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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)<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>


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)


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)<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>


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...


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)<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 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)


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...<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>


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)


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...<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>


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...


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)<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
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)


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...<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>


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)


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)


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


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


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


Chronic unilateral chemosis following the use of amlodipine besylate
Conclusion: Prior to invasive evaluation including biopsy, specific drugs should be considered as possible causes of idiopathic longstanding conjunctival chemosis. (Source: BioMed Central)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


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


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


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)<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>


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


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


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


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


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


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)


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)<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>


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)


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)<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>


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)


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)<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>


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)


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)<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>


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)


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)<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>


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)


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...<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-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)


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)<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>


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...


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


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


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


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 ...


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 ...<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 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)


“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)<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 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)


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)<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>


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)


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)<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 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)


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)


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)


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 ...<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 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)


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)<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 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...


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)<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>


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 ...


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...<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>


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)


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)<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>


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...


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)<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 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)


[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)<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 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)


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 ...<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 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)


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)


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)<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>


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)


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)<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>


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...


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...


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...<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>


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...


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)<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 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)


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)<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>


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)


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)<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>


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)


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)<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 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)


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)<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>


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)


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)<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>


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)


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 ...<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>


¿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...


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...<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 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)


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)


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·...


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)<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 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 ...


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)<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>


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...


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)<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>


[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)


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)<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>


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)


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...<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>


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...


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)<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>


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)


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)<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>


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)


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)<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 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)


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)<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>


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)


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)<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 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)


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)<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>


[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)


[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)<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>


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)


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)<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>


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)


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)<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>


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)


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)<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>


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...


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)<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 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...


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)<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>


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)


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...


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 (...<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 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)


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)<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>


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)


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)<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 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...


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)<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>


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)


[Current issues in functional dyspepsia].
This article is intended to review the validity of the Rome III criteria on the subdivisions of functional dyspepsia, i.e. PDS and EPS. The impact of sleep disorder, Helicobacter pylori-associated dyspepsia, and the emerging drug therapies in functional dyspepsia will also be discussed in this article. PMID: 25252861 [PubMed - in process] (Source: Korean J Gastroenter...)


Interventions for the management of oral ulcers in Behçet's disease.
CONCLUSIONS: Due to the heterogeneity of trials including trial design, choice of intervention, choice and timing of outcome measures, it was not possible to carry out a meta-analysis. Several interventions show promise and future trials should be planned and reported according to the CONSORT guidelines. Whilst the primary aim of many trials for Behç̧et's disease is not necessarily reduction of oral ulceration, reporting of oral ulcers in these studies should be standardised and pre-specified in the methodology. The use of a core outcome set for oral ulcer trials would be beneficial. PMID: 25254615 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)<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 brief primary care intervention to reduce fear of movement in chronic low back pain patients
This study provides evidence for the efficacy of a brief PCB fear avoidance intervention that was successfully implemented into a busy clinic for the treatment of chronic pain. (Source: Translational Behavioral Medicine)


Attentional bias for pain‐ and period‐related symptom words in healthy women who experienced a recent painful period
ConclusionsPain‐related attentional biases are associated with recent menstrual pain severity. The experience and severity of pain, rather than its duration (i.e., whether pain is chronic or acute), may be the primary determinants of pain‐related attentional bias. Future research could explore attentional biases in acute clinical pain samples to confirm this notion. (Source: European Journal of Pain)


Short (Low-dose) Ketamine Infusion for Managing Acute Pain in the Emergency Department: Case-Report Series
Patients with prior chronic opioid use or with preexisting chronic painful conditions that present to the Emergency Department (ED) with acute pain or acute exacerbation of their chronic pain present a great challenge to emergency physicians in terms of their pain management. Some of these patients are tolerant to doses of opioids that most emergency physicians are not comfortable giving; some refuse opioids because of their prior history of abuse and/or dependence. Furthermore, opioids at higher doses may cause significant side effects including respiratory depression, hemodynamic compromise, vomiting, and pruritus. (Source: The American Journal of Emergency Medicine)


Epigenetic Regulation of Genes that Modulate Chronic Stress-induced Visceral Pain in the Peripheral Nervous System
Chronic stress alters the hypothalamic–pituitary−adrenal axis, increases gut motility, and increases perception of visceral pain. We investigated whether epigenetic mechanisms regulate chronic stress-induced visceral pain in the peripheral nervous systems of rats. (Source: Gastroenterology)


A novel cardiovascular presentation of Alport Syndrome: Spontaneous coronary artery dissection
A 65year-old woman was admitted to the emergency department with persistent typical chest pain after a fibrobronchoscopy. At the age of 30 she was diagnosed with chronic interstitial nephritis secondary to a familiar Alport Syndrome (AS), which was confirmed with renal biopsy. This primary renal involvement finally led her to chronic hemodialysis four years ago. She also had a history of hypertension, treated with angiotensin converting enzyme (ACE) inhibitors. (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>


A surface electromyography based objective method to identify patients with nonspecific chronic low back pain, presenting a flexion related movement control impairment
Movement control impairments (MCI) are often present in patients with non-specific chronic low back pain (NS-CLBP). Therefore, movement control exercises are widely used to rehabilitate patients. However, the objective assessment remains difficult.The purpose of this study was to develop a statistical model, based on logistic regression analysis, to differentiate patients with NS-CLBP presenting a flexion-related MCI from healthy subjects. This model is based on trunk muscle activation patterns measured by surface electromyography (sEMG), during movement control exercises. (Source: Journal of Electromyography and Kinesiology)


Brain areas activated by itch-relieving drug identified
Brain areas that respond to reward and pleasure are linked to the ability of the drug butorphanol to relieve itch, according to new research. The findings point to the involvement of the brain's opioid receptors -- known for their roles in pain, reward, and addiction -- in itch relief, potentially opening up new avenues to the development of treatments for chronic itch. (Source: ScienceDaily Headlines)


Dislocated Ankle (Ankle Dislocation)
Title: Dislocated Ankle (Ankle Dislocation)Category: Diseases and ConditionsCreated: 9/24/2014 7:23:00 PMLast Editorial Review: 9/24/2014 7:23:38 PM (Source: MedicineNet Chronic Pain General)


'Polyherbacy' a Common Challenge in Pain Patients'Polyherbacy' a Common Challenge in Pain Patients
With chronic pain patients the leading drivers of the multi-billion-dollar dietary supplement industry, clinicians are put to the test to place things in perspective. Medscape Medical News (Source: Medscape Neurology and Neurosurgery Headlines)


Site and mechanism of morphine tolerance in the gastrointestinal tract
Abstract Opioid‐induced constipation is a major clinical problem. The effects of morphine, and other narcotics, on the gastrointestinal tract persist over long‐term use thus limiting the clinical benefit of these excellent pain relievers. The effects of opioids in the gut, including morphine, are largely mediated by the μ‐opioid receptors at the soma and nerve terminals of enteric neurons. Recent studies demonstrate that regional differences exist in both acute and chronic morphine along the gastrointestinal tract. While tolerance develops to the analgesic effects and upper gastrointestinal motility upon repeated morphine administration, tolerance does not develop in the colon with chronic opioids resulting in persistent constipation. Here, we review the mechanisms by which toleranc...<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 Frequent Nausea Is Associated With Progression to Chronic Migraine: AMPP Study Results
ConclusionsPersistent frequent nausea is common (43.7%) among persons with episodic migraine. After controlling for sociodemographics, migraine symptom severity, headache‐related disability, depression, and opioid medication use, migraineurs with frequent nausea that persisted for 2 years of study were twice as likely to progress to CM compared to those with no or low frequency nausea. The study is limited by self‐reports of symptom and headache frequency data and the use of modified diagnostic criteria. Additional prospective research is needed to confirm study findings. Persistent frequent nausea could be a marker for the risk of progression to CM or it could be in the causal pathway. (Source: Headache: The Journal of Head and Face Pain)


Suicide by Means of Opioid Overdose in Patients with Chronic Pain
Abstract Deaths from prescription opioid use continue to rise in North America. The main focus to date has been developing strategies to prevent nonintentional (accidental) fatalities, which constitute the majority of opioid deaths across all jurisdictions. Often overlooked is the complex group of individuals whose cause of death was suicide by opioid overdose. Although most opioid prescribing tools focus on identifying risk factors for potential abuse, diversion, and propensity for opioid addiction, physicians who consider prescribing opioids should also screen and optimize chronic pain treatment for patients at risk for suicide. (Source: Current Pain and Headache Reports)


Restless Legs Syndrome and Pain Disorders: What’s in common?
Abstract Between 10 % and 30 % of the population report chronic pain. More than half of these also have sleep complaints. From considering these data, it can be inferred there is a significant overlapping between these conditions. Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) is characterized by complaints of an “urge to move” frequently associated with dysesthesias. From that perspective, these sensations can also have painful characteristics. By the same token, the presence of comorbid diseases as predicted by a higher prevalence RLS/WED, have many of them with pain as an important complaint. Pain is a multidimensional response involving several levels of expression ranging from somatosensory to emotional. The potential shared mechanisms between RLS/WED and pain m...


Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial
Conclusions Recurrence rates did not differ significantly at 3-year follow-up and occurred in patients with index grade IV hemorrhoids. Chronic complications occurred only after hemorrhoidectomy. (Source: Techniques in Coloproctology)


Conducting qualitative longitudinal research using interpretative phenomenological analysis.
Conclusion A longitudinal design adds potential analytical pitfalls, including a priori theorising and emotional involvement. Interpretative and emotional safeguarding included reflection and reflexivity, an iterative approach and the role of phenomenological strategies such as the hermeneutic circle. The efficacy of these is discussed, along with the ambiguity surrounding concepts such as bracketing. Implications for research/practice Although the topics discussed relate specifically to this methodology and a particular research project sample, they are applicable to qualitative research designs in similar populations. PMID: 25251816 [PubMed - as supplied by publisher] (Source: Nurse Researcher)<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>


1525p * opioid endocrinopathy: a clinical problem in patients with cancer pain
Conclusions: We found that opioid theraphy in patients with cancer may inhibit gonadal function and may cause hyperprolactinemia.Disclosure: All authors have declared no conflicts of interest. (Source: Annals of Oncology)


Brain Neuroplastic Changes Accompany Anxiety and Memory Deficits in a Model of Complex Regional Pain Syndrome
Conclusions: The study findings provide novel observations regarding behavioral changes and brain plasticity in a mouse model of CRPS. In addition to elucidating some of the supraspinal correlates of the syndrome, this work supports the potential use of therapeutic interventions that not only directly target sensory input and other peripheral mechanisms, but also attempt to ameliorate the broader pain experience by modifying its associated cognitive and emotional comorbidities. (Source: Anesthesiology)


Longevity and Cost of Implantable Intrathecal Drug Delivery Systems for Chronic Pain Management: A Retrospective Analysis of 365 Patients
ConclusionsOverall, the cohort experienced an increased incidence of pump‐related complications and a device longevity that was within the range of the manufacturer's anticipated lifespan. Increasing the lifespan of the ITP and improving patient selection have the potential to significantly improve the cost‐effectiveness of intrathecal therapy. (Source: Neuromodulation)


Desipramine for neuropathic pain in adults.
CONCLUSIONS: This review found little evidence to support the use of desipramine to treat neuropathic pain. There was very low quality evidence of benefit and harm, but this came from studies that were methodologically flawed and potentially subject to major bias. Effective medicines with much greater supportive evidence are available. There may be a role for desipramine in patients who have not obtained pain relief from other treatments. PMID: 25246131 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Intimate partner violence and diurnal cortisol patterns in couples
Victimization of physical intimate partner violence (IPV), which ranges from being pushed, slapped, or kicked to severely beaten and assaulted with a knife or gun, may have long-lasting physical and psychological health consequences – including anxiety, depression, chronic pain, and psychosomatic disorders (Lawrence et al., 2012). However, despite the high prevalence of IPV (Slep and O’Leary, 2005), the underlying mechanisms that may explain the effects of IPV on health outcomes are not well understood. (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>


Opioid attentional bias and cue-elicited craving predict future risk of prescription opioid misuse among chronic pain patients
Chronic pain conditions are commonly treated with prescription opioids, which may relieve pain by targeting the descending pain modulatory system (Besson, 1999), decreasing somatosensory and thalamic activation (Wagner et al., 2007; Wise et al., 2002), modifying amygdala function (Oertel et al., 2007), and altering neurotransmission in spinal dorsal horn (Le Bars et al., 1980; Yaksh, 1985, 1981). In addition to analgesia, opioid administration stimulates dopamine release from the ventral tegmental area to the nucleus accumbens, facilitating opioid-related reinforcement learning (Shippenberg et al., 1993). (Source: Drug and Alcohol Dependence)


306 * implantable loop recorder monitoring after concomitant surgical ablation for atrial fibrillation: insights from more than two hundred continuously-monitored patients
Conclusion: Continuous ILR monitoring after concomitant surgical AF ablation was safe and feasible, and provided SR rate of 68.5 % at 1-year follow-up. Continuous rhythm monitoring helps to guide antiarrhythmic therapy and allows for safer withdrawal of anticoagulation therapy. (Source: Interactive CardioVascular and Thoracic Surgery)


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)


Deep Brain Stimulation for Chronic Pain: Intracranial Targets, Clinical Outcomes, and Trial Design Considerations
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)


Motivational Interviewing and Chronic Pain (Jill Schneiderhan MD)
(Source: Family Medicine Digital Resources Library (FMDRL) Recently Uploaded)<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>


Technology for Chronic Pain.
Authors: Zhang S, Seymour B Abstract Technology developed for chronic pain management has been fast evolving and offers new stand-alone prospects for the diagnosis and treatment of pain, rather than simply addressing the limitations of pharmacology-based approaches. There are two central challenges to be tackled: developing objective measures that capture the subjectivity of pain experience, and providing technology-based interventions that offer new approaches for pain management. Here we highlight recent developments that hold promise in addressing both of these challenges. PMID: 25247372 [PubMed - as supplied by publisher] (Source: Current Biology)


Associations between chronic non-cancer pain and medication assisted treatment outcomes for opiate addiction.
CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The correlations between CNCP and co-occurring depression/anxiety among MAT clients indicate an area of special concern for providers. A full biopsychosocial, including a focus on history of chronic physical pain, might be beneficial to help highlight potential co-morbidities and to encourage closer monitoring of the intertwining relationships between addiction, CNCP, and depression/anxiety. (Am J Addict 2014;XX:1-6). PMID: 25251420 [PubMed - as supplied by publisher] (Source: American Journal on Addictions)


The psychometric characteristics of an assessment instrument for perceived harmfulness in adolescents with musculoskeletal pain (PHODA‐youth)
ConclusionThe findings support the PHODA‐youth as a valid and reliable measure of the perceived harmfulness of activities in adolescents with musculoskeletal pain. (Source: European Journal of Pain)


Time to functional recovery after arthroscopic surgery for tennis elbow.
CONCLUSION: Arthroscopic surgery for lateral epicondylitis provides significant improvement in pain and functional recovery up to 3 months after surgery. However, it takes more than 6 months for the VAS score during activity to fall below 10 points. PMID: 25220200 [PubMed - in process] (Source: Hand Surgery)


Cancer Treatment-Related Neuropathic Pain Syndromes—Epidemiology and Treatment: An Update
Abstract Cancer treatment-related chronic neuropathic pain (NP) is a pervasive and distressing problem that negatively influences function and quality of life for countless cancer survivors. It occurs because of cancer treatment-induced damage to peripheral and central nervous system structures. NP becomes chronic when pain signal transmission persists, eventually sensitizing neurons in the dorsal horn and other pain-processing regions in the central nervous system. Frequently overlooked, NP due to cancer treatment has been understudied. Consequently, only a few pharmacologic interventions have been shown to be effective based on the results of randomized controlled trials. Future research designed to explore pathophysiologic mechanisms and effective mechanism-targeted interventi...<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 avoidance of activities due to fear of falling contributes to sedentary behavior among community-dwelling older adults with chronic musculoskeletal pain: a multisite observational study - Stubbs B, Patchay S, Soundy A, Schofield PA.
OBJECTIVE: Physical inactivity and sedentary behavior (SB) are leading causes of mortality. We investigated if older adults with chronic musculoskeletal pain (CMP) are more sedentary than a group of similar age and sex without CMP and possible contributory... (Source: SafetyLit: All (Unduplicated))


Aggression, impulsivity, and suicide risk in benign chronic pain patients - a cross-sectional study - Margari F, Lorusso M, Matera E, Pastore A, Zagaria G, Bruno F, Puntillo F, Margari L.
The objective of this study was to investigate the role that psychopathological dimensions as overt aggression and impulsivity play in determining suicide risk in benign chronic pain patients (CPPs). Furthermore we investigated the possible pro... (Source: SafetyLit: All (Unduplicated))


Testicular malakoplakia: A rare sonographic mimic of malignancy
ABSTRACT Testicular malakoplakia is a rare, benign condition that most often occurs in an immunocompromised patient with chronic infection. Its occurrence ifs acute, with pain and testicular enlargement. Sonography is commonly performed to evaluate the patient for epididymitis or torsion. The appearance of testicular malakoplakia on sonography examination has only rarely been described, making its diagnosis challenging. Because its appearance overlaps with testicular neoplasm and infection, it should be considered when making a differential diagnosis of a diffuse testicular abnormality in the appropriate clinical setting. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound, 2014; (Source: Journal of Clinical Ultrasound)


The burden of common chronic disease on health-related quality of life in an elderly community-dwelling population in the UK
Conclusions. This study quantifies the relative impact of 13 common chronic conditions on HRQL in a UK-based community-dwelling ageing population. Findings indicate that osteoarthritis, depression and neurological disease have a strong clinically important negative effect on HRQL. These findings may help clinical decision making and priority setting for management of individuals with multimorbidity. (Source: Family Practice)


Ultrasound-guided chronic musculoskeletal pain control.
Authors: Huang CC, Lin CS PMID: 25248468 [PubMed - as supplied by publisher] (Source: Acta Anaesthesiologica Taiwanica)<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>


Closed medial total subtalar joint dislocation without ankle fracture: a case report
Conclusions Medial subtalar dislocation is a rare dislocation and is not commonly seen as a sports injury because it requires transfer of a large amount of kinetic energy. The weaker talocalcaneal and talonavicular ligaments often bear the brunt of the energy and are more commonly disrupted, compared to the relatively stronger calcaneonavicular ligament. Urgent reduction is important, and closed reduction under general anesthesia is usually successful, often facilitated by keeping the knee in flexion to relax the gastrocnemius muscle. Long-term sequelae include talar avascular necrosis and osteochondral fracture, as well as chronic instability and pain. (Source: Journal of Medical Case Reports)


Hepatocellular Carcinoma With Osseous Metaplasia and Bone Marrow Elements
A 42-year-old woman presented with chronic right upper quadrant pain lasting for about 1 year, without fever or vomiting. The abdomen was soft and tender on physical examination. At the time, laboratory tests revealed isolated elevated serum transaminase level (alanine aminotransferase 2.3 times the upper limit of normal, and aspartate aminotransferase normal level), with unremarkable liver function tests. Alpha fetoprotein serum level was elevated (7.5 × 103 ng/mL). Hemoglobin and amylase levels were normal. (Source: Clinical Gastroenterology and Hepatology)


Dandelion (Taraxacum officinale, Blowball, Lion's Teeth)
Title: Dandelion (Taraxacum officinale, Blowball, Lion's Teeth) Category: MedicationsCreated: 3/2/2005 12:00:00 AMLast Editorial Review: 9/19/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Scientists Studying Sickle Cell Trait
Title: Scientists Studying Sickle Cell TraitCategory: Health NewsCreated: 9/18/2014 2:36:00 PMLast Editorial Review: 9/19/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Back-Related Leg Pain: Spine Manipulation Helps
Title: Back-Related Leg Pain: Spine Manipulation HelpsCategory: Health NewsCreated: 9/19/2014 11:01:00 AMLast Editorial Review: 9/19/2014 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>


Rational Pain Management in Complex Regional Pain Syndrome 1 (CRPS 1)—A Network Meta‐Analysis
ConclusionThis network meta‐analysis indicates that a rational pharmacological treatment strategy of pain management should consider bisphosphonates in early CRPS 1 and a short‐term course of calcitonin in later stages. While most medications showed some efficacy on short‐term follow‐up, only bisphosphonates, NMDA analogs and vasodilators showed better long‐term pain reduction than placebo. (Source: Pain Medicine)


Dependency-like behaviors and pain coping styles in subjects with chronic migraine and medication overuse: results from a 1-year follow-up study
Conclusions: Subjects who did not fall into medication overuse throughout the 12?months following the detoxification showed improved clinical, affective and dependence-related outcomes, but not pain coping strategies. Conversely, subjects who relapsed within one year into CMwMO continued to experience significant disability, pain intensity, and dependency-like behaviors. We believe that the persistence of maladaptive pain coping strategies and residual symptomatology increase the risk for recurrent relapses, against which pharmacological interventions are only partially effective. Further studies investigating predictors of relapse are needed to inform multi-disciplinary interventions for CMwMO. (Source: BMC Neurology)


The distinctive significance of analgesic drugs and olfactory stimulants on learned pain in mice.
We examined the effects of analgesic drugs and olfactory stimulants (preferred or repellent odor) on acute pain, the unconditioned nociceptive response (UCR) and the CR in mice. The CR was provoked by repeated injection of formalin into the hind-paw in animals in the same context, which elicited the typical pain behaviors of paw licking (including biting). The analgesic drugs acetaminophen, fentanyl, gabapentin and fluvoxamine diminished the UCR but did not affect the CR. In contrast, the preferred odor reduced both the UCR and the CR. Our findings suggest that, like chronic pain, the CR is resistant to analgesic drugs and that preferred odor suppress the neural pathways that mediate the CR of pain perception. PMID: 25242616 [PubMed - as supplied by publisher] (Source: Brain Research)


The Role of Experiential Avoidance, Resilience and Pain Acceptance in the Adjustment of Chronic Back Pain Patients Who Have Experienced a Traumatic Event: a Path Analysis.
CONCLUSIONS: This study demonstrates the role of a vulnerability pathway (i.e. experiential avoidance) and a protective pathway (i.e. resilience and pain acceptance) in adaptation to pain after a traumatic event. PMID: 25236672 [PubMed - as supplied by publisher] (Source: Annals of Behavioral Medicine)


Periaqueductal grey cyclooxygenase-dependent facilitation of C-nociceptive drive and encoding in dorsal horn neurons in the rat.
This article is protected by copyright. All rights reserved. PMID: 25239460 [PubMed - as supplied by publisher] (Source: The Journal of Physiology)<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 prospective study evaluating sleep quality in Failed Back Surgery Syndrome patients treated by multicolumn spinal cord stimulation: Study design protocol and presentation of the study population.
CONCLUSION: By providing an analysis of the quality of sleep in chronic pain patients who are candidates for implanted neurostimulation, this new approach focuses on an important aspect of quality of life often overlooked in these poly-medication patients. It could show a real clinical benefit and underestimation of these analgesic innovative expensive techniques, where medico-economic analysis, would or would not promote access. PMID: 25245920 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)


A systematic review of interventions aimed at increasing physical activity in adults with chronic musculoskeletal pain—protocol
Discussion This review will be of value to clinicians working in chronic pain services and to researchers involved in designing and evaluating interventions. Systematic review registration PROSPERO reference: CRD42014010640. (Source: Systematic Reviews)


The Aftermath of Cocaine-Induced Pneumothorax
By Joshua B. Hourizadeh, DO, & Joseph VM Kelly, MD, MBA   A 38-year-old African American man presented to the emergency department with severe left-sided inspiratory chest pain with no radiation for two days and increasing shortness of breath. The patient said he had recently broken up with his girlfriend, which lead him to smoke crack cocaine for three consecutive days.   The patient had no past medical or surgical history, but he had a past social history of illicit drug abuse, nicotine use, and social alcohol use. His heart rate was 96 bpm, blood pressure was 112/80 mm Hg, oxygen saturation was 86% on room air, his respiratory rate was 24 bpm, and his temperature was 98.7°F. Physical examination was unimpressive with the exception of diminished breath sounds on the left side. Che...


Narrow‐Band UVB Phototherapy for Management of Oral Chronic Graft‐versus‐Host Disease
ConclusionsIntraoral NB‐UVB may be effective for management of refractory oral cGVHD. Further optimization of treatment parameters, as well as minimal erythema dose testing, and inclusion of a control arm, are necessary in the consideration of future studies. (Source: Photodermatology, Photoimmunology and Photomedicine)


Reimagining End Of Life Care
Imagine being able to receive fully integrated medical, social, and spiritual care in your own home. Nursing care is available 24/7. Home health aides provide basic personal assistance. Care is person-centered and focused on the specific needs of each patient. And for people with incurable chronic conditions, it focuses on managing symptoms, including pain, thus vastly improving their quality of life. (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>


A Case of Cardiogenic Shock Treated with Paracorporeal Left Ventricular Assisted Device Caused by Acute Myocardial Infarction
Case: A 42-years-old man was suffered from chest pain and transferred to our hospital with cardiogenic shock. Under intraaortic balloon pumping (IABP) support, emergency coronary angiography was performed. Left anterior descending (LAD) and left circumflex branch (LCX) were chronic total occlusion, and right coronary artery (RCA) was total thrombotic occlusion. Percutaneous coronary intervention (PCI) was performed on RCA. However, cardiogenic shock was sustained and incessant ventricular tachycardia was occurred. (Source: Journal of Cardiac Failure)


Update: soccer injury and prevention, concussion, and chronic groin pain - Jones NS.
Soccer, or football, as it is known in much of the world, is one of the most popular sports in the world. The purpose of this article was to provide a concise update on select soccer-specific medical issues published in the last year as they relate to socc... (Source: SafetyLit: All (Unduplicated))


UCLA volunteers at free clinic solve small problems for poor that could become catastrophic
It was a typical misunderstanding that could have led to disastrous consequences. The man had run out of medication to control his hypertension. But he couldn’t afford to get it refilled, or so he thought. So instead of picking up a simple, generic medication at Wal-Mart or Target for $4, the man decided to go without it and unknowingly put himself at risk for a stroke. All because he didn’t realize he could obtain the medication cheaply. Fortunately, he was one of hundreds who were treated by UCLA health care workers volunteering at the Care Harbor’s annual health clinic held Sept. 11-14 at the Los Angeles Sports Arena. His story is typical of many who come to this free clinic for the poor and underserved, said Dr. Patrick Dowling, chief of the UCLA Department of Family Medicine at ...


What's trust got to do with it? Revisiting opioid contracts
Prescription opioid abuse (POA) is an escalating clinical and public health problem. Physician worries about iatrogenic addiction and whether patients are &lsquo;drug seeking&rsquo;, &lsquo;abusing&rsquo; and &lsquo;diverting&rsquo; prescription opioids exist against a backdrop of professional and legal consequences of prescribing that have created a climate of distrust in chronic pain management. One attempt to circumvent these worries is the use of opioid contracts that outline conditions patients must agree to in order to receive opioids. Opioid contracts have received some scholarly attention, with trust and trustworthiness identified as key values and virtues. However, few articles have provided a critical account of trust and trustworthiness in this context, particularly when there e...


Analysis of meaningful conditioned pain modulation effect in a pain-free adult population
This study aimed to determine the proportion of pain-free subjects exhibiting a meaningful CPM effect. Analyses of associations between serotonin transporter polymorphisms (5HTTLPR), gender and CPM effect were also carried out. (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>


Over-expression of P2X7 receptors in spinal glial cells contributes to the development of chronic postsurgical pain induced by skin/muscle incision and retraction (SMIR) in rats.
Authors: Ying YL, Wei XH, Xu XB, She SZ, Zhou LJ, Lv J, Li D, Zheng B, Liu XG Abstract Many patients suffer from chronic postsurgical pain (CPSP) following surgery, and the underlying mechanisms are poorly understood. In the present work, with use of skin/muscle incision and retraction (SMIR) model, the role of P2X7 receptors (P2X7Rs) in spinal glial cells in the development of CPSP was evaluated. Consistence with previous reports, we found that SMIR decreased the ipsilateral 50% paw withdrawal threshold (PWT), lasting for at least 2weeks. No injury was done to L3 dorsal root ganglia (DRG) neurons and no axonal or Schwann cell damage at the retraction site in the saphenous nerve was observed 7days after SMIR. The results of immunofluorescence showed that both microglia and astrocyt...


Effects of Flexibility in Coping with Chronic Headaches on Depressive Symptoms
Conclusion The CFH was supported in cases of chronic headache. Our findings indicate the importance of the effects of flexibility in coping with primary headaches on distress. (Source: International Journal of Behavioral Medicine)


EHMTI-0161. Personality profiles of patients with chronic post-traumatic headache: a case-control study
(Source: The Journal of Headache and Pain)


EHMTI-0268. Long term efficacy of repetitive sphenopalatine blockade with bupivacaine vs. Saline with the tx360 device for treatment of chronic migraine
(Source: The Journal of Headache and Pain)


EHMTI-0360. Chronic sympathetic activation in migraine headache: unique to migraine or common to sympathetic nervous system disorders?
(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>


EHMTI-0102. Prospective analysis of the use of onabotulinumtoxina (botox ® ) In the treatment of chronic migraine; real-life data in 299 patients from hull, UK
(Source: The Journal of Headache and Pain)


Bioequivalence of two formulations of montelukast sodium 4 mg oral granules in healthy adults
Abstract Montelukast is an effective and well-tolerated treatment for the prophylaxis and chronic treatment of asthma, acute prevention of exercise-induced bronchoconstriction and symptomatic relief of seasonal allergic rhinitis and perennial allergic rhinitis. The aim of the study was to compare bioavailability, and characterise the pharmacokinetic profile and safety of Sandoz generic montelukast 4 mg oral granules relative to Singulair® mini (Merck, Sharp & Dohme). An open-label, randomised, single-dose, two-treatment, two-period, two-sequence, two-way crossover bioequivalence study was conducted in healthy male volunteers aged 18–55 years, under fasting conditions. The duration of the clinical part of the trial was ≈ 11 days. Montelukast levels in plasma were quantifi...


Assessment of a Stool Symptom Screener and Understanding the Opioid-Induced Constipation Symptom Experience
Conclusion OIC patients understood this Stool Symptom Screener, and its content was relevant to this highly symptomatic patient sample. Pain and bloating may be considered as additional symptoms for future versions of the screener. An emerging conceptual model of the OIC experience, laxative use, and symptoms is presented. (Source: The Patient - Patient-Centered Outcomes Research)


Investigation of change in cardinal symptoms of chronic rhinosinusitis after surgical or ongoing medical management
ConclusionAcross a large population, surgical management is more effective at resolving the cardinal symptoms of CRS than ongoing medical management with the exception of sense of smell/taste. (Source: International Forum of Allergy and Rhinology)


Single-center, single-blinded, randomized study of self-gripping sutured mesh in open inguinal hernia repair
The primary aim of the present study was to evaluate whether usage of self-gripping mesh in open inguinal hernia repair, compared with standard Lichtenstein repair with sutured mesh, could result in a decreased rate of chronic pain at 6-mo follow-up. The secondary outcome was to evaluate foreign body feeling and the quality of life after inguinal hernia repair. (Source: Journal of Surgical 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>


AstraZeneca’s Movantik receives FDA approval to treat OIC
AstraZeneca has received approval from the US Food and Drug Administration (FDA) for its Movantik (naloxegol) tablets C-II to treat opioid-induced constipation (OIC) in adult patients with chronic non-cancer pain. (Source: Pharmaceutical Technology)


FDA Approves Movantik for Pain-med Constipation
Movantik is an oral treatment for opioid-induced constipation in adults with chronic non-cancer pain (Source: PharmaManufacturing.com)


DePuy Pinnacle Hip Lawsuit News: Bernstein Liebhard LLP Notes Latest...
The Firm is representing numerous DePuy Pinnacle hip lawsuit clients who suffered metallosis, chronic pain, premature device failure, and other serious complications, allegedly due to a metal-on-metal...(PRWeb September 16, 2014)Read the full story at http://www.prweb.com/releases/pinnacle-hip-lawsuit/depuy-pinnacle-hip-trial/prweb12174095.htm (Source: PRWeb: Medical Pharmaceuticals)


Type III B dens invaginatus: Diagnostic and clinical considerations using 128-slice computed tomography
Radhika Muppa, H Srinivas Nallanchakrava, Shanthan Mettu, Ravi Varma Dandu, Deepti Chaitanya TadikondaJournal of Indian Society of Pedodontics and Preventive Dentistry 2014 32(4):342-345Endodontic therapy is successful only when thorough knowledge of root canal morphology is understood. Dens invaginatus is malformation of teeth resulting from invagination of tooth before biological mineralization occurs. It is clinically significant with an early pulpal involvement and chronic periapical lesion, which are often associated with this anomaly. The present case report describes a 13-year-old female patient who reported to our institution with complaint of pain and swelling in the right maxillary region. Intraoral examination revealed Ellis Type II fracture of right maxillary central incisor an...


Imaging and management of greater trochanteric pain syndrome
Greater trochanteric pain syndrome (GTPS) is a commonly diagnosed regional pain syndrome with a wide spectrum of aetiologies, reflecting the anatomy of the structures outside the hip joint capsule. There are five muscle tendons that insert on to the greater trochanter and three bursae in the region of the greater trochanter. The term GTPS includes tendinopathies, tendinous tears, bursal inflammation and effusion. There are a range of treatments and therapies depending on the specific diagnosis and severity of the condition. Many patients with GTPS can be successfully managed conservatively with weight loss and non-steroidal anti-inflammatory drugs. Patients suffering from more chronic pain can receive varying degrees of symptomatic relief with lateral hip corticosteroid and local anaesthet...<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>


Symptom onset, diagnosis and management of osteoarthritis.
This study analyses data for a nationally representative sample of 4,565 Canadians aged 20 or older who responded to the Arthritis component of the 2009 Survey on Living with Chronic Diseases in Canada. Descriptive statistics are used to report the prevalence of hip and knee osteoarthritis; the mean age of symptom onset and diagnosis; medication use; and contacts with health professionals during the previous year. RESULTS: Among people with a physician diagnosis of arthritis, 37% reported osteoarthritis. Of these, 70% experienced pain in the hip(s), knee(s), or hip(s) and knee(s). Close to half (48%) of these people experienced symptoms the same year that they were diagnosed; 42% experienced symptoms at least a year before the diagnosis; and 10% experienced symptoms after the diagnosis...


Testing the Validity of Preventing Chronic Regional Pain Syndrome With Vitamin C After Distal Radius Fracture
The American Academy of Orthopaedic Surgeons recommends the use of vitamin C to prevent complex regional pain syndrome (CRPS) for patients with distal radius fractures (DRFs). We hypothesized that the evidence for supporting this recommendation is weak, based on epidemiological principles of association and causality. The specific aim of this project was to test the validity of this recommendation. (Source: The Journal of Hand Surgery)


Morbid obesity: a significant risk factor for failure of two-stage revision total knee arthroplasty for infection.
CONCLUSIONS: Morbid obesity significantly increased the risk of subsequent revision, reoperation, and reinfection following two-stage revision total knee arthroplasty for infection. In addition, these patients had worse pain relief and overall function at intermediate-term clinical follow-up. Although two-stage revision should remain a standard treatment for chronic periprosthetic joint infection in morbidly obese patients, increased failure rates and poorer outcomes should be anticipated. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. PMID: 25232084 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)


Predictors of multidisciplinary treatment outcome in patients with chronic musculoskeletal pain.
Conclusions: No strong predictors of treatment outcome were found other than the baseline scores of the respective outcome variables. More disabled patients and patients with more pain benefitted more from the rehabilitation program. Other predictors improved the prediction models slightly. Implications for Rehabilitation It remains challenging to correctly predict the outcome of treatment from patients' baseline sociodemographic and psychological characteristics; predictors other than baseline scores of the outcome variables are only slightly associated with treatment outcome. Patients with chronic musculoskeletal pain and poor physical functioning or mental health benefit most from pain rehabilitation. Older patients benefit less from a pain rehabilitation program than younger patients i...


The significance of pain catastrophizing in clinical manifestations of patients with lumbar spinal stenosis: mediation analysis with bootstrapping
Pain intensity in various chronic pain disorders has been associated with catastrophizing. Considering the pathomechanism and clinical symptoms of lumbar spinal stenosis (LSS), pain catastrophizing could be associated with pain intensity and disability in patients with LSS. (Source: The 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>


FDA approves Movantik for opioid-induced constipation
The U.S. Food and Drug Administration today approved Movantik (naloxegol), an oral treatment for opioid-induced constipation in adults with chronic non-cancer pain. (Source: Food and Drug Administration)


The Fatty and Not the Fat
We have all heard about the literal and figurative impact the obesity epidemic has on the weight-bearing joints: early and relentless degenerative arthritis, as our knees and hips struggle against that out-of-range Body Mass Index, cartilage deteriorating along with the will power to try another diet, worsening knee pain making exercise less desirable, and less feasible.read more (Source: Psychology Today Food and Diet Center)


The Avoidance of Activities due to Fear of Falling Contributes to Sedentary Behavior among Community‐Dwelling Older Adults with Chronic Musculoskeletal Pain: A Multisite Observational Study
ConclusionsOlder adults with CMP are significantly more sedentary than those of a similar sex and age without CMP. It appears that the avoidance of activities due to fear of falling is a significant contributory factor to SB in older adults with CMP. (Source: Pain Medicine)


An experimental study investigating the effect of pain relief from oral analgesia on lumbar range of motion, velocity, acceleration and movement irregularity
Conclusion: The results demonstrate that pain reduction did not alter lumbar range of motion, angular velocity, angular acceleration or movement irregularity questioning the role of pain in lumbar kinematics. (Source: BMC Musculoskeletal Disorders)


Isosorbide dinitrate ointment vs botulinum toxin A (Dysport®) as the primary treatment for chronic anal fissure: a randomized multicentre study
ConclusionDysport® is more effective than ISDN ointment and has fewer side effects in the primary treatment of chronic anal fissure. The recurrence rate within 1 year in both treatment groups is high. (Source: Colorectal Disease)<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>


Art and rheumatology: the artist and the rheumatologist's perspective
The reflection of medicine in the universal arts has motivated several rheumatologists to discover features of rheumatic diseases depicted by the artist&rsquo;s eyes long before they were defined as specific pathologic entities. The result has been the identification of several pieces of art dating from the Middle Ages, the Renaissance, the Baroque and Post-Impressionist periods that depict clear features of several rheumatic diseases such as RA, OA, camptodactyly and temporal arteritis, among others. On the other hand, great artists such as Pierre-Auguste Renoir, Antoni Gaud&iacute;, Raoul Dufy, Paul Klee, Frida Kahlo and Niki de Saint Phalle are good examples of how rheumatic diseases such as RA, scleroderma and chronic pain can influence the artist&rsquo;s perspective, the technique use...


Meanings of Being Received and Met by Others as Experienced by Women With Fibromyalgia
Fibromyalgia (FM) is a common chronic pain syndrome that mostly affects middle-aged women. Our aim with this study was to elucidate meanings of being received and met by others as experienced by women with FM. Interviews with a narrative approach were conducted with 9 women. We analyzed the transcribed interviews with a phenomenological hermeneutical interpretation. The findings revealed two themes: being seen as a malingerer and being acknowledged. Meanings of being received and met by others, as experienced by women with FM, can be understood as a movement between the two perspectives. When they were acknowledged, their feelings of security and trust increased, but the women could not rely on this because others received and met them in such an unpredictable manner. (Source: Qualitative ...


Non-steroidal anti-inflammatory drugs for acute gout.
CONCLUSIONS: Limited evidence supported the use of NSAIDs in the treatment of acute gout. One placebo-controlled trial provided evidence of benefit at 24 hours and little or no harm. We downgraded the evidence due to potential selection and reporting biases, and imprecision. While these data were insufficient to draw firm conclusions, they did not conflict with clinical guideline recommendations based upon evidence from observational studies, other inflammatory arthritis and expert consensus, which support the use of NSAIDs in acute gout.Moderate-quality evidence suggested that selective COX-2 inhibitors and non-selective NSAIDs are probably equally beneficial although COX-2 inhibitors are likely to be associated with significantly fewer total and gastrointestinal adverse events. We downgr...


A mixed methods epidemiological investigation of preventable deaths among U.S. Army soldiers assigned to a rehabilitative warrior transition unit.
CONCLUSIONS: There was no one single risk factor found to be associated with an increased likelihood of preventable deaths within the WTU. The unique design and operation of the WTUs as environments focused on treatment and rehabilitation provide both benefits and challenges to recovery and risk mitigation. PMID: 25227672 [PubMed - as supplied by publisher] (Source: Work)


Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation.
CONCLUSION: For patients with BRLP, SMT plus HEA was more effective than HEA alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks. PRIMARY FUNDING SOURCE: U.S. Department of Health and Human Services. PMID: 25222385 [PubMed - in process] (Source: Annals of Internal 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>


Use of the UPOINT phenotype system in treating Chinese patients with chronic prostatitis/chronic pelvic pain syndrome: a prospective study.
Authors: Guan X, Zhao C, Ou ZY, Wang L, Zeng F, Qi L, Tang ZY, Dun JG, Liu LF Abstract The urinary, psychosocial, organ-specific, infection, neurological/systemic and tenderness (UPOINT) phenotype system has been validated to be an effective phenotype system in classifying patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in western populations. To validate the utility of the UPOINT system and evaluate the effect of multimodal therapy based on the UPOINT system in Chinese patients with CP/CPPS, we performed this study. Chinese patients with CP/CPPS were prospectively offered multimodal therapy using the UPOINT system and re-examined after 6 months. A minimum 6-point drop in National Institutes of Health-Chronic Prostatitis Symptoms Index (NIH-CPSI) was set to...


