancreatitis complicated with inflammatory bowel disease and comparative study of type 1 and type 2 autoimmune pancreatitis
Conclusions A characteristic feature of type 2 AIP compared with type 1 AIP is a low frequency of obstructive jaundice that is related to rare lower bile duct stricture due to lower prevalence of pancreatic head swelling. Contrary to type 1 AIP, lower bile duct stricture in this condition has no apparent relation to sclerosing cholangitis. (Source: Journal of Gastroenterology)


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


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


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


Blockade of spinal glutamate recycling produces paradoxical antinociception in rats with orofacial inflammatory pain
Publication date: 3 March 2015 Source:Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 57 Author(s): Kui Y. Yang , Jun H. Mun , Ki D. Park , Min J. Kim , Jin S. Ju , Seong T. Kim , Yong C. Bae , Dong K. Ahn In our current study, we investigated the role of spinal glutamate recycling in the development of orofacial inflammatory pain. DL-threo-β-benzyloxyaspartate (TBOA) or methionine sulfoximine (MSO) was administered intracisternally to block spinal glutamate transporter and glutamine synthetase activity in astroglia. Intracisternal administration of high dose TBOA (10μg) produced thermal hyperalgesia in naïve rats but significantly attenuated the thermal hyperalgesia in rats that had been pretreated with interleukin (IL)-1β or Complete Freund's Adjuvant (CFA). ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Assessing Clinically Meaningful Treatment Effects in Controlled Trials: Chronic Migraine as an Example
In addition to headache, persons with chronic migraine experience multiple symptoms, both ictal and interictal, that may contribute to their suffering. Translating clinical trial results into practice requires assessment of the results’ clinical meaningfulness. When examining treatment benefit in this disabled patient population, multiple headache-symptom measures should be considered to fully reflect clinical relevance. Currently, only onabotulinumtoxinA is approved specifically for headache prophylaxis in adults with chronic migraine. (Source: The Journal of Pain)


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Use of kinematic algorithms to distinguish people with chronic non-specific low back pain from asymptomatic subjects: a validation study.
CONCLUSION: These results support the validity of using 2 movement algorithms, range of motion and speed, to discriminate asymptomatic subjects from those with low back pain. However, people simulating low back pain cannot be distinguished from those with real low back pain using this method. PMID: 24925284 [PubMed - in process] (Source: Journal of Rehabilitation Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Health Tip: Feeling Weak in the Knee?
Title: Health Tip: Feeling Weak in the Knee?Category: Health NewsCreated: 11/13/2014 12:00:00 AMLast Editorial Review: 11/13/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Dientamoeba fragilis and chronic abdominal pain in children: a case-control study
Conclusions There were no differences in symptoms comparing children with and without D fragilis infection. Furthermore, no relation was found between clinical and microbiological response after treatment for D. fragilis. This retrospective study suggests that there is no association between chronic AP and D. fragilis infection. (Source: Archives of Disease in Childhood)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Medical Management of Chronic Low Back Pain: Efficacy and Outcomes
Conclusions:  Personalized treatment plans should be informed by response to therapies previously tried, the severity and persistence of symptoms, and the availability of specialist expertise. (Source: Neuromodulation: Technology at the Neural Interface)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


European Position Paper on Rhinosinusitis and Nasal Polyps 2012.
Authors: Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, Cohen N, Cervin A, Douglas R, Gevaert P, Georgalas C, Goossens H, Harvey R, Hellings P, Hopkins C, Jones N, Joos G, Kalogjera L, Kern B, Kowalski M, Price D, Riechelmann H, Schlosser R, Senior B, Thomas M, Toskala E, Voegels R, Wang de Y, Wormald PJ Abstract The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007.The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the doc...


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


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


Serial blood serotonin levels in a randomized controlled trial comparing the efficacy of low-dose amitriptyline, amitriptyline with pindolol and surrogate placebo in patients with chronic tension-type facial pain.
CONCLUSION: When linked to the clinical response this study provides evidence that the serotonergic system is involved in the modulation of chronic MFP. Serotonin levels are sex-dependent and related to treatment response. PMID: 23943730 [PubMed - indexed for MEDLINE] (Source: Rhinology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


A Randomized Controlled Trial comparing the efficacy of low-dose amitriptyline, amitriptyline with pindolol and surrogate placebo in the treatment of chronic tension-type facial pain.
CONCLUSION: Low dose amitriptyline is effective in the management of MFP and is enhanced by the addition of pindolol. PMID: 23671895 [PubMed - indexed for MEDLINE] (Source: Rhinology)


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


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


Stomach Pain and Colon Cancer
Although chronic stomach pains are not typically a result of colon cancer, there are many treatable causes that should be investigated by your primary care doctor. (Source: About.com Colon Cancer)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Robot Assisted Thoracoscopic Resection of Giant Esophageal Leiomyoma
Conclusion Use of robot allows for removal of large esophageal leiomyoma. The improved dexterity and patient outcome offered by robot suggests its potential as the mainstay technique for giant esophageal leiomyoma removal. (Source: International Journal of Surgery Case Reports)


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


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


[Review] Pain assessment in elderly adults with dementia
Chronic pain is highly prevalent in the ageing population. Individuals with neurological disorders such as dementia are susceptible patient groups in which pain is frequently under-recognised, underestimated, and undertreated. Results from neurophysiological and neuroimaging studies showing that elderly adults are particularly susceptible to the negative effects of pain are of additional concern. The inability to successfully communicate pain in severe dementia is a major barrier to effective treatment. (Source: Lancet Neurology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


A Prospective Multicenter Clinical Study of Extralevator Abdominoperineal Resection for Locally Advanced Low Rectal Cancer
CONCLUSIONS: Extralevator abdominoperineal resection performed in the prone position for low rectal cancer is a relatively safe approach with acceptable circumferential resection margin involvement, intraoperative perforations, and local recurrences. Reconstruction of the pelvic floor with biological mesh might lower the rate of perineal wound complications (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A161 ). (Source: Diseases of the Colon and Rectum)


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


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


Motor Imagery in People With a History of Back Pain, Current Back Pain, Both, or Neither
Discussion:Trunk motor imagery performance is reduced in people with a history of back pain when they are in a current episode. This is consistent with disruption of cortical proprioceptive representation of the trunk in this group. On the basis of this result, we propose a conceptual model speculating a role of this measure in understanding the development of chronic back pain, a model that can be tested in future studies. (Source: The Clinical Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


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


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


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


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


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


Different Perspectives Regarding Quality of Life in Chronically ill and Healthy Individuals
Abstract The areas that were suggested as most important with regard to Quality of Life (QoL) were examined in groups of individuals who were healthy, and those with a chronic condition. An electronic survey was completed by 892 participants (261 healthy and 631 with a chronic condition). They answered three questions relating to QoL: what is most important to you; what areas most impact your QoL; and an open question what does QoL mean to you. Across the three questions both groups highlighted physical functioning, independence and mobility as key areas for QoL. However, the group with a chronic condition tended to find issues of functioning such as pain, fatigue, and sleep as more important to their QoL than the healthy participants. In contrast, the healthy participants tended...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Can a back pain screening tool help classify patients with acute pain into risk levels for chronic pain?
ConclusionsA risk classification schema using the recommended cut‐off scores with items similar to the STarT‐Back in a primary care population with strictly defined acute LBP had limited ability to identify persons who progressed to chronic pain. The results suggest caution when applying the STarT‐Back in patients with acute LBP and a need to consider a modification of its cut‐offs. (Source: European Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Characterization of osteoarthritis in cats and meloxicam efficacy using objective chronic pain evaluation tools
This study aimed to characterize osteoarthritis (OA)-related chronic pain and disability in experimental cats with naturally occurring OA. Peak vertical ground reaction force (PVF), accelerometer-based motor activity (MA) and the von Frey anesthesiometer-induced paw withdrawal threshold were used to define OA and to test the efficacy of meloxicam. A diagnosis of OA was based on radiographic and orthopedic examinations. Cats with OA (n =39) and classified as non-OA (n =6) were used to assess the reliability and sensitivity of the parameters to assess OA over 3weeks while being administered placebo medication. A randomised parallel design study was then used to investigate the effects on OA of daily oral meloxicam treatment for 4weeks at different dose rates (0.025mg/kg, n =10mg/kg; 0.04mg/k...


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


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


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


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


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


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


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


Stromal cell-derived CCL2 drives neuropathic pain states through myeloid cell infiltration in injured nerve
Publication date: Available online 4 November 2014 Source:Brain, Behavior, and Immunity Author(s): Juliette Van Steenwinckel , Constance Auvynet , Anaïs Sapienza , Annabelle Reaux-Le Goazigo , Christophe Combadière , Stéphane Melik Parsadaniantz Neuropathic pain resulting from peripheral nerve injury involves many persistent neuroinflammatory processes including inflammatory chemokines that control leukocyte trafficking and activate resident cells. Several studies have shown that CCL2 chemokine, a potent attractant of monocytes, and its cognate receptor, CCR2, play a critical role in regulating nociceptive processes during neuropathic pain. However, the role of CCL2 in peripheral leukocyte infiltration-associated neuropathic pain remains poorly understood. In particular, the contribut...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Identification of a functional interaction of HMGB1 with Receptor for Advanced Glycation End-products in a model of neuropathic pain
Publication date: November 2014 Source:Brain, Behavior, and Immunity, Volume 42 Author(s): Yohance M. Allette , Michael R. Due , Sarah M. Wilson , Polina Feldman , Matthew S. Ripsch , Rajesh Khanna , Fletcher A. White Recent studies indicate that the release of high mobility group box 1 (HMGB1) following nerve injury may play a central role in the pathogenesis of neuropathic pain. HMGB1 is known to influence cellular responses within the nervous system via two distinct receptor families; the Receptor for Advanced Glycation End-products (RAGE) and Toll-like receptors (TLRs). The degree to which HMGB1 activates a receptor is thought to be dependent upon the oxidative state of the ligand, resulting in the functional isoforms of all-thiol HMGB1 (at-HMGB1) acting through RAGE, and disufide HM...


Acute increases in intramuscular inflammatory cytokines are necessary for the development of mechanical hypersensitivity in a mouse model of musculoskeletal sensitization
Publication date: Available online 22 October 2014 Source:Brain, Behavior, and Immunity Author(s): Blair C. Sutton , Mark R. Opp Musculoskeletal pain is a widespread health problem in the United States. Back pain, neck pain, and facial pain are three of the most prevalent types of chronic pain, and each is characterized as musculoskeletal in origin. Despite its prevalence, preclinical research investigating musculoskeletal pain is limited. Musculoskeletal sensitization is a preclinical model of muscle pain that produces mechanical hypersensitivity. In a rodent model of musculoskeletal sensitization, mechanical hypersensitivity develops at the hind paws after injection of acidified saline (pH 4.0) into the gastrocnemius muscle. Inflammatory cytokines contribute to pain during a variety of...


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


Potential risk factors of re‐intervention after endovascular repair for type B aortic dissections
Conclusions: we concluded that chronic phase, smoking and too big oversizing were potential risk factors of re‐intervention. © 2014 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


Non-opioid substance use disorders and opioid dose predict therapeutic opioid addiction
This study examined TOA among 199 patients undergoing chronic opioid therapy at the time of admission to a pain rehabilitation program. It was hypothesized that non-opioid substance use disorders and opioid dosage would predict TOA. Daily mean opioid dose was 132.85mg ±175.39. Patients with non-opioid substance use disorders had 28x the odds (OR = 28.58; 95% CI = 10.86, 75.27) of having TOA. (Source: The Journal of Pain)


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


[Opioids in chronic neuropathic pain : A systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks duration.]
CONCLUSION: In short-term studies (4-12 weeks) in CNP, opioids were superior to placebo in terms of efficacy and inferior in terms of tolerability. Opioids and placebo did not differ in terms of safety. The conclusion relating to the safety of opioids compared to placebo in CNP is limited by the low number of SAE and deaths. Short-term opioid therapy may be considered in selected CNP patients. The English full-text version of this article is freely available at SpringerLink (under "Supplementary Material"). PMID: 25376548 [PubMed - as supplied by publisher] (Source: Schmerz)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


[Opioids in chronic osteoarthritis pain : A systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks duration.]
CONCLUSION: Opioids were superior to placebo in terms of efficacy and inferior in terms of tolerability. The effect sizes of average reduction in pain intensity and physical disability were small. Opioids and placebo did not differ in terms of safety. The conclusion on the safety of opioids compared to placebo is limited by the low number of SAE and deaths. Short-term opioid therapy may be considered in selected chronic OA pain patients. No current evidence-based guideline recommends opioids as first-line treatment option for chronic OA pain. To provide superior evidence for future treatment guidelines, RCTs must directly compare existing pharmacological and nonpharmacological therapies and administer these in various combinations and sequences. The English full-text version of this articl...


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


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


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


Effects of early childhood trauma on hypothalamic–pituitary–adrenal (HPA) axis function in patients with Chronic Fatigue Syndrome
Chronic Fatigue Syndrome (CFS) is characterized by chronic, medically unexplained fatigue and physical and/or mental fatigability in response to exertion in particular (Fukuda et al., 1994; Carruthers et al., 2011). It is a highly debilitating condition that most often affects women (Jason et al., 1999) and that is associated with high psychosocial and economic costs (Collin et al., 2011). A considerable proportion of CFS patients also suffers from chronic pain symptoms, and studies increasingly suggest that CFS may be part of a broader spectrum of chronic pain and fatigue disorders (Kanaan et al., 2007; Van Houdenhove et al., 2010; Ablin et al., 2012). (Source: Psychoneuroendocrinology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


The relationship between hemoglobin level and disease activity in patients with rheumatoid arthritis
Conclusion In conclusion, we determined that low hemoglobin level was significantly related to disability and impairment, disease activity, articular damage, pain and disease duration in RA patients in our study. We believe that by keeping disease activity under control, therefore preventing articular damage, the disability in RA patients can be lessened or possibly even eliminated. (Source: Revista Brasileira de Reumatologia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Characterization of the pain, sleep and alexithymia patterns of patients with fibromyalgia treated in a Brazilian tertiary center
Conclusion Studies have disclosed the presence of important and frequently underdiagnosed symptoms beyond pain complaints in FM, such as sleep complaints and alexithymia, and a better knowledge of such disturbances might improve FM patients’ approach and treatment. (Source: Revista Brasileira de Reumatologia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Satellite glial cells in sensory ganglia: its role in pain
Conclusions Satellite glial cells are important in the establishment of physiological pain, in addition to being a potential target for the development of new pain treatments. (Source: Brazilian Journal of Anesthesiology)


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


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


Arthritis among veterans - United States, 2011-2013.
This report summarizes the results of these analyses, which found that one in four veterans reported that they had arthritis (25.6%) and that prevalence was higher among veterans than nonveterans across most sociodemographic categories, including sex (prevalence among male and female veterans was 25.0% and 31.3%, respectively). State-specific, age-standardized arthritis prevalence among veterans ranged from 18.8% in Hawaii to 32.7% in West Virginia. Veterans comprise a large and important target group for reducing the growing burden of arthritis. Those interested in veterans' health can help to improve the quality of life of veterans by ensuring that they have access to affordable, evidence-based, physical activity and self-management education classes that reduce the adverse effects of ar...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Using the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) Model in Clinical Research: Application to Refine a Practice-based Research Network (PBRN) Study
Conclusions: The study was not as pragmatic as expected. The exercise results seem to be useful in identifying necessary refinements to the study methodology that may benefit future study design and increase generalizability. Readers can identify how the PRECIS model may be used to provide clarity and transparency for proposed or existing studies and may wish to replicate our exercise in planning their own studies. (Source: Journal of the American Board of Family Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


Treatment of Chronic Pain: Diffusion Tensor Imaging Identification of the Ventroposterolateral Nucleus Confirmed with Successful Deep Brain Stimulation
Conclusion: DTI has the potential to identify the thalamic nuclei in individuals, which would be more accurate than anatomical localization and likely identical to intraoperative physiological testing. Postoperative DBS electrode placement and the affected cortical areas can be confirmed with coregistration of CT and FT using the electrode as a seed ROI.Stereotact Funct Neurosurg 2014;92:365-371 (Source: Stereotactic and Functional Neurosurgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Long term effect of cupping for chronic neck pain
Publication date: Available online 14 October 2014 Source:Integrative Medicine Research Author(s): Jungtae Leem Aim To investigate long-term effects of cupping therapy in patients with chronic neck pain. Design Three 2-armed randomized waitlist-controlled trials (RCTs) were followed up 2 years after completion of each of the 3 studies. Assessments were conducted by researchers before and after the cupping therapy. Setting Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Germany. Participants Study subjects included patients aged 18–75 years who had experienced nonspecific neck pain with a pain intensity of more than 40mm on a 100mm visual analogue scale (VAS) for at least 3 months for a minimum of 5 days a week...


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


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


Hydrocodone Extended-Release: Pharmacodynamics, Pharmacokinetics and Behavioral Pharmacology of a Controversy
Publication date: Available online 6 October 2014 Source:Pharmacological Research Author(s): Harry J. Gould III , Dennis Paul Recently, the U.S. Food and Drug Administration (FDA) approved Zohydro®, an extended release formulation of the opioid analgesic hydrocodone that contains no acetaminophen. This approval was against the recommendation of the FDA's Expert Panel. Subsequently, both chronic pain advocates and anti-drug abuse advocates have steadfastly expressed their support of, or astonishment at this decision. Here, we review the pharmacokinetics, pharmacodynamics, safety and abuse liability of this hydrocodone formulation and how it relates to Expert Panel's opinion and the FDA decision. We discuss the important issues, risk mitigation, potential use of abuse deterrents, and how ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Postherpetic neuralgia is associated with an increased risk of coronary heart disease: A population-based cohort study
Postherpetic neuralgia (PHN), a type of chronic neuropathic pain, is the most frequent complication of herpes zoster [1]. Cell-mediated immunity plays an essential role in the development of herpes zoster and its complications such as PHN [2]. Inflammation and innate immunity also play central roles in the pathophysiological mechanisms of atherosclerosis and coronary heart disease (CHD) [3]. Studies using animal models have found that statins, widely used for treating hypercholesterolemia and for preventing CHD, could mitigate neuropathic pain by mediating nerve injury-associated inflammatory responses [4,5]. (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Are patients with chronic pain and fibromyalgia correctly classified by MMPI-2 validity scales and indexes?
Publication date: July 2013 Source:The European Journal of Psychology Applied to Legal Context, Volume 5, Issue 2 Author(s): Alfonso Palmer , Carmen Borrás , Javier Pérez-Pareja , Albert Sesé , Manuel Vilariño A study was designed to find out whether MMPI-2 validity scales and indexes differentiate between true fibromyalgia sufferers, patients with chronic organic pain and normal people, as well as whether they are correctly classified. 105 subjects participated in the study, 27 diagnosed with fibromyalgia and 44 with chronic organic pain and 34 were healthy people, who answered the MMPI-2 following standard instructions. The results showed that fibromyalgia patients scored higher than the control group in the F, Fb, F-K, Fp, Ds, and FBS scales and indexes and that patients with chro...


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


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


Reccomendations for the Detection, Study and Referral of Inflammatory Low-back Pain in Primary Care
Conclusions The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments. (Source: Reumatologia Clinica)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Clinical significance of bone mineral density in Ankylosing Spondylitis patients: Relation to disease activity and physical function
Conclusion The BMD was remarkably decreased at all measurement sites in AS patients. The BMD at the spine significantly negatively correlated with the disease activity and physical function. Bone loss in AS can be explained partly by the role of inflammatory mediators and partly as a consequence of reduced physical activity. (Source: The Egyptian Rheumatologist)


Acute graft-versus-host disease following simultaneous pancreas-kidney transplantation: report of a case
Abstract Acute graft-versus-host-disease (aGVHD) is a rare complication in the setting of pancreas-kidney transplantation (PKT). We herein describe the case of a 37-year-old male with severe type 1 diabetes with chronic renal failure who received simultaneous PKT from a female donor. Diarrhea developed on postoperative day (POD) 10. Subsequently, fever and liver dysfunction occurred on POD 32. Skin rashes appeared with pain and itching on his trunk and extremities on POD 40. As pancytopenia occurred on POD 63, bone marrow biopsies demonstrated profound hypoplastic marrow. On POD 69, we eventually made a definitive diagnosis of aGVHD because skin biopsies revealed the XX chromosome signal in a fluorescence in situ hybridization analysis. Thereafter, 100 mg of prednisolone was admi...


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


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


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


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


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


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


Spasticity in disorders of consciousness: A behavioral study.
CONCLUSION: A large proportion of patients with disorders of consciousness develop severe spasticity, possibly affecting their functional recovery and their quality of life. The observed correlation between degrees of spasticity and pain scores highlights the importance of pain management in these patients with altered states of consciousness. Finally, the relationship between spasticity and treatment (i.e., pharmacological and physical therapy) should be further investigated in order to improve clinical care. CLINICAL REHABILITATION IMPACT: Managing spasticity at first signs could improve rehabilitation of patients with disorders of consciousness and maximize their chances of recovery. In addition, decreasing this trouble could allow a better quality of life for these non-communicativ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Smoking 'increases risk of chronic back pain'
Conclusion This longitudinal study found sub-acute back pain was three times more likely to progress to persistent back pain in smokers. The researchers presented functional MRI findings, which indicated brain pathways that could be involved in this process. But further research will be required to fully understand the mechanisms at play. The study did not find that smoking provided any pain relief, and indeed the pain intensity did not increase for those people who stopped smoking. The study sample was quite small, meaning the results may not be applicable to larger and more diverse groups of people. As such, the results are not conclusive and should not be taken at face value. The general advice for the early management of lower back pain is: to continue normal activities as far as...


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


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


Nonspecific low back pain in young adults: Associated risk factors
Conclusion: Some variables related to chronic diffuse pain and lower quality of life might be associated to chronic low back pain in young adults. However, longitudinal studies are necessary. (Source: Revista Brasileira de Reumatologia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Genitofemoral neuralgia: A review
Genitofemoral neuralgia is a cause of neuropathic pain that is often debilitating in nature. It is characterized by chronic neuropathic groin pain that is localized along the distribution of the genitofemoral nerve. The symptoms include groin pain, paresthesias, and burning sensation spreading from the lower abdomen to the medial aspect of the thigh. It may present with scrotal pain in male, while females experience symptoms radiating to the labia majora and mons pubis. Genitofemoral neuropathy has been attributed to iatrogenic nerve injury occurring during inguinal and femoral herniorrhaphy, with cases developing after both open and laparoscopic techniques. Diagnosis of genitofemoral neuralgia can be challenging, due to the overlap in sensory distribution the nerve shares with the ilioing...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Efficacy of epidural methylprednisolone in radicular pain
Conclusions When radicular pain is refractory to conservative treatment based on pharmacological and physical therapy, epidural methylprednisolone is an effective and safe method in our setting. (Source: Colombian Journal of Anesthesiology)


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


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


Alberta Breakthrough Pain Assessment Tool: A validation multicentre study in cancer patients with breakthrough pain.
CONCLUSIONS: In this study, ABPAT resulted to be a well-accepted tool for BTP assessment and characterization in a relatively large cohort of cancer patients. It is effective in discovering the unmet needs of cancer patients and in exploring the outcomes of BTP treatment. PMID: 25370838 [PubMed - as supplied by publisher] (Source: Pain Physician)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Mindfulness intervention in the management of chronic pain and psychological comorbidity: A meta-analysis
Conclusion There is insufficient evidence that mindfulness intervention relieves pain intensity. However, it improves depression and trait anxiety in patients with chronic pain. Further research in larger, properly powered, and better-designed studies is warranted. (Source: International Journal of Nursing Sciences)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Low Back Pain in the ED – are the ACR Appropriateness Criteria being followed?
Conclusion The majority of patients presenting to the ED with low back pain did not undergo imaging. The vast majority of those who underwent imaging were appropriately imaged based on the ACR Appropriateness Criteria. Teaser We conducted a retrospective study of ED imaging for low back pain which demonstrated that the majority of our patient cohort was appropriately imaged based on the ACR Appropriateness Criteria. (Source: Journal of the American College of Radiology)


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


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


Spinal presynaptic inhibition in pain control
Publication date: Available online 22 September 2014 Source:Neuroscience Author(s): D. Guo , J. Hu The gate control theory proposed that the nociceptive sensory information transmitted to the brain relies on an interplay between the inputs from nociceptive and non-nociceptive primary afferent fibers. Both inputs are normally under strong inhibitory control in the spinal cord. Under healthy conditions, presynaptic inhibition activated by non-nociceptive fibers modulates the afferent input from nociceptive fibers onto spinal cord neurons, while postsynaptic inhibition controls the excitability of dorsal horn neurons, and silences the non-nociceptive information flow to nociceptive-specific (NS) projection neurons. However, under pathological conditions, this spinal inhibition may be altere...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Morfometrical and morphological analysis of the suprascapular notch with multidetector computerized tomography
This study was conducted on 100 patients (35 females–65 males). Average age of individuals included into the study was 17–87 years. Results The morphological study of the suprascapular notch revealed six different types of notches. Discussion The data we have obtained in our study are important to constitute a reference space of Turkish society. Furthermore, the fact that the differences between genders and right-left are exhibited will be helpful for surgeons who perform surgery in this region. Therefore, we conclude that the exhibited results will provide a better detail of information regarding morphometry of suprascapular notch and will aid in diagnosing and surgical treatment for shoulder pain. (Source: Journal of the Anatomical Society of India)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Interaction of the adenosine A1 receptor agonist N6-cyclopentyladenosine and κ-opioid receptors in rat spinal cord nociceptive reflexes
Antinociception induced by the adenosine A1 receptor agonist N6-cyclopentyladenosine (CPA) is linked to opioid receptors. We studied the subtype of receptors to which CPA action is related, as well as a possible enhancement of antinociception when CPA is coadministered with opioid receptor agonists. Spinal cord neuronal nociceptive responses of male Wistar rats with inflammation were recorded using the single motor unit technique. CPA antinociception was challenged with naloxone or norbinaltorphimine. The antinociceptive activity of fentanyl and U-50488H was studied alone and combined with CPA. Reversal of CPA antinociception was observed with norbinaltorphimine (82.9±13% of control) but not with low doses of naloxone (27±8% of control), indicating an involvement of κ-opioid but not µ-...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Spinal Surgery Varies by Region in U.S.: Study
Title: Spinal Surgery Varies by Region in U.S.: StudyCategory: Health NewsCreated: 10/31/2014 12:00:00 AMLast Editorial Review: 11/3/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Is This Bursitis?
Discussion Bursa are the body&#8217;s bumper pads for tendons. They are a small synovial fluid-filled sac that lies between tendon and a bone or skin. There are more than 150 of them in the body. With bursitis there can be thickening and proliferation of the synovial lining, bursal adhesions, chalky deposits and villus formation. Trauma, repetitive stress, infection and autoimmune usually are the reasons for bursitis but idiopathic etiology also occurs. The differential diagnosis includes infection, arthritis, tendonitis, tendon or ligament injury, fracture or neoplasm. The usual signs and symptoms are localized pain and tenderness over a bursa, and if the bursa is superficial edema can be seen. Other specific signs and symptoms occur because of location. Bursitis is described as septic or...


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


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


Hand self-Shiatsu for sleep problems in persons with chronic pain: a pilot study
Conclusion These preliminary findings are promising and future studies exploring the mechanism of action and with stronger control of treatment fidelity are indicated. (Source: Journal of Integrative Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Mesenteric Venous Thrombosis
Publication date: September 2014 Source:Journal of Clinical and Experimental Hepatology, Volume 4, Issue 3 Author(s): Bashar Hmoud , Ashwani K. Singal , Patrick S. Kamath Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Acute thrombosis commonly presents with abdominal pain and chronic type with features of portal hypertension. Contrast enhanced CT scan of abdomen is quite accurate for diagnosing and differentiating two types of mesenteric venous thrombosis. Prothrombotic state, hematological malignancy, and local abdominal inflammatory conditions are common predisposing conditions. Over the last decade, JAK-2 (janus kinase 2) mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenter...


