The Current State of Physical Therapy Pain Curricula in the United States: A Faculty Survey

Insufficient pain education is problematic across the health care spectrum. Recent educational advancements have been made to combat the deficits in pain education to ensure that health care professionals are proficient in assessing and managing pain. The purpose of this survey was to determine the extent of pain education in current Doctorate of Physical Therapy schools in the United States, including how pain is incorporated into the curriculum, the amount of time spent teaching about pain, and the resources used to teach about pain. The survey consisted of 10 questions in the following subject areas: basic science mechanisms and concepts about pain, pain assessment, pain management, and adequacy of pain curriculum. The overall response was 77% (167/216) for the first series of responses of the survey (Question 1), whereas 62% completed the entire survey (Questions 2–10). The average contact hours teaching about pain was 31 ± 1.8 (mean ± standard error of the mean) with a range of 5 to 115 hours. The majority of schools that responded covered the science of pain, assessment, and management. Less than 50% of respondents were aware of the Institute of Medicine report on pain or the International Association for the Study of Pain guidelines for physical therapy pain education. Only 61% of respondents believed that their students received adequate education in pain management. Thus, this survey demonstrated how pain education is incorporated into physical therapy schools and highlighted areas for improvement such as awareness of recent educational advancements. Perspective This article demonstrates how pain education is incorporated into physical therapy curricula within accredited programs. Understanding the current structure of pain education in health professional curriculum can serve as a basis to determine if recent publications of guidelines and competencies impact education

Co-Localization of p-CREB and p-NR1 in Spinothalamic Neurons in a Chronic Muscle Pain Model

Activation of the cAMP pathway is an important mediator of chronic muscle pain. This study examined phosphorylation of the transcription factor cAMP-response-element-binding protein (p-CREB) and the NR1 subunit of the NMDA receptor (p-NR1) in the spinal cord. Bilateral mechanical hyperalgesia of the paw was induced by administering two injections of acidic saline, 5 days apart, into the gastrocnemius muscle of male Sprague–Dawley rats. The proportion of spinothalamic neurons that expressed p-NR1 or p-CREB did not change in the dorsal horn 24 h after the second intramuscular acid injection compared with animals that received pH 7.2 injections. This lack of change in spinothalamic neurons in the dorsal horn may be due to increases in individual spinothalamic neurons or increases in non-spinothalamic neurons. There was an increase in the proportion of spinothalamic neurons expressing p-NR1 in lamina X. These findings suggest that there are region-specific changes in spinothalamic neurons that express p-NR1 and lamina X may play an important role in the modulation of chronic muscle pain

An Interprofessional Consensus of Core Competencies for Prelicensure Education in Pain Management: Curriculum Application for Physical Therapy

Core competencies in pain management for prelicensure health professional education were recently established. These competencies represent the expectation of minimal capabilities for graduating health care students for pain management and include 4 domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain (Appendix 1). The purpose of this article is to advocate for and identify how core competencies for pain can be applied to the professional (entry-level) physical therapist curriculum. By ensuring that core competencies in pain management are embedded within the foundation of physical therapist education, physical therapists will have the core knowledge necessary for offering best care for patients, and the profession of physical therapy will continue to stand with all health professions engaged in comprehensive pain management

Free-electron gas at charged domain walls in insulating BaTiO3

Hetero interfaces between metal-oxides display pronounced phenomena such as semiconductor-metal transitions, magnetoresistance, the quantum hall effect and superconductivity. Similar effects at compositionally homogeneous interfaces including ferroic domain walls are expected. Unlike hetero interfaces, domain walls can be created, displaced, annihilated and recreated inside a functioning device. Theory predicts the existence of 'strongly' charged domain walls that break polarization continuity, but are stable and conduct steadily through a quasi-two-dimensional electron gas. Here we show this phenomenon experimentally in charged domain walls of the prototypical ferroelectric BaTiO3. Their steady metallic-type conductivity, 10(9) times that of the parent matrix, evidence the presence of stable degenerate electron gas, thus adding mobility to functional interfaces

