17,154 research outputs found

    Epidemiology of neuropathic pain:an analysis of prevalence and associated factors in UK Biobank

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    Abstract. Introduction:. Previous epidemiological studies of neuropathic pain have reported a range of prevalences and factors associated with the disorder. Objectives:. This study aimed to verify these characteristics in a large UK cohort. Methods:. A cross-sectional analysis was conducted of 148,828 UK Biobank participants who completed a detailed questionnaire on chronic pain. The Douleur Neuropathique en Quatre Questions (DN4) was used to distinguish between neuropathic pain (NeuP) and non-neuropathic pain (non-NeuP) in participants with pain of at least 3 months' duration. Participants were also identified with less than 3 months' pain or without pain (NoCP). Multivariable regression was used to identify factors associated with NeuP compared with non-NeuP and NoCP, respectively. Results:. Chronic pain was present in 76,095 participants (51.1%). The overall prevalence of NeuP was 9.2%. Neuropathic pain was significantly associated with worse health-related quality of life, having a manual or personal service type occupation, and younger age compared with NoCP. As expected, NeuP was associated with diabetes and neuropathy, but also other pains (pelvic, postsurgical, and migraine) and musculoskeletal disorders (rheumatoid arthritis, osteoarthritis, and fibromyalgia). In addition, NeuP was associated with pain in the limbs and greater pain intensity and higher body mass index compared with non-NeuP. Female sex was associated with NeuP when compared with NoCP, whereas male sex was associated with NeuP when compared with non-NeuP. Conclusion:. This is the largest epidemiological study of neuropathic pain to date. The results confirm that the disorder is common in a population of middle- to older-aged people with mixed aetiologies and is associated with a higher health impact than non-neuropathic pain

    The Genetics of Pain: An exploration of gene-by-environment interactions and their effects on pain

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    The findings presented in this dissertation are part of the bigger SYMBIOME project which aims to use the biopsychosocial model of pain to develop a prognostic clinical phenotype for people that experience musculoskeletal (MSK) trauma. Chapter 2 presents an exploratory analysis to assess the relationships between genetic polymorphisms and pain severity and interference. Early childhood trauma was also explored as a moderator between genetic polymorphisms and pain outcomes. For pain severity, major allele carriers (A/A and G/A) of FKBP5 rs9394314 reported significantly higher scores than minor allele carriers (G/G). Further, major allele carriers who had at least one adverse childhood experience (ACE) reported significantly higher scores than minor allele carriers with at least one ACE. For pain interference, minor allele carriers (G/G) of CNR2 rs2501431 scored significantly higher than major allele carriers (A/A and G/A). Chapter 3 presents a cluster analysis that combines genotypes of FKBP5 rs9394314 and CNR2 rs2501431 to explore meaningful relationships with pain and trauma-related distress. ACE was also explored as a moderator of these relationships. Three clusters were identified where the second cluster characterized by major allele carriers of rs9394314 and minor allele carriers of rs2501431 reported significantly higher pain-related functional interference scores. Participants in the second cluster with at least one ACE reported higher pain interference and traumatic distress scores compared to the third cluster, while participants in the first cluster with at least one ACE reported higher pain severity compared to the first cluster. Chapter 4 presents genomic structural equation models (SEM) that explore the relationships of genotypes with trauma-related distress using the traumatic injuries distress scale (TIDS), ACE, and recovery outcomes. The results demonstrate a relationship between TIDS and recovery outcomes, and an indirect relationship between FKBP5 rs9394314 and recovery outcomes exist which is mediated by TIDS. Major allele carriers of FKBP5 rs9394314 reported higher TIDS scores, which was also demonstrated for participants that had at least one ACE. Major allele carriers that scored higher on the TIDS were predicted to be in the none-recovered category. These results support the notion that gene-x-environment interactions may play an important role in pain and recovery

    The Role of Ketamine in Trauma

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    Early and effective pain control in trauma patients improves outcomes and limits disability, but analgesia is often missed in the unstable patient, or hemodynamically depressing medications are avoided for fear of losing stability. This chapter outlines the role of ketamine in managing traumatic emergencies in both out-of-hospital and hospital environment, and beyond. Low-dose ketamine also called a sub-dissociative dose is safe, efficient and effective analgesic that can be considered for trauma patients, pediatric or adults, as an alternative to opioids or in combination with opioids for on additive or synergistic effect, with minimal impact on hemodynamic stability. Ketamine at higher doses is also an excellent drug for induction of anesthesia in rapid sequence induction (RSI), post-intubation sedation maintenance or procedural sedation in the trauma patient. Also, can be used for acute agitation and excited delirium. In this chapter, we are describing this drug focusing on a deeper understanding of the safety and efficacy of this agent and, if supported, to encourage physicians to consider ketamine for pain control in trauma and beyond. Also, we are presenting the current literature surrounding ketamine’s evidences in the trauma condition to establish its utility and profile of safety for these patients

