Complex regional pain syndrome in a competitive athlete and regional osteoporosis assessed by dual-energy X-ray absorptiometry: a case report.

Dual-energy X-ray absorptiometry is rarely utilized in the clinical care of patients with complex regional pain syndrome, but may be useful for the non-invasive determination of regional bone fragility and fracture risk, as well as muscular atrophy and regional body composition. This is the first report in the literature of complex regional pain syndrome and musculoskeletal co-morbidities in an athlete, and is the first to focus on dual-energy X-ray absorptiometry for the clinical assessment of complex regional pain syndrome

The Landscape of Chronic Pain : Broader Perspectives

Chronic pain is a global health concern. This special issue on matters related to chronic pain aims to draw on research and scholarly discourse from an eclectic mix of areas and perspectives. The purpose of this non-systematic topical review is to précis an assortment of contemporary topics related to chronic pain and its management to nurture debate about research, practice and health care policy. The review discusses the phenomenon of pain, the struggle that patients have trying to legitimize their pain to others, the utility of the acute-chronic dichotomy, and the burden of chronic pain on society. The review describes the introduction of chronic primary pain in the World Health Organization's International Classification of Disease, 11th Revision and discusses the importance of biopsychosocial approaches to manage pain, the consequences of overprescribing and shifts in service delivery in primary care settings. The second half of the review explores pain perception as a multisensory perceptual inference discussing how contexts, predictions and expectations contribute to the malleability of somatosensations including pain, and how this knowledge can inform the development of therapies and strategies to alleviate pain. Finally, the review explores chronic pain through an evolutionary lens by comparing modern urban lifestyles with genetic heritage that encodes physiology adapted to live in the Paleolithic era. I speculate that modern urban lifestyles may be painogenic in nature, worsening chronic pain in individuals and burdening society at the population level

An investigation into enlarging and reducing the size of mirror reflections of the hand on experimentally-induced cold-pressor pain in healthy human participants

Background and aims: Mirror visual feedback may be a useful clinical tool for reducing pain. Research suggests that reducing the size of a non-painful reflected hand can alleviate complex regional pain syndrome in the affected hand that is out of view. In contrast, research on healthy humans exposed to experimentally induced pain suggests that reducing the appearance of the size of a reflected body part can increase pain. The aim of this study was to investigate the effect of enlarging and reducing the visual appearance of the size of a hand using mirror visual feedback on pain threshold, intensity and tolerance in healthy human participants exposed to cold-pressor pain. Methods: Participants were a convenience sample of 20 unpaid, healthy pain free volunteers aged 18 years or above. Each participant took part in one experiment where they completed cold-pressor pain tests whilst observing normal, enlarged and reduced size reflections of a hand congruent to a hand immersed in the ice cold water. A 4 × 2 factorial repeated measures analysis of variance (ANOVA) was performed on time to pain threshold and pain tolerance, and pain intensity with Condition (four levels: no reflection, reduced reflection, normal reflection, enlarged reflection) being the within-subject factors and Sex (two levels: female, male) between-subject factors. Results: There were no significant effects for Condition, Sex, or Condition × Sex interaction for pain threshold, intensity or tolerance (p > 0.05). There were no significant differences between the 3 mirror reflection conditions for agreement with the statements: “It felt like I was looking directly at my hand rather than at a mirror image”; “It felt like the hand I was looking at was my hand”; and “Did it seem like the hand you saw was a right hand or a left hand?”. Conclusion: Enlarging or reducing the size of a hand using mirror visual feedback did not alter pain perception in healthy human participants exposed to cold-pressor pain. The different sizes of hands generated by mirror visual feedback created an illusion of looking at their own hand but this was not as strong as looking directly at the hand. Implications: In future, investigators and clinicians using mirror visual feedback may consider including an adaptive phase to ensure the reflection has been perceptually embodied. Reasons for the lack of effects are explored to inspire further research in the field

Painful shoulder? Remote clinical management of a field guide with shoulder pain and loss of shoulder function in Antarctica

© 2017, Australasian Medical Journal Pty Ltd. All rights reserved. We report the case of a female Field Guide based at the British Antarctic Survey’s Rothera Science Research Station on Adelaide Island, Antarctica who independently contacted a physiotherapist specialising in climbing related injuries (GJ) located in the UK. For a second opinion. The Field Guide was experiencing significant work difficulties due to shoulder pain and subsequent loss of function particularly in overhead activities. The case raises important issues about the medical management of Field Guides operating in extreme environments and remote locations

Managing pain by visually distorting the size of painful body parts: is there any therapeutic value?