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


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


Mucinous adenocarcinoma arising from recurrent perianal fistula in patient with Crohn's disease: case report
This study aims to report a case of mucinous adenocarcinoma originating from recurrent perianal fistula in patients with CD. Case report A man of 43 years, with melanoderma, complaining of perianal tumors, anal pain and mucopurulent secretion, the patient was diagnosed with fistulae. Colonoscopy revealed a chronic inflammatory process associated with villous polypoid lesion in the colonic and rectal mucosa. In a new episode, where it was diagnosed, chronic colitis of rectum and sigmoid was being prescribed sulfasalazine with improvement. There were relapses and the patient underwent repeated fistulectomias. After investigation, CD was diagnosed. Computed tomography (CT) of abdomen and pelvis showed multiple perineal and gluteal collections, and the patient underwent abdominoperineal resec...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Infiltration of Bupivacaine Local Anesthetic to Trocar Insertion Sites After Laparoscopy: A Randomized, Double-blind, Stratified, and Controlled Trial
Conclusion The postoperative injection of bupivacaine in trocar port sites did not significantly improve pain scores after laparoscopic gynecologic surgery. (Source: Journal of Minimally Invasive Gynecology)


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


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


Associations between aspects of pain and cognitive performance and the contribution of depressive symptoms in mid-life women: A cross-sectional analysis
Chronic pain has been associated with cognitive problems in the domains of memory, concentration, problem solving, abstract thinking, and cognitive efficiency [1–3]. Most evidence related to the adverse effect of pain on cognitive functioning is derived from chronic pain patients, including those with fibromyalgia, whiplash, arthritis and other chronic pain conditions [4–7]. It is unclear whether general pain experiences affect cognitive function in the middle-aged and older adult population. This question is important because general pain experiences occur in a substantial proportion of middle-aged and older adults [8]. (Source: Maturitas)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Resting state connectivity correlates with drug and placebo response in fibromyalgia patients
This study indicates that ACC–IC connectivity might play a role in the mechanism of action of MLN, and perhaps more importantly fcMRI might be a useful tool to predict pharmacological treatment response. (Source: NeuroImage: Clinical)


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


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


Herlyn-Werner-Wunderlich syndrome: 3D ultrasonographic diagnosis in premenarche
We report a case with premenarche diagnosis and treatment and make a review of the illness. Case report A premenarche 11year old female was referred for pediatric nephrology and neurodevelopment consultation due to prenatal diagnosis of left renal agenesis. A pelvic ultrasound was performed and an anomalous uterus and a cystic pelvic mass was incidentally discovered. A 3D trans-rectal ultrasound identified a bicolis didelfus uterus and mucocolpos. A unidigital vaginal exam revealed a single cervix with soft bulging of the left apical vaginal wall. Using monopolar knife, an incision was done allowing drainage of the cavity. A part of the apical vaginal septum was removed and a normal cervix was seen. Comments A high degree of clinical suspicion is important for the diagnoses. 3D ultrasoun...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


Erythropoietin attenuates loss of potassium chloride co-transporters following prenatal brain injury
Publication date: July 2014 Source:Molecular and Cellular Neuroscience, Volume 61 Author(s): L.L. Jantzie , P.M. Getsy , D.J. Firl , C.G. Wilson , R.H. Miller , S. Robinson Therapeutic agents that restore the inhibitory actions of γ-amino butyric acid (GABA) by modulating intracellular chloride concentrations will provide novel avenues to treat stroke, chronic pain, epilepsy, autism, and neurodegenerative and cognitive disorders. During development, upregulation of the potassium-chloride co-transporter KCC2, and the resultant switch from excitatory to inhibitory responses to GABA guide the formation of essential inhibitory circuits. Importantly, maturation of inhibitory mechanisms is also central to the development of excitatory circuits and proper balance between excitatory and inhibit...


Effectiveness of jyoti meditation for patients with chronic neck pain and psychological distress - a randomized controlled clinical trial
This article presents the results of a randomized controlled trial on the clinical effects of an 8-week meditation program or self-care exercise in patients with chronic neck pain. Meditation reduced pain at rest but not disability and might be a useful treatment option for pain management of chronic neck pain. (Source: The Journal of Pain)


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


Psychological Factors and Personality Traits Associated With Patients in Chronic Foot and Ankle Pain
Conclusion: The study showed a significant association of anxiety, depression, and neuroticism in patients presenting with chronic foot and ankle pain. Clinicians should recognize the influence of these specific psychological issues to provide a more holistic approach to the clinical problem. Level of Evidence: Level III, case control study. (Source: Foot and Ankle International)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


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


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


Pediatric Chronic Pain Eased by Early Intervention, Parental Involvement
Comfort Ability program provides psychological strategies to help children self-manage symptoms (Source: The Rheumatologist)


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


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


Anatomical Analysis of Medial Branches of Dorsal Rami of Cervical Nerves for Radiofrequency Thermocoagulation
Conclusions: The present anatomical study may help improve accuracy and safety during radiofrequency denervation of the cervical medial branches. (Source: Regional Anesthesia and Pain Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Randomized placebo-controlled clinical trial showed cold atmospheric argon plasma relieved acute pain and accelerated healing in herpes zoster
In this study, weekday 5min plasma treatments with the MicroPlaSter ß device was assessed for safety, pain reduction and healing rates of herpes zoster. 37 inpatients with herpes zoster were treated in a prospective randomized placebo-controlled phase II study with either weekday 5min of cold atmospheric argon plasma (19, active) or with 5min of argon gas (18, placebo), in addition to a standard treatment regime. Pain was assessed by visual analogue scale before and after active or placebo application. Digital images of lesions were evaluated independently by three blinded clinicians, with regard to vesicles, erythema and general impression. Analysis revealed a significantly greater (p&lt;0.01) reduction in pain in plasma-treated patients compared to controls over the course of treatm...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


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


Materials considerations of implantable neuroengineering devices for clinical use
Publication date: Available online 16 September 2014 Source:Current Opinion in Solid State and Materials Science Author(s): Daniel R. Merrill Implantable devices for recording and stimulation of the human nervous system offer promise for the treatment of disorders including spinal cord injury, stroke, traumatic brain injury, sensory and motor deficits, chronic pain, epilepsy, Parkinson’s disease and amputation. While advances in neuroengineering devices have been impressive, often the expectations and desires for a chronically implantable device remain unrealized. In the face of engineering approaches which perform well on the bench or in acute implantations is an immune response which is well-tuned to recognize foreign bodies, including the materials chosen for our innovations. Recent...


Perioperative analgesia: Ever-changing technology and pharmacology
Publication date: March 2014 Source:Best Practice &amp; Research Clinical Anaesthesiology, Volume 28, Issue 1 Author(s): Alan David Kaye , Syed Irfan Q. Ali , Richard D. Urman Our understanding of pain and its long-term implications have dramatically changed with the advent of advancements in molecular mechanisms involved in acute or postoperative pain and chronic pain. This better understanding has led to multiple pharmacologic advancements to better treat pain with minimal side effects. Currently, we are still struggling to find the right balance between all of the different modalities that we have at our leisure. In order to best take care of postoperative pain, we are improving patient satisfaction, decreasing hospital stays, and decreasing the development of long-term pain and i...


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


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


Chronic abdominal pain with a difficult diagnosis
Publication date: May–June 2014 Source:GE Jornal Português de Gastrenterologia, Volume 21, Issue 3 Author(s): Ana Maria Oliveira , Catarina Rodrigues , Liliana Santos , Alexandra Martins , João Ramos de Deus (Source: GE Jornal Portugues de Gastrenterologia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults.
CONCLUSIONS: When all psychological therapies included this review were combined they were superior to usual care or waiting list in terms of reduction of symptom severity, but effect sizes were small. As a single treatment, only CBT has been adequately studied to allow tentative conclusions for practice to be drawn. Compared with usual care or waiting list conditions, CBT reduced somatic symptoms, with a small effect and substantial differences in effects between CBT studies. The effects were durable within and after one year of follow-up. Compared with enhanced or structured care, psychological therapies generally were not more effective for most of the outcomes. Compared with enhanced care, CBT was not more effective. The overall quality of evidence contributing to this review was rated...


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


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


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


Ultrasound Evaluation of Pelvic Pain
This article reviews the ultrasound imaging technique and provides a thorough differential of gynecologic and nongynecologic causes of both acute and chronic pelvic pain. (Source: Radiologic Clinics of North America)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Serum Soluble Bone Turnover Biomarkers in Psoriatic Arthritis and Psoriatic Spondyloarthropathy.
The objectives of our systematic review were to determine whether serum soluble bone and cartilage turnover biomarkers are (1) associated with PsA or psoriatic spondyloarthropathy; and (2) associated with disease activity, disease severity, or clinical phenotype. Ten studies met eligibility criteria. Matrix metalloproteinase (MMP)-3, Dickkopf (DKK)-1, macrophage colony-stimulating factor (M-CSF), crosslinked telopeptide of collagen-1, and tumor necrosis factor-related apoptosis-inducing ligand were associated with PsA, with equivocal results for osteoprotegerin (OPG) and bone alkaline phosphatase (ALP). MMP-3, DKK-1, M-CSF, CPII:C2C (ratio of cartilage degradation vs byproduct formation), and possibly OPG were associated with PsA independently of psoriasis. C1-2C (a neoepitope released whe...


The role of pain‐related anxiety in adolescents' disability and social impairment: ALSPAC data
ConclusionsPain‐related anxiety was associated with greater pain‐related disability and impaired social functioning. Social functioning should be explored as an integral part of fear‐avoidance models of adolescent chronic pain. (Source: European Journal of Pain)


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


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


Efficacy and safety of oral ketamine for the relief of intractable chronic pain: A retrospective 5‐year study of 51 patients
ConclusionsPain was reduced or abolished in two‐thirds of patients under ketamine therapy; ketamine was effective for patients taking opioids and resulted in few adverse effects. (Source: European Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Intravenous Lipid Emulsion Therapy Does Not Improve Hypotension Compared to Sodium Bicarbonate for Tricyclic Antidepressant Toxicity: A Randomized, Controlled Pilot Study in a Swine Model.
CONCLUSIONS: Intravenous lipid emulsion treatment failed to improve amitriptyline-induced hypotension when compared to the standard treatment of sodium bicarbonate in a large animal model of severe TCA overdose. Larger groups with better survival may yield different results from the high mortality observed in this pilot study. Similar amounts of amitriptyline were found in the aqueous and lipid layers. These conclusions are limited to a single ILE regimen. PMID: 25377397 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)


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


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


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


Endpoints in Pain: the Suitability for Health Economic Evaluation of Endpoint Designs in Chronic Pain Studies
A wide range of instruments are used to measure outcomes in clinical studies of chronic pain. However, the suitability of study outcomes for economic evaluations in chronic pain is limited by variability in the instruments used and the failure of those that are in common use to adequately capture the dimensions of a patient’s experience of pain, including function, quality of life and tolerability. The current study aims to identify the pain instruments and study endpoints most commonly used in the clinical trial setting. (Source: Value in Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Predictors of Functional Disability in Patients With Chronic Lumbosacral Radicular Pain
The objective of this study was to assess the functional disability and factors affecting it in patients with chronic lumbosacral radicular pain. (Source: Value in Health)


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


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


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


Cost-Effectiveness Analysis of Celecoxib In the Treatment of Patients With Chronic Pain In Japan
To evaluate the cost-effectiveness of celecoxib compared with loxoprofen for the treatment of patients with chronic pain caused by osteoarthritis, rheumatoid arthritis and low back pain in Japan. (Source: Value in Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Direct Health Care Costs Associated With Opioid-Induced Constipation
Opioid-induced constipation (OIC) is the most common and distressing side effect of opioid treatment in patients with chronic pain. There are limited data to estimate the occurrence of OIC; however, estimates in non-cancer patients range from 40-50% and can be as high as 90% in cancer patients. Increased resource utilisation is associated with the diagnosis and management of OIC; however, the economic burden of OIC remains under-reported. (Source: Value in Health)


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


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


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


Examining Opioid-Dependent Chronic Pain Patients Experiences On Buprenorphine Maintenance Therapy In The Texas Workers Compensation System: Pilot Study - Part 2
The objective of this pilot study was to examine opioid analgesic (OA) use and patient reported outcomes (PRO) among opioid-dependent chronic nonmalignant pain (CNMP) patients placed on buprenorphine therapy in the Functional Restoration and Pain Management (FRPM) program. (Source: Value in Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


[Water-filtered infrared-A (wIRA) promotes wound healing].
Authors: Winkel R, Hoffmann G, Hoffmann R Abstract Water-filtered infrared-A (wIRA) is a special form of heat radiation with high tissue penetration and low thermal load to the skin surface which promotes the healing of acute and chronic wounds both by thermal and thermic as well as by non-thermal and non-thermic effects. Water-filtered infrared-A increases tissue temperature (+ 2.7 °C at a tissue depth of 2 cm), tissue oxygen partial pressure (+ 32 % at a tissue depth of 2 cm) and tissue perfusion. These three factors are decisive for a sufficient supply of tissue with energy and oxygen and consequently also for wound healing and infection defense. Water-filtered infrared-A promotes normal as well as disturbed wound healing by diminishing inflammation and exudation, by ...


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


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


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


Single‐ and multiple‐dose study to evaluate pharmacokinetics, safety and tolerability in healthy volunteers: A comparison of extended‐release oxycodone with sequestered naltrexone 40 mg twice daily to oxycontin 40 mg twice daily and extended‐release oxycodone with sequestered naltrexone 80 mg once daily
This article is protected by copyright. All rights reserved (Source: Clinical Pharmacology in Drug Development)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Comment on Nakamura et al.: Investigation of chronic musculoskeletal pain (third report): with special reference to the importance of neuropathic pain and psychogenic pain
(Source: Journal of Orthopaedic Science)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Histamine antagonism and postinflammatory visceral hypersensitivity
Abdominal pain is one of the most difficult to treat symptoms in patients suffering from IBS. Recent evidence shows that abnormal perception of visceral stimuli, or visceral hypersensitivity, represents an important underlying mechanism. Of interest, similar mechanisms may be involved in abdominal pain reported by UC and Crohn's disease patients in remission. Although the underlying mechanisms are not fully understood, it becomes increasingly clear that intestinal inflammation may provide an initial stimulus for a persistent state of visceral hypersensitivity. Most insight in the role of inflammation in chronic abdominal pain comes from studies evaluating patients with postinfectious (PI)-IBS. Colonic biopsies of patients with PI-IBS reveal no signs of overt inflammation but show persisten...


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


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


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


Aromatherapy Hand Massage for Older Adults With Chronic Pain Living in Long-Term Care
Conclusions: M technique hand massage with or without aromatherapy significantly decreased chronic pain intensity compared to nurse presence visits. M technique hand massage is a safe, simple, but effective intervention. Caregivers using it could improve chronic pain management in this population. (Source: Journal of Holistic Nursing)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


Adherence Barriers to Chronic Dialysis in the United States
In conclusion, poor adherence to hemodialysis treatments may be a substantial roadblock to achieving better patient outcomes. Addressing systemic and patient barriers that impede access to hemodialysis care may decrease missed appointments and reduce patient morbidity. (Source: Journal of the American Society of Nephrology : JASN)


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


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


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


Scientists Find Differences In The Brains Of People With Chronic Fatigue Syndrome
By Nathan Collins Chronic fatigue syndrome affects as many as four in a thousand people in the United States -- perhaps more. Despite that, there's been slow progress in understanding the disease, and researchers still aren't exactly sure what causes it. Now, a small new study hints that subtle differences in the brain's white matter might have something to do with the disease. CFS has a controversial past. For years, health officials denied it even existed, ironically dismissing it as a sign of mental illness. But in the last few years, more and more researchers are taking it seriously. The latest research points to mold-produced toxins as a likely cause -- or at least trigger -- of CFS, the symptoms of which include impaired memory and concentration, extreme fatigue after exercise, mus...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Percutaneous Tibial Nerve Stimulation as an Off-label Treatment of Clitoral Pain
ConclusionsThe findings of this report suggest that PTNS may be a therapeutic option in patients with idiopathic clitoral pain. (Source: Female Pelvic Medicine and Reconstructive Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Effectiveness of the Godelieve Denys-Struyf (GDS) Method in Patients With Low Back Pain: A Cluster Randomized Controlled Trial.
CONCLUSIONS: Disability improvement was slightly higher with Group GDS sessions than with the program routinely used in PT Units within the SNHS. Adding individualized GDS sessions eliminates this advantage. Further studies should compare GDS with other types of exercise. PMID: 25359444 [PubMed - as supplied by publisher] (Source: Physical Therapy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The Ghost of Pregnancies Past
For centuries, theologians have grappled with that line in Exodus 20:5, which states: “For I, the Lord your God, am a jealous God, visiting the iniquity of the fathers on the children to the third and fourth generations of those who hate Me.” From a genetic viewpoint, the iniquity of the fathers might occasionally miss its target, only to hit that innocent bystander, Mom.read more (Source: Psychology Today Sex Center)


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


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


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


A Pain Research Agenda for the 21st Century
Chronic pain represents an immense clinical problem. With tens of millions of people in the United States alone suffering from the burden of debilitating chronic pain, there is a moral obligation to reduce this burden by improving the understanding of pain and treatment mechanisms, developing new therapies, optimizing and testing existing therapies, and improving access to evidence-based pain care. Here, we present a goal-oriented research agenda describing the American Pain Society's vision for the pain research aimed at tackling the most pressing issues in the field. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Why You Should Never Ask 'Have You Tried...?'
One day I walked into the doctor's office and I came out with a diagnosis. At first the diagnosis gave me relief, even joy. At last I have an answer. I know what the problem is, and surely I can therefore find the solution. I can get better. I can feel better. I will be whole again. It's all good from here. You'd think that incurable, life-long stuff would hit you immediately, right in the cerebral cortex and wham! a solution would process. Sadly, it doesn't work like that. Incurable and life-long are concepts that are beyond the human ability to process immediately. In my case, it was beyond my human ability to process them for years. Incurable. Life-long. This is big stuff. So, as I'm processing, I'm also jumping on and off the medical merry-go-round. Like all merry-go-rounds, ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Pain Provocation and Low Gallbladder Ejection Fraction with CCK Cholescintigraphy Are Not Predictive of Chronic Acalculous Gallbladder Disease Symptom Relief After Cholecystectomy
Conclusion Provocation of pain by CCK-CS and low GBEF are unreliable predictors of postoperative relief of symptoms following cholecystectomy for biliary dyskinesia or chronic acalculous gallbladder disease. (Source: Digestive Diseases and Sciences)


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


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


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


Somatosensory and Affective Contributions to Emotional, Social, and Daily Functioning in Chronic Pain Patients
ConclusionsResults suggest that both intensity and unpleasantness contribute unique variance to functional outcomes. The results highlight the importance of interventions that not only try to reduce pain levels but also reduce levels of pain unpleasantness. (Source: Pain Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Co-morbid pain and opioid addiction: Long term effect of opioid maintenance on acute pain
Recent years have seen increasing recognition of the critical intersection between opioid addiction and chronic (non-malignant) pain. However, despite the increased interest in this topic, there is little known about the psycho-physiological links between opioid addiction and pain and extremely few empirically validated treatments (Wachholtz et al., 2011a, 2011b). (Source: Drug and Alcohol Dependence)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Unexpected Cause of Acute Recurrent Vomiting
Question: A 70-year-old woman who was visiting our city presented to the emergency department with a 24-hour history of nausea, voluminous, recurrent vomiting, and epigastric pain. Medical history disclosed gastroesophageal reflux disease, osteoporosis, and chronic cognitive impairment. There was no antecedent of trauma or surgical interventions. She was taking omeprazole and raloxifene hydrochloride as regular medications. At presentation, vital signs were unexceptional and she did not look seriously ill. (Source: Gastroenterology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Total Pancreatectomy With Islet Autotransplantation: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop
AbstractA workshop sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases focused on research gaps and opportunities in total pancreatectomy with islet autotransplantation (TPIAT) for the management of chronic pancreatitis (CP). The session was held on July 23, 2014, and structured into 5 sessions: (1) patient selection, indications, and timing; (2) technical aspects of TPIAT; (3) improving success of islet autotransplantation; (4) improving outcomes after total pancreatectomy; and (5) registry considerations for TPIAT. The current state of knowledge was reviewed; knowledge gaps and research needs were specifically highlighted. Common themes included the need to identify which patients best benefit from and when to intervene with TPIAT, current limitations of the...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


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


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


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


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


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


Health Tip: Coping With Chronic Pain
Title: Health Tip: Coping With Chronic PainCategory: Health NewsCreated: 10/23/2014 12:00:00 AMLast Editorial Review: 10/23/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Surgical anatomy of greater occipital nerve and its relation to occipital artery
Conclusion The knowledge of the anatomy of greater occipital nerve and its relation to occipital artery is important for the surgeon. Blockage or surgical release of greater occipital nerve is clinically effective in eliminating chronic migraine headache. (Source: Alexandria Journal of Medicine)


Prevalence and risk factors of pelvic pain
Conclusions High prevalence of CPP symptoms in Málaga (22.8%); this is related to several significant risk factors. (Source: Actas Urologicas Espanolas)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


Tongue Piercing and Chronic Abdominal Pain with Nausea and Vomiting-2 Cases
Chronic upper gastrointestinal (GI) symptoms of unclear etiology are frustrating to patients and physicians alike. The integrative medicine procedures of acupuncture and neural therapy may provide treatment options. Tongue piercing which is prevalent in 5.6 percent of the adolescent population,1 may be a contributing factor in upper gastrointestinal symptoms. (Source: Explore)


Tongue Piercing and Chronic Abdominal Pain With Nausea and Vomiting—Two Cases
The objectives of the study were as follows: (1) To demonstrate the usefulness of an integrative medicine treatment approach in two cases of patients with chronic abdominal pain, nausea, and vomiting of unclear etiology who had failed standard medical management. (Source: Explore)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Assessment and Management of Pain in Juvenile Idiopathic Arthritis
Abstract Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. Persistent pain is the most common and distressing symptom of JIA, and pain in childhood arthritis is multifactorial. Children and adolescents with persistent pain due to JIA experience significantly more problems with physical, emotional, social, and school functioning than healthy individuals. Assessment of pain at each office visit is the cornerstone of effective pain management and should include an evaluation of pain intensity, interference, and coping. Following the biopsychosocial model of pain management, a multi-modal approach is recommended for pain control in children with arthritis. Pharmacologic strategies for the treatment of pain in JIA include aggressive treatmen...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


A Developmental Analysis of the Factorial Validity of the Parent-report Version of the Adult Responses to Children’s Symptoms (ARCS) in Children versus Adolescents with Chronic Pain or Pain-related Chronic Illness
The widely used Adult Responses to Children’s Symptoms (ARCS) measures parental responses to child symptom complaints among youth aged 7-18 years with recurrent/chronic pain. Given developmental differences between children and adolescents and the impact of developmental stage on parenting, the factorial validity of the parent-report version of the ARCS with a pain-specific stem was examined separately in 743 parents of 281 children (7-11 years) and 462 adolescents (12-18 years) with chronic pain or pain-related chronic illness. (Source: The Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


Works of Illness and the Challenges of Social Risk and the Specter of Pain in the Lived Experience of TMD
Temporomandibular Disorders (TMD) represent a particular form of chronic pain that, while not outwardly debilitating, profoundly impacts interactions as fundamental to human existence as smiling, laughing, speaking, eating, and intimacy. Our analysis, informed by an expanded “works of illness” assessment, draws attention to work surrounding social and physical risk. We refer to these as the work of stoicism and the work of vigilance and identify double binds created in contexts that call for both. Conflicting authorial stances in informants’ narratives are shown to be essential in maintaining a positive identity in the face of illness. While earlier ethnographic studies report TMD sufferers’ experience of stigma and search for diagnosis and legitimacy, we present a group of individ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


Patient quality of life and pain improve after autologous islet transplantation (AIT) for treatment of chronic pancreatitis: 53 patient series at the University of Arizona
Pancreatectomy with autologous islet transplantation has slowly been proving to be an effective way of treating chronic pancreatitis while lessening the effects of the concomitant surgical diabetes of pancreatectomy alone. Assessing patient quality of life and pain after the procedure is particularly important as intractable pain is the main complaint for which patients undergo total pancreatectomy. (Source: Pancreatology)


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


Application of Dienogest in Chronic Pelvic Pain Associated with the Diffuse Form of External Endometriosis
Endometriosis is one of the most common and “mysterious” gynecological diseases in women of reproductive age. (Source: The Journal of Minimally Invasive Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


Inguinal Hernia as a Cause of Chronic Pelvic Pain: A Key Sign to Make the Diagnosis
To identify key presenting characteristics for inguinal hernia in women as a primary source of chronic pelvic pain. (Source: The Journal of Minimally Invasive Gynecology)


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


Hospital-Associated Costs of Chronic Pelvic Pain in Canada
To determine the hospital-related costs associated with women requiring surgery or inpatient admission for chronic pelvic pain in Canada. (Source: The Journal of Minimally Invasive Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


Laparoscopic Excision of Endometriosis in a 14 Year-Old Patient with Chronic Pelvic Pain
This video depicts the laparoscopic excision of endometriosis in a 14 year old patient with chronic pelvic pain. The patient underwent menarche at age 11, and developed cyclic pelvic pain 6 months later. Over the past year the pain has progressed to daily, but with more discomfort during meses. She has been seen by many specialists: a pediatrician, gynecologist, reproductive endocrinologist, gastroenterologist, urologist, pain specialist, and a psychiatrist, who recommended various medical management. (Source: The Journal of Minimally Invasive Gynecology)


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


CA125 and VAS Pain Score Modifications Following GnRH-Analog Administration as Ex Adiuvantibus Criteria to Diagnose Endometriosis as Cause of Chronic Pelvic Pain
To assess the diagnostic accuracy of the combination of two simple parameters for the noninvasive detection of pelvic endometriosis: modifications of serum CA125 and VAS pain score following one dose of GnRH-analog (GnRH-a). (Source: The Journal of Minimally Invasive Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


Robotic Stapler for Coincidental Appendectomy
Coincidental appendectomy has been shown to be beneficial in numerous patient populations such as patients with endometriosis and chronic pelvic pain. Previous reports have noted that laparoscopic surgical staplers used at the time of gynecologic surgery allow for simple, rapid removal of the appendix with decreased procedure time and no spillage of appendiceal contents into the peritoneal cavity. The use of a robotic stapler will provide the same benefits and eliminate the need of the surgeon to rely on conventional laparoscopy to complete the appendectomy. (Source: The Journal of Minimally Invasive Gynecology)


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


Chronic Pelvic Pain & Stress Urinary Incontinence Resolution after Laparoscopic TVT Removal & Burch/Paravaginal Repair
1) Discuss the surgical treatment of pain complications associated with TVT type retropubic slings 2) demonstrate our laparoscopic approach to complete TVT removal 3) demonstrate simultaneous laparoscopic Burch and paravaginal repair for stress urinary incontinence (SUI) and a cystocele. (Source: The Journal of Minimally Invasive Gynecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


Mental health disorders among women victims of conflict-related sexual violence in the Democratic Republic of Congo - Dossa NI, Zunzunegui MV, Hatem M, Fraser WD.
To assess the effects of sexual violence (SV) in armed conflicts on women's mental health, on its own and in conjunction with reproductive health issues such as fistula or chronic pelvic pain (CPP). A cross-sectional population-based study of 320 women liv... (Source: SafetyLit: All (Unduplicated))


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


Minimally invasive facet restoration implant for chronic lumbar zygapophysial pain: 1-year outcomes
Conclusions: A minimally invasive facet restoration implant is a promising treatment option in select patients with chronic lumbar zygapophysial pain who have exhausted nonsurgical treatments, with therapeutic benefit persisting at 1?year follow-up. (Source: Annals of Surgical Innovation and Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


AP pelvis and frog lateral for a limping child
A 5-year-old boy presented to the emergency department with a limp on the left side. The examination was unremarkable, and inflammatory markers were normal. An anteroposterior (AP) pelvic radiograph was arranged (figure 1), and the child was referred to fracture clinic. No lateral radiographs were obtained. Due to a slight irregularity in the articular surface, an MRI scan was organised to investigate the possibility of Legg&ndash;Calv&eacute;&ndash;Perthes disease. The child's symptoms settled; his parents missed his MRI scan appointment. Two years later, the child presented with pain on the opposite side. AP and lateral radiographs showed bilateral slipped upper femoral epiphysis (SUFE) (figures 2 and 3). A CT scan confirmed the diagnosis, with severe chronic slip on the left that was mi...


