The unusual case of dental pain with sham repetitive transcranial magnetic stimulation: a benign idiosyncrasy or diagnostic opportunity?

Abstract not availableBrenton Hordacre, Kristina Comacchio, G. Lorimer Mosele

The disappearing hand: vestibular stimulation does not improve hand localisation.

Bodily self-consciousness depends on the coherent integration of sensory information. In addition to visual and somatosensory information processing, vestibular contributions have been proposed and investigated. Vestibular information seems especially important for self-location, but remains difficult to study. This randomised controlled experiment used the MIRAGE multisensory illusion box to induce a conflict between the visually- and proprioceptively-encoded position of one hand. Over time, the perceived location of the hand slowly shifts, due to the fact that proprioceptive input is progressively weighted more heavily than the visual input. We hypothesised that left cold caloric vestibular stimulation (CVS) augments this shift in hand localisation. The results from 24 healthy participants do not support our hypothesis: CVS had no effect on the estimations with which the perceived position of the hand shifted from the visually- to the proprioceptively-encoded position. Participants were more likely to report that their hand was 'no longer there' after CVS. Taken together, neither the physical nor the subjective data provide evidence for vestibular enhanced self-location

Factors associated with vitamin D testing, deficiency, intake and supplementation in patients with chronic pain

Published online: 02 Nov 2017.Vitamin D deficiency is a public health issue, with reports of six- to twenty-five–fold rise in vitamin D testing. Vitamin D deficiency has been linked to many chronic diseases such as diabetes mellitus, cardiovascular disease, depression, and chronic pain. Identifying factors associated with risk of deficiency in individuals with chronic pain will help minimize time and cost. This study aims to examine the factors associated with vitamin D testing, intake, and physician-advised supplementation in individuals with chronic pain. Using a cross-sectional design, data were collected from 465 individuals with chronic pain. These data were analyzed using penalized logistic regression with the LASSO technique. Fifty-seven percent reported being tested for vitamin D, about 40% reported being diagnosed with vitamin D deficiency, and of those who had been tested, 60% reported taking vitamin D supplementation. The findings suggest older age (OR 3.12, CI [1.02, 9.50]) and higher mean pain intensity score (OR 2.02, CI [1.13, 3.59]) increased an individual's chance of being vitamin D deficient. Unemployment or on leave due to pain (OR 1.79, [CI 1.03, 3.11]), part-time employment (OR 1.86, CI [1.02, 3.39]), and being a resident of Australia (OR 2.32, CI [1.13, 4.72]) increased chances of being tested for vitamin D. Being diagnosed with vitamin D deficiency (OR 6.67, CI [2.75, 16.19]), unemployed or on leave due to pain (OR 3.71, CI [1.25, 11.00]), and in part-time employment (OR 2.69, CI [0.86, 8.38]) were associated with physician-advised vitamin D supplementation. Our results may have practical implications, as identifying pretest risk factors may assist in identifying who is at risk of vitamin D deficiency, whom to test, and when to treat.Manasi Gaikwad, Simon Vanlint, G. Lorimer Moseley, Murthy N. Mittinty, and Nigel Stock

Causal mechanisms in the clinical course and treatment of back pain

In recent years, there has been increasing interest in studying causal mechanisms in the development and treatment of back pain. The aim of this article is to provide an overview of our current understanding of causal mechanisms in the field. In the first section, we introduce key concepts and terminology. In the second section, we provide a brief synopsis of systematic reviews of mechanism studies relevant to the clinical course and treatment of back pain. In the third section, we reflect on the findings of our review to explain how understanding causal mechanisms can inform clinical practice and the implementation of best practice. In the final sections, we introduce contemporary methodological advances, highlight the key assumptions of these methods, and discuss future directions to advance the quality of mechanism-related studies in the back pain field

Conflation between self-report and neurocognitive assessments of cognitive flexibility: a critical review of the Jingle Fallacy