Painful conditions such as complex regional pain syndrome, phantom limb pain and low back pain may change the sense of body image, so that body parts are perceived as large, swollen, heavy or stuck in one position [1]. In 1995, Ramachandran et al. [2] reported that phantom limb pain could be relieved by creating a visual illusion whereby the amputated limb appeared to be wholly intact by reflecting a nonpainful intact limb in a mirror (i.e., using mirror visual feedback). Randomized, sham-controlled clinical trials of mirror visual feedback have confirmed the potential utility of the technique. For example, Chan et al. [3] assigned 22 patients with phantom limb pain to a 4-week course of one of the following interventions: viewing a reflected image of their intact foot in a mirror; viewing a covered mirror; or mental visualization. All patients receiving mirror visual feedback reported a decrease in pain (n = 6) compared with only one patient in the covered mirror group and two in the mental visualization group. Three patients reported worsening pain in the covered mirror group and four patients reported worsening pain in the mental visualization group. Nowadays, mirror visual feedback, often termed mirror box therapy, has been incorporated within therapeutic programs to treat painful conditions associated with alterations of body image resulting from neuropathy [4], complex regional pain syndrome [5], fibromyalgia [6] and nonspecific mechanical back pain [7]

Do pull-out programs create a mirage of long-term results for at-risk youth?

Educators and researchers cannot afford to ignore the achievement gap between at-risk students and their counterparts. The review examines educational practices for this targeted population. Historically, educational experts have supported the belief that teaching in isolated settings is one of the most effective practices for improving student achievement. Smaller class sizes are proposed as reform methods to substantially impact student performance (Odden, 1990). However, class size reduction must be coupled with research-based instructional strategies proven to further academic development. Traditionally, at-risk students receive instruction through pull-out interventions. A pull-out program in this study shall be defined as the removal of a student at risk of academic failure from the regular classroom to a small self-contained group setting to receive specialized instruction (Haas, l 993). The purpose of this study was to examine the academic and behavioral outcomes for middle school students who were pulled out of the general education setting and taught in a self-contained classroom. An examination of a pull-out program developed in an urban middle school for students who did not meet state proficiency on the Iowa Test of Basic Skills was conducted in the areas of reading and math. These pull-out classes were created to provide intensive instruction in the content areas of reading, math and language arts. The curriculum focused on basic comprehension, computation, written language and a social skills component to address behavioral concerns. Descriptive data show the percentage of students in each of three cohorts who attained changes in reading and math proficiency levels on the ITBS achieved between grade-level administrations. Some students improved in their proficiency category while others declined. Absence and suspension data suggest students in the at-risk program showed little change in behavior between seventh grade and the first semester of eighth grade. Absences and suspensions increased when students reentered general education classrooms. Educational decision makers should evaluate the effectiveness of self-contained programming for at-risk students. Educators should align individualized needs with instructional practices that benefit all students. Researchers are challenged to conduct in-depth assessment of pull-out programs based on long-term outcomes rather than short-term results

Acupuncture for the Relief of Chronic Pain : A Synthesis of Systematic Reviews

Background and Objectives: It is estimated that 28 million people in the UK live with chronic pain. A biopsychosocial approach to chronic pain is recommended which combines pharmacological interventions with behavioural and non-pharmacological treatments. Acupuncture represents one of a number of non-pharmacological interventions for pain. In the current climate of difficult commissioning decisions and constantly changing national guidance, the quest for strong supporting evidence has never been more important. Although hundreds of systematic reviews (SRs) and meta-analyses have been conducted, most have been inconclusive, and this has created uncertainty in clinical policy and practice. There is a need to bring all the evidence together for different pain conditions. The aim of this review is to synthesise SRs of RCTs evaluating the clinical efficacy of acupuncture to alleviate chronic pain and to consider the quality and adequacy of the evidence, including RCT design. Materials andMethods: Electronic databases were searched for English language SRs and meta-analyses on acupuncture for chronic pain. The SRs were scrutinised for methodology, risk of bias and judgement of efficacy. Results: A total of 177 reviews of acupuncture from 1989 to 2019 met our eligibility criteria. The majority of SRs found that RCTs of acupuncture had methodological shortcomings, including inadequate statistical power with a high risk of bias. Heterogeneity between RCTs was such that meta-analysis was often inappropriate. Conclusions: The large quantity of RCTs on acupuncture for chronic pain contained within systematic reviews provide evidence that is conflicting and inconclusive, due in part to recurring methodological shortcomings of RCTs. We suggest that an enriched enrolment with randomised withdrawal design may overcome some of these methodological shortcomings. It is essential that the quality of evidence is improved so that healthcare providers and commissioners can make informed choices on the interventions which can legitimately be provided to patients living with chronic pain

