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Persistent chronic pain

H MacPherson, E A Vertosick, N E Foster, G Lewith, K Linde, K J Sherman, C M Witt, A J Vickers
There is uncertainty regarding how long the effects of acupuncture treatment persist after a course of treatment. We aimed to determine the trajectory of pain scores over time following acupuncture, using a large individual patient dataset from high quality randomized trials of acupuncture for chronic pain. The available individual patient dataset included 29 trials and 17,922 patients. The chronic pain conditions included musculoskeletal pain (low back, neck and shoulder), osteoarthritis of the knee and headache/migraine...
October 17, 2016: Pain
Nathan D Crosby, John J Janik, Warren M Grill
Kilohertz-frequency spinal cord stimulation (KHF-SCS) is a potential paresthesia-free treatment for chronic pain. However, the effects of KHF-SCS on spinal dorsal column (DC) axons and its mechanisms of action remain unknown. The objectives of this study were to quantify activation and conduction block of DC axons by KHF-SCS across a range of kHz frequencies (1, 5, 10, or 20 kHz) and waveforms (biphasic pulses or sinusoids). Custom platinum electrodes delivered SCS to the T10/T11 DCs of anesthetized male Sprague-Dawley rats...
October 19, 2016: Journal of Neurophysiology
Seth H Richman, Marcelo Bogliolo Piancastelli Siqueira, Kirk A McCullough, Mark J Berkowitz
BACKGROUND: K-wire fixation has been the most common method of fixation for hammertoe deformity. However intramedullary devices are gaining ground in both number of available choices and in procedures performed. This study aimed to compare the outcomes of hammertoe correction performed with K-wire fixation versus a novel intramedullary fusion device (CannuLink). METHODS: A retrospective review of hammertoe correction by a single surgeon was performed from June 2011 to December 2013...
October 18, 2016: Foot & Ankle International
Juying Jin, Lihua Peng, Qibin Chen, Dong Zhang, Li Ren, Peipei Qin, Su Min
BACKGROUND: Chronic post-surgical pain (CPSP) remains a major clinical problem which may be associated with impaired activities of daily life and decreased health-related quality of life. Although cesarean section is one of the most commonly performed operations, chronic pain after cesarean delivery has not been well-studied. The purpose of this prospective study was to assess the incidence and risk factors of chronic pain at 3, 6 and 12 months after cesarean delivery. METHODS: We prospectively investigated preoperative demographic and psychological factors, intraoperative clinical factors, and acute postoperative pain in a cohort of 527 women undergoing cesarean section...
October 18, 2016: BMC Anesthesiology
Cláudia Carvalho, Joaquim Machado Caetano, Lidia Cunha, Paula Rebouta, Ted J Kaptchuk, Irving Kirsch
This randomized controlled trial was performed to investigate whether placebo effects in chronic low back pain could be harnessed ethically by adding open-label placebo (OLP) treatment to treatment as usual (TAU) for 3 weeks. Pain severity was assessed on three 0- to 10-point Numeric Rating Scales, scoring maximum pain, minimum pain, and usual pain, and a composite, primary outcome, total pain score. Our other primary outcome was back-related dysfunction, assessed on the Roland-Morris Disability Questionnaire...
October 13, 2016: Pain
Monica D Prakash, Sarah Miller, Sarron Randall-Demllo, Kulmira Nurgali
Cancer development is often associated with chronic inflammation. To date, research into inflammation-induced cancer has largely focused on chemokines, cytokines, and their downstream targets. These inflammatory mediators may promote tumor growth, invasion, metastasis, and facilitate angiogenesis. However, the exact mechanisms by which inflammation promotes neoplasia remain unclear. Inflammatory bowel disease (IBD) is characterized by recurrent, idiopathic intestinal inflammation, the complications of which are potentially fatal...
November 2016: Inflammatory Bowel Diseases
Kathryn E Mansfield, Julius Sim, Peter Croft, Kelvin P Jordan
Chronic widespread pain (CWP) is common in the general population. It is unclear how people reporting this problem present in primary care; they may regularly consult for regional pains without being recognized as having a generalized condition. Our objectives were to determine the prevalence of people consulting in primary care for musculoskeletal conditions in different body regions on different occasions (recurrent regional pain consultation), the proportion with diagnosed generalized pain and survey-reported widespread pain, and if they have features characteristic of CWP...
