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Latest & greatest articles for chronic pain
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The effect of lumbosacral orthosis on the thickness of deep trunk muscles using ultrasound imaging: A randomized controlled trial in patients with chronic low back pain. This study was conducted to evaluate the changes occurring in the thickness of deep trunk muscles, measured using ultrasound imaging, after four weeks of lumbosacral orthosis (LSO) use in conjunction with routine physical therapy.This parallel-group, randomized, controlled trial was conducted on 44 patients with nonspecific (...) chronic low back pain (CLBP), randomly allocated to the experimental and control groups. Both groups received eight sessions of physical therapy twice per week for four weeks. The experimental group wore non-extensible LSO in addition to undergoing routine physical therapy. The thickness of the transversus abdominis (TrA), obliquus internus (IO) and lumbar multifidus (LM) was measured by ultrasound before and after the four-week intervention.The deep trunk muscles differed in thickness in various test
Effects of an anteroposterior mobilization of the glenohumeral joint in overhead athletes with chronic shoulder pain: A randomized controlled trial. Passive oscillatory mobilizations are often employed by physiotherapists to reduce shoulder pain and increase function. However, there is little data about the neurophysiological effects of these mobilizations.To investigate the initial effects of an anteroposterior (AP) shoulder joint mobilization on measures of pain and function in overhead (...) athletes with chronic shoulder pain.Double-blind, controlled, within-subject, repeated-measures design.Thirty-one overhead athletes with chronic shoulder pain participated. The effects of a 9-min, AP mobilization of the glenohumeral joint were compared with manual contact and no-contact interventions. Self-reported pain, pressure pain threshold (PPT), range of movement (ROM), muscle strength, and disability were measured immediately before and after each intervention.No significant differences were
Identifying and Engaging Neuronal Oscillations by Transcranial Alternating Current Stimulation in Patients With Chronic Low Back Pain: A Randomized, Crossover, Double-Blind, Sham-Controlled Pilot Study Chronicpain is associated with maladaptive reorganization of the central nervous system. Recent studies have suggested that disorganization of large-scale electrical brain activity patterns, such as neuronal network oscillations in the thalamocortical system, plays a key role (...) in the pathophysiology of chronicpain. Yet, little is known about whether and how such network pathologies can be targeted with noninvasive brain stimulation as a nonpharmacological treatment option. We hypothesized that alpha oscillations, a prominent thalamocortical activity pattern in the human brain, are impaired in chronicpain and can be modulated with transcranial alternating current stimulation (tACS). We performed a randomized, crossover, double-blind, sham-controlled study in patients with chronic low
Cannabinoids for ChronicPain Cannabinoids for ChronicPain November 2018 Mailing Address: Therapeutics Initiative The University of British Columbia Department of Anesthesiology, Pharmacology & Therapeutics 2176 Health Sciences Mall Vancouver, BC Canada V6T 1Z3 Tel.: 604 822 0700 Fax: 604 822 0701 E-mail: firstname.lastname@example.org www.ti.ubc.ca 115 C anada’s parliament legalized the recreational use of herbal cannabis (marijuana) in October 2018. The well-publicized limitations of clinical re- search (...) and well-recognized side effects such as canna- bis intoxication have not deterred people from seeking out and using herbal cannabis for chronicpain in in- creasing numbers. This is occurring with or without a physician’s authorization. 1 In fact, half of Canadians reporting a medical use of herbal cannabis used it for pain relief. 2 Adult patients in Canada still require a physician’s ‘au- thorization’ to legally access cannabis from a licensed producer of cannabis for medical purposes. Facilitating