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


Impaired pre-attentive auditory processing in fibromyalgia: A mismatch negativity (MMN) study
Fibromyalgia (FM) is a commonly encountered chronic pain disorder characterized by widespread pain and tenderness, which are often accompanied by affective and cognitive symptoms (Wolfe et al., 1990; Clauw, 2009; Clauw et al., 2011). A high proportion of patients with FM exhibit cognitive deficits in attention (de Melo et al., 2012), executive function (Verdejo-Garcia et al., 2009), and working memory (Luerding et al., 2008). Recently, the American College of Rheumatology included cognitive symptoms among the developing diagnostic criteria for FM (Wolfe et al., 2010). (Source: Clinical Neurophysiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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


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


[Endoprosthetic treatment of the ankle.]
CONCLUSION: Total ankle replacement is a good option for treating osteoarthritis of the ankle joint in rheumatoid arthritis when attention is paid to the eligibility of the patients. PMID: 25315121 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Rheumatologie)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


Risks From Epidural, Spinal Anesthesia Very Low, Study Says
Title: Risks From Epidural, Spinal Anesthesia Very Low, Study SaysCategory: Health NewsCreated: 10/14/2014 12:00:00 AMLast Editorial Review: 10/15/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


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


Physician practicing preferences for conventional or homeopathic medicines in elderly subjects with musculoskeletal disorders in the EPI3-MSD cohort.
CONCLUSION: NSAID use was significantly higher in elderly MSD patients consulting a conventional practice general practitioner. In contrast, analgesic use and MSD evolution were similar in the three groups. Consulting a homeopathic physician for MSD management does not appear to represent a loss of therapeutic opportunity, and decreases the use of NSAIDs. PMID: 25298739 [PubMed] (Source: Pain Physician)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


Managing chronic pain in adults.
Authors: Barrie J, Loughlin D Abstract The management of chronic pain is complex. Services and support for people living with chronic pain are variable despite the publication of a number of reports highlighting the problem. Due to the epidemiology of pain, nurses deliver care to patients with persistent pain in a variety of settings. It is important that nurses have the knowledge, skills and correct attitude to deliver compassionate, person-centred care, in line with best practice in chronic pain management. PMID: 25315569 [PubMed - in process] (Source: Nursing Standard)


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


Microglia phenotypes in the spinal cords of aging and obese mice: Comorbidity with altered sensory response
In this study, we aimed to characterize the phenotypes of spinal microglia in both obese and aging conditions and to seek whether there is a direct correlation between spinal microglial activation and impaired sensory response. (Source: Journal of Neuroimmunology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


Septic Cavernous Sinus Thrombosis Caused by Sinusitis
By Ichwan, Brian MD; Barrie, Michael MD; Neltner, Kurt MD A 37-year-old man with no significant medical history presented to the emergency department with a headache. He described it as an insidious, constant severe pain that was initially localized occipital but progressed to a bitemporal distribution. His neurologic exam, extraocular movements, and visual acuity were all normal. The patient was given symptomatic treatment with compazine and Benadryl. He was responsive to therapy and discharged home after his headache symptoms resolved.   Seven days later, however, he presented to the emergency department with a worsening headache, progressive altered mental status, fever, and bilateral proptosis. His temperature was of 103.9°F, blood pressure was 194/82 mm Hg, pulse rate was 87 bpm,...


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


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


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


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


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


Long-term success rates after an anterior neurectomy in patients with an abdominal cutaneous nerve entrapment syndrome
Surgery occasionally is proposed in patients with chronic abdominal wall pain caused by an anterior cutaneous nerve entrapment syndrome (ACNES) who are refractory to injection therapy. An anterior neurectomy may seem successful, but follow-up is usually short and populations are small. The primary aim of this study was to determine the long-term success rate of surgery in a large ACNES population. (Source: Surgery)


Complementary and alternative therapy: No benefit from acupuncture for chronic knee pain
Nature Reviews Rheumatology 10, 636 (2014). doi:10.1038/nrrheum.2014.178 In a study in patients aged &#8805;50 years with moderate or severe chronic knee pain, neither laser acupuncture nor needle acupuncture was effective for improving pain or function. The trial allocated 282 community volunteers to treatment with needle acupuncture (n = 70), laser (Source: Nature Reviews Rheumatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Cross-cultural adaptation, evaluation and validation of the Spouse Response Inventory: a study protocol
Introduction Since the response of spouses has been proven to be an important reinforcement of pain behaviour and disability it has been addressed in research and therapy. Fordyce suggested pain behaviour and well behaviour be considered in explaining suffering in chronic pain patients. Among existing instruments concerning spouse's responses the aspect of well behaviour has not been examined so far. The SRI (Spouse Response Inventory) tries to consider pain behaviour and well behaviour and appears to be acceptable because of its brevity and close proximity to daily language. The aim of the study is the translation into German, followed by evaluation and validation, of the SRI on a German sample of patients with chronic pain. Methods and analyses The study is comprehensively designed: ini...


Peripheral pain is enhanced by insulin-like growth factor 1 through a G protein-mediated stimulation of T-type calcium channels.
Authors: Zhang Y, Qin W, Qian Z, Liu X, Wang H, Gong S, Sun YG, Snutch TP, Jiang X, Tao J Abstract Insulin-like growth factor 1 (IGF-1) is implicated in the nociceptive (pain) sensitivity of primary afferent neurons. We found that the IGF-1 receptor (IGF-1R) functionally stimulated voltage-gated T-type Ca(2+) (CaV3) channels in mouse dorsal root ganglia (DRG) neurons through a mechanism dependent on heterotrimeric G protein (heterotrimeric guanine nucleotide-binding protein) signaling. IGF-1 increased T-type channel currents in small-diameter DRG neurons in a manner dependent on IGF-1 concentration and IGF-1R but independent of phosphatidylinositol 3-kinase (PI3K). The intracellular subunit of IGF-1R coimmunoprecipitated with Gαo. Blocking G protein signaling by the intracellular ...


The Tao of IGF-1: Insulin-Like Growth Factor Receptor Activation Increases Pain by Enhancing T-Type Calcium Channel Activity.
Authors: Stemkowski PL, Zamponi GW Abstract T-type calcium channels are important players in the transmission of pain signals in the primary afferent pathway. Indeed, inhibiting or depleting T-type calcium channels in dorsal root ganglion (DRG) neurons mediates analgesia. Conversely, nerve injury or peripheral inflammation have been shown to induce T-type calcium channel activity in DRG neurons, and this in turn has been linked to the development of chronic pain states. The mechanisms that underlie this enhancement of T-type channels remain incompletely understood and may include changes in channel stability in the plasma membrane or alterations in channel function. In this issue of Science Signaling, Zhang and colleagues identify a cell signaling pathway that potently regulates T-...


Chronic pain treatment in children and adolescents: less is good, more is sometimes better
Conclusions: Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well. (Source: BMC Pediatrics)


Transurethral Intraprostatic Injection of Botulinum Toxin Type A for the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Results of a Prospective Pilot Double‐Blind and Randomized Placebo‐Controlled study
ConclusionsTransurethral intraprostatic BoNT‐A injection may be an effective therapeutic option in CP/CPPS patients by reducing pain and improving QoL. (Source: BJU International)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


“Not your grandfather's pleural disease”: Rapid progression, ventilatory impairment, and chronic pleuritic pain from Libby vermiculite/amphibole
(Source: American Journal of Industrial Medicine)


The impact of abdominal pain on global measures in patients with chronic idiopathic constipation, before and after treatment with linaclotide: a pooled analysis of two randomised, double‐blind, placebo‐controlled, phase 3 trials
ConclusionsWhen abdominal pain is present in CIC, abdominal and not bowel symptoms may drive patient assessments of constipation severity, HRQOL, and treatment satisfaction. Linaclotide (145 μg and 290 μg) is an effective treatment for both abdominal and bowel symptoms, even in CIC patients with more severe abdominal pain at baseline. (Clinicaltrials.gov: NCT00765882, NCT00730015). (Source: Alimentary Pharmacology and Therapeutics)


What we know, and don’t know, about the impact of state policy and systems-level interventions on prescription drug overdose
In 2011, drug overdose was the leading cause of injury death, reaching epidemic levels in the United States. Among deaths where the drugs involved were specified, three quarters (over 16,000) of prescription drug overdoses involved opioid analgesics (CDC, 2014). While effective in treating cancer pain (Wiffen et al., 2013) and acute pain, such as in the perioperative setting (American Society of Anesthesiologists Task Force on Acute Pain Management, 2012), the evidence that opioids are effective at treating chronic, non-cancer pain safely over time is limited in quantity and quality (Haroutiunian et al., 2012; Noble et al., 2010). (Source: Drug and Alcohol Dependence)


Personalized Coaching Systems to support healthy behavior in people with chronic conditions
Chronic conditions cannot be cured but daily behavior has a major effect on the severity of secondary problems and quality of life. Changing behavior however requires intensive support in daily life, which is not feasible with a human coach. A new coaching approach - so-called Personal Coaching Systems (PCSs) - use onbody sensing, combined with smart reasoning and context-aware feedback to support users in developing and maintaining a healthier behavior. Three different PCSs will be used to illustrate the different aspects of this approach:(1) Treatment of neck/shoulder pain. (Source: Journal of Electromyography and Kinesiology)


Addressing sleep problems and cognitive dysfunctions in comprehensive rehabilitation for chronic musculoskeletal pain
We would like to thank Helena Hachul, Marcele Siegler, Cristina Frange, Monica L Andersen and Sergio Tufik for their positive feedback on our recently published professional issue article on altering pain memories as part of exercise therapy for chronic musculoskeletal pain (Nijs et al, 2014). In addition, Hachul et al. highlighted some important issues regarding the role of sleep and cognitive dysfunctions in chronic pain patients. Here we take the opportunity kindly offered by the Editors to respond to their commentary. (Source: Manual Therapy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Adverse events among seniors receiving spinal manipulation and exercise in a randomized clinical trial
Spinal manipulative therapy (SMT) and exercise have demonstrated effectiveness for neck pain (NP). Adverse events (AE) reporting in trials, particularly among elderly participants, is inconsistent and challenges informed clinical decision making.This paper provides a detailed report of AE experienced by elderly participants in a randomized comparative effectiveness trial of SMT and exercise for chronic NP.AE data, consistent with CONSORT recommendations, were collected on elderly participants who received 12 weeks of SMT with home exercise, supervised plus home exercise, or home exercise alone. (Source: Manual Therapy)


Interactive cervical motion kinematics: Sensitivity, specificity and clinically significant values for identifying kinematic impairments in patients with chronic neck pain
The objectives of this study were: to compare interactive cervical kinematics in patients with neck pain and controls; to explore the new measures of cervical motion accuracy; and to find the sensitivity, specificity, and optimal cutoff values for defining impaired kinematics in those with neck pain. (Source: Manual Therapy)


Update on the management of anal fissure
Publication date: Available online 8 October 2014 Source:Journal of Visceral Surgery Author(s): T. Higuero Anal fissure is an ulceration of the anoderm in the anal canal. Its pathogenesis is due to multiple factors: mechanical trauma, sphincter spasm, and ischemia. Treatment must address these causative factors. While American and British scientific societies have published recommendations, there is no formal treatment consensus in France. Medical treatment is non-specific, aimed at softening the stool and facilitating regular bowel movements; this results in healing of almost 50% of acute anal fissures. The risk of recurrent fissure remains high if the causative factors persist. If non-specific medical treatment fails, specific medical treatment can be offered to reversibly decrease hyp...


Doppler-guided ligation of hemorrhoidal arteries with mucopexy: A technique for the future
Conclusions THD is a safe procedure and is, at present, one of the most effective treatments of hemorrhoidal disease. (Source: Journal of Visceral Surgery)


Small nerve fiber pathology in critical illness documented by serial skin biopsies
Discussion: Serial IENFD measurements confirmed the development of small fiber sensory involvement in the acute phase of critical illness. © 2014 Wiley Periodicals, Inc. (Source: Muscle and Nerve)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Chronic Pain Anesthesia for Procedures
This article describes the anesthetic techniques used in interventional pain procedures and their indications, side effects, and complications. (Source: Anesthesiology Clinics)


The one-cut meatoplasty: novel surgical technique and outcomes
Conclusions The one-cut meatoplasty is an effective alternative to traditional techniques that is simple to perform. The results of the Chronic Ear Survey indicate the one-cut meatoplasty supports a stable and healthy, open cavity with functional results that compare favorably to other series evaluating canal wall down tympanomastoidectomy with traditional meatoplasty. Additionally, patients report high satisfaction with the appearance of their ear, and all hearing aid users could continue to utilize a hearing aid without feedback, pain, or other difficulties related to poor fitting. (Source: American Journal of Otolaryngology)


Comparison of outcomes and cost in patients undergoing tonsillectomy with electrocautery and thermal welding
Conclusions While the tissue welder remains a viable option for the adult tonsillectomy procedure, it has not demonstrated in our study the necessary parameters intraoperatively, postoperatively, or via cost analysis to become the choice instrument at our institution. We cannot ignore the increase in cost that may be seen for short and routine procedures without an added benefit to the patient in terms of outcome or safety. A larger study is needed to determine if secondary bleeding rates are lower with this instrument. (Source: American Journal of Otolaryngology)


0168: Profiles of pericarditis in internal medicine: about 15 cases
Conclusion The pericarditis is often easy to diagnose. A complete etiological investigation allows an earlier and adapted therapeutic. A good collaboration between an internist and cardiologist would allow an effective prevention of the acute risk of tamponade and chronic evolution toward the constriction. (Source: Archives of Cardiovascular Diseases Supplements)


The sick LADy who cried wolf: A case of Wellens’ syndrome presenting in the shadow of chronic sickle cell pain
Discussion Wellens’ syndrome refers to a pre-infarction stage of acute coronary syndrome with distinct ECG T-wave changes that strongly predict the presence of critical LAD coronary artery stenosis; it is a harbinger of impending extensive anterior myocardial infarction. Emergency physicians must be able to recognize its ECG features and institute appropriate intervention. (Source: African Journal of Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Validation of an Arabic version of the Oswestry index in Saudi Arabia
Conclusion The Arabic version of the ODI adapted to the Saudi population has high metrological qualities. Further studies assessing its responsiveness to change should be conducted. (Source: Annals of Physical and Rehabilitation Medicine)


Non-traumatic calcifications/ossifications of the bone surface and soft tissues of the wrist, hand and fingers: A diagnostic approach
Publication date: Available online 16 September 2014 Source:Diagnostic and Interventional Imaging Author(s): S. Touraine , M. Wybier , E. Sibileau , I. Genah , D. Petrover , C. Parlier-Cuau , V. Bousson , J.-D. Laredo In the absence of obvious trauma, the calcifications/ossifications of the bone surface and soft tissues of the wrist, hand and fingers can be challenging and may not be noticed or lead to unnecessary examinations and monitoring. Although these are usually benign conditions and despite a favorable spontaneous outcome, surgical resection may be required and recurrence may occur. In practice, only paraneoplastic syndromes such as secondary hypertrophic osteoarthropathy (Pierre Marie-Bamberger syndrome) may reveal a malignant tumor, most often pulmonary. We suggest a diagnostic...


Hoffa's disease: A report on 5 cases
We report the case of five patients referred to our department with Hoffa's disease: three patients were at the initial stage of the disease and the two others had reached the chronic stage. This condition is one of the less well-documented causes of pain in the anterior compartment of the knee. The pathophysiological mechanism is still unclear. It is probably caused by repetitive micro trauma resulting in inflammatory, haemorrhagic and fibrous changes to Hoffa's fat pad. The final outcome of the disease is an osteochondroma. The diagnosis is established by MRI, which demonstrates inflammation of the fat pat. At the chronic stage, a standard X-ray is sufficient to demonstrate ossification of the fat pad. (Source: Diagnostic and Interventional Imaging)


The Model of Human Occupation-Based Intervention for Patients with Stroke: A Randomised Trial
Conclusion The MOHO-based intervention was more effective in the improvement of ADL and QOL than non-MOHO-based intervention. (Source: Hong Kong Journal of Occupational Therapy)


Efficacy of low-energy extracorporeal shockwave therapy and a supervised clinical exercise protocol for the treatment of chronic lateral epicondylitis: A randomised controlled study
Publication date: June 2013 Source:Hong Kong Physiotherapy Journal, Volume 31, Issue 1 Author(s): Bibhuti Sarkar , Pooja Ghosh Das , Ameed Equebal , Puspal Kumar Mitra , Ratnesh Kumar , Shahnawaz Anwer This randomised controlled trial was designed to evaluate the efficacy of low-energy extracorporeal shockwave therapy with a supervised exercise protocol for the treatment of chronic lateral epicondylitis. Thirty patients of lateral epicondylitis were randomly placed into two groups: an experimental group (n = 15) and a control group (n = 15). The experimental group received low-energy extracorporeal shockwave therapy and supervised exercise once a week for 3 weeks, whereas the control group received a supervised exercise protocol three times a week. Both the groups were instructed to ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Efficacy and safety of ultrasound-guided saphenous nerve block in patients with chronic knee pain
Conclusions Interventionist chronic knee pain management with ultrasound-guided saphenous nerve block was an effective and safe approach for these patients. (Source: Colombian Journal of Anesthesiology)


Botulinum toxin for the treatment of chronic pain. Review of the evidence
Conclusions Botulinum toxin has certain properties that might have a beneficial effect on chronic pain. However, there is not sufficient evidence supporting its use in the majority of indications in this group of patients. Additional studies are required to recommend its use. Ultrasound is considered a useful tool to guide its application. (Source: Colombian Journal of Anesthesiology)


Management of somatic pain induced by head-and-neck cancer treatment: Definition and assessment. Guidelines of the French Oto-Rhino-Laryngology- Head and Neck Surgery Society (SFORL)
Conclusion The management of somatic pain induced by head-and-neck cancer treatment above all requires identifying and assessing the intensity of the various types of pain involved, their functional impact and their emotional component. (Source: European Annals of Otorhinolaryngology, Head and Neck Diseases)


Functional abdominal pain syndrome treated with Korean medication
This report shows a therapeutic potential of Korean medicine-based treatment for functional abdominal pain syndrome. (Source: Integrative Medicine Research)


Antinociceptive effect of Mirabilis jalapa on acute and chronic pain models in mice
Conclusions Based on its use in traditional medicine, the results of the present study confirmed the antinociceptive properties of Eta in clinically relevant pain models. Also its effect on the CFA-induced chronic inflammation seems to be related to acetylcholinesterase inhibition and cholinergic system. Graphical abstract (Source: Journal of Ethnopharmacology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Update on the use of cardiac markers in the diagnosis of acute coronary syndrome
Publication date: December 2013 Source:Journal of Acute Medicine, Volume 3, Issue 4 Author(s): Swee Han Lim , Ziwei Lin Accurate identification of the cause of chest pain is a challenge to the emergency physician because a significant proportion of patients with acute coronary syndrome (ACS) present atypically. Cardiac troponins are the most sensitive and specific biochemical markers of myocardial damage, and are an important diagnostic tool in the evaluation of ACS. High-sensitivity troponins (hsTn) have been introduced in recent years, and have been shown to have increased accuracy in the diagnosis of acute myocardial infarction (AMI), both at presentation and upon early onset of chest pain. A combination of hsTn readings at presentation and at either 2 hours or 3 hours after the onset...


Rectus sheath abscess caused by perforation of the small bowel by a fish bone
We report a 55-year-old man who presented to the emergency department with complaints of acute abdominal pain and an abdominal wall mass after severe coughing. A rectus sheath hematoma was impressed after a computed tomography study, but his symptoms were refractory to medical treatment. Ultrasonography revealed a foreign body within the mass. A fish bone with abscess formation was found during the surgery. Emergency physicians should maintain a high index of suspicion for an occult retained foreign body in any abscess and consider etiologies other than rectus sheath hematoma if the patient has signs of infection, leukocytosis, or progression of peritonitis. Abdominal ultrasonography may diagnose foreign bodies that are missed by computed tomography. (Source: Journal of Acute Medicine)


Initial presentation of mesenteric venous thrombosis mimicking acute duodenitis: A true gastrointestinal vascular emergency
We present a patient who had a 3-day history of epigastric pain and acid regurgitation and was found to have gastroesophageal reflux disease and duodenitis by esophagogastroduodenoscopy. His symptoms were refractory to treatment with a proton pump inhibitor. Peritonitis developed subsequently. Enhanced computed tomography (CT) confirmed a diagnosis of mesenteric venous thrombosis (MVT) with jejunum infarction. Emergency exploratory laparotomy with segmental resectioning of the jejunum was performed. We emphasize that emergency department (ED) physicians should always thoroughly re-evaluate patients with abdominal pain using serial physical examinations in accordance with the chronic nature of the disease. There is a need to be highly alert to pain that is out of the proportion to the physi...


Extramedullary blast crisis of chronic myelogenous leukemia as an initial presentation
Publication date: 2013 Source:Leukemia Research Reports, Volume 2, Issue 2 Author(s): Shokichi Tsukamoto , Satoshi Ota , Chikako Ohwada , Yusuke Takeda , Masahiro Takeuchi , Emiko Sakaida , Naomi Shimizu , Koutaro Yokote , Tohru Iseki , Chiaki Nakaseko Extramedullary blast crisis of chronic myelogenous leukemia (CML) is defined as the development of extramedullary disease caused by the infiltration of blasts regardless of proliferation of blasts in the bone marrow. The onset of extramedullary blast crisis in the newly diagnosed patients is known to be extremely rare. Here, we present a case of extramedullary blast crisis of CML as an initial presentation in a 17-year-old female presenting with pain in the left femur tumor. This case was treated successfully with dasatinib and allogeneic ...


Persistent renal hyperparathyroidism caused by intrathyroidal parathyroid glands
Publication date: September 2014 Source:Journal of the Chinese Medical Association, Volume 77, Issue 9 Author(s): Chin-Li Chen , Shih-Hua Lin , Jyh-Cherng Yu , Ming-Lang Shih Renal hyperparathyroidism usually occurs in chronic renal failure patients on regular dialysis. However, renal hyperparathyroidism resulting from intrathyroidal parathyroid glands is an uncommon condition. We herein present the case of a 35-year-old woman who has been on hemodialysis for 20 years. She had renal hyperparathyroidism with generalized weakness and bone pain for 2 years. The patient initially underwent parathyroidectomy at a local institution, during which two large parathyroid glands were resected from the right side (no parathyroid glands were found on the left side); however, the surgical procedure wa...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Atypical focal forms of Whipple's disease seen by rheumatologists
We report two atypical cases of focal Whipple's disease with rheumatic presenting symptoms. In one of these cases, the patient presented with chronic intermittent polyarthritis, systemic inflammation, and leukocytosis. Tests were positive for rheumatoid factor and anti-cyclic citrullinated peptide antibodies. There was no structural joint damage. Combined glucocorticoid and methotrexate therapy was only partially effective. Endocarditis requiring emergency valve replacement surgery occurred 4 years later. Evaluation of this event led to the diagnosis of Tropheryma whipplei infection responsible for both the endocarditis and the joint disease. The other patient presented with subacute inflammatory low back pain. His medical history was chiefly remarkable for intermittent inflammatory involv...


Short-term evaluation of arthroscopic management of tennis elbow; including resection of radio-capitellar capsular complex
Conclusion Arthroscopic release of ECRB in patients with chronic lateral epicondylitis is a reproducible method with a marked improvement in function within a short period, with special consideration for resection of radio-capitellar capsular complex. (Source: Journal of Orthopaedics)


A rare clinical presentation of heterotopic gastric mucosa of the jejunum: A case report and review of the literature
We present the case of a baby girl with FTT due to chronic abdominal pain associated with recurrent episodes of abdominal distention, vomiting, and diarrhea. The cause was found to be HGM in the jejunum. The purpose of this paper is to describe this unusual clinical presentation of jejunal HGM. (Source: Journal of Pediatric Surgery Case Reports)


Several submaximal exercise tests are reliable, valid and acceptable in people with chronic pain, fibromyalgia or chronic fatigue: a systematic review
Conclusion: Moderate evidence was found for reliability, validity and acceptability of submaximal exercise tests in patients with chronic pain, fibromyalgia or chronic fatigue. There is no evidence about maximal exercise tests in patients with chronic pain, fibromyalgia and chronic fatigue. [Ratter J, Radlinger L, Lucas C (2014) Several submaximal exercise tests are reliable, valid and acceptable in people with chronic pain, fibromyalgia or chronic fatigue: a systematic review. Journal of Physiotherapy 60: 144–150] (Source: Journal of Physiotherapy)


Chronic pain
Publication date: September 2014 Source:Journal of Physiotherapy, Volume 60, Issue 3 Author(s): Sandra Brauer (Source: Journal of Physiotherapy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Kinesio Taping to generate skin convolutions is not better than sham taping for people with chronic non-specific low back pain: a randomised trial
Conclusion: Kinesio Taping applied with stretch to generate convolutions in the skin was no more effective than simple application of the tape without tension for the outcomes measured. These results challenge the proposed mechanism of action of this therapy. Trial registration: Brazilian Registry of Clinical Trials, RBR-7ggfkv. [Parreira PCS, Costa LCM, Takahashi R, Hespanhol Junior LC, da Luz Junior MA, da Silva TM, Costa LOP (2014) Kinesio Taping to generate skin convolutions is not better than sham taping for people with chronic non-specific low back pain: a randomised trial. Journal of Physiotherapy 60: 90–96] (Source: Journal of Physiotherapy)


The role of long chain fatty acids and their epoxide metabolites in nociceptive signaling
Publication date: Available online 18 September 2014 Source:Prostaglandins &amp; Other Lipid Mediators Author(s): Karen Wagner , Steve Vito , Bora Inceoglu , Bruce D. Hammock Lipid derived mediators contribute to inflammation and the sensing of pain. The contributions of omega-6 derived prostanoids in enhancing inflammation and pain sensation are well known. Less well explored are the opposing anti-inflammatory and analgesic effects of the omega-6 derived epoxyeicosatrienoic acids. Far less has been described about the epoxidized metabolites derived from omega-3 long chain fatty acids. The epoxide metabolites are turned over rapidly with enzymatic hydrolysis by the soluble epoxide hydrolase being the major elimination pathway. Despite this, the overall understanding of the role of li...


Partner validation in chronic pain couples
Publication date: Available online 7 October 2014 Source:Scandinavian Journal of Pain Author(s): Silje Endresen Reme (Source: Scandinavian Journal of Pain)


Invisible pain – Complications from too little or too much empathy among helpers of chronic pain patients
Publication date: Available online 2 October 2014 Source:Scandinavian Journal of Pain Author(s): Harald Breivik (Source: Scandinavian Journal of Pain)


Exonic mutations in SCN9A (NaV1.7) are found in a minority of patients with erythromelalgia
Conclusions We conclude that functionally characterized mutations of NaV1.7 (I848T) are present only in a minority of patient with EM. Albeit the majority of patients (27/48) carried rare protein-modifying mutations the vast majority of those will most probably not be causally linked to their disease. Implications The key question remaining to be solved is the possible role of rare variants of NaV1.8, NaV1.9, or beta-subunits in provoking chronic pain conditions or even EM. (Source: Scandinavian Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Symptoms, disabilities, and life satisfaction five years after whiplash injuries
Conclusions This study shows that five years after a whiplash injury, patients reported symptoms that are typical of mild traumatic brain injury. Further, this study emphasizes the possibility of screening patients with chronic WAD for these symptoms as a complement to the assessment. Implications Untreated symptoms may negatively affect the outcome of pain rehabilitation. This implies that it might be clinically meaningful to quantify symptoms earlier in the rehabilitation process. (Source: Scandinavian Journal of Pain)


Repeated sinomenine administration alleviates chronic neuropathic pain-like behaviours in rodents without producing tolerance
Conclusions The results suggest that repeated administration of simomenine produced an enhanced anti-allodynic effect without tolerance in rodent models of neuropathic pain. Implications Sinomenine may be tested as a novel analgesic in treating some forms of chronic neuropathic pain in patients. (Source: Scandinavian Journal of Pain)


Low health related quality of life (QoL) in older adults is associated with chronic pain in women and with disturbed sleep in men
Publication date: October 2014 Source:Scandinavian Journal of Pain, Volume 5, Issue 4 Author(s): Harald Breivik (Source: Scandinavian Journal of Pain)


Evaluation of the cost-effectiveness of buprenorphine in treatment of chronic pain using competing EQ-5D weights
Conclusions The results imply that the 7-day buprenorphine patch may be a cost-effective treatment of moderate chronic pain in patients over 50 years of age. The UK and the Swedish EQ-5D weights generated vastly different HRQoL estimates but buprenorphine remains cost-effective regardless choice of weight set. Implications Buprenorphine is a treatment alternative that could be included in the Swedish reimbursement system, although the substantial different HRQoL estimates call for clear guidelines regarding the applicability of each weight regimen. (Source: Scandinavian Journal of Pain)


I see you’re in pain – The effects of partner validation on emotions in people with chronic pain
Conclusions Our results indicate that the partner or closest family member, after brief validation training, increased validating responses and decreased invalidating responses towards the person with pain, which had an immediate positive impact on emotions in the other person. Implications This study suggests that using validation in interpersonal interactions is a promising tool for couples where chronic pain is present. (Source: Scandinavian Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Hybrid emotion-focused exposure treatment for chronic pain
Publication date: July 2014 Source:Scandinavian Journal of Pain, Volume 5, Issue 3 Author(s): Michael K. Nicholas (Source: Scandinavian Journal of Pain)


A hybrid emotion-focused exposure treatment for chronic pain: A feasibility study
Conclusions This emotion-regulation hybrid exposure intervention resulted in considerable improvements for the participants. The results of this study underscore the potential utility of addressing emotions in the treatment of chronic pain. Further, they support the idea that targeting emotional stimuli and using emotion regulation skills in conjunction with usual exposure may be important for obtaining the best results. Finally, we found that this treatment is feasible to provide and may be an important addition to usual exposure. However, since we did not directly compare this hybrid treatment with other treatments, additional research is needed before firm conclusions can be made. Implications Addressing emotional distress in the treatment of patients suffering chronic pain appears to ...


