Interventions for treating pain and disability in adults with complex regional pain syndrome - An overview of systematic reviews

This article is available open access through the publisher’s website at the link below. Copyright © 2013 The Cochrane Collaboration.Background - There is currently no strong consensus regarding the optimal management of complex regional pain syndrome although a multitude of interventions have been described and are commonly used. Objectives - To summarise the evidence from Cochrane and non-Cochrane systematic reviews of the effectiveness of any therapeutic intervention used to reduce pain, disability or both in adults with complex regional pain syndrome (CRPS). Methods - We identified Cochrane reviews and non-Cochrane reviews through a systematic search of the following databases: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Ovid MEDLINE, Ovid EMBASE, CINAHL, LILACS and PEDro. We included non-Cochrane systematic reviews where they contained evidence not covered by identified Cochrane reviews. The methodological quality of reviews was assessed using the AMSTAR tool. We extracted data for the primary outcomes pain, disability and adverse events, and the secondary outcomes of quality of life, emotional well being and participants' ratings of satisfaction or improvement. Only evidence arising from randomised controlled trials was considered. We used the GRADE system to assess the quality of evidence. Main results - We included six Cochrane reviews and 13 non-Cochrane systematic reviews. Cochrane reviews demonstrated better methodological quality than non-Cochrane reviews. Trials were typically small and the quality variable. There is moderate quality evidence that intravenous regional blockade with guanethidine is not effective in CRPS and that the procedure appears to be associated with the risk of significant adverse events. There is low quality evidence that bisphosphonates, calcitonin or a daily course of intravenous ketamine may be effective for pain when compared with placebo; graded motor imagery may be effective for pain and function when compared with usual care; and that mirror therapy may be effective for pain in post-stroke CRPS compared with a 'covered mirror' control. This evidence should be interpreted with caution. There is low quality evidence that local anaesthetic sympathetic blockade is not effective. Low quality evidence suggests that physiotherapy or occupational therapy are associated with small positive effects that are unlikely to be clinically important at one year follow up when compared with a social work passive attention control. For a wide range of other interventions, there is either no evidence or very low quality evidence available from which no conclusions should be drawn. Authors' conclusions - There is a critical lack of high quality evidence for the effectiveness of most therapies for CRPS. Until further larger trials are undertaken, formulating an evidence-based approach to managing CRPS will remain difficult

Globalization: How it has impacted Venezuela and Chile

People around the world have very different perceptions of globalization; in the developed world, the idea is that globalization has failed, whereas the developing countries have had a different experience with globalization. In the developing countries, their economic growth has been supported by foreign direct investment, which has helped to create a middle class. But ultimately, even between the developing countries, globalization has had a different impact on the countries and their respective economies. Chile is one of the countries that has taken advantage of globalization and benefited from it. Meanwhile, Venezuela has cut itself off from globalization and this has led to many disasters for the country. The research for this paper shows how globalization has been a positive aspect in Chile, while Venezuela has avoided globalization and faced many consequences. This paper compares the role of globalization in Chile and Venezuela.https://openriver.winona.edu/urc2019/1086/thumbnail.jp

Non-invasive brain stimulation techniques for chronic pain

Copyright © 2014 The Cochrane Collaboration.Various devices are available that can electrically stimulate the brain without the need for surgery or any invasive treatment in order to manage chronic pain. There are four main treatment types: repetitive transcranial magnetic stimulation (rTMS) in which the brain is stimulated by a coil applied to the scalp, cranial electrotherapy stimulation (CES) in which electrodes are clipped to the ears or applied to the scalp, transcranial direct current stimulation (tDCS) and reduced impedance non-invasive cortical electrostimulation (RINCE) in which electrodes are applied to the scalp. These have been used to try to reduce pain by aiming to alter the activity of the brain, but the efficacy of these treatments is uncertain. This review update included 56 studies: 30 of rTMS, 11 of CES, 14 of tDCS and one of RINCE. We judged only three studies as having a low risk of bias. Low or very low-quality evidence suggests that low-frequency rTMS and rTMS applied to pre-frontal areas of the brain are not effective but that a single dose of high-frequency stimulation of the motor cortex area of the brain provides short-term pain relief. This effect appears to be small and may be exaggerated by a number of sources of bias. Studies that gave a course of multiple treatments of rTMS produced conflicting results with no overall effect seen when we pooled the results of these studies. Most studies of rTMS are small and there is substantial variation between studies in terms of the treatment methods used. Low-quality evidence does not suggest that CES or tDCS are effective treatments for chronic pain. A single small study of RINCE provided very low-quality evidence of a short-term effect on pain. For all forms of stimulation the evidence is not conclusive and uncertainty remains. The reporting of side effects varied across the studies. Of the studies that clearly reported side effects, short-lived and minor side effects such as headache, nausea and skin irritation were usually reported both after real and sham stimulation. There were two reports of seizure following real rTMS. While the broad conclusions for rTMS and CES have not changed substantially, the addition of this new evidence and the application of the GRADE system has modified some of our interpretation. Previous readers should re-read this update. More studies of rigorous design and adequate size are required to evaluate accurately all forms of non-invasive brain stimulation for the treatment of chronic pain

A quantum violation of the second law?