    Building body identities - exploring the world of female bodybuilders

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    This thesis explores how female bodybuilders seek to develop and maintain a viable sense of self despite being stigmatized by the gendered foundations of what Erving Goffman (1983) refers to as the 'interaction order'; the unavoidable presentational context in which identities are forged during the course of social life. Placed in the context of an overview of the historical treatment of women's bodies, and a concern with the development of bodybuilding as a specific form of body modification, the research draws upon a unique two year ethnographic study based in the South of England, complemented by interviews with twenty-six female bodybuilders, all of whom live in the U.K. By mapping these extraordinary women's lives, the research illuminates the pivotal spaces and essential lived experiences that make up the female bodybuilder. Whilst the women appear to be embarking on an 'empowering' radical body project for themselves, the consequences of their activity remains culturally ambivalent. This research exposes the 'Janus-faced' nature of female bodybuilding, exploring the ways in which the women negotiate, accommodate and resist pressures to engage in more orthodox and feminine activities and appearances

    TOWARDS AN UNDERSTANDING OF EFFORTFUL FUNDRAISING EXPERIENCES: USING INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS IN FUNDRAISING RESEARCH

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    Physical-activity oriented community fundraising has experienced an exponential growth in popularity over the past 15 years. The aim of this study was to explore the value of effortful fundraising experiences, from the point of view of participants, and explore the impact that these experiences have on people’s lives. This study used an IPA approach to interview 23 individuals, recognising the role of participants as proxy (nonprofessional) fundraisers for charitable organisations, and the unique organisation donor dynamic that this creates. It also bought together relevant psychological theory related to physical activity fundraising experiences (through a narrative literature review) and used primary interview data to substantiate these. Effortful fundraising experiences are examined in detail to understand their significance to participants, and how such experiences influence their connection with a charity or cause. This was done with an idiographic focus at first, before examining convergences and divergences across the sample. This study found that effortful fundraising experiences can have a profound positive impact upon community fundraisers in both the short and the long term. Additionally, it found that these experiences can be opportunities for charitable organisations to create lasting meaningful relationships with participants, and foster mutually beneficial lifetime relationships with them. Further research is needed to test specific psychological theory in this context, including self-esteem theory, self determination theory, and the martyrdom effect (among others)

    Wrist Arthroscopy

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    This article is dedicated to our special interest in hand surgery - arthroscopy. We are the initiators of the wrist arthroscopy in our clinic as well as in country. In this chapter we can only sketch some aspects of this fascinating, intriguing and specific direction of hand surgery. Indications for arthroscopic surgery and application in different wrist conditions including novel techniques. There is a short historical review at the beginning - names and contribution of the pioneers of the wrist arthroscopy, development of instruments and surgical possibilities. This is followed by arthroscopic anatomy of the portals and structures accessible via these portals. The most common arthroscopic procedures in our practice are listed and described, such as arthroscopic treatment of ganglions and bone cysts, intercarpal ligament or TFCC tears, application of the arthroscopy in treatment of the articular distal radius fractures, scaphoid fractures and nonunions The text is supplemented with photos of our patients

    Omics measures of ageing and disease susceptibility

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    While genomics has been a major field of study for decades due to relatively inexpensive genotyping arrays, the recent advancement of technology has also allowed the measure and study of various “omics”. There are now numerous methods and platforms available that allow high throughput and high dimensional quantification of many types of biological molecules. Traditional genomics and transcriptomics are now joined by proteomics, metabolomics, glycomics, lipidomics and epigenomics. I was lucky to have access to a unique resource in the Orkney Complex Disease Study (ORCADES), a cohort of individuals from the Orkney Islands that are extremely deeply annotated. Approximately 1000 individuals in ORCADES have genomics, proteomics, lipidomics, glycomics, metabolomics, epigenomics, clinical risk factors and disease phenotypes, as well as body composition measurements from whole body scans. In addition to these cross-sectional omics and health related measures, these individuals also have linked electronic health records (EHR) available, allowing the assessment of the effect of these omics measures on incident disease over a ~10-year follow up period. In this thesis I use this phenotype rich resource to investigate the relationship between multiple types of omics measures and both ageing and health outcomes. First, I used the ORCADES data to construct measures of biological age (BA). The idea that there is an underlying rate at which the body deteriorates with age that varies between individuals of the same chronological age, this biological age, would be more indicative of health status, functional capacity and risk of age-related diseases than chronological age. Previous models estimating BA (ageing clocks) have predominantly been built using a single type of omics assay and comparison between different omics ageing clocks has been limited. I performed the most exhaustive comparison of different omics ageing clocks yet, with eleven clocks spanning nine different omics assays. I show that different omics clocks overlap in the information they provide about age, that some omics clocks track more generalised ageing while others track specific disease risk factors and that omics ageing clocks are prognostic of incident disease over and above chronological age. Second, I assessed whether individually or in multivariable models, omics measures are associated with health-related risk factors or prognostic of incident disease over 10 years post-assessment. I show that 2,686 single omics biomarkers are associated with 10 risk factors and 44 subsequent incident diseases. I also show that models built using multiple biomarkers from whole body scans, metabolomics, proteomics and clinical risk factors are prognostic of subsequent diabetes mellitus and that clinical risk factors are prognostic of incident hypertensive disorders, obesity, ischaemic heart disease and Framingham risk score. Third, I investigated the genetic architecture of a subset of the proteomics measures available in ORCADES, specifically 184 cardiovascular-related proteins. Combining genome-wide association (GWAS) summary statistics from ORCADES and 17 other cohorts from the SCALLOP Consortium, giving a maximum sample size of 26,494 individuals, I performed 184 genome-wide association meta-analyses (GWAMAs) on the levels of these proteins circulating in plasma. I discovered 592 independent significant loci associated with the levels of at least one protein. I found that between 8-37% of these significant loci colocalise with known expression quantitative trait loci (eQTL). I also find evidence of causal associations between 11 plasma protein levels and disease susceptibility using Mendelian randomisation, highlighting potential candidate drug targets