Spinal cord stimulation: Background and clinical application
Publication date: July 2014 Source:Scandinavian Journal of Pain, Volume 5, Issue 3 Author(s): Kaare Meier Background Spinal cord stimulation (SCS) is a surgical treatment for chronic neuropathic pain refractory to conventional treatment. SCS treatment consists of one or more leads implanted in the epidural space of the spinal canal, connected to an implantable pulse generator (IPG). Each lead carries a number of contacts capable of delivering a weak electrical current to the spinal cord, evoking a feeling of peripheral paresthesia. With correct indication and if implanted by an experienced implanter, success rates generally are in the range of about 50–75%. Common indications include complex regional pain syndrome (CRPS I), angina pectoris, and radicular pain after failed back surgery ...


Depression and anxiety in adolescents aggravate abdominal pain, and abdominal pain deepens depression which increases suffering from chronic pain
Publication date: July 2014 Source:Scandinavian Journal of Pain, Volume 5, Issue 3 Author(s): Harald Breivik (Source: Scandinavian Journal of Pain)


Associations between abdominal pain symptom dimensions and depression among adolescents
Conclusions and implications The prevalence of depression is considerably increased among adolescents with AP and IBS in the general population, in particular among those reporting severe, widespread abdominal pain, and co-morbid chronic pain. Evaluating these symptom dimensions may be of value for identifying subgroups adolescents with AP and IBS that have greater risk of depression. (Source: Scandinavian Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Psychological factors in genital pain: The role of fear-avoidance, pain catastrophizing and anxiety sensitivity among women living in Sweden
Conclusions The study had a low response rate, but still indicates that genital pain is common and is associated with several aspects of fear and avoidance. In sum, the results support the FA model by giving strong support for fear reactions (vaginal tension) and fear avoidance beliefs, and moderate support for negative affect. In the model negative affect drives pain catastrophizing. Implications It seems that the experience of genital pain among women in the general population is common and could be associated with increased levels of anxiety and fear-avoidance beliefs. However, the associations should not be understood in isolation from physiological mechanisms but seem to indicate interactions between, e.g. fungal infections, negative appraisals of pain and symptoms, lack of sexual fu...


When sex hurts: Female genital pain with sexual consequences deserves attention: A position paper
Conclusions and implications There is a growing interest in the problem of female genital pain and associated problems with sexual pain. However, research predominately refers to the field of sex research, and the involvement from the pain community has to date been relatively low. There is an immediate need to identify the psychosocial mechanisms involved in the transition from acute to chronic genital pain in women and to address these components in treatment using established methods. Since sexual pain is far more than pain during vaginal penetration, there is a risk of treatment interventions being oriented towards performance in terms of a narrowly defined sexual behavior instead of focusing on valued activities, meaning and pleasure for the individual. Assessment and treatment have t...


Chronic whiplash, pain and pain tolerance
Publication date: July 2014 Source:Scandinavian Journal of Pain, Volume 5, Issue 3 Author(s): Solbjørg Makalani Myrtveit , Jens Christoffer Skogen , Børge Sivertsen , Ólöf Anna Steingrímsdóttir , Audun Stubhaug , Christopher Sivert Nielsen (Source: Scandinavian Journal of Pain)


Protein alterations in women with chronic widespread pain—A proteomic study of the trapezius muscle
Publication date: July 2014 Source:Scandinavian Journal of Pain, Volume 5, Issue 3 Author(s): P. Olausson , N. Ghafouri , D. Sjöström , E. Blixt , B. Gerdle , B. Ghafouri (Source: Scandinavian Journal of Pain)


Levels of N-acylethanolamines in the interstitium of trapezius muscle during the tissue trauma: A microdialysis study on women with chronic widespread pain
Publication date: July 2014 Source:Scandinavian Journal of Pain, Volume 5, Issue 3 Author(s): N. Stensson , N. Ghafouri , B. Gerdle , B. Ghafouri (Source: Scandinavian Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Ketamine – More mechanisms of action than just NMDA blockade
Publication date: June 2014 Source:Trends in Anaesthesia and Critical Care, Volume 4, Issues 2–3 Author(s): Jamie Sleigh , Martyn Harvey , Logan Voss , Bill Denny Ketamine has been in clinical use for over half a century, yet its precise mechanisms of action remain mysterious for the large part. Its hypnotic effects appear to be largely mediated by blockade of NMDA and HCN1 receptors, but cholinergic, aminergic, and opioid systems appear to play both a positive and negative modulatory role in both sedation and analgesia. Ketamine's effects in chronic pain, and as an antidepressant, far outlast the actual drug levels, and are probably mediated by a secondary increase in structural synaptic connectivity that is mediated by a neuronal response to the ketamine-induced hyper-glutamatergic s...


Chronic Radiation Proctopathy and Colopathy
This article is part of an expert video encyclopedia. (Source: Video Journal and Encyclopedia of GI Endoscopy)


The Approach to Chronic Pelvic Pain in the Adolescent
Publication date: September 2014 Source:Obstetrics and Gynecology Clinics of North America, Volume 41, Issue 3 Author(s): Jill PowellTeaser Adolescents present to outpatient and acute care settings commonly for evaluation and treatment of chronic pelvic pain (CPP). Primary care providers, gynecologists, pediatric and general surgeons, emergency department providers, and other specialists should be familiar with both gynecologic and nongynecologic causes of CPP so as to avoid delayed diagnoses and potential adverse sequelae. Treatment may include medications, surgery, physical therapy, trigger-point injections, psychological counseling, and complementary/alternative medicine. Additional challenges arise in caring for this patient population because of issues of confidentiality, embarrassm...


Surgical Evaluation and Treatment of the Patient with Chronic Pelvic Pain
Publication date: September 2014 Source:Obstetrics and Gynecology Clinics of North America, Volume 41, Issue 3 Author(s): M. Brigid Holloran-SchwartzTeaser Treatment of patients with chronic pelvic pain is assisted by detailed history, physical examination, pain diary, and ultrasonography. The possibility of other contributing systems (eg, gastrointestinal, genitourinary, musculoskeletal) should also be addressed and treatment initiated if present. A diagnostic surgical procedure is helpful in patients for whom medical management or whose severity of pain warrants an urgent diagnosis. Limited evidence exists to support adhesions, endometriosis, ovarian cysts, ovarian remnants, and hernias as being causes of chronic pelvic pain. In select patients, ovarian cystectomy, excision of endometr...


Interstitial Cystitis Epidemiology, Pathophysiology, and Clinical Presentation
Publication date: September 2014 Source:Obstetrics and Gynecology Clinics of North America, Volume 41, Issue 3 Author(s): Mary T. McLennanTeaser Interstitial cystitis, or painful bladder syndrome, can present with lower abdominal pain/discomfort and dyspareunia, and pain in any distribution of lower spinal nerves. Patients with this condition experience some additional symptoms referable to the bladder, such as frequency, urgency, or nocturia. It can occur across all age groups, although the specific additional symptoms can vary in prevalence depending on patient age. It should be considered in patients who have other chronic pain conditions such as fibromyalgia, chronic fatigue, irritable bowel, and vulvodynia. The cause is still largely not understood, although there are several postul...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Vulvodynia
This article gives the primary gynecologist a basic framework with which to identify, diagnose, and begin treatment for these patients and refer if necessary. Initial evaluation and physical examination are discussed in detail. Treatments ranging from self-management strategies to nonpharmacologic and pharmacologic therapies will be explored. Because vulvodynia is a chronic pain disorder, diagnosis is the key to beginning treatment and support for this patient population. (Source: Obstetrics and Gynecology Clinics of North America)


Gastrointestinal Causes of Abdominal Pain
Publication date: September 2014 Source:Obstetrics and Gynecology Clinics of North America, Volume 41, Issue 3 Author(s): Elizabeth Marsicano , Giao Michael Vuong , Charlene M. PratherTeaser Gastrointestinal causes of abdominal pain are numerous. These causes are reviewed in brief here, divided into 2 categories: acute abdominal pain and chronic abdominal pain. They are further subcategorized by location of pain as it pertains to the abdomen. (Source: Obstetrics and Gynecology Clinics of North America)


Opioid Use and Depression in Chronic Pelvic Pain
Publication date: September 2014 Source:Obstetrics and Gynecology Clinics of North America, Volume 41, Issue 3 Author(s): Andrew SteeleTeaser Opioid pain medications and antidepressants are commonly prescribed to patients for chronic non-cancer pain. However, little evidence exists for their effectiveness in most pain states, including chronic pelvic pain. Whenever possible, initiation of opioid pain medications in chronic non-cancer pain should be avoided. If patients present for evaluation of disease states such as endometriosis or interstitial cystitis already using regular narcotics, physicians should be aware of ways to mediate misuse and diversion. Women with chronic pain should be screened for depression as well as a history of prior sexual abuse, and treatment or referral initiat...


Complementary and Alternative Medications for Chronic Pelvic Pain
This article concentrates on other sources of alternative and complementary medicine, such as dietary supplementation and acupuncture. (Source: Obstetrics and Gynecology Clinics of North America)


The Perils of Opioid Prescribing During Pregnancy
Publication date: June 2014 Source:Obstetrics and Gynecology Clinics of North America, Volume 41, Issue 2 Author(s): Marjorie MeyerTeaser Chronic opioid therapy during pregnancy is perilous, but not simply because of neonatal effects: it is perilous because women are at particular risk for misprescription, misuse, dependence, overdose, and death. Opioids may be teratogens and should be avoided in the periconception period. Accidental childhood poisoning and purposeful teen experimentation are increased with opioid prescriptions in the home. Risks to pregnancy span the pre- and periconception period; neonatal risk following in utero opioid exposure is well documented. When the authors’ patients request opioids for chronic pain, they care for them in a comprehensive and compassionate mat...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Chronic pain 1year after foot surgery: Epidemiology and associated factors
The objectives of this prospective single-centre study were to determine the rates of occurrence and associated factors of any chronic pain and of neuropathic chronic pain 1year after orthopaedic surgery on the foot. Methods We included consecutive patients who underwent scheduled orthopaedic surgery on the foot or ankle at a university hospital centre between 2009 and 2011. All patients received a multimodal analgesia regimen that usually combined a continuous popliteal sciatic nerve block, paracetamol, and ketoprofen, with additional ketamine if deemed appropriate. A telephone interview was conducted 1year after the surgical procedure. The main outcome measures were moderate-to-severe pain (numerical rating scale score&gt;3/10) 1year after surgery at rest and during walking, and pre...


Outcomes of bipolar radial head prosthesis to treat complex radial head fractures in 22 patients with a mean follow-up of 50 months
Discussion Outcomes after Guepar® bipolar radial head prosthesis implantation were disappointing in patients with complex radial head fractures seen in the acute or chronic setting. The associated injuries to bones and ligaments and the measures taken to repair them influence the prognosis. The complication rate is non-negligible and seems to increase over time. Level of evidence IV, retrospective study. (Source: Orthopaedics and Traumatology: Surgery and Research)


Local and regional anaesthetic techniques in wound management
Publication date: September 2014 Source:Surgery (Oxford), Volume 32, Issue 9 Author(s): Ganesan Baranidharan , Michelle Briggs Adequate pain control is vital in perioperative care. Pain affects respiratory and cardiovascular function with knock-on effects on many other organs and systems. Surgery is also recognized as one of the most frequent causes of chronic pain with surgical approach and level of pain experienced being modifiable risk factors for the development of chronic post-surgical pain. Local anaesthetic can be used to facilitate pain relief either by local infiltration or nerve blocks, increased mobility and a better perioperative and postoperative experience for the patients. There are two pharmacological types, esters and amides, that have different uses. Commonly used block...


Health outcomes and socio-economic status among the mid-aged and elderly in China: Evidence from the CHARLS national baseline data
Publication date: April 2014 Source:The Journal of the Economics of Ageing, Volume 3 Author(s): Xiaoyan Lei , Xiaoting Sun , John Strauss , Yaohui Zhao , Gonghuan Yang , Perry Hu , Yisong Hu , Xiangjun Yin Using a very rich set of health indicators that include both self-reported measures and biomarkers from the CHARLS national baseline data, we document health conditions of the Chinese mid-aged and elderly, examine correlations between these health outcomes and socio-economic status and compare these associations by gender, hukou status and region. As expected, we find that Chinese mid-aged and elderly are facing challenges from chronic diseases including hypertension. Overnutrition has become a bigger problem than undernutrition, particularly for women, reflected in a higher rate of ov...


Common anesthetic procedure dramatically improves well being of veterans with PTSD
A single application of a common anesthetic procedure could be the answer to alleviating anxiety, depression and psychological pain in those suffering from chronic, extreme post-traumatic stress disorder (PTSD), according to research. (Source: ScienceDaily Headlines)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The painful primary hip replacement - review of the literature.
Authors: Forster-Horvath C, Egloff C, Nowakowski AM, Valderrabano V Abstract Total hip replacement is one of the most successful surgical procedures of the 20th century (World Health Organisation). The success rate is dependent on the chosen endpoint. Evaluation of the outcome in joint replacement surgery has shifted from the revision rate toward patient satisfaction and quality of life. Patient satisfaction is reported to be up to 96% 16 years postoperatively, but the prevalence of groin pain after conventional total hip replacement ranges from 0.4% to 18.3% and activity-limiting thigh pain is still an existing problem linked to the femoral component of uncemented hip replacement in up to 1.9% to 40.9% of cases in some series. The aim of our article is to review the aetiology, dia...


The use of cinacalcet in pregnancy to treat a complex case of parathyroid carcinoma.
We present the case of a patient with metastatic parathyroid carcinoma whose hypercalcaemia was medically managed through two pregnancies. The diagnosis was made when the patient presented with chronic knee pain and radiological findings consistent with a brown tumour, at the age of 30. Her corrected calcium and parathyroid hormone (PTH) levels were significantly elevated. Following localisation studies, a right parathyroidectomy was performed with histology revealing parathyroid carcinoma, adherent to thyroid tissue. Aged 33, following biochemical recurrence of disease, the patient underwent a second operation. A subsequent CT and FDG-PET revealed bibasal pulmonary metastases. Aged 35, the patient was referred to our unit for treatment of persistent hypercalcaemia. The focus of treatment ...


An intriguing finding in the right atrium
A 67-year-old male presented with shortness of breath, exacerbated by standing up and walking around and alleviated upon lying down. There was no associated coughing or chest pain. His medical history was notable for chronic alcohol abuse, chronic obstructive pulmonary disease and two recent admissions for aspiration pneumonitis. An inferior vena cava (IVC) filter had been placed 10&nbsp;years earlier due to a pulmonary embolism. He denied illicit drug use. He was not taking any regular medications. On physical examination: T 97.6, P 100, BP 101/70, RR 30, O2 sat 95% supine and 91% upright on room air. He looked dishevelled, without respiratory distress. There was no jugular venous distention, and carotid pulses were brisk. Lungs were clear on auscultation. Heart sounds were normal without...


[Case Report] Dyspnoea, weight loss, fever, and headache caused by extrapulmonary tuberculosis in a prison inmate
A 55-year-old Panamanian man was referred from a penitentiary clinic to Hospital Santo Tomás in March, 2014. He presented with a 10-day history of breathing difficulty, chest pain, fever, headache, and had also lost more than 10 kg in weight over the previous 2 months. His medical and family history was unremarkable; however, he reported that he had been in contact with inmates who had had chronic cough for 2 years. The patient's vital signs were normal, apart from a respiratory rate of 28 breaths per min. (Source: LANCET)


A possible link between dysmenorrhoea and the development of chronic pelvic pain
This study describes the timeline for the transition from dysmenorrhoea to CPP in a cohort of new patients attending a private gynaecology clinic. In 16.4% of cases, transition occurred within one year, and within 12 years in over 50%. Our study suggests clinicians need to observe women with severe dysmenorrhoea for signs of chronic pain. Further research is needed into the transition from dysmenorrhoea to CPP, and effective early interventions. (Source: The Australian and New Zealand Journal of Obstetrics and Gynaecology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Pharmacological Treatment of Chronic Non-Cancer Pain in Pediatric Patients.
This article reviews the major medications used for pediatric chronic pain conditions. PMID: 25304005 [PubMed - as supplied by publisher] (Source: Paediatric Drugs)


Pharmacological Treatment of Chronic Non-Cancer Pain in Pediatric Patients
This article reviews the major medications used for pediatric chronic pain conditions. (Source: Pediatric Drugs)


P2X Receptors, Sensory Neurons and Pain.
Authors: Bele T, Fabbretti E Abstract Pain represents a very large social and clinical problem since the insufficient pain relief during current treatment. Plasticity of pain receptors together with sensitization of sensory neurons, and the role of soluble mediators released from non-neuronal cells render difficult to understand the spatial and temporal scale of pain development, neuronal responses and disease progression. In pathological conditions, ATP is one of the most powerful mediators that activate P2X receptors that behave as sensitive ATP-detectors, such as neuronal P2X3 receptor subtypes and P2X4 and P2X7 receptors expressed on non-neuronal cells. Dissecting the molecular mechanisms occurring in sensory neurons and in accessory cells allow design appropriate tissue- and c...


C.R. Bard Settles Vaginal Mesh Suits For $21 Million
Surgical products maker C.R. Bard agreed to settle more than 500 lawsuits for $21 million over its transvaginal mesh implants that patients claim had caused chronic pain, organ damage, and other complications. (Source: Medical Design Online News)


Sociodemographic and disease-related factors are associated with patient-reported anxiety and depression in spondyloarthritis patients in the Swedish SpAScania cohort
This study aims to explore which factors are associated with self-reported anxiety and depression in a well-defined cohort of spondyloarthritis (SpA) patients. In 2009, 3,711 patients from the SpAScania cohort were sent a postal questionnaire to assess health-related quality of life (HRQoL) and physical and mental functioning. The Hospital Anxiety and Depression Scale measured anxiety (HADS-A) and depression (HADS-D), subscales 0–21, best–worst. HADS ≥8 indicates possible cases of anxiety or depression. One-way ANOVA (p &lt; 0.05) tested for differences among the SpA subtypes in HADS scores. Linear regression analysis adjusted for age, gender, and disease duration was used to test for associations between HADS and independent variables. In total, 2,167 (58 %) patients (52 % fem...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Efficacy of an out-patient pain management programme for people with joint hypermobility syndrome
Abstract Joint hypermobility syndrome (JHS) is common in patients presenting to rheumatologists and can cause a range of symptoms leading to physical and psychological distress. Chronic musculoskeletal pain in patients with JHS often responds poorly to analgesics, and a pain management approach may be helpful. Since patients with JHS often have beliefs and experiences different to those of other chronic pain patients, they could fare better in JHS-specific programmes. Here, we report on the outcomes of patients in a JHS cognitive behavioural pain management programme. Patients fulfilling the Brighton criteria for JHS, who had suffered pain for at least 3 months, were assessed by a psychologist and physiotherapist for suitability for this programme. Those accepted took part in a ...


Opioid Prescribing by Physicians With and Without Electronic Health Records
Conclusions We found higher levels of opioid prescribing among physicians with EHRs compared to those without. These results highlight the need to better understand how using EHR systems may influence physician prescribing behavior so that EHRs can be designed to reliably guide physicians toward high quality care. (Source: Journal of Medical Systems)


Diagnostic Performance and Comparative Cost-Effectiveness of Non-invasive Imaging Tests in Patients Presenting with Chronic Stable Chest Pain with Suspected Coronary Artery Disease: A Systematic Overview
Abstract Several non-invasive imaging techniques are currently in use for the diagnostic workup of adult patients with stable chest pain suspected of having coronary artery disease (CAD). In this paper, we present a systematic overview of the evidence on diagnostic performance and comparative cost-effectiveness of new modalities in comparison to established technologies. A literature search for English language studies from 2009 to 2013 was performed, and two investigators independently extracted data on patient and study characteristics. The reviewed published evidence on diagnostic performance and cost-effectiveness support a strategy of CTCA as a rule out (gatekeeper) test of CAD in low- to intermediate-risk patients since it has excellent diagnostic performance and as initial...


External Noninvasive Peripheral Nerve Stimulation Treatment of Neuropathic Pain: A Prospective Audit
ConclusionIn this first prospective report on the use of EN‐PNS in neuropathic pain, this technology provided significant clinical benefit for some patients. Controlled studies are required to confirm our results and the place of EN‐PNS in future neuromodulation treatment algorithms. Given the refractory nature of these conditions, these results are encouraging. (Source: Neuromodulation)


Treatment of low back pain: extended follow up of an original trial (NCT00600197) comparing a multidisciplinary group‐based rehabilitation program with oral drug treatment alone up to 24 months
This study aimed to examine the effects of the extended follow‐up of an original trial (NCT00600197) which has been published in The Clinical Journal of Pain. MethodsEighty‐three percent (165 of 197) of the original study, including 82 patients in intervention and 83 patients in the control group, provided extended 24‐month follow‐up data. The intervention was a group‐based multidisciplinary rehabilitation program which was continued by monthly motivational consultation. Data on measures of Short Form 36 (SF‐36), Quebec Disability Scale (QDS) and Ronald Morris Disability (RDQ) were collected at 12‐, 18‐ and 24‐month follow‐ups and analyzed through repeated measures analysis of variance. ResultsThe patients who responded (n = 165) and who did not respond (n = 32) to ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Quality of care among patients undergoing lower extremity revascularization
Conclusions: Although adherence to guidelines improved over time, we found a significant gap between guidelines and practice for this cohort of patients at increased risk for adverse cardiovascular events. (Source: Vascular Medicine recent issues)


Retroperitoneal fibrosis
(RPF) is a rare disease that is marked by systemic inflammation and the development of a periaortic fibroinflammatory mass. The fibroinflammatory infiltration can encase the abdominal aorta, ureters, and other abdominal organs. The clinical presentation often includes constitutional symptoms, abdominal pain, and signs of renal insufficiency or renal failure related to ureteral obstruction. Less frequently, RPF may present with vascular complications, such as venous thrombosis or claudication. The idiopathic form of RPF is most common but secondary forms have been described and are associated with malignancy and a variety of different medications. The pathophysiology is uncertain, but RPF has been linked with periaortitis and IgG4-related disease. Treatment centers on the relief of symptom...


Adenylyl cyclase subtype 1 is essential for late-phase long term potentiation and spatial propagation of synaptic responses in the anterior cingulate cortex of adult mice
Long-term potentiation (LTP) is a key cellular mechanism for pathological pain in the central nervous system. LTP contains at least two different phases: early-phase LTP (E-LTP) and late-phase LTP (L-LTP). Among several major cortical areas, the anterior cingulate cortex (ACC) is a critical brain region for pain perception and its related emotional changes. Periphery tissue or nerve injuries cause LTP of excitatory synaptic transmission in the ACC. Our previous studies have demonstrated that genetic deletion of calcium-stimulated adenylyl cyclase 1 (AC1) or pharmacological application of a selective AC1 inhibitor NB001 blocked E-LTP in the ACC. However, the effect of AC1 on L-LTP, which requires new protein synthesis and is important for the process of chronic pain, has not been investigat...


The impact of the stimulation method on differences in pain thresholds and brain responses between chronic pain patients and healthy controls
(Source: European Journal of Pain)


Endovascular Treatment in a Patient with Left Main Coronary and Pulmonary Arterial Stenoses as an Initial Manifestation of Takayasu's Arteritis
We report a case of Takayasu's arteritis who presented with exertional dyspnoea and generalised oedema due to severe bilateral pulmonary and left main coronary arterial stenoses. (Source: Heart, Lung and Circulation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Skin&ndash;Nerve Preparation to Assay the Function of Opioid Receptors in Peripheral Endings of Sensory Neurons
This chapter describes the methodology of the in vitro skin&ndash;saphenous nerve preparation and its application to test for the modulatory effects of opioids on the function of cutaneous sensory neurons in experimental models of pain. We detail the skin&ndash;nerve setup requirements and the technique to record action potentials from single sensory fibers. We address how to test for inhibitory effects of opioid receptor activation on mechanical and thermal sensitivity of nociceptors and mechanoreceptors in the complete Freund&rsquo;s adjuvant-induced inflammation and the chronic constriction injury model of neuropathic pain. (Source: Springer protocols feed by Pharmacology/Toxicology)


Hodgkin’s lymphoma after 2-month infliximab therapy: case report
Abstract Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the axial skeleton. Joint pain and stiffness as well as reduced spinal mobility are among the clinical symptoms of this disease. AS mostly affects younger males. TNF blocker drugs like infliximab are among the best treatments for AS, relieving many symptoms of the disease by neutralizing the effect of TNF. However, the use of these drugs may increase the risk of malignancies. In this research, a 23-year-old male with a history of AS was investigated, who was afflicted with Hodgkin’s lymphoma as a rare complication following infliximab administration. (Source: Comparative Clinical Pathology)


Comparing Chronic Pain Treatment SeekersComparing Chronic Pain Treatment Seekers
Do characteristics of patients seeking chronic pain treatment in primary care differ from those seeking treatment in tertiary care settings? Journal of the American Board of Family Medicine (Source: Medscape Today Headlines)


Pulmonary arterial hypertension associated with the use of interferon therapy for chronic hepatitis C infection complicated by extrinsic left main coronary artery compression
We report a case of a 43‐year‐old man treated for chronic hepatitis C infection complicated by decompensated right heart failure diagnosed with PAH and external coronary artery compression secondary to a dilated pulmonary trunk. The novel complication of extrinsic coronary artery compression should be considered in PAH patients presenting with chest pain or acute coronary syndrome. Establishing a diagnosis has clinical value as pulmonary vasodilator therapy may improve symptoms. (Source: Internal Medicine Journal)


Mobilization versus manipulations versus sustain appophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: Randomized control Trial.
CONCLUSION: The results suggest that an HVLA and PA mob groups relieved pain at rest more than SNAG in patients with Neck pain. Among psychological factors, only trait anxiety seems interact with Manual therapy, mainly high anxiety conditions interact with the Mobilization and SNAG effects but under low anxiety conditions interact with the HVLA effects Significant mean differences can be observed both in VAS in Flexion/Extension and in CROM in Lateral--Flexion movement when using mobilization under high anxiety conditions. CLINICAL REHABILITATION IMPACT: The findings provide a preliminary evidence to support that three different techniques have similar immediate effects over neck pain and while under high anxiety levels a better outcome is expected after mobilization intervention, unde...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Effects of whole body cryo-chamber therapy on pain in patients with chronic low back pain - a prospective double blind randomised controlled trial.
CONCLUSION: Cryochamber therapy with --67 °C is not superior to (sham cryo chamber) with --5 °C. CLINICAL REHABILITATION IMPACT: Cryo chambers therapy show positive effect by improving pain. For the treatment, --5 °C seems to be sufficient for these patients. PMID: 25296740 [PubMed - as supplied by publisher] (Source: European Journal of Physical and Rehabilitation Medicine)


Persons With Chronic Hip Joint Pain Exhibit Reduced Hip Muscle Strength.
Conclusion Our results demonstrate that persons with CHJP have weakness in the hip rotator and hip abductor muscles. Weakness also was found in the uninvolved hip of persons with CHJP. J Orthop Sports Phys Ther, Epub 9 October 2014. doi:10.2519/jospt.2014.5268. PMID: 25299750 [PubMed - as supplied by publisher] (Source: Physical Therapy)


Chronic Complaints After Ankle Sprains: A Systematic Review on Effectiveness of Treatments.
Conclusions In chronic ankle complaints after an ankle sprain, a training program gives better results for pain and function, and a decrease of recurrent ankle sprains, than a 'wait and see' policy. There is insufficient evidence to determine the most effective surgical treatment, but limited evidence suggests that postoperative, early mobilization is more effective than plaster cast. J Orthop Sports Phys Ther, Epub 9 October 2014. doi:10.2519/jospt.2014.5221 Level of Evidence Therapy, level 1a-. J Orthop Sports Phys Ther, Epub 9 October 2014. doi:10.2519/jospt.2014.5221. PMID: 25299494 [PubMed - as supplied by publisher] (Source: Physical Therapy)


Epidemiology, pharmacology and clinical characterization of bisphosphonate-related osteonecrosis of the jaw. A retrospective study of 70 cases.
CONCLUSIONS: 25% of the BRONJ cases were related to the administration of oral bisphosphonates, especially alendronate. Zoledronic acid was the bisphosphonate that required the fewest milligrams to induce osteonecrosis. Single bone exposure was the most common clinical finding, especially in the molar mandibular region in patients with metastatic disease. PMID: 25308796 [PubMed - as supplied by publisher] (Source: Acta Otorrinolaringologica Espanola)


Movement observation-induced modulation of pain perception and motor cortex excitability.
CONCLUSIONS: The observation of hand-movements led to a side-specific reduction in pain perception and a decrease in intracortical inhibition. SIGNIFICANCE: These exploratory findings support the notion that M1 is a robust modulator of pain-related neural networks. This effect might be mediated through modulation of the GABAergic system and appears to differ from what is observed in chronic pain. PMID: 25308309 [PubMed - as supplied by publisher] (Source: Clinical Neurophysiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


[Perspective] The Tao of IGF-1: Insulin-like Growth Factor Receptor Activation Increases Pain by Enhancing T-type Calcium Channel Activity
A new target for treating chronic pain is identified. (Source: Signal Transduction Knowledge Environment)


Properties and use of transdermal fentanyl
Steve Chaplin and Dr Austin Leach provide an overview of the properties of transdermal fentanyl preparations in the management of severe chronic pain in adults and opioid‐tolerant children. (Source: Prescriber)


Comparison of morphologic findings obtained by optical coherence tomography in acute coronary syndrome caused by vasospasm and chronic stable variant angina
This study used optical coherence tomography (OCT) to evaluate morphologic changes in vasospastic lesions, which can cause acute coronary syndrome (ACS) or chronic stable VA. Thirty-nine patients (52.4 ± 9.0 years, 33 males) with vasospasm-induced ACS who presented with chest pain and displayed transient ST segment elevation on electrocardiography were included in the ACS group. Forty-one patients (49.3 ± 7.7 years, 33 males) who presented with chronic stable variant angina were included in the VA group. The clinical characteristics and morphologic OCT results of the two groups were compared. There were no differences in baseline characteristics, including the proportions of hypertension, diabetes mellitus, and smoking, between the two groups. Intimal tear, erosion, and intra-lumin...


