Articles: pain-clinics.
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Present interventions utilized in musculoskeletal rehabilitation are guided, in large part, by a biomedical model where peripheral structural injury is believed to be the sole driver of the disorder. There are, however, neurophysiological changes across different areas of the peripheral and central nervous systems, including peripheral receptors, dorsal horn of the spinal cord, brain stem, sensorimotor cortical areas, and the mesolimbic and prefrontal areas associated with chronic musculoskeletal disorders, including chronic low back pain, osteoarthritis, and tendon injuries. These neurophysiological changes appear not only to be a consequence of peripheral structural injury but also to play a part in the pathophysiology of chronic musculoskeletal disorders. ⋯ Musculoskeletal rehabilitation professionals have at their disposal tools to address these neuroplastic changes, including top-down cognitive-based interventions (eg, education, cognitive-behavioral therapy, mindfulness meditation, motor imagery) and bottom-up physical interventions (eg, motor learning, peripheral sensory stimulation, manual therapy) that induce neuroplastic changes across distributed areas of the nervous system and affect outcomes in patients with chronic musculoskeletal disorders. Furthermore, novel approaches such as the use of transcranial direct current stimulation and repetitive transcranial magnetic stimulation may be utilized to help renormalize neurological function. Comprehensive treatment addressing peripheral structural injury as well as neurophysiological changes occurring across distributed areas of the nervous system may help to improve outcomes in patients with chronic musculoskeletal disorders.
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Chronic pain is very common worldwide and can lead to disability, depression and absence from work. Catastrophizing has been proven to affect individuals' belief systems and coping strategies, and it is an essential risk factor for chronic pain. The pain catastrophizing scale (PCS) has been developed for the assessment of catastrophizing. However, a Chinese version of this scale is not available, and physicians are therefore unable to determine which patients are prone to catastrophizing. Additionally, the risk factors for catastrophizing are unknown. ⋯ The PCS has been linguistically translated into simplified Chinese and culturally adapted for a Chinese population with remarkable clinical acceptance, good construct validity, and excellent internal consistency and test-retest reliability. Education, pain duration, marital status, gender, income, and use of pain medications are important factors affecting catastrophizing.
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Slipping rib syndrome is an overlooked cause of persistent abdominal or chest pain. The etiology of this syndrome is not well understood, but the characteristic pain is from hypermobility of the false ribs. ⋯ A simple clinical examination via the hooking maneuver is the most significant feature of its diagnosis. We describe the case of a 41-year-old woman with slipping rib syndrome.
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Clinical Trial
Methadone Pharmacogenetics: CYP2B6 Polymorphisms Determine Plasma Concentrations, Clearance, and Metabolism.
Interindividual variability in methadone disposition remains unexplained, and methadone accidental overdose in pain therapy is a significant public health problem. Cytochrome P4502B6 (CYP2B6) is the principle determinant of clinical methadone elimination. The CYP2B6 gene is highly polymorphic, with several variant alleles. CYP2B6.6, the protein encoded by the CYP2B6*6 polymorphism, deficiently catalyzes methadone metabolism in vitro. This investigation determined the influence of CYP2B6*6, and other allelic variants encountered, on methadone concentrations, clearance, and metabolism. ⋯ CYP2B6 polymorphisms influence methadone plasma concentrations, because of altered methadone metabolism and thus clearance. Genetic influence is greater for oral than IV methadone and S- than R-methadone. CYP2B6 pharmacogenetics explains, in part, interindividual variability in methadone elimination. CYP2B6 genetic effects on methadone metabolism and clearance may identify subjects at risk for methadone toxicity and drug interactions.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2015
["Symptomatic Treatment of Delirium, Anxiety and Stress, and Protocol Based Analgesia, Sedation and Management of Sleep in Intensive Care Patients"].
Critically ill patients suffer from anxiety, stress, pain, sleep disturbance and delirium. The updated version of the German evidence and consensus based guideline "Analgesia, Sedation and Delirium management in Intensive Care - DAS 2015" contributes an improved therapeutic management and is aimed to improve clinical outcome based on the current state of evidence. The task force members were representatives from 17 national medical societies therefore have consented following guiding principle in common: "Patients in intensive care shall be awake, alert and free of pain, anxiety and delirium, to be able to participate in the healing process actively."