Do people with chronic pain have impaired executive function? A meta-analytical review.
Authors: Berryman C, Stanton TR, Bowering KJ, Tabor A, McFarlane A, Moseley GL Abstract A widely held belief within the clinical community is that chronic pain is associated with cognitive impairment, despite the absence of a definitive systematic review or meta-analysis on the topic. The current systematic review and meta-analysis aimed to establish the current evidence concerning the difference in executive function between people with chronic pain and healthy controls. Six databases were searched for citations related to executive function and chronic pain from inception to June 24, 2013. Two reviewers independently assessed studies for eligibility and extracted relevant data according to the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-An...


Could meditation help combat migraines?
ConclusionThis pilot RCT, based on just 19 adult migraine sufferers, showed an eight-week mindfulness-based stress reduction course led to benefits for headache duration, disability, self-efficacy and mindfulness measures, compared to a control group who received usual care. There were non-significant benefits observed for measures of migraine frequency and severity. Both groups continued to take any migraine medication (prophylactic or for treatment during a headache) they were already taking before the trial.The research group themselves were very reasonable in their conclusions and called for larger trials to be done to investigate this issue further. As they acknowledge, relatively little can be said with reliability based on this small pilot study alone. This is because small studies...


How Does an Undergraduate Pain Course Influence Future Physicians' Awareness of Chronic Pain Concepts? A Comparative Study
ConclusionsAlthough students enter medical school with little knowledge about pain issues, pain awareness can be positively influenced by education. A curriculum about pain should not only teach the basic science of pain but also present treatment strategies available and address the socio‐emotional dimensions of pain. Additionally, if misconceptions about opioid use and addiction are properly elucidated early in medical education, the future health practitioners will be one step forward in achieving the goal of alleviating suffering patients' pain. (Source: Pain Medicine)


p38 MAPK:A Potential Target of Chronic Pain Running title: p38 targeting for chronic pain.
Authors: Lin X, Wang M, Zhang J, Xu R Abstract p38 mitogen-activated protein kinases (p38 MAPK, p38) consist of 4 subunits: p38α#945;, p38β#946;, p38γ#947; and p38α#948;. They play a well-recognized role in regulating intracellular signaling transduction in mammalian cells. p38 MAPK induces a variety of intracellular responses associated with neuropathic pain and other chronic pain. Thus, specific targeting p38 MAPK molecule and its signaling pathway represent potential therapeutic strategies for pain management. Based on the understanding of the crystal structure, biological functions and its signaling pathway of p38 MAPK, chemically synthesized p38 MAPK inhibitors have become available. Natural products and biological components may also serve as potential p38 MAPK inhibitors...<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>


Herniorrhaphy: an unusual cause of ureteral injury in Nigeria
We present a case of ureteric injury complicating an inguinal herniorrhaphy for a huge right inguino‐scrotal hernia. Patient had primary uretero‐neocystostomy but died from septicemia in the postoperative period. Herniorrhaphy is a common surgery worldwide. Common complications include hemorrhage, infection, chronic pain, and recurrence. Ureteric injury from herniorrhaphy is unusual. We present a case of ureteric injury complicating an inguinal herniorrhaphy for a huge right inguino‐scrotal hernia. Patient had primary uretero‐neocystostomy but died from septicemia in the postoperative period. (Source: Clinical Case Reports)


Hering's Law Assessment Tool Revisited: Introducing a Modified Novel Version--Patients' Response Assessment Tool After Homeopathic Treatment (PRATHoT) in Chronic Cases
Hering&rsquo;s Law Assessment Tool emerged as a systematic outcome assessment tool following homeopathic intervention. The authors intend to modify it and develop a new tool&mdash;Patient Response Assessment Tool after Homeopathic Treatment (PRATHoT)&mdash;in chronic cases through Delphi technique for systematic categorization of probable outcomes following individualized homeopathic treatment in chronic cases. The PRATHoT was drafted after literature review and iterative Delphi rounds with multidisciplinary expert panel, setting Fleiss of 0.41 to 1.00 a priori as the desired level of multirater agreement. Following pilot testing, the tool was implemented on 37 patients suffering from knee osteoarthritis over 6 months. Logistic regression analysis confirmed that higher PRATHoT score was si...


[Multimodal pain therapy for treatment of chronic pain syndrome : Consensus paper of the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society on treatment contents.]
Authors: Arnold B, Brinkschmidt T, Casser HR, Diezemann A, Gralow I, Irnich D, Kaiser U, Klasen B, Klimczyk K, Lutz J, Nagel B, Pfingsten M, Sabatowski R, Schesser R, Schiltenwolf M, Seeger D, Söllner W Abstract Multimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management.In daily practice there is, however, stil...


American Gastroenterological Association Technical Review on the Pharmacological Management of Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by abdominal pain and/or discomfort associated with altered defecation.1 Other common symptoms include bloating, straining, rectal urgency, and the sensation of incomplete evacuation. These symptoms occur in approximately 11% of the world’s population.2–4 Women report symptoms of IBS more frequently than men; likewise, younger people are more susceptible than older people. IBS negatively impacts health-related quality of life5 and results in a significant financial burden through reduced work productivity and increased use of health-related resources. (Source: Gastroenterology)


Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions
Conclusions The global burden of ASD was huge compared with other self-reported chronic conditions in the general population of eight industrialized countries. The impact of ASD on HRQL warrants the same research and health policy attention as other important chronic diseases. (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>


Relationships of low back outcomes to internal spinal load: a prospective cohort study of professional drivers
Conclusions In this prospective cohort study, measures of internal spinal dose performed better than measures of daily vibration exposure (external dose) for the prediction of low back outcomes in professional drivers. The ISO boundary values of the risk factor R for low and high probabilities of adverse health effects on the lumbar spine tend to underestimate the health risk in professional drivers. (Source: International Archives of Occupational and Environmental Health)


American Gastroenterological Association Institute Technical Review on the Pharmacological Management of Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by abdominal pain and/or discomfort associated with altered defecation.1 Other common symptoms include bloating, straining, rectal urgency, and the sensation of incomplete evacuation. These symptoms occur in approximately 11% of the world’s population.2–4 Women report symptoms of IBS more frequently than men; likewise, younger people are more susceptible than older people. IBS negatively impacts health-related quality of life5 and results in a significant financial burden through reduced work productivity and increased use of health-related resources. (Source: Gastroenterology)


Venipuncture-induced complex regional pain syndrome: a case report and review of the literature.
Authors: Elahi F, Reddy CG Abstract Venipuncture, the most frequently performed invasive medical procedure, is usually benign. Generally it produces only transitory mild discomfort. Venipuncture-induced neuropathic pain is hard to recognize at an early stage. Medical literature reviews show that there is not adequate medical knowledge about this important subject. The inciting incident in complex regional pain syndrome (CRPS) can often seem far too trivial to result in a condition with such severe pathophysiologic effects. The practicing physician has little information available to enable early recognition of the condition, initiation of multidisciplinary treatment modalities, and proper referral to pain specialists. We encountered a unique case of venipuncture-induced complex reg...


Mast cell leukemia associated with undefined morphology and chronic basophilic leukemia
Conclusion: Elevations in CRP and IL-6 levels occurring with increases in basophil counts to high levels revealed that febrile episodes with abdominal pain seen in our patient were induced by increase in IL-6 levels released from neoplastic basophils. Neoplastic basophils with diffuse and coarse basophilic granules possibly mimic neutrophils with toxic granules and cause wrong characterization of neoplastic basophils as neutrophils by the automated blood cell counters and misleaded physicians. (Source: Epidemiologic Perspectives and Innovations)


Quantifying blood-spinal cord barrier permeability after peripheral nerve injury in the living mouse
Conclusions: DCE-MRI provides a sensitive and non-invasive method to follow BSCB permeability in the same group of mice over time. Examining differences between mouse strains, we demonstrated that there is an important genetically-based control of the PNI-induced increase in BSCB permeability and that the critical genetic determinants of BSCB opening after PNI are distinct from those that determine genetic variability in PNI-induced pain hypersensitivity. (Source: Epidemiologic Perspectives and Innovations)<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>


Methodology and demographics of a single blinded, randomized controlled trial of chiropractic compared to physical therapy for balance impairments in community dwelling geriatric patients with or without low back pain
This study evaluated the use of either chiropractic care or physical therapy as a treatment for patients with balance problems and with low back pain (68.5%) or without low back pain (31.5%) in the geriatric population. One hundred and sixty eight consecutively enrolled community dwelling adults between 60 and 85?years old (72.8 +/? 6.8) were randomly assigned to 6?weeks of either chiropractic care or physical therapy (12 ? 18 visits). Testing occurred prior to randomization, after 6?weeks of treatment, and again 6?weeks later. Functional and self-report outcome measures for balance included the Berg Balance Scale, Performance Oriented Mobility Assessment, Timed Up and Go Test, and NeuroCom balance tests. Pain was assessed with the Visual Analog Scale, 21-Point Box Scale, and pressure algo...


Uterine peristalsis-induced stresses within the uterine wall may sprout adenomyosis.
Authors: Shaked S, Jaffa AJ, Grisaru D, Elad D Abstract Adenomyosis is a disease in which ectopic endometrial glands and stromal cells appear in the uterine myometrium. This pathology is common among women of reproductive age, and in addition to chronic pelvic pain and heavy periods it may also cause infertility. The 'tissue injury and repair' mechanism in response to increased intrauterine pressures was proposed as the etiology for migration of fragments of basal endometrium into the myometrial wall. In order to investigate this mechanism, a conceptual two-dimensional model of the uterine wall subjected to intrauterine pressures was implemented using ADINA commercial software. The stress field within the uterine wall was examined for a variety of intrauterine sinusoidal pressure w...


Select steroid hormone glucuronide metabolites can cause toll-like receptor 4 activation and enhanced pain.
Authors: Lewis SS, Hutchinson MR, Frick MM, Zhang Y, Maier SF, Sammakia T, Rice KC, Watkins LR Abstract We have recently shown that several classes of glucuronide metabolites, including the morphine metabolite morphine-3-glucuronide and the ethanol metabolite ethyl glucuronide, cause toll like receptor 4 (TLR4)-dependent signaling in vitro and enhanced pain in vivo. Steroid hormones, including estrogens and corticosterone, are also metabolized through glucuronidation. Here we demonstrate that in silico docking predicts that corticosterone, corticosterone-21-glucuronide, estradiol, estradiol-3-glucuronide and estradiol-17-glucuronide all dock with the MD-2 component of the TLR4 receptor complex. In addition to each docking with MD-2, the docking of each was altered by pre-docking wi...


Methodology and demographics of a single blinded, randomized controlled trial of chiropractic compared to physical therapy for balance impairments in community dwelling geriatric patients with or without low back pain
This study evaluated the use of either chiropractic care or physical therapy as a treatment for patients with balance problems and with low back pain (68.5%) or without low back pain (31.5%) in the geriatric population. One hundred and sixty eight consecutively enrolled community dwelling adults between 60 and 85 years old (72.8 +/− 6.8) were randomly assigned to 6 weeks of either chiropractic care or physical therapy (12 – 18 visits). Testing occurred prior to randomization, after 6 weeks of treatment, and again 6 weeks later. Functional and self-report outcome measures for balance included the Berg Balance Scale, Performance Oriented Mobility Assessment, Timed Up and Go Test, and NeuroCom balance tests. Pain was assessed with the Visual Analog Scale, 21-Point Box Scale, and press...


Mast cell leukemia associated with undefined morphology and chronic basophilic leukemia
Conclusion Elevations in CRP and IL-6 levels occurring with increases in basophil counts to high levels revealed that febrile episodes with abdominal pain seen in our patient were induced by increase in IL-6 levels released from neoplastic basophils. Neoplastic basophils with diffuse and coarse basophilic granules possibly mimic neutrophils with toxic granules and cause wrong characterization of neoplastic basophils as neutrophils by the automated blood cell counters and misleaded physicians. (Source: BMC Hematology)<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>


Methodology and demographics of a single blinded, randomized controlled trial of chiropractic compared to physical therapy for balance impairments in community dwelling geriatric patients with or without low back pain
Conclusion The methodology of this multimodal treatment protocol for balance disorders and low back pain in the geriatric population and patient demographics are described in this paper. Additional research in this area is needed for this growing at risk population. Trial registration NCT02031562. (Source: Chiropractic and Manual Therapies)


Use of dental care and effective preventive services in preventing tooth decay among u.s. Children and adolescents --- medical expenditure panel survey, United States, 2003--2009 and national health and nutrition examination survey, United States, 2005--2010.
Authors: Griffin SO, Barker LK, Wei L, Li CH, Albuquerque MS, Gooch BF Abstract Tooth decay is one of the most common chronic conditions among children. Approximately 23% of children aged 2-11 years have at least one primary tooth with untreated decay and 20% of adolescents aged 12-19 years have at least one permanent tooth with untreated decay. Tooth decay, if left untreated, can cause pain and infection, and can lead to problems with eating, speaking, and learning. Risk factors for tooth decay include recent history of cavities, low fluoride exposure, and living in a low-income household. Prevalence of untreated decay in primary or permanent teeth among children from lower-income households is more than twice that among children from higher-income households. Prevalence of untrea...


Epigenetic regulation of spinal cord gene expression controls Opioid-Induced Hyperalgesia
Conclusions: The present study identified two genes whose expression is regulated by epigenetic mechanisms during morphine exposure. Treatments aimed at preventing the acetylation of histones or blocking BDNF and dynorphin signaling may reduce OIH and improve long-term pain using opioids. (Source: Epidemiologic Perspectives and Innovations)


A Pain Unit in a Developing Country: Epidemiology of Chronic Pain in Maputo, Mozambique
(Source: Pain Medicine)


Conversion from High‐Dose Full‐Opioid Agonists to Sublingual Buprenorphine Reduces Pain Scores and Improves Quality of Life for Chronic Pain Patients
ConclusionAverage pain scores decreased from 7.2 to 3.5, and quality of life scores increased from 6.1 to 7.1 for 35 patients converted from high‐dose full‐opioid agonists to SL buprenorphine therapy for more than 60 days. Clinicians should consider buprenorphine SL conversion for all patients on high‐dose opioids, particularly patients with severe pain (7–10) unrelieved by their current opioid regimen or patients for whom the clinician does not feel comfortable prescribing high‐dose opioids. (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>


Association between home posture habits and low back pain in high school adolescents.
CONCLUSION: Our findings support the high prevalence and the substantial impact of LBP in late adolescence and add the association with inappropriate home postural habits. PMID: 25212451 [PubMed - as supplied by publisher] (Source: Pain Physician)


ABL tyrosine kinase inhibitor-induced pulmonary alveolar proteinosis in chronic myeloid leukemia.
We report a case of acquired PAP in a patient with CML receiving tyrosine kinase inhibitors. A 67-year-old man with CML presented with progressive back pain 5 months after starting imatinib treatment. Acquired PAP was diagnosed based on physical, radiographic, and histopathological findings. The presence of granulocyte-macrophage colony-stimulating autoantibodies suggested that autoimmune mechanisms were involved in the pathogenesis. Interestingly, PAP developed in association with imatinib and dasatinib administration, but not with nilotinib treatment. The patient died of refractory leukemia in lymphoid blast crisis with a newly emerged T315I mutation. Although the incidence is very rare, imatinib and dasatinib associated with PAP development has been reported. Meanwhile, PAP in nilotini...


"MAST" prospective study: Value of minimal access spine technologies technique for multicolumn spinal cord stimulation surgical lead implantation in the context of a French multicentre randomized controlled trial (ESTIMET study).
CONCLUSION: Minimally invasive techniques have now been used for spine surgery for the past 12 years, and could also be useful in the context of SCS lead implantation, especially in patients with chronic back pain prior to implantation. PMID: 25224961 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)


Positions Are Key When Sex Causes Back Pain
Title: Positions Are Key When Sex Causes Back PainCategory: Health NewsCreated: 9/10/2014 12:36:00 PMLast Editorial Review: 9/11/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


New Guidelines for Sickle Cell Disease
Title: New Guidelines for Sickle Cell DiseaseCategory: Health NewsCreated: 9/10/2014 2:36:00 PMLast Editorial Review: 9/11/2014 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>


Unilateral surgical treatment for patients with midportion Achilles tendinopathy may result in bilateral recovery
Conclusion Unilateral treatment with a scraping operation can have benefits contralaterally; the clinical implication is that unilateral surgery may be a logical first treatment in cases of bilateral Achilles tendinopathy. (Source: British Journal of Sports Medicine)


Inhibition of CaV2.3 channels by NK1 receptors is sensitive to membrane cholesterol but insensitive to caveolin-1.
Authors: Licon Y, Leandro D, Romero-Mendez C, Rodriguez-Menchaca AA, Sanchez-Armass S, Meza U Abstract Voltage-gated, CaV2.3 calcium channels and neurokinin-1 (NK1) receptors are both present in nuclei of the central nervous system. When transiently coexpressed in human embryonic kidney (HEK) 293 cells, CaV2.3 is primarily inhibited during strong, agonist-dependent activation of NK1 receptors. NK1 receptors localize to plasma membrane rafts, and their modulation by Gq/11 protein-coupled signaling is sensitive to plasma membrane cholesterol. Here, we show that inhibition of CaV2.3 by NK1 receptors is attenuated following methyl-β-cyclodextrin (MBCD)-mediated depletion of membrane cholesterol. By contrast, inhibition of CaV2.3 was unaffected by intracellular diffusion of caveolin-1 ...


Transcutaneous Electrical Nerve Stimulation Attenuates Postsurgical Allodynia and Suppresses Spinal Substance P and Proinflammatory Cytokine Release in Rats.
CONCLUSIONS: Our results reveal that TENS attenuates prolonged postoperative allodynia following SMIR operation. Increased levels of spinal substance P and proinflammatory cytokines, activated after SMIR surgery, are important in the processing of persistent post-surgical allodynia. The protective effect by TENS may be relating to the suppression of spinal substance P and proinflammatory cytokines in SMIR rats. PMID: 25212520 [PubMed - as supplied by publisher] (Source: Physical Therapy)


Effect of Transcutaneous Electrical Nerve Stimulation on Pain, Function, and Quality of Life in Fibromyalgia: A Double-Blind Randomized Clinical Trial.
CONCLUSIONS: The results of this study will provide us with some of the first evidence from a large double-blind placebo-controlled trial on the effectiveness of transcutaneous electrical stimulation on pain control and quality of life changes in patients with fibromyalgia. PMID: 25212518 [PubMed - as supplied by publisher] (Source: Physical Therapy)


Chronic pain and pattern of health care utilization among Malaysian elderly population: National Health and Morbidity Survey III (NHMS III, 2006)
Population ageing is one of the most important demographic phenomena. According to World Health Organization (WHO), the world's population of people 60 years of age and older has doubled since 1980 and is forecast to reach two billion by 2050. At present, although the Malaysian population has not reached the ageing proportion, the ageing phenomenon will eventually occur. According to the Statistics Department of Malaysia, there is a transition of age structure towards ageing population in Malaysia. (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>


Cytokines and Neuropathic Pain
I have been frequently posting results of testing blood serum of our clients suffering from Autoimmune (including Neuroimmuno) Diseases and Autistic Children. Our testing includes both standard medical testing (serum levels of toxins, metals, pathogen loads and markers like Cortisol, CRP, CDs, ALPS, NSE, S100b). In addition, we also doing testing using our Quantibody® Antibody.Many of the clients report chronic mild to severe neuropathic pain.By definition, this pain encompasses a series of heterogeneous conditions with some similar clinical manifestations. Peripheral examples include traumatic nerve injury, diabetic peripheral neuropathy and chemotherapy-induced peripheral neuropathy or Multiple Sclerosis. (see: Front Pharmacol. 2013; 4: 142.Published online Nov 22, 2013. doi: 10.3389/fp...


A prospective interventional study in chronic prostatitis with emphasis to clinical features.
CONCLUSION: Phytotherapeutic agents may improve pain and prostatitis related difficulty in urination. Fur&shy;ther randomized, placebo-controlled studies are needed to substantiate safer conclusions.&nbsp; PMID: 25194085 [PubMed - in process] (Source: Urology Journal)


Cancer caregiving predicts physical impairments: Roles of earlier caregiving stress and being a spousal caregiver
CONCLUSIONSThe current findings suggest that the adverse long‐term health effects of earlier caregiving stress and of being a spousal caregiver should be acknowledged and that caregiving‐related stress management programs should be incorporated into routine health care for family caregivers of cancer patients. Cancer 2014. © 2014 American Cancer Society. (Source: Cancer)


Chronic Pelvic Allodynia is Mediated by CCL2 through Mast Cells in an Experimental Autoimmune Cystitis Model.
Authors: Bicer F, Altuntas CZ, Izgi K, Ozer A, Kavran M, Tuohy VK, Daneshgari F Abstract The cause of chronic pelvic pain in interstitial cystitis/painful bladder syndrome (IC/PBS) remains unclear; autoimmunity is a possible etiology. We recently showed that injection of a single immunogenic peptide of uroplakin 3A (UPK3A 65-84) induces experimental autoimmune cystitis (EAC) in female BALB/cJ mice that is unique among experimental models in accurately reflecting both the urinary symptoms and pelvic pain of IC/PBS. The aim of this project was to identify the roles of mast cells and the mast cell chemoattractant/activator monocyte chemoattractant protein-1 (CCL2) in the allodynia in this model. We immunized 6-8-week-old female BALB/cJ mice with UPK3A 65-84 peptide and, 5 to 40 days l...


Transdermal Administration of Aqueous Pregabalin Solution as a Potential Treatment Option for Patients with Neuropathic Pain to Avoid Central Nervous System-Mediated Side Effects.
Authors: Fukasawa H, Muratake H, Nagae M, Sugiyama K, Shudo K Abstract Pregabalin, (S)-3-isobutyl-γ-aminobutyric acid (GABA), is a widely used adjuvant therapy for patients with neuropathic pain, which is defined as chronic pain caused by lesions or diseases of the somatosensory nervous system. However, dizziness and somnolence (sleepiness) are common dose-limiting side effects, probably due to excessive sedative effects on higher centers of the central nervous system (CNS) which are involved in the anticonvulsant and analgesic actions of pregabalin. We speculated that transdermal delivery would minimize centrally mediated side effects. To test this idea, we evaluated the analgesic effects of pregabalin delivered through the transdermal route in animal models of neuropathic 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>


Discovery and Characterization of 2-(Cyclopropanesulfonamido)-N-(2-ethoxyphenyl)benzamide, ML382: a Potent and Selective Positive Allosteric Modulator of MrgX1.
Authors: Wen W, Wang Y, Li Z, Tseng PY, McManus OB, Wu M, Li M, Lindsley CW, Dong X, Hopkins CR Abstract Previous studies have shown that the activation of mouse MrgC11, a G-protein-coupled receptor, by its peptide ligand BAM8-22 can inhibit chronic pain. A large-scale screen has been carried out to isolate small-molecule allosteric agonists of MrgX1, the human homologue of MrgC11. The goal of this study is to improve the efficacy and potency of positive allosteric modulators (PAMs) with therapeutic implications in combating chronic pain. Herein we report an iterative parallel synthesis effort and a structure-activity relationship study of a series of arylsulfonamides which led to the discovery of the first PAM of MrgX1, ML382. PMID: 25209672 [PubMed - as supplied by publisher]...


Healthcare Use and Prescription of Opioids in Rural Residents with Pain
Researches the factors affecting healthcare use and prescription of opioids in low-income individuals living in rural areas with chronic pain receiving treatment at federally qualified health centers. -- (Source: Rural publications via the Rural Assistance Center)


Intensive short-term vasodilation effect in the pain area of sciatica patients - case study
Conclusion: In the examined cases, trigger points-related short-term vasodilation was recorded. Confirmation of these findings in a controlled, blinded study would indicate the existence of a link between the pain of sciatica patients (radicular or sciatica-like pain) and the activity of the autonomic nervous system. Further studies on a bigger group of patients are still needed. (Source: BMC Research Notes)


A curious case of urinary retention
A 45 year-old male presented with acute onset urinary retention. 1.8L of urine was catheterised in A&E and he was found to have low grade fever. He was started on ciprofloxacin and an alpha-blocker under the presumptive diagnosis of prostatitis but failed to void after 2 weeks and began reporting sweats and lower back pain. He was diagnosed with Human Immunodeficiency Virus (HIV) infection in the past but was not antiretrovirals; CD4 count was 350 cells/mm3 and viral load 22,000 copies/mL. Without a urological cause being established, a neurological review was requested and examination suggested absent third and fourth sacral dermatomal sensations and anal reflex. MRI revealed suspicious enhancement over the lower thoracic cord. CSF protein was 1.44 g/L, glucose 2.3 mmol/l, 62 leukocyt...


Disability correlates in Canadian Armed Forces Regular Force Veterans.
Conclusions: Disability, measured as activity limitation, was associated with a range of personal and environmental factors and health conditions, indicating multifactorial and multidisciplinary approaches to disability mitigation. Implications for Rehabilitation Consider activity limitations in all veterans with health problems, particularly women or veterans with current or lost marital relationship; post-secondary non-degree education; low income; junior non-commissioned member rank; high life stress; chronically painful conditions; musculoskeletal disorders; or mental health conditions. Comorbidity indicates the need for coordinated multidisciplinary care, especially between physical and mental health care services. Since disability is associated with psychosocial factors, service prov...<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>


Simvastatin reduces fibrosis and protects against muscle weakness after massive rotator cuff tear
Chronic rotator cuff tears are a common source of shoulder pain and disability, and patients with chronic cuff tears often have substantial weakness, fibrosis, inflammation, and fat accumulation. Identifying therapies to prevent the development of these pathologic processes will likely have a positive impact on clinical outcomes. Simvastatin is a drug with demonstrated anti-inflammatory and antifibrotic effects in many tissues but had not previously been studied in the context of rotator cuff tears. (Source: Journal of Shoulder and Elbow Surgery)


Ameliorative potential of Vernonia cinerea on chronic constriction injury of sciatic nerve induced neuropathic pain in rats.
Authors: Thiagarajan VR, Shanmugam P, Krishnan UM, Muthuraman A Abstract The aim of the present study is to investigate the ameliorative potential of ethanolic extract of whole plant of Vernonia cinerea in the chronic constriction injury (CCI) of sciatic nerve induced neuropathic pain in rats. Behavioral parameters such as a hot plate, acetone drop, paw pressure, Von Frey hair and tail immersion tests were performed to assess the degree of thermal, chemical and mechanical hyperalgesia and allodynia. Biochemical changes in sciatic nerve tissue were ruled out by estimating thiobarbituric acid reactive substances (TBARS), reduced glutathione (GSH) and total calcium levels. Ethanolic extract of Vernonia cinerea and pregabalin were administered for 14 consecutive days starting from the ...


The need for improved risk stratification in chronic critical limb ischemia
Vascular surgeons are well acquainted with chronic critical limb ischemia (CLI), the most severe manifestation of peripheral arterial disease, with patients presenting with ischemic rest pain or ulcerations, or both. Epidemiologic data predict a burgeoning epidemic of CLI within the United States, commensurate with the increasing incidence and prevalence of atherosclerotic risk factors, especially age and diabetes. Untreated, the risk of major amputation (above the ankle) or death, or both, ranges between 20% and 40% at 1 year. (Source: Journal of Vascular Surgery)


Efficacy and Safety of Gabapentin for Uremic Pruritus and Restless Legs Syndrome in Conservatively Managed Patients With Chronic Kidney Disease
Pruritus and restless legs syndrome (RLS) frequently affect patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), impacting quality of life. Gabapentin alleviates these symptoms in hemodialysis (HD) patients but data are lacking for patients on the conservative pathway. (Source: Journal of Pain and Symptom Management)


High molecular weight hyaluronic acid increases the differentiation potential of the murine chondrocytic ATDC5 cell line
In this study, we investigated whether a LMWHA (Low‐0.9 MDa) and two types of HMWHA (High‐1.9 MDa and 6 MDa) differentially affected chondroregulatory action. We tested this using ATDC5 cell, a murine chondrocytic cell line widely used in culture systems to study chondrogenic differentiation. We found that HMWHA, especially hylan G‐F 20 (High‐6 MDa), significantly induced aggrecan and proteoglycan accumulation, nodule formation, and mRNA expression of chondrogenic differentiation markers in a time‐ and dose‐dependent manner. In addition, we showed that HMWHA prevented TNF‐α induced inhibition of chondrogenic differentiation, with no effect on cell proliferation or viability. These results reveal that HMWHA significantly promotes chondrogenic differentiation of ATDC5 ...<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 a new multifunctional surfactant‐based biomaterial dressing with 1% silver sulphadiazine in chronic wounds
Abstract Chronic wounds represent a large and growing segment of health care and add considerably to human suffering and economic burden as populations age. More effective materials, especially those promoting ease of use and economy, are needed to treat this increasing number of patients. A case series conducted at a European outpatient tertiary wound centre used a novel surfactant‐based biomaterial dressing containing 1% silver sulphadiazine on 226 chronic wound patients with various aetiologies. Eighty‐eight patients had been undergoing standard of care treatment at the facility, while the remainder (n = 138) began treatment with the surfactant‐based biomaterial dressing on enrollment. A total of 73% of the first group healed or showed improvement, with 60% healing by a median...


Reducing Variation In Hospital Admissions From The Emergency Department For Low-Mortality Conditions May Produce Savings [Emergency Department Use]
In this study we used a national sample of ED visits to examine variation in risk-standardized hospital admission rates from EDs and the relationship of this variation to inpatient mortality for the fifteen most commonly admitted medical and surgical conditions. We then estimated the impact of variation on national health expenditures under different utilization scenarios. Risk-standardized admission rates differed substantially across EDs, ranging from 1.03-fold for sepsis to 6.55-fold for chest pain between the twenty-fifth and seventy-fifth percentiles of the visits. Conditions such as chest pain, soft tissue infection, asthma, chronic obstructive pulmonary disease, and urinary tract infection were low-mortality conditions that showed the greatest variation. This suggests that some of t...


Aquatic exercise and pain neurophysiology education versus aquatic exercise alone for patients with chronic low back pain: a randomized controlled trial.
CONCLUSIONS: This study's findings support the provision of pain neurophysiology education as a clinically effective addition to aquatic exercise. PMID: 25200879 [PubMed - as supplied by publisher] (Source: Clinical Rehabilitation)


The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: a systematic review.
CONCLUSION: There is moderate evidence for the acute effect of guided imagery on pain, although the content of the visualization is a matter of debate. Other relaxation formats and the effects on functionality and autonomic function require further study. PMID: 25200878 [PubMed - as supplied by publisher] (Source: Clinical Rehabilitation)


Spinal neuroimmmune activation is independent of T-cell infiltration and attenuated by A3 adenosine receptor agonists in a model of oxaliplatin-induced peripheral neuropathy.
Authors: Janes K, Wahlman C, Little JW, Doyle T, Tosh DK, Jacobson KA, Salvemini D Abstract Many commonly used chemotherapeutics including oxaliplatin are associated with the development of a painful chemotherapy-induced peripheral neuropathy (CIPN). This dose-limiting complication can appear long after the completion of therapy causing a significant reduction in quality-of-life and impeding cancer treatment. We recently reported that activation of the Gi/Gq-coupled A3 adenosine receptor (A3AR) with selective A3AR agonists (i.e., IB-MECA) blocked the development of chemotherapy induced-neuropathic pain in models evoked by distinct agents including oxaliplatin without interfering with their anticancer activities. The mechanism(s) of action underlying these beneficial effects has yet...<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>


Suicidal ideation and behavior associated with antidepressant medications: implications for the treatment of chronic pain - Pereira A, Conwell Y, Gitlin MJ, Dworkin RH.
[Abstract unavailable] Language: en... (Source: SafetyLit: All (Unduplicated))


Older adults with chronic musculoskeletal pain are at increased risk of recurrent falls and the brief pain inventory could help identify those most at risk - Stubbs B, Eggermont L, Patchay S, Schofield P.
AIM: Chronic musculoskeletal pain (CMP) and falls are common among community-dwelling older adults. The study aims were: (i) to investigate the relationship between CMP and any falls (≥1), single falls and recurrent falls (≥2) in community-dwelling old... (Source: SafetyLit: All (Unduplicated))


Evaluation of the effects of methadone and tramadol on postoperative analgesia and serum interleukin-6 in dogs undergoing orthopaedic surgery
Background: Acute postsurgical pain is of great interest due to potential risk of becoming chronic if not treated properly, worsening patient?s recovery and quality of life. Twenty-eight dogs with ruptured cruciate ligaments were divided into three groups that received intramuscular injections of 4?mg/kg of tramadol (TRA), 0.5?mg/kg of methadone (MET0.5), or 0.7?mg/kg of methadone (MET0.7). Physiological parameters (heart and respiratory rates and blood pressure) were evaluated at specified times: baseline (TBL), 1 (T1), 2 (T2), 4 (T4), 6 (T6), and 24 (T24) hours after premedication. Pain scores were described by visual analogue scale (VAS), modified Glasgow Composite, and Colorado University Acute Pain scales. Blood samples for measurement of interleukin (IL)-6 were collected at TBL, T1, ...


[Chronic pain and artificial diseases.]
Authors: Roch C, Knöchlein C, Albrecht J Abstract A 34-year-old woman presented with a complex pain disorder and a previous diagnosis of the rare Gitelman syndrome but with a negative genetic test. The patient was admitted to a routine ward for treatment of the pain but was transferred to the intensive care unit after suffering severe hypokalemia and a narcoleptic attack. In the period of intensive care all blood parameters were stable but on release to the normal ward severe hypokalemia immediately reoccurred. With consent the patient's belongings were inspected and many diuretics and laxatives were found. The patient admitted to uncontrolled self-medication so that the diagnosis of Gitelman syndrome also appeared to be an artificial disorder. PMID: 25190610 [PubMed - as supp...


Is suprascapular neuropathy common in high-performance beach volleyball players? A retrospective analysis.
CONCLUSIONS: A lesion of the suprascapular nerve could not be shown in any of the players. Therefore, a biomechanical cause has to be considered for the clinical symptoms in the present study population. PMID: 25193481 [PubMed - as supplied by publisher] (Source: Wiener Klinische Wochenschrift)<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>


Altered gait biomechanics and increased knee-specific impairments in patients with coexisting tibiofemoral and patellofemoral osteoarthritis
Osteoarthritis (OA) impacts approximately 27 million adults in the United States, with the knee as one of the most commonly affected joints with 50% lifetime risk of developing symptoms [1,2]. Although the majority of the mechanistic, prognostic and intervention studies of knee OA have focused on the disease of the tibiofemoral (TF) joint, the patellofemoral (PF) joint appears to be the most prevalent site of pathology, with 40–69% of adults with complaints of chronic knee pain having isolated or combined radiographic evidence of PFOA [3,4]. (Source: Gait and Posture)


Radiosynovectomy in haemophilia: Long-term results of 500 procedures performed in a 38-year period
Radiosynovectomy (RS) can reduce the number of haemarthroses in chronic haemophilic synovitis. The purpose of this study was to assess the effectiveness of RS in terms of the objective improvement of five parameters (number haemarthroses, articular pain, degree of clinical synovitis, clinical score of the World Federation of Haemophilia (WFH), and radiological score of the WFH. (Source: Thrombosis Research)


Understanding and Treatment of Chronic Abdominal Pain in Pediatric Primary Care
This study examined the practices used by primary care pediatricians to assess and treat chronic abdominal pain (CAP), as an initial step in guiding clinical practice guideline (CPG) development. A survey was mailed to a random sample of office-based pediatrician members (primary care pediatricians [PCPs]) of the American Medical Association. PCPs (n = 470) provided information about the typical presentation of CAP, assessment/treatment approaches used in their own practice, their definition of a functional gastrointestinal disorder (FGID), and their familiarity with the Rome Criteria for diagnosing FGIDs. Substantial variability among PCPs was noted across all these areas. Results suggest that perceptions and practices of pediatric CAP vary widely among PCPs; no single standard of care em...


Pericranial tenderness in chronic tension-type headache: the Akershus population-based study of chronic headache
Conclusions People with CTTH have increased pericranial tenderness. Elevated tenderness scores are associated with co-occurrence of migraine, bilateral headache and low age. Whether the increased muscle tenderness is primary or secondary to the headache should be addressed by future studies. (Source: The Journal of Headache and Pain)


Functional Capacity Evaluation: Performance of Patients with Chronic Non-specific Low Back Pain Without Waddell Signs
Conclusions WS should be assessed for interpretation of FCE results. Despite long work absence, patients with CNSLBP with negative WS demonstrated a physical capacity corresponding to substantial physical work demands. (Source: Journal of Occupational 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>


Development and pharmacological characterization of a model of sleep disruption‐induced hypersensitivity in the rat
ConclusionsThese results show that acute and low‐stress sleep disruption causes mechanical and heat hypersensitivity in rats. Mechanical and heat hypersensitivity exhibited differential sensitivity to pharmacological agents, thus suggesting dissociable mechanisms for those two modalities. Ultimately, this model could help identify underlying mechanisms linking sleep disruption and hypersensitivity. (Source: European Journal of Pain)


Potential effect and mechanism of action of topical chamomile ( L.) oil on migraine headache: A medical hypothesis
Migraine is a chronic recurring headache for which no complete treatment has been found yet. Therefore, finding new treatment approaches and medicines is important. In this review, we consider the probable mechanism of action of a traditional and ethnic formulary of chamomile extract in sesame oil as a new topical medication for migraine pain relief.Chamomile oil is prepared in Traditional Persian Medicine by boiling aqueous extract of chamomile in sesame oil. To optimize the procedure, we can use a Clevenger-type apparatus to extract the essential oil and add it to the end product. (Source: Medical Hypotheses)


G.P.305: Pain in adolescents with spinal muscular atrophy and Duchenne and Becker muscular dystrophy
Pain is a frequent problem in neuromuscular disorders. It is essential for physical therapists and physicians to systematically assess pain and offer an individual approach of interventions to reduce pain in this population. The aim of this study was to explore the prevalence, nature and scope of pain in adolescents with spinal muscular atrophy and Duchenne and Becker muscular dystrophy, and whether the pain differs between diagnostic groups or between adolescents with different ambulation status. Furthermore to study the consequences of pain in everyday life and to identify pain-exacerbating and pain-relieving factors. Fifty-five adolescents, 12–18years of age, with spinal muscular atrophy and Duchenne and Becker muscular dystrophy completed a questionnaire assessing pain frequency, dur...


G.P.296: Severe, early onset Charcot-Marie-Tooth disease with rare presentations
Charcot–Marie–Tooth disease (CMT) has diverse clinical presentations and molecular genetic heterogeneity. Herein we describe the clinical features, neurophysiological and morphological studies of 2 fatal cases of CMT. Case 1 was a healthy newborn who developed foot drop, daily frequent vomiting and severe constipation at 7months of age. His arm and leg weakness rapidly progressed within a few months. He subsequently developed diaphragmatic paralysis and died at 2.5years of age due to respiratory failure. NCS/EMG showed a severe, axonal sensory and motor neuropathy. He had a novel and de novo mutation (c.296–297dupAAG) of the MFN2 gene. Case 2 had congenital hypomyelinating neuropathy confirmed by NCS and nerve biopsy, associated with a novel and de novo missense mutation (p.His384Arg...


G.P.240: Next Generation Sequencing reveals IGHMBP2 variants as a cause for distal hereditary motor neuronopathy in two children
IGHMBP2 variants are associated with autosomal recessive distal spinal muscular atrophy 1 and distal hereditary motor neuronopathy type VI (dHMN6). Here we present two patients with potentially pathogenic variants in IGHMBP2 gene. Case 1-A 16year old male patient with a progressive distal weakness and deformity of both hands and feet which presented in childhood. He also had marked pain (possibly radicular in origin) mainly in toes and chest, which was severe enough to require opiates. His hands showed marked thenar and hypothenar loss of muscle bulk. Neurophysiological investigations revealed an active and partial chronic denervation. Initial genetic investigations did not reveal any abnormalities. His DNA was subsequently analysed by gene panel testing. Gene panel testing (simultaneous t...<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>


G.P.28: Through myotubes normalization, CYTOO 2D+ increase sensitivity of muscle damage HCS assay
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. Moreover, 2D+ technology standardizes myotubes formation and enables accessing new parameters for myo...


The opioid abuse and misuse epidemic: Implications for pharmacists in hospitals and health systems.
CONCLUSION: Pharmacists in hospitals and health systems can play a key role in recognizing the various forms of opioid toxicity and in preventing inappropriate prescribing and diversion of opioids. PMID: 25174015 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)


Proove Biosciences Exhibits Industry Leading Data and Research at...
Proove Biosciences will present evidence-based research on how genetic testing and their proprietary services can improve chronic pain treatment(PRWeb September 03, 2014)Read the full story at http://www.prweb.com/releases/2014/09/prweb12139809.htm (Source: PRWeb: Medical Pharmaceuticals)


Scapular spine stress fractures: To fix or not to fix, our experience in a patient with bilateral fractures and review of the literature
We report a case of bilateral scapular spine stress fracture, treated conservatively on one side and operatively on the other side. Besides, we performed a literature review to establish management options. A 61-year-old right-handed gentleman came to our clinic with acute on chronic deterioration of shoulder pain and loss of arm function. Clinical assessment and investigations revealed long-standing bilateral rotator cuff tear and scapular spine stress fractures. The fracture on the right side united with conservative management for 2 months. However, his left side remained symptomatic with pain, abnormal mobility and no radiological evidence of union. The fracture progressed to union after fixation and bone grafting. At the final follow-up at 2 years, the patient was asymptomatic with re...