Jejunal overexpression of peptide YY in celiac disease complicated with pneumatosis cystoides intestinalis
Abstract A 61-year old man with coeliac disease and chronic lack of appetite, malabsorption and weight loss, despite the gluten-free diet, was operated because of a sub-diaphragmatic free air due to a small-bowel pneumatosis cystoides intestinalis (PCI). The jejunum showed granulomatous lesions with a honeycombed appearance of air cysts in the submucosa/subserosa. We found overexpression of peptide YY (PYY) into only the jejunum with PCI, while the expression was very weak or absent in the tissue without cysts. One year after surgery, he had no abdominal pain or PCI recurrence. The above chronic symptoms were plausibly attributable to the PYY. (Source: Clinical and Experimental Medicine)


Groin defects seen at extra-peritoneal laparoscopic dissection during surgical treatment of athletic pubalgia
Conclusion AP is a new diagnostic entity with poorly understood etiology. It mostly affects young active adults, often involved in competitive sports and surgical methods may be most effective at achieving the cure. In our experience all of the patients presented with groin defects, though not all were the same. It is our belief that these defects, although likely not the only component, play a significant role in the pathophysiology of AP. (Source: Surgical Endoscopy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Whole-genome expression profile in zebrafish embryos after chronic exposure to morphine: identification of new genes associated with neuronal function and mu opioid receptor expression
Conclusions: Our study identified different functional classes of genes and individual candidates involved in the mechanisms underlying susceptibility to morphine actions related to CNS development. These results open new lines to study the treatment of pain and the molecular mechanisms involved in addiction. We also found a set of zebrafish-specific morphine-induced genes, which may be putative targets in human models for addiction and pain processes. (Source: BMC Genomics)


Ligustilide inhibits microglia-mediated proinflammatory cytokines production and inflammatory pain.
Authors: Zhu MD, Zhao LX, Wang XT, Gao YJ, Zhang ZJ Abstract Ligustilide is the main component of Danggui essential oil, and recently reported to have anti-inflammatory and neuroprotective effect. Increasing evidence suggests that glia-mediated neuroinflammation in the spinal cord plays a vital role in the pathogenesis of chronic pain. In the present study, we investigated the anti-inflammatory and anti-nociceptive effect of ligustilide both in vitro and in vivo. In microglial cell line BV2 cells, lipopolysaccharide (LPS) time-dependently increased the mRNA expression of proinflammatory cytokines (TNF-α, IL-1β, and IL-6), which was decreased by pretreatment with ligustilide in a dose-dependent manner. Ligustilide also decreased LPS-induced proinflammatory cytokines production in ...


Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study
Elbow tendinopathy is the most common cause of elbow pain affecting active populations. Surgical excision is reserved for patients with refractory symptoms. Percutaneous ultrasonic tenotomy performed under local anesthesia also removes degenerated tissue and therefore provides an alternative treatment option to surgical excision. This investigation prospectively documented the safety and 1-year efficacy of ultrasonic percutaneous tenotomy performed by a single operator. (Source: Journal of Shoulder and Elbow Surgery)


Spinescope
Spinal manipulation for the care of chronic low back pain remains a controversial treatment. There have not been any full-scale trials focusing on the optimum number of visits for the care of a specific condition. The authors attempted to identify the dose- response relationship between visits to a chiropractor for spinal manipulation and chronic low back pain outcomes. (Source: Seminars in Spine Surgery)


▪▪▪
Multiple studies have confirmed that chronic abdominal pain (CAP) is the most frequent reason esophagogastroduodenoscopies (EGDs) are being performed in children.1–3 The use of EGD for CAP seems to be increasing, along with the number of biopsies performed during EGD.1 With clinical guidelines suggesting that most children with CAP have functional disorders, we sought to determine if these EGDs are largely unnecessary or if EGDs offer some value in children with CAP. We discovered substantial gaps in the existing evidence. (Source: Clinical Gastroenterology and Hepatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Persistent Pain and Neurosensory Disturbance After Dental Implant Surgery
This article describes the basic anatomy and pathophysiology associated with nerve injury. The incidence and diagnosis of these problems, in addition to factors that result in the development of chronic persistent neuropathic pain and sensory disturbances associated with surgical implant placement, are discussed. (Source: Dental Clinics of North America)


A pilot evaluation of Arthritis Self-Management Program by lay leaders in patients with chronic inflammatory arthritis in Hong Kong
The objectives of this paper are to evaluate the efficacy of a community-based lay-led Arthritis Self-Management Program (ASMP) among patients with chronic inflammatory arthritis and evaluate the effectiveness of “shared care collaboration” between hospital and community. We trained 17 lay leaders and recruited patients with chronic inflammatory arthritis via a new shared-care model between hospital rheumatology centers and community organizations. Participants were allocated to interventional group or a wait list control group. Evaluations were completed before, after (6 weeks), and 3 months after ASMP. We performed analysis of covariance with adjustment with age, sex, marital status, education, employment, duration of illness, and disability at baseline. A total of 65 participants ...


'Medical Food' Bests Ibuprofen in Chronic Low Back Pain'Medical Food' Bests Ibuprofen in Chronic Low Back Pain
Study showed theramine, an amino acid blend, alone or combined with ibuprofen is better than ibuprofen alone in patients with chronic low back pain. Medscape Medical News (Source: Medscape Neurology and Neurosurgery Headlines)


Power boost that could save your life
You probably know someone who’s fallen and broken a hip. But what you may not know is that it’s not just the elderly who fall, or break their hips. You can be very youthful and still be at high risk. The risk of hip fracture doubles every five years after you turn fifty. Nine out of ten hip fractures happen to people over sixty. Over 25% of those people will develop complications and die within a year.1 However, no matter what your age or level of fitness, you can take one simple step right now to keep this from happening to you. It involves improving the signals to your muscles, which start to slow down as you get older. This makes it harder to keep your balance, and for your muscles to respond when you need them – to keep you from falling, for example. Researchers at the Univ...


Self-reported health and satisfaction of patients with chronic diseases who meditate: a case–control study
Conclusions Regular practice of meditation was not clearly associated with better health perception in chronically diseased patients. However, those who regularly used meditation reported better pain-related quality of life and are more satisfied with their life. (Source: Quality of Life Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


A definition of recovery in myalgic encephalomyelitis and chronic fatigue syndrome should be based upon objective measures
Conclusion To resolve the debate about the clinical status, proposed effectiveness of therapies and recovery in ME and CFS, it is crucial to accurately diagnose patients using well-defined criteria for ME and CFS and an objective assessment of various typical symptoms, since subjective measures such as “fatigue” will perpetuate the debate. (Source: Quality of Life Research)


Epigenetic modulation of chronic anxiety and pain by histone deacetylation
Authors: L Tran, J Schulkin, C O Ligon & B Greenwood-Van Meerveld (Source: Molecular Psychiatry)


Nabilone as an Adjunctive to Gabapentin for Multiple Sclerosis‐Induced Neuropathic Pain: A Randomized Controlled Trial
ConclusionNabilone as an adjunctive to GBP is an effective, well‐tolerated combination for MS‐induced NPP. The results of this study identify a novel therapeutic combination for use in this population of patients predisposed to tolerability issues that may otherwise prevent effective pain management. (Source: Pain Medicine)


Racial Disparities Across Provider Specialties in Opioid Prescriptions Dispensed to Medicaid Beneficiaries with Chronic Noncancer Pain
ConclusionsOur findings suggest that, in our study population, black beneficiaries with CNCP are less likely than whites to fill prescriptions for opioid analgesics as a function of their provider's specialty. Although race‐based differences in patients filling opioid prescriptions have been noted in previous studies, this is the first study that clearly demonstrates these disparities by provider specialty. (Source: Pain Medicine)


Baseline Brain Activity Predicts Response to Neuromodulatory Pain Treatment
ConclusionsThe findings support the idea that different patients respond to different pain treatments and that between‐person treatment response differences are related to brain states as measured by EEG. The results have implications for the possibility of enhancing pain treatment response by either 1) better patient/treatment matching or 2) influencing brain activity before treatment is initiated in order to prepare patients to respond. Research is needed to replicate and confirm the findings in additional samples of individuals with chronic pain. (Source: Pain Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Racial Disparities Across Provider Specialties in Opioid Prescriptions Dispensed to Medicaid Beneficiaries with Chronic Noncancer Pain.
CONCLUSIONS: Our findings suggest that, in our study population, black beneficiaries with CNCP are less likely than whites to fill prescriptions for opioid analgesics as a function of their provider's specialty. Although race-based differences in patients filling opioid prescriptions have been noted in previous studies, this is the first study that clearly demonstrates these disparities by provider specialty. PMID: 25287703 [PubMed - as supplied by publisher] (Source: Pain Physician)


Dietary supplements for chronic gout.
CONCLUSIONS: While dietary supplements may be widely used for gout, this review has shown a paucity of high-quality evidence assessing dietary supplementation. PMID: 25287939 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Circadian rest/activity rhythms in knee osteoarthritis with insomnia: A study of osteoarthritis patients and pain-free controls with insomnia or normal sleep.
Authors: Spira AP, Runko VT, Finan PH, Kaufmann CN, Bounds SC, Liu L, Buenaver LF, McCauley LM, Ancoli-Israel S, Smith MT Abstract Aberrant circadian rest/activity rhythms (RARs) may promote poor aging-related health outcomes. Osteoarthritis and chronic insomnia are common age-related conditions, but the circadian RARs of each group have not been well characterized or compared. We evaluated actigraphic RARs in individuals with: (1) knee osteoarthritis (KOA) only; (2) chronic insomnia only; (3) KOA + insomnia; and (4) pain-free good sleepers. Compared to participants with KOA only, those with KOA + insomnia had less robust RARs. There were no differences between other groups. Further research is needed to evaluate whether aberrant RARs contribute to arthritis symptoms and in...


Chronic musculoskeletal pain: Ultrasound guided pain control.
Authors: Chiou HJ, Chou YH, Wang HK, Lai YC Abstract The review demonstrates the unique advantages of ultrasonography in pain control. Several imaging modalities can be used to guide pain control, such as computed tomography, magnetic resonance imaging, and radiography. Ultrasonography has unique advantages over these other modalities in terms of its non-ionizing radiation, real-time imaging, portability, and cost-effectiveness. Ultrasonography with color Doppler and elastography can provide safer guidance to avoid blood vessels and the nerve trunk when using steroid or xylocaine infusions to encase the nerve trunk. This review focuses on the control of chronic pain in the upper limbs, lower limbs, and trunk. PMID: 25304316 [PubMed - as supplied by publisher] (Source: Acta Anae...


Pain severity reduces life quality in chronic pancreatitis: Implications for design of future outcome trials
Chronic pancreatitis (CP) is a disabling disease characterised by abdominal pain, and various pancreatic and extra-pancreatic complications. We investigated the interactions between pain characteristics (i.e. pain severity and its pattern in time), complications, and quality of life (QOL) in patients with CP. (Source: Pancreatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Evaluation of Urinary Protein Precipitation Protocols for the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network.
Authors: Jonscher KR, Osypuk AA, van Bokhoven A, Lucia MS Abstract Standardization of sample collection, shipping, and storage has been a major focus of biorepositories servicing large, multi-institute studies. The standardization of total protein concentration measurements may also provide an important metric for characterizing biospecimens. The measurement of total protein concentration in urine is challenging because of widely variable sample dilutions obtained in the clinic and the lack of a reference matrix for use with a standard curve and blank subtraction. Urinary proteins are therefore typically precipitated and reconstituted in a reference solution before quantitation. We have tested three different methods for protein precipitation and evaluated them using variability in...


Bone Marrow-derived Cells and Biophysical Stimulation for Talar Osteochondral Lesions: A Randomized Controlled Study
Conclusion: A superior clinical outcome was found in the experimental group with more than 10 points higher AOFAS score at final follow-up. Biophysical stimulation started soon after surgery aided patient recovery leading to pain control and a better clinical outcome with these improvements lasting more than 1 year after surgery. Level of Evidence: Level II, prospective comparative study. (Source: Foot and Ankle International)


Spinal cord stimulators in an outpatient interventional neuroradiology practice
Conclusions Neuromodulation procedures can be performed safely in an outpatient interventional radiology setting. Although the infection rate was relatively higher in this study population, the other complication rates and trial-to-implant ratio are similar to published data. (Source: Journal of NeuroInterventional Surgery)


Minocycline Enhances the Effectiveness of Nociceptin/Orphanin FQ during Neuropathic Pain.
In this study, we determine the role of activated microglia on the analgesic effects of N/OFQ in a rat model of neuropathic pain induced by chronic constriction injury (CCI) to the sciatic nerve. Repeated 7-day administration of minocycline (30 mg/kg i.p.), a drug that affects microglial activation, significantly reduced pain in CCI-exposed rats and it potentiates the analgesic effects of administered N/OFQ (2.5-5 μg i.t.). Minocycline also downregulates the nerve injury-induced upregulation of NOP protein in the dorsal lumbar spinal cord. Our in vitro study showed that minocycline reduced NOP mRNA, but not protein, level in rat primary microglial cell cultures. In [(35)S]GTPγS binding assays we have shown that minocycline increases the spinal N/OFQ-stimulated NOP signaling. We s...


Alterations in the anandamide metabolism in the development of neuropathic pain.
Authors: Malek N, Kucharczyk M, Starowicz K Abstract Endocannabinoids (EC), particularly anandamide (AEA), released constitutively in pain pathways might be accountable for the inhibitory effect on nociceptors. Pathogenesis of neuropathic pain may reflect complex remodeling of the dorsal root ganglia (DRGs) and spinal cord EC system. Multiple pathways involved both in the biosynthesis and degradation of AEA have been suggested. We investigated the local synthesis and degradation features of AEA in DRGs and spinal cord during the development and maintenance of pain in a model of chronic constriction injury (CCI). All AEA synthesis and degradation enzymes are present on the mRNA level in DRGs and lumbar spinal cord of intact as well as CCI-treated animals. Deregulation of EC system c...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The Purinergic System and Glial Cells: Emerging Costars in Nociception.
Authors: Magni G, Ceruti S Abstract It is now well established that glial cells not only provide mechanical and trophic support to neurons but can directly contribute to neurotransmission, for example, by release and uptake of neurotransmitters and by secreting pro- and anti-inflammatory mediators. This has greatly changed our attitude towards acute and chronic disorders, paving the way for new therapeutic approaches targeting activated glial cells to indirectly modulate and/or restore neuronal functions. A deeper understanding of the molecular mechanisms and signaling pathways involved in neuron-to-glia and glia-to-glia communication that can be pharmacologically targeted is therefore a mandatory step toward the success of this new healing strategy. This holds true also in the fie...


Teva shedding 14 new drug candidates
Teva Pharmaceutical Industries Ltd. said Monday its discontinuing or divesting 14 new drug-development programs in non-core therapeutic areas. Going forward, Teva said its plans to focus its research and development efforts for branded products on two key areas: central nervous system disorders (including multiple sclerosis, neurodegenerative diseases and pain); and respiratory diseases (including asthma and chronic obstructive pulmonary disease.) “Our late-stage pipeline assets are expected… (Source: bizjournals.com Health Care:Hospitals headlines)


Nevro registers $100m IPO
Nevro plans to raise more than $100 million in an initial public offering of stock for its implantable spinal cord stimulation system to treat chronic pain. Nevro Corp. said it plans to raise more than $100 million in an initial public offering of stock for its implantable spinal cord stimulation system to treat chronic pain. Nevro Corp.News Well, Initial Public Offering (IPO), Neuromodulation/Neurostimulation, Spinalread more (Source: Mass Device)


Spinal Cord Stimulator in Chronic Neuropathic Back PainSpinal Cord Stimulator in Chronic Neuropathic Back Pain
Neuropathic pain is a complex, chronic, and disabling condition that has physical, functional, and psychosocial repercussions. Can spine stimulation curb the downward spiral? Pain Management Nursing (Source: Medscape Today Headlines)


Reliability of intra‐oral quantitative sensory testing (QST) in patients with atypical odontalgia and healthy controls – a multicentre study
Summary The reliability of comprehensive intra‐oral quantitative sensory testing (QST) protocol has not been examined systematically in patients with chronic oro‐facial pain. The aim of the present multicentre study was to examine test–retest and interexaminer reliability of intra‐oral QST measures in terms of absolute values and z‐scores as well as within‐session coefficients of variation (CV) values in patients with atypical odontalgia (AO) and healthy pain‐free controls. Forty‐five patients with AO and 68 healthy controls were subjected to bilateral intra‐oral gingival QST and unilateral extratrigeminal QST (thenar) on three occasions (twice on 1 day by two different examiners and once approximately 1 week later by one of the examiners). Intra‐class correlation coe...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Take-home naloxone expands to chronic pain patients on opioids
Read the full story on MD Consult: Take-home naloxone expands to chronic pain patients on opioids (Source: MD Consult: News: Top Stories)


Chronic administration of amitriptyline differentially alters neuropathic pain-related behaviour in the presence and absence of a depressive-like phenotype.
In conclusion, these data demonstrate that chronic amitriptyline differentially alters somatic nociceptive responding following peripheral nerve-injury, depending on stimulus modality and the presence or absence of a depressive-like phenotype, an effect which may involve modulation of neuroinflammatory processes. PMID: 25300472 [PubMed - as supplied by publisher] (Source: Behavioural Brain Research)


Epidural chronic inflammatory mass of the lumbar spine in a Human Immunodeficiency Virus (HIV) - positive patient with a history of repeated epidural injections
This study is a rare case of an epidural chronic inflammatory mass of the lumbar spine in a HIV-positive patient with a history of 12 times epidural injections for 3 years due to chronic low back pain (LBP). A 61-year-old man had a 10-year history of LBP and buttock pain. He also has been HIV-positive for 4 years. Patient underwent magnetic resonance imaging (MRI) at the lumbar region. The MRI showed degenerated disc bulging, mild stenosis and hypertrophied ligament flavum at multiple levels in the lumbar spine (Fig 1). (Source: The Spine Journal)


Epidural chronic inflammatory mass of the lumbar spine in a human immunodeficiency virus positive patient with a history of repeated epidural injections
This study is a rare case of an epidural chronic inflammatory mass of the lumbar spine in an HIV-positive patient with a history of 12 epidural injections for 3 years because of chronic low back pain (LBP). A 61-year-old man had a 10-year history of LBP and buttock pain. He also has been HIV-positive for 4 years. Patient underwent magnetic resonance imaging (MRI) at the lumbar region. The MRI showed degenerated disc bulging, mild stenosis, and hypertrophied ligament flavum at multiple levels in the lumbar spine (Fig. 1). (Source: The Spine Journal)


Pain and pressure pain thresholds in adolescents with chronic fatigue syndrome and healthy controls: a cross-sectional study
Conclusions We found a higher prevalence of severe pain among adolescents with CFS and lowered pain thresholds compared with HCs. The mechanisms, however, are still obscure. Large longitudinal population surveys are warranted measuring pain thresholds prior to the onset of CFS. Trial registration number Clinical Trials, NCT01040429; The Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial (NorCAPITAL) http://www.clinicaltrials.gov. (Source: BMJ Open)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Effectiveness of Back School program versus hydrotherapy in elderly patients with chronic non-specific low back pain: a randomized clinical trial.
CONCLUSIONS: Back School program and Hydrotherapy could be valid treatment options in the rehabilitation of non-specific CLBP in elderly people. Both therapies proved to be effective and can be used in association with other rehabilitation programs. We believe that Back School program should be favored for its simplicity and the small number of resources required.  PMID: 25265444 [PubMed - in process] (Source: Acta Bio-Medica : Atenei Parmensis)


Case Report of Mannose-Binding Lectin (MBL) Deficiency and Postoperative Sepsis and Coagulopathy in a Patient Following Total Pancreatectomy for Chronic Pancreatitis.
CONCLUSION: This is the first reported case of alternative and mannose-binding lectin pathways depletion associated with major postoperative bleeding and sepsis following pancreatic surgery. Future research should examine the relationship between complement pathways activity and postoperative complications in order to possibly introduce it as a preoperative screening and possible replacement therapy prior to any major surgical intervention. PMID: 25262717 [PubMed - in process] (Source: JOP)


DePuy Pinnacle Lawsuits Surpass 6,800 in Federal Texas Litigation, as...
The Firm is representing numerous clients whose DePuy Pinnacle hip lawsuits allege metallosis, chronic pain, premature device failure and other complications allegedly caused by a metal-on-metal...(PRWeb October 05, 2014)Read the full story at http://www.prweb.com/releases/depuy-pinnacle-lawsuit/pinnacle-hip-lawsuit/prweb12222694.htm (Source: PRWeb: Medical Pharmaceuticals)


Hydrocodone Combination Products: New Written Rx Required Starting Today (Mon 10/6)
Miscommunication and misinterpretation by DEA, states, and insurance companies of new rules to restrict prescriptions for hydrocodone combination products (mostly hydrocodone/acetaminophen) are leaving chronic pain patients confused and without their medicine. (Source: Forbes.com Healthcare News)


Today Is The Last Day For Current Refills Of Hydrocodone Combination Products (Sunday, October 5)
Miscommunication and misinterpretation by DEA, states, and insurance companies of new rules to restrict prescriptions for hydrocodone combination products (mostly hydrocodone/acetaminophen) are leaving chronic pain patients confused and without their medicine. (Source: Forbes.com Healthcare News)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Neurotropin(®) Ameliorates Chronic Pain via Induction of Brain-Derived Neurotrophic Factor.
Authors: Ishikawa T, Yasuda S, Minoda S, Ibuki T, Fukuhara K, Iwanaga Y, Ariyoshi T, Sasaki H Abstract Neurotropin (NTP)(®), a non-protein extract isolated from the inflamed skin of rabbits inoculated with vaccinia virus, is used clinically for the treatment of neuropathic pain. Moreover, NTP may activate the descending pain inhibitory system. Depression-like behavior is often complicated by chronic pain. However, little is known about NTP-mediated prevention of mood disorders in chronic pain and its molecular mechanisms. We aimed to investigate the effects of NTP on brain-derived neurotrophic factor (BDNF)-mediated signaling and gene expression in chronic pain. In addition, these effects of NTP were compared with pregabalin which is an anticonvulsant, anxiolytic analgesic used to...


Memory impairment in chronic pain patients and the related neuropsychological mechanisms: a review.
CONCLUSIONS: The currently available data and theory have explained memory impairment in chronic pain patients, but many controversies remain. Future research should focus on the subclinical characteristics of chronic pain, enlarging the sample size, and emphasise on the experimental intervention method and the cognitive neuroscience method. PMID: 25279415 [PubMed - in process] (Source: Acta Neuropsychiatrica)


Sensitization of neurons in the central nucleus of the amygdala via the decreased GABAergic inhibition contributes to the development of neuropathic pain-related anxiety-like behaviors in rats
Conclusions: This study suggests that reduction of GABAergic inhibition may be responsible for potentiated plasticity and sensitization of CeA neurons, which likely underlie the enhanced output of amygdala and neuropathic pain-related anxiety in SNL rats. (Source: Epidemiologic Perspectives and Innovations)


Point-Process Deconvolution of fMRI BOLD Signal Reveals Effective Connectivity Alterations in Chronic Pain Patients.
Authors: Wu GR, Marinazzo D Abstract It is now recognized that important information can be extracted from the brain spontaneous activity, as exposed by recent analysis using a repertoire of computational methods. In this context a novel method, based on a blind deconvolution technique, is used to analyze potential changes due to chronic pain in the brain pain matrix's effective connectivity. The approach is able to deconvolve the hemodynamic response function from spontaneous neural events, i.e., in the absence of explicit onset timings, and to evaluate information transfer between two regions as a joint probability of the occurrence of such spontaneous events. The method revealed that the chronic pain patients exhibit important changes in the insula's effective connectivity which...


