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Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147110/1/pmr2539.pd

Read the Paper! Re: Cheng/Ho Point/Counterpoint on Electrodiagnostic Testing Before Surgery for Spinal Stenosis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147193/1/pmr2340.pd

Controlling the Midfield: Treating Patients With Chronic Pain Using Alternative Payment Models

The entire American health care system is turning upside down, except for the parts that aren’t— yet. For physiatrists who manage pain problems, the future is complex. The usual challenge of treating these devastating and costly problems that cannot be measured physiologically is compounded by the requirement to do so in a health care system that doesn’t know what it wants to be yet. Payment, regulation, and the very structure of practice are changing at a pace that is halting and unpredictable. Nonetheless, knowledge about some structures is necessary, and some themes almost certainly emerge. I propose that the role of the pain physiatrist is best understood through a soccer analogy. Whereas the casual spectator of the past might note the goals scored by surgical colleagues and shots missed by primary care partners, sophisticated health care systems of the future will learn that the pain game is won by creating a strong physiatry midfield. Physiatrists can reach to the backfield to help primary care with tough cases, send accurate referrals to surgeons, and reorganize the team when chronic pain complicates the situation. Current and emerging payment structures include insurance from government, employers, or individuals. Although the rules may change, certain trends appear to occur: Individuals will be making more choices, deductibles will increase, narrow groups of practitioners will work together, pricing will become important, and the burden on primary care colleagues will increase. Implications of each of these trends on pain medicine and specific strategy examples are addressed. A general concept emerges that, although procedure‐ and activity‐based practice is still important, pain physiatrists can best prepare for the future by leading programs that create value for their health care system.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147152/1/pmr2s248.pd

The impact of managing a child’s chronic fatigue syndrome/ myalgic encephalopathy (CFS/ME) on family relationships

Although there is a large body of research literature concerning the impact of childhood chronic illness on family relationships, very little of this has specifically focussed on the impact of childhood Chronic Fatigue Syndrome/Myalgic Encephalopathy (CFS/ME). The current study therefore aims to investigate the impact of having a child with CFS/ME on family relationships from the perspective of parents. This study takes a qualitative approach. Semi-structured interviews were used to explore 18 parents’ experiences of having a child with CFS/ME and the impact this has had on family relationships. Interview data were transcribed and analysed using thematic analysis. The analysis led to the identification of 5 main themes: “Long and Difficult Journey”, “Uncertainty”, “Isolation and Restriction”, “Focus on the unwell person at the expense of family life” and “Parental roles”. They felt that life had become a constant struggle and often felt exhausted. They felt uncertainty, isolation and restriction. These parents talked about feeling like family life had become focussed on their unwell child, such that some expressed a need to escape from the situation. They also described how, as a consequence of managing their child’s CFS/ME, family members could often feel marginalised and the illness could be seen as a destructive force. However, many parents also described working as a team and feeling that family relationships had benefitted in some way. The results of this study are in line with findings of other studies into other chronic illnesses. In addition, this is the first study to focus exclusively on the impact of CFS/ME on family relationships from the perspective of the parents, and is unique in that there is a dual focus on both mothers and fathers. Clinicians should be aware that parents of children with CFS/ME may need additional support, such as information as to what to expect at various stages of the illness and where to access the relevant support

Chronic Pain: Cure It First, Treat It Second

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147056/1/pmr2s324.pd

Female babies and risk-aversion : causal evidence from hospital wards

Using ultrasound scan data from paediatric hospitals, and the exogenous ‘shock’ of learning the gender of an unborn baby, the paper documents the first causal evidence that offspring gender affects adult risk-aversion. On a standard Holt-Laury criterion, parents of daughters, whether unborn or recently born, become almost twice as risk-averse as parents of sons. The study demonstrates this in longitudinal and cross-sectional data, for fathers and mothers, for babies in the womb and new-born children, and in a West European nation and East European nation. These findings may eventually aid our understanding of risky health behaviors and gender inequalities

Poster 153: Walking Assessment in People With Lumbar Spinal Stenosis: Capacity, Performance, and Self‐report Measures

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146939/1/pmr2s71a.pd

Symmetry of paraspinal muscle denervation in clinical lumbar spinal stenosis: Support for a hypothesis of posterior primary ramus stretching?

Introduction Denervation of the paraspinal muscles in spinal disorders is frequently attributed to radiculopathy. Therefore, patients with lumbar spinal stenosis causing asymmetrical symptoms should have asymmetrical paraspinal denervation. Methods Seventy‐three patients with clinical lumbar spinal stenosis, aged 55–85 years, completed a pain drawing and underwent masked electrodiagnostic testing, including bilateral paraspinal mapping and testing of 6 muscles on the most symptomatic (or randomly chosen) limb. Results With the exception of 10 subjects with unilateral thigh pain ( P = 0.043), there was no relationship between side of pain and paraspinal mapping score for any subgroups (symmetrical pain, pain into 1 calf only). Among those with positive limb EMG (tested on 1 side), no relationship between side of pain and paraspinal EMG score was found. Conclusion Evidence suggests that paraspinal denervation in spinal stenosis may not be due to radiculopathy, but rather due to stretch or damage to the posterior primary ramus. Muscle Nerve , 48: 198–203, 2013Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99085/1/mus23750.pd

Disability Policy Must Espouse Medical as well as Social Rehabilitation

A confident statement in Social Inclusion by Mannon and MacLacLan that disability is not a health problem places doubt on the rationale of their otherwise well-written research agenda for disability studies. Both by definition and in practice disability is in part about the impact of health on a person's functioning. The consequence of this misperception among social policy makers is a decreased emphasis on the resources and research needed to build medical rehabilitation programs. This is especially true in lower resource countries where naive inclusion of medical rehabillitation within community based rehabilitation strategies has resulted in fewer resources and less expertise to deliver the distinctly different, and well validated services of a medical rehabilitation team. Any rational research agenda on disability must focus on disease and medical rehabilitation as well as the psychological, social, and environmental factors discussed in this article