Spatial and temporal pattern of changes in the number of GAD65-immunoreactive inhibitory terminals in the rat superficial dorsal horn following peripheral nerve injury
Inhibitory interneurons are an important component of dorsal horn circuitry where they serve to modulate spinal nociception. There is now considerable evidence indicating that reduced inhibition in the spinal dorsal horn contributes to neuropathic pain. A loss of these inhibitory neurons after nerve injury is one of the mechanisms being proposed to account for reduced inhibition; however, this remains controversial. This is in part because previous studies have focused on global measurements of inhibitory neurons without assessing the number of inhibitory synapses. To address this, we conducted a quantitative analysis of the spatial and temporal changes in the number of inhibitory terminals, as detected by glutamic acid decarboxylase 65 (GAD65) immunoreactivity, in the superficial dorsal h...<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>


Rectal Pain and Cancer
Although most causes are typically benign, chronic rectal pain can be a sign of colorectal cancer. Learn more about acute and chronic anorectal pains. (Source: About.com Colon Cancer)


Outcomes of Non‐Tunneled Non‐Cuffed Hemodialysis Catheters in Patients on Chronic Hemodialysis in a Resource Limited Sub‐Saharan Africa Setting
Abstract The aim of the present study was to investigate the adverse outcomes of non‐tunneled hemodialysis catheters and determinants in chronic hemodialysis patients receiving care at the Yaoundé General Hospital hemodialysis center, Cameroon. This was a prospective study of 11 months duration (February–December 2008) involving 81 non‐tunneled non‐cuffed catheters (63 femoral, 18 internal jugular) placed in 72 adults (47 men, 65.3%) on chronic hemodialysis. Baseline clinical and laboratory parameters associated with catheter‐related complications during follow‐up were investigated. The difference between variables was assessed using the χ2 test and equivalents. Sixty‐five (80.2%) catheters were inserted for emergency dialysis, 11 (13.6%) for a failed native arteriovenous f...


[Sexuality and urological diseases.]
Authors: Droupy S Abstract Patients with lower urinary tract symptoms related to benign prostatic hyperplasia (BPH) frequently suffer from sexual dysfunction (erectile dysfunction and ejaculatory dysfunction). Erectile dysfunction and premature ejaculation are two times more common in men with chronic pelvic pain/chronic prostatitis. All treatments of prostate cancer are responsible for sexual dysfunctions. Sexual disorders frequently appear during the management of infertile couples. Information and support should be offered to couples. Women with urinary incontinence also suffer frequently from coital incontinence. PMID: 25201599 [PubMed - as supplied by publisher] (Source: Presse Medicale)


Minimally invasive preperitoneal single-layer mesh repair versus standard Lichtenstein hernia repair for inguinal hernia: a prospective randomized trial
Conclusion MIP single-layer mesh repair is as effective and safe as LHR, with the additional benefits of minimally invasive nature, less chronic pain at 2 years and low polypropylene load when compared with the original Kugel patch. (Source: Hernia)


Researchers unlock new mechanism in pain management
(University of Calgary, Faculty of Medicine) Neuroscientist Gerald Zamponi, Ph.D., and his team at the University of Calgary's Hotchkiss Brain Institute have discovered a new mechanism that can reverse chronic pain. Using an animal model, their research has found that pain signals in nerve cells can be shut off by interfering with the communication of a specific enzyme with calcium channels, a group of important proteins that control nerve impulses.Their Canadian Institutes of Health Research funded study was published in the September issue of Neuron. (Source: EurekAlert! - Medicine and 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>


Focal amyotrophy in multiple sclerosis
We report the case of a 71 year old man with primary progressive MS and longstanding right arm weakness who presented with intermittent right arm pain. Neurological examination showed atrophy, weakness, and hyporeflexia, and electromyography (EMG) showed acute and chronic partial denervation in multiple segments of the right arm. Magnetic resonance imaging (MRI) demonstrated asymmetric volume loss and increased T2 signal in the right anterior spinal cord from C3 to C7, with no evidence of nerve root compression. Discussion: We conclude that the lower motor neuron involvement of his right arm was caused by MS with involvement of either the anterior horn cells or the intraspinal motor nerve roots. © 2014 Wiley Periodicals, Inc. (Source: Muscle and Nerve)


Therapeutic Potential of Inhibitors of Endocannabinoid Degradation for the Treatment of Stress-Related Hyperalgesia in an Animal Model of Chronic Pain
Authors: Ermelinda Lomazzo, Laura Bindila, Floor Remmers, Raissa Lerner, Claudia Schwitter, Ulrich Hoheisel & Beat Lutz Keywords: (Source: Neuropsychopharmacology)


Tofacitinib with methotrexate in third‐line treatment of patients with active rheumatoid arthritis: Patient‐reported outcomes from a Phase 3 trial
Conclusion. Tofacitinib treatment resulted in significant, clinically meaningful improvements in multiple PROs versus placebo over 3 months’ treatment in patients with active RA and previous inadequate response to TNFi. © 2014 American College of Rheumatology. (Source: Arthritis Care and Research)


Chronic morphine treatment increased the expression of myeloid differentiation primary response protein 88 in rat spinal cord.
Authors: Xu H, Xu T, Ma XQ, Jiang W Abstract Chronic morphine exposure leads to tolerance, which limits the clinical use of this potent analgesic in the treatment of severe and chronic pain. Compelling evidence suggest that neuro-immune activation (pro-inflammatory cytokines including IL-1β, IL-6 and TNF) as well as neuro-inflammation have been shown to mediate the development of morphine analgesic tolerance. Toll-like receptors (TLRs), especially TLR-4, have also been reported to contribute to the development of morphine analgesic tolerance. Besides, mitogen-activated protein kinases (MAPKs; especially p38 MAPK and c-Jun N-terminal kinase), as well as nuclear factor-κB (NF-κB) modulate the development of morphine antinociceptive tolerance. Hence, we hypothesis the possible invo...


[Childhood abuse experiences and chronic low back pain : Direct and mediated effects of childhood abuse in different pain dimensions of nonspecific chronic low back pain.]
CONCLUSION: The influence of childhood abuse on CLBP is different for specific pain dimensions; therefore, CLBP should be faced as a complex construct that comprises different dimensions. Childhood abuse is suggested as a risk factor for spreading pain in CLBP persons; therefore, CLBP patients reporting additional pain locations might benefit from diagnostic and therapeutic interventions specific for childhood abuse experiences. PMID: 25179418 [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>


Catechol-O-Methyltransferase Polymorphisms Predict Opioid Consumption in Postoperative Pain.
CONCLUSIONS:: The genetic variant of the COMT rs4680 single nucleotide polymorphism is associated with variability in opioid consumption in postoperative nephrectomy patients. The COMT rs4818 polymorphism may prove useful in predicting emesis medication use postoperatively. PMID: 25185591 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)


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. PMID: 25185440 [PubMed - as supplied by publisher] (Source: The British Journal of Ophthalmology)


Narcotic Bowel Syndrome and Opioid-Induced Constipation
Abstract Prescription opioid use for chronic non-cancer pain has reached epidemic levels in the USA. With this increased use is the recognition of serious opioid-related gastrointestinal complications such as narcotic bowel syndrome (NBS) and opioid-induced constipation (OIC). NBS consists of a paradoxical worsening of abdominal pain with escalating doses of opioids and is likely mediated by the central nervous system. Therapy requires an intensive multidisciplinary approach to detoxification. OIC is the most common gastrointestinal side effect of opioids. Several novel therapeutics are available to treat OIC that fails to respond to laxative therapy. This review will summarize recent findings on the pathophysiology and treatment approaches to NBS and OIC with a focus on controve...


Percutaneous injection of autologous bone marrow concentrate cells significantly reduces lumbar discogenic pain through 12 months
This study provides evidence of safety and feasibility in the non‐surgical treatment of DDD with autologous BMC and indicates an effect of mesenchymal cell concentration on discogenic pain reduction. Stem Cells 2014 (Source: Stem Cells)


Revival of 5-HT3 antagonism as treatment of IBS-D?
While drug development for chronic constipation and IBS with constipation has moved ahead with the marketing of prucalopride and linaclotide in many countries, the development of agents for functional diarrhoea and IBS-D has been more troubled. With the limited availability of the serotonin (5-HT)3 antagonist alosetron, the global market of drugs for diarrhoeal disorders is still led by agents developed 40&ndash;60&nbsp;years ago, including opioid receptor agonists (eg, loperamide), bile acid binders (eg, cholestyramine) and tricyclic antidepressants (eg, amitriptyline). Clearly, the development of new effective and safe drugs for diarrhoeal disorders is greatly needed to provide more options for patients and physicians, higher efficacy and fewer side effects. The problem is of great relev...<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>


Preclinical toxicity evaluation of AAV for pain: evidence from human AAV studies and from the pharmacology of analgesic drugs
Gene therapy with adeno-associated virus (AAV) has been advanced in the last few years from promising results in animal models to >100 clinical trials (reported or under way). While vector availability was a substantial hurdle a decade ago, innovative new production methods now routinely match the scale of AAV doses required for clinical testing. These advances may become relevant to translational research in the chronic pain field. AAV for pain targeting the peripheral nervous system was proven to be efficacious in rodent models several years ago, but has not yet been tested in humans. The present review addresses the steps needed for translation of AAV for pain from the bench to the bedside focusing on pre-clinical toxicology. We break the potential toxicities into three conceptual categ...


Multidisciplinary biopsychosocial rehabilitation for chronic low back pain.
CONCLUSIONS: Patients with chronic LBP receiving MBR are likely to experience less pain and disability than those receiving usual care or a physical treatment. MBR also has a positive influence on work status compared to physical treatment. Effects are of a modest magnitude and should be balanced against the time and resource requirements of MBR programs. More intensive interventions were not responsible for effects that were substantially different to those of less intensive interventions. While we were not able to determine if symptom intensity at presentation influenced the likelihood of success, it seems appropriate that only those people with indicators of significant psychosocial impact are referred to MBR. PMID: 25180773 [PubMed - as supplied by publisher] (Source: Cochrane Data...


Further development in the assessment of psychological flexibility: A shortened Committed Action Questionnaire (CAQ‐8)
ConclusionsThe CAQ‐8 appears equally adequate as the CAQ as a measure of committed action. Its development ought to facilitate further study of this process of engagement in activity and of the wider psychological flexibility model in relation to chronic pain. (Source: European Journal of Pain)


Pan‐European, open‐label dose titration study of fentanyl buccal tablet in patients with breakthrough cancer pain
ConclusionsThis study involving a real clinical practice setting showed a similar percentage of patients safely achieving an effective dose by titration starting with 100 versus 200 μg of FBT. (Source: European Journal of Pain)


Marijuana may reduce painkiller overdoses
States that have legalized marijuana for managing chronic pain have significantly fewer deaths from prescription painkiller overdoses each year, according to a new study published Monday in JAMA Internal Medicine. (Source: CNN.com - 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>


Update: Soccer Injury and Prevention, Concussion, and Chronic Groin Pain
Soccer, or football, as it is known in much of the world, is one of the most popular sports in the world. The purpose of this article was to provide a concise update on select soccer-specific medical issues published in the last year as they relate to soccer injury and prevention, concussions, and chronic groin pain. Both the Fédération Internationale de Football Association and the Union of European Football Associations published data from their longstanding injury tracking systems, providing foundation for further research. Concussion research continues to drive much interest, especially as it relates to heading and the controversy of subconcussive trauma. Lastly, our understanding of chronic groin pain continues to be refined as we try to understand the complexity of its pathophysiol...


Reactive Lymphoid Hyperplasia of the Terminal Ileum: A Benign (Lymphoma-like) Condition That May Harbor Aberrant Immunohistochemical Patterns or Clonal Immunoglobulin Heavy Chain Gene Rearrangements
Small endoscopic biopsies of the terminal ileum may be difficult to assess for early involvement by lymphoma. Immunophenotypic and genotypic analyses are often utilized, but the performance of these studies in this setting is not well defined. Terminal ileal biopsies from 66 patients with prominent lymphoid hyperplasia and abnormal “lymphoma-like” morphology were evaluated by immunohistochemistry (IHC) for CD3, CD5, CD43, CD20, CD21, and CD10 expression and for IGH@ gene rearrangement by polymerase chain reaction using BIOMED-2 primers. Patients ranged in age from 3 to 80 years. Indications for endoscopy included inflammatory bowel disease (29), diarrhea and/or abdominal pain (28), history of lymphoma (13), and others (4). Four biopsies with abnormal morphology had abnormal IHC and a c...


Sensorimotor Polyneuropathy After a 1-Month Treatment With Oral Acitretin
We report a 40-year-old male patient with widespread chronic plaque psoriasis, who complained of distal numbness in the right leg with gradual proximal extension after 1 month of treatment with oral acitretin. Neurological examination showed suppressed ankle reflexes, reduced pain and vibration sense in a glove and stocking distribution, and mild weakness of feet dorsiflexion. Neurophysiologic examination revealed a shift of the amplitude of all sensory and compound muscle action potentials toward low values, whereas in the case of sural and popliteal nerves, the amplitude felt below reference limits. Follow-up examination of the patient 1 month after treatment discontinuation revealed no abnormal neurological symptoms or signs, whereas the values of the neurophysiologic measurements had r...


Early Signs of Osteoarthritis in Professional Ballet Dancers: A Preliminary Study
Conclusions: Early signs of OA, in different joints, were present in a small but highly selected cohort of professional ballet dancers. In future, prospective studies among a number of ballet companies should control for medical and natural history alongside the visual analysis of images and plain radiographs to confirm these preliminary results. (Source: Clinical Journal of Sport Medicine)


Humeral Stress Edema: An Injury in Overhead Athletes Quarterback With Humeral “Shin” Splints—A Case Report
Abstract: Stress injury to the distal humerus has been reported as a cause of chronic arm pain among competitive tennis players. As the serve is technically similar to an overhead throwing motion, it is conceivable that this injury could occur in other overhead athletes. Overuse injuries, including rotator cuff tears, ulnar collateral ligament injuries, and joint sprains have routinely been reported in quarterbacks, but there are few reported cases of upper extremity bony stress injuries in these athletes. Magnetic resonance imaging aids in the diagnostic evaluation of an upper extremity injury as it can identify numerous structural injuries and early stress changes within bone. Accurately diagnosing stress reactions helps prevent progression toward stress fracture, which is possible if co...<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>


Inhaled nebulized and intranasal opioids for the relief of breathlessness
Purpose of reviewInhaled nebulized and intranasal opioid administration is available with a proven short onset of action for the relief of pain. As breathlessness episodes are short, these routes of administration seem to be attractive for breathlessness management. This review describes the recent studies evaluating the effectiveness of inhaled nebulized and intranasal application of opioids for patients suffering from refractory breathlessness. Recent findingsSince 2012, one systematic review and three primary studies have been identified. The systematic review summarized five studies including seventy patients testing nebulized fentanyl and two studies including five patients evaluating intranasal application. Two randomized controlled trials tested inhaled fentanyl or morphine and one ...


The assessment and management of cancer cachexia: hypogonadism and hypermetabolism among supportive and palliative care patients
Purpose of reviewTo update the healthcare providers on the potential contribution of increased basal metabolic rate, hypermetabolism, and low testosterone in the development of weight loss in cancer patients. Recent findingsCancer cachexia, the loss of skeletal muscle with or without the loss of fat, is a multifactorial syndrome. A wide variation in the frequency of hypermetabolism exists in cancer patients and can only be accurately identified by an indirect calorimeter. The frequency of hypermetabolism increases depending on the histology and stage of tumor, associated with the presence of an acute inflammatory response, and is often accompanied by weight loss. Hypogonadism, as a result of chemotherapy, radiation treatment, or the use of opioids to treat chronic pain, is frequently noted...


Fentanyl Overdose Caused by Malfunction of SynchroMed II Intrathecal Pump: Two Case Reports
Conclusions: We present 2 cases of intrathecal pump malfunction, which most likely led to overinfusion of fentanyl intrathecally. To reduce the risk of this complication, particular attention should be paid to drug reservoir volume discrepancies and overdose symptoms reported by patients. (Source: Regional Anesthesia and Pain Medicine)


Chronic pancreatitis
Purpose of review: We review selected important clinical observations in chronic pancreatitis reported in 2013. Recent findings: Early diagnosis of chronic pancreatitis remains difficult, although newer techniques utilizing endoscopic ultrasonography-elastography and MRI hold promise. Patients with chronic pancreatitis are at risk of nutritional deficiencies. Osteoporosis, osteopenia, and bone fracture are particularly common in these patients, and require active intervention and treatment. Diabetes caused by chronic pancreatitis, type 3c diabetes, has specific characteristics and requires careful management. Antioxidants and neuromodulators may decrease pain in some patients with chronic pancreatitis. Endoscopic treatment is effective and can be utilized in patients with painful chronic p...


Endoscopic approach to the diagnosis and treatment of pancreatic disease
Purpose of review: The purpose of this review is to provide an update on the diagnosis and treatment of pancreatic disorders using endoscopy. Recent findings: The role of endoscopy in the diagnosis and management of pancreatic disorders continues to increase in importance. The use of post-endoscopic retrograde cholangio-pancreatography (ERCP) provides therapy for many pancreatic disorders, including in the treatment of pancreatitis, its complications and pancreatic neoplasia. In recent years, there has been a focus on improving its safety in the prevention of post-ERCP pancreatitis. Pancreatic endotherapy by ERCP for the treatment of biliary strictures and chronic pain in chronic pancreatitis will also be reviewed. Endoscopic ultrasound (EUS) has a vital diagnostic role in pancreatic disor...<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>


Associated capitellar and elbow ligamentous injuries in isolated type 1 radial head fractures based on MRI
Conclusions:The incidence of capitellar and MCL injury is higher than previously reported in patients with isolated Mason type 1 radial head fractures. Patients diagnosed with such injuries should be followed closely and evaluated with advanced imaging if there is a failure of motion progression or persistent pain. Long-term clinical outcome of such patients with osteochondral damage of the capitellum should be investigated. Level of Evidence:IV, Case Series, Diagnostic Study. (Source: Current Orthopaedic Practice)


Health effects associated with working in the wind power generation industry: a comprehensive systematic review.
Conclusion: These results will be useful in informing strategies for the prevention and management of musculoskeletal disorders in wind technicians. International Journal of Evidence-Based Healthcare (C) 2014 The Joanna Briggs Institute (Source: International Journal of Evidence-Based Healthcare)


Corticosteroid Versus Platelet-Rich Plasma Injection in Epicondylitis
Lateral epicondylitis (LE) is often considered an inflammatory disease characterized by tendon microtears that are followed by an incomplete reparative response that leads to chronic pain and decreased function on the upper extremity. A modality that is commonly used for the treatment of LE is the injection of corticosteroids. Evidence supports corticosteroid injections to be an effective short-term intervention that lacks intermediate and long-term relief as well as having negative effects on tenocyte proliferation, which is essential in the tissue healing process. Platelet-rich plasma (PRP) has been shown to be more effective, providing longer positive results with a lower recurrence rate. PRP's powerful growth factor stimulates tissue repair and protects tenocytes from the cytotoxic eff...


Heart Failure Symptom Relationships: A Systematic Review
Conclusions: The findings of this systematic review provide support for the presence of heart failure symptom clusters. Depression was related to several of the symptoms, providing an indication to clinicians that individuals with heart failure who experience depression may have other concurrent symptoms. Some symptom relationships such as the relationships between fatigue and anxiety or sleep or pain were dependent on the symptom characteristics studied. Symptom prevalence in the sample and restricted sampling may influence the robustness of the symptom relationships. These findings suggest that studies defining the phenotype of individual heart failure symptoms may be a beneficial step in the study of heart failure symptom clusters. (Source: Journal of Cardiovascular Nursing)


Infrequent Assessment of Pain in Elderly Trauma Patients
There are inherent difficulties in assessing and managing pain in elderly trauma patients, especially those with chronic health conditions or diminished capacities for self-reporting pain. This retrospective study identifies and describes patterns of pain assessment for a trauma population of older adults (age ≥65 years). Gaps between patient assessments existed in all phases of hospitalization and did not meet hospital guidelines for frequency of assessment. In addition, assessment methods were not always appropriate for the patient population. We conclude that older patients were not assessed for pain frequently enough, and that more regular and routine pain assessments may improve patient outcomes. (Source: Journal of Trauma 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>


Long-Term Follow-up of Treatment for Synthetic Mesh Complications
ABSTRACT: Transvaginal synthetic mesh products were introduced more than 10 years ago to improve success rates of traditional pelvic organ prolapse and stress urinary incontinence repair methods. However, limited data are available showing symptomatic benefits of transvaginal mesh use. Moreover, with increased use of vaginal mesh, there has been increasing incidence of mesh complications, including vaginal mesh exposure and contraction. Although several treatments of mesh complications have been investigated, it is unclear whether these treatments alleviate their symptoms, especially long-term. This retrospective study had 2 aims. The first was to describe the presenting symptoms, findings, and treatment of complications resulting from placement of synthetic vaginal mesh. The second was to...


Reconstruction of the Acromioclavicular Joint, its Superior Capsule, and Coracoclavicular Ligaments Using an Interpositional Acellular Dermal Matrix and Tibialis Tendon Allograft
Acromioclavicular (AC) separations are one of the most common shoulder injuries that may lead to pain, disability, and dysfunction of the shoulder girdle. Over 100 different surgical procedures have been described in the literature for the treatment of this injury. Initial surgical repairs were nonanatomic and nonbiological. In recent years, allograft reconstruction has become accepted for the treatment of chronic separations, but most reconstructions are aimed at restoring the coracoclavicular ligaments. Very little attention has been placed on the reconstruction of the AC joint itself. The technique described is an anatomic, biological reconstruction of the coracoclavicular ligaments to restore stability in the vertical plane, and of the AC joint to restore stability in the horizontal pl...


Development of the Italian version of the Pain Stages of Change Questionnaire in patients with chronic low back pain: cross-cultural adaptation, confirmatory factor analysis, reliability and validity
Translating, culturally adapting and validating the Italian version of the Pain Stages of Change Questionnaire (PSOCQ-I) to allow its use with Italian-speaking patients with low back pain. The PSOCQ-I was developed by forward–backward translation, a final review by an expert committee and a test of the prefinal version to establish its correspondence with the original English version. Psychometric testing included confirmatory factor analysis, reliability by internal consistency (Cronbach’s α) and test–retest reliability (intraclass coefficient correlation), and construct validity by comparing PSOCQ-I with the Pain Catastrophising Scale (PCS), the Tampa Scale of Kinesiophobia (TSK), the Roland Morris Disability Scale (RMDQ), a pain Numerical Rating Scale (NRS), and the Hospital Anxi...


Epicondylitis: Lateral
Lateral epicondylitis is the most common cause of lateral elbow pain in adults. Although it is typically a self-limiting process, there are many nonsurgical and surgical treatment options available if lateral epicondylitis becomes chronic and continues to cause pain. Its common name, tennis elbow, is somewhat of a misnomer because the condition is often work-related and occurs in athletes and nonathletes alike. Acute onset of symptoms occurs more often in young athletes; chronic, recalcitrant symptoms typically occur in older patients. In this review, we describe the pathogenesis and clinical presentation and the nonsurgical and surgical treatment options currently available. (Source: Sports Medicine and Arthroscopy Review)


Arthroscopic and Open Management of Posterolateral Rotatory Instability of the Elbow
This report describes arthroscopic repair of the radial ulnohumeral ligament and open reconstruction with associated outcomes. A high index of suspicion is necessary to correctly diagnosis this condition in patients with lateral elbow pain and feelings of instability. (Source: Sports Medicine and Arthroscopy Review)<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>


Treatment of Chronic Deltoid Ligament Injury Using Suture Anchors
ConclusionUsing suture anchors to treat chronic deltoid ligament injury has relatively satisfactory outcomes. (Source: Orthopaedic Surgery)


Serotonin Receptor Gene (5HT‐2A) Polymorphism is Associated with Provoked Vestibulodynia and Comorbid Symptoms of Pain
ConclusionThe results indicate a contribution of alterations in the serotonergic system to the patho‐genesis of PVD and gives further evidence of PVD being a general pain disorder similar to other chronic pain disorders. Heddini U, Bohm‐Starke N, Grönbladh A, Nyberg F, Nilsson KW, and Johannesson U. Serotonin receptor gene (5HT‐2A) polymorphism is associated with provoked vestibulodynia and comorbid symptoms of pain. J Sex Med **;**:**–**. (Source: The Journal of Sexual Medicine)


Nonpeptidic 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‐1R is a potential target molecule for the treatment of pain hypersensitivity including inflammatory nociception. (Source: British Journal of Pharmacology)


Loneliness, daily pain, and perceptions of interpersonal events in adults with fibromyalgia.
Conclusions: Chronic and transient episodes of loneliness are associated with more negative daily social relations and pain. However, boosts in positive events yield greater boosts in day-to-day enjoyment of social relations for lonely versus nonlonely individuals, and during loneliness episodes, a finding that can inform future interventions for individuals with chronic pain. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (Source: Health Psychology)


Effects of pain intensity on goal schemas and goal pursuit: A daily diary study.
Conclusions: Whereas morning pain intensity exhibited inconsistent effects across analytic levels, morning goal-related schematic thinking consistently predicted goal pursuit across analytic levels, type of goal, and time of day. These findings have implications for treatment and prevention of pain’s potentially deleterious effects on workplace and lifestyle goals. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (Source: Health Psychology)<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>


Course Content Related to Chronic Wounds in Nursing Degree Programs in Spain
ConclusionsThis review of available information about nursing degree programs in Spain indicates that pain management in patients with chronic wounds is not addressed in any course, and more courses consider the treatment of pressure ulcers than their prevention. Clinical RelevanceDegree programs responsible for the training of future nurses should be reviewed and revised as needed to ensure that graduates have acquired minimum basic competencies in the prevention and treatment of chronic wounds that help to decrease the theory–practice gap in this field. (Source: Journal of Nursing Scholarship)


A difficult combination: chronic physical illness, depression, and pain.
Authors: Cocksedge KA, Simon C, Shankar R PMID: 25179047 [PubMed - in process] (Source: The British Journal of General Practice)


Hematopoietic Stem Cell Transplantation for Sickle Cell Disease: State of the Science
This article is protected by copyright. All rights reserved. (Source: European Journal of Haematology)


Association Between Human Pain‐Related Genotypes and Variability in Opioid Analgesia: An Updated Review
We present recent experimentally induced pain, postoperative pain, and cancer pain and chronic non‐malignant pain conditions studies in humans, focusing on the association between genetic variation and analgesic response assessed as opioid consumption or changes in pain scores. Studies have shown promising results regarding pharmacogenetics as a diagnostic tool for predicting the individual response to a given opioid in the experimental settings; however, in the clinic, it is a more complicated task to accomplish. (Source: Pain Practice)


Mechanisms and management of functional abdominal pain.
Authors: Farmer AD, Aziz Q Abstract Summary Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported population prevalence of between 0.5% and 1.7%, with a female preponderance. The pathophysiology of functional abdominal pain is incompletely understood although it has been postulated that peripheral sensitisation of visceral afferents, central sensitisation of the spinal dorsal horn and aberrancies within descending modulatory systems may have an important role. The management of patients with functional abdominal pain requires a tailored multidisciplinary approach in a supportive and empathetic environment in order to develop an effective therapeutic relationship. Patient edu...<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>


Oro‐facial pain and nutrition: a forgotten relationship?
Summary Oro‐facial pain (OFP) is known to exert profound impacts on quality of life including functionally and psychosocially mediated changes in dietary intake and thereby nutrition. This commentary explores the evidence base available on chronic oro‐facial pain, diet and nutrition and discusses current dietary guidance for individuals with chronic OFP; potential impact of chronic OFP on eating and nutritional status; impact of nutritional status on pathophysiology of chronic OFP; and potential role of nutrition in the management of chronic OFP. (Source: Journal of Oral Rehabilitation)


1,2,4‐Benzothiadiazine‐1,1‐dioxide Derivatives as Ionotropic Glutamate Receptor Ligands: Synthesis and Structure–Activity Relationships
Ionotropic glutamate receptor (iGluR) modulators, specially AMPA receptor antagonists, are potential tools for numerous therapeutic applications in neurological disorders, including Alzheimer's and Parkinson's diseases, amyotrophic lateral sclerosis, epilepsy, chronic pain, and neuropathology ensuing from cerebral ischemia or cardiac arrest. In this work, the synthesis and binding affinities at the Gly/NMDA, AMPA, and kainic acid (KA) receptors of a new series of 1,2,4‐benzothiadiazine‐1,1‐dioxide derivatives are reported. The results show that 1,2,4‐benzothiadiazine‐1,1‐dioxide is a new scaffold for obtaining iGluR ligands. Moreover, this work has led us to the 7‐(3‐formylpyrrol‐1‐yl)‐6‐trifluoromethyl substituted compound 7, which displays the highest AMPA recepto...


Altered fMRI responses to non‐painful sensory stimulation in fibromyalgia patients
Conclusion: FM patients showed strong attenuation of brain responses to non‐painful 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 fibromyalgia symptoms, suggesting that they may be part of the pathophysiology of the disease. © 2014 American College of Rheumatology. (Source: Arthritis and Rheumatism)


Update: soccer injury and prevention, concussion, and chronic groin pain.
Authors: Jones NS Abstract Soccer, or football, as it is known in much of the world, is one of the most popular sports in the world. The purpose of this article was to provide a concise update on select soccer-specific medical issues published in the last year as they relate to soccer injury and prevention, concussions, and chronic groin pain. Both the Fédération Internationale de Football Association and the Union of European Football Associations published data from their longstanding injury tracking systems, providing foundation for further research. Concussion research continues to drive much interest, especially as it relates to heading and the controversy of subconcussive trauma. Lastly, our understanding of chronic groin pain continues to be refined as we try to understand...


Is There a Need for Including Spiritual Care in Interdisciplinary Rehabilitation of Chronic Pain Patients? Investigating an Innovative Strategy
ConclusionsActive coping seems beneficial for maintaining positive long‐term outcomes of interdisciplinary pain rehabilitation Spiritual care may be conducive to active coping. Further research is warranted to explore the additive value of this spiritual care in the context of a multidimensional care pathway. (Source: Pain 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>


Management of venous leg ulcers in general practice - a practical guideline.
CONCLUSION: Most chronic venous leg ulcers can be managed effectively in the general practice setting by following the simple, evidence-based approach described in this article. Figure 1 provides a flow chart to aid in this process. Figure 2 illustrates the principles of management in general practice. DISCUSSION: Effective management of chronic ulcers involves the assessment of both the ulcer and the patient. The essential requirements of management are to debride the ulcer with appropriate precautions, choose dressings that maintain adequate moisture balance, apply graduated compression bandage after evaluation of the arterial circulation and address the patient's concerns, such as pain and offensive wound discharge. PMID: 25225642 [PubMed - in process] (Source: Australian Family...


Pelvic Examination Experiences in Women With and Without Chronic Pain During Intercourse
ConclusionsThe results provide empirical support that PEs are more physically and emotionally difficult for women who experience chronic pain during intercourse. These findings have important clinical implications, as PEs are a critical part of complete reproductive care and play an essential role in the assessment/management of sexual pain, including Genito‐Pelvic Pain/Penetration Disorder. Boyer SC and Pukall CF. Pelvic examination experiences in women with and without chronic pain during intercourse. J Sex Med **;**:**–**. (Source: The Journal of Sexual Medicine)


Changes in Quality of Life after 3 months of Usual Care in a Large Sample of Patients with Noncancer Pain: The “QOOL: Quality of Life and Pain” Study
In conclusion, 3 months of usual care in noncancer pain patients led to substantial improvements in QOL and pain outcomes. (Source: Pain Practice)


Spinal manipulation results in specific effects on pain sensitivity associated with altered central nociceptive processing in chronic low back pain
Expanding on their growing body of research into the specific therapeutic mechanisms of spinal manipulation therapy (SMT), Bialosky et al.1 have conducted a study aiming to extend their prior findings that SMT results in immediate lessening of pain sensitivity by determining whether this is specific to SMT or the product of an expectation of receiving SMT. (Source: International Journal of Osteopathic Medicine)


Dienogest is a safe and effective treatment for chronic pelvic pain associated to endometriosis
Endometriosis is a chronic disease primarily affecting women of childbearing age, typically leading to painful symptoms, fatigue, and infertility. Quality of life studies show that symptoms of endometriosis impact on many aspects of a woman’s life, including work and education, relationships, and social functioning.(1) Dienogest is a progestin investigated for the treatment of endometriosis in several clinical studies in Europe and Japan. (2) The aim of this study is to assess the safety and efficacy of dienogest 2mg/day for long-term treatment of endometriosis associated pain, and to evaluate adverse effects and improvement in quality life for long-term endometriosis treatment. (Source: Fertility and Sterility)<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>


Special research presentation: defining the role of ghrelin in wound healing and the inflammatory response in the post-operative setting
Peritoneal adhesion formation is a well-recognized consequence of abdominal and pelvic surgery, causing infertility, chronic pelvic pain and intestinal obstruction. We hypothesized that ghrelin, a 28 amino acid peptide predominantly found in the stomach, can play an important role in reducing adhesion formation in order to establish a novel approach to prevent post-operative surgical adhesions. The purpose of the study is to define the role that ghrelin plays in wound healing in a post-surgical animal model and to determine the molecular mechanism by which ghrelin impacts the inflammatory response and adhesion formation. (Source: Fertility and Sterility)


Deep Repetitive Transcranial Magnetic Stimulation (dTMS) Treatment of Chronic Neuropathic Back Pain: Case Series
dTMS over the motor cortex with the sagittal HMCCPN coil has been successfully used to reduce symptoms in patients with diabetic neuropathic foot pain. (Source: BRAIN STIMULATION: Basic, Translational, and Clinical Research in Neuromodulation)


Methadone Safety Guidelines: A New Care Delivery Paradigm
We applaud the recently published Methadone Safety Guidelines by Chou and colleagues for its comprehensive approach to ensuring patient safety during both initiation and maintenance phases of methadone treatment.2 This guideline mirrors a previously published cardiac safety guideline in methadone treatment5 focused on prolongation of the QTc interval and extends its focus to mitigation of the risks of respiratory depression and opioid misuse via routine urine drug testing. This is increasingly relevant since the distinction between opioid treatment for chronic pain and opioid dependency is not always clear in clinical practice. (Source: The Journal of Pain)


Total Pancreatectomy With Islet Cell Auto-Transplantation: Update and Outcomes From Major Centers
Opinion statement Chronic pancreatitis is the result of irreversible damage to pancreatic acinar cells, and can result in debilitating chronic pain for patients. Treatment centers on pain relief, often with chronic narcotic use. Surgical therapy consists of both resection procedures to remove affected pancreatic parenchyma and drainage procedures to facilitate drainage of the main pancreatic duct. Total pancreatectomy historically was utilized in extreme cases due to the brittle glucose control that followed from the total loss of islet cells. Total pancreatectomy with islet cell auto-transplantation (TP-AIT) is gaining in popularity due to the maintenance of beta cell mass and the ability of patients to potentially be insulin independent post-operatively. TP-AIT is very helpful ...


Understanding the Etiology and Management of HIV-Associated Peripheral Neuropathy
Abstract HIV may cause several forms of peripheral neuropathy, the most common of which is distal symmetric polyneuropathy (DSP) characterized by pain and sensory deficits in a stocking-glove distribution. The pathophysiology of DSP remains largely unknown but is thought to be related both to the neurotoxicity of HIV—through indirect immunomodulatory mechanisms—and to the neurotoxic effects of anti-retroviral therapies, most notably the dideoxynucleoside reverse transcription inhibitors or so-called d-drugs. Determining whether symptoms arise from the virus or the treatment poses a challenge to the clinician who must decide if a patient’s HAART regimen should be altered. Treatment of symptoms related to HIV-DSP is a difficult task and there is no evidence that the tradition...<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>


Prospective analysis of the use of OnabotulinumtoxinA (BOTOX) in the treatment of chronic migraine; real-life data in 254 patients from Hull, UK
Conclusion OnabotulinumtoxinA is a valuable addition to current treatment options in patients with chronic migraine. Our results support findings of PREEMPT study in a large cohort of patients, we believe, is representative of the patients seen in an average tertiary headache centre. While it can be used as a first line prophylaxis its cost may restrict its use to more refractory patients who failed three oral preventive treatments. (Source: The Journal of Headache and Pain)


Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS): Is There Anything New under the Sun?
Abstract IC/PBS can be a chronic debilitating bladder condition that has eluded a major diagnostic or treatment breakthrough since the first cases were reported nearly 130 years ago. This condition is defined by a constellation of symptoms including urinary urgency, frequency, and bladder pain without identifiable causes. Potential etiologic mechanisms include bladder urothelial dysfunction, immune dysregulation, pelvic floor myalgia, and nervous system dysfunction. The etiology of IC/PBS is likely multifactorial. Our ability to treat this condition effectively is also limited by the heterogeneity of presentation (varying phenotypes). Very few studies of high-level evidence are available to direct treatment strategies. Since there have been many reviews detailing diagnosis and t...


Update on biological therapies for knee injuries: osteoarthritis
Abstract Osteoarthritis (OA) is a progressive disease that causes functional impairment of the joints. Chronic forms of knee OA have been increasing worldwide, limiting patients’ quality of life. Recent studies have sought to increase effectiveness and quality in the development of new therapies, such as platelet-rich plasma, hyaluronic acid, stem cells, and nuclear factor κB, aimed principally at reducing proinflammatory activity, pain, and degeneration of the knee joints. The goal of this review is to present an update on biological therapies for knee OA and to provide guidance for future OA studies. (Source: Current Reviews in Musculoskeletal Medicine)


Gluten Sensitivity in Pediatrics: A Clinical Conundrum
Abstract Non-celiac gluten sensitivity (NCGS) is a condition in which symptoms are triggered by gluten ingestion, in which both allergic and autoimmune mechanisms have been ruled out. The “classical” presentation of NCGS is a combination of gastrointestinal symptoms (including abdominal pain, bloating, and bowel habit abnormalities) and extra-intestinal manifestations. So far, NCGS has been described extensively in adults, and few data are available for the pediatric population. Due to lack of a serological or histological marker, the diagnosis of NCGS remains clinical and it is based on the exclusion of celiac disease and wheat allergy and on gluten challenge. G is a 2.5-year-old child referred to our Center for chronic diarrhea, diurnal abdominal pain, and mild failure ...


Renew: An Integrative Psychotherapy Program for Women Veterans with Sexual Trauma
Abstract Renew is an integrative treatment consisting of 210 hours of programming for women Veterans to address sexual trauma, including military sexual trauma. The curriculum consists of a holistic approach to healing and is based on the principles of Holographic Reprocessing. Of the 119 women Veterans enrolled in an uncontrolled outcome study (e.g., completed pre- and post-treatment questionnaires), 80 of the participants reported multiple traumas across their lifespan and 95 experienced military sexual trauma. Of the 112 who started treatment, 97 graduated (13 % dropout rate). Graduates showed a significant reduction in posttraumatic stress disorder (PTSD), psychiatric symptoms, and posttraumatic negative cognitions (up to 60 % had reliable clinical change at the 95 % conf...<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 self-reported disability and functional capacity in patients with Whiplash Associated Disorder
Conclusions Self-reported disability and functional capacity are related but different. Both can part be predicted by pain intensity. A pending claim can predict higher self-reported disability. Both constructs are complementary and are recommended to determine disability in patients with WAD comprehensively. (Source: Journal of Occupational Rehabilitation)


TRPV1, TRPA1, and TRPM8 channels in inflammation, energy redirection, and water retention: role in chronic inflammatory diseases with an evolutionary perspective
Abstract Chronic inflammatory diseases are accompanied by a systemic response of the body, necessary to redirect energy-rich fuels to the activated immune system and to induce volume expansion. The systemic response is switched on by two major pathways: (a) circulating cytokines enter the brain, and (b) signals via sensory nerve fibers are transmitted to the brain. Concerning item b, sensory nerve terminals are equipped with a multitude of receptors that sense temperature, inflammation, osmolality, and pain. Thus, they can be important to inform the brain about peripheral inflammation. Central to these sensory modalities are transient receptor potential channels (TRP channels) on sensory nerve endings. For example, TRP vanilloid 1 (TRPV1) can be activated by heat, inflammatory fa...