Efficacy of Low-Dose Amitriptyline for Chronic Low Back Pain: A Randomized Clinical Trial Antidepressants at low dose are commonly prescribed for the management of chronic low back pain and their use is recommended in international clinical guidelines. However, there is no evidence for their efficacy.To examine the efficacy of a low-dose antidepressant compared with an active comparator in reducing pain, disability, and work absence and hindrance in individuals with chronic low back pain.A (...) double-blind, randomized clinical trial with a 6-month follow-up of adults with chronic, nonspecific, low back pain who were recruited through hospital/medical clinics and advertising was carried out.Low-dose amitriptyline (25 mg/d) or an active comparator (benztropine mesylate, 1 mg/d) for 6 months.The primary outcome was pain intensity measured at 3 and 6 months using the visual analog scale and Descriptor Differential Scale. Secondary outcomes included disability assessed using the Roland Morris
Does the Use of Electrotherapies Increase the Effectiveness of Neck Stabilization Exercises for Improving Pain, Disability, Mood, and Quality of Life in Chronic Neck Pain?: A Randomized, Controlled, Single-Blind Study This study was a prospective, randomized, controlled study.The aim of this study was to determine whether transcutaneous electrical nerve stimulation (TENS) or interferential current (IFC) increase the effectiveness of neck stabilization exercises (NSEs) on pain, disability, mood (...) and quality of life for chronic neck pain (CNP).Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Electrotherapies, such as IFC and TENS, have been applied solo or combined with exercise for management of neck pain; however, the efficacy of these combinations is unclear.A total of 81 patients with CNP were included in this study. Patients were randomly assigned into three groups regarding age and gender. First group had NSE, second group had TENS and NSE
Postmenopausal Subacute or Chronic Pelvic Pain New 2018 ACR Appropriateness Criteria ® 1 Postmenopausal Subacute or Chronic Pelvic Pain American College of Radiology ACR Appropriateness Criteria ® Postmenopausal Subacute or Chronic Pelvic Pain Variant 1: Postmenopausal subacute or chronic pelvic pain, localized to the deep pelvis. Initial imaging. Procedure Appropriateness Category Relative Radiation Level US pelvis transvaginal Usually Appropriate O US duplex Doppler pelvis Usually Appropriate (...) Not Appropriate ???? CT pelvis without IV contrast Usually Not Appropriate ??? Radiography abdomen and pelvis Usually Not Appropriate ??? Variant 2: Postmenopausal subacute or chronic pelvic pain, clinically suspected pathologies in perineum, vulva, or vagina. Initial imaging. Procedure Appropriateness Category Relative Radiation Level US duplex Doppler pelvis Usually Appropriate O US pelvis transabdominal Usually Appropriate O US pelvis transvaginal Usually Appropriate O MRI pelvis without and with IV
Chronic Chest Pain-Noncardiac Etiology Unlikely: Low to Intermediate Probability of Coronary Artery Disease Revised 2018 ACR Appropriateness Criteria ® 1 Chronic Chest Pain–Noncardiac Etiology Unlikely American College of Radiology ACR Appropriateness Criteria ® Chronic Chest Pain-Noncardiac Etiology Unlikely: Low to Intermediate Probability of Coronary Artery Disease Variant 1: Chronic chest pain, noncardiac etiology unlikely: low to intermediate probability of coronary artery disease. Initial (...) chest without and with IV contrast Usually Not Appropriate ??? CT chest without IV contrast Usually Not Appropriate ??? Tc-99m SPECT/CT MPI rest only Usually Not Appropriate ??? ACR Appropriateness Criteria ® 2 Chronic Chest Pain–Noncardiac Etiology Unlikely CHRONIC CHEST PAIN-NONCARDIAC ETIOLOGY UNLIKELY: LOW TO INTERMEDIATE PROBABILITY OF CORONARY ARTERY DISEASE Expert Panel on Cardiac Imaging: Amar B. Shah, MD a ; Jacobo Kirsch, MD b ; Michael A. Bolen, MD c ; Juan C. Batlle, MD d ; Richard K. J