    GENDERED EMBODIMENT, STABILITY AND CHANGE: WOMEN’S WEIGHTLIFTING AS A TOOL FOR RECOVERY FROM EATING DISORDERS

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    This thesis explores the everyday embodied experiences of women who use amateur weightlifting as a vehicle for recovery from eating disorders. Within online spaces and on social media, women frequently share their experiences of using weightlifting to overcome issues relating to disordered eating, body image, and mental health. In particular, women with a history of eating disorders credit weightlifting to be integral to their recovery journey. However, there is a dearth of research on women’s experiences with exercise during eating disorder recovery and no research that identifies weightlifting as beneficial to this process. To the contrary, discursive links are drawn between the practices of self-surveillance exercised by both eating disorder sufferers and weightlifters alike. In this regard, engagement with weightlifting during eating disorder recovery may signal the transferal of pathology from one set of behaviours to another. That is, from disordered eating to rigid and self-regulatory exercise routines. This thesis examines how women subjectively navigate and make sense of this pathologisation. The data for this research comes from longitudinal semi-structured interviews and photo elicitation with 19 women, living in the United Kingdom, who engaged in weightlifting during their eating disorder recovery. In addition, to build up a holistic picture and to explore how this phenomenon also ‘takes place’ online, I conducted a netnography of the overlapping subcultures of female weightlifting and eating disorder recovery on Instagram. Women’s standpoint theory and interpretative phenomenological analysis are combined to form the underpinning theoretical and analytical tools used to engage with these three rich data sets. Moreover, throughout I draw on an eclectic range of disciplinary perspectives, in order to bring together multiple fields of research and develop novel theoretical frameworks. In the findings, I argue that women’s experiences using weightlifting as a tool for recovery from eating disorders manifests in an embodied sense of multiplicity. In this sense, understandings of the body that are often viewed as ontologically distinct (muscularity/thinness/fatness) hang-together at once in the lived experience of a single individual. I argue that women, particularly those who have previously struggled with an eating disorder, are too readily positioned as vulnerable to media and representation. To theoretically combat these ideas regarding women’s assumed passivity, I develop the concept of ‘digital pruning’ to account for women’s agency in relation to new media. I contend that weightlifting offers women in recovery from eating disorders a new framework for approaching eating and exercise. Specifically, weightlifting’s norms and values legitimate occupying a larger body, which gives women in recovery permission to eat and gain-weight in a way that is both culturally sanctioned and health-promoting. Finally, I explore identity transformation as a specific tenet of recovery from eating disorders. I argue that, on social media, recovery identities are characterised by personal empowerment, resilience, and independence. While offline, quieter and less culturally glorified aspects of recovery (such as relationships of care) are central to women’s accounts of developing a new sense of self as they transition away from an eating disorder identity. In summary, this thesis is an examination of the ways in which women strategically navigate pathology in relation to their bodies, social media, food/exercise practices, and identity. I argue that women develop a set of ‘DIY’ recovery practices that allow them to consciously channel and draw on their negative experiences with eating disorders, to develop new ways of living that serve their overall wellbeing. Weightlifting is integral to this process, as it provides women transitioning out of this difficult phase in their lives with new ways of relating to their bodies and of being in the world. I situate this phenomenon within a neoliberal socio-political climate in which individuals are required to take personal responsibility for their mental health and wellbeing, despite living within conditions which are not conducive to recovery
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