Mirtazapine for New Daily Persistent Headache‐Associated Chronic Nausea
(Source: Headache: The Journal of Head and Face Pain)


Sex Differences in Patients with Chronic Pain Following Whiplash Injury: The Role of Depression, Fear, Somatization, Social Support, and Personality Traits
ConclusionExcept for emotional support in problem situations and social companionship, psychosocial factors do not differ between men and women with chronic WAD. These findings imply little to no risk for sex bias in studies investigating psychosocial issues in patients with chronic WAD. (Source: Pain Practice)


Dispersal pattern of injectate following ct‐guided perineural infiltration in the canine thoracolumbar spine: a cadaver study
An increasing proportion of canine patients are presented with chronic thoracolumbar back pain and without compressive spinal lesions. In humans, spinal perineural infiltrations have been reported to have a favorable effect on pain control. The purpose of this prospective cadaver study was to describe the dispersal pattern of injectate following CT‐guided spinal perineural infiltration in the canine thoracolumbar region. Seven fresh canine cadavers were first scanned using multislice CT and then CT‐guided spinal perineural infiltration was performed at 42 sites from T13/L1 to L6/L7. The injectate for each site was a mixture of new methylene blue and iodinated contrast medium. Immediately following CT‐guided injection, cadavers were frozen, cut, and dissected macro‐ and mesoscopical...<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>


Manage pain before, during and after total knee arthroplasty using a multimodal approach to analgesia
Abstract Total knee arthroplasty is often associated with acute pain after surgery, which frequently develops into chronic pain. Careful management of pain during and after surgery, including implementation of a multimodal analgesic strategy, may lead to less pain after surgery, faster functional recovery and a lower likelihood of chronic post-surgical pain. (Source: Drugs and Therapy Perspectives)


Antiepileptics for Post-Herpetic Neuralgia in the Elderly: Current and Future Prospects
Abstract Post-herpetic neuralgia is a painful condition and its prevalence increases with age. It is a burden for older patients and the association of age-related pharmacokinetic and pharmacodynamic changes, high co-morbidity and polypharmacy leads to the risk of adverse drug reactions and interactions. This type of neuropathic pain is particularly difficult to treat and guidelines recommend the use of gabapentinoids and some antidepressants, the utility of which may be hampered by adverse effects such as sedation, dizziness and impaired age-related renal function. Re-formulations of antiepileptics (anticonvulsants) are being developed and/or marketed and suggest interesting innovative profiles with improved bioavailability, low drug–drug interactions and better tolerability t...


Illness and Treatment Perceptions of Patients with Chronic Low Back Pain: Characteristics and Relation to Individual, Disease and Interaction Variables
Abstract The significance of various cognitive and psychosocial factors in the development, progression and persistence of chronic low back pain (CLBP) is well demonstrated. However, only a few studies have addressed CLBP patients’ cognitive representations or beliefs about their disease and its treatment. The present study aimed to: (1) describe the illness and treatment beliefs of patients with CLBP, e.g., expected timeline, controllability or treatment related concerns; and (2) explore the relation of these illness and treatment beliefs to individual-, disease- and interaction-related variables. We conducted a cross-sectional survey with N = 201 patients at four inpatient rehabilitation centers. The characteristics of illness and treatment perceptions were analyzed using d...


Chronic rhinosinusitis in patients requiring surgical repair of a midface fracture.
We report the incidence of chronic rhinosinusitis in patients who underwent surgical repair of a midface fracture. Our evaluation tool was the 20-item Sino-Nasal Outcome Test quality-of-life survey (SNOT-20). We mailed a demographic survey and the SNOT-20 questionnaire to 486 eligible patients who had undergone surgical repair of either a midface (n = 234) or mandible (n = 252) fracture; we had intended to use the latter cohort as a control group. Of the 234 midface patients, 34 (14.5%) returned a usable survey, but only 7 of the 252 mandibular patients (2.8%) did so, which was not a sufficient number for analysis; therefore we used normative data obtained from another study for comparison purposes. The mean SNOT-20 score in our cohort was 24.15, which was similar to the 28.7 mean score in...


Pathogenesis, diagnosis and management of Paget's disease of the bone.
Authors: Walker J Abstract Paget's disease of the bone is a chronic condition that affects bone remodelling in focal areas of the skeleton. The disease may affect one or several sites and can cause a variety of subsequent complications such as pain, bony deformity, osteoarthritis, fracture or nerve compression. Understanding the disease and how it affects patients enables nurses to understand patient needs and improve the quality of care delivered. PMID: 25258240 [PubMed - in process] (Source: Nursing Older People)<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>


R‐flurbiprofen attenuates experimental autoimmune encephalomyelitis in mice
Abstract R‐flurbiprofen is the non‐cyclooxygenase inhibiting R‐enantiomer of the non‐steroidal anti‐inflammatory drug flurbiprofen, which was assessed as a remedy for Alzheimer's disease. Because of its anti‐inflammatory, endocannabinoid‐modulating and antioxidative properties, combined with low toxicity, the present study assessed R‐flurbiprofen in experimental autoimmune encephalomyelitis (EAE) models of multiple sclerosis in mice. Oral R‐flurbiprofen prevented and attenuated primary progressive EAE in C57BL6/J mice and relapsing‐remitting EAE in SJL mice, even if the treatment was initiated on or after the first flare of the disease. R‐flurbiprofen reduced immune cell infiltration and microglia activation and inflammation in the spinal cord, brain and optic nerve a...


[Thoracic epidural catheter: reasonable or over-instrumentation?].
Authors: Loop T Abstract The efficient and persisting treatment of the pain accompanying thoracic surgery is fundamental and beneficial for patients, since severe postoperative pulmonary complications and the incidence of chronic pain will be reduced. In this review the role of thoracic epidural analgesia in preventing and treating pain after thoracic surgery will be discussed critically and alternative strategies presented. PMID: 25264720 [PubMed - in process] (Source: Zentralblatt fur Chirurgie)


[Hereditary angioedema: strange cause of abdominal pain].
CONCLUSIONS: Hereditary angioedema is caused by a deficiency (type I) or dysfunction (type II) in complement C1 inhibitor. Abdominal associated with angioedema may manifest as severe acute-onset abdominal pain or as moderately severe chronic recurrent abdominal pain. Two medications are currently FDA-approved for the treatment of these patients. PMID: 25259437 [PubMed - in process] (Source: Cirugia y Cirujanos)


[Acute gastric volvulus: late complication of Nissen fundoplication. Report of two cases and review of the literature].
CONCLUSION: Gastric volvulus rarely occurs as a complication of Nissen fundoplication with an incidence similar to others of late complications. The described mechanisms that originate gastric volvulus postfundoplication are related to adhesions, foreign bodies as suture (polyester), gastrostomy tubes and mesh, gastropexy and internal gastric herniation through a "transfundoplication" window. A high index of suspicion is required in those patients presenting with acute symptoms of gastric obstruction in the first year following laparoscopic Nissen fundoplication. Laparoscopic approach is safe with or without gastropexy, always correcting the underlying mechanisms that cause gastric volvulus. PMID: 25259434 [PubMed - in process] (Source: Cirugia y Cirujanos)


Chronic Exertional Compartment Syndrome of the Leg in the Military
Chronic exertional compartment syndrome causes leg pain during exercise and resolves at rest. Paresthesia, especially in the distribution of the superficial peroneal nerve, is common. Nonoperative management may not lead to long-term clinical success. This condition is more difficult to treat in the military setting. Operative treatment is reserved for patients whose symptoms are refractory to conservative management. Fascial decompression has not yielded consistent results in a high-demand cohort, with notable rates of symptom recurrence, incomplete return of physical function, and medical discharge. (Source: Clinics in Sports 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>


Benzodiazepine Use among Chronic Pain Patients Prescribed Opioids: Associations with Pain, Physical and Mental Health, and Health Service Utilization
ConclusionsCNCP patients using BZDs daily represent a high‐risk group with multiple comorbid mental health conditions and higher rates of emergency health care use. The high prevalence of BZD use is inconsistent with guidelines for the management of CNCP or chronic mental health conditions. (Source: Pain Medicine)


Primary osseous inflammatory malignant fibrous histiocytoma masquerading as chronic osteomyelitis.
This article presents an extremely rare and unique case of primary osseous inflammatory malignant fibrous histiocytoma, highlighting retrospectively the subtle clinical, radiologic, and pathologic features that can suggest this diagnosis. A 63-year-old woman with a history of nephrectomy for right kidney tuberculosis 20 years ago presented with slowly increasing left hip pain for 6 months. The relatively benign-appearing radiograph and biopsy report of chronic inflammation resulted in curettage and nailing of the lesion. The pathologic diagnosis was chronic osteomyelitis, but culture findings for bacteria and tuberculosis were negative. The patient remained well until 4 months later, when left thigh pain returned with fever and leukocytosis (white blood cell count as high as 20.7×10(9)/L,...


Real‐World Economic Impact of OnabotulinumtoxinA in Patients With Chronic Migraine
ConclusionsAlthough we are unable to distinguish onabotulinumtoxinA's treatment effect from other potential confounding variables, our analysis showed that severely afflicted, treatment‐refractory patients with chronic migraine experienced a significant cost‐offset through reduced migraine‐related emergency department visits, urgent care visits, and hospitalizations in the 6 months following treatment initiation of onabotulinumtoxinA. Future analyses will assess the longer‐term effect of onabotulinumtoxinA treatment and the potential contribution of regression to the mean. (Source: Headache: The Journal of Head and Face Pain)


Response to Letter to the Editor
We appreciate the opportunity to respond to the letter by Salaga et al. regarding our study . Salaga et al. agree that our data are consistent with previous studies showing that enhanced endocannabinoid (CB) signaling may abolish abdominal pain in animals and humans and that the decrease in anandamide (AEA) levels may cause enhanced visceromotor response (VMR) to colorectal distention due to weakened activation of CB receptors . They also agree that based on our study, acute treatment with serotonin (5-HT) may serve as a CB signaling activator. They propose that our data showing that exogenous AEA attenuates chronic luminal 5-HT-induced visceral hyperalgesia supports the hypothesis that pharmacological blockade of fatty acid amide hydrolase (FAAH) may reverse 5-HT-induced pronociception. M...


A Brief Peer Support Intervention for Veterans with Chronic Musculoskeletal Pain: A Pilot Study of Feasibility and Effectiveness
ConclusionsThis study suggests that peers can effectively deliver pain self‐management strategies to other veterans with pain. Although this was a pilot study with a relatively short intervention period, patients improved on several outcomes. (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>


Systematic review and meta-analysis of published randomized controlled trials comparing the role of self-gripping mesh against suture mesh fixation in patients undergoing open inguinal hernia repair
The objective of this article is to analyze systematically the randomized, controlled trials comparing the use of self-gripping mesh (SGM) versus suture mesh fixation (SMF) in patients undergoing open inguinal hernia repair. Randomized, controlled trials comparing the use of SGM versus SMF in patients undergoing open inguinal hernia repair were analyzed using RevMan®, and combined outcomes were expressed as odds ratio (OR) and standardized mean difference (SMD). Four randomized, controlled trials recruiting 1,115 patients undergoing open inguinal hernia repair using SGM versus SMF were retrieved from the search of medical electronic databases. There were 553 patients in the SGM group and 562 patients in the SMF group. The incidence of chronic groin pain (OR 1.04; 95 % CI 0.72, 1.49; z =...


Intrathecal drug delivery for chronic pain management-scope, limitations and future
Abstract Intrathecal drug delivery system (IDDS) is a targeted therapy system for treating pain and muscle spasm. IDDS is recommended for the treatment of chronic pain which does not respond to optimal medical management. The aim of this review article is to give an up to date and concise account of the use of IDDS. It will explore the main indications, pre-implantation trials and different implantation techniques, the licensing of drugs for intrathecal use and the adverse effects and benefits of this therapy. IDDS is an invasive technique, which can result in severe morbidity and mortality. The up to date knowledge gained from this article along with the recommendations for improving safety in patients receiving IDDS, makes it a valuable resource for healthcare practitioners. Con...


Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis
Conclusion: Clinically relevant effects of OMT were found for reducing pain and improving functional status in patients with acute and chronic nonspecific LBP and for LBP in pregnant and postpartum women at 3 months posttreatment. However, larger, high-quality randomized controlled trials with robust comparison groups are recommended. (Source: BMC Musculoskeletal Disorders)


Current overview of extrinsic and intrinsic factors in etiology and progression of inflammatory bowel diseases.
Authors: Sobczak M, Fabisiak A, Murawska N, Wesołowska E, Wierzbicka P, Wlazłowski M, Wójcikowska M, Zatorski H, Zwolińska M, Fichna J Abstract Inflammatory bowel diseases (IBD) are chronic, relapsing disorders affecting gastrointestinal (GI) tract and associated with intestinal mucosa damage and inflammation. The principal therapeutic goals in IBD include control of the intestinal inflammation and treatment of the major symptoms, mainly abdominal pain and diarrhea. Current therapeutic strategies for IBD rely on the use of non-specific anti-inflammatory agents and immunosuppressive drugs (e.g. aminosalicylates, monoclonal antibodies, and antibiotics), which cause severe side effects, and - in a significant number of patients - do not induce long-term benefits. In this review, w...


Inhibition of intracellular signaling pathways NF-κB and MEK1/2 attenuates neuropathic pain development and enhances morphine analgesia.
CONCLUSIONS: These results indicate that the inhibition of the NF-κB pathway has better analgesic effects. Both inhibitors similarly potentiate morphine analgesia, which parallels the up-regulation of both mor and dor mRNAs expression spinal levels of the model of neuropathy. PMID: 25149989 [PubMed - in process] (Source: Pharmacological 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>


Opioids, Sedatives, and Sleep Hypoventilation
The emphasis on improved pain control and the focus on treating chronic pain syndromes have led to a large increase in the number of patients on chronic opioid medications. The use of opioids chronically is associated with a variety of breathing disorders and potential for fatal outcomes. Understanding the mechanisms underlying control of respiration and opioid-mediated respiratory depression is essential in applying treatment options and providing new directions for management without sacrificing adequate pain control. (Source: Sleep Medicine Clinics)


Sleep Deprivation Aggravates Median Nerve Injury-Induced Neuropathic Pain and Enhances Microglial Activation by Suppressing Melatonin Secretion
Conclusions:Sleep deprivation makes rats more vulnerable to nerve injury-induced neuropathic pain, probably because of associated lower melatonin levels. Melatonin supplements to restore a circadian variation in melatonin concentrations during the sleep deprived period could alleviate nerve injury-induced behavioral hypersensitivity.Citation:Huang CT, Chiang RP, Chen CL, Tsai YJ. Sleep deprivation aggravates median nerve injury-induced neuropathic pain and enhances microglial activation by suppressing melatonin secretion. SLEEP 2014;37(9):1513-1523. (Source: Sleep)


'Doctor-Shopping' for Painkillers Common After Broken-Bone Surgery, Study Finds
Title: 'Doctor-Shopping' for Painkillers Common After Broken-Bone Surgery, Study FindsCategory: Health NewsCreated: 8/29/2014 9:35:00 AMLast Editorial Review: 8/29/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Chronic pelvic pain.
Authors: Steege JF, Siedhoff MT Abstract As opposed to the satisfying solutions found in the management of acute pain, chronic pelvic pain can be a vexing problem for the patient and physician. Seldom is a single source or cause found, and nearly always the condition is influenced by the broader social and psychological context of the patient. In this article, we discuss the evaluation of chronic pelvic pain, often considering pain as the disease itself, and identify peripheral generators, which gynecologists can address to help reduce their contributions to symptoms. PMID: 25162265 [PubMed - in process] (Source: Pain Physician)


Towards comprehensive and transparent reporting: context-specific additions to the ICF taxonomy for medical evaluations of work capacity involving claimants with chronic widespread pain and low back pain
Conclusions: The ICF taxonomy represents a universally applicable standard for reporting health and functioning information. However, when applying the ICF for comprehensive and transparent reporting in medical evaluations of work capacity involving CWP and LBP context-specific additions are needed. This is particularly true for the documentation of specific pain-related issues, work activities and personal factors. To ensure the practicability of the multidisciplinary evaluation process, the large number of ICF categories and context-specific additions necessary for comprehensive documentation could be specifically allocated to the disciplines in charge of their assessment. (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>


Radiation‐induced morphea – a literature review
Abstract Radiation‐induced morphea (RIM) is a rare and under‐recognized skin complication of radiotherapy. It is commonly wrongly diagnosed as other dermatological conditions or malignancy because of similar clinical characteristics. This literature review analyses 66 cases that have been reported in the literature since 1989. The clinical appearance often includes pain and disfiguration of affected area, which may influence the patient's quality of life. There is no clear connection between the radiotherapy dose, the fractionation scheme, the use of a boost, age, the presence of other dermatological conditions or other connective tissue diseases and the occurrence of RIM. Its pathogenesis is still unclear, but several theories are proposed to explain this phenomenon. The available dat...


Twenty-year experience of transvenous lead extraction at a single centre
Conclusion Pacing and ICD leads can be safely extracted with mechanical techniques. The presence of device infection appears to be the major predictor of procedural complications. (Source: Europace)


African Americans With Cancer Pain Are More Likely to Receive an Analgesic With Toxic Metabolite Despite Clinical Risks: A Mediation Analysis Study [Palliative and Supportive Care]
Conclusion Reducing racial disparities in the type of opioid prescription and understanding mechanisms of disproportionate opioid-related adverse effects in African American patients might decrease the clinical disparities in cancer pain outcomes. (Source: Journal of Clinical Oncology)


Musculoskeletal Pain in Patients With Chronic Myeloid Leukemia After Discontinuation of Imatinib: A Tyrosine Kinase Inhibitor Withdrawal Syndrome? [CORRESPONDENCE]
(Source: Journal of Clinical Oncology)


Trochanteric bursitis: the last great misnomer.
This study was designed to test this hypothesis. Patients undergoing primary total hip replacement were enrolled in this prospective, case-controlled, blinded study. Twenty-five patients who met the criteria for diagnosis of trochanteric bursitis (group A) were matched with a control group of 25 patients (group B). Trochanteric bursal samples were harvested from all patients intraoperatively and sent for histological analysis for the presence of inflammation. The intraoperative appearance of the abductor tendon insertion was also noted. None of the samples showed any evidence of acute or chronic inflammatory changes. Intraoperatively, five patients (20%) in group A were noted to have thinning of the gluteus medius tendon but no macroscopic tendon tears were detected in any bursal samples. ...<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 is associated with risky drinking over time among HIV-infected persons in St. Petersburg, Russia
Chronic pain and substance use, including alcohol use, frequently overlap (Morasco et al., 2011). Despite the fact that alcohol use disorders are the most common substance use disorders, there is relatively less research to explore relationships between pain and alcohol compared to opiates. Acute alcohol use is known to have analgesic properties, while alcohol withdrawal is associated with hyperalgesia in animal and human studies. As such, persons may use alcohol initially to “self-medicate” existing pain, but subsequently persist in a pattern of use to relieve alcohol-related pain and affective disorders (Egli et al., 2012). (Source: Drug and Alcohol Dependence)


DePuy ASR Settlement Enrollment Deadline Extended Until September 30,...
The Firm represents a number of DePuy ASR hip lawsuit clients who suffered chronic pain, metallosis, premature device failure and other serious complications allegedly due to the recalled...(PRWeb August 27, 2014)Read the full story at http://www.prweb.com/releases/depuy-asr-recall-lawsuit/depu-asr-settlement/prweb12125844.htm (Source: PRWeb: Medical Pharmaceuticals)


Depression therapy aids other cancer symptoms
Conclusion Not surprisingly, this well-conducted study suggests that offering cancer patients with clinical depression an intensive, systematic treatment for depression involving all the people involved in their care, works better than the current approach. As the authors point out, the trial had some limitations. The sample was mainly women receiving follow-up or adjuvant treatment for breast and gynaecological cancers, so it is unclear whether the findings are generalisable to other cancer patients. Also, patients and their GPs could not be “masked” as to whether they were in the DCPC group or the group receiving usual care, which might have influenced the findings. The striking results for patients in the DCPC group is probably attributable to treatment for depression being intens...


Intranasal Ketorolac as Part of a Multimodal Approach to Postoperative Pain
In this report, we present a review of the literature with a focus on intranasal ketorolac in order to provide a timely update regarding past, present, and future multi‐modal treatment options for postoperative pain. (Source: Pain Practice)


Trigger Point Injections for Headache Disorders: Expert Consensus Methodology and Narrative Review
ConclusionsWhen performed in the appropriate setting and with the proper expertise, TPIs seem to have a role in the adjunctive treatment of the most common headache disorders. We hope our effort to characterize the methodology of TPIs by expert opinion in the context of published data motivates the performance of evidence‐based and standardized treatment protocols. (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>


What has functional connectivity and chemical neuroimaging in fibromyalgia taught us about the mechanisms and management of `centralized¿ pain?
Research suggests that fibromyalgia is a central, widespread pain syndrome supported by a generalized disturbance in central nervous system pain processing. Over the past decades, multiple lines of research have identified the locus for many functional, chronic pain disorders to the central nervous system, and the brain. In recent years, brain neuroimaging techniques have heralded a revolution in our understanding of chronic pain, as they have allowed researchers to non-invasively (or minimally invasively) evaluate human patients suffering from various pain disorders. While many neuroimaging techniques have been developed, growing interest in two specific imaging modalities has led to significant contributions to chronic pain research. For instance, resting functional connectivity magnetic...


Novel treatment of chronic perineal pain in a woman by extracorporeal shock wave therapy: A case report and published work review
We report a case of female chronic perineal pain successfully treated by ESWT. A 51‐year‐old woman presented with persistent perineal scar pain after excision of a vulval–vaginal nodule despite oral analgesics and gabapentin. After 11 cycles of ESWT, she reported termination of analgesics consumption and decreased perineal pain score from 8 to 2. The Short Form 36 Questionnaire demonstrated improvement in physical and mental health conditions. There was no complication encountered. We postulate that the effect of ESWT in this patient was based on reduction of muscle tone and alternating the threshold of pain memory, similar to the mechanisms in male patients. Further study is required to determine the use of ESWT in treating female chronic perineal pain. (Source: Journal of Obstetric...


Association Between Experimental Pain Biomarkers and Serological Markers in Patients With Different Degree of Painful Knee Osteoarthritis
Conclusion: A platform of mechanistic pain bio‐markers in combination with structure related serological biomarkers provides new possibilities of understanding how OA related structural features may be associated with pain and pain sensitization. The study showed significant correlations between central pain sensitization and MMP‐dependent degradation of CRP as a possible measure for chronic inflammation. Future pain association studies should include biomarkers representing more specifically the local joint environment. © 2014 American College of Rheumatology. (Source: Arthritis and Rheumatism)


Long-term Results of Autologous Chondrocyte Implantation in the Knee for Chronic Chondral and Osteochondral Defects
Conclusion: Autologous chondrocyte implantation can provide a long-term solution in more than 70% of young patients of a difficult-to-treat group with large chronic articular cartilage lesions, even in the salvage situation. (Source: The American Journal of Sports Medicine)


Further delineation of Loeys-Dietz syndrome type 4 in a family with mild vascular involvement and a
Conclusions: Our data confirm that loss-of-function mutations in TGFB2 gene do not always lead to aggressive vascular phenotypes and that articular and skeletal signs are prevalent, therefore suggesting that LDS4 must be considered in patients with sparse signs of LDS and related disorders also in the absence of vascular events. (Source: BMC Medical Genetics - Latest articles)<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>


Blended care; development of a day treatment program for medically unexplained physical symptoms (MUPS) in the Dutch Armed Forces.
CONCLUSION: The blended care program for MUPS that focused on allostatic load awareness offered a more holistic and preventive approach that contributed to a reduction of unnecessary medical consumption, and increased job participation. We recommend that the development of guidelines for diagnoses and treatment of these complaints in military settings will improve the quality of patient care, reduce disability, facilitate reintegration, and encourage scientific research. PMID: 25167909 [PubMed - as supplied by publisher] (Source: Work)


Post-deployment multi-symptom disorder rehabilitation: An intgrated approach to rehabilitatione.
CONCLUSION: The case examples demonstrate how vocational rehabilitation services are an integral component of PMD treatment.} PMID: 25167903 [PubMed - as supplied by publisher] (Source: Work)


Notch3 is necessary for neuronal differentiation and maturation in the adult spinal cord.
Authors: Rusanescu G, Mao J Abstract Notch receptors are key regulators of nervous system development and promoters of neural stem cells renewal and proliferation. Defects in the expression of Notch genes result in severe, often lethal developmental abnormalities. Notch3 is generally thought to have a similar proliferative, anti-differentiation and gliogenic role to Notch1. However, in some cases, Notch3 has an opposite, pro-differentiation effect. Here, we show that Notch3 segregates from Notch1 and is transiently expressed in adult rat and mouse spinal cord neuron precursors and immature neurons. This suggests that during the differentiation of adult neural progenitor cells, Notch signalling may follow a modified version of the classical lateral inhibition model, involving the se...


Effectiveness of Intra-Articular Injection in Wrist Joints According to Triamcinolone Hexacetonide Dose in Rheumatoid Arthritis: A Randomized Controlled Double-Blind Study.
CONCLUSIONS: High and low triamcinolone hexacetonide doses had good effectiveness in wrist-blinded intra-articular injection of rheumatoid arthritis patients, without statistical difference between them. PMID: 25171663 [PubMed - as supplied by publisher] (Source: Medical Physics)


Mast Cell Activation Syndrome as a Significant Comorbidity in Sickle Cell Disease.
Authors: Afrin LB 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;...<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>


Patent Issued for Research Related to Alleviating Pain in Cattle
A patent has been issued for research that alleviates pain in cattle suffering from lameness and following castration, dehorning. The patent covers administering meloxicam alone or administering a combination of meloxicam and gabapentin to help alleviate acute and chronic pain and improve the performance of cattle. Researchers found that combinations of meloxicam and gabapentin improved the welfare of cattle by reducing the severity of lameness. Meloxicam alone improved weight gain after dehorning and reduced the incidence of bovine respiratory disease after castration. (Source: ScienceDaily Headlines)


Spanish guidelines for the management of autosomal dominant polycystic kidney disease
Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent cause of genetic renal disease and accounts for 6&ndash;10% of patients on renal replacement therapy (RRT). Very few prospective, randomized trials or clinical studies address the diagnosis and management of this relatively frequent disorder. No clinical guidelines are available to date. This is a consensus statement presenting the recommendations of the Spanish Working Group on Inherited Kidney Diseases, which were agreed to following a literature search and discussions. Levels of evidence found were C and D according to the Centre for Evidence-Based Medicine (University of Oxford). The recommendations relate to, among other topics, the use of imaging and genetic diagnosis, management of hypertension, pain, cyst inf...


A stepwise approach for effective management of chronic pain in autosomal-dominant polycystic kidney disease
Chronic pain, defined as pain existing for &gt;4&ndash;6 weeks, affects &gt;60% of patients with autosomal-dominant polycystic disease (ADPKD). It can have various causes, indirectly or directly related to the increase in kidney and liver volume in these patients. Chronic pain in ADPKD patients is often severe, impacting physical activity and social relationships, and frequently difficult to manage. This review provides an overview of pathophysiological mechanisms that can lead to pain and discusses the sensory innervation of the kidneys and the upper abdominal organs, including the liver. In addition, the results of a systematic literature search of ADPKD-specific treatment options are presented. Based on pathophysiological knowledge and evidence derived from the literature an argumentati...


Notch3 is necessary for neuronal differentiation and maturation in the adult spinal cord
Abstract Notch receptors are key regulators of nervous system development and promoters of neural stem cells renewal and proliferation. Defects in the expression of Notch genes result in severe, often lethal developmental abnormalities. Notch3 is generally thought to have a similar proliferative, anti‐differentiation and gliogenic role to Notch1. However, in some cases, Notch3 has an opposite, pro‐differentiation effect. Here, we show that Notch3 segregates from Notch1 and is transiently expressed in adult rat and mouse spinal cord neuron precursors and immature neurons. This suggests that during the differentiation of adult neural progenitor cells, Notch signalling may follow a modified version of the classical lateral inhibition model, involving the segregation of individual Notch re...


The Effect of Motivational Interviewing on Prescription Opioid Adherence Among Older Adults With Chronic Pain
PurposeTo test the effect of office‐based motivational interviewing (MI) on prescription opioid adherence in older adults with chronic pain. Design and MethodsPre‐ and post‐design was used. Thirty chronic pain patients participated in a 4‐week MI in two outpatient settings. FindingsParticipants demonstrated a significantly reduced risk of prescription opioid misuse, decreased substance use, increased self‐efficacy, increased motivation to change, and decreased depression at both the post‐test and 1‐month follow‐up. Practice ImplicationMI can be effectively delivered in outpatient settings for older adults who are at risk for opioid misuse. Clinicians could incorporate MI techniques to enhance prescription opioid adherence. (Source: Perspectives In Psychiatric Care)<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 Marijuana
Source: HealthDay - Related MedlinePlus Pages: Chronic Pain, Marijuana, Prescription Drug Abuse (Source: MedlinePlus Health News)


Well-Differentiated Papillary Mesothelioma of the PeritoneumWell-Differentiated Papillary Mesothelioma of the Peritoneum
A 28-year-old woman presented with chronic lower abdominal pain, dysuria, and dyspareunia. What did the FNA cytology reveal? American Journal of Clinical Pathology (Source: Medscape Today Headlines)


The Case Files: The Undifferentiated Bradycardic Patient
Robbins, Shari MD; King, Andrew MD Delineating a specific cause when evaluating patients with bradycardia in the emergency department can often be difficult. Unlike tachycardia, which often accompanies sepsis, fever, dehydration, and other common presentations, bradycardia is less frequently encountered, and can provide a challenge for the emergency practitioner. Physicians must re-examine the potential causes when a patient is refractory to initial treatments, and ensure accurate vital signs to rule out a commonly missed but easily reversible cause. Bradycardia is initially overlooked because many patients present in stable condition, and the most frequently encountered cause is physiologic bradycardia in athletes or other healthy individuals. Bradycardia may also be medication-induced, a...


Weed may lower painkiller ODs
States that have legalized marijuana for managing chronic pain have significantly fewer deaths from prescription painkiller overdoses each year, according to a new study published Monday in JAMA Internal Medicine. (Source: CNN.com - Health)


Study Questions Value of Certain Knee Surgeries
Title: Study Questions Value of Certain Knee SurgeriesCategory: Health NewsCreated: 8/25/2014 12:36:00 PMLast Editorial Review: 8/26/2014 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>


Fewer Painkiller Deaths in States With Medical Marijuana: Study
Title: Fewer Painkiller Deaths in States With Medical Marijuana: StudyCategory: Health NewsCreated: 8/25/2014 4:35:00 PMLast Editorial Review: 8/26/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Gastrointestinal Causes of Abdominal Pain
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)


The Approach to Chronic Pelvic Pain in the Adolescent
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, embarrassment surrounding the history or examination, and combined parent-child decision making. (Source: Obstetrics and Gynecology Clinics)


Foreword
This issue of the Obstetrics and Gynecology Clinics of North America, guest edited by Dr. Mary T. McLennan, Dr. Andrew Steele, and Dr. Fah Che Leong, focuses on a condition that is often frustrating for both the patient and her obstetrician-gynecologist. Chronic pelvic pain is defined as pain that occurs below the umbilicus and lasts for at least 6 months. It may be a symptom resulting from one or more different conditions. In many cases, chronic pelvic pain results from abnormal functioning of the nervous system (often called “neuropathic pain”). (Source: Obstetrics and Gynecology Clinics)


Preface
Pelvic pain is a very difficult and at times frustrating condition confronting the obstetrician and gynecologist in the office setting. These patients have often seen multiple providers and are often passed between providers with no one really accepting the responsibility of trying to determine the actual cause of the pain. Oftentimes the primary care physician will say it’s a gynecologic issue, and the gynecologist will say it’s nongynecologic and refer them back to their primary care physician for further evaluation. It is very difficult to estimate the number of patients who suffer from chronic pelvic pain but it is estimated that anywhere between 6% and 26% of patients may have chronic pelvic pain as defined by noncyclical pain lasting for more than 6 months. This can lead to a low...<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>


Finger Length Pattern as a Biomarker for Osteoarthritis and Chronic Joint Pain: A Population‐Based Study and Meta‐Analysis After Systematic Review
ConclusionType 3 finger length pattern, as an indicator of prenatal androgen exposure, was associated with having symptomatic knee OA, chronic pain, and hand OA. Therefore, it may be applicable as an easy measurable biomarker to identify susceptible subjects for these traits. (Source: Arthritis Care and Research)


Criteria for the Diagnosis of Fibromyalgia: Validation of the Modified 2010 Preliminary American College of Rheumatology Criteria and the Development of Alternative Criteria
ConclusionThe 2011ModCr had robust operating characteristics. Alternative criteria based on symptom items from the SIQR and pain locations from the PLI had comparable operating characteristics, with somewhat better specificity and ease of use. (Source: Arthritis Care and Research)


NK cells mediate the cumulative analgesic effect of electroacupuncture in a rat model of neuropathic pain
Conclusions: Repeated EA interventions have a time-dependent cumulative analgesic effect in neuropathic pain rats, which is closely associated with its regulatory effects on NK cells, splenic IL-2, beta-EP, and plasma IL-2, IL-1beta, IFN-gamma and TGF-beta levels. (Source: BMC Complementary and Alternative Medicine)


Short‐Term Effects of Bright Light Therapy in Adults with Chronic Nonspecific Back Pain: A Randomized Controlled Trial
ConclusionThe present randomized controlled trial shows that light therapy even in low dose could improve depressive symptoms and reduce pain intensity in CNBP patients. Further research is needed for optimizing parameters of frequency, dose, and duration of therapeutic light exposure. (Source: Pain Medicine)


σ1s activate astrocytes via p38 MAPK phosphorylation leading to the development of mechanical allodynia in a mouse model of neuropathic pain
Conclusions and ImplicationsThese findings demonstrate that spinal σ1s are localized in astrocytes, and that blockade of σ1s inhibits the pathologic activation of astrocytes via modulation of p‐p38, which ultimately prevents the development of MA in neuropathic mice. (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>


Imipramine Ameliorates Pain-related Negative Emotion via Induction of Brain-derived Neurotrophic Factor.
Authors: Yasuda S, Yoshida M, Yamagata H, Iwanaga Y, Suenaga H, Ishikawa K, Nakano M, Okuyama S, Furukawa Y, Furukawa S, Ishikawa T Abstract Depression-like behavior is often complicated by chronic pain. Antidepressants including imipramine (IMI) are widely used to treat chronic pain, but the mechanisms are not fully understood. Brain-derived neurotrophic factor (BDNF) is a neuromodulator that reduces depression by regulating synaptic transmission. We aimed to characterize the antidepressant effects of IMI without analgesia based on BDNF (trkB)-mediated signaling and gene expression in chronic pain. A chronic constriction injury (CCI) model was constructed in Sprague-Dawley (SD) rats. IMI (5 mg/kg, i.p.) was administered from day 10 after CCI. The pain response was assessed using ...


Contribution of Transient Receptor Potential Ankyrin 1 to Chronic Pain in Aged Mice With Complete Freund's Adjuvant–Induced Arthritis
ConclusionThese findings reveal marked differences in the long‐term mechanical behavioral sensitivity of aged and young mice, and suggest that TRPA1 may be a key contributor to the transition from acute to chronic inflammatory pain in response to mechanical stimuli as well as to the development of nociceptor sensitization selectively in aged mice. (Source: Arthritis and Rheumatism)


WITHDRAWN: Non-invasive physical treatments for chronic/recurrent headache.
CONCLUSIONS: A few non-invasive physical treatments may be effective as prophylactic treatments for chronic/recurrent headaches. Based on trial results, these treatments appear to be associated with little risk of serious adverse effects. The clinical effectiveness and cost-effectiveness of non-invasive physical treatments require further research using scientifically rigorous methods. The heterogeneity of the studies included in this review means that the results of a few additional high-quality trials in the future could easily change the conclusions of our review. PMID: 25157618 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


[Patellofemoral arthroplasty : Indication, technique and results.]
CONCLUSION: Patellofemoral arthroplasty is an effective and safe procedure if the indication criteria are respected and the specific surgical technique is used. However, comparative results on current inlay and onlay prostheses have not been published in the literature to date. PMID: 25154928 [PubMed - as supplied by publisher] (Source: Der Orthopade)


Non-invasive ventilation after surgery.
Authors: Jaber S, De Jong A, Castagnoli A, Futier E, Chanques G Abstract After surgery, hypoxemia and/or acute respiratory failure (ARF) mainly develop following abdominal and/or thoracic surgery. Anesthesia, postoperative pain and surgery will induce respiratory modifications: hypoxemia, pulmonary volumes decrease and atelectasis associated to a restrictif syndrome and a diaphragm dysfunction. Maintenance of adequate oxygenation in the postoperative period is of major importance, especially when pulmonary complications such as ARF occur. Although invasive endotracheal mechanical ventilation has remained the cornerstone of ventilatory strategy for many years for severe acute respiratory failure, several studies have shown that mortality associated with pulmonary disease is largely ...<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 presentation of acute and chronic coronary artery disease in diabetics.
Authors: Khafaji HA, Suwaidi JM Abstract In patients with diabetes mellitus, cardiovascular disease is the principal cause of mortality and chest pain is the most frequent symptom in patients with stable and acute coronary artery disease. However, there is little knowledge concerning the pervasiveness of uncommon presentations in diabetics. The symptomatology of acute coronary syndrome, which comprises both pain and non-pain symptoms, may be affected by traditional risk factors such as age, gender, smoking, hypertension, diabetes, and dyslipidemia. Such atypical symptoms may range from silent myocardial ischemia to a wide spectrum of non-chest pain symptoms. Worldwide, few studies have highlighted this under-investigated subject, and this aspect of ischemic heart disease has also b...


A Novel Anxiogenic Role for the Delta Opioid Receptor Expressed in GABAergic Forebrain Neurons
The delta opioid receptor (DOR) is broadly expressed throughout the nervous system and regulates chronic pain, emotional responses, motivation and memory. Neural circuits underlying DOR activities have been poorly explored by genetic approaches. Here we used conditional mouse mutagenesis to elucidate receptor function in GABAergic neurons of the forebrain. (Source: Biological Psychiatry)


Marijuana laws may reduce painkiller abuse
States that have legalized marijuana for managing chronic pain have significantly fewer deaths from prescription painkiller overdoses each year, according to a new study published Monday in JAMA Internal Medicine. (Source: WDSU.com - Health)


Fewer Painkiller Deaths in States With Medical Marijuana: Study
People with chronic pain may use pot instead of narcotics, researchers suggest (Source: WebMD 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 marijuana may reduce painkiller overdoses
States that have legalized marijuana for managing chronic pain have significantly fewer deaths from prescription painkiller overdoses each year, according to a new study published Monday in JAMA Internal Medicine. (Source: CNN.com - Health)


Heart doctors overstate benefits of procedures for stable chest pain
NEW YORK (Reuters Health) – Cardiologists sometimes overstate the benefits of an invasive procedure for chronic angina and patients make decisions based on what cardiologists tell them. (Source: Reuters: Health)


Fewer Painkiller Deaths in States with Medical Marijuana
People with chronic pain may use pot instead of narcotics, researchers suggestSource: HealthDay Related MedlinePlus Pages: Chronic Pain, Marijuana, Prescription Drug Abuse (Source: MedlinePlus Health News)


Epithelioid Osteosarcoma of the Scapula.
In conclusion, epithelioid neoplasms of the bone are extremetumourly rare and must be distinguished from metastatic carcinoma. Despite the presence of cytokeratine positive cells a thorough histological evaluation is mandatory and osteoid detection is essential in order to establish the correct diagnosis and further treatment. Key words: osteosarcoma, epithelioid, aneurysmal bone cyst, chondrosarcoma, pathology, immunohistochemistry. PMID: 25137500 [PubMed - as supplied by publisher] (Source: Acta Orthopaedica)


State medical marijuana laws linked to lower prescription overdose deaths
(Johns Hopkins University Bloomberg School of Public Health) In states where it is legal to use medical marijuana to manage chronic pain and other conditions, the annual number of deaths from prescription drug overdose is 25 percent lower than in states where medical marijuana remains illegal, new research suggests. (Source: EurekAlert! - Social and Behavioral 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>


Addiction Disorders.
Authors: Merrill JO, Duncan MH Abstract Substance use disorders are common in primary care settings, but detection, assessment, and management are seldom undertaken. Substantial evidence supports alcohol screening and brief intervention for risky drinking, and pharmacotherapy is effective for alcohol use disorders. Substance use disorders can complicate the management of chronic noncancer pain, making routine monitoring and assessment for substance use disorders an important aspect of long-term opioid prescribing. Patients with opioid use disorders can be effectively treated with methadone in opioid treatment programs or with buprenorphine in the primary care setting. PMID: 25134875 [PubMed - as supplied by publisher] (Source: The Medical Clinics of North America)


The mediator role of psychological morbidity in patients with chronic low back pain in differentiated treatments
This study analyzed the mediating role of psychological morbidity and the variables that discriminated low versus high disability, in patients receiving physiotherapy and acupuncture. A total of 203 patients answered measures of illness and medication representations, coping, depression, anxiety, quality of life, and functional disability. Morbidity was a mediator between functional disability and quality of life. Treatment consequences and quality of life, in the acupuncture group, and emotional representations, quality of life, depression, anxiety, and active strategies for pain relief, in the physiotherapy group, discriminated patients with low versus high disability. These results have important implications for identifying high-risk patients. (Source: Journal of Health Psychology)


An integrated approach to the examination and treatment of a patient with chronic low back pain.
Discussion: Symptomatic response to active movement, observations of quality of movement and joint mobility assessment were key factors in directing a therapeutic program that was successful in helping the patient meet his treatment goals. PMID: 25152958 [PubMed - as supplied by publisher] (Source: Physiotherapy Theory and Practice)


Assessment of chronic post‐surgical pain after knee replacement: Development of a core outcome set
ConclusionsThis core outcome set serves to guide assessment of CPSP after TKR. Consistency in assessment can promote standardized reporting and facilitate comparability between studies that address a common but understudied type of CPSP. (Source: European Journal of Pain)


The Effect of CYP2D6 Drug–Drug Interactions on Hydrocodone Effectiveness / El Efecto de las Interacciones Farmacológicas con el CYP2D6 en la Efectividad de la Hidrocodona
ConclusionsCYP2D6 drug–drug interactions appear to change effectiveness of commonly prescribed drugs in the ED. Drug–drug interaction should be considered prior to prescribing CYP2D6 drugs. Resumen ObjetivosEl citocromo hepático 2D6 (CYP2D6) es una enzima saturable responsable del metabolismo de aproximadamente un 25% de los medicamentos conocidos. Las interacciones con el CYP pueden alterar la eficacia de medicamentos prescritos. La hidrocodona es muy dependiente del metabolismo del CYP2D6 para la analgesia, el ondansetrón es inactivado por el CYP2D6 y la analgesia de la oxicodona es en gran medida independiente del CYP2D6. El objetivo fue determinar si la toma conjunta de fármacos CYP2D6 disminuía la efectividad de la hidrocodona. MetodologíaEstudio observacional prospectivo ll...<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 Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness.
CONCLUSIONS: CYP2D6 drug-drug interactions appear to change effectiveness of commonly prescribed drugs in the ED. Drug-drug interaction should be considered prior to prescribing CYP2D6 drugs. PMID: 25156930 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)


Comment on “An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy”
We read the review on “An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy” by Kreiner at al. [1] with great interest. We send our kudos to the authors for their excellent work. Their very practical questions are near to a spine surgeon's everyday work. Therefore, the questions will be fundamental to future discussions. The intention of this letter is to follow their impulse for discussion. We would like to focus on the recommendation (Grade I, ie, insufficient evidence) for or against the performance of aggressive discectomy or sequestrectomy for the avoidance of chronic low back pain in patients with lumbar disc herniation with radiculopathy whose symptoms warrant surgery (Question 24). (Source: The Spine Journal)


[Design of an educational tool for Primary Care patients with chronic non-specific low back pain.]
Authors: Díaz-Cerrillo JL, Rondón-Ramos A Abstract Current scientific evidence on the management of chronic non-specific low back pain highlights the benefits of physical exercise. This goal is frequently undermined due to lack of education of the subjects on the multifactorial, benign, and non-specific nature of low back pain, which can lead to a chronic disease with genuine psychosocial risk factors. Its influence may not only interfere with individual decision to adopt more adaptive coping behaviors, but also with the endogenous mechanisms of pain neuromodulation. Thus, the educational strategies and control of these factors have become important objectives to be incorporated into the management of the disorder and research guidelines. This paper presents the theoretical model...