This Week: Much Ado About Opioids
(MedPage Today) -- The AAN released a policy statement against prescription opioids in chronic pain as the NIH met in Washington to discuss their efficacy. (Source: MedPage Today Psychiatry)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Pain words stand out more for those experiencing it
Ache, agony, distress and pain draw more attention than non-pain related words when it comes to people who suffer from chronic pain, a research using state-of-the-art eye-tracking technology has found. (Source: ScienceDaily Headlines)


Effectiveness of Pharmacist-led Medication Review in Chronic Pain Management: Systematic Review and Meta-analysis
Discussion:Pharmacist-led medication review reduces pain intensity and improves physical functioning and patient satisfaction. However, the clinical significance of these findings remain uncertain due to small effect size and nature of reported data within clinical trials that limits recommendation of wider clinical role of pharmacist in chronic pain management. (Source: The Clinical Journal of Pain)


What Are Patient Beliefs and Perceptions About Exercise for Nonspecific Chronic Low Back Pain?: A Systematic Review of Qualitative Studies
Discussion:People are likely to prefer and participate in exercise or training programs and activities that are designed with consideration of their preferences, circumstances, fitness levels, and exercise experiences. (Source: The Clinical Journal of Pain)


Chronic Pain in the Newborn: Toward a Definition
Discussion:Although several etiologic factors were defined, no useful diagnostic criterion could be identified. The survey resulted in a description of chronic pain in the newborn. Identifying chronic pain is clinically relevant because it interferes with growth, prolongs hospitalization, leads to altered pain perception, and impairs cognitive and behavioral development. (Source: The Clinical Journal of Pain)


Pain-QuILT: Assessing Clinical Feasibility of a Web-based Tool for the Visual Self-Report of Pain in an Interdisciplinary Pediatric Chronic Pain Clinic
Discussion:Consultations with adolescents and their health team indicate that the PQ is a clinically feasible tool for eliciting detailed self-report records of the sensory experience of chronic pain. (Source: The Clinical Journal of Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Pain words stand out more for those experiencing it: York U study
(York University) Ache, agony, distress and pain draw more attention than non-pain related words when it comes to people who suffer from chronic pain, a York University research using state-of-the-art eye-tracking technology has found. (Source: EurekAlert! - Medicine and Health)


Assessment of Pain Intensity in Clinical Trials: Individual Ratings vs Composite Scores
ConclusionsThe findings provide additional evidence that two‐item composite scores may be adequate for assessing the primary outcome of pain intensity in chronic pain clinical trials. Additional research is needed to further establish the generalizability of these findings. (Source: Pain Medicine)


The Influence of Contextual Variables on Judgments about Patients and Their Pain
ConclusionsThese findings suggest that contextual variables have an important influence on medical and nursing students' perceptions of patients and their pain. Theoretical and practical implications for provider training and community education are discussed. (Source: Pain Medicine)


Polypharmacy and Chronic Pain: Harm Exposure Is Not All about the Opioids
ConclusionsWhile treatment with multiple medications for synergistic or adjunctive effects may assist in medical management of chronic pain, this approach generates increased potential harm exposure. We show that the majority of detriment comes from medications other than opioids and highlight the importance of profiling all pain medications contributing to polypharmacy in clinical pain studies. (Source: Pain Medicine)


Prevalence and Use of Complementary Health Approaches among Women with Chronic Pelvic Pain in a Prospective Cohort Study
Conclusion(s)Many women with CPP consistently use complementary health approaches. The substantial interest in and high prevalence of complementary health approaches used alongside conventional medical approaches highlight the need for better understanding of multimodal approaches to address the complex condition of CPP. (Source: Pain Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Comparative Effects of Morning vs Evening Dosing of Extended‐Release Hydromorphone on Sleep Physiology in Patients with Low Back Pain: A Pilot Study
ConclusionsER hydromorphone QAM dosing may be preferred if sleep‐disordered breathing associated with ongoing opioid therapy is of concern; however, QPM dosing may be advantageous in terms of pain relief and quality/quantity of sleep. Further research is recommended to provide more definitive clinical guidance. (Source: Pain Medicine)


Intrathecal Opioids for Chronic Pain: A Call for Evidence
(Source: Pain Medicine)


Lumbar Kinematic Variability during Gait in Chronic Low Back Pain and Associations with Pain, Disability and Isolated Lumbar Extension Strength
Considering the role of the lumbar extensors in gait, the relationship between both isolated lumbar extension strength and disability with transverse plane pattern variability suggests gait variability may result in consequence of lumbar extensor deconditioning or disability accompanying chronic low back pain. However, further prospective study should examine the temporality of the relationships reported here and what other variables might account for the unexplained variance. (Source: Clinical Biomechanics)


Hysteroscopic diagnosis and excision of myometrial cystic adenomyosis
Abstract In 1908, Cullen described the first cases of cystic adenomyosis in his textbook on adenomyomata. Although not very common, with the introduction of noninvasive imaging techniques such as magnetic resonance imaging (MRI) and 3-D transvaginal ultrasound, an increasing number of cases have been reported. Patients primarily complain of severe dysmenorrhea, chronic pelvic pain, and dysfunctional uterine bleeding. Currently, it is unclear whether adenomyosis and, more specifically, cystic adenomyosis can be an underlying reason for impaired fertility and reproductive outcome. With the postponement of childbearing, the number of patients with adenomyosis and cystic adenomyosis seeking fertility treatment is increasing. Therefore, in these patients, uterine exploration should inc...


AAN Position Paper Takes a Tough Stance on Prescribing Opioids for Chronic Noncancer Pain
No abstract available (Source: Neurology Today)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


For most chronic pain, neurologists declare opioids a bad choice
Patients taking opioid painkillers for chronic pain not associated with cancer -- conditions such as headaches, fibromyalgia and low-back pain -- are more likely to risk overdose, addiction and a range of debilitating side effects than they are to improve their ability to function, a leading... (Source: Los Angeles Times - Science)


alpha9-nicotinic acetylcholine receptors contribute to the maintenance of chronic mechanical hyperalgesia, but not thermal or mechanical allodynia
Conclusions: The alpha9-nAChR is not involved in acute pain perception or chronic thermal or mechanical allodynia but does contribute to the intensity and duration of chronic mechanical hyperalgesia, suggesting that pain-relieving actions of antagonists that target this site may be restricted to high threshold mechanosensation. The alpha9-nAChR appears to be a valid target for pharmacological compounds that alleviate long-term mechanical hyperalgesia and may be of use as a prophylactic drug to prevent the development of some symptoms of chronic pain. (Source: BioMed Central)


Managing chronic pain in adults with haemophilia: current status and call to action
Summary Haemophilic arthroses are associated with acute pain during bleeding episodes and with chronic pain caused by arthritic complications of repeated bleeding into joints. Unlike other conditions (e.g. osteoarthritis, rheumatoid arthritis, sickle cell disease), there are limited data on pain management in haemophilia. Management of arthritic individuals and those with sickle cell disease relies heavily on administration of acetaminophen, non‐steroidal anti‐inflammatory drugs (NSAIDs) and opioid analgesics. In haemophilia, acetaminophen often has limited efficacy at therapeutic doses, offering a narrow dosing range in those with liver disease due to chronic hepatitis C. NSAIDs can effectively manage pain in patients with haemophilia, but these agents are potentially associated with ...


¿9-nicotinic acetylcholine receptors contribute to the maintenance of chronic mechanical hyperalgesia, but not thermal or mechanical allodynia
Conclusions: The alpha9-nAChR is not involved in acute pain perception or chronic thermal or mechanical allodynia but does contribute to the intensity and duration of chronic mechanical hyperalgesia, suggesting that pain-relieving actions of antagonists that target this site may be restricted to high threshold mechanosensation. The alpha9-nAChR appears to be a valid target for pharmacological compounds that alleviate long-term mechanical hyperalgesia and may be of use as a prophylactic drug to prevent the development of some symptoms of chronic pain. (Source: Molecular Pain)


Heart Coherence Training Combined with Back School in Patients with Chronic Non-specific Low Back Pain: First Pragmatic Clinical Results.
Authors: Soer R, Vos D, Hofstra B, Reneman MF Abstract The aim of this study was to explore on which variables a stress reduction program based on heart coherence can enhance the effects of a back school (BS) in patients with chronic non-specific low back pain and to explore possible moderators for treatment success. A retrospective explorative design was carried out with 170 patients with chronic non-specific low back pain. 89 Patients were admitted to BS and 81 patients were selected for BS and heart coherence training (BS-HCT). Six sessions of heart coherence were provided. At T0 (baseline) and T1 (discharge), the Numeric Rating Scale for pain (NRS pain), Roland Morris Disability Questionnaire (RMDQ), Pain Disability Index (PDI) and Rand-36 were administered in both groups. Both...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Heart Coherence Training Combined with Back School in Patients with Chronic Non-specific Low Back Pain: First Pragmatic Clinical Results
Abstract The aim of this study was to explore on which variables a stress reduction program based on heart coherence can enhance the effects of a back school (BS) in patients with chronic non-specific low back pain and to explore possible moderators for treatment success. A retrospective explorative design was carried out with 170 patients with chronic non-specific low back pain. 89 Patients were admitted to BS and 81 patients were selected for BS and heart coherence training (BS–HCT). Six sessions of heart coherence were provided. At T0 (baseline) and T1 (discharge), the Numeric Rating Scale for pain (NRS pain), Roland Morris Disability Questionnaire (RMDQ), Pain Disability Index (PDI) and Rand-36 were administered in both groups. Both groups improved significantly on NRS pain,...


Efficacy of the McKenzie Method in Patients With Chronic Nonspecific Low Back Pain: A Protocol of Randomized Placebo-Controlled Trial.
CONCLUSION: This will be the first trial to compare McKenzie to placebo in patients with chronic non-specific low back pain. The results of this study will contribute to better management of this population. PMID: 25278336 [PubMed - as supplied by publisher] (Source: Physical Therapy)


Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials
Abstract This is to our knowledge the first systematic review regarding the efficacy of manual therapy randomized clinical trials (RCT) for primary chronic headaches. A comprehensive English literature search on CINHAL, Cochrane, Medline, Ovid and PubMed identified 6 RCTs all investigating chronic tension-type headache (CTTH). One study applied massage therapy and five studies applied physiotherapy. Four studies were considered to be of good methodological quality by the PEDro scale. All studies were pragmatic or used no treatment as a control group, and only two studies avoided co-intervention, which may lead to possible bias and makes interpretation of the results more difficult. The RCTs suggest that massage and physiotherapy are effective treatment options in the management o...


The role of headache chronicity among predictors contributing to quality of life in patients with migraine: a hospital-based study
Conclusions Chronic migraine appears to impair QOL directly as well as indirectly by provoking disability and depression. (Source: The Journal of Headache and Pain)


The impact of conveying the diagnosis when using a biopsychosocial approach: A qualitative study among adolescents and young adults with NES (non-epileptic seizures)
This study investigates the impact on young people diagnosed with non-epileptic seizures (NES) when health professionals explain the condition using a biopsychosocial approach. NES can be deemed a medically unexplained condition.6 Furthermore, people with NES often have other medically unexplained somatic conditions, such as irritable bowel syndrome, fibromyalgia and chronic pain. (Source: Seizure: European Journal of Epilepsy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Comparison Between Neck Pain Disability and Cervical Range of Motion in Patients With Episodic and Chronic Migraine: A Cross-Sectional Study
The purpose of this study was to evaluate neck pain–related disability and cervical range of motion (CROM) in patients with episodic migraine (EM) and chronic migraine (CM) and to examine the correlation of both outcomes. (Source: Journal of Manipulative and Physiological Therapeutics)


Lenalidomide for Complex Regional Pain Syndrome Type 1: Lack of Efficacy in a Phase II Randomized Study
Complex regional pain syndrome (CRPS) is a potentially debilitating chronic pain syndrome with a poorly understood but likely neuroimmune/multifactorial pathophysiology associated with axonal injury. Based on the potential contribution of pro-inflammatory cytokines to CRPS pathogenesis and prior research with thalidomide, we investigated lenalidomide, a thalidomide derivative, for CRPS treatment. We conducted a phase II, randomized, double-blind, placebo-controlled study to evaluate the efficacy of oral lenalidomide 10 mg once daily in consenting patients with unilateral or bilateral CRPS type 1. (Source: The Journal of Pain)


Washington medical professionals win $540K in grants for palliative care
Two doctors and one nurse are among the recipients of this year's Cambia Health Foundation Sojourns Scholars Leadership Program awards for palliative care, a field of health care that works with patients with serious illness. Palliative care focuses on easing the pain of chronic disease for patients and their families by forming a broad support net of doctors and nurses who listen closely to how patients want, or don't want, to receive care. This type of care is often for patients with terminal… (Source: bizjournals.com Health Care:Hospitals headlines)


Effect of high-intensity laser therapy in the management of myofascial pain syndrome of the trapezius: a double-blind, placebo-controlled study
Abstract Myofascial pain syndrome (MPS) of the trapezius muscle is one of the main causes of neck pain. In this randomized, double-blind study, we evaluated the effects of high-intensity laser therapy (HILT) in female patients with chronic MPS of the trapezius muscle. The patients were assigned to two groups. The HILT group was treated with HILT and exercise, and the sham therapy group was treated with placebo HILT and exercise. The patients were assessed for pain, cervical active range of motion, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (weeks 4 and 12). Both groups showed significant improvement in all parameters at weeks 4 and 12. However, in a comparison of the percentage changes in the parameters at weeks 4 and ...


Acupuncture 'does not improve chronic knee pain'
Scientists at the University of Melbourne found 'no real or direct effect' of needle or laser acupuncture when studying 282 patients over 50 suffering chronic knee pain. (Source: the Mail online | Health)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Medical discovery first step on path to new painkillers
A major medical discovery could lead to the development of an entirely new type of painkiller, scientists suggest. The new drug would offer new hope to sufferers of chronic pain conditions such as traumatic nerve injury, for which few effective painkillers are currently available, they say. (Source: ScienceDaily Headlines)


Acupuncture does not improve chronic knee pain, study finds
In patients older than 50 years with moderate or severe chronic knee pain, acupuncture did not provide any benefit, a study has concluded. Acupuncture is the most popular of alternative medical systems. Although traditionally administered with needles, laser acupuncture (low-intensity laser therapy to acupuncture points) is a non-invasive alternative with evidence of benefit in some pain conditions. (Source: ScienceDaily Headlines)


Acupuncture Falls Short in Chronic Knee PainAcupuncture Falls Short in Chronic Knee Pain
Acupuncture did not significantly improve pain and function better than sham acupuncture in chronic knee pain; both modalities were modestly better than no acupuncture in the short term. Medscape Medical News (Source: Medscape Medical News Headlines)


Acupuncture May Not Help Chronic Knee Pain, Study Finds
Title: Acupuncture May Not Help Chronic Knee Pain, Study FindsCategory: Health NewsCreated: 9/30/2014 12:00:00 AMLast Editorial Review: 10/1/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Comorbidities and the Complexities of Chronic Pain
No abstract available (Source: Anesthesiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Lamiophlomis rotata, an Orally Available Tibetan Herbal Painkiller, Specifically Reduces Pain Hypersensitivity States through the Activation of Spinal Glucagon-like Peptide-1 Receptors
Conclusions: Results support the notion that the activation of spinal GLP-1Rs leads to specific antinociception in pain hypersensitivity and further suggest that GLP-1R is a human-validated target molecule for the treatment of chronic pain. (Source: Anesthesiology)


Chronic pain after surgery in children
Purpose of reviewTo present the recent literature on chronic postsurgical pain in children. Recent findingsChronic postsurgical pain is an important problem in children, however, with a lower prevalence than in adults. SummaryThe literature on the topic is sparse. Prospective studies, including clinical examination, quantitative sensory testing, and long-term follow-up, are needed to increase our knowledge about the prevalence, risk factors, and underlying mechanisms. (Source: Current Opinion in Anaesthesiology)


The anxiodepressive comorbidity in chronic pain
Purpose of reviewChronic pain is often accompanied by mood, sleep and cognitive complications affecting the patient’s quality of life. This reviews aims to provide a synthesis of the recent clinical and preclinical findings concerning the chronic pain and mood disorder comorbidity. Recent findingsThe possible mechanisms underlying the presence of anxiety and/or depression in neuropathic pain, chronic widespread pain (fibromyalgia) and inflammatory pain are reviewed based on recent evidences from neuroimaging, anatomical, behavioral, pharmacological, genetic and biochemical studies. Clinical data from patients and preclinical findings from pain models in rodents are considered. SummaryThe epidemiological studies report a high prevalence of mood disorders in patients with chronic pain, and...


Association Between a Composite Score of Pain Sensitivity and Clinical Parameters in Low-back Pain
Conclusions:Pain sensitivity may be important for the prognosis of LBP, but QST is not currently part of routine clinical examination of LBP patients. The selected set of pain tests and the composite score of pain sensitivity could serve as a clinically applicable QST procedure in the examination of LBP. (Source: The Clinical Journal of Pain)


Phenotype Matters: The Absence of a Positive Association Between Cortical Thinning and Chronic Low Back Pain When Controlling for Salient Clinical Variables
Aims/Objectives/Background:Studies have associated chronic low back pain (cLBP) with grey matter thinning. But these studies have not controlled for important clinical variables (such as a comorbid affective disorder, pain medication, age, or pain phenotype), which may reduce or eliminate these associations. Methods:We conducted cortical thickness and voxel-based morphometry (VBM) analyses in 14 cLBP patients with a discogenic component to their pain, not taking opioids or benzodiazepines, and not depressed or anxious. They were age and gender matched to 14 pain-free controls (PFCs). An ROI-driven analysis (regions of interest) was conducted, using 18 clusters from a previous arterial spin labeling study demonstrating greater regional cerebral blood flow (rCBF) in these cLBP subjects than ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


A Phase 2 Study of Lower-dose, Indomethacin Submicron Particle Capsules Demonstrates Early Onset of Acute Pain Relief
The objective of this study was to evaluate the efficacy and safety of investigational, lower-dose, indomethacin submicron particle capsules compared with placebo in a study of patients with postsurgical pain. Materials and Methods:This phase 2, multicenter, randomized, double-blind, single-dose, and placebo-controlled study enrolled 203 patients (18 to 50 y old) following extraction of ≥2 third molars who experienced moderate-to-severe pain intensity ≤6 hours after surgery. Patients received indomethacin submicron particle capsules (20 or 40 mg), celecoxib 400 mg, or placebo. The primary efficacy endpoint was the sum of total pain relief over 0 to 8 hours (TOTPAR-8) determined from the area under the curve for pain relief over 0 to 8 hours following administration of the study drug, w...


MPI Profile Classifications and Associated Clinical Findings Among Litigating Motor Vehicle Collision Patients
This study extends the MPI literature by establishing the usefulness of the measure in determining those reports of MVC-related pain and emotional distress that are most likely to be associated with postcollision psychological disability. The current study supports the usefulness of MPI profile classifications in identifying MVC patients who are likely to require and benefit from intensive psychological and other rehabilitative interventions. (Source: The Clinical Journal of Pain)


Contributions of Mood, Pain Catastrophizing, and Cold Hyperalgesia in Acute and Chronic Low Back Pain: A Comparison With Pain-free Controls
Discussion:We found evidence for localized and generalized cold hyperalgesia in chronic, but not acute LBP. We might speculate that hyperalgesia develops as a consequence of long-lasting LBP, but prospective studies are needed to confirm this assumption. (Source: The Clinical Journal of Pain)


The Cognitive Fusion Questionnaire: A Preliminary Study of Psychometric Properties and Prediction of Functioning in Chronic Pain
This study explored the reliability and validity of the Cognitive Fusion Questionnaire (CFQ) within a chronic pain population. A total of 326 adults with chronic pain completed this measure and a set of other standard clinical measures at the start of treatment in a specialty chronic pain service in the United Kingdom. Results:An exploratory factor analysis revealed an interpretable 2-factor structure within the items of the CFQ. Internal consistency reliability was good (α=0.87). In the analyses of validity the CFQ significantly correlated with general psychological acceptance and pain-related acceptance as expected. In multiple regression analyses, which included relevant patient background variables, pain, and acceptance of pain, cognitive fusion contributed significantly to the explai...


Massive Splenic Infarction and Portal Vein Thrombosis in Children With Chronic Myeloid Leukemia
We describe 2 children who were presented with massive splenic infarction and PVT in the course of CML. Massive splenic infarction and PVT treated with splenectomy in one and with medical treatment in another in whom PVT resolved by cytoreductive treatment, led to downsizing of spleen or splenectomy. Splenic infarct and PVT should be considered in CML patients with long-lasting severe abdominal pain despite appropriate medical attempts. Splenectomy should be spared for persistent symptoms and complications. (Source: Journal of Pediatric Hematology Oncology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Impact of the 2012 London Olympic and Paralympic Games on Physical Activity of Rheumatology Patients
Conclusions: Only a small minority of patients increased their amount of exercise in response to the 2012 Olympic and Paralympic Games. The message about the importance of physical exercise to health needs to be clear, unambiguous, and consistent, because a significant number of patients still think that physical activity does harm. Big sporting events such as the London 2012 Olympic and Paralympic Games can be used as an opportunity to remind patients that physical activity does good and is not harmful. Athletes’ individual stories could be used in future as part of a strategy to encourage exercise for all patients. (Source: JCR: Journal of Clinical Rheumatology)


Inflammatory Genes and Psychological Factors Predict Induced Shoulder Pain Phenotype
Conclusions: These findings support the combined predictive ability of specific genetic and psychological factors for shoulder pain phenotypes by revealing novel combinations that may merit further investigation in clinical cohorts to determine their involvement in the transition from acute to chronic pain conditions. (Source: Medicine and Science in Sports and Exercise)


Percutaneous Radiofrequency Facet Joint Denervation With Monitoring of Compound Muscle Action Potential of the Multifidus Muscle Group for Treating Chronic Low Back Pain: A Preliminary Report
Study Design:A retrospective review. Objective:The aim of this study was to study the effectiveness of percutaneous radiofrequency neurotomy of facet joints by monitoring compound muscle action potentials (CMAPs) of the multifidus muscle group as an objective index of treatment efficacy. Summary of Background:Percutaneous radiofrequency neurotomy of the medial branches of the dorsal rami of the lumbar nerves is a widely accepted treatment for chronic lumbar intervertebral joint pain. However, its success rate has varied in different studies because an objective method for evaluating the facet joint denervation is lacking. Methods:Fifty-five patients (age range, 19–76 y; mean age, 55 y) with low back pain persisting for ≥3 months, in whom facet block and/or block of the medial branch of...


Long-term Outcomes After Replacement of Percutaneous Leads With Paddle Leads in a Retrospective Cohort of Patients With Spinal Cord Stimulation Systems
CONCLUSION: Revision of percutaneous SCS systems with implantation of a new paddle lead is safe and more effective in patients who have undergone not more than 1 prior revision. ABBREVIATIONS: CRPS, complex regional pain syndrome FBSS, failed back surgery syndrome IQR, interquartile range MR, multiple revisions NRS, numerical rating scale SCS, spinal cord stimulation SD, standard deviation SR, single revision (Source: Neurosurgery)


Concerns Regarding Data Collection Timing and Insufficient Follow-up in a Study Investigating the Affective Component of Chronic Pain
No abstract available (Source: Neurosurgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


In Reply: Concerns Regarding Data Collection Timing and Insufficient Follow-up in a Study Investigating the Affective Component of Chronic Pain
No abstract available (Source: Neurosurgery)


Use of a Synthetic Cannabinoid in a Correctional Population for Posttraumatic Stress Disorder–Related Insomnia and Nightmares, Chronic Pain, Harm Reduction, and Other Indications: A Retrospective Evaluation
This study supports the promise of nabilone as a safe, effective treatment for concurrent disorders in seriously mentally ill correctional populations. Prospective, randomized controlled trials are required to confirm our preliminary results. Follow-up in the community will be required to confirm effectiveness in harm reduction. (Source: Journal of Clinical Psychopharmacology)


Laparoscopic Lateral Pancreaticojejunostomy and Laparoscopic Berne Modification of Beger Procedure for the Treatment of Chronic Pancreatitis: The First UK Experience
Conclusions:The laparoscopic approach to pancreatic duct drainage and duodenum-preserving head resection in carefully selected patients and in experienced hands is feasible and safe with good short-term results and potential advantages. Further expansion of experience and longer follow-up is required. (Source: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques)


Lumbosacral Plexopathy
This article provides an up-to-date review of the clinical features and pathogenesis of different types of lumbosacral plexopathy and a clinical approach to their evaluation and management. Often, the pathologic involvement is not limited to the plexus and also involves the root and nerve levels. These conditions are called lumbosacral radiculoplexus neuropathies. Recent Findings:The pathophysiology of diabetic and nondiabetic lumbosacral radiculoplexus neuropathy has been elucidated; it is ischemic injury due to a perivascular inflammatory process and microvasculitis. The clinical and neurophysiologic features of these two entities have been found to be similar, consisting of acute or subacute onset of pain and paresthesia followed by profound motor weakness asymmetrically involving the l...


Small Fiber Neuropathies
This article reviews the clinical, neurophysiologic, and neuropathologic findings in patients presenting with small fiber neuropathies. Emphasis is placed on recent updates to the literature, but also on understanding the differential diagnosis and initial evaluation of patients with small fiber neuropathy. Recent Findings:There have been several updates in the literature about diseases associated with small fiber neuropathy. First, treatment-induced neuropathy in diabetes mellitus is an iatrogenic small fiber neuropathy linked to overly rapid correction in blood glucose levels in the setting of chronic hyperglycemia. Second, several novel mutations to sodium channels have been identified in patients presenting with idiopathic small fiber neuropathy that may significantly alter our underst...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Efficacy and Complications of Polyethylene Glycols for Treatment of Constipation in Children: A Meta-Analysis
Abstract: Constipation is a common childhood complaint. In 90% to 95% of children, constipation is functional, which means that there is no objective evidence of an underlying pathological condition. Polyethylene glycol (PEG or macrogol) solution is an osmotic laxative agent that is absorbed in only trace amounts from the gastrointestinal tract and routinely used to treat chronic constipation in adults. Here, we report the results of a meta-analysis of PEG-based laxatives compared with lactulose, milk of magnesia (magnesium hydroxide), oral liquid paraffin (mineral oil), or acacia fiber, psyllium fiber, and fructose in children. This meta-analysis was conducted in accordance with PRISMA guidelines and involved searches of MEDLINE, Cochrane, EMBASE, and Google Scholar databases up to Februa...


Fibromyalgia and the role of brain connectivity in pain inhibition
(Mary Ann Liebert, Inc./Genetic Engineering News) The cause of fibromyalgia, a chronic pain syndrome is not known. However, the results of a new study that compares brain activity in individuals with and without fibromyalgia indicate that decreased connectivity between pain-related and sensorimotor brain areas could contribute to deficient pain regulation in fibromyalgia, according to an article published in Brain Connectivity. (Source: EurekAlert! - Medicine and Health)


Who is the expert for the evaluation of work ability?
The decision to award a disability pension includes a formal procedure that varies between countries. Medical doctors are often used as experts in this process, sometimes they also make the final decision. The study by Dell-Kuster et al (1) shows how evaluations can differ among physicians. The judgments between the physicians who treat the patients and a group of specialized physicians differed considerably. The differences reported in the study is probably greater than in a random sample of patients who apply for disability pension as the study includes cases that have been referred for further investigation by a disability insurance officer due to inconsistencies in the assessments. However, the differences raise a question about the validity of judgments and justice – do similar cases...


Ipsilateral free semitendinosus tendon graft with interference screw fixation for minimally invasive reconstruction of chronic tears of the Achilles tendon.
Authors: Maffulli N, Del Buono A, Loppini M, Denaro V Abstract OBJECTIVE: Minimally invasive ipsilateral semitendinosus reconstruction of large chronic tears aims to be advantageous for the patient in terms of plantar flexion recovery, anthropometric measures, fast return to daily and sport activity, is safe, with low donor site co-morbidities, low risks of wound complications and neurovascular injuries. INDICATIONS: Tendon gaps greater than 6 cm and in cases of revision surgery (rerupture). CONTRAINDICATIONS: Diabetes, vascular diseases, previous anterior cruciate ligament (ACL) reconstruction using ipsilateral semitendinosus tendon graft. SURGICAL TECHNIQUE: The semitendinosus tendon is harvested through an incision in the medial aspect of the popliteal fossa, and th...


Prevalence, severity and correlates of fatigue in newly diagnosed patients with myelodysplastic syndromes
Summary The primary objective of this study was to investigate factors associated with fatigue severity in newly diagnosed patients with higher‐risk myelodysplastic syndromes (MDS). The secondary objectives were to assess symptom prevalence and to examine the relationships between fatigue, quality of life (QoL) and overall symptom burden in these patients. The analyses were conducted in 280 higher‐risk MDS patients. Pre‐treatment patient‐reported fatigue was evaluated with the Functional Assessment of Chronic Illness Therapy (FACIT)‐Fatigue scale and QoL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Core 30 (EORTC QLQ‐C30). Female gender (P = 0·018), poor performance status (i.e., ECOG of 2–4) (P &lt; 0·...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


A comparative effectiveness trial of postoperative management for lumbar spine surgery: changing behavior through physical therapy (CBPT) study protocol
DiscussionEffective rehabilitation treatments that can guide clinicians in their recommendations, and patients in their actions will have the potential to effect change in current clinical practice.Trial registration: NCT02184143. (Source: BMC Musculoskeletal Disorders)


Acupuncture Shows Little Benefit in Chronic Knee Pain (FREE)
By Kelly Young Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM Needle and laser acupuncture offer no long-term benefit over sham treatment … (Source: Physician's First Watch current issue)


Rib plating of acute and sub-acute non-union rib fractures in an adult with cystic fibrosis: a case report
Conclusions: In our case report, rib plating with bone grafting improved rib pain and allowed healing of the fractures and recovery, although the immediate post-op period required close attention and care. We believe repair may be of benefit in selected cystic fibrosis patients, such as our patient who had suffered multiple rib fractures that were healing poorly. (Source: BMC Research Notes)


Acupuncture doesn’t improve chronic knee pain
Sham acupuncture just as effective in reducing pain and improving functionRelated items from OnMedicaModerate exercise may reduce risk of chronic painAcupuncture could ease nerve pain of cancer treatmentAcupuncture may benefit COPD patientsSupervised exercise reduces knee painPlacebo may not rely on deception (Source: OnMedica Latest News)


Painful varicoceles: Role of varicocelectomy
Nitin Abrol, Arabind Panda, Nitin S KekreIndian Journal of Urology 2014 30(4):369-373The incidence of varicocele in the general population is up to 15&#x0025;. It is estimated that the prevalence of pain with varicoceles is around 2-10&#x0025;. Till the year 2000, only two studies evaluated efficacy of varicocelectomy in painful varicoceles with conflicting results. Over the past decade many other studies have addressed this issue and reported on the treatment outcome and predictors of success. We critically appraised studies published from March 2000 to May 2013 evaluating surgical management in painful varicoceles to provide an evidence based review of effectiveness of varicocelectomy in relieving pain in patients with symptomatic painful varicoceles. The association between varicoceles ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Arteriovenous malformation causing obstructive uropathy: A different dimension to ovarian vein syndrome
We report an ovarian vein syndrome caused by a true vascular anomaly in an 8-year-old child. Laparoscopic ureterolysis was performed with ligation of the arteriovenous malformation during the first operation. As ureterolysis was not effective, the patient was reoperated and ureteroureterostomy was performed after 3 months, which emphasizes the importance of removing the diseased segment even if it looks normal. (Source: Indian Journal of Urology)


Providing Care for Patients with Chronic Migraine: Diagnosis, Treatment, and Management
Abstract Chronic migraine, a subtype of migraine defined as ≥ 15 headache days per month for ≥ 3 months, in which ≥ 8 days per month meet criteria for migraine with or without aura or respond to migraine‐specific treatment, is a disabling, underdiagnosed, and undertreated disorder associated with significant disability, poor health‐related quality of life, and high economic burden. The keys to caring for chronic migraine patients include: (1) making a proper diagnosis; (2) identifying and eliminating exacerbating factors; (3) assessing for medication overuse (patients with chronic headache often overuse acute medications); and (4) continued management. Communication between patient and physician about treatment goals is important. The patient management guidelines presented ...


