Stage of chronicity and treatment response in patients with musculoskeletal injuries and concurrent symptoms of depression

Abstract The present study examined the relation between stage of chronicity and treatment response in patients with work-related musculoskeletal conditions and concurrent depressive symptoms. Also of interest was the role of reductions in pain severity, catastrophic thinking and fear of movement/re-injury as mediators of the relation between chronicity and treatment response. A sample of 80 individuals (38 women, 42 men) with a disabling musculoskeletal pain condition and concurrent depressive symptoms participated in the research. Individuals with work absence of less than 6 months (range 12-26 weeks) were classified as early chronic (N = 40), and individuals with work absence greater than 6 months (range 27-52 weeks) were classified as chronic. Both groups were matched on sex, age (±2 years) and severity of depressive symptoms. All participants were enrolled in a 10-week community-based disability management intervention. The early chronic group showed significantly greater reduction in depressive symptoms, and pain symptoms, than the chronic group. Regression analyses revealed that pain reduction, but not catastrophic thinking or fear of movement/ re-injury, mediated the relation between chronicity and improvement in depressive symptoms. The results highlight the importance of early detection and treatment of depressive symptoms, given that treatment response decreases over time. The results also suggest that reductions in depressive symptoms might be a precondition to the effective reduction of pain symptoms in this population. Discussion addresses the factors that might contribute to treatment resistance as the period of disability extends over time.

Subchondral pre-solidified chitosan/blood implants elicit reproducible early osteochondral wound-repair responses including neutrophil and stromal cell chemotaxis, bone resorption and repair, enhanced repair tissue integration and delayed matrix deposition

Background: In this study we evaluated a novel approach to guide the bone marrow-driven articular cartilage repair response in skeletally aged rabbits. We hypothesized that dispersed chitosan particles implanted close to the bone marrow degrade in situ in a molecular mass-dependent manner, and attract more stromal cells to the site in aged rabbits compared to the blood clot in untreated controls. Methods: Three microdrill hole defects, 1.4 mm diameter and 2 mm deep, were created in both knee trochlea of 30 month-old New Zealand White rabbits. Each of 3 isotonic chitosan solutions (150, 40, 10 kDa, 80% degree of deaceylation, with fluorescent chitosan tracer) was mixed with autologous rabbit whole blood, clotted with Tissue Factor to form cylindrical implants, and press-fit in drill holes in the left knee while contralateral holes received Tissue Factor or no treatment. At day 1 or day 21 post-operative, defects were analyzed by micro-computed tomography, histomorphometry and stereology for bone and soft tissue repair. Results: All 3 implants filled the top of defects at day 1 and were partly degraded in situ at 21 days post-operative. All implants attracted neutrophils, osteoclasts and abundant bone marrow-derived stromal cells, stimulated bone resorption followed by new woven bone repair (bone remodeling) and promoted repair tissue-bone integration. 150 kDa chitosan implant was less degraded, and elicited more apoptotic neutrophils and bone resorption than 10 kDa chitosan implant. Drilled controls elicited a poorly integrated fibrous or fibrocartilaginous tissue. Conclusions: Pre-solidified implants elicit stromal cells and vigorous bone plate remodeling through a phase involving neutrophil chemotaxis. Pre-solidified chitosan implants are tunable by molecular mass, and could be beneficial for augmented marrow stimulation therapy if the recruited stromal cells can progress to bone and cartilage repair

The young athlete with physical challenges

Médecine du sport pour jeunes sportifs handicapés. Systèmes de classification en fonction de la sévérité du handicap. Problèmes spécifiques du contrôle médical de l'aptitude à la pratique sportive. Pathologies et traumatismes physiques des athlètes en fauteuil roulant, des athlètes amputés, des athlètes déficients visuels ou auditifs

The young athlete with physical challenges

Médecine du sport pour jeunes sportifs handicapés. Systèmes de classification en fonction de la sévérité du handicap. Problèmes spécifiques du contrôle médical de l'aptitude à la pratique sportive. Pathologies et traumatismes physiques des athlètes en fauteuil roulant, des athlètes amputés, des athlètes déficients visuels ou auditifs