An apparent violation of the second law of thermodynamics occurs when an atom coupled to a zero-temperature bath, being necessarily in an excited state, is used to extract work from the bath. Here the fallacy is that it takes work to couple the atom to the bath and this work must exceed that obtained from the atom. For the example of an oscillator coupled to a bath described by the single relaxation time model, the mean oscillator energy and the minimum work required to couple the oscillator to the bath are both calculated explicitly and in closed form. It is shown that the minimum work always exceeds the mean oscillator energy, so there is no violation of the second law

Rotation and Spin in Physics

We delineate the role of rotation and spin in physics, discussing in order Newtonian classical physics, special relativity, quantum mechanics, quantum electrodynamics and general relativity. In the latter case, we discuss the generalization of the Kepler formula to post-Newtonian order $(c^{-2}$) including spin effects and two-body effects. Experiments which verify the theoretical results for general relativistic spin-orbit effects are discussed as well as efforts being made to verify the spin-spin effects

Balmer and Metal Absorption Feature Gradients in M32

Spectra from MDM Observatory are used to assess Lick/IDS feature strength gradients inside the half-light radius of the compact Local Group elliptical galaxy M32. All but a few (of 24 measured) indices show a statistically significant gradient. Comparing with models, the index gradients indicate a mean age and abundance gradient in the sense that the nucleus is a factor of 2.5 younger and a factor of 0.3 dex more metal-rich than at 1 effective radius. This conclusion is only weakly dependent on which index combinations are used and is robust to high accuracy. Stars near the M32 nucleus have a mean age and heavy element abundance [M/H] of (4.7 Gyr, +0.02), judging from models by Worthey with variable abundance ratios. This result has very small formal random errors, although, of course, there is significant age-metallicity degeneracy along an (age, abundance) line segment from (5.0 Gyr, 0.00) to (4.5 Gyr, +0.05). An abundance pattern of [C/M]=+0.077, [N/M]=-0.13, [Mg/M]=-0.18, [Fe/M]~0.0, and [Na/M]=+0.12 is required to fit the feature data, with a fitting precision of about 0.01 dex. Model uncertainties make the accuracies of these values at least twice the magnitude of the precision. Forcing scaled-solar abundances does not change the age very much, but it increases the rms goodness of model-data fit by a factor of 3 and broadens the allowed range of age to $\pm 1$ Gyr. The overall abundance pattern contrasts with larger elliptical galaxies, in which all measurable lighter elements are enhanced relative to iron and calcium.Comment: 23 pages, 9 figures, Astronomical Journal, in pres

Fluctuations Do Matter: Large Noise-Enhanced Halos in Charged-Particle Beams

The formation of beam halos has customarily been described in terms of a particle-core model in which the space-charge field of the oscillating core drives particles to large amplitudes. This model involves parametric resonance and predicts a hard upper bound to the orbital amplitude of the halo particles. We show that the presence of colored noise due to space-charge fluctuations and/or machine imperfections can eject particles to much larger amplitudes than would be inferred from parametric resonance alone.Comment: 13 pages total, including 5 figure

A multi-layer extension of the stochastic heat equation

Motivated by recent developments on solvable directed polymer models, we define a 'multi-layer' extension of the stochastic heat equation involving non-intersecting Brownian motions.Comment: v4: substantially extended and revised versio

Consistency of a Causal Theory of Radiative Reaction with the Optical Theorem

The Abraham-Lorentz-Dirac equation for a point electron, while suffering from runaway solutions and an acausal response to external forces, is compatible with the optical theorem. We show that a theory of radiative reaction that allows for a finite charge distribution is not only causal and free of runaway solutions, but is also consistent with the optical theorem and the standard formula for the Rayleigh scattering cross section.Comment: 4 pages, 2 figure

Untangling Source-To-Sink Geochemical Signals in a ~3.5 Ga Martian Lake: Sedimentology and Geochemistry of the Murray Formation

Sedimentary rocks are historical archives of planetary surface processes; their grains, textures, and chemistry integrate the effects of source terrains, paleoclimatic conditions, weathering and transport processes, authigenic mineral precipitation, and diagenesis, which records groundwater chemistry through time. Source to Sink basin analysis seeks to constrain the influence of each of these different signals through sedimentary and geochemical analyses. Here, we use Mars Science Laboratory (MSL) Curiosity rover images and geochemical and mineralogical data from a traverse across a portion of the Murray formationthe lowermost unit exposed in the Gale crater central moundto begin to constrain the aspects of the source to sink system that formed this Martian mudstone between 3.7 and 3.2 Ga