September 29, 2016: Pain
Brian M Ilfeld
A continuous peripheral nerve block (CPNB) consists of a percutaneously inserted catheter with its tip adjacent to a target nerve/plexus through which local anesthetic may be administered, providing a prolonged block that may be titrated to the desired effect. In the decades after its first report in 1946, a plethora of data relating to CPNB was published, much of which was examined in a 2011 Anesthesia & Analgesia article. The current update is an evidence-based review of the CPNB literature published in the interim...
October 3, 2016: Anesthesia and Analgesia
Yi-Chia Su, Chih-Chien Wu
A 54-year-old woman presented at the emergency department after experiencing lower limb weakness and bilateral ankle pain for 2 days. She had a history of type 2 diabetes mellitus, diabetes mellitus nephropathy with chronic kidney disease, and chronic gouty arthritis. She had received 0.6 mg colchicine orally once or twice daily for 8 months. Four days prior to her emergency department visit, she was discharged from our nephrology ward, where she had been admitted because of a urinary tract infection. During hospitalization, she was treated with intravenous cefazolin for 7 days...
December 2015: Drug Saf Case Rep
M Studer, J Stewart, N Egloff, E Zürcher, R von Känel, J Brodbeck, M Grosse Holtforth
BACKGROUND: Increased pain sensitivity is characteristic for patients with chronic pain disorder with somatic and psychological factors (F45.41). Persistent stress can induce, sustain, and intensify pain sensitivity, thereby modulating pain perception. In this context, it would be favorable to investigate which psychosocial stressors are empirically linked to pain sensitivity. OBJECTIVES: The aim of this study was to examine the relationship between psychosocial stressors and pain sensitivity in a naturalistic sample of patients with chronic pain disorder with somatic and psychological factors (F45...
October 17, 2016: Der Schmerz
Jennifer Greene Naples, Walid F Gellad, Joseph T Hanlon
When possible, chronic noncancer pain (CNCP) in older adults should be managed by nonpharmacologic modalities in conjunction with nonopioid analgesics. If moderate-to-severe pain persists despite these approaches, however, nonparenteral opioids may be considered as adjunctive therapy. This article reviews the epidemiology of opioid use and their effectiveness for CNCP in older adults and summarizes important age-related changes in opioid pharmacokinetics and pharmacodynamics that increase the risks of adverse effects in the elderly...
November 2016: Clinics in Geriatric Medicine
Gloria B Chiu, Christos Theophanous, John A Irvine
PURPOSE: To report a case of persistent epithelial defects in a patient with ocular chronic graft-versus-host disease that required coordinated modulation of systemic immunosuppressive treatment and overnight wear of Prosthetic Replacement of the Ocular Surface Ecosystem (BostonSight PROSE, Needham, MA) devices to achieve ocular surface healing. CASE REPORT: The case of a 38-year-old male patient who presented with a 2-year history of ocular chronic graft-versus-host disease, ocular burning, pain, light sensitivity, and a 3-week history of bilateral corneal epithelial defects is presented...
October 12, 2016: Optometry and Vision Science: Official Publication of the American Academy of Optometry
W Ma, B St-Jacques, U Rudakou, Y N Kim
BACKGROUND: Persistent peripheral sensitization contributes to chronic pain. Plasticity of nociceptive dorsal root ganglion (DRG) neurons (nociceptors) induced by pro-inflammatory mediators contributes to sensitization. Prostaglandin E2 (PGE2) enriched in injured tissues is known not only directly to sensitize DRG neurons, but also to potentiate sensitizing effects of other pain mediators such as capsaicin and its receptor transient receptor potential vanilloid-1 (TRPV1). It remains unknown whether PGE2 potentiates TRPV1 activity by stimulating its synthesis, cell surface and axonal trafficking in DRG neurons...