Cognitive flexibility is a widely studied construct and is considered an important treatment target for several psychological disorders. The convergence of several independent fields of research has led to assumptions about the assessment of cognitive flexibility – assumptions that are not empirically supported and often conflate different notions of flexibility. This critical review discusses how the conflation of self-report and neurocognitive assessments has seemingly arisen from literature on eating disorders. We describe how seminal early observations of “inflexible” personality characteristics, communication competence research, and investigations of frontal lobe function after injury led to two methods of assessing “cognitive flexibility”. We discuss the impact that conflation of self-report and neurocognitive assessments has had on the field, and we provide recommendations for assessing cognitive flexibility in both research and clinical settings.Caitlin A. Howlett, Stephanie Miles, Carolyn Berryman, Andrea Phillipou and G. Lorimer Mosele

What do I need to know? Essential educational concepts for complex regional pain syndrome

First published: 22 May 2022Background: Complex Regional Pain Syndrome (CRPS) is a rare but disabling pain condition. Accurate and timely education about CRPS is key to promote optimal clinical outcomes, but it is unclear what the content of that education should be. We aimed to determine the content that both people with CRPS and expert health care professionals (HCPs) reported as important. Methods: An international three-round e-Delphi was conducted, recruiting adults diagnosed with CRPS and HCPs. In Round 1, participants were asked to list the most important information people with CRPS should know regarding the condition. Data were organized into concepts and allocated to themes. In Rounds 2 and 3, participants rated each concept on a 9-point Likert Scale, categorized as ‘not important’ (0–3), ‘important’ (4–6) and ‘very important’ (7–9). A concept attained consensus when ≥75% agreement was reached within a category. Results: Sixty-two participants (HCPs: n =7; CRPS: n =55) proposed 193 concepts in Round 1, resulting in 22 themes. Fifteen additional concepts were identified in Round 2, resulting in a total of 208 concepts. From that list, 48 concepts that emphasized understanding and evidence-based management of the disorder, the importance of self-management strategies, pacing and movement, reached joint consensus as ‘very important’. One concept: ‘Advise that movement does not help’ reached joint consensus as ‘not important’. Conclusion: Forty-eight concepts were jointly considered ‘very important’ for future CRPS-related educational content. Future research to better understand group differences and to canvas a broader HCP group is warranted. Significance: This e-Delphi study identified the 48 core concepts that those with the lived experience of CRPS, and advanced practitioner health care professionals jointly rated as ‘very important’ to include in fundamental and accessible educational material.Emily Moore, Felicity A. Braithwaite, Tasha R. Stanton, Valeria Bellan, G. Lorimer Moseley, Carolyn Berryma

Use of behavioural activation to manage pain: a systematic scoping review

Background: Behavioural activation (BA) is an effective treatment for depression; however, it is unclear if it can be used to manage pain. Objectives: To conduct a scoping review of primary research that reported using BA to support people living with chronic pain to understand how BA had been used in relation to pain. In addition, we wanted to understand whether there were any reported changes in that pain, and how and who delivered BA. Eligibility: criteria Primary research published in English. Sources of evidence: We searched seven databases MEDLINE, Ovid Embase, Ovid Emcare, PsycINFO, CINAHL, Scopus and Web of Science, for primary research. No initial date limit was used with the date the searches were conducted used as the end date limit (1 July 2021). Charting methods: A customised data extraction table was developed, piloted and used. Results: 551 papers were screened for inclusion, with 15 papers included in our review. Studies were conducted in North America and in Canada. These included three case studies, nine uncontrolled trials and three randomised controlled trials. Only two studies reported pain as the primary outcome. BA was applied across a range of pain related conditions. The dose of BA ranged from 3 to 16 sessions. Duration of treatment was 3 weeks to 12 months. Most studies reported reductions in pain following exposure to BA. Conclusion: BA has the potential to reduce pain. Caution needs to be exercised in the interpretation of these findings as a high risk of bias was observed in most studies. High-quality research is required to test if BA is an effective intervention for chronic pain.Sandra Walsh, G Lorimer Moseley, Richard John Gray, Marianne Gillam, Kate M. Gunn, Trevor Barker, Kham Tran, Tesfahun Eshetie, Martin Jone

Using PROGRESS-Plus to identify current approaches to the collection and reporting of equity-relevant data: a scoping review