Chronic Knee Pain Revised 2018 ACR Appropriateness Criteria ® 1 Chronic Knee Pain American College of Radiology ACR Appropriateness Criteria ® Chronic Knee Pain Variant 1: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography knee Usually Appropriate ? Aspiration knee Usually Not Appropriate Varies CT arthrography knee Usually Not Appropriate ? CT knee with IV contrast Usually (...) . Chronic knee pain. Initial knee radiograph negative or demonstrates joint effusion. Next imaging procedure. Procedure Appropriateness Category Relative Radiation Level MRI knee without IV contrast Usually Appropriate O Aspiration knee May Be Appropriate Varies CT arthrography knee May Be Appropriate ? CT knee without IV contrast May Be Appropriate ? US knee May Be Appropriate (Disagreement) O Radiography hip ipsilateral May Be Appropriate ??? Radiography lumbar spine May Be Appropriate ??? MR
Osteopathic Manipulative Treatment Including Specific Diaphragm Techniques Improves Pain and Disability in Chronic Nonspecific Low Back Pain: A Randomized Trial To investigate the effects of an osteopathic manipulative treatment (OMT), which includes a diaphragm intervention compared to the same OMT with a sham diaphragm intervention in chronic nonspecific low back pain (NS-CLBP).Parallel group randomized controlled trial.Private and institutional health centers.Participants (N=66) (18-60y (...) ) with a diagnosis of NS-CLBP lasting at least 3 months.Participants were randomized to receive either an OMT protocol including specific diaphragm techniques (n=33) or the same OMT protocol with a sham diaphragm intervention (n=33), conducted in 5 sessions provided during 4 weeks.The primary outcomes were pain (evaluated with the Short-Form McGill Pain Questionnaire [SF-MPQ] and the visual analog scale [VAS]) and disability (assessed with the Roland-Morris Questionnaire [RMQ] and the Oswestry Disability Index
Effect of Mobile Device-Supported Single-Patient Multi-crossover Trials on Treatment of Chronic Musculoskeletal Pain: A Randomized Clinical Trial Individually designed single-patient multi-crossover (n-of-1) trials can facilitate tailoring of treatments directed at various conditions, including chronic musculoskeletal pain (CMSP) but are potentially burdensome, which may limit uptake in research and practice.To determine whether patients randomized to participate in an n-of-1 trial supported (...) by a mobile health (mHealth) app would experience less pain and improved global health, adherence, satisfaction, and shared decision making compared with patients assigned to usual care.This randomized clinical trial compared participation in an individualized, mHealth-supported n-of-1 trial vs usual care. The participating 215 patients had CMSP for at least 6 weeks, had a smartphone or tablet with a data plan, were enrolled in northern California from July 2014 through July 2016, and were followed for up
The Effects of a Life Stress Emotional Awareness and Expression Interview for Women with Chronic Urogenital Pain: A Randomized Controlled Trial Women with chronic urogenital pain (CUP) conditions have elevated rates of lifetime trauma, relational stress, and emotional conflicts, but directly assessing and treating psychological stress is rarely done in women's health care settings. We developed and tested the effects on patients' somatic and psychological symptoms of a life stress interview (...) that encourages disclosure about stressors and uses experiential techniques to increase awareness of links between stress, emotions, and symptoms.In this randomized trial, women with CUP recruited at a multidisciplinary women's urology center received either a single 90-minute life stress interview (N = 37) or no interview (treatment-as-usual control; N = 25). Self-report measures of pain severity (primary outcome), pain interference, pelvic floor symptoms, and psychological symptoms (anxiety and depression
ChronicPain Among Suicide Decedents, 2003 to 2014: Findings From the National Violent Death Reporting System. More than 25 million adults in the United States have chronicpain. Chronicpain has been associated with suicidality, but previous studies primarily examined nonfatal suicidal behaviors rather than suicide deaths associated with chronicpain or the characteristics of such deaths.To estimate the prevalence of chronicpain among suicide decedents in a large multistate sample (...) states participating in the NVDRS.Suicide decedents with and without chronicpain who died during 1 January 2003 to 31 December 2014.Demographic characteristics, mechanism of death, toxicology results, precipitating circumstances (mental health, substance use, interpersonal problems, life stressors), and suicide planning and intent.Of 123 181 suicide decedents included in the study, 10 789 (8.8%) had evidence of chronicpain, and the percentage increased from 7.4% in 2003 to 10.2% in 2014. More than