October 14, 2016: European Journal of Pain: EJP
Ashok Kumar Saxena, Geetanjali T Chilkoti, Anand K Chopra, Basu Dev Banerjee, Tusha Sharma
BACKGROUND: The present study was undertaken to evaluate the incidence of chronic persistent post-surgical pain (CPPP) and the role of signal transduction genes in patients undergoing staging laparotomy for carcinoma ovary. METHODS: The present observational study was undertaken following institutional ethical committee approval and informed consent from all the participants. A total 21 patients of ASA grade I to III with age 20-70 years, scheduled for elective staging laparotomy for carcinoma ovary were included...
October 2016: Korean Journal of Pain
Humberto G Rosas
Although rare, posterolateral corner (PLC) injuries can result in sustained instability and failed cruciate ligament reconstruction if they are not diagnosed. The anatomy of the PLC was once thought to be perplexing and esoteric-in part because of the varying nomenclature applied to this region in the literature, which added unnecessary complexity. More recently, three major structures have been described as the primary stabilizers of the PLC on the basis of biomechanical study findings: the lateral collateral ligament, popliteus tendon, and popliteofibular ligament...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Perry Rosenthal, David Borsook, Eric A Moulton
The cornea is supplied principally by the ophthalmic branch of the trigeminal nerve and is the most densely innervated organ in the human body. Under normal conditions, the corneal nerve terminals incorporate sensors that monitor the thickness and integrity of the tear film, which are essential for meaningful vision. A disrupted tear film or direct noxious stimulation of these corneal nerves can produce discomfort or pain limited to the affected surface. Damage to these nerves can sometimes lead to a chronic neuropathic condition, where pain persists months following the initial insult, long after the nerves appear to have healed in the cornea itself following treatment...
October 1, 2016: Investigative Ophthalmology & Visual Science
Mesut Mutluoglu, Gunalp Uzun, Michael Bennett, Peter Germonpré, David Smart, Daniel Mathieu
Diabetic foot ulcers (DFUs) are one of the most common indications for hyperbaric oxygen treatment (HBOT). The role of HBOT in DFUs is often debated. Recent evidence based guidelines, while recommending its use, urge further studies to identify the patient subgroups most likely to benefit from HBOT. A recent study in Diabetes Care aimed to assess the efficacy of HBOT in reducing the need for major amputation and improving wound healing in patients with chronic DFUs. In this study, patients with Wagner grade 2-4 diabetic foot lesions were randomly assigned to have HBOT (30 sessions/90 min/244 kPa) or sham treatment (30 sessions/90 min/air/125 kPa)...
September 2016: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
David M Klyne, Mary F Barbe, Paul W Hodges
Systemic inflammation is linked with development and persistence of many pathological pain states. Although chronic phase inflammatory responses are well reported, the acute phase has received limited attention. Here we investigated circulating pro-inflammatory cytokines and C-reactive protein (CRP), and explored their relationships with symptom severity and other factors in acute low back pain (LBP). Ninety-nine individuals within two weeks of onset of acute LBP and 55 pain-free controls completed questionnaires related to their pain (visual analogue scale, VAS) and disability, behaviour, sleep quality and psychological status...
October 6, 2016: Brain, Behavior, and Immunity
M Heesen, M Klimek, R Rossaint, G Imberger, S Straube
We examined whether paravertebral block has an effect on the prevalence of persistent postsurgical pain after breast surgery. Seven randomised, controlled trials (559 patients) which had the outcome assessor blinded were included, comparing patients who received paravertebral blocks after breast surgery with patients who did not. The risk ratio (95% CI) was 0.75 (0.48-1.15) for the incidence of postoperative pain at 3 months (four studies, 317 patients); the risk ratio (95% CI) obtained from three studies including 301 patients reporting on pain after 6 months was 0...
October 7, 2016: Anaesthesia
Samuel S Duffy, Chamini J Perera, Preet G S Makker, Justin G Lees, Pascal Carrive, Gila Moalem-Taylor
Pain is a widespread and debilitating symptom of multiple sclerosis (MS), a chronic inflammatory demyelinating disease of the central nervous system. Although central neuroinflammation and demyelination have been implicated in MS-related pain, the contribution of peripheral and central mechanisms during different phases of the disease remains unclear. In this study, we used the animal model experimental autoimmune encephalomyelitis (EAE) to examine both stimulus-evoked and spontaneous pain behaviors, and neuroinflammatory changes, over the course of chronic disease...
2016: Frontiers in Immunology
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