MENTAL HEALTH ISSUES AMONG THE ELDERLY POPULATION

The aging population has experienced a steady growth over the past several decades not only in the United States but also worldwide. This growth comes with increased needs for mental health services. The American Psychological Association (2019) estimated that the number of senior citizens in the United States with mental health and behavioral problems could reach 15 million in 2030. This study explored social workers’ perceptions of the apparatus of mental health services that target older adults. Using a snowball sampling, this study drew nine social workers, mostly Asian-Americans (N = 9). The findings generated four major themes, which were 1) broad range of challenges, 2) re- imagination of the service delivery process, 3) good faith cooperation between the family and the agency, and 4) conflicting viewpoints of service effectiveness. Nine sub-themes supported the four major themes. These were (a) personal challenges, (b) organizational challenges, (c) structural challenges, (d) need for more resources, (e) need for more mental health awareness, (f) need for more interagency collaboration, (g) knowledge about resources, (h) no resistance to services, and (i) proper medication management. The findings in this study have major implications for theory, research, and gerontological and geriatric social work

Reduction in plantar heel pain and a return to sport after a barefoot running intervention in a female triathlete with plantar fasciitis.

Patient characteristics: In a 27 year-old female triathlete, magnetic resonance imaging revealed mild thickening and oedema at the calcaneal insertion of the plantar fascia in keeping with a degree of plantar fasciitis. Intervention: After 6 weeks of conservative treatment failed to elicit a return to sport, the patient engaged in 6 sessions of barefoot running (15 – 30 minutes) on a soft grass surface, without further conservative treatment. Comparative outcome: After two sessions of barefoot running the patient was pain free before, during and after running. This outcome was maintained at the 6 week follow up period. Interpretation: This is the first case report to use barefoot running as a treatment strategy for chronic heel pain. Barefoot running has the potential to reduce the load on the plantar fascia and warrants further investigation using a case series

A survey of the attitudes and beliefs about the use of TENS for pain management by physiotherapists working in two cities in Sri Lanka.

INTRODUCTION: Transcutaneous electrical nerve stimulation (TENS) is a noninvasive, inexpensive, self-administered technique used throughout the world to relieve pain. In Sri Lanka, physiotherapists may use TENS for their patients as they receive a small amount of education about the principles and practice of TENS in their undergraduate training. To date, there have been no data gathered about the use of TENS by physiotherapists in Sri Lanka. The aim of this study was to assess attitudes and beliefs of physiotherapists working in Sri Lanka about their use of TENS for pain management. METHODS: A postal survey was undertaken using a 12-item questionnaire developed by the investigators to gather information about attitudes, beliefs and use of TENS in clinical practice. The questionnaire was distributed to 100 physiotherapists working in three government hospitals and six private hospitals in the cities of Kandy and Colombo. A descriptive analysis of data was performed. RESULTS: Sixty-seven completed questionnaires were returned (67% response rate). Over half of the respondents (58.2%) reported that they used TENS to treat pain "often" or "very often", with use for musculoskeletal/orthopedic (61.3%) and neuropathic/neuralgic (79.1%) pain being most common. TENS was used less for postsurgical pain and rarely for cancer pain. Most (95.5%) respondents reported that their patients benefitted "considerably" from TENS. 76.1% of the respondents reported that they did not recommend and/or prescribe TENS for patients to use at home. CONCLUSION: Physiotherapists value TENS as a treatment option to manage musculoskeletal and neuropathic pain. However, there is a need for systems and resources to enable to patients to self-administer TENS rather than having to visit clinics