Objectives: Our objectives were to identify what and how data relating to the social determinants of health are collected and reported in equity-relevant studies and map these data to the PROGRESS-Plus framework. Study Design and Setting: We performed a scoping review. We ran two systematic searches of MEDLINE and Embase for equityrelevant studies published during 2021. We included studies in any language without limitations to participant characteristics. Included studies were required to have collected and reported at least two participant variables relevant to evaluating individual-level social determinants of health. We applied the PROGRESS-Plus framework to identify and organize these data. Results: We extracted data from 200 equity-relevant studies, providing 962 items defined by PROGRESS-Plus. A median of 4 (interquartile range 5 2) PROGRESS-Plus items were reported in the included studies. 92% of studies reported age; 78% reported sex/gender; 65% reported educational attainment; 49% reported socioeconomic status; 45% reported race; 44% reported social capital; 33% reported occupation; 14% reported place and 9% reported religion. Conclusion: Our synthesis demonstrated that researchers currently collect a limited range of equity-relevant data, but usefully provides a range of examples spanning PROGRESS-Plus to inform the development of improved, standardized practices.Emma L. Karrana, Aidan G. Cashina, Trevor Barker, Mark A. Boyd, Alessandro Chiarotto, Omar Dewidar, Vina Mohabir, Jennifer Petkovic Saurab Sharma, Sinan Tejani, Peter Tugwell, G. Lorimer Mosele

A pain science education and walking program to increase physical activity in people with symptomatic knee osteoarthritis: A feasibility study

Introduction: Nine of 10 people with knee osteoarthritis are inactive. Unhelpful pain beliefs may negatively influence physical activity levels. Targeting these unhelpful pain beliefs, through contemporary pain science education (PSE), may provide benefit. Objectives: To evaluate the feasibility of conducting a clinical trial to determine the effect of adding PSE (vs adding sham ultrasound) to an individualised, physiotherapist-led education and walking program in people with painful knee osteoarthritis. Methods: Twenty participants were randomised (1:1) into the PSE group or Control group, each receiving 4 in-person weekly treatments, then 4 weeks of at-home activities (weekly telephone check-in). Clinical outcomes and physical activity (7 days of wristworn accelerometry) were assessed at baseline, 4 (clinical outcomes only), 8, and 26 weeks. A priori feasibility criteria for recruitment, intervention adherence, viability of wrist-based accelerometry, and follow-up retention were set. Perceived intervention credibility, acceptability, and usefulness from participants and clinicians were assessed (ratings, written/verbal feedback). Results: Most feasibility criteria were met. On average, 7 adults/wk were eligible, with 70% recruited. Treatment compliance was high (in-person: 80% PSE; 100% Control; at-home: 78% PSE; 75% Control). Wrist-based accelerometry had .75% valid weartime. Sufficient follow-up rates were not achieved (26 weeks: 65%). Participant and clinician feedback highlighted that PSE was too complex and did not match patient expectations of “physiotherapy”, that sham ultrasound was problematic (clinician), but that both treatments had high credibility, acceptability, and usefulness. Conclusions: Progression to a full trial is warranted. Strategies to increase participant retention, refine the PSE content/delivery, and replace/remove the sham intervention are required.Tasha R. Stanton, Emma L. Karran, David S. Butler, Melissa J. Hull, Sarah N. Schwetlik, Felicity A. Braithwaite, Hannah G. Jones, G. Lorimer Moseley, Catherine L. Hill, Christy Tomkins-Lane, Carol Maher, Kim Bennel

Dust in Supernovae and Supernova Remnants II: Processing and survival

Observations have recently shown that supernovae are efficient dust factories, as predicted for a long time by theoretical models. The rapid evolution of their stellar progenitors combined with their efficiency in precipitating refractory elements from the gas phase into dust grains make supernovae the major potential suppliers of dust in the early Universe, where more conventional sources like Asymptotic Giant Branch (AGB) stars did not have time to evolve. However, dust yields inferred from observations of young supernovae or derived from models do not reflect the net amount of supernova-condensed dust able to be expelled from the remnants and reach the interstellar medium. The cavity where the dust is formed and initially resides is crossed by the high velocity reverse shock which is generated by the pressure of the circumstellar material shocked by the expanding supernova blast wave. Depending on grain composition and initial size, processing by the reverse shock may lead to substantial dust erosion and even complete destruction. The goal of this review is to present the state of the art about processing and survival of dust inside supernova remnants, in terms of theoretical modelling and comparison to observations