Self-assessment/CPD – questions
A 57-year-old woman presented to the emergency department with central chest pain radiating to her jaw, associated with profuse sweating. She had a history of type 2 diabetes mellitus resulting in chronic renal failure, hypercholesterolaemia and hypertension. She was undergoing chronic renal replacement therapy in the form of peritoneal dialysis. She was also taking insulin, aspirin, atorvastatin, lisinopril, amlodipine, doxazosin and erythropoietin. She had no known drug allergies. (Source: Medicine)


Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas
In conclusion, this is an unusual presentation of NPHPT and highlights the long-term complications.Hiperparatiroidismo primário normocalcêmico (NPHPT) caracteriza-se pela elevação do hormônio da paratiroide (PTH), na ausência da elevação dos níveis séricos de cálcio e exclusão de causas secundárias. O caso descrito ilustra o seguimento de uma mulher na pós-menopausa com NPHPT que evoluiu com múltiplos adenomas. Este caso relata uma paciente de 77 anos de idade que tem dor generalizada crônica e osteoporose. O PTH inicial foi elevado com níveis séricos de cálcio, albumina, fósforo e 25OH vitamina D normais. A densitometria óssea (DMO) evidenciou um T-SCORE da coluna lombar: -3.0, colo do fêmur: -2.6 e rádio distal: -4.2. Outras causas de hiperparatireoidismo secundár...<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>


More common procedures for painful facial tics carry high costs
For patients who need surgery for facial pain caused by trigeminal neuralgia, the most cost-effective procedure is the least often used, reports a study. Trigeminal neuralgia is a relatively common chronic pain condition, especially among older adults. Sometimes called "tic douloureux," trigeminal neuralgia is associated with a typical pattern of painful facial tics. Pain is thought to be caused by blood vessels placing pressure on the trigeminal nerve in the face. (Source: ScienceDaily Headlines)


Driving ability in patients with severe chronic low back or osteoarthritis knee pain on stable treatment with tapentadol prolonged release: a multicenter, open-label, phase 3b trial - Sabatowski R, Scharnagel R, Gyllensvärd A, Steigerwald I.
INTRODUCTION: Strong centrally acting analgesics, including tapentadol prolonged release (PR), have demonstrated efficacy for the management of non-malignant, chronic pain. Maintaining patient independence, including the ability to drive safely, is a key g... (Source: SafetyLit: All (Unduplicated))


Concomitant Vascular Compressive Syndromes: Median Arcuate Ligament Syndrome With Nutcracker Syndrome
This article describes the presentation and management of two vascular compressive syndromes occurring within the same patient. Median arcuate ligament syndrome (MALS) presents as chronic mesenteric ischemia secondary to compression of the celiac trunk by the median arcuate ligament. Treatment by surgical decompression can provide relief. Nutcracker syndrome presents as vague flank or pelvic pain along with hematuria. It occurs secondary to compression of the left renal vein (LRV) by the superior mesenteric artery (SMA). (Source: Journal of Vascular Surgery)


Many U.S. Workers on Disability Use Narcotic Painkillers, Study Finds
Title: Many U.S. Workers on Disability Use Narcotic Painkillers, Study FindsCategory: Health NewsCreated: 8/22/2014 9:36:00 AMLast Editorial Review: 8/22/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


A Multifaceted Initiative to Improve Clinician Awareness of Pain Management Disparities
This study identifies health care provider attitudes, knowledge, and practices regarding the treatment of chronic pain in vulnerable patient populations and assesses whether a certified continuing medical education (CME) intervention can improve knowledge in this area. Survey responses revealed several knowledge gaps, including a lack of knowledge that the undertreatment of pain is more common in minority patients than others. Respondents identified language barriers, miscommunication, fear of medication diversion, and financial barriers as major obstacles to optimal pain management for this patient population. Participants who completed a CME-certified activity on pain management disparities demonstrated increased confidence in caring for disadvantaged patients, but only 1 of 3 knowledge ...<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>


Functions of the Temporomandibular System in Extracranial Chronic Pain Conditions: Modulatory Effects on Nocifensive Behavior in an Animal Model
Mastication may be able to activate endogenous pain inhibitory mechanisms and therefore lead to modulation of nociceptive processing. The purpose of this study was to examine the possible effect of food consistency on noxious input from the spinal system. (Source: Journal of Manipulative and Physiological Therapeutics)


The Impact of Multimorbidity on Sexual Function in Middle‐Aged and Older Women: Beyond the Single Disease Perspective
ConclusionsWomen with multiple chronic health conditions are at increased risk for decreased sexual function. Depression and incontinence may have particularly strong effects on sexual desire, frequency of activity, and satisfaction in women, independent of other comorbid conditions. Women's overall sexual satisfaction may be more strongly influenced by multimorbidity than age. Appa AA, Creasman J, Brown JS, Van Den Eeden SK, Thom DH, Subak LL, and Huang AJ. The impact of multimorbidity on sexual function in middle‐aged and older women: Beyond the single disease perspective. J Sex Med **;**:**–**. (Source: The Journal of Sexual Medicine)


The clinical significance of somatostatin in pancreatic diseases.
Authors: Sliwińska-Mossoń M, Veselý M, Milnerowicz H Abstract The aim of the study was to provide knowledge on somatostatin and its action on the body, particularly the pancreas - in physiological and pathological conditions. In order to get to know the properties of somatostatin, a hormone discovered over forty years ago, many studies that define its structure and the mechanisms by which it operates have been conducted. The properties of somatostatin receptors and the effect of somatostatin on the body - both a healthy one and in various disease stages - were determined. It was proven that the somatostatin had an inhibitive effect on the endo- and exocrine secretion of this organ, which allowed a hypothesis that it might play an important role in the pathophysiology of di...


Competing Goals Attenuate Avoidance Behavior in the Context of Pain
This study investigated whether pain-related fear and avoidance behavior are attenuated when individuals are faced with a pain avoidance goal and another valued but competing goal, operationalized as obtaining a monetary reward. Fifty-five healthy participants moved a joystick towards different targets. In the experimental condition, a movement to one target (Conditioned Stimulus; CS+) was followed by a painful unconditioned stimulus (pain-US) and a rewarding unconditioned stimulus on 50% (reward-US) of the trials, whereas the CS- movement was not. (Source: The Journal of Pain)


Randomized clinical trial comparing self‐gripping mesh with suture fixation of lightweight polypropylene mesh in open inguinal hernia repair
ConclusionSelf‐gripping mesh for open inguinal hernia repair was well tolerated and reduced early postoperative pain (within the first week), without increasing the risk of early recurrence. It did not reduce chronic pain. Registration number: NCT00827944 (http://www.clinicaltrials.gov). (Source: British Journal of 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>


Nerve Damage Might Explain Chronic Pain
New clues to fibromyalgia's origins could crack the case of chronic pain -- Read more on ScientificAmerican.com (Source: Scientific American - Official RSS Feed)


Botox may be useful in treating stomach cancers
ConclusionThese laboratory experiments show that nerves have a role in the development and advancement of stomach cancer. The early experiments in mice found that stopping the nervous supply by either cutting the vagus nerve or injecting it with Botox improved survival rates and reduced cancer growth.The Botox injections were not performed on any humans in this study. However, an early-phase clinical trial in humans with inoperable stomach cancer began in Norway in January 2013, with the results expected in 2016. This will determine the safety of such a procedure and work out the number of people who would need to be treated in a larger controlled trial to see whether the treatment is effective.You can reduce your risk of stomach cancer by quitting smoking if you smoke and moderating your ...


No Man is an Island: living in a disadvantaged neighborhood influences chronic pain development after motor vehicle collision, and this effect is moderated by common genetic variation influencing HPA axis function - Ulirsch JC, Weaver MA, Bortsov AV, Soward AC, Swor RA, Peak DA, Jones JS, Rathlev NK, Lee DC, Domeier RM, Hendry PL, McLean SA.
Living in a lower socioeconomic status neighborhood has been shown to alter stress system function and is associated with a number of adverse health outcomes, but its influence on musculoskeletal pain (MSP) outcomes after traumatic stress exposures such as... (Source: SafetyLit: All (Unduplicated))


Blood Transfusions May Cut Risk of 'Silent' Stroke in Kids With Sickle Cell
Title: Blood Transfusions May Cut Risk of 'Silent' Stroke in Kids With Sickle CellCategory: Health NewsCreated: 8/20/2014 5:36:00 PMLast Editorial Review: 8/21/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


One‐Year Outcomes of Spinal Cord Stimulation of the Dorsal Root Ganglion in the Treatment of Chronic Neuropathic Pain
DiscussionDespite methodological differences in the literature, DRG‐SCS appears to be comparable to traditional SCS in terms of pain relief and associated benefits in mood and quality of life. Its benefits may include the ability to achieve precise pain–paresthesia concordance, including in regions that are typically difficult to target with SCS, and to consistently maintain that coverage over time. (Source: Neuromodulation)<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>


Stage‐dependent C‐reflex, pain‐like behavior and opioid analgesia during the induction of chronic arthritis in rats
Abstract Chronic arthritis (CA) is a common clinical entity associated with persistent pain and limited response to opioid analgesic therapy. However, it is unknown whether these features of CA change depending on its stage of evolution. To address this, in a well‐established animal model of CA we studied the time course of electromyographic responses to electrical stimulation of C fibers (C‐reflex), pain‐like behavior as a response to mechanical nociceptive stimulation, and the inhibition of both responses by a prototypic opioid analgesic, morphine. To induce CA, rats received a single injection of complete Freund's adjuvant into the ankle joint and the C‐reflex responses to electrical stimuli or the nociceptive response to paw pressure test were studied 2, 4 or 6 weeks later. Th...


Antioxidants for pain in chronic pancreatitis.
CONCLUSIONS: Current evidence shows that antioxidants can reduce pain slightly in patients with chronic pancreatitis. The clinical relevance of this small reduction is uncertain, and more evidence is needed. Adverse events in one of six patients may prevent the use of antioxidants. Effects of antioxidants on other outcome measures, such as use of analgesics, exacerbation of pancreatitis and quality of life remain uncertain because reliable data are not available. PMID: 25144441 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


New strategy during complicated open appendectomy: Convert open operation to laparoscopy.
CONCLUSION: Lengthened-incision open appendectomy increases the incidence of complications and prolongs the hospital stay. Conversion of open to laparoscopic appendectomy is feasible and efficient in complicated cases. It decreases the rate of incisional and abdominal infections, allows faster return of bowel movements, and shortens the hospital stay. PMID: 25152597 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)


Pseudoparasitic appearance of undigested quinoa
A 42-year-old male farmer presented with chronic right lower quadrant abdominal pain, described as a persistent dull ache with an associated sensation of epigastric fullness. No other lower GI symptoms were described. There was no travel history. The result of stool examination was positive for only Blastocystis hominis EGD showed mild edema and erythema of the stomach mucosa compatible with gastritis. Colonoscopy revealed numerous egg-like tan-yellow ovoid objects, 2 to 3 mm in diameter, of unclear cause (A). (Source: Gastrointestinal Endoscopy)


Multimodal Treatment of Pain
This article discusses treatment modalities other than surgical and interventional approaches and also discusses the literature regarding these treatment modalities, including pharmacotherapy, physical and occupational therapy, psychological approaches including cognitive behavior therapy, and other adjunctive treatments like yoga and tai chi. (Source: Neurosurgery 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>


Repetitive transcranial magnetic stimulation in neuropathic pain secondary to malignancy: A randomized clinical trial
ConclusionThe results demonstrate that 10 rTMS sessions over the M1 can induce short‐term pain relief in malignant neuropathic pain. (Source: European Journal of Pain)


Effect of Diode Laser in the Treatment of Patients with Nonspecific Chronic Low Back Pain: A Randomized Controlled Trial
Photomedicine and Laser Surgery Sep 2014, Vol. 32, No. 9: 490-494. (Source: Photomedicine and Laser Surgery)


Systematic Review and Meta-Analysis of Psychological Therapies for Children With Chronic Pain
Conclusions&nbsp;Evidence for psychological therapies treating chronic pain is promising. Recommendations for clinical practice and research are presented. (Source: Journal of Pediatric Psychology)


Pain: Finding motivation in pain
In this study, the decreased motivation that occurred in two mouse models of chronic pain was associated with reduced activity in medium spiny neurons of the nucleus (Source: Nature Reviews Neuroscience)


An international consensus algorithm for management of chronic postoperative inguinal pain
Conclusion There is a need for guidelines with regard to management of CPIP. This algorithm can serve as a guide with regard to the diagnosis, management, and treatment of these patients and improve clinical outcomes. If an expectative phase of a few months has passed without any amelioration of CPIP, a multidisciplinary approach is indicated and a pain management team should be consulted. Pharmacologic, behavioral, and interventional modalities including nerve blocks are essential. If conservative measures fail and surgery is considered, triple neurectomy, correction for recurrence with or without neurectomy, and meshoma removal if indicated should be performed. Surgeons less experienced with remedial operations for CPIP should not hesitate to refer their patients to dedicated h...<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>


Dynamic spectral indices of the electroencephalogram provide new insights into tonic pain
Experimental pain models are widely used in the pain research community and have recently also gained increasing popularity in the clinical setting. They are used to unravel pain mechanisms in acute and chronic pain conditions, and to evaluate the mechanisms of action underlying analgesic treatments. Experimental pain models are also commonly used in phase II studies where new analgesics are used as proof of concept in healthy individuals before initiation of clinical studies, as they keep down expenses and allows for fast and efficient evaluation of new analgesic compounds (Mitchell et al., 2004; Olesen et al., 2012). (Source: Clinical Neurophysiology)


Adolescent chronic pain and association to perinatal factors: Linkage of Birth Registry data with the Young‐HUNT Study
ConclusionsPerinatal factors, and especially preterm birth and low birthweight, did not seem to have a major impact on pain complaints in adolescence. (Source: European Journal of Pain)


Addiction Disorders
Substance use disorders are common in primary care settings, but detection, assessment, and management are seldom undertaken. Substantial evidence supports alcohol screening and brief intervention for risky drinking, and pharmacotherapy is effective for alcohol use disorders. Substance use disorders can complicate the management of chronic noncancer pain, making routine monitoring and assessment for substance use disorders an important aspect of long-term opioid prescribing. Patients with opioid use disorders can be effectively treated with methadone in opioid treatment programs or with buprenorphine in the primary care setting. (Source: Medical Clinics of North America)


Evaluation of the perception of chronic ischemic pain in humans with peripheral arterial disease
The objective of this study was to evaluate the perception of chronic ischemic pain using the descriptors of pain and to rate the main descriptors of chronic pain to people with peripheral arterial disease (PAD). The study was conducted in two hospitals in Brazil and consisted of two phases. In phase I, 100 participants with a diagnosis of PAD and chronic pain evaluated 50 descriptors of pain using the Multidimensional Pain Evaluation Scale by the psychophysical method of category estimation using a numerical scale with 11 points. (Source: Journal of Vascular Nursing)


Antidepressant Drugs for Prevention of Acute and Chronic Postsurgical Pain: Early Evidence and Recommended Future Directions
Conclusions: There is currently insufficient evidence to support the clinical use of antidepressants—beyond controlled investigations—for treatment of acute, or prevention of chronic, postoperative pain. Multiple positive trials suggest the therapeutic potential of antidepressants, which need to be replicated. Other nontrial evidence suggests potential safety concerns of perioperative antidepressant use. Future studies are needed to better define the risk–benefit ratio of antidepressants in postoperative pain management. Higher-quality trials should optimize dosing, timing and duration of antidepressant treatment, trial size, patient selection, safety evaluation and reporting, procedure specificity, and assessment of movement-evoked pain relevant to postoperative functional recovery....<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 Marijuana
Source: HealthDay - Related MedlinePlus Pages: Chronic Pain, Marijuana, Prescription Drug Abuse (Source: MedlinePlus Health News)


Evaluation of the perception of chronic ischemic pain in humans with peripheral arterial disease
This study showed that the chronic ischemic pain by PAD is associated with multidimensional components of pain. (Source: Journal of Vascular Nursing)


[In Context] “It burns, it stabs, it throbs, it never stops”
The title of this book review is a quotation from a chapter written by a woman with chronic neuropathic pain that perfectly describes the sensory perception that can drastically impair the quality of life of a patient with a lesion of the nervous system. Neuropathic Pain, edited by Cory Toth and Dwight E Moulin, is a welcome, comprehensive book covering various aspects of neuropathic pain. It is authored by world authorities in both basic science and clinical neurology from Canada and around the world. (Source: Lancet Neurology)


Operating Characteristics of PROMIS Four‐Item Depression and Anxiety Scales in Primary Care Patients with Chronic Pain
ConclusionsThe PROMIS four‐item depression and anxiety scales are reasonable options as ultra‐brief measures for screening in patients with chronic pain. (Source: Pain Medicine)


Reliability and Validity of the Pain on Movement Questionnaire (POM) in Chronic Neck Pain
ConclusionsThe POM seems to be a reliable and valid instrument to assess POM in patients with chronic nonspecific neck 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>


Aberrant Drug‐Related Behaviors: A Qualitative Analysis of Medical Record Documentation in Patients Referred to an HIV/Chronic Pain Clinic
ConclusionsThe impact of including emotional language in the medical record is unknown. Development of instruments that can be used to facilitate ADRB documentation, as well as evidence‐based approaches to addressing ADRBs, is needed. (Source: Pain Medicine)


Associations of Socioeconomic Position and Pain Prevalence in the United States: Findings from the National Health and Nutrition Examination Survey
ConclusionTrends of chronic pain by SEP were opposite of acute pain as those in the highest SEP group tended to have less chronic pain than those in lower SEP groups. These findings suggest that SEP, in addition to race and ethnicity, may play a role in the development of pain as well as its treatment and management. (Source: Pain Medicine)


Prevalence Comparisons of Somatic and Psychiatric Symptoms Between Community Nonpatients Without Pain, Acute Pain Patients, and Chronic Pain Patients
ConclusionsCPPs are characterized to a significantly greater extent than comparison groups by somatic/psychiatric symptoms that are highly intercorrelated. This has implications for clinical practice and future research. (Source: Pain Medicine)


Mechanisms Underlying Chronic Whiplash: Contributions from an Incomplete Spinal Cord Injury?
ConclusionsThe potential value of MRI to quantify neuromuscular degeneration in chronic whiplash is recognized. Larger scaled prospective studies are warranted before stronger conclusions can be drawn. (Source: Pain Medicine)


Clonal differences in IgE antibodies affect cutaneous anaphylaxis-associated thermal sensitivity in mice.
Authors: Mack M, Tonc E, Ashbaugh A, Wetzel A, Sykes A, Engblom C, Shabani E, Mora-Solano C, Trier A, Swanson L, Ewan E, Martinov T, Chatterjea D Abstract Cellular and molecular mediators of immune responses are increasingly implicated in acute and chronic pain pathophysiologies. Here we demonstrate that passive cutaneous IgE/Ag anaphylaxis provokes increased thermal sensitivity in the hind paw tissue of mice. The murine anti-DNP IgE antibodies SPE-7 and ɛ26 are known to induce differential cytokine production in bone marrow cultured mast cells in vitro without antigen challenge. We found a novel, antigen-dependent heterogeneity in the thermal pain responses elicited in the hind paws between SPE-7 and ɛ26 sensitized DNP-challenged mice. Mice experienced pronounced hind paw therma...<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>


RGS9-2 modulates sensory and mood related symptoms of neuropathic pain.
Authors: Terzi D, Gaspari S, Manouras L, Descalzi G, Mitsi V, Zachariou V Abstract The signal transduction modulator Rgs9-2 (Regulator of G protein signaling 9-2) plays a key role in dopaminergic and opioidergic transmission in the striatum. Rgs9-2 is a potent modulator of opiate reward and analgesia, but its role in chronic pain remains unknown. Here, we use the spared nerve injury model (SNI), to evaluate the influence of Rgs9-2 in sensory symptoms, as well as in anxiety and depression-like behaviors observed under neuropathic pain conditions. Our data demonstrate that knockout of the Rgs9 gene reduces the intensity of thermal hyperalgesia and mechanical allodynia the first few days after nerve injury. This small, but significant effect is only observed at early time points after...


The efficacy of Acceptance and Commitment Therapy: An updated systematic review and meta-analysis.
Authors: Ost LG Abstract Acceptance and Commitment therapy (ACT) has attracted a lot of interest during the last 10-15 years with a strong increase of the number of randomized controlled trials (RCTs). The present review and meta-analysis includes 60 RCTs (4234 participants) on psychiatric disorders, somatic disorders, and stress at work. The mean effect size across all comparisons was small (0.42). Compared to the Öst (2008) meta-analysis there was no significant improvement in methodological quality and deterioration in effect size (from 0.68). When ACT was compared to various forms of cognitive or behavioral treatments a small and non-significant effect size of 0.16 was obtained. An evidence-base evaluation showed that ACT is not yet well-established for any disorder. It is pro...


Interoception, body awareness and chronic pain: results from a case-control study
Chronic pain remains an unresolved issue in clinical practice despite the extensive research investigating its behavioural and neural correlates. Evidence demonstrates that chronic pain results in altered representation of the body in the brain. Arguably, this impacts on the perception of the self and its associated processes; namely, interoceptive awareness and body awareness. However, there is minimal research investigating the links between interoceptive awareness, body awareness and chronic pain. (Source: International Journal of Osteopathic Medicine)


A Clinical Intervention in Chronic Pain and Insomnia with a Combined Model of Treatment: A Test of Concept
Abstract Co-occurring chronic pain and insomnia are common in a clinical setting. Cognitive–behavioral theoretical (CBT) frameworks exist for both conditions independently. The purpose of this study was to address the problem of co-occurring chronic pain and insomnia with an integrated CBT model based on empirical support. One-hundred eleven individuals (age range 21–65 years) meeting the general criteria for chronic pain and insomnia were included in this study. Participants completed a demographic form, the Dysfunctional Beliefs and Attitudes about Sleep—16-item version, Insomnia Severity Index, Sleep Hygiene Index, Sleep Associated Monitoring Index, Pain Catastrophizing Scale, Pain Disability Questionnaire, Modified Somatic Perceptions Questionnaire, Hospital Anxiety and...


Doctors, patients at the crossroads make difficult decisions together
Ann Johansson/UCLA When Craig Mann was diagnosed with prostate cancer, UCLA’s novel shared decision-making program helped him, working closely with his physicians, to make the choices he felt were right for him. Craig Mann was bewildered enough when he was diagnosed with prostate cancer late last year. The 54-year-old Lake Forest, Calif., man is a laboratory scientist who takes good care of himself, eating healthy foods and participating in marathons and triathlons. He was certainly unprepared to hear that he had cancer. But the diagnosis was only the first blow. Mann was taken aback by the numerous and different treatment options doctors presented to him. A urologist recommended surgery. A radiation oncologist recommended radiation therapy. Each option had pros and cons. Mann’s prima...<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>


Psychic surgeons can 'channel spirits who can shrink cancers and end chronic pain'
Cynthia Knapp (top) from Worthing and Cheryl Buckley (bottom) from Liss were in constant pain. But sessions with psychic surgeon Ray Brown cured them of their ills (Source: the Mail online | Health)


What Causes Proteinuria?
Discussion Proteinuria occurs relatively often in pediatric practice with 5-15% of school children having transient proteinuria, the most common cause. However, proteinuria can be a sign of kidney disease. Therefore, it is important to evaluate the proteinuria in light of the clinical situation. A good history and physical examination along with a full urinalysis and/or BUN and creatinine, or urine protein/creatinine ratio may be all that is necessary. Another patient with edema, hypertension or hematuria needs a fuller evaluation and treatment. Proteinuria is usually categorized into three groups to assist with evaluation and treatment and they include: transient, orthostatic or persistent. Transient means just that. It occurs only during the inciting problem and remits afterwards. It ge...


4‐bromopropofol decreases action potential generation in spinal neurons by inducing a glycine receptor‐mediated tonic conductance
Conclusions And ImplicationsThe highest glycine levels in the CNS were reported in the ventral horn of the spinal cord. This region mediates pain‐induced motor reflexes and participates in the control of muscle tone. We conclude that 4‐bromopropofol may serve as a starting point for the development of non‐sedative non‐addictive muscle relaxants and analgesics to be used in the therapy of patients suffering from low back pain. (Source: British Journal of Pharmacology)


Assessing structural changes in axial spondyloarthritis using a low-dose biplanar imaging system
Conclusion. Our results suggest that EOS could replace CR for the follow-up of structural damage of the spine, but its place in the classification of sacroiliitis needs to be further explored. (Source: Rheumatology)


Placebo and nocebo effects in chronic pain patients: How expectations and emotional feelings contribute to the experience of pain.
Placebo, as well as nocebo, effects have been primarily investigated in studies with healthy volunteers exposed to acute experimental pain. Yet with regard to chronic pain patients, there is emerging evidence for significant placebo effects but not for nocebo effects. Expectations of pain relief are known to contribute to placebo effects, and lately the influence of emotional feelings has also been investigated. In this line of research, an experiential method has been applied to capture the emotional feelings that chronic pain patients experience during placebo and nocebo interventions. The findings indicate that the patients’ expectations of treatment effects are highly embedded in their emotional feelings. Hence, in order to optimize placebo factors in the clinical treatment of patien...<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>


Analgesics in chronic back pain: The significance of patient attitudes to them and prior experience with them for placebo responses.
Patients’ attitude toward and their personal experience of analgesics may not only influence their expectations about new medications they are prescribed but might also influence placebo effects. We assessed attitudes toward pain medication with an 8-item instrument and experiences with pain medication with an 11-item instrument and evaluated the relationship of attitudes and experiences and placebo responses in chronic back pain patients. On average, patients reported a slightly negative attitude toward analgesics and a slightly positive experience with them compared to healthy pain-free controls that had a more positive attitude toward and experience of analgesics. Pain patients seemed to report their short-term experience with analgesics when completing our instrument, as can be seen ...


Imaging of degenerative lumbar intervertebral discs; linking anatomy, pathology and imaging
Low back pain is a common medical condition that has significant implications for healthcare providers and the UK economy. Low back pain can be classified as &lsquo;specific&rsquo; in which an underlying pathophysiological mechanism is identified (eg, herniated intervertebral disc). Advanced imaging should be performed in this situation and in those patients in whom systemic disease is strongly suspected. In the majority (approximately 90%), low back pain in &lsquo;non specific&rsquo; and there is a weak correlation with imaging abnormalities. This is an area of ongoing research and remains controversial in terms of imaging approach and treatment (eg, theory of discogenic pain, interpretation and treatment of endplate changes). With regards Modic endplate changes, current research suggests...


Development of onabotulinumtoxinA for chronic migraine
Discovery of the neuromuscular effects of botulinum toxin began in the early 19th century and has continued to evolve. Currently, onabotulinumtoxinA is approved by the U.S. Food and Drug Administration for two cosmetic and eight medical indications, including chronic migraine (CM). CM is a disabling form of migraine characterized by ≥15 headache days monthly and is believed to result from neuronal hypersensitivity to proinflammatory mediators, upregulation of sensory receptors, and consequent maladaptive pain responses with peripheral and central sensitization. OnabotulinumtoxinA achieves migraine prophylaxis in CM through regulation of vesicular trafficking and exocytosis, inhibition of peripheral release of neuropeptides and inflammatory peptides, and reduced cell surface expression of...


Evaluation of endoscopic dorsal ramus rhizotomy in managing facetogenic chronic low back pain
The lumbar facet or zygapophysial joints are paired diarthrodial articulations between posterior elements of adjacent vertebrae [1]. It consists of a distinct joint space capable of accommodating between 1 and 1.5mL of fluid, a synovial membrane, hyaline cartilage surfaces, and a fibrous capsule [2]. The facet joint capsule and the surrounding structures are innervated [3]. Chemical or mechanical stimulation of the facet joints and their nerve supply may elicit back and/or leg pain [4]. Facet joints have been implicated as a source of chronic pain with an overall prevalence of 31% (circa. (Source: Clinical Neurology and Neurosurgery)


Pain Management
Chronic pain is a complex problem to treat. Pain is at the crossroads of affective, cognitive, and somatic disorders not only symptomatically but also in terms of neural networks. That adds a complex and amorphous dimension of “sorrow” to pain disorders, making it more difficult to treat. In the last two decades, treatment of chronic pain has evolved. This evolution can be noted primarily in two main categories: conceptual evolution and technological evolution. This issue of Neurosurgery Clinics of North America is an attempt to provide a glimpse into how pain can be assessed and managed by several medical disciplines and approaches. We have covered classical or conventional techniques as well as innovative techniques in this issue. (Source: Neurosurgery 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>


Intrathecal Pain Pumps: Indications, Patient Selection, Techniques, and Outcomes
This article reviews the advantages and indications for intrathecal therapy, as well as recommendations for proper patient selection using a multidisciplinary team to provide a global assessment of the impact of chronic pain on the patient’s well-being. The goals and expectations of trialing are discussed alongside advantages and disadvantages of several trialing techniques. A discussion of outcomes is presented for patients with chronic pain due to both malignant and nonmalignant causes. (Source: Neurosurgery Clinics of North America)


Neurolysis, Neurectomy, and Nerve Repair/Reconstruction for Chronic Pain
Neuropathic pain may be a result of focal injury to a peripheral nerve. The treatment algorithm begins with nonoperative, then operative, options. In our practice, first-line surgical treatment should directly treat the injured nerve. Nerve decompression or neurolysis is useful in patients with entrapment syndromes and in cases where the course and/or the function of the nerve is altered by local scar or pathoanatomy. Neurectomy is an option in primary cases where numbness is an acceptable alternative to dysesthetic pain, or as an alternative following failed neurolysis. Nerve repair or reconstruction may improve pain by guiding axons past the neuroma. (Source: Neurosurgery Clinics of North America)


Peripheral Nerve/Field Stimulation for Chronic Pain
Peripheral nerve stimulation and peripheral nerve field stimulation involve the delivery of electrical stimulation using implanted electrodes either over a target nerve or over the painful area with the goal of modulating neuropathic pain. The selection of appropriate candidates for this therapy hinges on skillful application of inclusion and exclusion criteria, psychological screening, and an invasive screening trial. Patients with significant improvement in pain severity and pain-related disability during the trial are considered candidates for implantation of a permanent system. As with other implanted devices for neuromodulation, risks of mechanical failures, infection, and neurologic complications exist. (Source: Neurosurgery Clinics of North America)


Chronic Pain Rehabilitation
The article discusses chronic pain rehabilitation and describes its components and some of the core operating principles. Outcomes in chronic pain are best when multiple treatment strategies with a focus on functional restoration are employed, and this is often best done in an interdisciplinary pain rehabilitation program. (Source: Neurosurgery Clinics of North America)


Spinal pain: When is it time for an intervention?
The number of working-aged persons in the United States who are disabled and unable to lead productive lives has increased dramatically in the past 3 decades,1 swelling the rolls of the Social Security Disability Insurance system to a financial tipping point. As a useful metric to quantify this disability, the US Burden of Disease Collaborators have identified 3 of the top 5 causes of years lived with disability (YLD) in the United States: back, neck, and other musculoskeletal disorders accounted for about 6.2 million YLD in 1990 and 7.9 million YLD in 2010.2 It is critical that neurologists understand the complex tradeoffs of risk and benefit that invariably go along with addressing the pain symptoms that are often at the heart of disability claims. Utilization rates and costs have soared...<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>


Affective disturbance associated with premenstrual dysphoric disorder does not disrupt emotional modulation of pain and spinal nociception
Summary: Unlike persons with insomnia, major depression, and fibromyalgia, women with premenstrual dysphoric disorder do not have disrupted emotional modulation of pain.Abstract: In healthy individuals, emotions modulate pain and spinal nociception according to a valence linear trend (ie, pain/nociception is highest during negative emotions and lowest during positive emotions). However, emerging evidence suggests that emotional modulation of pain (but not spinal nociception) is disrupted in fibromyalgia and disorders associated with chronic pain risk (eg, major depression, insomnia). The present study attempted to extend this work and to examine whether women with premenstrual dysphoric disorder (PMDD), a cyclical syndrome associated with debilitating affective symptoms during the late-lut...


Osteoid osteoma of the phalanx and metacarpal bone: report of 17 cases
Conclusion The diagnosis of OO of the hand can be difficult, and it should be considered with bony pain or bony swelling, especially when the history is a chronic one. The CT scan allows visualisation and precise localisation of such benign tumour of the hand. The care should be taken to make the excision complete in order to avoid recurrence. (Source: Musculoskeletal Surgery)


Spinal Cord Injury Causes Brain Inflammation Associated with Cognitive and Affective Changes: Role of Cell Cycle Pathways - Wu J, Zhao Z, Sabirzhanov B, Stoica BA, Kumar A, Luo T, Skovira J, Faden AI.
Experimental spinal cord injury (SCI) causes chronic neuropathic pain associated with inflammatory changes in thalamic pain regulatory sites. Our recent studies examining chronic pain mechanisms after rodent SCI showed chronic inflammatory changes not only... (Source: SafetyLit: All (Unduplicated))


The Development and Testing of a Checklist to Study Behaviour Change Techniques used in a Treatment Programme for Canadian Armed Forces Members with Chronic Non-specific Low Back Pain.
CONCLUSIONS: The BCT nomenclature arising from this study and the PT-BCT checklist will be useful to further explore behaviour change in physiotherapy practice. The observation in this study that BCT were integrated into physiotherapists' practice illustrates how physiotherapists can play a role in changing behaviour, specifically in the presence of CNSLBP. PMID: 25125787 [PubMed] (Source: Physiotherapy Canada)


Negotiating the maze: risk factors for suicidal behavior in chronic pain patients - Newton-John TRO.
Chronic pain disorders can exert major negative effects on virtually every aspect of an individual's life. It is not surprising then that many chronic pain sufferers find themselves at a point of emotional fragility where they experience thoughts of ending... (Source: SafetyLit: All (Unduplicated))<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>


Monteggia type IV fracture in a child with radial head dislocation irreducible by closed means: a case report
Conclusion: Monteggia lesions of the paediatric elbow, albeit uncommon, should be considered in all forearm fractures. Accurate reduction of the radiocapitellar joint is crucial to prevent significant long-term consequences and failed closed reduction requires open reduction. Here we have described the management of a rare type IV lesion in which there was buttonholing of the radial head through the anterior capsule, causing the radiocapitellar dislocation to be irreducible (even after fixation of the radial and ulnar fractures). (Source: BMC Research Notes)


The effect of chronic shoulder pain on maximal force of shoulder abduction
The aim of this study was to determine if chronic shoulder pain had an effect on arm abduction strength and recruitment strategies of the serratus anterior, middle deltoid, and upper trapezius. (Source: Journal of Bodywork and Movement Therapies)


Clinical Roundup: Selected Treatment Options for Chronic Joint Pain
Alternative and Complementary Therapies Aug 2014, Vol. 20, No. 4: 218-223. (Source: Alternative and Complementary Therapies)


Pee-Shy: When You Don’t Go When You Gotta Go
For many experts, paruresis is most easily defined as an inability to urinate in public restrooms, particularly when other persons are present or may enter the room, that is often associated with considerable avoidance behavior, and is therefore best classified as social phobia behavior. (Photo; GooglePlay)read more (Source: Psychology Today Anxiety Center)


Federal Ethicon Trial Scheduled to Begin at the End of August in U.S....
The Firm is representing hundreds of women who allegedly suffered mesh erosion, chronic pain, organ damage and other serious and debilitating injuries after receiving implants marketed by Ethicon,...(PRWeb August 14, 2014)Read the full story at http://www.prweb.com/releases/ethicon-mesh-lawsuit/transvaginal-mesh-lawsuit/prweb12096073.htm (Source: PRWeb: Medical Pharmaceuticals)<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>


Report of the NIH Task Force on Research Standards for Chronic Low Back Pain
ConclusionThe RTF believes these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes. We expect the RTF recommendations will become a dynamic document, and undergo continual improvement. PerspectiveA task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of pheno...