Chronic Pelvic PainChronic Pelvic Pain | Uroweb › Chronic Pelvic PainChronic Pelvic Pain To access the pdfs & translations of individual guidelines, please as EAU member. Non-EAU members can view the web versions. To become an EAU member, click . D. Engeler (Chair), A.P. Baranowski, B. Berghmans, J. Borovicka, A.M. Cottrell, P.S. Elneil, J. Hughes, E. Messelink (Vice-chair), A.C. de C Williams Guidelines Associates: L. Pacheco-Figueiredo, B. Parsons, S. Goonewardene TABLE OF CONTENTS (...) REFERENCES 1. Fall, M., et al., EAU Guidelines on Chronic Pelvic Pain., In: EAU Guidelines on Chronic Pelvic Pain. Presented at the 18th EAU Annual Congress Madrid 2003. 2003, European Association of Urology: Arnhem. 2. Fall, M., et al. EAU guidelines on chronic pelvic pain. Eur Urol, 2004. 46: 681. 3. Fall, M., et al., EAU Guidelines on Chronic Pelvic Pain, In: EAU Guidelines on Chronic Pelvic Pain. Presented at the 18th EAU Annual Congress Barcelona 2010. 2010, EAU: Arnhem. 4. Fall, M., et al. EAU
Traditional and augmented reality mirror therapy for patients with chronic phantom limb pain (PACT study): results of a three-group, multicentre single-blind randomized controlled trial To compare the effects of traditional mirror therapy (MT), a patient-centred teletreatment (PACT) and sensomotor exercises without a mirror on phantom limb pain (PLP).Three-arm multicentre randomized controlled trial.Rehabilitation centres, hospital and private practices.Adult patients with unilateral lower limb (...) total, 75 patients received traditional MT ( n = 25), teletreatment ( n = 26) or sensomotor exercises ( n = 24). Mean (SD) age was 61.1 (14.2) years and mean (SD) pain intensity was 5.7 (2.1) on the NRS. Effects of MT at four weeks on PLP were not significant. MT significantly reduced the duration of PLP at six months compared to the teletreatment ( P = 0.050) and control group ( P = 0.019). Subgroup analyses suggested significant effects on PLP in women, patients with telescoping and patients
Efficacy of adding interoceptive exposure to intensive interdisciplinary treatment for adolescents with chronicpain: a randomized controlled trial Fear of pain plays an important role in the maintenance of chronicpain. It may be reduced through exposure therapy. This 2-arm parallel samples randomized controlled trial aimed to investigate whether interoceptive exposure (IE) therapy enhances reductions in fear of pain (primary outcome), pain (pain intensity, pain-related disability, and school (...) absence), and emotional characteristics (anxiety and catastrophizing) when implemented as an adjunctive treatment in the context of intensive interdisciplinary pain treatment for pediatric chronicpain patients. N = 126 adolescents, aged 11 to 17 years, who were receiving standard intensive interdisciplinary pain treatment were randomly assigned to either receive additional IE (n = 64) or additional relaxation therapy (RT) (n = 62). All patients were assessed at admission, discharge, and 3 months
Proximal Medial Gastrocnemius Recession and Stretching Versus Stretching as Treatment of Chronic Plantar Heel Pain Plantar heel pain is a common disorder that can lead to substantial pain and disability. Gastrocnemius recession has been described as an operative treatment option, but there is a lack of prospective clinical and biomechanical outcome data. The aim of this study was to evaluate the clinical and biomechanical outcomes of gastrocnemius recession and stretching compared (...) with a stretching exercise protocol for patients with plantar heel pain lasting more than 12 months.Forty patients with plantar heel pain lasting more than 1 year were randomized to a home stretching exercise program only or to surgery consisting of a proximal medial gastrocnemius recession in addition to stretching exercises. The main outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at 12 months. Secondary clinical outcomes were the Short Form-36 (SF-36) and visual