Do Teaching General Practitioners' Fear‐Avoidance Beliefs Influence Their Management of Patients with Low Back Pain?
DiscussionTeaching general practitioners' fear‐avoidance beliefs about LBP are lower than previously reported by their GP colleagues but still negatively influence the way they follow guidelines for LBP patients. This may influence the way they teach the management of LBP. (Source: Pain Practice)


Different patterns of morphological changes in the hippocampus and dentate gyrus accompany the differential expression of disability following nerve injury.
Authors: Kalman E, Keay KA Abstract Physical and psychological trauma which results in mood disorders and the disruption of complex behaviours is associated with reductions in hippocampal volume. Clinical evaluation of neuropathic pain reveals mood and behavioural change in a significant number of patients. A rat model of neuropathic injury results in complex behavioural changes in a subpopulation (~30%) of injured rats; these changes are co-morbid with a range of other 'disabilities'. The specific objective of this study was to determine in rats the morphology of the hippocampus and dentate gyrus in individuals with and without complex behavioural disruptions following a constriction injury of the sciatic nerve, and to determine whether rats that develop disabilities following ner...


Providing Care for Patients with Chronic Migraine: Diagnosis, Treatment, and Management.
Authors: Dougherty C, Silberstein SD Abstract Chronic migraine, a subtype of migraine defined as ≥ 15 headache days per month for ≥ 3 months, in which ≥ 8 days per month meet criteria for migraine with or without aura or respond to migraine-specific treatment, is a disabling, underdiagnosed, and undertreated disorder associated with significant disability, poor health-related quality of life, and high economic burden. The keys to caring for chronic migraine patients include: (1) making a proper diagnosis; (2) identifying and eliminating exacerbating factors; (3) assessing for medication overuse (patients with chronic headache often overuse acute medications); and (4) continued management. Communication between patient and physician about treatment goals is important. The...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Acupuncture for chronic knee pain: a randomized clinical trial.
CONCLUSIONS AND RELEVANCE: In patients older than 50 years with moderate or severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function. Our findings do not support acupuncture for these patients. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12609001001280. PMID: 25268438 [PubMed - indexed for MEDLINE] (Source: Pain Physician)


[Mitochondrial neurogastrointestinal encephalopathy disease.]
We present the case of a 14-year-old Caucasian female whose symptoms started in early childhood. The diagnosis was suspected after magnetic resonance imaging (MRI), performed given the atypical features of mental anorexia, which revealed white matter abnormalities. She presented chronic vomiting, postprandial abdominal pain, and problems gaining weight accompanied by cachexia. This diagnosis led to establishing proper care, in particular an enteral and parenteral nutrition program. There is no known specific effective treatment, but numerous studies are in progress. In this article, after reviewing the existing studies, we discuss the main diagnostic and therapeutic aspects of the disease. We argue for the necessity of performing a cerebral MRI given the atypical features of a patient with...


Angiographic coronary artery disease and high‐sensitivity troponin‐T in a native Pakistani cohort presenting with chronic chest pain
ConclusionsThis study shows that measurement of troponin‐T is not an alternative to imaging in an Indian asian population, but that it does identify a separate potentially high‐risk population that would not be identified by the use of imaging alone which is potentially at higher risk of CVD events. (Source: International Journal of Clinical Practice)


OnabotulinumtoxinA (Botox) Nerve Blocks Provide Durable Pain Relief for Men with Chronic Scrotal Pain: A Pilot Open‐Label Trial
ConclusionsOur pilot study found that Botox cord blocks provide pain reduction for 3 months or more for most men with CSP. Khambati A, Lau S, Gordon A, and Jarvi KA. OnabotulinumtoxinA (Botox) nerve blocks provide durable pain relief for men with chronic scrotal pain: A pilot open‐label trial. J Sex Med **;**:**–**. (Source: The Journal of Sexual Medicine)


Naproxen Effects on Brain Response to Painful Pressure Stimulation in Patients with Knee Osteoarthritis: A Double-blind, Randomized, Placebo-controlled, Single-dose Study.
CONCLUSION: Naproxen effectively reduces pain-related brain responses involving different regions and the attenuation is related to subjective pain changes. Our current work yields further support to the utility of fMRI to objectify the acute analgesic effects of a single naproxen dose in patients affected by knee OA. The trial was registered at the EuropeanClinicalTrials Database, "EudraCT Number 2008-004501-33". PMID: 25274897 [PubMed - as supplied by publisher] (Source: J Rheumatol)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Effect of hydrosoluble vitamin E on erythrocyte membrane lipid composition in patients with advanced cirrhosis: an open label pilot trial
ConclusionsIn patients with advanced cirrhosis, low vitamin E plasma levels and chronic anemia with hemolysis, oral tocofersolan was overall well tolerated, but didn't affect erythrocyte membrane lipid composition. (Source: Hepatology Research)


Correlation between the levels of non‐specific physical symptoms and pressure pain thresholds measured by algometry in patients with temporomandibular disorders
Summary Recent studies showed that patients with chronic TMD pain also feature increased sensitivity in other craniofacial regions, and even in remote peripheral areas, suggesting that nociceptive processing is centrally facilitated in this patient population. The aim of this study was to investigate the existence of a negative correlation between the levels of non‐specific physical symptoms and pressure pain thresholds measured by algometry at sites distant from the chief complaint of oro‐facial pain in patients with TMD. A total of 20 female patients were evaluated comprising 11 patients diagnosed with myofascial pain (Group I of RDC/TMD) and 9 patients with arthralgia (Group III of RDC/TMD), with both reporting chronic TMD pain for at least 3 months. Patients were tested by the pre...


Probiotic Lactobacillus rhamnosus GG (LGG) and prebiotic prevent neonatal inflammation‐induced visceral hypersensitivity in adult rats
Conclusions & InferencesResults document that in rats LGG can attenuate neonatally induced chronic visceral pain measured in adulthood. Prolonged intake of LGG alters some key brain neurotransmitters and biogenic amines that could be involved in pain modulation. In rats, Lactobacillus rhamnosus (LGG) can attenuate neonatally induced chronic visceral pain measured in adulthood. Prolonged intake of LGG alters some key brain neurotransmitters and biogenic amines that could be involved in pain modulation. (Source: Neurogastroenterology and Motility)


Intrathecal ketorolac does not improve acute or chronic pain after hip arthroplasty: a randomized controlled trial
Abstract Hypersensitivity to mechanical stimuli following surgery has been reported in patients who subsequently develop chronic pain after surgery. In animals, peripheral injury increases prostaglandin production in the spinal cord, and spinal cyclooxygenase inhibitors reduce hypersensitivity after injury. We therefore tested the hypothesis that spinal ketorolac reduces hypersensitivity and acute and chronic pain after hip arthroplasty (www.clinicaltrials.gov NCT 00621530). Sixty-two patients undergoing total hip arthroplasty with spinal anesthesia were randomized to receive 13.5 mg hyperbaric bupivacaine with spinal saline or 13.5 mg hyperbaric bupivacaine with 2 mg preservative-free ketorolac. The primary outcome was area of hypersensitivity surrounding the wound 48 h afte...


Effects of stress and relaxation on pain perception in subjects with pain‐free occlusional disharmony compared with healthy controls
ConclusionsThese results suggest that subjects with occlusal disharmony show signs of disturbed endogenous pain inhibition during relaxation. Clinical RelevanceThere is evidence for the presence of sensitization of the nociceptive system in subjects with occlusal disharmony. Possibly, deficient inhibition of extratrigeminal and trigeminal pain perception by relaxation might contribute to the development of TMD or other chronic pain disorders. (Source: Oral Diseases)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Smoking increases risk of pain chronification through shared corticostriatal circuitry
Abstract Smoking is associated with increased incidence of chronic pain. However, the evidence is cross‐sectional in nature, and underlying mechanisms remain unclear. In a longitudinal observational study, we examined the relationship between smoking, transition to chronic pain, and brain physiology. In 160 subjects with subacute back pain (SBP: back pain lasting 4–12 weeks, and no prior back pain [BP] for at least 1 year) pain characteristics, smoking status, and brain functional properties were measured repeatedly over 1 year. Sixty‐eight completed the study, subdivided into recovering (SBPr, n = 31) and persisting (SBPp, n = 37), based on &gt;20% decrease in BP over the year. Thirty‐two chronic back pain (CBP: duration &gt; 5 years) and 35 healthy controls were simil...


Relationships Between Intravaginal Ejaculatory Latency Time and National Institutes of Health‐Chronic Prostatitis Symptom Index in the Four Types of Premature Ejaculation Syndromes: A Large Observational Study in China
ConclusionMen with complaints of PE reported worse NIH‐CPSI scores than men without complaints of PE. Relationships between IELT and NIH‐CPSI scores were strongest in men with APE. Gao J, Xu C, Liang C, Su P, Peng Z, Shi K, Tang D, Gao P, Lu Z, Liu J, Xia L, Yang J, Hao Z, Zhou J, and Zhang X. Relationships between intravaginal ejaculatory latency time and National Institutes of Health‐Chronic Prostatitis Symptom Index in the four types of premature ejaculation syndromes: A large observational study in China. J Sex Med **;**:**–**. (Source: The Journal of Sexual Medicine)


Surgical treatment of chronic pancreatitis in young patients
Summary The main treatment strategies for chronic pancreatitis in young patients include therapeutic endoscopic retrograde cholangio-pancreatography (ERCP) intervention and surgical intervention. Therapeutic ERCP intervention is performed much more extensively for its minimally invasive nature, but a part of patients are referred to surgery at last. Historical and follow-up data of 21 young patients with chronic pancreatitis undergoing duodenum-preserving total pancreatic head resection were analyzed to evaluate the outcomes of therapeutic ERCP intervention and surgical intervention in this study. The surgical complications of repeated therapeutic ERCP intervention and surgical intervention were 38% and 19% respectively. During the first therapeutic ERCP intervention to surgical ...


Hydrogen Breath Tests in Gastrointestinal Diseases
Abstract Hydrogen breath tests are widely used to explore pathophysiology of functional gastrointestinal (GI) disorders. Small intestinal bacterial overgrowth (SIBO) and carbohydrate malabsorption are disorders detected by these tests that have been proposed to be of great importance for symptoms of GI diseases. Glucose hydrogen breath test is more acceptable for diagnosis of SIBO whereas lactose and fructose hydrogen breath tests are used for detection of lactose and fructose maldigestion respectively. Lactulose hydrogen breath test is also used widely to measure the orocecal transit time for GI motility. These methods are noninvasive and inexpensive. Many patients with functional gut disorders are unaware of the relationship between diet and GI symptoms they present. In particu...


Glial Cell-Derived Neurotrophic Factor Attenuates Neuropathic Pain in a Mouse Model of Chronic Constriction Injury: Possible Involvement of E-cadherin/p120ctn Signaling
Abstract Treating neuropathic pain is a major clinical challenge, and several key molecules associated with nociception have been suggested as potential targets for novel analgesics. Many studies have reported the anti-nociceptive effects of glial cell-derived neurotrophic factor (GDNF), but the underlying mechanism remains largely unknown. The present study was performed to assess the effects of GDNF in a mouse model of chronic constriction injury (CCI)-induced neuropathic pain. We also determined the potential role of E-cadherin/p120 catenin (p120ctn) signaling in these effects. Mice received an intrathecal acute injection of PBS, GDNF, and DECMA-1 (an E-cadherin functional blocking antibody) or a combination of DECMA-1 with GDNF on the testing days. Our results demonstrated th...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Pilot Testing a Positive Psychology Intervention in Individuals with Chronic, Disability-related Pain
To determine the effects, feasibility and acceptability of a computer-based tailored intervention based on positive psychology to enhance subjective well-being and reduce pain in individuals with physical disabilities. (Source: Archives of Physical Medicine and Rehabilitation)


Behavioural Therapy combined with Physical Training improves function and diminishes pain in Chronic Back Pain
To demonstrate the therapeutic capacity of integrating physical exercise with behavioural principles for chronic back pain patients. In contrast to traditional cognitive behavioural programmes, the goal of this rehabilitation programme is restore function and to actually diminish pain. (Source: Archives of Physical Medicine and Rehabilitation)


Yoga Improves Physical Functioning in People with Chronic Traumatic Brain Injury: A Case-Study
To assess change in physical functioning (balance, pain, strength, endurance, and gait-speed) after 8 weeks of therapeutic-yoga for people with chronic traumatic brain injury (TBI). (Source: Archives of Physical Medicine and Rehabilitation)


Function and Quality of Life With Long-Term Opioid Use For Chronic Non-Cancer Pain
To conduct a systematic review of the published scientific literature of the impact of long-term opioid therapy on function and quality of life among patients with chronic non-cancer pain. (Source: Archives of Physical Medicine and Rehabilitation)


Neurocognitive Test Performances in Chronic Pain Patients
To provide a quantitative analysis of the association between chronic pain and neurocognitive test performances. (Source: Archives of Physical Medicine and Rehabilitation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Musculoskeletal Pain and Arthritis in MS and Other Types of Chronic Pain: Case Control Study
To investigate the prevalence of lower extremity arthritis in persons with MS compared to other chronic pain patients. A priori hypothesis was that persons with MS have younger onset arthritis. (Source: Archives of Physical Medicine and Rehabilitation)


Cervical and cervicomedullary spinal cord stimulation for chronic pain: Efficacy and outcomes
Chronic pain is a debilitating condition [8,9]. Over 100 million adults in the United States are estimated to be afflicted, and rates of chronic pain are increasing due to a combination of factors including the obesity epidemic, the aging population, as well as the improved survival rates following traumatic injuries [12,35]. Causes of chronic pain conditions are numerous and include injuries, chronic disease (such as cancer, diabetes), peripheral and/or autonomic nerve disorders (such as complex regional pain syndrome or CRPS) as well as primary pain disorders (such as neuropathic pain, and fibromyalgia) [12]. (Source: Clinical Neurology and Neurosurgery)


Radiofrequency Intradiscal Biacuplasty for Treatment of Discogenic Lower Back Pain: A 12‐Month Follow‐Up
ConclusionsClinically significant improvements after IDB initially reported at 6 months were maintained at 9 and 12 months. The cross‐over subjects had similar improvement in all outcome measures at all observed time points. (Source: Pain Medicine)


Chronic vomiting and recurrent pneumonia in an adolescent female
A 17-year-old girl presented with episodic vomiting associated with chest pain, a 20-pound weight loss over the past year, and multiple hospitalizations for pneumonia. She was bradycardic, cachectic ( (Source: Journal of Pediatric Surgery)


Chronic Orofacial Pain in Dental Patients: Retrospective Investigation over 12 years.
In conclusion, early consultation with a dentist is useful to prevent chronicity of odontogenic pain and to make a differential diagnosis in patients with orofacial pain. PMID: 25338483 [PubMed - in process] (Source: Acta Med Okayama)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Immediate Effects of Active Versus Passive Scapular Correction on Pain and Pressure Pain Threshold in Patients With Chronic Neck Pain
The purpose of this study was to investigate the effect of active vs passive scapular correction on pain and pressure pain threshold at the most symptomatic cervical segment in patients with chronic neck pain. (Source: Journal of Manipulative and Physiological Therapeutics)


Prevalence of Persistent Pain in the U.S. Adult Population: New Data From the 2010 National Health Interview Survey
In this study, secondary analyses of the 2010 Quality of Life Supplement of the National Health Interview Survey are used to calculate the point prevalence of “persistent pain,” which we defined as constant or frequent pain persisting for at least 3 months. Rates of persistent pain are also calculated by risk group, chronic condition, and disability status. (Source: The Journal of Pain)


G.p.28
Since classical ADME/Tox tests failed to detect statin drugs family as toxicant by inducing chronic muscle damages such as myositis, rhabdomyolysis, muscle pain; which leaded to a considerable economic burden for pharmaceutical industry, e.g. cerivastatin withdrawal from the market, companies need to develop more relevant in vitro models dedicated to muscle damage drug discovery. In this context, CYTOO developed a physiological muscle model improving the sensitivity of myotoxic drug detection. When cultured on 2D+ technology, primary human myoblasts faster differentiate in myotubes containing a higher level of sarcomere striation and nuclei alignment compared to standard culture condition. (Source: Neuromuscular Disorders)


10‐kHz High‐Frequency SCS Therapy: A Clinical Summary
ConclusionsThe clinical experience reported in this article supports the efficacy and pain relief provided by HF10 SCS therapy. Clinical studies have also concluded that HF10 SCS does not generate paresthesia nor was it necessary to provide adequate coverage for pain relief. As clinical evidence accumulates and technological innovation improves patient outcomes, neuromodulatory techniques will be sought earlier in the treatment continuum to reduce the suffering for the many with otherwise intractable chronic pain. (Source: Pain Medicine)


National Study of Chronic Disease Self-Management: Age Comparison of Outcome Findings
Conclusions. The current study documented improved health outcomes but more so among the middle-aged population. Findings suggest the importance of examining how age and interacting life circumstances may affect chronic disease self-management. (Source: Health Education)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Literature review of pain management for people with chronic pain
ConclusionWe identified possible options of pain management strategies and explored effectiveness of chronic pain interventions. The long‐term effects of pain relief interventions and social support for individuals with chronic pain require further investigation. (Source: Japan Journal of Nursing Science)


Deep Brain Stimulation for Chronic Pain
For over half a century, neurosurgeons have attempted to treat pain from a diversity of causes using acute and chronic intracranial stimulation. Targets of stimulation have included the sensory thalamus, periventricular and periaqueductal gray, the septum, the internal capsule, the motor cortex, posterior hypothalamus, and more recently, the anterior cingulate cortex. The current work focuses on presenting and evaluating the evidence for the efficacy of these targets in a historical context while also highlighting the major challenges to having a double-blind placebo-controlled clinical trial. Considerations for pain research in general and use of intracranial targets specifically are included. (Source: Neurosurgery Clinics of North America)


Intracranial Ablative Procedures for the Treatment of Chronic Pain
Three main techniques delineate a possible role for intracranial ablative procedures in patients with chronic pain. Recent studies demonstrate a continued need for clinical investigation into central mechanisms of neuroablation to best define its role in the care of patients with otherwise intractable and severe pain syndromes. Cingulotomy can result in long-term pain relief. Although it can be associated with subtle impairments of attention, there is little risk to other cognitive domains. (Source: Neurosurgery Clinics of North America)


Chronic Pain and PTSD: Evolving Views on Their Comorbidity
PurposeThis paper presents a literature review of post‐traumatic stress disorder (PTSD) and its link to chronic pain. Design and MethodsTwenty‐four papers are reviewed (included research and reviews), with the goal of improving and updating our understanding on this issue and its theoretical and clinical repercussions. FindingsThe tight interdependence of symptoms that can be observed in both PTSD and chronic pain syndromes lends support to the idea that these disorders both constitute a reactive disorder. Practice ImplicationsVarious forms of therapy and treatment focus on PTSD, but chronic pain symptoms must also be assessed. (Source: Perspectives In Psychiatric Care)


Chronic Pain: Content Validation of Nursing Diagnosis in Slovakia and the Czech Republic


The validity and reliability of "The liver disease symptom index 2.0" for Turkish society.
CONCLUSION: Our study findings provide supportive evidence of the reliability of the assessment tool. Its validity is similar to the original construct validity and was confirmed in our sample. Therefore, it was concluded that LDSI 2.0 was an appropriate tool for daily clinical use and research purposes. Simultaneous use of this life-quality assessment tool and SF-36 will enable a comprehensive but practical assessment of our patients. PMID: 25417615 [PubMed - in process] (Source: The Turkish Journal of Gastroenterology)


Acupuncture May Not Help Chronic Knee Pain, Study Finds
Laser, needle treatment worked no better than 'sham' procedure (Source: WebMD Health)


Acupuncture may not be effective for knee pain: study
NEW YORK (Reuters Health) - Acupuncture won't improve chronic knee pain in middle-aged people, researchers say. (Source: Reuters: Health)


Long-Term Outcomes After Total Pancreatectomy and Islet Cell Autotransplantation: Is It a Durable Operation?
Conclusions: This represents one of the largest series examining long-term outcomes after TPIAT. This operation produces durable pain relief and improvement in QOL parameters. Insulin independence rates decline over time, but most patients maintain stable glycemic control. (Source: Annals of Surgery)


Acupuncture May Not Help Chronic Knee Pain, Study Finds
Laser, needle treatment worked no better than 'sham' procedure Source: HealthDay Related MedlinePlus Pages: Acupuncture, Knee Injuries and Disorders (Source: MedlinePlus Health News)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


An etiological paradigm shift for chronic hemiplegic shoulder pain
No abstract available (Source: American Journal of Physical Medicine and Rehabilitation)


Decreased activation of cingulo-frontal-parietal cognitive/attention network during an attention-demanding task in patients with chronic low back pain
Conclusion Our study provides in vivo imaging evidence of abnormal CFP network function during attention-demanding condition in patients with CLBP, which might reflect partly an adaptation/maladaptation of the brain to the chronic pain states. (Source: Neuroradiology)


Toward standardised documentation in psychiatric evaluations: Identifying functioning aspects and contextual factors in psychiatric reports of Swiss disability claimants with chronic widespread pain.
CONCLUSIONS: The list of ICF and personal factor categories we determined in this study addresses concepts commonly reported in psychiatric evaluations of medical work capacity involving CWP. It can serve as a starting point in developing a standard for comprehensive functioning documentation in the present context. PMID: 25254893 [PubMed - in process] (Source: Swiss Medical Weekly)


Gabapentin significantly decreases posthemorrhoidectomy pain: a prospective study
Conclusions Daily use of gabapentin in perioperative period significantly decreased reported levels of postoperative pain. This effective, inexpensive addition improves pain after hemorrhoid surgery. Randomized placebo-controlled studies would better define the usefulness of this medication for posthemorrhoidectomy pain. (Source: International Journal of Colorectal Disease)


Doctors' Group Issues Painkiller Guidelines
Title: Doctors' Group Issues Painkiller GuidelinesCategory: Health NewsCreated: 9/29/2014 4:35:00 PMLast Editorial Review: 9/30/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Prescribing Opioids for Chronic Noncancer Pain: AAN Policy Statement (FREE)
By Christine Sadlowski Edited by David G. Fairchild, MD, MPH A position paper from the American Academy of Neurology on the prescription of opioids for noncancer pain outlines "best practices" clinicians should … (Source: Physician's First Watch current issue)


Risk factors outweigh benefits of opioids for chronic noncancer pain
Read the full story on MD Consult: Risk factors outweigh benefits of opioids for chronic noncancer pain (Source: MD Consult: News: Top Stories)


High‐Affinity Glutamate Transporters in Chronic Pain: An Emerging Therapeutic Target
This article is protected by copyright. All rights reserved. (Source: Journal of Neurochemistry)


Risk factors associated with adverse events of acupuncture: a prospective study.
CONCLUSIONS: The prevalence of AEs was higher than usual, probably due to the low threshold in our definition of AEs and the systematic collection from the patients' perspective. Baseline variables were largely unable to predict AEs associated with acupuncture. Further studies should explore the roles of practitioners, patients' anxiety during treatment and patient-practitioner interactions. TRIAL REGISTRATION NUMBER: NCT01707706. PMID: 25271149 [PubMed - as supplied by publisher] (Source: Acupuncture in Medicine)


Endoscopic imaging of the vermiform appendix (with video)
Chronic appendicitis may be detected in as many as 10% of patients with right lower quadrant pain. Although the appendiceal orifice is easily identified during colonoscopy, its lumen has not been investigated so far. (Source: Gastrointestinal Endoscopy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


EUS-guided drainage: beware of the pancreatic fluid collection (with videos)
The true incidence of cancer presenting with a pancreatic fluid collection (PFC) is unknown, and evidence is limited to a number of case reports.1-4 PFCs most commonly occur in association with acute or chronic pancreatitis.5,6 Indications for treatment include abdominal pain, infection, and obstruction of the gastric outlet or biliary tract. Treatment usually involves internal or percutaneous drainage, which may be achieved by endoscopic, surgical, or radiologic techniques or a combination of modalities. (Source: Gastrointestinal Endoscopy)


Abstract CT319: A randomized, controlled trial of high dose vs. standard dose vitamin D for aromatase inhibitor-induced arthralgia in breast cancer survivors
This study targets a very common cause of pain among breast cancer survivors and aims to offer an effective treatment strategy to alleviate pain and improve quality of life as well as medication compliance. Citation Format: Polly A. Niravath, Sue Hilsenbeck, Tao Wang, Mothaffar Rimawi. A randomized, controlled trial of high dose vs. standard dose vitamin D for aromatase inhibitor-induced arthralgia in breast cancer survivors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr CT319. doi:10.1158/1538-7445.AM2014-CT319 (Source: Cancer Research)


Abstract 4022: Combination of PI3K inhibitor BAY 1082439 with radium-223 is a promising treatment of cancer with bone metastases
About 80% of advanced prostate, breast and lung cancer patients develop bone metastases, which cause significant morbidity including chronic pain and pathologic fractures. Patients with bone metastases have a poor prognosis and currently there is no curative treatment. This is largely due to the unique biological microenvironments of bone where a wide range of growth factors promote tumor cell survival and tumor cells stimulate bone remodeling. Activation of PI3K plays important role in prostate and breast cancer cell proliferation, survival and metastasis. PI3K also mediates critical signaling pathways involving tumor and stromal cell interaction, including cancer-induced bone turnover and osteolysis. BAY 1082439 is a highly selective and potent PI3K inhibitor with balanced activity again...


Abstract 5392: High-throughput screening of compounds for targeting system Xc(-) in human breast cancer cells
In conclusion we have identified several lead compounds for in vivo pain monitoring tests. Information obtained from this study will not only advance our understanding of the role of system Xc(-) in breast cancer cells, but also help design novel drugs for blocking breast cancer induced-bone pain, thereby improving the quality of life for breast cancer patients. (This project was supported by Canadian Breast Cancer Foundation-Ontario) Citation Format: Han-xin Lin, Jennifer Fazzari, Katja Linher-Melville, Gurmit Singh. High-throughput screening of compounds for targeting system Xc(-) in human breast cancer cells. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19...