Characterizing Heat‐Sensitization Responses in Suspended Moxibustion with High‐Density EEG
ConclusionsThese data were the first objective evidence of heat‐sensitization responses during suspended moxibustion, which were characterized by widespread oscillatory changes in scalp EEG. (Source: Pain Medicine)


Successful Treatment of Athletic Pubalgia in a Lacrosse Player with Ultrasound-Guided Needle Tenotomy and Platelet Rich Plasma Injection: A Case Report
Athletic pubalgia is a syndrome of persistent groin pain due to chronic, repetitive trauma or stress involving the pelvic joints and many musculotendinous structures that cross the anterior pelvis. As a result, the differential diagnosis can be complex, but insertional tendinopathies are the most common. This case report describes a novel approach to the treatment of distal rectus abdominis tendinopathies with ultrasound-guided needle tenotomy and platelet rich plasma (PRP) injection. Following injection, the patient returned to pain-free play at his previous level of intensity. (Source: PM and R)


The Effect of Exercise on Sleep and Fatigue in Rheumatoid Arthritis: A Randomized Controlled Study.
CONCLUSION: Our study demonstrates that an exercise program resulted in significant improvement in sleep quality and fatigue. This is particularly interesting given the importance of fatigue as an outcome measure in RA and gives us yet another reason to prescribe exercise in this population. PMID: 25128510 [PubMed - as supplied by publisher] (Source: J Rheumatol)


Improvement in quality of life after surgery for glomus tumors of the fingers.
This study aimed to assess improvement in quality of life after surgery in patients with glomus tumors. We performed a retrospective study from 1992 to 2011 to analyze 23 glomus tumors of the upper limbs in 22 patients. Pain was systematically the predominant symptom. Quality of life and disability were assessed preoperatively and postoperatively using two questionnaires in 11 patients: the Medical Outcome Study Short Form (SF-36 French version) and the Cochin Hand Functional Disability Scale. An evaluation of the visual analog scale (VAS) completed the study. The average age of patients was 48years with a sex ratio of 0.28. The location of the tumor was in the fingers in 20 (87%) cases. The average delay between onset of symptoms and surgery was 8.5years. Patients consulted an average ...<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 matter involvement in chronic musculoskeletal pain
In this study, we used whole-brain tract-based spatial statistics, and region-of-interest analyses of diffusion tensor imaging (DTI) data to demonstrate that patients with chronic musculoskeletal pain exhibit several abnormal WM integrity as compared to healthy controls. (Source: The Journal of Pain)


Opioids for Chronic Back Pain: Short-Term Effectiveness, Long-Term Uncertain.
Authors: Barry HC PMID: 25251003 [PubMed - as supplied by publisher] (Source: American Family Physician)


Successful Treatment of Athletic Pubalgia in a Lacrosse Player with Ultrasound-Guided Needle Tenotomy and Platelet Rich Plasma Injection: A Case Report
Athletic pubalgia is a syndrome of persistent groin pain due to chronic, repetitive trauma or stress involving the pelvic joints and many musculotendinous structures that cross the anterior pelvis. As a result, the differential diagnosis can be complex, but insertional tendinopathies are the most common. This case report describes a novel approach to the treatment of distal rectus abdominis tendinopathies with ultrasound-guided needle tenotomy and platelet rich plasma (PRP) injection. Following injection, the patient returned to pain-free play at his previous level of intensity. (Source: PM and R)


Fatigue Is Associated With Serum Interleukin-6 Levels and Symptoms of Depression in Patients on Chronic Hemodialysis
Little is known about activated immune-inflammatory pathways and interleukin-6 (IL-6) in the development of fatigue and/or depression in patients with end-stage renal disease on chronic hemodialysis (HD). (Source: Journal of Pain and Symptom Management)


Sleep Disordered Breathing and Chronic Respiratory Failure in Patients with Chronic Pain on Long Term Opioid Therapy
Conclusions:Patients on long-term opioids frequently have severe SDB, which in part is central in origin. PVT was markedly impaired. Half of the patients studied have evidence of chronic ventilatory failure.Commentary:A commentary on this article appears in this issue on page 853.Citation:Rose AR, Catcheside PG, McEvoy RD, Paul D, Kapur D, Peak E, Vakulin A, Antic NA. Sleep disordered breathing and chronic respiratory failure in patients with chronic pain on long term opioid therapy. J Clin Sleep Med 2014;10(8):847-852. (Source: Journal of Clinical Sleep Medicine : JCSM)<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 Opioids on Sleep and Breathing in Chronic Pain Patients
(Source: Journal of Clinical Sleep Medicine : JCSM)


High Prevalence of Opioid Use by Social Security Disability Recipients
More than 40 percent of Social Security Disability Insurance (SSDI) recipients take opioid pain relievers, while the prevalence of chronic opioid use is over 20 percent and rising, reports a study in the September issue of Medical Care. (Source: News at Dartmouth Medical School)


Arthroscopic repair of an avulsed latissimus dorsi tendon transfer for massive, irreparable rotator cuff tear: a report of two cases
Chronic, massive tears of the rotator cuff can cause significant pain and loss of function. Although some patients with massive tears of the rotator cuff respond well to nonoperative therapy, others progress to debilitating pain despite nonsurgical measures.10 Depending on the quality of the residual tendon or the presence of fatty infiltration of the rotator cuff musculature, or both, adequate repair may be unsuccessful or impossible.3,8 Transfer of the latissimus tendon remains a viable option for patients with irreparable posterior-superior rotator cuff tears who have weakness in forward elevation and external rotation with or without severe pain. (Source: Journal of Shoulder and Elbow Surgery)


RhoA/ROCK pathway mediates p38 MAPK activation and morphological changes downstream of P2Y12/13 receptors in spinal microglia in neuropathic pain
Recent studies have indicated an important role of ATP receptors in spinal microglia, such as P2Y12 or P2Y13, in the development of chronic pain. However, intracellular signaling cascade of these receptors have not been clearly elucidated. We found that intrathecal injection of 2‐(methylthio)adenosine 5′‐diphosphate (2Me‐SADP) induced mechanical hypersensitivity and p38 mitogen‐activated protein kinase (MAPK) phosphorylation in the spinal cord. Intrathecal administration of P2Y12/P2Y13 antagonists and Rho‐associated coiled‐coil‐containing protein kinase (ROCK) inhibitor H1152 suppressed not only p38 MAPK phosphorylation, but also mechanical hypersensitivity induced by 2Me‐SADP. In the rat peripheral nerve injury model, intrathecal administration of antagonists for the P2Y...


Cannabinoids increasingly recognized as powerful medicine for pain control, Alzheimer's prevention, stress relief and more
(NaturalNews) You may have noticed the flurry of new dietary supplements containing cannabinoids (CBDs) -- active chemical constituents of the cannabis plant. People everywhere are discovering the power of CBDs to reduce pain, enhance mood, relax the nerves and even help prevent chronic... (Source: NaturalNews.com)<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>


High prevalence of opioid use by Social Security disability recipients, reports Medical Care
(Wolters Kluwer Health) More than 40 percent of Social Security Disability Insurance recipients take opioid pain relievers, while the prevalence of chronic opioid use is over 20 percent and rising, reports a study in the September issue of Medical Care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. (Source: EurekAlert! - Medicine and Health)


Primary myelofibrosis: 2014 update on diagnosis, risk‐stratification, and management
Disease overview: Primary myelofibrosis (PMF) is a myeloproliferative neoplasm characterized by stem cell‐derived clonal myeloproliferation, abnormal cytokine expression, bone marrow fibrosis, anemia, splenomegaly, extramedullary hematopoiesis (EMH), constitutional symptoms, cachexia, leukemic progression, and shortened survival. Diagnosis: Diagnosis is based on bone marrow morphology. The presence of JAK2, CALR, or MPL mutation is supportive but not essential for diagnosis; approximately 90% of patients carry one of these mutations and 10% are “triple‐negative.” None of these mutations are specific to PMF and are also seen in essential thrombocythemia (ET). Prefibrotic PMF mimics ET in its presentation and the distinction, enabled by careful bone marrow morphological examination, ...


Reliability and validity of a simple and clinically applicable pain stimulus: sustained mechanical pressure with a spring-clamp.
Conclusions: Clamp pain was sensitive to changes in pain sensitivity provoked by conditioned pain modulation (CPM). Test/re-test reliability of the spring-clamp pain was better for healthy volunteers over a period of days, than for hospital patients over a period of weeks. A strong correlation (??=?0.73, P?>?0.0001) was found between clamp force and evoked pain intensity. Correlation to other pain stimuli varied, with a strong correlation between pre and post-CPM clamp pain intensity (??=?0.81, P?>?0.0001), moderate correlation between clamp pain and PPT (??=??0.43, P?>?0.0001), as well as CPT pain intensity (??=?0.32, P?>?0.0001) and a weak correlation with time to onset of CPT pain (??=??0.14, P? (Source: BioMed Central)


Cyclic phosphatidic acid relieves osteoarthritis symptoms
Conclusions: Our results suggest that 2ccPA significantly reduces the pain response to OA by inducing hyaluronic acid production and suppressing MMP-1, -3, and -13 production in synoviocytes and chondrocytes. (Source: Molecular Pain)


Safe Management of Chronic Pain in Pregnancy in an Era of Opioid Misuse and Abuse
ABSTRACT Safe and effective management of chronic pain in pregnancy is challenging. Use of over‐the‐counter analgesics, opioids, opioid substitution therapies, complementary and alternative therapies, antidepressants, and anxiolytics each have benefits and risks for the mother and neonate that must be considered. Because of their potency, opioids are often used despite associated risks for adverse effects, abuse, diversion, and addiction. Development of a pain management protocol for the counsel and care of pregnant women with pain is necessary. (Source: Journal of Obstetric, Gynecologic, and Neonatal 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>


Central changes associated with chronic pelvic pain and endometriosis
CONCLUSIONS The evidence reviewed in this paper demonstrates that CPP is associated with significant central changes when compared with healthy pain-free women. Moreover, the presence of these changes has the potential to both exacerbate symptoms and to predispose these women to the development of additional chronic conditions. These findings support the use of adjunctive medication targeting the CNS in these women. (Source: Human Reproduction Update)


Reliability and validity of a simple and clinically applicable pain stimulus: sustained mechanical pressure with a spring-clamp
Conclusions: Clamp pain was sensitive to changes in pain sensitivity provoked by conditioned pain modulation (CPM). Test/re-test reliability of the spring-clamp pain was better for healthy volunteers over a period of days, than for hospital patients over a period of weeks. A strong correlation (ρ = 0.73, P > 0.0001) was found between clamp force and evoked pain intensity. Correlation to other pain stimuli varied, with a strong correlation between pre and post-CPM clamp pain intensity (ρ = 0.81, P > 0.0001), moderate correlation between clamp pain and PPT (ρ = −0.43, P > 0.0001), as well as CPT pain intensity (ρ = 0.32, P > 0.0001) and a weak correlation with time to onset of CPT pain (ρ = −0.14, P  (Source: Chiropractic and Osteopathy)


Transcranial Magnetic Stimulation for Chronic Pain
Current data suggest that transcranial magnetic stimulation (TMS) has the potential to be an effective and complimentary treatment modality for patients with chronic neuropathic pain syndromes. The success of TMS for pain relief depends on the parameters of the stimulation delivered, the location of neural target, and duration of treatment. TMS can be used to excite or inhibit underlying neural tissue that depends on long-term potentiation and long-term depression, respectively. Long-term randomized controlled studies are warranted to establish the efficacy of repetitive TMS in patients with various chronic pain syndromes. (Source: Neurosurgery Clinics of North America)


Long-term outcome after randomizing prolene hernia system, mesh plug repair and lichtenstein for inguinal hernia repair
Conclusions Long-term outcome after randomizing PHS, MPR and L showed no clinically relevant differences in chronic pain and its consequences. Although chronic pain is diminishing over time it remains a serious complication and has sometimes an onset long after the inguinal repair. (Source: Hernia)


Reliability and validity of a simple and clinically applicable pain stimulus: sustained mechanical pressure with a spring-clamp
Conclusions Clamp pain was sensitive to changes in pain sensitivity provoked by conditioned pain modulation (CPM). Test/re-test reliability of the spring-clamp pain was better for healthy volunteers over a period of days, than for hospital patients over a period of weeks. A strong correlation (ρ = 0.73, P &gt; 0.0001) was found between clamp force and evoked pain intensity. Correlation to other pain stimuli varied, with a strong correlation between pre and post-CPM clamp pain intensity (ρ = 0.81, P &gt; 0.0001), moderate correlation between clamp pain and PPT (ρ = −0.43, P &gt; 0.0001), as well as CPT pain intensity (ρ = 0.32, P &gt; 0.0001) and a weak correlation with time to onset of CPT pain (ρ = −0.14, P &lt; 0.05). ...<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>


Make the Diagnosis: Aching Foot
(MedPage Today) -- Case Study: A seventy-four-year-old woman presented with right midfoot and hindfoot pain. Clinical and radiographic evaluation showed midfoot arthritis and chronic tendinopathy of the Achilles tendon. Medical history included severe wound complication following cholecystectomy twenty years prior. Preoperative blood test results were normal. Two days after complex right midfoot fusion and Achilles tendon reconstruction, the foot was moderately painful with severe swelling. Blood tests showed leukocytosis and an increased CRP level. Infection was considered, and six days after surgery, a debridement was performed. Antibiotic therapy was started after the biopsy, but the lesion spread rapidly. Repeat debridements were performed, but the ulcerations became deeper, and the s...


Interactive Sections of an Internet-Based Intervention Increase Empowerment of Chronic Back Pain Patients: Randomized Controlled Trial
Conclusions: Results suggest that interactive sections as part of Internet-based interventions can positively alter patients&#8217; feelings of empowerment and help prevent medication misuse. Detrimental effects were not observed. Trial Registration: ClinicalTrials.gov: NCT02114788; http://www.clinicaltrials.gov/ct2/show/NCT02114788 (Archived by WebCite at http://www.webcitation.org/6ROXYVoPR). (Source: Journal of Medical Internet Research)


Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: short-term and long-term results.
CONCLUSIONS: Symptoms and degenerative structural changes of chronic lateral epicondylitis are reduced after US-guided PNE associated with EccEx and stretching, with encouragingly low recurrences in the mid to long term. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02085928. PMID: 25122629 [PubMed - as supplied by publisher] (Source: Acupuncture in Medicine : journal of the British Medical Acupuncture Society)


The effect of chronic low back pain on tactile suppression during back movements.
Authors: Van Damme S, Van Hulle L, Danneels L, Spence C, Crombez G Abstract The aim of the present study was to examine whether tactile suppression, the phenomenon whereby tactile perception is suppressed during movement, would occur in the context of back movements. Of particular interest, it was investigated if tactile suppression in the back would be attenuated in those suffering from chronic low back pain. Individuals with chronic low back pain (N=30) and a matched control group (N=24) detected tactile stimuli on three possible locations (back, arm, chest) while performing a back or arm movement, or no movement. We hypothesized that the movements would induce tactile suppression, and that this effect would be largest for low-intense stimuli on the moving body part. We further h...


An uncommon pattern of polyneuropathy induced by lifetime exposures to drift containing organophosphate pesticides.
We examined 60 individuals (males: 50/60; 83.3%) from the original cohort still residing (more than 40 years) in the same communities. Exposure assessment was based on reports by Israeli institutions and the Bureau of Statistics. Information on personal status, work experience, exposures and symptoms was collected by questionnaires. The nervous system was systematically studied, evaluating cortical upper motor neurons, corticospinal tracts, lower motor neurons and peripheral nerves. Electrophysiological studies included conduction velocities, amplitudes and distal latencies of sensory and motor median, ulnar, tibial and sural nerves; F-waves for proximal nerve functions; thermal and pain thresholds for small thinly-myelinated and non-myelinated fibers; Transcranial Magnetic Stimulation 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>


Learning pain-related fear: Neural mechanisms mediating rapid differential conditioning, extinction and reinstatement processes in human visceral pain.
CONCLUSIONS: Abdominal pain stimuli are effective US that elicit conditioned pain-related fear even after very few learning experiences without full contingency awareness. These findings extend similar evidence of "rapid learning" in response to interoceptive US (e.g., conditioned taste aversion, conditioned nausea), and have implications for the pathophysiology and treatment of chronic abdominal pain such as in IBS. PMID: 25128878 [PubMed - as supplied by publisher] (Source: Neurobiology of Learning and Memory)


The Anterior Cingulate Cortex is a Critical Hub for Pain-Induced Depression
Besides chronic stress, chronic pain is a prevalent determinant for depression. Changes induced in specific brain regions by sustained pain may alter the processing of affective information, thus resulting in anxiodepressive disorders. Here, we compared the role of the anterior cingulate cortex (ACC) and of the posterior insular cortex (pIC) in the anxiodepressive, sensory and affective aspects of chronic pain. (Source: Biological Psychiatry)


Is the incidence of temporomandibular disorder increased in polycystic ovary syndrome?
Abstract: 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 fibrocartilage in temporomandibular disorders. Our aim was to evaluate the incidence of temopormandibular dysfunction in women with PCOS compared with an age-matched, disease-free, control group. We studie...


The Anterior Cingulate Cortex is a Critical Hub for Pain-Induced Depression
Besides chronic stress, chronic pain is a prevalent determinant for depression. Changes induced in specific brain regions by sustained pain may alter the processing of affective information, thus resulting in anxiodepressive disorders. Here, we compared the role of the anterior cingulate cortex (ACC) and of the posterior insular cortex (pIC) in the anxiodepressive, sensory and affective aspects of chronic pain. (Source: Biological Psychiatry)


Pathologic rupture of the spleen in a patient with acute myelogenous leukemia and leukostasis
Rupture of the spleen can be classified as spontaneous, traumatic, or pathologic. Pathologic rupture has been reported in infectious diseases such as infectious mononucleosis, and hematologic malignancies such as acute and chronic leukemias. Splenomegaly is considered the most relevant factor that predisposes to splenic rupture. A 66-year-old man with acute myeloid leukemia evolved from an unclassified myeloproliferative neoplasm, complaining of fatigue and mild upper left abdominal pain. He was pale and presented fever and tachypnea. Laboratory analyses showed hemoglobin 8.3 g/dL, white blood cell count 278 × 109/L, platelet count 367 × 109/L, activated partial thromboplastin time (aPTT) ratio 2.10, and international normalized ratio (INR) 1.60. A blood smear showed 62% of myeloblasts. ...<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>


Treating Chronic Pain Patients Is Rarely Easy
Despite rising rates of prescription drug abuse, there is no real consensus in the physician community on treatment protocols. Physicians often follow their own heart. (Source: Physicians Practice)


Mon Valley Hospital begins offering acupuncture
Monongahela Valley Hospital has begun offering acupuncture, a first for the Washington County hospital. Acupuncture is a procedure used to treat a variety of ailments including chronic pain, arthritis and headaches. Dr. Lauren Ayersman, who is a licensed medical acupuncturist, is offering the new service at the Mon-Vale HealthPlex in Rostraver. “The overall goal is to improve the body’s energy flow, which ultimately results in pain relief or an improved quality of life,” Ayersman said in… (Source: bizjournals.com Health Care:Biotechnology headlines)


Pelvic Pain: The Master of Disguise
Sourced from The Hysterectomy Association: Hysterectomy Association - Hysterectomy Association - hysterectomy, menopause and hormone replacement therapy (hrt) information and support for women. In July we started a new series of posts about invisible illnesses in conjunction with Covance. This month&#8217;s post is one which has a huge amount of relevance to our readers because it&#8217;s a problem which will almost certainly affect most, if not all at some point. The reason the subject caught our eye was because one study in particular has stood out for Covance recently &#8211; the trialling of a brand new treatment for chronic pain relief. But should we be searching for a treatment for pain, if that pain is just one symptom of a bigger condition? Why not concentrate on curing the disease...


The Appropriate Use of Neurostimulation of the Spinal Cord and Peripheral Nervous System for the Treatment of Chronic Pain and Ischemic Diseases: The Neuromodulation Appropriateness Consensus Committee
ConclusionsAppropriate neurostimulation is safe and effective in some chronic pain conditions. Technological refinements and clinical evidence will continue to expand its use. The NACC seeks to facilitate the efficacy and safety of neurostimulation. (Source: Neuromodulation)


The Appropriate Use of Neurostimulation: Stimulation of the Intracranial and Extracranial Space and Head for Chronic Pain
ConclusionsThe NACC concludes that extracranial nerve stimulation should be considered in the algorithmic treatment of migraine and other disorders of the head. We should strive to perfect targets outside the cranium when treating pain, if at all possible. (Source: Neuromodulation)<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 Appropriate Use of Neurostimulation: Avoidance and Treatment of Complications of Neurostimulation Therapies for the Treatment of Chronic Pain
ConclusionsThe NACC has identified the possibility of improving patient care and safety through practice modification. We recommend that all implanting physicians review this guidance and consider adapting their practice accordingly. (Source: Neuromodulation)


The Appropriate Use of Neurostimulation: New and Evolving Neurostimulation Therapies and Applicable Treatment for Chronic Pain and Selected Disease States
ConclusionsThe NACC concludes that the field of neurostimulation is an evolving and rapidly changing one that will lead to improved patient access, safety, and outcomes. (Source: Neuromodulation)


Muscle Fibers are Injured at the Time of Acute and Chronic Rotator Cuff Repair.
CONCLUSIONS: In a rat model, marked injury to muscle fibers is induced when the tendons of torn rotator cuffs are repaired to their anatomic footprint. CLINICAL RELEVANCE: In this animal model, we found that repair of chronically torn cuff muscles results in extensive injury throughout the muscle. Based on these findings, we posit that inducing a widespread injury at the time of surgical repair of chronically torn rotator cuff muscles may contribute to the problems of failed repairs or continued progression of fatty degeneration that is observed in some patients that undergo rotator cuff repair. Therapeutic interventions to protect muscle fiber membranes potentially could enhance outcomes for patients undergoing rotator cuff repair. To evaluate this, future studies that evaluate the us...


Outcomes of children after esophagogastroduodenoscopy for chronic abdominal pain
(Source: Clinical Gastroenterology and Hepatology)


Report of the National Institutes of Health Task Force on Research Standards for Chronic Low Back Pain
Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed nonspecific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. The purpose of this article is to disseminate the report of the National Institutes of Health (NIH) task force on research standards for cLBP. (Source: Journal of Manipulative and Physiological Therapeutics)<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>


Aloperine attenuated neuropathic pain induced by chronic constriction injury via anti-oxidation activity and suppression of the nuclear factor kappa B pathway.
CONCLUSION: ALO has antinociceptive effects on neuropathic pain induced by CCI. The antinociceptive effects of ALO against neuropathic pain is related to reduction of ROS, via suppression of NF-κB pathway. PMID: 25128276 [PubMed - as supplied by publisher] (Source: Biochemical and Biophysical Research communications)


Symptomatic Osseous Abnormalities at the Posteromedial Tubercle of the Talus: Magnetic Resonance Imaging Features
We present 5 cases of osseous abnormalities at the posteromedial tubercle of the talus depicted on magnetic resonance imaging in subjects with chronic symptoms at this location, with no history of local trauma, who had presented with posteromedial mechanical pain and/or tarsal tunnel syndrome. (Source: Journal of Foot and Ankle Surgery)


Treatment of Calcaneal Fracture with Severe Soft Tissue Injury and Osteomyelitis: A Case Report
We present the case of a complex calcaneal fracture complicated by soft tissue injury and osteomyelitis that highlights the importance of shared decision-making between patient and surgeon when considering reconstruction versus amputation. (Source: Journal of Foot and Ankle Surgery)


Outcomes of Children After Esophagogastroduodenoscopy for Chronic Abdominal Pain
Thakkar et al1 present a study suggesting that children with recurrent abdominal pain (RAP) of childhood very commonly have proximal gastrointestinal pathology when subjected to upper gastrointestinal endoscopy. These results challenge long-held beliefs and clinical experience suggesting that children with RAP invariably have functional, nonorganic disorders with strong psychosomatic origins. (Source: Clinical Gastroenterology and Hepatology)


Symptomatic Osseous Abnormalities at the Posteromedial Tubercle of the Talus: Magnetic Resonance Imaging Features
We present 5 cases of osseous abnormalities at the posteromedial tubercle of the talus depicted on magnetic resonance imaging in subjects with chronic symptoms at this location, with no history of local trauma, who had presented with posteromedial mechanical pain and/or tarsal tunnel syndrome. (Source: Journal of Foot and Ankle 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>


Treatment of Calcaneal Fracture with Severe Soft Tissue Injury and Osteomyelitis: A Case Report
We present the case of a complex calcaneal fracture complicated by soft tissue injury and osteomyelitis that highlights the importance of shared decision-making between patient and surgeon when considering reconstruction versus amputation. (Source: Journal of Foot and Ankle Surgery)


Opioid-Induced Hyperalgesia (OIH): A Real Clinical Problem or Just an Experimental Phenomenon?
Although opioid-induced hyperalgesia (OIH) is mentioned as a potential cause of opioid dose escalation without adequate analgesia, true evidence in support of this notion is relatively limited. Most studies conducted in the context of acute and experimental pain, which seemingly demonstrated evidence for OIH, actually might have measured other phenomena such as acute opioid withdrawal or tolerance. OIH studies in patients with chronic pain have used various experimental pain models (such as cold pain tolerance or heat pain intensity). (Source: Journal of Pain and Symptom Management)


Search for biomarkers aimed at improving treatment of painful bladder condition
Taking advantage of technology that can analyze tissue samples and measure the activity of thousands of genes at once, scientists are on a mission to better understand and treat interstitial cystitis (IC), a painful and difficult-to-diagnose bladder condition. IC is also known as bladder pain syndrome. Symptoms can include severe pelvic pain, urinary urgency and frequency and painful sexual intercourse. IC is often misdiagnosed as other conditions such as endometriosis, kidney stones or chronic urinary tract infections. (Source: ScienceDaily Headlines)


Clinical trial evaluates safety of stem cell transplantation in spine
A clinical trial to investigate the safety of neural stem cell transplantation in patients with chronic spinal cord injuries has been launched in the United States. Related goals of the clinical trial include evaluating the stem cell graft's survival and the effectiveness of immunosuppression drugs to prevent rejection. The researchers will also look for possible therapeutic benefits such as changes in motor and sensory function, bowel and bladder function, and pain levels. (Source: ScienceDaily Headlines)


Chronic cough: from a complex dysfunction of the neurological circuit to the production of persistent cough
Chronic cough or cough that lasts more than 8 weeks, once a chest x-ray and spirometry are confirmed normal, is caused by an alteration in a section of the route between peripheral receptors, mainly in the upper and lower airway and oesophagus, spinal cord and the cough centre in the brain stem involving the cortex. These mechanisms of cough have their homology in the circuit of chronic pain, and on that basis, should expand future research of chronic cough. Clinically chronic cough is easy to diagnose by an excessive response or hypertussia to low-intensity stimuli or banal stimuli, which we now call hypersensitivity cough syndrome, quantified by a positive reflex cough with capsaicin or citric acid. However, hypersensitivity cough syndrome can be impossible to quantify in the laboratory ...<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>


Urological chronic pelvic pain syndrome symptom flares: characterisation of the full range of flares at two sites in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network
ConclusionsOur findings suggest that flares are common and associated with greater symptoms, healthcare utilization, disruption and bother. Our findings also show the characteristics of flares most bothersome to patients (i.e. increased pelvic pain and duration), and thus of greatest importance to consider in future research on flare prevention and treatment. (Source: BJU International)


Characteristics of Cancer Patients Presenting to an Integrative Medicine Practice-Based Research Network
Conclusions: Demographic characteristics, depression scores, perceived stress scores, and reasons for seeking integrative cancer care were not significantly different between cancer patients and noncancer patients. Perceived stress may be an important indicator of QOL. The association of perceived stress, depression and pain with seeking spirituality suggests that providing IM interventions, such as effective stress management techniques and pastoral or spiritual counseling, may be helpful to patients living with cancer. (Source: Integrative Cancer Therapies)


Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes.
CONCLUSIONS: There was a reduction in operative time across all the subgroups. There was also a reduction in the period of hospitalisation post-caesarean section except in the subgroup where parietal peritoneum only was not sutured where there was no difference in the period of hospitalisation. The evidence on adhesion formation was limited and inconsistent. There is currently insufficient evidence of benefit to justify the additional time and use of suture material necessary for peritoneal closure. More robust evidence on long-term pain, adhesion formation and infertility is needed. PMID: 25110856 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Nerve Blocks for Chronic Pain
This article is an introduction and brief synopsis of the different available blocks that can be offered to a patient. (Source: Neurosurgery Clinics of North America)


Surgical treatment of chronic acromioclavicular joint dislocation with autogenous tendon grafts
Conclusions: Anatomic reconstruction of CC ligaments showed a moderate subjective outcome at the 4-year follow-up. After surgery, almost half the AC joints failed to stabilize. Lateral clavicle osteolysis and tunnel widening were notably common complications. (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>


Chronic intermittent hypoxia decreases pain sensitivity and increases the expression of HIF1α and opioid receptors in experimental rats.
CONCLUSIONS: CIH decreases pain sensitivity in rats, possibly through activating HIF-1α and increasing MOR and DOR expression. PMID: 25108706 [PubMed - as supplied by publisher] (Source: Sleep and Breathing)


MicroRNAs as modulators and biomarkers of inflammatory and neuropathic pain conditions.
Authors: Andersen HH, Duroux M, Gazerani P Abstract The post-transcriptional regulator molecules, microRNAs, have emerged as important biomarkers and modulators of numerous pathophysiological processes including oncogenesis and cardiovascular disease. Recently, a significant number of dysregulations in microRNAs have been reported in patients suffering from painful disorders such as complex regional pain syndrome, cystitis-induced chronic pain and irritable bowel disorder, in both affected tissues and the circulation. Moreover, microRNAs are known to be involved in pain processing based on several recent findings in animal models of inflammatory and neuropathic pain. The basis of this review was to cover and summarize available articles in English encompassing "microRNA and pain". ...


Prevalence of Chronic Narcotic Use Among Children with Inflammatory Bowel Disease
Narcotic analgesics are not recommended for long-term management of pain for patients with inflammatory bowel disease (IBD)—particularly pediatric patients. We compared chronic use of narcotics among children with IBD and the general population, and investigated factors associated with narcotic use in the pediatric IBD population. (Source: Clinical Gastroenterology and Hepatology)


The Effect of Diabetes Mellitus on Costs and Length of Stay in Patients with Peripheral Arterial Disease Undergoing Vascular Surgery.
CONCLUSION: The impact of diabetes as a comorbid condition in patients with PAD is significant, both clinically and economically. Factors that predict increased LOS in patients with PAD are DM, bypass surgery, amputation, CKD stage V, infection, and emergency admission. PMID: 25116276 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)


Attenuation of Neuropathic Pain by Saikosaponin a in a Rat Model of Chronic Constriction Injury.
Authors: Zhou X, Cheng H, Xu D, Yin Q, Cheng L, Wang L, Song S, Zhang M Abstract Despite immense advances in the treatment strategies, the effective treatment of patients suffering from neuropathic pain remains challenging. Saikosaponin a possesses anti-inflammatory activity. However, the role of saikosaponin a in neuropathic pain is still unclear. Therefore, the objective of this study was to investigate the effects of saikosaponin a on neuropathic pain. Neuropathic pain was induced by chronic constriction injury (CCI) of the sciatic nerve in rats. After CCI, rats were administered saikosaponin a (6.25, 12.50 and 25.00 mg/kg intraperitoneal, once daily) for 14 days. Mechanical withdrawal threshold and thermal withdrawal latency were assessed before surgery and on days 1, 3, 7,...<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>


Lumbosacral discitis-osteomyelitis after mesh abdominosacrocolpopexy
A 61 year-old female was referred with a 1-month history of acute-on-chronic low back pain with left L5 radiculopathy. She had undergone transvaginal hysterectomy with mesh abdominosacrocolpopexy for vaginal prolapse 2-months prior. Medical history was otherwise unremarkable. The patient reported pain with percussion of the lumbosacral spine. She had a mild left foot drop with normal sensation and reflexes. Straight leg raise was negative. (Source: The Spine Journal)


Prevalence of Chronic Narcotic Use Among Children With Inflammatory Bowel Disease
Narcotic analgesics are not recommended for long-term management of pain for patients with inflammatory bowel disease (IBD), particularly pediatric patients. We compared chronic use of narcotics among children with IBD and the general population and investigated factors associated with narcotic use in the pediatric IBD population. (Source: Clinical Gastroenterology and Hepatology)


Lumbosacral discitis-osteomyelitis after mesh abdominosacrocolpopexy
A 61-year-old woman was referred with a 1-month history of acute-on-chronic low back pain with left L5 radiculopathy. She had undergone transvaginal hysterectomy with mesh abdominosacrocolpopexy for vaginal prolapse 2 months prior. Medical history was otherwise unremarkable. The patient reported pain with percussion of the lumbosacral spine. She had a mild left foot drop with normal sensation and reflexes. Straight leg-raise test was negative. (Source: The Spine Journal)


Topical Calcium Carbonate Soda Crystals for Refractory Cancer-Related Lower Limb Edema
Peripheral edema is a palpable swelling of the soft tissues of one or more upper or lower limbs caused by expansion of the interstitial fluid volume. Chronic limb edema is a common problem in cancer patients in which obstruction of lymphatic flow develops as a result of the cancer itself, cancer complications such as thromboembolism, or cancer treatment such as surgery or radiotherapy.1 (Source: Journal of Pain and Symptom Management)


Emotional Balance for Healthy Aging – 1st in a new series
While emotions can affect people of all ages, older adults are particularly susceptible as their bodies begin to exhibit the signs of normal wear and tear after decades of use. And because seniors are also at risk of being over-medicated for physical pain by doctors who do not assess its emotional components, I’ll be focusing on that topic during the next several months.read more (Source: Psychology Today Depression Center)<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>


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Pediatric Health Associates is excited to announce that we are starting a walk-in clinic starting Wednesday September 2nd at the Napervilleoffice from 8 to 9am Monday through Friday. Our goal is to provide parents with more convenient access in a familiar environment with pediatricians that know your children and allow families with busy schedules the ability to better manage their day. We do request that if your child has a chronic illness, multiple issues, or a lengthy complaint that requires more time with a provider to please schedule an appointment.Walk-ins will be based on a first come first serve basis. In order to maintain the convenience aspect of our walk-in program, we please ask families to use the walk-ins primarily for acute illnesses such as fever, cough, sore throat, ear pa...


Scientists Inch Closer Toward Using Stem Cells for Spinal Injuries
Title: Scientists Inch Closer Toward Using Stem Cells for Spinal InjuriesCategory: Health NewsCreated: 8/7/2014 2:35:00 PMLast Editorial Review: 8/8/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


The reported pain coping strategies of pediatric burn survivors-does a correlation exist between coping style and development of anxiety disorder? - Brubaker Rimmer R, Bahar Alam N, Bay RC, Sadler IJ, Foster KN, Caruso DM.
This study sought to determine whether an association existed between self-reported pain coping skills and anxiet... (Source: SafetyLit: All (Unduplicated))


The anti-suicidal potential of buprenorphine: a case report - Striebel JM, Kalapatapu RK.
The very strong relationship between suicide, depressive disorders, and substance use disorders is well recognized. Certain pain syndromes are significantly associated with suicide, irrespective of co-occurring medical or psychiatric diagnosis. Chronic pai... (Source: SafetyLit: All (Unduplicated))


Effectiveness of Intra‐Articular Steroid Injection for Atlanto‐Occipital Joint Pain
ConclusionAO intra‐articular steroid injection appears effective for the short‐term control of chronic refractory pain arising from the AO joint. (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>


Study protocol for patient response to spinal manipulation - a prospective observational clinical trial on physiological and patient-centered outcomes in patients with chronic low back pain
DiscussionBeside alterations in material properties of the passive components of the spine, increased neuromuscular activity may also contribute to a stiffened spine. Examining changes in both spinal stiffness and flexion-relaxation along the course of the treatment provides an opportunity to understand if the therapeutic effect of SM is associated with its action on active and/or passive components of the spine.Trial registration: NCT01670292 on clinicaltrials.gov. (Source: BMC Complementary and Alternative Medicine)


Results of spine surgery and hip replacement in patients with chronic back pain after undergoing a structured rehabilitation program including cognitive - behavioral therapy
Conclusions: The indication for surgical intervention in patients with chronic low back pain and degenerative diseases must be critically assessed. THA in this cohort should focus on functional aspects, such as the improvement of range of motion, rather than the reduction of pain. Spine surgery in chronic low back pain patients after multidisciplinary pain program including cognitive ? behavioral therapy cannot be recommended due to its questionable success. (Source: BioMed Central)


Stair climbing - An insight and comparison between women with and without joint hypermobility: a descriptive study
Generalized joint hypermobility (GJH) is a frequent entity in rheumatology with higher prevalence among women. It is associated with chronic widespread pain, joint dislocations, arthralgia, fibromyalgia and early osteoarthritis. Stair climbing is an important functional task and can induce symptoms in hypermobile persons. The aim of this study was to compare ground reaction forces (GRF) and muscle activity during stair climbing in women with and without GJH. A cross-sectional study of 67 women with normal mobility and 128 hypermobile women was performed. (Source: Journal of Electromyography and Kinesiology)


Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study.
Conclusions A zero-profile integrated plate and spacer device for ACDF surgery produces clinical and radiological outcomes that are comparable to those for nonintegrated plate and spacer constructs. Chronic dysphagia rates are comparable to or better than those for previously published case series. PMID: 25105338 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)


Low back pain patients' beliefs about effective/ineffective constituents of a counseling intervention: a follow-up interview study.
Conclusions: The intervention had affected the patients' personal agency and space for action. We suggest that this effect was linked to the individually tailored approach drawing on both educational and motivational agents. Implications for Rehabilitation Maintaining everyday activities, including retaining one's occupation, is an important factor in low back pain rehabilitation. Counselling on low back pain rehabilitation must be aligned with people's beliefs about their illness. A counselling intervention made patients adopt exercising into their long-term management of low back pain. PMID: 25104215 [PubMed - as supplied by publisher] (Source: Disability 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>


Fulminant systemic vasculitis in systemic lupus erythematosus. Case report and review of the literature.
We report the case of a previously healthy 17-year-old woman with eight months' history of arthralgias and myalgias. Subsequently, she developed facial and lower limbs edema, and hair loss. Two weeks before admission to a secondary level hospital, she developed fever up to 40 ℃ followed by abdominal pain, rectal bleeding, hematemesis and blisters on both legs, reason for which she was hospitalized. With active bullous SLE with rapidly progressive glomerulonephritis suspected, she was treated with methylprednisolone pulses without response. After one week of treatment, she was transferred to a tertiary level hospital. On admission she presented acute arterial insufficiency of the lower extremities, respiratory failure with apnea, metabolic acidosis and shock; six hours later she died. A...


Quality Assessment of Acute Inpatient Pain Management in an Academic Health Center.
Authors: Lin RJ, Reid MC, Chused AE, Evans AT Abstract The quality of acute inpatient pain management remains suboptimal and poorly understood. In this retrospective study, we analyze acute pain management practice in a large academic health center using several quality indicators. Not surprisingly, despite high rate of pain assessment, many patients still have frequent, prolonged, and unrelieved severe pain episodes. Upon examination of naloxone administration, we identify potential inappropriate opioid prescription practices such as the use of wrong opioids in hepatic and renal failure and simultaneous use of multiple short-acting opioids. Most importantly, we find that chronic opioid users appear to suffer the most in terms of undertreatment of pain as well as opioid overdose, h...


Stair climbing – An insight and comparison between women with and without joint hypermobility: A descriptive study
Generalized joint hypermobility (GJH) is a frequent entity in rheumatology with higher prevalence among women. It is associated with chronic widespread pain, joint dislocations, arthralgia, fibromyalgia and early osteoarthritis. Stair climbing is an important functional task and can induce symptoms in hypermobile persons. The aim of this study was to compare ground reaction forces (GRF) and muscle activity during stair climbing in women with and without GJH. A cross-sectional study of 67 women with normal mobility and 128 hypermobile women was performed. (Source: Journal of Electromyography and Kinesiology)


Biodegradable Thin-Films Could Provide Long-Term, Localized Medication
As many as one in four adults suffer from chronic pain. Generally, these patients are treated for pain using medications in a pill form. But, the systemic application of drugs like this often leads to side effects, as they disperse throughout the whole body. (Source: Medical Design Online News)


Implementation of chronic illness care in German primary care practices - how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling
Conclusions: This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient's assessment is associated not only with practice-level factors, but also with individual, patient-level factors.Trial registration: Current Controlled Trials ISRCTN89818205. (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>


Prevalence and Risk Factors of Sexual Problems and Sexual Distress in a Sample of Women Suffering from Chronic Widespread Pain
ConclusionsCWP patients report more sexual pain and sexual distress compared with controls. Assessment of sexual problems should therefore be added to routine care of patients with CWP. Burri A, Lachance G, and Williams FMK. Prevalence and risk factors of sexual problems and sexual distress in a sample of women suffering from chronic widespread pain. J Sex Med **;**:**–**. (Source: The Journal of Sexual Medicine)


Burden of reduced work productivity among people with chronic knee pain: a systematic review
Conclusions A number of high quality studies consistently demonstrated that chronic knee pain or knee osteoarthritis is associated with absenteeism. However, data are lacking regarding presenteeism and individual or work-related risk factors for reduced work productivity among older workers with chronic knee pain. Systematic review registration number PROSPERO registry number: CRD42013004137. (Source: Occupational and Environmental Medicine)


Implementation of chronic illness care in German primary care practices ¿ how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling
Conclusions: This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient’s assessment is associated not only with practice-level factors, but also with individual, patient-level factors.Trial registrationCurrent Controlled Trials ISRCTN89818205. (Source: BMC Health Services Research)


Endoscopic ultrasound in the diagnosis and treatment of pancreatic disease.
Authors: Teshima CW, Sandha GS Abstract Endoscopic ultrasound (EUS) is an important part of modern gastrointestinal endoscopy and now has an integral role in the diagnostic evaluation of pancreatic diseases. Furthermore, as EUS technology has advanced, it has increasingly become a therapeutic procedure, and the prospect of multiple applications of interventional EUS for the pancreas is truly on the near horizon. However, this review focuses on the established diagnostic and therapeutic roles of EUS that are used in current clinical practice. In particular, the diagnostic evaluation of acute pancreatitis, chronic pancreatitis, cystic pancreatic lesions and solid masses of the pancreas are discussed. The newer enhanced imaging modalities of elastography and contrast enhancement are e...


Pathophysiology of autism spectrum disorders: Revisiting gastrointestinal involvement and immune imbalance.
Authors: Samsam M, Ahangari R, Naser SA Abstract Autism spectrum disorders (ASD) comprise a group of neurodevelopmental abnormalities that begin in early childhood and are characterized by impairment of social communication and behavioral problems including restricted interests and repetitive behaviors. Several genes have been implicated in the pathogenesis of ASD, most of them are involved in neuronal synaptogenesis. A number of environmental factors and associated conditions such as gastrointestinal (GI) abnormalities and immune imbalance have been linked to the pathophysiology of ASD. According to the March 2012 report released by United States Centers for Disease Control and Prevention, the prevalence of ASD has sharply increased during the recent years and one out of 88 childr...<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>


Multiple intraosseous vertebral lipomas with chronic back pain
A 53-year-old male patient presented with a 2-year history of low back dull pain, exacerbated by standing and alleviated slightly by lying down. Magnetic resonance imaging (MRI) showed multiple lipoid lesions within numerous vertebrae (Fig. 1). Computed tomography (CT) showed osteolytic lesions (Fig. 2). Tissue biopsy showed intraosseous lipoma (Fig. 3). (Source: The Spine Journal)


Introduction to Neuropathic Pain Syndromes
This article provides an overview of the epidemiology, clinical presentation, and treatment outcomes for craniofacial, spinal, and peripheral neurologic pain syndromes. Although the authors recognize that the diagnosis and treatment of the chronic forms of neuropathic pain syndromes represent a clinical challenge, there is an urgent need for standardized classification systems, improved epidemiologic data, and reliable treatment outcomes data. (Source: Neurosurgery Clinics of North America)


A longitudinal study evaluating the effects of interferon-alpha therapy on cognitive and psychiatric function in adults with chronic hepatitis C
To prospectively evaluate for changes in objective cognitive performance (attention, memory, and executive function) and psychiatric symptom severity (depression, anxiety, fatigue, and pain) in patients before, during and after interferon-alpha based therapy (IFN) for chronic hepatitis C virus infection (HCV). (Source: Journal of Psychosomatic Research)


No man is an island: Living in a disadvantaged neighborhood influences chronic pain development after motor vehicle collision
Summary: Pain recovery after trauma is influenced by neighborhood socioeconomic characteristics. These findings are independent of individual characteristics, and moderated by genetic variation in FKBP5.Abstract: Living in a lower socioeconomic status neighborhood has been shown to alter stress system function and is associated with a number of adverse health outcomes, but its influence on musculoskeletal pain (MSP) outcomes after traumatic stress exposures such as motor vehicle collision (MVC) has not been assessed. We performed a multicenter, prospective study that enrolled 948 European-American individuals within 24hours of MVC who were discharged home after emergency department evaluation. Follow-up evaluations were completed via telephone or Internet survey 6 weeks, 6 months, and 1 ye...