Formation of charged ferroelectric domain walls with controlled periodicity

Charged domain walls in proper ferroelectrics were shown recently to possess metallic-like conductivity. Unlike conventional heterointerfaces, these walls can be displaced inside a dielectric by an electric field, which is of interest for future electronic circuitry. In addition, theory predicts that charged domain walls may influence the electromechanical response of ferroelectrics, with strong enhancement upon increased charged domain wall density. The existence of charged domain walls in proper ferroelectrics is disfavoured by their high formation energy and methods of their preparation in predefined patterns are unknown. Here we develop the theoretical background for the formation of charged domain walls in proper ferroelectrics using energy considerations and outline favourable conditions for their engineering. We experimentally demonstrate, in BaTiO3 single crystals the controlled build-up of high density charged domain wall patterns, down to a spacing of 7 mu m with a predominant mixed electronic and ionic screening scenario, hinting to a possible exploitation of charged domain walls in agile electronics and sensing devices

Physics and applications of charged domain walls

The charged domain wall is an ultrathin (typically nanosized) interface between two domains; it carries bound charge owing to a change of normal component of spontaneous polarization on crossing the wall. In contrast to hetero-interfaces between different materials, charged domain walls (CDWs) can be created, displaced, erased, and recreated again in the bulk of a material. Screening of the bound charge with free carriers is often necessary for stability of CDWs, which can result in giant two-dimensional conductivity along the wall. Usually in nominally insulating ferroelectrics, the concentration of free carriers at the walls can approach metallic values. Thus, CDWs can be viewed as ultrathin reconfigurable strongly conductive sheets embedded into the bulk of an insulating material. This feature is highly attractive for future nanoelectronics. The last decade was marked by a surge of research interest in CDWs. It resulted in numerous breakthroughs in controllable and reproducible fabrication of CDWs in different materials, in investigation of CDW properties and charge compensation mechanisms, in discovery of light-induced effects, and, finally, in detection of giant two-dimensional conductivity. The present review is aiming at a concise presentation of the main physical ideas behind CDWs and a brief overview of the most important theoretical and experimental findings in the field

Spermatogenesis and sertoli cell activity in mice lacking Sertoli cell receptors for follicle stimulating hormone and androgen

Spermatogenesis in the adult male depends on the action of FSH and androgen. Ablation of either hormone has deleterious effects on Sertoli cell function and the progression of germ cells through spermatogenesis. In this study we generated mice lacking both FSH receptors (FSHRKO) and androgen receptors on the Sertoli cell (SCARKO) to examine how FSH and androgen combine to regulate Sertoli cell function and spermatogenesis. Sertoli cell number in FSHRKO-SCARKO mice was reduced by about 50% but was not significantly different from FSHRKO mice. In contrast, total germ cell number in FSHRKO-SCARKO mice was reduced to 2% of control mice (and 20% of SCARKO mice) due to a failure to progress beyond early meiosis. Measurement of Sertoli cell-specific transcript levels showed that about a third were independent of hormonal action on the Sertoli cell, whereas others were predominantly androgen dependent or showed redundant control by FSH and androgen. Results show that FSH and androgen act through redundant, additive, and synergistic regulation of spermatogenesis and Sertoli cell activity. In addition, the Sertoli cell retains a significant capacity for activity, which is independent of direct hormonal regulation

Treating sample covariances for use in strongly coupled atmosphere-ocean data assimilation

Strongly coupled data assimilation requires cross-domain forecast error covariances; information from ensembles can be used, but limited sampling means that ensemble derived error covariances are routinely rank deficient and/or ill-conditioned and marred by noise. Thus they require modification before they can be incorporated into a standard assimilation framework. Here, we compare methods for improving the rank and conditioning of multivariate sample error covariance matrices for coupled atmosphere-ocean data assimilation. The first method, reconditioning, alters the matrix eigenvalues directly; this preserves the correlation structures but does not remove sampling noise. We show it is better to recondition the correlation matrix rather than the covariance matrix as this prevents small but dynamically important modes from being lost. The second method, model state-space localisation via the Schur product, effectively removes sample noise but can dampen small cross-correlation signals. A combination that exploits the merits of each is found to offer an effective alternative

Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials.

BACKGROUND: Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief. METHODS: Systematic review with meta-analysis of efficacy within 1-4 weeks and at follow up at 1-12 weeks after the end of treatment. RESULTS: 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm [95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n = 343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped. CONCLUSION: TENS, EA and LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK