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Complex regional pain

Frank Birklein, Seena K Ajit, Andreas Goebel, Roberto S G M Perez, Claudia Sommer
Complex regional pain syndrome (CRPS) is a pain condition that usually affects a single limb, often following an injury. The underlying pathophysiology seems to be complex and probably varies between patients. Clinical diagnosis is based on internationally agreed-upon criteria, which consider the reported symptoms, presence of signs and exclusion of alternative causes. Research into CRPS biomarkers to support patient stratification and improve diagnostic certainty is an important scientific focus, and recent progress in this area provides an opportunity for an up-to-date topical review of measurable disease-predictive, diagnostic and prognostic parameters...
March 16, 2018: Nature Reviews. Neurology
Yu-Chen Lu, Yu-Jun Wang, Bin Lu, Ming Chen, Ping Zheng, Jing-Gen Liu
Itch is an unpleasant sensation that initiates scratching behavior. Itch-scratch reaction is a complex phenomenon whose occurrence implicates supraspinal structures required for regulation of sensory, emotional, cognitive, and motivational aspects. However, the central mechanisms underlying the processing of itch and the interplay of the supraspinal regions and spinal cord in regulating itch-scratch processes are poorly understood. Here, we have identified that the neural projections from anterior cingulate cortex (ACC) to dorsal medial striatum (DMS) constitute a critical circuit element for regulating itch-related behaviors in the brain of male C57BL/6J mice...
March 14, 2018: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Michael J Moskal
No abstract text is available yet for this article.
April 2018: Clinical Orthopaedics and related Research
Marc Sorel, Jacques-Christian Beatrix, Blanche Locko, Catherine Armessen, Anne-Marie Domec, Otilia Lecompte, Sofiane Boucheneb, Benoit Harache, Jacques Robert, Jean-Pascal Lefaucheur
OBJECTIVES: The efficacy of ketamine in relieving complex regional pain syndrome (CRPS) lacks predictive factors. The value of three-phase bone scintigraphy (TPBS) was assessed or this purpose. METHODS: TPBS was performed in 105 patients with unilateral, focal CRPS of type 1 before 5 days of ketamine infusions. Tracer uptake was measured in the region of interest concerned by CRPS and the contralateral homologous region. For the three scintigraphic phases (vascular, tissular, and bone phases), an asymmetry ratio of fixation was calculated between the affected and the unaffected sides (VPr, TPr, and BPr)...
March 13, 2018: Clinical Journal of Pain
Jijun Xu, Christopher Herndon, Samantha Anderson, Philip Getson, Victor Foorsov, Peter Moskovitz, R Norm Harden
Objective: To find and reach a consensus on the usage of ketamine in the treatment of complex regional pain syndrome and to determine a reference protocol for future studies. Design: Three hundred fifty-one medical professionals participated in our survey on practice procedures, with 104 respondents providing information on their usage of ketamine for treating the pain associated with complex regional pain syndrome. Respondents answered questions about inpatient treatment, outpatient treatment, children vs adults, safety, and basic demographic information...
March 9, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Veysel Antar, Okan Turk
OBJECTIVE: Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture...
March 2018: Journal of Korean Neurosurgical Society
Vita Boyar
PURPOSE: The purpose of this study was to report on our experience with a portable, single-use negative pressure wound therapy device used in combination with activated active Leptospermum honey (ALH) in the treatment of colonized or infected, dehisced, thoracic wounds in neonates with complex congenital heart disease. DESIGN: Retrospective, descriptive study. SUBJECTS AND SETTING: We reviewed medical records of 18 neonates and reported on findings from 11; the remaining 7 were not included secondary to incomplete records, transfer to a different institution prior to wound healing, or death...
March 2018: Journal of Wound, Ostomy, and Continence Nursing
D Keszthelyi, Q Aziz, J K Ruffle, O O'Daly, D Sanders, K Krause, S C Williams, M A Howard
BACKGROUND: Traditional psychometric measures aimed at characterizing the pain experience often show considerable overlap, due to interlinked affective and modulatory processes under central nervous system control. Neuroimaging studies have been employed to investigate this complexity of pain processing, in an attempt to provide a quantifiable, adjunctive description of pain perception. In this exploratory study, we examine psychometric and neuroimaging data from 38 patients with painful osteoarthritis of the carpometacarpal joint...
March 9, 2018: European Journal of Pain: EJP
Giovanni Berlucchi, Giuseppe Vallar
The development and change of knowledge on the function of the parietal lobe from the second half of the 19th century to the early 1970s are reviewed. Motor and somatosensory functions were initially localized in a broad frontoparietal region. At the beginning of the 20th century the motor cortex was restricted to the posterior frontal lobe. The separate attribution of somatosensory functions to the parietal lobe was initially based on anatomic considerations, but mostly on localized bodily sensations elicited by electric stimulation in awake patients...
2018: Handbook of Clinical Neurology
Sean C Maguire, Christina A Fleming, Gavin O'Brien, Gerald McGreal
BACKGROUND: Lumbar sympthectomy (LS) was traditionally performed for intermittent claudication but is now eclipsed by revascularisation for that indication. However, it retains a role in the management of critical limb ischaemia and other conditions causing lower limb pain with or without ischaemia. We report the role of LS in modern surgical practice when revascularisation and pain management options have been exhausted. METHODS: A medical chart review was performed on all patients who underwent LS in our unit from 2005 to 2016 (inclusive)...
March 7, 2018: Irish Journal of Medical Science
Aviv Ouanounou, Michael Goldberg, Daniel A Haas
Temporomandibular disorder (TMD) is a collective term that includes disorders of the temporomandibular joint (TMJ) and of the masticatory muscles and their associated structures. TMDs are characterized by pain, joint sounds and restricted mandibular movement, and drugs are widely used in the management of that pain. Pharmacological agents commonly used for the treatment of TMDs include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, muscle relaxants, antidepressants, anticonvulsants and benzodiazepines...
July 2017: Journal—Canadian Dental Association, Journal de L'Association Dentaire Canadienne
Kristian Thorborg, Michael P Reiman, Adam Weir, Joanne L Kemp, Andreas Serner, Andrea Mosler, Per Hölmich
Study Design Groin pain is common in athletes participating in multidirectional sports and has traditionally been considered a difficult problem to understand, diagnose, and manage. This may be due to sparse historical focus on this complex region in sports medicine. Until recently, there was no agreement regarding terminology, definitions, and classification of groin pain in athletes. This has made clear communication between clinicians difficult, and the results of research difficult to interpret and implement into practice...
March 6, 2018: Journal of Orthopaedic and Sports Physical Therapy
Xian Wang, Shaolei Ma, Haibo Wu, Xiaofeng Shen, Shiqin Xu, Xirong Guo, Maria L Bolick, Shizheng Wu, Fuzhou Wang
Our previous works disclosed the contributing role of macrophage migration inhibitory factor (MIF) and dopaminergic inhibition by lysine dimethyltransferase G9a/Glp complex in peripheral nerve injury-induced hypersensitivity. We herein propose that the proinflammatory cytokine MIF participates in the regulation of neuropathic hypersensitivity by interacting with and suppressing the descending dopaminergic system. The lumbar spinal cord (L-SC) and ventral tegmental area (VTA) are two major locations with significant upregulation of MIF after chronic constriction injury (CCI) of the sciatic nerve, and they display time-dependent changes, along with a behavioral trajectory...
February 16, 2018: Experimental & Molecular Medicine
Mark Gaertner, Jiang-Ti Kong, Kristen H Scherrer, Alyssa Foote, Sean Mackey, Kevin A Johnson
INTRODUCTION: Complex Regional Pain Syndrome (CRPS), a rare and severe chronic pain condition, often responds poorly to existing treatments. Previous studies demonstrated Transcranial Magnetic Stimulation (TMS) provided short-term pain relief for upper extremity CRPS. METHODS: Building on previous methodologies, we employed a TMS protocol that may lead to significant pain relief for upper and lower extremity CRPS in a nonrandomized open label pilot trial involving 21 participants...