Multiple intraosseous vertebral lipomas with chronic back pain
A 53-year-old man presented with a 2-year history of low back dull pain, exacerbated by standing and alleviated slightly by lying down. Magnetic resonance imaging showed multiple lipoid lesions within numerous vertebrae (Fig. 1). Computed tomography showed osteolytic lesions (Fig. 2). Tissue biopsy showed intraosseous lipoma (Fig. 3). (Source: The 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>


Trevena begins Phase I trial of TRV734 to treat acute and chronic pain
US-based pharmaceutical firm Trevena has started the next Phase I trial for TRV734, a new drug candidate being developed as an orally administered treatment for moderate-to-severe acute and chronic pain. (Source: Drug Development Technology)


Lidocaine Injection May Help Treat Fibromyalgia, Study Suggests
Title: Lidocaine Injection May Help Treat Fibromyalgia, Study SuggestsCategory: Health NewsCreated: 8/5/2014 2:36:00 PMLast Editorial Review: 8/6/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


The prevalence of pain in bipolar disorder: a systematic review and large‐scale meta‐analysis
ConclusionPeople with BD experience significantly increased levels of pain (particularly chronic pain and migraine). The assessment and treatment of pain should form an integral part of the management of BD. (Source: Acta Psychiatrica Scandinavica)


Dopamine D3 Receptor Ser9Gly and Catechol-O-Methyltransferase Val158Met Polymorphisms and Acute Pain in Sickle Cell Disease.
CONCLUSIONS:: These exploratory findings suggest that DRD3 Ser9Gly and COMT Val158Met may contribute to pain heterogeneity in SCD, as suggested by the different rates of acute pain crisis. Specifically, SCD patients with the DRD3 homozygote genotypes, COMT 158 Met allele or Met/Met genotype, are more likely to have acute care utilization, an indicator of acute pain. These results, however, will need to be further examined in future large prospective studies. PMID: 25102390 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)


Practical Considerations for the Use of Tapentadol Prolonged Release for the Management of Severe Chronic Pain.
Authors: Sánchez Del Águila MJ, Schenk M, Kern KU, Drost T, Steigerwald I Abstract PURPOSE: Chronic pain is often challenging to address appropriately. Although patients with severe chronic pain may respond to treatment with an opioid analgesic, opioids are often associated with adverse effects that may lead patients to disrupt or discontinue therapy. In addition, opioid analgesics alone may not be effective for all types of chronic pain, including neuropathic pain. Tapentadol prolonged release (PR), a centrally acting analgesic with 2 mechanisms of action (μ-opioid receptor agonism and noradrenaline reuptake inhibition), provides strong and reliable analgesia across a range of indications, including nociceptive, neuropathic, and mixed types of chronic pain, and is associated wi...<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>


Short Term Effects of Classic Massage Compared to Connective Tissue Massage on Pressure Pain Threshold and Muscle Relaxation Response in Women With Chronic Neck Pain: A Preliminary Study
The purpose of this study was to evaluate the short-term effects of classic massage (CM) and connective tissue massage (CTM) on pressure pain threshold and muscle relaxation response in women with chronic neck pain. (Source: Journal of Manipulative and Physiological Therapeutics)


Cystic Adventitial Disease of the Common Femoral Artery Presenting with Acute Limb Ischemia
We present a case of CAD presenting as acute lower limb ischemia. A 54-year-old woman presented with a 48-hr history of sudden-onset right leg and foot pain associated with paresthesia and weakness. Duplex ultrasound and computed tomography angiogram showed acute occlusion of the common, superficial, and profunda femoral arteries. On surgical exploration, a mucinous cystic structure was found occluding the common femoral artery (CFA), which was later confirmed on histology as CAD. (Source: Annals of Vascular Surgery)


Pannexin 1: A novel participant in neuropathic pain signaling in the rat spinal cord
In this study, we examined the effect of three panx1 blockers, namely, 10panx peptide, carbenoxolone, and probenecid, on C-reflex wind-up activity and mechanical nociceptive behavior in a spared nerve injury neuropathic rat model involving sural nerve transection. In addition, the expression of panx1 protein in the dorsal horn of the ipsilateral lumbar spinal cord was measured in sural nerve–transected and sham-operated control rats. Sural nerve transection resulted in a lower threshold for C-reflex activation by electric stimulation of the injured hindpaw, together with persistent mechanical hypersensitivity to pressure stimuli applied to the paw. Intrathecal administration of the panx1 blockers significantly depressed the spinal C-reflex wind-up activity in both neuropathic and sham co...


Skip the Steroids for Shoulder Pain?
Title: Skip the Steroids for Shoulder Pain?Category: Health NewsCreated: 8/5/2014 9:35:00 AMLast Editorial Review: 8/5/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Parental chronic pain in relation to chronic pain in their adult offspring: family-linkage within the HUNT Study, Norway
Conclusions: This large family-linkage study show that maternal and paternal CMP are positively associated with CMP in the adult offspring, irrespective of parental and offspring age, and that the associations are strongest when both parents have CMP. Although the high prevalence of CMP in both parents and offspring suggests that not all cases are clinically relevant, the results suggest that chronic pain has a heritable component. (Source: BMC Public Health - Latest articles)<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 pain profiles in four cases of chronic non-specific axial low back pain: An examination of the limitations of contemporary classification systems
Classifying patients with chronic low back pain (CLBP) may facilitate targeted treatment, and optimise outcomes. Most classification systems (CS) do not consider multiple, interacting dimensions (for example, psychological or movement dimensions) involved in the lived experience of people with CLBP. A framework incorporating these multiple dimensions, and acknowledging individual variability, could provide a pathway to better assess and treat people with CLBP. Here we explored this proposition, presenting four cases (P1–4), profiling their clinical presentations within a multidimensional framework. (Source: Manual Therapy)


Negotiating the Maze: Risk Factors for Suicidal Behavior in Chronic Pain Patients
Abstract Chronic pain disorders can exert major negative effects on virtually every aspect of an individual’s life. It is not surprising then that many chronic pain sufferers find themselves at a point of emotional fragility where they experience thoughts of ending their life. Suicidal behavior encompasses a spectrum of experience, from “life weariness” or passive suicidal ideation, to more active suicidal intent and suicide completion. A range of risk factors for suicidal behavior in the general population have been identified, and these apply equally to the chronic pain population: a family history of mental illness, past history of suicide attempts, and the presence of comorbid depression. With regard specifically to chronic pain patients, elevated suicide risk is also a...


Headache in Behçet’s Syndrome: Review of Literature and NYU Behçet’s Syndrome Center Experience
Abstract Headache, a common and disabling symptom in Behçet’s syndrome, may be associated with a variety of neurologic syndromes and ocular inflammation, or may present as an isolated feature. Our objective is to describe the various neurologic and ocular syndromes of Behçet’s syndrome of which headache is a symptom, and to review the features of isolated headaches in Behçet’s. We also report results of a study of headache in Behçet's syndrome patients who are followed at NYU Hospital for Joint Diseases, the first study of its kind in North American patients, and the first to document prevalence of both episodic and chronic daily headache in Behçet’s. (Source: Current Pain and Headache Reports)


Intrathecal Opioids for Chronic Nonmalignant Pain: A Case Study and the Search for Balance
(Source: Pain Medicine)


Analgesic Use in Older Adults with Back Pain: The BACE Study
ConclusionsIn these older adults consulting their GP with back pain, 72% used analgesics at baseline. Despite a decrease in medication use during follow‐up, at 3 and 6 months a considerable proportion still used analgesics. (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>


Comparison of Pain, Functioning, Coping, and Psychological Distress in Patients with Chronic Low Back Pain Evaluated for Spinal Cord Stimulator Implant or Behavioral Pain Management
ConclusionsPre‐SCS patients possibly underreport psychological symptoms perhaps to gain SCS approval for SCS. Separate norms and cutoffs for pre‐SCS psychological evaluations may be needed to better identify risks of unsuccessful outcomes. Validity scales for measures of psychological distress also could be developed to detect biased reporting. Alternatively, referring clinicians may have referred patients for BPM who were more psychologically distressed and perceived as more in need of psychosocial intervention than those referred for pre‐SCS evaluations. Further investigation of clinical referral decisions and assessment bias is warranted to clarify the meaning of these differences and how they apply to patient outcomes. (Source: Pain Medicine)


Successful Management of Chronic Postsurgical Pain Following Total Knee Replacement
We report reversal of chronic postsurgical pain (CPSP) along with functional restoration after total knee replacement (TKR) in two patients, using a combination therapy that included ultrasonography‐guided pulsed radiofrequency (PRF) of nerves supplying the knee to provide pain relief, along with dry needling (DN) to relax myofascial triggers/bands that caused painful stiffness and restricted movement of muscles acting across the knee. Both patients showed demonstrable pain relief, as evidenced by changes in pain as assessed on the Numeric Rating Scale (patient 1: 4–9/10 [pre‐treatment] to 0–3/10 [6 months post‐treatment]; patient 2: 5–9/10 to 0–4/10), Oxford Knee Score (patient 1: 17 to 40; patient 2: 12 to 39), Self‐Administered Leeds Assessment of Neuropathic Symptoms an...


Contemporary Concepts in Management of Acute Otitis Media in Children
Acute otitis media (AOM) is a common disease of childhood. AOM is most appropriately diagnosed by careful otoscopy with an understanding of clinical signs and symptoms. The distinction between AOM and chronic otitis media with effusion should be emphasized. Treatment should include pain management, and initial antibiotic treatment should be given to those most likely to benefit, including young children, children with severe symptoms, and those with otorrhea and/or bilateral AOM. Tympanostomy tube placement may be helpful for those who experience frequent episodes of AOM or fail medical therapy. Recent practice guidelines may assist the clinician with such decisions. (Source: Otolaryngologic clinics of North America)


Motor Cortex Stimulation for Chronic Pain
Motor cortex stimulation produces significant relief of symptoms in many forms of refractory chronic pain disorders. (Source: Neurosurgery Clinics of North America)


Percutaneous Spinal Cord Stimulation for Chronic Pain: Indications and Patient Selection
Percutaneous spinal cord stimulation has a clinical benefit in selected patients with chronic neuropathic pain related to failed back surgery syndrome and complex regional pain syndrome. Patients with other peripheral neuropathic pain syndromes may also respond favorably. The cause of the chronic pain must be established to rule out remediable causes. Drug abuse or aberrant drug-related behaviors should be assessed before proceeding. A psychological evaluation identifies patients who may not benefit. Risk factors for infection should be corrected where possible. This safe, reversible treatment should be considered early for patients with intractable peripheral neuropathic pain. (Source: Neurosurgery 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>


A systematic review of therapeutic interventions to reduce acute and chronic post‐surgical pain after amputation, thoracotomy or mastectomy
ConclusionsAppropriate dose regimes of gabapentinoids, antidepressants, local anaesthetics and regional anaesthesia may potentially reduce the severity of both acute and chronic pain for patients. Ketamine was not effective at reducing chronic pain. Intercostal cryoanalgesia was not effective and has the potential to increase the risk of chronic pain. TIVA may be beneficial but the effects of opioids are unclear. (Source: European Journal of Pain)


The association of interpersonal trauma with somatic symptom severity in a primary care population with chronic pain: exploring the role of gender and the mental health sequelae of trauma - McCall-Hosenfeld J, Winter M, Heeren T, Liebschutz JM.
OBJECTIVE Female trauma survivors develop somatic symptoms more frequently than male survivors. We propose a model for somatic symptom development among trauma survivors, focusing on gender differences. METHODS Among 597 urban primary care patien... (Source: SafetyLit: All (Unduplicated))


Current pain perspectives: assessing suicide risk in patients with chronic pain and depression - Cheatle MD.
Nearly one-half of all patients seen in primary care experience persistent pain, and major depressive disorder is a common comorbidity with chronic pain. Language: en... (Source: SafetyLit: All (Unduplicated))


Precordial chest pain in patients with chronic Chagas disease
Precordial chest pain affects about 15% to 33% of patients with chronic Chagas disease. In the absence of megaesophagus, it should be ascribed to chronic Chagas heart disease. Precordial chest pain is atypical because it can usually neither be associated to physical exercise nor alleviated by nitroglycerin. However, in certain circumstances, precordial chest pain can masquerade as acute coronary syndrome. Although obstructive coronary artery disease can occasionally be found, microvascular angina seems to be the mechanism behind such phenomenon. (Source: International Journal of Cardiology)


Scientists create transparent mouse complete with see-through organs
Scientists have created see-through mice complete with transparent organs, in a new technique that could pave the way to a new generation of therapies for conditions ranging from autism to chronic pain. (Source: The Independent - Science)


Fighting Chronic Pain
How you can help a loved one cope (Source: Heart Insight)


The MAPP research network: design, patient characterization and operations
DiscussionThe MAPP Research Network represents a novel, comprehensive approach to the study of UCPPS, as well as other concomitant NUAS. Findings are expected to provide significant advances in understanding UCPPS pathophysiology that will ultimately inform future clinical trials and lead to improvements in patient care. Furthermore, the structure and methodologies developed by the MAPP Network provide the foundation upon which future studies of other urologic or non-urologic disorders can be based.Trial registration: ClinicalTrials.gov identifier: NCT01098279 "Chronic Pelvic Pain Study of Individuals with Diagnoses or Symptoms of Interstitial Cystitis and/or Chronic Prostatitis (MAPP-EP)". http://clinicaltrials.gov/show/NCT01098279 (Source: Epidemiologic Perspectives and Innovations)


[Research Article] Decreased motivation during chronic pain requires long-term depression in the nucleus accumbens
The effort mice are willing to put into obtaining a reward is decreased in inflammatory and neuropathic models of pain. [Also see Perspective by Fields] Authors: Neil Schwartz, Paul Temkin, Sandra Jurado, Byung Kook Lim, Boris D. Heifets, Jai S. Polepalli, Robert C. Malenka (Source: Science: Current Issue)


[Chronic Pain] A neuropeptide kills patient's motivation
Chronic pain is not only extremely disturbing and unpleasant; it can also make people depressed and demotivated. What causes these effects? Schwartz et al. discovered that – [Read More] (Source: This Week in 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>


Chronic Neuropathic Pain in SCI: Evaluation and Treatment.
Authors: Felix ER Abstract Chronic neuropathic pain develops in approximately 40% of people after a spinal cord injury (SCI) and is notoriously difficult to treat. Because of the frequent presence of more than one pain type and the complex mechanisms and symptoms associated with pain in individuals with SCI, a thorough evaluation is important. This review includes an overview of the most recent guidelines for evaluating and classifying pain, suggestions for standardizing outcome measures for clinical use, and a review of the positive and negative evidence for pharmacologic and nonpharmacologic interventions to consider when treating individuals with SCI and chronic neuropathic pain. PMID: 25064788 [PubMed - as supplied by publisher] (Source: Medical Physics)


The roles of adolescent attentional bias and parental invalidation of sadness in significant illness: A comparison between eating disorders and chronic pain.
Authors: Hughes-Scalise A, Connell A Abstract Biopsychosocial conceptualizations of eating disorders (EDs) suggest the combination of an individual's emotional vulnerability and invalidating environment increases the likelihood of developing pervasive emotion dysregulation, and subsequent use of ED behaviors to regulate emotion (Haynos & Fruzetti, 2011; Safer, Telch, & Chen, 2009). The current study aimed to provide initial support for this model in adolescent EDs, through examining the interaction between an adolescent's emotional vulnerability, indexed by attentional biases for emotions, and an invalidating family environment. Specifically, we examined the ability of this interaction to discriminate youth with EDs from a comparison group of youth with chronic pain diagnos...


Modeling effects of spinal cord stimulation on wide-dynamic range dorsal horn neurons: influence of stimulation frequency and GABAergic inhibition
Spinal cord stimulation (SCS) is a clinical therapy for chronic, neuropathic pain, but an incomplete understanding of the mechanisms underlying SCS contributes to the lack of improvement in SCS efficacy over time. To study the mechanisms underlying SCS, we constructed a biophysically based network model of the dorsal horn circuit consisting of interconnected dorsal horn interneurons and a wide-dynamic range (WDR) projection neuron and representations of both local and surround receptive field inhibition. We validated the network model by reproducing cellular and network responses relevant to pain processing including wind-up, A fiber-mediated inhibition, and surround receptive field inhibition. We then simulated the effects of SCS on the activity of the WDR projection neuron and found that...


A meta‐ethnography of patients' experiences of chronic pelvic pain: struggling to construct chronic pelvic pain as ‘real’
ConclusionThe innovation of our model is to demonstrate, for the first time, the central struggle to construct ‘pathological’ vs. ‘normal’ chronic pelvic pain, a struggle that is exacerbated by a culture of secrecy. More research is needed to explore men's experience and to compare this with women's experience. (Source: Journal of Advanced Nursing)


[Comparison of two screening questionnaires for patients with low back pain : Collation of risk factors for chronification].
CONCLUSION: Both screening questionnaires for chronic LBP have insufficient diagnostic and prognostic validity for routine use in ambulatory care. Further studies are needed to improve diagnostic and prognostic validity and to elaborate criteria for a targeted use of screening questionnaires to guide therapeutic interventions. PMID: 25070723 [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>


The MAPP research network: a novel study of urologic chronic pelvic pain syndromes
: Urologic chronic pelvic pain syndrome (UCPPS) may be defined to include interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The hallmark symptom of UCPPS is chronic pain in the pelvis, urogenital floor, or external genitalia often accompanied by lower urinary tract symptoms. Despite numerous past basic and clinical research studies there is no broadly identifiable organ-specific pathology or understanding of etiology or risk factors for UCPPS, and diagnosis relies primarily on patient reported symptoms. In addition, there are no generally effective therapies. Recent findings have, however, revealed associations between UCPPS and "centralized" chronic pain disorders, suggesting UCPPS may represent a local manifestation of mo...


beta-arrestin-2-biased agonism of delta opioid receptors sensitizes transient receptor potential vanilloid type 1 (TRPV1) in primary sensory neurons
Despite advances in understanding the signaling mechanisms involved in the development and maintenance of chronic pain, the pharmacologic treatment of chronic pain has seen little advancement. Agonists at the mu opioid receptor (MOPr) continue to be vital in the treatment of many forms of chronic pain, but side-effects limit their clinical utility and range from relatively mild, such as constipation, to major, such as addiction and dependence. Additionally, chronic activation of MOPr results in pain hypersensitivity known as opioid-induced hyperalgesia (OIH), and we have shown recently that recruitment of beta-arrestin2 to MOPr, away from transient potential vanilloid receptor type 1 (TRPV1) in primary sensory neurons contributes to this phenomenon. The delta opioid receptor (DOPr) has bec...


Azathioprine and 6-mercaptopurine for maintenance of surgically-induced remission in Crohn's disease.
CONCLUSIONS: Purine analogues may be superior to placebo for maintenance of surgically-induced remission in patients with CD, although this is based on two small studies. The results for efficacy outcomes between purine analogues and 5-ASA agents were uncertain. However, patients taking purine analogues were more likely than 5-ASA patients to discontinue therapy due to adverse events. No firm conclusions can be drawn from the two small studies that compared azathioprine to infliximab or adalimumab. Adalimumab may be superior to azathioprine but further research is needed to confirm these results. Further research investigating the efficacy and safety of azathioprine and 6-mercaptopurine in comparison to other active medications in patients with surgically-induced remission of CD is warrant...


Pain management following the Nuss procedure: a survey of practice and review
ConclusionsPost‐operative pain management following the Nuss procedure is variable and poorly characterized. Clinical trials or large observational registries comparing the safety and efficacy of primary modalities and long‐term outcomes are needed to enable evidence‐based decision‐making for the management of these patients. (Source: Acta Anaesthesiologica Scandinavica)


A meta-ethnography of patients' experiences of chronic pelvic pain: struggling to construct chronic pelvic pain as 'real'
CONCLUSION: The innovation of our model is to demonstrate, for the first time, the central struggle to construct 'pathological' vs. 'normal' chronic pelvic pain, a struggle that is exacerbated by a culture of secrecy. More research is needed to explore men's experience and to compare this with women's experience. PMID: 25081990 [PubMed - as supplied by publisher] (Source: Adv Data)<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>


NPSR1 polymorphisms influence recurrent abdominal pain in children: a population‐based study
Conclusions & InferencesGenetic variation at the NPSR1 locus impacts children's predisposition to RAP episodes in a Swedish population. Genetic variation in the NPSR1 gene, which codes for the neuropeptide S receptor, influences children's predisposition to recurrent abdominal pain (RAP) in a Swedish population. Based on this and previous genetic findings on colonic transit, the NPS‐NPSR1 system is proposed as a modulator of bowel function, which can affect individual risk of functional gastrointestinal disorders. (Source: Neurogastroenterology and Motility)


The Effect of NR2B Subunit Palmitoylation at the Spinal Level After Chronic Dorsal Root Ganglia Compression in Rats.
CONCLUSIONS:: These data suggest that upregulated NR2B palmitoylation in CCD-induced neuropathic pain and intrathecal injection of 2-BP could reduce pain behaviors and NR2B phosphorylation. Our findings indicate that spinal NR2B palmitoylation is an important component of CCD-induced neuropathic pain, and it might be a potential target for chronic pain therapy. PMID: 25089731 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)


Mitigating the Impact of Acute and Chronic Post-thoracotomy Pain
MODERN THORACIC SURGERY is used to treat a wide variety of disease states ranging from infectious diseases to malignancies. Thoracotomy and video-assisted thoracoscopic surgery (VATS) can be associated with significant pain, which may negatively impact patient recovery, rehabilitation, and overall satisfaction with medical care as well as potentially lead to chronic postsurgical pain syndromes, underscoring the importance of optimizing pain control. Strategies for acute postoperative pain control and for the treatment of chronic postsurgical pain after thoracic surgery will be discussed. (Source: Journal of Cardiothoracic and Vascular Anesthesia)


ß-arrestin-2-biased agonism of delta opioid receptors sensitizes transient receptor potential vanilloid type 1 (TRPV1) in primary sensory neurons
Despite advances in understanding the signaling mechanisms involved in the development and maintenance of chronic pain, the pharmacologic treatment of chronic pain has seen little advancement. Agonists at the mu opioid receptor (MOPr) continue to be vital in the treatment of many forms of chronic pain, but side-effects limit their clinical utility and range from relatively mild, such as constipation, to major, such as addiction and dependence. Additionally, chronic activation of MOPr results in pain hypersensitivity known as opioid-induced hyperalgesia (OIH), and we have shown recently that recruitment of beta-arrestin2 to MOPr, away from transient potential vanilloid receptor type 1 (TRPV1) in primary sensory neurons contributes to this phenomenon. The delta opioid receptor (DOPr) has bec...


Mediastinal mass in a 25-year-old man.
Authors: Waghray A, Sherpa L, Carpio G, Barreiro TJ Abstract A 25-year-old black man presented with left-sided chest pain and cough for 3 days. His pain was pressure-like and nonradiating and was aggravated with movement and relieved when the patient lay at a 45° angle. The patient denied fevers, chills, night sweats, and swelling but reported gaining 4 to 6 kg (10 to 15 lbs) in the past few months. His cough had started 2 weeks prior with yellow mucus production but he denied facial swelling or tenderness. He had no chronic medical conditions and was not taking medications. He had no known exposure to chemicals, fumes, or dust and no history of tobacco or alcohol abuse. PMID: 25091762 [PubMed - in process] (Source: Chest)<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>


Cell and molecular biology of intervertebral disc degeneration: current understanding and implications for potential therapeutic strategies
This article describes the background of IDD, current understanding and implications of potential therapeutic strategies. (Source: Cell Proliferation)


The Accuracy of Template‐Guided Refill Technique of Intrathecal Pumps Controlled by Fluoroscopy: An Observational Study
ConclusionsOur results suggest poor accuracy of insertion point identification using the template. This highlights the potential risk of errors related to identification of the puncture site using the template‐guided technique. (Source: Neuromodulation)


Invasive Cardiac Aspergillosis after Orthotopic Liver Transplantation.
Authors: Wiltberger G, Schmelzle M, Schubert S, Lübbert C, Brandmaier P, Berg T, Pfeiffer D, Rodloff A, Mohr FW, Jonas S Abstract Invasive aspergillus infection occurs in 5 - 42 % of liver-transplanted recipients and is a dangerous complication, associated with high mortality if untreated. However, the early diagnosis of invasive aspergillosis can be elusive, as clinical signs are unspecific and the pathogenic agent is difficult to demonstrate. We here report about a 58-year-old man with acute liver failure caused by newly diagnosed chronic hepatitis B infection who underwent liver transplantation. The postoperative course was uneventful, and the patient was discharged after 30 days. After 105 days the patient was readmitted because of fever, recurrent chest and abdominal pain....


Novel Tunneling System for Implantation of Percutaneous Nerve Field Stimulator Electrodes: A Technical Note
ConclusionsThe great adaptability of this system allows for implantation of electrodes subcutaneously with efficacy and ease. Here we present a technical note on the use of this system for subcutaneous implantation of peripheral nerve field stimulators. (Source: Neuromodulation)


Pain and inflammation in hidradenitis suppurativa correspond to morphological changes identified by high‐frequency ultrasound
ConclusionPatient assessments of flare activity and pain, and investigator assessment of erythema are strongly associated with morphological changes identified using ultrasound, suggesting that these patient‐ and investigator‐assessed items might be strong indicators of the degree of present inflammation in HS. (Source: Journal of the European Academy of Dermatology and Venereology)<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>


GP pain management: What are the 'Ps' and 'As' of pain management?
This article presents an easy scheme to help general practitioners efficiently assess, manage and review/follow up patients with chronic pain. DISCUSSION: The mnemonic presented for assessment is the '4Ps' (pain, other pathology/past medical history, performance/function and psychological/psychiatric status). For management, we can also use '4Ps' (physical, psychological, pharmacological and procedural) and for review there are the '6As' (activities, analgesia, adverse effects, aberrance behaviours, affects and adequate documentation). PMID: 25114989 [PubMed - in process] (Source: Australian Family Physician)


Dynamic long-term microstructural and ultrastructural alterations in sensory nerves of rats of paclitaxel-induced neuropathic pain.
CONCLUSION: Our research suggests a causal role for axonal degeneration, abnormalities in axonal mitochondria, and structural modification of axonal microtubules in paclitaxel-induced neuropathic pain, and the abnormal mitochondria could be connected to the chronic neuropathic pain. PMID: 25131233 [PubMed - in process] (Source: Chinese Medical Journal)


[Chronic knee pain in children and adolescents : Review of anatomical and overload-related knee pain].
Authors: Behnisch-Gärtner CM, Berger N Abstract BACKGROUND: Knee pain in children and adolescents is a common reason for presentation in pediatric orthopedic consultation. The causes are manifold and require a thorough patient history, detailed physical examination and extensive diagnostics. DIAGNOSTICS: Chronic knee pain in children and adolescents is a diagnosis by exclusion. An extensive patient history including training habits, pain localization and clinical examination provide indications vital for the diagnosis. Overuse is often the trigger. In dynamic investigations consideration should be given to muscle imbalance. Imaging techniques have a high sensitivity and specificity only in combination with the anamnesis and clinical findings. THERAPY: With pain therapy, ta...


Validation of a Brief Opioid Compliance Checklist for Patients with Chronic Pain
There has been a need for a brief assessment tool to determine compliance with use of prescribed opioids for pain. The purpose of this study was to develop and begin the validation of a brief and simple compliance checklist (Opioid Compliance Checklist; OCC) for chronic pain patients prescribed long-term opioid therapy. A review of the literature of opioid therapy agreements led to a 12-item OCC that was repeatedly administered to 157 patients who were taking opioids for chronic pain and followed for six months. (Source: The Journal of Pain)


Lack of Body Positional Effects on Paresthesias When Stimulating the Dorsal Root Ganglion (DRG) in the Treatment of Chronic Pain
ConclusionsNeuromodulation of the DRG produces paresthesias that remain consistent across body positions, suggesting that this paradigm may be less susceptible to positional effects than dorsal column stimulation. (Source: Neuromodulation)<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>


Preliminary evidence of altered biomechanics in adolescents with Juvenile Fibromyalgia
Conclusions: This study showed that adolescents with JFM exhibited objective alterations in biomechanics, and self‐reported fear of movement which may reinforce their activity avoidance. Interventions for JFM should include a focus on correcting functional deficits and instilling greater confidence in adolescents with JFM to engage in exercise to improve functional outcomes. © 2014 American College of Rheumatology. (Source: Arthritis Care and Research)


Barriers and facilitators to yoga use in a population of individuals with self-reported chronic low back pain: A qualitative approach.
Authors: Combs MA, Thorn BE Abstract Yoga has been found to be efficacious in treating chronic low back pain, yet biomedical treatments are most commonly used for pain. Promoting yoga as part of integrative care would reduce exclusive reliance on high-cost, higher-risk biomedical treatments. Attitudes toward yoga play a role in consideration of it as a treatment. The current study examined attitudes toward yoga in adults with chronic low back pain and compared these results to those found in a 2009 general population study. Participants completed a semi-structured interview where they responded to items about perceptions of potential barriers and facilitators to trying yoga. Participant responses were analyzed qualitatively and several common themes emerged. Themes identified by pa...


Report on a membership audit of the Association of Chartered Physiotherapists in Reflex Therapy (ACPIRT).
Authors: Berry G, Svarovska B Abstract Reflex Therapy (RT), akin to reflexology, is a non-invasive physiotherapy modality approved by the UK Chartered Society of Physiotherapists. One hundred members of the Association of Chartered Physiotherapists in Reflex Therapy (ACPIRT) participated in an audit to establish a baseline of practice. Findings indicate that experienced therapists use RT in conjunction with their professional skills to induce relaxation (95%) and reduce pain (86%) for patients with conditions including whiplash injury and chronic pain. According to 68% of respondents, RT is "very good," "good" or "as good as" orthodox physiotherapy practices. Requiring minimal equipment, RT may be as cost effective as orthodox physiotherapy with regards to duration and frequency of...


Use of dermal injection of activated protein C for treatment of large chronic wounds secondary to pyoderma gangrenosum
ConclusionAlthough this study has limited because of its small sample size and lack of a true placebo group, it does indicate that APC has potential as a therapeutic option for patients with chronic skin ulcers from PG. (Source: Clinical And Experimental Dermatology)


Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid‐induced constipation
Abstract BackgroundOpioids are effective for acute and chronic pain conditions, but their use is associated with often difficult‐to‐manage constipation and other gastrointestinal (GI) effects due to effects on peripheral μ‐opioid receptors in the gut. The mechanism of opioid‐induced constipation (OIC) differs from that of functional constipation (FC), and OIC may not respond as well to most first‐line treatments for FC. The impact of OIC on quality of life (QoL) induces some patients to decrease or stop their opioid therapy to relieve or avoid constipation. PurposeAt a roundtable meeting on OIC, a working group developed a consensus definition for OIC diagnosis across disciplines and reviewed current OIC treatments and the potential of treatments in development. By consensus, OI...<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>


Modified Weaver-Dunn procedure versus the use of a synthetic ligament for acromioclavicular joint reconstruction.
CONCLUSION. Chronic ACJ reconstruction using the Surgilig synthetic ligament achieved better Oxford Shoulder score and Nottingham Clavicle score and earlier return to work and sports, compared with the modified Weaver-Dunn procedure. PMID: 25163955 [PubMed - in process] (Source: Journal of Orthopaedic Surgery)


Correlation between radiographic and arthroscopic findings in Asian osteoarthritic knees.
CONCLUSION. The K&L scale correlated poorly with arthroscopic findings of articular cartilage degeneration in an Asian population with knee OA. PMID: 25163945 [PubMed - in process] (Source: Journal of Orthopaedic Surgery)


The Effect of Hydromorphone Therapy on Psychophysical Measurements of the Descending Inhibitory Pain Systems in Patients with Chronic Radicular Pain
ConclusionsThese results suggest that the descending inhibitory pain modulation, as manifested in humans by CPM and OA, is unlikely to be mediated by hydromorphone therapy. (Source: Pain Medicine)


A rare case of acetabulum osteomyelitis mimicking bone sarcoma.
Authors: Anagnostakos K, Schmitt E, Orth P Abstract A 57-year-old man presented to the authors' department with pain over the right hip joint over a 3-month period. External magnetic resonance imaging showed a structure in the right acetabulum that was highly suspicious for a bone sarcoma. External 3-phase bone scintigraphy substantiated the suspected diagnosis. A computer tomography-guided biopsy was performed. Microbiologic examination showed a Staphylococcus aureus strain. Histopathologic findings showed chronic fibrous osteomyelitis. Because of doubts about these findings made by radiologists, open biopsy with retrieval of bony samples from the acetabulum and hip joint puncture was repeated. At that time, the serum C-reactive protein level was 48.8 mg/dL and the white blood cel...


Incidence of Neuropathic Pain after Cooled Radiofrequency Ablation of Sacral Lateral Branch Nerves
ConclusionThe incidence of postprocedural neuropathic pain after cooled RFA for posterior sacroiliac joint complex denervation is low and in a similar range to that in the lumbar spine. We consider this procedure safe to be utilized by pain medicine practitioners. (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>


Validation of a Brief Opioid Compliance Checklist for Patients With Chronic Pain
There has been a need for a brief assessment tool to determine compliance with use of prescribed opioids for pain. The purpose of this study was to develop and begin the validation of a brief and simple compliance checklist (Opioid Compliance Checklist [OCC]) for chronic pain patients prescribed long-term opioid therapy. A review of the literature of opioid therapy agreements led to a 12-item OCC that was repeatedly administered to 157 patients who were taking opioids for chronic pain and followed for 6 months. (Source: The Journal of Pain)


High‐Cervical Spinal Cord Stimulation for Medically Intractable Chronic Migraine
ConclusionIn patients with intractable chronic migraine treated with high‐cervical SCS, pain and quality of life significantly improved, warranting further research. (Source: Neuromodulation)


Functional and Metabolic Changes in the Brain in Neuropathic Pain Syndrome against the Background of Chronic Epidural Electrostimulation of the Spinal Cord
Changes in functional and metabolic activities of the brain were evaluated by EEG and positron-emission/computer tomography with 18F-fluorodeoxyglucose in patients with neuropathic pain syndrome previous to and 3 months after implantation of a system for chronic epidural spinal cord stimulation. In most cases, the use of a nerve stimulator was followed by alleviation of neuropathic pain and partial normalization of functional and metabolic activities of brain structures responsible for pain perception, emotiogenic, behavioral, and autonomic responses. (Source: Bulletin of Experimental Biology and Medicine)


Animal models of inflammatory bowel disease: a review
Abstract Inflammatory bowel disease (IBD) represents a group of idiopathic chronic inflammatory intestinal conditions associated with various areas of the GI tract, including two types of inflammatory conditions, i.e., ulcerative colitis (UC) and Crohn’s disease (CD). Both UC and CD are chronic inflammatory disorders of the intestine; in UC, inflammation starts in the rectum and generally extends proximally in a continuous manner through the entire colon. Bloody diarrhea, presence of blood and mucus mixed with stool, accompanied by lower abdominal cramping, are the characteristic symptoms of the disease. While in CD, inflammatory condition may affect any part of the GI tract from mouth to anus. It mainly causes abdominal pain, diarrhea, vomiting and weight loss. Although th...


The Use of 10‐Kilohertz Spinal Cord Stimulation in a Cohort of Patients With Chronic Neuropathic Limb Pain Refractory to Medical Management
ConclusionsIn this small cohort of patients, high‐frequency 10‐kHz SCS reduced pain and improved quality of life. However, before we can conclude that high‐frequency 10‐kHz SCS for neuropathic pain of the upper and lower extremities is efficacious, a large‐scale multicenter observational study should be performed to corroborate our small retrospective study. (Source: Neuromodulation)<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>


Spinal Cord Stimulation Ameliorates Neuropathic Pain‐Related Sleep Disorders: A Case Series
ConclusionWith the use of an actigraph, improvements in sleep of patients with chronic pain undergoing SCS were demonstrated. One case showing improvement in sleep despite pain palliation may suggest that SCS might have independently affected the sleep system, although further studies are necessary. (Source: Neuromodulation)


Diagnostic and therapeutic efficacy of double-balloon endoscopy in patients with small intestinal diseases: Single-center experience in 513 procedures.
CONCLUSION: Double-balloon endoscopy is effective for the diagnosis and treatment of small intestinal diseases. Therapeutic interventions carried out by DBE seem to be useful and safe. PMID: 25254518 [PubMed - in process] (Source: The Turkish Journal of Gastroenterology)


Analysis of Adverse Events in the Management of Chronic Migraine by Peripheral Nerve Stimulation
ConclusionImplantation of the IPG closer to the lead location was associated with reduced AEs. PNS is a relatively new procedure, and the skill and precision in performing these procedures improves with experience. Our results demonstrate that as the implanter gains more experience with these procedures, a significant reduction in device‐ and procedure‐related AEs may be expected. (Source: Neuromodulation)


The Use of Non-Narcotic Pain Medication in Pediatric Gastroenterology
Abstract The perception of pain in children is easily influenced by environmental factors and psychological comorbidities that are known to play an important role in its origin and response to therapy. Chronic abdominal pain is one of the most commonly treated conditions in modern pediatric gastroenterology and is the hallmark of ‘functional’ disorders that include irritable bowel syndrome, functional dyspepsia, and functional abdominal pain. The development of pharmacological therapies for these disorders in adults and children has been limited by the lack of understanding of the putative, pathophysiological mechanisms that underlie them. Peripheral and central pain-signaling mechanisms are known to be involved in chronic pain originating from the gastrointestinal tract, but...


Clinical and Psychological Parameters associated with Pain Pattern Phenotypes in Women with Interstitial Cystitis/Bladder Pain Syndrome
We examined data on patients with interstitial cystitis/bladder pain syndrome, including body pain location mapping, and associated medical and psychosocial phenotyping to validate these body pain maps in a cohort of female patients with interstitial cystitis/bladder pain syndrome undergoing tertiary care. (Source: The Journal of Urology)<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>


Spinal Cord Stimulation for the Treatment of Chronic Back Pain Patients: 500‐Hz vs. 1000‐Hz Burst Stimulation
ConclusionThe results suggest that increasing the frequency from 500 to 1000 Hz while keeping the pulse width constant does not add any extra benefit in suppressing pain. Further studies should verify whether increasing the frequency above 1000 Hz has a similar lack of effect. (Source: Neuromodulation)


Conclusion: 38 Year Old Male – Chest Pain and Leg Paralysis.
Recap In the post yesterday , the paramedic crew was evaluating a 38 y.o. male who had sudden, severe chest pain, as well as leg numbness and paralysis, and whose vital signs showed a mild bradycardia and pronounced hypertension. The ECG obtained by EMS appears to be junctional, with an unclear contribution from the SA node. More concerning, however, is the ST segment elevation in V2-V5, with modest ST depression in aVF and perhaps in III. This would usually define an anterior wall acute coronary occlusion (i.e. STEMI). However, the depth of the S wave in V2 and V3, combined with the high R wave in V5 and V6, strongly suggest that left ventricular hypertrophy (LVH) is complicating interpretation of the ECG. Clinical Course At the time, the ED did not activate the cardiac catheterization l...


Teen 'Growing Pains' May Persist for Years
Left untreated, knee discomfort can become chronic, researchers caution Source: HealthDay Related MedlinePlus Pages: Chronic Pain, Knee Injuries and Disorders, Teen Health (Source: MedlinePlus Health News)


Diverticulitis patients reveal psychological and physical symptoms long after acute attacks
UCLA researchers interviewed people with diverticulitis and confirmed that many suffer psychological and physical symptoms long after their acute illness has passed.  For the study, published this week in the peer-reviewed journal Quality of Life Research, a UCLA team led by Dr. Brennan Spiegel interviewed patients in great detail about the symptoms they experience weeks, months or even years after an acute diverticulitis attack. Their striking findings add to growing evidence that, for some patients, diverticulitis goes beyond isolated attacks and can lead to a chronic condition that mimics irritable bowel syndrome. As they age, most people develop diverticulosis, a disorder characterized by the formation of pouches in the lining of the colon. More than 50 percent of people over 60 have...


