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

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

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

Production of Enhanced Beam Halos via Collective Modes and Colored Noise

We investigate how collective modes and colored noise conspire to produce a beam halo with much larger amplitude than could be generated by either phenomenon separately. The collective modes are lowest-order radial eigenmodes calculated self-consistently for a configuration corresponding to a direct-current, cylindrically symmetric, warm-fluid Kapchinskij-Vladimirskij equilibrium. The colored noise arises from unavoidable machine errors and influences the internal space-charge force. Its presence quickly launches statistically rare particles to ever-growing amplitudes by continually kicking them back into phase with the collective-mode oscillations. The halo amplitude is essentially the same for purely radial orbits as for orbits that are initially purely azimuthal; orbital angular momentum has no statistically significant impact. Factors that do have an impact include the amplitudes of the collective modes and the strength and autocorrelation time of the colored noise. The underlying dynamics ensues because the noise breaks the Kolmogorov-Arnol'd-Moser tori that otherwise would confine the beam. These tori are fragile; even very weak noise will eventually break them, though the time scale for their disintegration depends on the noise strength. Both collective modes and noise are therefore centrally important to the dynamics of halo formation in real beams.Comment: For full resolution pictures please go to http://www.nicadd.niu.edu/research/beams

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

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

Time-Series Photometry of M67: W UMa Systems, Blue Stragglers, and Related Systems

We present an analysis of over 2200 V images taken on 14 nights at the Mt. Laguna 1 m telescope of the open cluster M67. Our observations overlap but extend beyond the field analyzed by Gilliland et al. (1991), and complement data recently published by van den Berg et al. (2002) and Stassun et al. (2002). We show variability in the light curves of all 4 of the known W UMa variables on timescales ranging from a day to decades (for AH Cnc). We have modeled the light curve of AH Cnc, and the total eclipses allow us to determine q = 0.16 +0.03/-0.02 and i = 86 +4/-8 degrees. The position of this system near the turnoff of M67 makes it useful for constraining the turnoff mass for the cluster. We have also detected two unusual features in the light curve of AH Cnc that may be caused by prominences. We have also monitored cluster blue stragglers for variability, and we present evidence hinting at low level variations in the stragglers S752, S968, and S1263, and we place limits on the variability of a number of other cluster blue stragglers. Finally, we provide photometry of the sub-subgiant branch star S1063 showing variability on timescales similar to the orbital period, while the ``red straggler'' S1040 shows evidence of an unexplained drop in brightness at phases corresponding to the passage of the white dwarf in front of the giant.Comment: 44 pages, 16 figures, AASTeX, accepted for A

Isospin Breaking and ω\omega->ππ\pi\pi Decay

We study $\omega\to\pi^+\pi^-$ decay up to including all orders of the chiral expansion and one-loop level of mesons in formlism of chiral constituent quark model. This G-parity forbidden decay is caused by $m_u\neq m_d$ and electromagnetic interaction of mesons. We illustrate that in the formlism both nonresonant contact interaction and $\rho$ resonance exchange contribute to this process, and the contribution from $\rho$ resonance exchange is dominant. We obtain that transition matrix element is $=[-(3956\pm 280)-(1697\pm 130)i]$MeV$^2$, and isospin breaking parameter is $m_d-m_u=3.9\pm 0.22$MeV at energy scale $\mu\sim m_\omega$.Comment: Revtex file, 16 pages, four eps figur

Orbital Ferromagnetism and Quantum Collapse in Stellar Plasmas

The possibility of quantum collapse and characteristics of nonlinear localized excitations is examined in dense stars with Landau orbital ferromagnetism in the framework of conventional quantum magnetohydrodynamics (QMHD) model including Bohm force and spin-orbit polarization effects. Employing the concepts of effective potential and Sagdeev pseudopotential, it is confirmed that the quantum collapse and Landau orbital ferromagnetism concepts are consistent with the magnetic field and mass-density range present in some white dwarf stars. Furthermore, the value of ferromagnetic-field found in this work is about the same order of magnitude as the values calculated earlier. It is revealed that the magnetosonic nonlinear propagations can behave much differently in the two distinct non-relativistic and relativistic degeneracy regimes in a ferromagnetic dense astrophysical object. Current findings should help to understand the origin of the most important mechanisms such as gravitational collapse and the high magnetic field present in many compact stars.Comment: To appear in journal Physics of Plasma

Anomalous diffusion in quantum Brownian motion with colored noise

Anomalous diffusion is discussed in the context of quantum Brownian motion with colored noise. It is shown that earlier results follow simply and directly from the fluctuation-dissipation theorem. The limits on the long-time dependence of anomalous diffusion are shown to be a consequence of the second law of thermodynamics. The special case of an electron interacting with the radiation field is discussed in detail. We apply our results to wave-packet spreading