March 4, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Erin Sweet, Christine S Shusterman, Marina S Nedeljkovic, Jean C Solodiuk
Pain is a complex physical and emotional experience. Therefore, assessment of acute pain requires self-report when possible, observations of emotional and behavioral responses and changes in vital signs. Peripheral nerve and epidural catheters often provide postoperative analgesia in children. Administration of chloroprocaine (a short acting local anesthetic) via a peripheral nerve or epidural catheter allows for a comparison of pain scores, observations of emotional and behavioral responses and changes in vital signs to determine catheter function...
March 1, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Kenneth J Hunt, Eric Lakey
Patient-reported outcomes (PROs) are a measure of health care quality that empower patients to share their health care perceptions with their providers. In orthopedic foot and ankle surgery, these measures can range from global assessments of pain or satisfaction to complex questionnaires designed to assess the function of specific anatomic regions or the recovery from specific procedures. This article seeks to characterize the use of PROs in foot and ankle surgery, describe some of the most commonly used measures, discuss implementation in everyday clinical practice, and explore the future of PROs in foot and ankle orthopedics...
April 2018: Orthopedic Clinics of North America
Silvia Duong, Daniela Bravo, Keith J Todd, Roderick J Finlayson, De Q Tran
PURPOSE: Although multiple treatments have been advocated for complex regional pain syndrome (CRPS), the levels of supportive evidence are variable and sometimes limited. The purpose of this updated review is to provide a critical analysis of the evidence pertaining to the treatment of CRPS derived from recent randomized-controlled trials (RCTs). SOURCE: The MEDLINE, EMBASE, Psychinfo, and CINAHL databases were searched to identify relevant RCTs conducted on human subjects and published in English between 1 May 2009 and 24 August 2017...
February 28, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
T Grieser
CLINICAL ISSUE: Both benign and malignant tumours are encountered in the foot and ankle. Due to their rarity, however, diagnosis is often uncertain. Usual criteria such as tumour size, invasiveness or pain fail to differentiate benign from malignant neoplasias. STANDARD RADIOLOGICAL METHODS: Plain radiography and-due to the complex foot anatomy-CT are important in the diagnostic evaluation of primary bone tumours. In the case of soft tissue tumours, ultrasonography is used to identify ganglion cysts...
February 28, 2018: Der Radiologe
Kevin Hall, John D Borstad
Shoulder pain is a common musculoskeletal complaint that is difficult to treat because of the biomechanical complexity of the shoulder region, the interplay between mobility and stability, and the vital role played by the shoulder in moving, positioning, and providing stability for hand function. Despite advances in biomechanics and pain science, there is still much to learn about how impairments influence shoulder function and health. One impairment, posterior shoulder tightness (PST), is often noted in individuals with shoulder pain and consequently has generated much discussion and debate in recent years...
March 2018: Journal of Orthopaedic and Sports Physical Therapy
Anthony L Logli, Brian J Bear, Edric G Schwartz, Kenneth J Korcek, Brian J Foster
PURPOSE: To determine if any significant differences exist in patient-reported or clinical outcomes among 3 different postoperative orthotic regimens: no orthosis, removable orthosis, and plaster nonremovable orthosis-following miniopen carpal tunnel release (CTR) surgery for symptomatic isolated carpal tunnel syndrome. METHODS: A total of 249 patients received a miniopen CTR and were subsequently randomized into 1 of 3 orthotic regimens: 80, no orthosis; 83, removable orthosis; and 86, nonremovable orthosis-to be removed at the first postoperative visit 10 to 14 days later...
February 24, 2018: Journal of Hand Surgery
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