Study protocol for a double blind, randomised, placebo-controlled trial of continuous subpectoral local anaesthetic infusion for pain and shoulder function following mastectomy: SUB-pectoral Local anaesthetic Infusion following MastEctomy (SUBLIME) study
This study assesses the effectiveness of a 24-hour continuous local anaesthetic in the subpectoral plane in improving postoperative pain and quality of life in patients undergoing mastectomy. Methods and analysis This is a randomised, double blind, placebo-controlled, two-centre, parallel group trial in women undergoing mastectomy with or without axillary involvement. One hundred and sixty participants will be randomised in a 1:1 ratio to receive either 0.25% levobupivacaine or 0.9% saline by subpectoral infusion postoperatively for 24&nbsp;h. All participants will be provided with an intravenous morphine patient-controlled analgesia (PCA) system. Participants will be followed-up for 24&nbsp;h in hospital and at approximately 14&nbsp;days and 6&nbsp;months postoperatively. Joint primary o...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Early Identification of Patients With Chronic Pain in Pre-Op Center Leads to Better Outcomes for Pain Control After Surgery
Pre-operative Assessment Consultation and Evaluation (PACE) Clinic noted an increase in number of patients with chronic pain going to surgery. Surgical history confirmed patients with chronic pain typically had a more difficult time with management of pain post-operatively. Earlier identification and triaging of patients in pre-op clinic may offer an opportunity to develop a pain regimen prior to surgery. (Source: Journal of PeriAnesthesia Nursing)


Complementary Health Approaches for Chronic Pain
This issue of the digest summarizes current scientific evidence about the complementary health approaches most often used by people for chronic pain, including fibromyalgia, headache, irritable bowel syndrome, low-back pain, neck pain, osteoarthritis, and rheumatoid arthritis. (Source: NCCAM Featured Content)


AAN Warns Against Opioids in Chronic Noncancer Pain (CME/CE)
(MedPage Today) -- The neurology society says the drugs have no place in headache, back pain, or fibromyalgia. (Source: MedPage Today Emergency Medicine)


Musculoskeletal Pain Relief With Stem Cell InjectionsMusculoskeletal Pain Relief With Stem Cell Injections
The evidence is still very preliminary, but clinicians report some success with bone marrow and adipose-derived stem cell injections for chronic musculoskeletal pain. Medscape Medical News (Source: Medscape Medical News Headlines)


[Just one number alone will not suffice : For a differentiating epidemiological collation of chronic pain].
Authors: Petzke F, Kohlmann T PMID: 25245593 [PubMed - in process] (Source: Schmerz)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


[Chronic pain, pain disease, and satisfaction of patients with pain treatment in Germany : Results of a representative population survey].
CONCLUSION: There is a need to improve the care of persons with chronic disabling pain. Whether pain specialist treatment is (cost) effective in chronic disabling pain needs to be examined by longitudinal studies. PMID: 25245594 [PubMed - in process] (Source: Schmerz)


[Recurrent cystitis and vaginitis: role of biofilms and persister cells. From pathophysiology to new therapeutic strategies.]
Authors: Graziottin A, Zanello PP, D'Errico G Abstract Recurrent vaginitis and cystitis are a daily challenge for the woman and the physician. The recurrence worsens the symptoms' severity, increases comorbidities, both pelvic (provoked vestibulodynia, bladder pain syndrome, levator ani hyperactivity, introital dyspareunia, obstructive constipation, chronic pelvic pain) and cerebral (neuroinflammation and depression), increases health costs, worsens the quality of life. Antibiotics increase the risk of bacterial resistences and devastate the ecosystems: intestinal, vaginal and mucocutaneous. Pathogenic biofilms are the (still) neglected etiology of recurrences. Biofilms are structured communities of bacteria and yeasts, protected by a self-produced polymeric matrix adherent to a li...


Clinical Consequences of Inadequate Pain Relief: Barriers to Optimal Pain Management.
Authors: Baratta JL, Schwenk ES, Viscusi ER Abstract SUMMARY:: Uncontrolled postoperative pain may result in significant clinical, psychological, and socioeconomic consequences. Not only does inadequate pain management following surgery result in increased morbidity and mortality but it also may delay recovery, result in unanticipated readmissions, decrease patient satisfaction, and lead to chronic persistent postsurgical pain. Pain is multifactorial in nature, and understanding both the complexity of pain and its side effects is imperative to achieving a successful surgical outcome. In this section, we review the consequences of pain as they pertain to plastic surgery with a focus on the impact of pain on the surgical stress response and risk of wound infections and the effect of ...


Opioids for chronic noncancer pain: A position paper of the American Academy of Neurology
The objectives of the article are to review the following: (1) the key initiating causes of the epidemic; (2) the evidence for safety and effectiveness of opioids for chronic pain; (3) federal and state policy responses; and (4) recommendations for neurologists in practice to increase use of best practices/universal precautions most likely to improve effective and safe use of opioids and to reduce the likelihood of severe adverse and overdose events. (Source: Neurology)


Acute and chronic postsurgical pain after living liver donation: Incidence and predictors
In conclusion, this study has identified a subset of patients who experience persistent pain after living liver donation. Additional prospective research using larger samples of liver donors is needed to replicate this work, to obtain a more detailed account of the acute and long‐term pain experience, and to determine whether targeted interventions can minimize the frequency and severity of chronic pain. Liver Transpl, 2014. © 2014 AASLD. (Source: Liver Transplantation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Assessing psychological factors, social aspects and psychiatric co-morbiditiy associated with Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CP/CPPS) in men - A systematic review
Chronic Prostatitis/ChronicPelvic Pain Syndrome (CP/CPPS) is a chronic pain disease with high prevalence rates and substantial health care costs. An interdisciplinary classification system is commonly used (UPOINT) which includes psychosocial factors. Nevertheless, psychosocial influences on CP/CPPS only recently became a research focus. Therefore, we aimed to synthesize the existing data and to identify further research topics. Then, based on our results, diagnosis and treatment can be improved. (Source: Journal of Psychosomatic Research)


Neck/upper back and low back pain in parents and their adult offspring: Family linkage data from the Norwegian HUNT Study
ConclusionParental chronic spinal pain was consistently associated with increased occurrence of chronic spinal pain in their adult offspring, and this association was particularly strong for multilevel spinal pain. (Source: European Journal of Pain)


Eye movements during visual search for emotional faces in individuals with chronic headache
ConclusionsIndividuals with chronic headache show facilitated initial orienting towards pain expressions specifically when used as targets in a visual search task. This study adds to a growing body of research supporting the presence of pain‐related attentional biases in chronic pain as assessed via different experimental paradigms, and shows biases to exist when multiple stimuli competing for attention are presented simultaneously. (Source: European Journal of Pain)


Should placebo be used routinely for chronic pain in older people?
Placebos come by many names – placebo, obecalp (‘placebo’ backwards), cebocap (or sugar pill), pure or impure placebos, dummy and sham treatments. An exemplar is the administration of an inert sugar pill with no active pharmacologic agent, although placebos do not need to be medications as interventions such as sham surgeries also have demonstrable placebo effects. Whatever the form, placebos may improve a patient's condition due to a variety of biopsychosocial factors, including patient expectancy of therapeutic benefit, prior conditioning, and the psychosocial context of the setting such as the patient–doctor relationship. (Source: Maturitas)


Re: “Chronic rupture of abdominal aortic aneurysm with vertebral erosion. An uncommon but important cause of back pain”
Singla et al1 reported, in their recent article, an interesting clinical case on a 68-year-old patient admitted to their hospital for episodic low-back pain and pulsatile abdominal mass, secondary to chronic contained rupture (CCR) of an infrarenal abdominal aortic aneurysm (AAA) and the third lumbar vertebra erosion (VE). The treatment was endovascular aortic repair (EVAR). (Source: Annals of Vascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Assessing psychological factors, social aspects and psychiatric co-morbidity associated with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) in men — A systematic review
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a chronic pain disease with high prevalence rates and substantial health care costs. An interdisciplinary classification system is commonly used (UPOINT) which includes psychosocial factors. Nevertheless, psychosocial influences on CP/CPPS only recently became a research focus. Therefore, we aimed to synthesize the existing data and to identify further research topics. Then, based on our results, diagnosis and treatment can be improved. (Source: Journal of Psychosomatic Research)


Inguinal hernia repair using a synthetic long-term resorbable mesh: results from a 3-year prospective safety and performance study
Conclusion The use of a synthetic long-term resorbable mesh (TIGR® Matrix Surgical Mesh) in Lichtenstein repair was found to be safe, without recurrences, and promising regarding pain/discomfort at 3-year follow-up in patients with LIH. However, patients with medial and combined inguinal hernias had high recurrence rates. (Source: Hernia)


Answer to the Letter to the Editor of L. Uhrenholt et al. concerning “Do X-ray-occult fractures play a role in chronic pain following a whiplash injury?” by Hertzum-Larsen R, Petersen H, Kasch H, Bendix T, Eur Spine J, 2014; DOI 10.1007/s00586-014-3362-3
(Source: European Spine Journal)


Validity of the French version of the Core Outcome Measures Index for low back pain patients: a prospective cohort study
Conclusions The COMI is a self-report questionnaire with the capacity to easily and quickly explore several dimensions in patients with LBP that can be then summarized in a meaningful sum score. Additional knowledge provided by our study should encourage the widespread use of the COMI among the spine community. (Source: European Spine Journal)


Letter to the Editor regarding “Do X-ray-occult fractures play a role in chronic pain following a whiplash injury?” by Hertzum-Larsen R, Petersen H, Kasch H, Bendix T. Eur Spine J. 2014; DOI 10.1007/s00586-014-3362-3
(Source: European Spine Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Can pain influence the proprioception and the motor behavior in subjects with mild and moderate knee osteoarthritis?
Conclusion: The presence of pain does not influence the proprioception and the motor behavior of the thigh muscles during stair ascent and descent in subjects with mild and moderate knee OA. (Source: BioMed Central)


Experimental autoimmune prostatitis induces microglial activation in the spinal cord
CONCLUSIONOur data show that prostatitis leads to inflammation in the spinal cord and the activation and expansion of microglia, mechanisms that may contribute to the development and maintenance of chronic pelvic pain. Prostate © 2014 Wiley Periodicals, Inc. (Source: The Prostate)


Reduction of Intraepidermal Nerve Fiber Density (IENFD) in the skin biopsies of patients with fibromyalgia: A controlled study
Fibromyalgia (FM) is one of the most common chronic pain syndromes. Various pathogenetic mechanisms have been implicated but none is proven. Our scope was to determine if Intraepidermal Nerve Fiber Density (IENFD) is reduced in the skin of FM patients, as observed in patients with painful small fiber sensory neuropathy (SFSN). (Source: Journal of the Neurological Sciences)


Delayed diaphragmatic rupture presenting with acute gastric volvulus.
We report the case of an 82-year-old man who presented following an out-of-hospital cardiac arrest. Chest radiography and thoracic computed tomography revealed an acute gastric volvulus and a chronic diaphragmatic hernia containing transverse colon and abdominal viscera. He had complained of retching and associated epigastric pain prior to collapse, and had sustained a motorcycle accident approximately 60 years earlier. Insertion of a nasogastric tube was unsuccessful (completing Borchardt's diagnostic triad) and his condition prevented both operative and endoscopic reduction of his volvulus. He died soon afterwards. PMID: 25245717 [PubMed - in process] (Source: Annals of the Royal College of Surgeons of England)


Interhemispheric somatosensory differences in chronic pain reflect abnormality of the Healthy side
This study compared the S1 spatial representation of the hand in 17 patients with upper‐limb CRPS to 16 healthy controls, using functional MRI. Innocuous vibration was delivered to digits one (D1) and five (D5) in a block‐design. Resultant activation maxima were located within a bilateral S1 mask, determined a priori. Distance between D1 and D5 activation maxima, calculated for both hands, was used as a measure of S1 representation. Analyses were blinded to group and hand. In patients, S1 representation was smaller for the affected hand than it was for the healthy hand (t(11) = 2.02, P = 0.03), as predicted. However, S1 representation of the affected hand was no different to that of either hand in controls. Critically, S1 representation of the healthy hand of patients was large...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Low prevalence of hypersensitivity to nonsteroidal anti-inflammatory drugs in Chinese patients with chronic rhinosinusitis
The objective of this study is to investigate the prevalence of NSAID hypersensitivity in Chinese patients diagnosed with CRS. In a unique cohort study, consecutive CRS patients received intramuscular diclofenac sodium injection or diclofenac sodium sustained-release tablets to relieve intraoperative and postoperative pain following nasal surgery. In addition, data on NSAID hypersensitivity in large-sample series of CRS patients were collected by searching relevant literature published in Chinese to determine the prevalence of NSAID hypersensitivity in Chinese patients with CRS. A total of 244 consecutive CRS patients were included in this study. Three (1.34 %) patients experienced a severe asthmatic attack after intramuscular diclofenac sodium injection and were diagnosed with NSAID hype...


Patient’s response to a simple question on recovery after hemodialysis session strongly associated with scores of comprehensive tools for quality of life and depression symptoms
Conclusions The results support the validity of a simple question on post-hemodialysis recovery as a proxy for scores of complex instruments for depression symptoms and HRQOL. The results suggest that the poorer HRQOL and higher depression probability in patients who need a time to recover from hemodialysis could be partially explained by the presence of hemodialysis-related symptoms. (Source: Quality of Life Research)


The effects of anxiety sensitivity, pain hypervigilance, and pain catastrophizing on quality of life outcomes of patients with chronic pain: a preliminary, cross-sectional analysis
Conclusions These cross-sectional analyses gave results consistent with pain hypervigilance, mediating the relationship of pain catastrophic cognition and anxiety sensitivity with pain-related fear. The net suppression effects of pain catastrophizing point to anxiety sensitivity, enhancing the effect of pain catastrophic cognition on pain hypervigilance. These findings elucidate how the interdependence of dispositional factors might influence pain adjustment and functioning. (Source: Quality of Life Research)


Changes in physical activity and heart rate variability in chronic neck–shoulder pain: monitoring during work and leisure time
Conclusion Changes in HRV reflected an autonomic imbalance in workers with chronic musculoskeletal pain. This can be explained by reduced physical activity in leisure time. Intervention studies aimed at increasing physical activity may shed further light on the association between autonomic regulation and physical activity in work-related NSP. (Source: International Archives of Occupational and Environmental Health)


The Pain Self‐Efficacy Questionnaire: Cross‐Cultural Adaptation into Italian and Assessment of Its Measurement Properties
Abstract The Pain Self‐Efficacy Questionnaire (PSEQ) is a patient self‐reported measurement instrument that evaluates pain self‐efficacy beliefs in patients with chronic pain. The measurement properties of the PSEQ have been tested in its original and translated versions, showing satisfactory results for validity and reliability. The aims of this study were 2 fold as follows: (1) to translate the PSEQ into Italian through a process of cross‐cultural adaptation, (2) to test the measurement properties of the Italian PSEQ (PSEQ‐I). The cross‐cultural adaptation was completed in 5 months without omitting any item of the original PSEQ. Measurement properties were tested in 165 patients with chronic low back pain (CLBP) (65% women, mean age 49.9 years). Factor analysis confirmed th...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Risk Factors for Chronic Saphenous Neuralgia Following Coronary Artery Bypass Graft Surgery Utilizing Saphenous Vein Grafts
ConclusionsChronic SN after CABG surgery utilizing GSV grafts is not uncommon. Risk factors identified in this trial are younger age, female gender, higher body mass index, diabetes mellitus, distal‐to‐proximal dissection of the GSV, and closure of the leg wound in two layers. (Source: Pain Practice)


A Pilot Study of Audio-Visual Stimulation as a Self-Care Treatment for Insomnia in Adults with Insomnia and Chronic Pain.
Authors: Tang HY, Vitiello MV, Perlis M, Mao JJ, Riegel B Abstract This pilot study tested the efficacy of an audio-visual stimulation (AVS) program for the promotion of sleep in individuals with chronic pain. Insomnia and chronic pain are common comorbid conditions and their relationship has been viewed as bidirectional. Recent studies suggest a relatively dominant role of sleep in this dyad. The premise of this pilot study was that AVS enhances low frequency while reducing high frequency brain activity resulting in decreased hyperarousal and improved sleep with potential consequent reduction in pain. We conducted a pilot intervention study of AVS using a pre-post design. Participants self-administered a 30-min AVS program nightly at bedtime for 1 month. Sleep and pain were asses...


A Pilot Study of Audio–Visual Stimulation as a Self-Care Treatment for Insomnia in Adults with Insomnia and Chronic Pain
Abstract This pilot study tested the efficacy of an audio–visual stimulation (AVS) program for the promotion of sleep in individuals with chronic pain. Insomnia and chronic pain are common comorbid conditions and their relationship has been viewed as bidirectional. Recent studies suggest a relatively dominant role of sleep in this dyad. The premise of this pilot study was that AVS enhances low frequency while reducing high frequency brain activity resulting in decreased hyperarousal and improved sleep with potential consequent reduction in pain. We conducted a pilot intervention study of AVS using a pre–post design. Participants self-administered a 30-min AVS program nightly at bedtime for 1 month. Sleep and pain were assessed at baseline and at the conclusion of the 4-week i...


Expression of 5-HT 3 receptors and TTX resistant sodium channels (Na V 1.8) on muscle nerve fibers in pain-free humans and patients with chronic myofascial temporomandibular disorders
Conclusions This study showed that the 5-HT3A-receptor is highly expressed in human masseter and tibialis muscles and that there are more nerve fibers that express 5-HT3A-receptors in the masseter of women with myofascial TMD compared to healthy women. These findings indicate that 5-HT3-receptors might be up-regulated in myofascial TMD and could serve as potential biomarkers of chronic muscle pain. (Source: The Journal of Headache and Pain)


Sleep features and central sensitization symptoms in primary headache patients
Conclusion Self reported duration of sleep seems a useful index to be correlated with allodynia, pericranial tenderness and chronic headache as a therapeutic target to be assessed in forthcoming studies aiming to prevent central sensitization symptoms development. (Source: The Journal of Headache and Pain)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Transcystic access of the common bile duct in a patient with a type III choledochal cyst (choledochocele) and cystolithiasis
A 75-year-old woman with chronic intermittent right upper quadrant pain was referred to our institution for an abnormal fluid-containing structure protruding into the duodenum at the ampulla of Vater and associated dilated extrahepatic ducts to 12 mm noted on contrast-enhanced abdominal CT scan. EGD revealed a diverticulum in the second portion of the duodenum and a subepithelial lesion at the side of the diverticulum (Fig. 1A; Video 1, available online at www.giejournal.org). EUS demonstrated an intraduodenal cystic lesion communicating with the distal common bile duct and hyperechoic filling defects within the cyst; the distal common bile duct was free of filling defects (Fig. 1B). (Source: Gastrointestinal Endoscopy)


Pain in patients with COPD: a systematic review and meta-analysis
Conclusions Although literature on this topic is limited and shows substantial heterogeneity, pain seems to be a significant problem in patients with COPD and is related to several other symptoms, comorbidity and QoL. Data synthesis suggests that pain is more prevalent in patients with moderate COPD compared to patients with severe or very severe COPD. Further research is needed and should focus on determining a more accurate pain prevalence, investigating the relationship between pain prevalence, disease severity and comorbidity and explore implementation and efficacy of pain management interventions in patients with COPD. (Source: BMJ Open)


Systematic Review of Early Surgery for Chronic Pancreatitis: Impact on Pain, Pancreatic Function, and Re-intervention
Conclusions Data from this study supports considering early surgery for pain management in patients with chronic pancreatitis, with the potential of a reduced risk of pancreatic insufficiency and the need for further intervention. Further prospective randomized studies are warranted comparing early surgery against conservative step-up approaches. (Source: Journal of Gastrointestinal Surgery)


Performance of different criteria sets for inflammatory back pain in patients with axial spondyloarthritis with and without radiographic sacroiliitis
In this study, new ASAS criteria for IBP performed almost as good as but not better than the existing criteria sets. Performances of the criteria sets were quite comparable in the differentiation of IBP from MBP in patients with and without radiographic sacroiliitis. (Source: Clinical Rheumatology)


The effectiveness of balneotherapy in chronic low back pain
Abstract The aim of this study is to determine the effectiveness of balneotherapy plus physical therapy versus only physical therapy in patients with chronic low back pain. In this trial, 81 patients with low back pain were followed up in two groups. Patients in group I (n = 44) were treated with physical therapy alone. Patients in group II (n = 37) were treated with balneotherapy in addition to the same physical therapy protocol in group I. Patients in both groups were given a home-based standardized exercise program. The following parameters were measured: visual analog scale (0–10 cm), fingertip-to-floor distance (cm), Oswestry Disability Index, and Short Form 36 quality of life scale. First evaluations were done at the time of enrollment, and second evaluations wer...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Recurrence of type I Modic inflammatory changes in the lumbar spine: effectiveness of intradiscal therapy
Abstract Here we report a case of recurrence of Modic type I inflammatory changes in the lumbar spine. A 49-year-old man was referred to our department with a history of chronic low back pain of at least 20 years. At the first consultation, he complained of low back pain only and had no other symptoms such as leg pain, numbness, or weakness. Although his pain was typically mild, he experienced one or two episodes of severe and incapacitating low back pain a year. After two intradiscal steroid injections, his pain disappeared immediately and completely. After 6 months of conservative treatment, Modic type I change switched to Modic type II change. However, 12 months after the first treatment, he once again experienced severe low back pain. Follow-up magnetic resonance imaging (...


Chronic Pain Awareness Event in September Is Open to the Public and...
In honor of Chronic Pain Awareness Month this September, Arizona Pain (arizonapain.com), the premier pain center in Phoenix, AZ, will be hosting a complimentary “Chronic Pain Awareness Expo” at the JW...(PRWeb September 24, 2014)Read the full story at http://www.prweb.com/releases/2014/09/prweb12158071.htm (Source: PRWeb: Medical Pharmaceuticals)


Medial retinacular flap advancement and arthroscopic lateral release for symptomatic chronic patellar lateral subluxation with tilting
Conclusions Medial retinacular flap advancement and arthroscopic lateral release offer a promising treatment for symptomatic chronic patellar lateral subluxation and tilt without frank traumatic episode. Level of evidence Retrospective study, Level IV. (Source: Knee Surgery, Sports Traumatology, Arthroscopy)


Patellofemoral arthrodesis as pain relief in extreme patella alta
Conclusions A patellofemoral arthrodesis can be regarded safe and also very effective in the relief of pain in extreme patella alta. Level of evidence Therapeutic studies, Level IV. (Source: Knee Surgery, Sports Traumatology, Arthroscopy)


Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain
Conclusion What has been found suggests that clinical improvement in pain and disability is associated with a reduction in catastrophizing and kinesiophobia. Therefore, co-interventions to reduce catastrophizing thinking and kinesiophobia may enhance the results. Level of evidence Prospective Cohort Study, Level I for prognosis. (Source: Knee Surgery, Sports Traumatology, Arthroscopy)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Laparoscopic appendectomy for chronic right lower quadrant abdominal pain
Conclusions A significant reduction of pain was achieved after an appendectomy in all patients suffering from chronic RLQAP in this series. Seven out of ten patients were completely free of pain. (Source: International Journal of Colorectal Disease)


Beyond acute appendicitis: imaging and pathologic spectrum of appendiceal pathology
Abstract While acute appendicitis is a common and important clinical problem, a variety of other disease processes can affect the appendix. Simple and perforated appendicitis, tip appendicitis, and stump appendicitis share a common clinical presentation including anorexia, right lower quadrant pain, and fever. By imaging, most cases of acute appendicitis exhibit luminal dilation, wall thickening, and periappendiceal inflammatory stranding. In tip appendicitis, these changes are isolated to the distal appendix, often with an obstructing appendicolith. Perforated appendicitis can exhibit mural discontinuity, periappendiceal abscess, and/or extraluminal appendicoliths. After appendectomy, the appendiceal remnant or “stump” can become inflamed, often necessitating repeat surgery...


Effect of a Roux-en-Y Gastric Bypass on the Pharmacokinetics of Oral Morphine Using a Population Approach
Conclusion RYGB and the BMI reduction that followed it dramatically increased the rate of morphine absorption and slightly increased morphine exposure. The dose of immediate-release forms of morphine may be divided in obese patients after RYGB to prevent adverse events due to early and high morphine plasma peaks. (Source: Clinical Pharmacokinetics)


Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study
Conclusion Discontinuation of chronic BZD/Z use is feasible in the nursing home setting without noticeable withdrawal symptoms, without a switch in medication use, without detrimental effect on quality of life and with a positive effect on the self-perceived sleep quality. (Source: European Journal of Clinical Pharmacology)


Non-steroidal anti-inflammatory drug use in chronic pain conditions with special emphasis on the elderly and patients with relevant comorbidities: management and mitigation of risks and adverse effects
Conclusions Management of pain and inflammation must consider those risks and find alternative drugs or approaches to limit the negative impact of NSAIDs on mortality and morbidity. Alternative drugs, low-dose/short-term use, but especially non-pharmacologic approaches, such as physiotherapy, exercise, neurophysiologic measures, and local therapies, need to be further utilized. The appalling equation “less pain–more deaths/morbidity” ultimately necessitates treatment optimization in the individual patient. (Source: European Journal of Clinical Pharmacology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Consequences of dextropropoxyphene market withdrawal in elderly patients with chronic pain
Conclusion DXP market withdrawal had no consequences on the intensity or impact of chronic pain in elderly patients. (Source: European Journal of Clinical Pharmacology)


Chronic Postsurgical Pain
(Source: Canadian Journal of Anesthesia)


Suicidal behavior in a patient with burning mouth syndrome.
Discussion. Burning mouth syndrome (BMS) is characterized by a burning sensation in the tongue or other oral sites. BMS has high psychiatric comorbidity but can occur in the absence of psychiatric diagnosis. Patients with multiple forms of pain must be considered as potential candidates for underdiagnosed depression (major) and suicidal thoughts. PMID: 25247103 [PubMed] (Source: Case Reports in Psychiatry)


Challenges for treatment of alcoholic neuropathic symptoms aggravated by niacin treatment of alcoholic pellagra
Pellagra is the disease manifestation of Niacin deficiency. It is currently seen, it is seen in association with other conditions of chronic nutritional deficiencies, like alcoholism. Alcoholic neuropathy is a condition of Bilateral degeneration of peripheral nerves. The incidence of neuropathy in chronic alcoholism has ranged widely in the literature from 9-67% [1].It manifests by altered superficial sensations and pain. Given that patients with chronic alcoholism, commonly have malnutrition and that alcoholism is at present the commonest documented cause of pellagra in developed countries [2], theoretical implications point towards the possibility of co-existence of alcoholic neuropathy and alcoholic pellagra. (Source: General Hospital Psychiatry)


Biopsychosocial factors associated with pain in veterans with the hepatitis C virus
Abstract Little research has examined etiological factors associated with pain in patients with the hepatitis C virus (HCV). The purpose of this study was to evaluate the relationship between biopsychosocial factors and pain among patients with HCV. Patients with HCV and pain (n = 119) completed self-report measures of pain, mental health functioning, pain-specific psychosocial variables (pain catastrophizing, self-efficacy for managing pain, social support), prescription opioid use, and demographic characteristics. In multivariate models, biopsychosocial factors accounted for 37 % of the variance in pain severity and 56 % of the variance in pain interference. In adjusted models, factors associated with pain severity include pain catastrophizing and social support, whereas va...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Peripheral nerve stimulation by ‘sandwich’ paddle leads: technical note
Conclusion In selected cases where an open surgical PNS lead needs to be placed, the ‘sandwich’ technique can be used to augment the stimulation without additional morbidity. Although occasionally used in practice, this technique is still unreported. (Source: Acta Neurochirurgica)


Parental behaviour in paediatric chronic pain: A qualitative observational study
Conclusions: This research identifies categories of parental behaviour that were derived directly from observation, rather than imposed on the basis of results from different populations. Four categories of behaviour were derived, which clarify and extend dimensions used in existing self-report instruments. Careful description of parental behaviours showed features that past research has neglected, and highlighted potential drawbacks of apparently positive parental actions. (Source: Clinical Child Psychology and Psychiatry)


The evaluation of flap growth and long‐term results of pediatric mandible reconstructions using free fibular flaps
In this study, we sought to measure flap growth objectively in our series. Ten pediatric patients who underwent reconstruction with free fibular flaps were retrospectively reviewed. Flap growth was evaluated by comparing the intraoperative photographs with photographs of the control panoramic mandibular radiographs taken using photo‐anthropometric techniques. The measurements were converted to proportionality indices (PI), and these indices were compared. Subsequent complications and functional results were also evaluated. The mean patient age was 11.8 years, and the mean follow up was 57.7 months. The mean preoperative PI value was 10.74 ± 2.47. The mean postoperative PI value was 12.52 ± 2.34. The mean difference between the preoperative and postoperative PI values was −1.7...


[Investigation of the use of triclosan in patients with indwelling catheters : A randomized, double blind, multicenter, placebo-controlled clinical study.]
CONCLUSIONS: Using the antimicrobial solution triclosan as a fluid for inflation of catheter balloons led to a statistically significant extension in the catheter indwelling time. The reduction of pain during changing the catheter and the reduction of incrustation, although not statistically significant, led to an improvement in the quality of life of these patients. PMID: 25249158 [PubMed - as supplied by publisher] (Source: Der Urologe. Ausg. A)