Pharmacological treatment of diabetes in older people
Abstract The pharmacologic management of diabetes in older people is complex and challenging. It requires a comprehensive understanding of the individual beyond the diabetes itself. Through the ageing years, the older individual presents with diabetes‐related and non‐related comorbidities and complications, develops functional limitations and psychological issues, and may lack social support and access to care. A disturbance in these categories, known as the four geriatric domains, will negatively impact the diabetes self‐management and self‐efficacy, leading to poor outcomes and complications. Furthermore, older people with diabetes may be more interested in the management of other chronic conditions such as pain or impaired mobility, and diabetes may be lower in their list of pri...<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>


Predictive value of the complex magnetocardiographic index in patients with intermediate pretest probability of chronic coronary artery disease: results of a two-center study
ConclusionThe MCG test at rest has the potential to be useful in the noninvasive diagnosis of CAD in patients with intermediate pretest probability of disease and uninformative results of routine tests. (Source: Coronary Artery Disease)


codeine
Title: codeineCategory: MedicationsCreated: 12/31/1997 12:00:00 AMLast Editorial Review: 7/31/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


oxycodone, Oxycontin, Roxicodone, Oxect
Title: oxycodone, Oxycontin, Roxicodone, OxectCategory: MedicationsCreated: 5/11/1998 12:00:00 AMLast Editorial Review: 7/31/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Musculoskeletal Pain on Stopping Imatinib: Should We Worry?Musculoskeletal Pain on Stopping Imatinib: Should We Worry?
A first report on a withdrawal syndrome documents patients with chronic myelogenous leukemia with musculoskeletal pain after imatinib withdrawal. Medscape Medical News (Source: Medscape Hematology-Oncology Headlines)


Topical Ginger Treatment With a Compress or Patch for Osteoarthritis Symptoms
Conclusion: Topical ginger treatment has the potential to relieve symptoms, improve the overall health, and increase independence of people with chronic osteoarthritis. (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>


Ginger Therapy for Osteoarthritis: A Typical Case
Purpose: To describe a treatment for osteoarthritis known as ginger therapy applied by anthroposophic nurses for a specific personality type. Background: Ginger has been used medicinally in Asia since ancient times to bring inner warmth. Ginger therapy is part of the tradition of anthroposophic nursing, when managing chronic inflammatory conditions such as osteoarthritis. Osteoarthritis is a progressive disease of the synovial joint tissue that primarily affects those older than 65 years, causing pain on movement. Design: A patient with specific characteristics suffering osteoarthritis received 7 consecutive days of ginger therapy by anthroposophic nurses at an integrative medical center. Two weeks after the therapy, education was given to enable self-treatment in the home for a further 24...


Efficacy and safety of tanezumab added on to diclofenac sustained release in patients with knee or hip osteoarthritis: a double-blind, placebo-controlled, parallel-group, multicentre phase III randomised clinical trial
Conclusions Addition of tanezumab to DSR resulted in significant improvements in pain, function and global assessments in patients with OA. Although no new safety signals were observed, the higher incidence of adverse events in the tanezumab+diclofenac group suggests that combination therapy is unfavourable. Further investigations of tanezumab monotherapy for OA pain treatment are required. Clinical trial registration number NCT00864097 (Source: Annals of the Rheumatic Diseases)


Does stress affect the joints? Daily stressors, stress vulnerability, immune and HPA axis activity, and short-term disease and symptom fluctuations in rheumatoid arthritis
Conclusions Daily stressors and the stress-vulnerability factor worrying predict indicators of the short-term course of RA disease activity and fatigue and pain, while specific cytokines predict short-term fluctuations of fatigue. These stress-related variables and immune markers seem to affect different aspects of disease activity or symptom fluctuations independently in RA. (Source: Annals of the Rheumatic Diseases)


The impact of cortical remapping interventions on pain and disability in chronic low back pain: a systematic review
Cortical change, in the manner of cortical remapping is a common feature of and potential driver for chronic low back pain (CLBP). Novel interventions such as graded motor imagery (GMI) and mirror visual feedback (MVF) have been shown to facilitate correction of cortical changes and improve symptoms in other chronic pain states. However, little is known regarding the effectiveness of these treatment approaches in CLBP. (Source: Physiotherapy)


A randomised controlled trial protocol comparing McKenzie Therapy and motor control exercises on trunk muscle recruitment in people with chronic low back pain and directional
To investigate if McKenzie exercises when applied to a cohort of patients with chronic LBP who have a directional preference demonstrate improved recruitment of the transversus abdominis compared to motor control exercises when measurements where assessed from ultrasound images. (Source: 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>


Low Dose Radiotherapy for Plantar Fasciitis. Treatment Outcome of 171 patients
Plantar fasciitis (PF) is a chronic pain syndrome that significantly affects the quality of life of patients. Approximately 10%–16% of the population worldwide suffers from chronic, painful PF [1]. The underlying cause of PF is thought to be multifactorial. Degenerative changes of the heel fat pad, mechanical arch abnormalities that increase tension on the plantar fascia, and patient demographics, notably increasing age, obesity, and work-related weight-bearing are commonly implicated [2]. The present study included only patients above 65 years of age. (Source: The Foot)


Associations of Depressive Symptoms and Pain with Dialysis Adherence, Health Resource Utilization, and Mortality in Patients Receiving Chronic Hemodialysis.
CONCLUSIONS: Depressive symptoms and pain are independently associated with dialysis nonadherence and health services utilization. Depressive symptoms are also associated with mortality. Interventions to alleviate these symptoms have the potential to reduce costs and improve patient-centered outcomes. PMID: 25081360 [PubMed - as supplied by publisher] (Source: Clinical Journal of the American Society of Nephrology : CJASN)


Role of Nitrous Oxide in Ambulatory Anaesthesia
Abstract As the oldest anaesthetic still in routine use, the continued role of nitrous oxide is frequently questioned. There are a few well-defined situations in which nitrous oxide is contraindicated or undesirable; it is environmentally damaging and known to be toxic with prolonged exposure. However, evidence of serious harm is relatively lacking and mostly relates to prolonged and major surgery. In the ambulatory setting, the adverse effects of nitrous oxide are more limited and of minimal clinical relevance. Furthermore, there are numerous benefits which are not easily replicated by possible alternatives. Specifically, nitrous oxide improves the quality, speed and safety of induction of anaesthesia, enhances the quality of the maintenance phase, facilitates faster recovery and...


How should we measure the impact of chronic pain? Limitations of utility measurement using the EQ-5D and SF-6D
The measurement of health state utilities is conceptually relatively straightforward. Health states are valued such that a value of 1.0 is assigned to full health and 0.0 to being dead . Negative values reflect health states worse than death. (Source: Pain)


tDCS modulates cortical nociceptive processing but has little to no impact on pain perception
Summary: Our findings indicate that transcranial direct current stimulation does not significantly influence the processing of experimental nociceptive input on a cortical level. The clinical pain reduction observed in chronic pain populations was not supported.Abstract: Transcranial direct current stimulation (tDCS) effectively modulates cortical excitability. Several studies suggest clinical efficacy in chronic pain syndromes. However, little is known regarding its effects on cortical pain processing. In this double-blind, randomized, cross-over, sham controlled study, we examined the effects of anodal, cathodal, and sham stimulation of the left motor cortex in 16 healthy volunteers using functional imaging during an acute heat pain paradigm as well as pain thresholds, pain intensity rat...<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>


Stephen I. Katz on Improving the Lives of Patients with Arthritis
To improve the lives of people with arthritis, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is working toward a better understanding of the basic biology of diseases affecting the joints, better diagnosis and treatment of arthritis, and better tools to facilitate clinical trials. NIAMS was a key contributor to the development of tofacitinib, the first oral disease modifying antirheumatic drug (DMARD) for rheumatoid arthritis (RA) in a decade, which recently received  approval from the U.S. Food and Drug Administration. In the early 1990’s, NIAMS intramural researchers discovered Janus kinase 3, one member of the Janus kinases (JAKs) family of proteins, which are important in regulating the human immune system. This discovery, in concert with other st...


Frequent nocturnal awakening in children: prevalence, risk factors, and associations with subjective sleep perception and daytime sleepiness
Conclusion: FNA was associated with poor sleep and daytime sleepiness. Compared to sleep environment and family susceptibility, chronic health problems, poor psychosocial condition, and poor sleep hygiene had greater impact on FNA, indicating childhood FNA could be partly prevented by health promotion, by psychological intervention, and by improving sleep hygiene routine. (Source: BMC Psychiatry - Latest articles)


Flex-rigid Pleuroscopy Under Local Anesthesia in Patients with Dry Pleural Dissemination on Radiography
Conclusions Flex-rigid pleuroscopy under local anesthesia can be a well-tolerated diagnostic procedure for radiographic dry pleural dissemination with respect to diagnostic yield and complications. (Source: Japanese Journal of Clinical Oncology)


New perspectives on patient expectations of treatment outcomes: results from qualitative interviews with patients seeking complementary and alternative medicine treatments for chronic low back pain
Conclusions: Overall, these findings contribute to a growing body of literature exploring the role of expectations in patient outcomes. This paper provides important guidance that may help refine the way treatment expectations are studied in the future. In particular, participants' statements indicate that standardized measures of patient expectations should include items that capture hesitancy to articulate overly optimistic outcomes as well as interrelationships among different outcomes. (Source: BMC Complementary and Alternative Medicine)


Epigenetics in the Perioperative Period
Summary The perioperative period is characterized by profound changes in the body's homoeostatic processes. This review seeks to address whether epigenetic mechanisms may influence an individual's reaction to surgery and anaesthesia. Evidence from animal and human studies suggests that epigenetic mechanisms can explain many facets of susceptibility to acute and chronic pain, making them potential therapeutic targets. Modern pain management is still based upon opiates, and both the developmental expression of opioid receptors and opioid‐induced hyperalgesia have been linked to epigenetic mechanisms. In general, opiates seem to increase global methylation levels. This is in contrast to local anaesthetics, which have been ascribed a global demethylating effect. Even though no direct investi...<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>


Rocker bottom shoes for chronic back pain
Read the full story on MD Consult: Rocker bottom shoes for chronic back pain (Source: MD Consult: News: Top Stories)


Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias. A regional cohort study
This study investigated the total recurrence and risk of chronic pain in small primary ventral hernias. (Source: American Journal of Surgery)


Ehlers-Danlos Syndrome: A cause of epilepsy and periventricular heterotopia
Ehlers-Danlos syndrome (EDS) includes a group of hereditary connective tissue disorders (genetics defects affecting the biosynthesis and structure of collagen type I, III and V), mainly characterized by joint hypermobility, skin fragility, hyperextensibily and easy bruisability.1–7 It may also presents neurological features such as disease of the cerebrovascular system, peripheral neuropathy, plexopathy, chronic pain syndrome, spontaneous intracranial hypotension, polymicrogyria, subependymal periventricular heterotopias and epilepsy. (Source: Seizure: European Journal of Epilepsy)


Ehlers–Danlos syndrome: A cause of epilepsy and periventricular heterotopia
Ehlers–Danlos syndrome (EDS) includes a group of hereditary connective tissue disorders (genetics defects affecting the biosynthesis and structure of collagen type I, III and V), mainly characterized by joint hypermobility, skin fragility, hyperextensibility and easy bruisability.1–7 It may also presents neurological features such as disease of the cerebrovascular system, peripheral neuropathy, plexopathy, chronic pain syndrome, spontaneous intracranial hypotension, polymicrogyria, subependymal periventricular heterotopias and epilepsy. (Source: Seizure: European Journal of Epilepsy)


Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada
The nonmedical use of prescription opioids (POs) has emerged as a major public health concern, especially in North America where it has reached epidemic proportions, causing extensive morbidity and mortality (Dhalla et al., 2009; Fischer & Argento, 2012; Manchikanti, Boswell, & Hirsch, 2013). POs, pharmaceutical analgesic drugs (such as oxycodone and hydrocodone) designed for the treatment of moderate to severe chronic pain, are the most commonly misused class of prescription drugs (Fischer & Argento, 2012; Substance Abuse and Mental Health Service Administration, 2010). (Source: International Journal of Drug Policy)<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>


Corrigendum to: “Shared genetic factors underlie the chronic pain syndromes” [PAIN® 2014;155(8):1562–68]
The article above indicates that DED was classified by asking about a clinician’s diagnosis of dry eye disease together with the concomitant use of artificial tear eye drops or gel. The classification that was used in the article was by asking about a clinician’s diagnosis of dry eye disease together with the presence of dry eye symptoms in the last three months. (Source: Pain)


Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study
This study investigated the total recurrence and risk of chronic pain in small primary ventral hernias. (Source: American Journal of Surgery)


Ehlers–Danlos syndrome: A cause of epilepsy and periventricular heterotopia
Ehlers–Danlos syndrome (EDS) includes a group of hereditary connective tissue disorders (genetics defects affecting the biosynthesis and structure of collagen type I, III and V), mainly characterized by joint hypermobility, skin fragility, hyperextensibility and easy bruisability.1–7 It may also presents neurological features such as disease of the cerebrovascular system, peripheral neuropathy, plexopathy, chronic pain syndrome, spontaneous intracranial hypotension, polymicrogyria, subependymal periventricular heterotopias and epilepsy. (Source: Seizure: European Journal of Epilepsy)


Christopher F. Smith on Improving the Lives of Patients
Like PhRMA, improving the lives of people with arthritis is one of the cornerstones of the mission of the Arthritis Foundation.   The Foundation achieves this mission in several ways including help and support for people with arthritis, advocacy and access to critical medications, and research. Every day thousands of individuals with arthritis seek answers to a myriad of questions about this chronic, debilitating and incurable disease.   And they will seek those answers tomorrow, next week, next month and next year and beyond. As a 24/7 resource, the Arthritis Foundation is ready to provide answers.   In response to PhRMA report – Medicines in Development: Arthritis – we reached out to some Arthritis Foundation advocates to get their response to this question about how PhRMA can con...<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>


Christopher F. Smith on Improving the Lives of Patients with Arthritis
Like PhRMA, improving the lives of people with arthritis is one of the cornerstones of the mission of the Arthritis Foundation.   The Foundation achieves this mission in several ways including help and support for people with arthritis, advocacy and access to critical medications, and research. Every day thousands of individuals with arthritis seek answers to a myriad of questions about this chronic, debilitating and incurable disease.   And they will seek those answers tomorrow, next week, next month and next year and beyond. As a 24/7 resource, the Arthritis Foundation is ready to provide answers.   In response to PhRMA report – Medicines in Development: Arthritis – we reached out to some Arthritis Foundation advocates to get their response to this question about how PhRMA can con...


Cognitive and physical fatigue tasks enhance pain, cognitive fatigue and physical fatigue in people with fibromyalgia
Conclusions: These data show that people with fibromyalgia show larger increases in pain, perceived cognitive fatigue and perceived physical fatigue to both cognitive and physical fatigue tasks compared to healthy controls. The increases in pain and fatigue during cognitive and physical fatigue tasks could influence subject participation in daily activities and rehabilitation. © 2014 American College of Rheumatology. (Source: Arthritis Care and Research)


Local and regional anaesthetic techniques in wound management
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. (Source: Surgery (Medicine Publishing))


STAT3 inhibitor WP1066 as a novel therapeutic agent for bCCI neuropathic pain rats.
Authors: Xue ZJ, Shen L, Wang ZY, Hui SY, Huang YG, Ma C Abstract Activation of signal transducer and activator of transcription-3 (STAT3) is suggested to be critically involved in the development of chronic pain, but the complex regulation of STAT3-dependent pathway and the functional significance of inhibiting this pathway during the development of neuropathic pain remain elusive. To evaluate the contribution of the JAK2/STAT3 pathway to neuropathic pain and the potentiality of this pathway as a novel therapeutic target, we examined the effects of the STAT3 inhibitor WP1066 by intrathecal administration in a rat model of bilateral chronic constriction injury (bCCI). The pain behavior tests were performed before the surgery and on postoperative day 3, 7, 14 and 21. L4~L6 dorsal sp...


Prescription Opioid Misuse in the United States and the United Kingdom: Cautionary Lessons
In the United States, opioid analgesics have increasingly been prescribed in the treatment of chronic pain, and this trend has accompanied increasing rates of misuse and overdose. Lawmakers have responded with myriad policies to curb the growing epidemic of opioid misuse, and a global alarm has been sounded amongst countries wishing to avoid this path. In the United Kingdom, a similar trend of increasing opioid consumption, albeit at lower levels, has been observed without an increase in reported misuse or drug-related deaths. (Source: International Journal of Drug Policy)<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>


Prescription opioid misuse in the United States and the United Kingdom: Cautionary lessons
In the United States, opioid analgesics have increasingly been prescribed in the treatment of chronic pain, and this trend has accompanied increasing rates of misuse and overdose. Lawmakers have responded with myriad policies to curb the growing epidemic of opioid misuse, and a global alarm has been sounded among countries wishing to avoid this path. In the United Kingdom, a similar trend of increasing opioid consumption, albeit at lower levels, has been observed without an increase in reported misuse or drug-related deaths. (Source: International Journal of Drug Policy)


Chronic Neuropathic Pain in SCI: Evaluation and Treatment
Chronic neuropathic pain develops in approximately 40% of people after a spinal cord injury (SCI) and is notoriously difficult to treat. Because of the frequent presence of more than one pain type and the complex mechanisms and symptoms associated with pain in individuals with SCI, a thorough evaluation is important. This review includes an overview of the most recent guidelines for evaluating and classifying pain, suggestions for standardizing outcome measures for clinical use, and a review of the positive and negative evidence for pharmacologic and nonpharmacologic interventions to consider when treating individuals with SCI and chronic neuropathic pain. (Source: Physical Medicine and Rehabilitation Clinics of North America)


Proove Biosciences Exhibits Industry Leading Data and Research at...
Proove Biosciences will present evidence-based research on how genetic testing and their proprietary services can improve chronic pain treatment.(PRWeb July 28, 2014)Read the full story at http://www.prweb.com/releases/2014/07/prweb12050214.htm (Source: PRWeb: Medical Pharmaceuticals)


Health Tip: Risk Factors for a Herniated Disk
Title: Health Tip: Risk Factors for a Herniated DiskCategory: Health NewsCreated: 7/28/2014 7:35:00 AMLast Editorial Review: 7/28/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Healthy vitamin D levels help relieve chronic pain
(NaturalNews) Previous studies have proven that maintaining adequate levels of vitamin D in the bloodstream increases our emotional well-being, encourages longevity and offers relief to patients suffering from chronic pain.Researchers at the Mayo Clinic concluded that sufficient... (Source: NaturalNews.com)<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>


Biopsychosocial Chronic Pain
The degree of chronic pain suffered is varied, and does not always correlate with the changes seen on x-ray, or even MRI. Psychosocial factors are consistently associated with the symptomatology of OA: Pain and restricted function are associated with more depressive symptoms, and the existence of depression has predicted which patients might worsen over time.read more (Source: Psychology Today Depression Center)


Subgrouping of Patients With Rheumatoid Arthritis Based on Pain, Fatigue, Inflammation, and Psychosocial Factors
ConclusionAlthough most patients had low levels of inflammation, pain, and fatigue, 47.3% continued to report having moderate to high levels of pain and fatigue. Most of these patients had minimal signs of inflammation but high levels of fatigue, pain catastrophizing, and sleep disturbance, indicative of a chronic widespread pain syndrome. (Source: Arthritis and Rheumatism)


Is Patellofemoral Osteoarthritis Common in Middle‐Aged People With Chronic Patellofemoral Pain?
ConclusionPF joint OA was highly prevalent, more so than TF joint OA, and even in individuals ages &lt;50 years. Further research is needed to elucidate the cause and effect relationship between chronic PF pain and PF joint OA. (Source: Arthritis Care and Research)


Radiofrequency ablation for chronic low back pain: A systematic review of randomized controlled trials.
Authors: Leggett LE, Soril LJ, Lorenzetti DL, Noseworthy T, Steadman R, Tiwana S, Clement F PMID: 25068973 [PubMed - as supplied by publisher] (Source: Pain Research and Management)


Non-alcoholic fatty liver disease and obesity: Biochemical, metabolic and clinical presentations.
This article reviews the available information on the biochemical and metabolic phenotypes associated with obesity and fatty liver disease. The relative contribution of visceral and liver fat to insulin resistance is discussed, and recommendations for clinical evaluation of affected individuals is provided. PMID: 25071327 [PubMed - as supplied by publisher] (Source: World Journal of Gastroenterology : WJG)<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>


Novel continuous passive motion device for self-treatment of chronic lower back pain: a randomised controlled study
To evaluate the efficacy of a novel, angular, continuous passive motion device for self-treatment at home in patients with mild-to-moderate, non-specific, chronic low back pain (LBP). (Source: Physiotherapy)


Physical, lifestyle, psychological, and social determinants of pain intensity, pain disability, and the number of pain locations in depressed older adults
Summary: It is important to adopt a biopsychosocial approach for chronic pain in late-life depression, paying special attention to associations between anxiety, chronic pain, and depression.Abstract: Late-life depression and pain more often co-occur than can be explained by chance. Determinants of pain in late-life depression are unknown, even though knowledge on possible determinants of pain in depression is important for clinical practice. Therefore, the objectives of the present study were 1) to describe pain characteristics of depressed older adults and a nondepressed comparison group, and 2) to explore physical, lifestyle, psychological, and social determinants of acute and chronic pain intensity, disability, and multisite pain in depressed older adults. Data from the Netherlands Stud...


Systematically searching for and assessing the literature for self-management of chronic pain: a lay users' perspective
Conclusion: This project was able to identify a number of exemplars of self management material along with some general rules regarding the categories identified. We must point out that the materials identified were not age specific, were often locally developed and would need to be adapted to older adults with chronic pain. For copyright issues we have not included them in this paper. The key message is really related to the format rather than the content. However, the group acknowledge that these may vary according to the requirements of each individual older adult and therefore recommend the development of a leaflet to help others in their search for resources. This leaflet has been developed as part of Phase IV of the EOPIC study. (Source: BMC Geriatrics)


Risk factors for chronic pelvic pain: hospital‐based case–control study from Turkey
Conclusion, this study has found that reproduction, urinary, gastrointestinal, musculoskeletal systems and psychological factors affect women with chronic pelvic pain. (Source: International Journal of Urological Nursing)


Infrapatellar Saphenous Neuralgia After TKA Can Be Improved With Ultrasound-guided Local Treatments.
CONCLUSIONS: In summary, we believe injury to the IPSN may be an underappreciated cause of persistent medial pain after TKA. We report favorable preliminary results with local treatment to the nerve in nine of our 16 patients, suggesting that the neuritis is a reversible process in some patients; however, because of the possibility of a placebo effect, we believe this treatment modality should be tested in a randomized, placebo-controlled trial. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID: 25062704 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related 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>


Understanding Sickle Cell Anemia in the Perianesthesia Arena
Perianesthesia nurses encounter individuals with chronic conditions within their practice on a regular basis. As more procedures are shifted to the ambulatory surgery arena, it is essential that the perianesthesia nurse is able to understand these chronic conditions in ways that assist in their clinical care. Sickle cell disease, a chronic disease historically found in the pediatric environment, is now often experienced with adult patients because of increased care and management of the disease increasing life expectancies. Knowing the background of this disease and the care required in the perianesthesia environment assists the perianesthesia nurse in adapting their care plans to incorporate the sickle cell disease patients' unique hemodynamic and pain management requirements. (Source: Jo...


Tough-to-Abuse Formulation of Oxycodone Approved
Title: Tough-to-Abuse Formulation of Oxycodone ApprovedCategory: Health NewsCreated: 7/24/2014 12:36:00 PMLast Editorial Review: 7/25/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


FDA Approves Hard-to-Abuse Narcotic Painkiller
Title: FDA Approves Hard-to-Abuse Narcotic PainkillerCategory: Health NewsCreated: 7/24/2014 12:36:00 PMLast Editorial Review: 7/25/2014 12:00:00 AM (Source: MedicineNet Chronic Pain General)


Substantive review of the literature of medication treatment of chronic low back pain among adults
ConclusionsThe collected data revealed that there are a number of approaches to the management of CLBP. Medication regimens are frequently used and widely available, but alternative treatment modalities can also be effective. Implications for practiceProviders should encourage patients to explore a variety of treatment modalities that can provide pain relief and improve functionality and overall well‐being. (Source: Journal of the American Academy of Nurse Practitioners)


Predictors for chronic pain‐related health care utilization: a cross‐sectional nationwide study in Iceland
ConclusionsPain‐related variables are better predictors of chronic pain‐related health care utilization than sociodemographic factors. Even though gender does not predict chronic pain‐related health care utilization, there are gender differences in the relationships between pain‐related variables and health care utilization. Men tend to postpone health care consultations for chronic pain longer than women. (Source: Health Expectations)<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>


Nerve growth factor promotes expression of novel genes in intervertebral disc cells that regulate tissue degradation.
Conclusions Nerve growth factor has potential effects on matrix turnover activity and influences the catabolic/anabolic balance of IVD cells in an adverse way that may potentiate IVD degeneration. Anti-NGF treatment might be beneficial to ameliorate progressive tissue breakdown in IVD degeneration and may lead to pain relief. PMID: 25062286 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)


A cognitive dual task affects gait variability in patients suffering from chronic low back pain.
Authors: Hamacher D, Hamacher D, Schega L Abstract Chronic pain and gait variability in a dual-task situation are both associated with higher risk of falling. Executive functions regulate (dual-task) gait variability. A possible cause explaining why chronic pain increases risk of falling in an everyday dual-task situation might be that pain interferes with executive functions and results in a diminished dual-task capability with performance decrements on the secondary task. The main goal of this experiment was to evaluate the specific effects of a cognitive dual task on gait variability in chronic low back pain (CLBP) patients. Twelve healthy participants and twelve patients suffering from CLBP were included. The subjects were asked to perform a cognitive single task, a walking sin...


Mycophenolate mofetil versus methotrexate for prevention of graft-versus-host disease in people receiving allogeneic hematopoietic stem cell transplantation.
CONCLUSIONS: The use of mycophenolate mofetil compared with methotrexate for primary prevention of GVHD seems to be associated with a more favorable toxicity profile, without an apparent compromise on disease relapse, transplant-associated mortality, or overall survival. The effects on incidence of GVHD between people receiving mycophenolate mofetil compared with people receiving methotrexate were uncertain. There is a need for additional high-quality RCTs to determine the optimal GVHD prevention strategy. Future studies should take into account a comprehensive view of clinical benefit, including measures of morbidity, symptom burden, and healthcare resource utilization associated with interventions. PMID: 25061777 [PubMed - as supplied by publisher] (Source: Cochrane Database of Syste...


Effects of age-related loss of P/Q-type calcium channels in a mice model of peripheral nerve injury
We analyzed the role of P/Q-type calcium channels in sciatic nerve regeneration after lesion induced by chronic constriction injury (CCI) in heterozygous null mutant mice lacking the CaV2.1α1 subunit of these channels (Cacna1a+/-). Compared to wild-type (WT), Cacna1a+/- mice showed an initial reduction of the CCI-induced allodynia, indicating a reduced pain perception, but they also evidenced a lack of recovery over time, with atrophy of the injured hindpaw still present 3 months after CCI when WT mice fully recovered. (Source: Neurobiology of Aging)


Anti-allodynic effects of obtusifolin and gluco-obtusifolin against inflammatory and neuropathic pain: possible mechanism for neuroinflammation.
In this study we investigated the potential of obtusifolin and gluco-obtusifolin, two anthraquinones found in the seeds of the widely used traditional Chinese medical botanical Cassia obtusifolia, to reduce neuropathic and inflammatory pain. The potential analgesic effects of obtusifolin and gluco-obtusifolin were evaluated by mice formalin test and complete Freund's adjuvant (CFA)-induced nociceptive behaviors in rats. Chronic constriction injury (CCI), L5 spinal nerve ligation (L5 SNL), diabetes, and chemotherapeutics inducing allodynia were used to test whether repeated treatment with obtusifolin and gluco-obtusifolin ameliorated neuropathic pain. Finally, we explored whether obtusifolin and gluco-obtusifolin altered the degree of neuroinflammation in rat spinal cord after CFA administr...<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>


Prevalence and conditions associated with chronic pelvic pain in women from São Luís, Brazil.
The objective of the present study was to estimate the prevalence of chronic pelvic pain in the community of São Luís, capital of the State of Maranhão, Northeastern Brazil, and to identify independent conditions associated with it. A cross-sectional study was conducted, including a sample of 1470 women older than 14 years predominantly served by the public health system. The interviews were held in the subject's home by trained interviewers not affiliated with the public health services of the municipality. The homes were visited at random according to the city map and the prevalence of the condition was estimated. To identify the associated conditions, the significant variables (P=0.10) were selected and entered in a multivariate analysis model. Data are reported as odds ratio and 95%...


Contingency learning deficits and generalization in chronic unilateral hand pain patients
Contingency learning, in particular the formation of danger beliefs, underpins conditioned fear and avoidance behavior, yet equally important is the formation of safety beliefs. That is, when threat beliefs and accompanying fear/avoidance spread to technically safe cues, it might cause disability. Indeed, such overgeneralization has been advanced as a transdiagnostic pathological marker, but it has not been investigated in chronic pain. Using a novel hand pain scenario contingency learning task, we tested the hypothesis that chronic hand pain patients demonstrate less differential pain expectancy judgments due to poor safety learning, and broader generalization gradients, than healthy controls. (Source: The Journal of Pain)


Effects of age-related loss of P/Q-type calcium channels in a mice model of peripheral nerve injury.
This study demonstrates the important role played by P/Q-type channels in recovery from nerve injury and has important implications for the knowledge of age-related processes. PMID: 25150573 [PubMed - as supplied by publisher] (Source: Neurobiology of Aging)


Effects of age-related loss of P/Q-type calcium channels in a mice model of peripheral nerve injury
We analyzed the role of P/Q-type calcium channels in sciatic nerve regeneration after lesion induced by chronic constriction injury (CCI) in heterozygous null mutant mice lacking the CaV2.1α1 subunit of these channels (Cacna1a+/−). Compared with wild type, Cacna1a+/− mice showed an initial reduction of the CCI-induced allodynia, indicating a reduced pain perception, but they also evidenced a lack of recovery over time, with atrophy of the injured hindpaw still present 3 months after CCI when wild-type mice fully recovered. (Source: Neurobiology of Aging)


Contingency Learning Deficits and Generalization in Chronic Unilateral Hand Pain Patients
Contingency learning, in particular the formation of danger beliefs, underpins conditioned fear and avoidance behavior, yet equally important is the formation of safety beliefs. That is, when threat beliefs and accompanying fear/avoidance spread to technically safe cues, it might cause disability. Indeed, such overgeneralization has been advanced as a transdiagnostic pathologic marker, but it has not been investigated in chronic pain. Using a novel hand pain scenario contingency learning task, we tested the hypotheses that chronic hand pain patients demonstrate less differential pain expectancy judgments because of poor safety learning and demonstrate broader generalization gradients than healthy controls. (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>


Randomized controlled trial of interpersonal psychotherapy versus enhanced treatment as usual for women with co-occurring depression and pelvic pain
Our study assessed the effectiveness of Interpersonal Psychotherapy (IPT) tailored for biomedical patients with depression and pain. IPT was compared to enhanced treatment as usual (E-TAU) among women with co-occurring depression and chronic pain presenting for care at a women's health or family medicine practice. We hypothesized that women presenting to urban medical practices with depression and chronic pain would benefit from IPT tailored to address their needs to a greater degree than from E-TAU. (Source: Journal of Psychosomatic Research)


Trajectories of pain and functional disability in CBT for pediatric chronic pain: Is statistically significant change meaningful to patients and families?
This study also highlights ongoing challenges for the field, including issues related to the measurement of clinically meaningful change in disability and pain among youth with chronic pain, and how length of treatment exposure and treatment success might be related. (Source: Pain)


Pain referents used to respond to the Pain Catastrophizing Scale
ConclusionThe examination of pain referents while responding to a catastrophizing measure would add to our understanding of a person's pain experience and related catastrophic cognitions. (Source: European Journal of Pain)


‘Keeping going’: chronic joint pain in older people who describe their health as good
Research Articles JANE C. RICHARDSON, JANET C. GRIME, BIE NIO ONG, Ageing & Society, Volume 34 Issue 08, pp 1380-1396Abstract (Source: Ageing)


Acetaminophen May Not Help Against Back Pain, Study Contends
Title: Acetaminophen May Not Help Against Back Pain, Study ContendsCategory: Health NewsCreated: 7/23/2014 7:36:00 PMLast Editorial Review: 7/24/2014 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>


Lone Aortic Insufficiency and Conduction Disease: A Marker of Reactive Arthritis
A 48‐year‐old male with history of chronic arthritis and uveitis presented with 1 year of progressively reduced exercise capacity and nonexertional chest pain. Physical examination was consistent with severe aortic insufficiency. An electrocardiogram demonstrated sinus rhythm with first degree atrioventricular block. Transthoracic and transesophageal echocardiography demonstrated severe lone central aortic insufficiency of a trileaflet valve due to leaflet thickening, retraction of leaflet margins and mild aortic root dilation in the setting of left ventricular dilatation. In addition, computed tomographic angiography revealed a small focal aneurysm of the distal transverse arch. He was found to be positive for the immunogenetic marker HLA‐B27. The patient subsequently underwent unc...


Identification of initial severity determinants to predict arthritis after chikungunya infection in a cohort of French gendarmes
Conclusion: Initial CHIKV severity predicted recovery, with higher severity associated with arthritis and lower severity with arthralgia. More interestingly, specific markers of post-CHIKV arthritis, which can easily be used by clinicians for case management, were identified. (Source: BioMed Central)


Paracetamol ineffective for lower back pain
Study suggests rethink on doctors recommending drug for back painRelated items from OnMedicaGPs urged not to over prescribe painkillersReassure patients about opioid effectsNICE offers guidance on opioidsSteroid injection doesn’t help tennis elbowTelecare in general practice tackles chronic pain (Source: OnMedica Latest News)


S1PR1 Involvement in Paclitaxel-induced Neuropathic Pain [Neurobiology]
The ceramide-sphingosine 1-phosphate (S1P) rheostat is important in regulating cell fate. Several chemotherapeutic agents, including paclitaxel (Taxol), involve pro-apoptotic ceramide in their anticancer effects. The ceramide-to-S1P pathway is also implicated in the development of pain, raising the intriguing possibility that these sphingolipids may contribute to chemotherapy-induced painful peripheral neuropathy, which can be a critical dose-limiting side effect of many widely used chemotherapeutic agents. We demonstrate that the development of paclitaxel-induced neuropathic pain was associated with ceramide and S1P formation in the spinal dorsal horn that corresponded with the engagement of S1P receptor subtype 1 (S1PR1)-dependent neuroinflammatory processes as follows: activation of red...


Topical lidocaine for neuropathic pain in adults.
CONCLUSIONS: This review found no evidence from good quality randomised controlled studies to support the use of topical lidocaine to treat neuropathic pain, although individual studies indicated that it was effective for relief of pain. Clinical experience also supports efficacy in some patients. Several large ongoing studies, of adequate duration, with clinically useful outcomes should provide more robust conclusions about both efficacy and harm. PMID: 25058164 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)<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>


Prognostic factors and course for successful clinical outcome quality of life and patients' perceived effect after a cognitive behaviour therapy for chronic non-specific low back pain: A 12-months prospective study
This study investigates the clinical course of and prognostic factors for quality of life (Short Form 36 items Health survey) and global perceived effect (GPE) in patients treated for chronic non-specific low back pain at 5 and 12-months follow-up. Data from a prospective cohort (n=1760) of a rehabilitation center were used, where patients followed a 2-months cognitive behavior treatment. The outcome ‘improvement in quality of life (SF-36)’ was defined as a 10% increase in score on the SF-36 at follow-up compared with baseline. (Source: Manual Therapy)


Prognostic factors and course for successful clinical outcome quality of life and patients' perceived effect after a cognitive behavior therapy for chronic non-specific low back pain: A 12-months prospective study
This study investigates the clinical course of and prognostic factors for quality of life (Short Form 36 items Health survey (SF-36)) and global perceived effect (GPE) in patients treated for chronic non-specific low back pain at 5 and 12-months follow-up. Data from a prospective cohort (n = 1760) of a rehabilitation center were used, where patients followed a 2-months cognitive behavior treatment. The outcome ‘improvement in quality of life (SF-36)’ was defined as a 10% increase in score on the SF-36 at follow-up compared with baseline. (Source: Manual Therapy)


Neuromics' Transfection Kits-Genes Studied
Delivering siRNA, miRNA, Plasmids and Viral Vectors&nbsp;for Gene Expression Analysis.I have shared the many genes researchers have studied using our Transfection Kits. These include: β-arrestin, ABCA, ASIC, β-arrestin, CAV1.2, CX3CR1, DOR, EHDAC2, LOVL4, IKBKAP, K+-ATPase, KV1.1, KV9.1 , neuroligin 2, The β3 subunit of the Na+,K+-ATPase, NTS1, NAV1.8, NTS1, NOV, Raf-1, RANK, SNSR1, hTert, NOV, Survivin, TLR4, Troy and TRPV1 and More!We can now add GPNMB to this list: Lili Hou, Yanfeng Zhang, Yong Yang, Kai Xiang, Qindong Tan, Qulian Guo. Intrathecal siRNA Against GPNMB Attenuates Nociception in a Rat Model of Neuropathic Pain. Journal of Molecular Neuroscience. July 2014...Ten micrograms of siRNA1- GPNMB dissolved in 30 μl i-Fect transfection reagent (Neuromics, Edina, MN, USA) was ad...


Pain Research Gene Expression Analysis
Potent and Proven Transfection KitsPain Researchers have successfully modulated 25+ genes involved in pain pathways using our Transfection Kits. Highlights include: DOR,The β3 subunit of &nbsp;Na+,K+-ATPase, NTS1, NAV1.8, Kv 1.1, Kv 9.1, TROY, NOV, β-arrestin, TRPV1, CAV1.2, TLR4 and ASIC and more! &nbsp;To learn more, check out our Transfection Kit Publications and Blog.Figures: Intrathecal Kv9.1 siRNA treatment induces pain behaviors in naive rats. A, qRT-PCR quantification of Kv9.1 mRNA in rat PASMC cultures transfected with one of three Kv9.1 siRNA sequences or control siRNA. B, qRT-PCR showing Kv9.1 in vivo knock-down in L5 DRG, 4 d after intrathecal delivery of siRNA #1 compared with vehicle or matched scrambled control. &nbsp;C, IHC for Kv9.1 in scrambled- and siRNA-treated DRG to...


Topical treatments of skin pain: a general review with a focus on hidradenitis suppurativa with topical agents.
Authors: Scheinfeld N Abstract Hidradenitis Supprurativa (HS) is a painful chronic follicular disease. Few papers have addressed pain control for this debilitating condition. Possible topical agents include tricyclic antidepressants, opioids, anticonvulsants, NSAIDs, NMDA receptor antagonists, local anesthetics and other agents. The first line agents for the topical treatment of the cutaneous pain of HS are diclonefac gel 1% and liposomal xylocaine 4% and 5% cream or 5% ointment. The chief advantage of topical xylocaine is that is quick acting i.e. immediate however with a limited duration of effect 1-2 hours. The use of topical ketamine, which blocks n-methyl-D-aspartate receptors in a non-competitive fashion, might be a useful tool for the treatment of HS pain. Topical doxepin, w...<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>


Controlling childbirth pain tied to lower depression risk
(Northwestern University) Controlling pain during childbirth and post delivery is linked to reduced risk of postpartum depression, says a Northwestern perinatal psychiatrist, based on a new study. The study showed postpartum depression rates doubled for women without pain control. Significant numbers of women have acute and chronic pain related to childbirth and need to consult with their physician if pain continues for several months. (Source: EurekAlert! - Social and Behavioral Science)


A Web-Based Peer-Modeling Intervention Aimed at Lifestyle Changes in Patients With Coronary Heart Disease and Chronic Back Pain: Sequential Controlled Trial
Conclusions: Usage of the lebensstil-aendern website corresponds to more positive lifestyle changes. However, as-treated analyses do not allow for differentiating between causal effects and selection bias. Despite these limitations, the trial indicates that more than occasional website usage is necessary to reach dose-response efficacy. Therefore, future studies should concentrate on strategies to improve adherence to Web-based interventions and to encourage more frequent usage of these programs. (Source: Journal of Medical Internet Research)


Connexin-43 induces chemokine release from spinal cord astrocytes to maintain late-phase neuropathic pain in mice
In this study, we investigated whether nerve injury could upregulate connexin-43 to sustain late-phase neuropathic pain by releasing chemokine from spinal astrocytes. Chronic constriction injury elicited a persistent upregulation of connexin-43 in spinal astrocytes for &gt;3 weeks. Spinal (intrathecal) injection of carbenoxolone (a non-selective hemichannel blocker) and selective connexin-43 blockers (connexin-43 mimetic peptides 43Gap26 and 37,43Gap27), as well as astroglial toxin but not microglial inhibitors, given 3 weeks after nerve injury, effectively reduced mechanical allodynia, a cardinal feature of late-phase neuropathic pain. In cultured astrocytes, TNF-&alpha; elicited marked release of the chemokine CXCL1, and the release was blocked by carbenoxolone, Gap26/Gap27, and connexin...


Age and the role of restricted activities in adjustment to disability-related pain
This study analyzed relationships among pain variables, age, and mood in 521 individuals with multiple sclerosis or spinal cord injury. As predicted, pain interference mediated the relationship between pain severity and depressed mood. There was no evidence that older adults were less distressed by pain interference than were younger adults. (Source: Journal of Health Psychology)