Individual differences and health in chronic pain: are sex-differences relevant?

Background: Because psychological variables are known to intercorrelate, the goal of this investigation was to compare the unique association between several well-established psychological constructs in pain research and pain-related outcomes. Sex differences are considered because pain is experienced differently across sex groups. Methods: Participants were 456 consecutive chronic pain patients attending a tertiary pain clinic (mean age = 58.4 years, SD = 14.8, 63.6% women). The study design was cross-sectional. Psychological constructs included personality (NEO-Five Factor Inventory), irrational thinking (General Attitudes and Beliefs Scale), and coping (Social Problem Solving Inventory). Outcomes were pain severity and interference (Brief Pain Inventory) and physical, general, and mental health status (Short Form-36). To decide whether the bivariate analyses and the two-block, multivariate linear regressions for each study outcome (block 1 = age, sex, and pain severity; block 2 = psychological variables) should be conducted with the whole sample or split by sex, we first explored whether sex moderated the relationship between psychological variables and outcomes. An alpha level of 0.001 was set to reduce the risk of type I errors due to multiple comparisons. Results: The moderation analyses indicated no sex differences in the association between psychological variables and study outcomes (all interaction terms p > .05). Thus, further analyses were calculated with the whole sample. Specifically, the bivariate analyses revealed that psychological constructs were intercorrelated in the expected direction and mostly correlated with mental health and overall perceived health status. In the regressions, when controlling for age, sex, and pain severity, psychological factors as a block significantly increased the explained variance of physical functioning (ΔR2 = .037, p < .001), general health (ΔR2 = .138, p < .001), and mental health (ΔR2 = .362, p < .001). However, unique associations were only obtained for mental health and neuroticism (β = − 0.30, p < .001) and a negative problem orientation (β = − 0.26, p < .001). Conclusions: There is redundancy in the relationship between psychological variables and pain-related outcomes and the strength of this association is highest for mental health status. The association between psychological characteristics and health outcomes was comparable for men and women, which suggests that the same therapeutic targets could be selected in psychological interventions of pain patients irrespective of sex

Fisiopatología de las transposiciones tendinosas

Las transposiciones tendinosas constituyen la base fundamental para la restauración de una función perdida en el miembro paralizado. Los buenos resultados de estas transposiciones requieren no sólo una técnica meticulosa, sino también un conocimiento del comportamiento de los tejidos involucrados en todo el proceso. Los factores que inciden en el resultado de una transposición tendinosa son: a) mecánicos (potencia muscular, trayecto tendinoso y fijación terminal): b) biológicos(irrigación de la transposición, nuevos planos de deslizamiento y cicatrices); c) individuales (edad, dolor y sensibilidad en mano, estado articular previo, antigüedad del proceso y reeducación), y d) técnicos (cirugía precisa y tensión apropiada de la transposición). En este trabajo se analizan los elementos fundamentales constituyentes de una transposición tendinosa: el músculo motor, el tendón transferido y su nuevo trayecto, la fijación del tendón y el estado de las articulacione

A reduction in pain intensity is more strongly associated with improved physical functioning in frustration tolerant individuals: a longitudinal moderation study in chronic pain patients

Objective: the onset and chronification of pain often has devastating consequences on the physical and mental functioning of individuals. Medical interventions are quite efficacious in reducing pain levels. However, changes in physical and mental health status after medical interventions are not proportional. In the past decades, rational/irrational beliefs, especially catastrophizing, have contributed to a better understanding of the pain experience. This study explores whether pain reduction efforts are more beneficial for individuals scoring high in rational thinking (moderation). Methods: the study design was longitudinal. Patients were assessed twice, 2 weeks prior to the start of medical treatment at the pain clinic and 6 months after. A total of 163 patients with heterogeneous pain (mostly low back and neck pain) participated in the study. Their mean age was 58.74 years (SD = 14.28) and 61.3% were female. Results: Overall, there was a reduction in pain intensity (t = 4.25, p < 0.001, d = 0.32). An improvement in physical functioning (t = 4.02, p < 0.001, d = 0.19), but not mental health (t = -0.66, p = 0.511, d = 0.11) was also observed. In the regression analyses, a decrease in pain intensity was moderately associated with improved physical health (beta = 0.87, t = 4.96, p < 0.001, R-2 change = 0.177). This association was found to be moderated by frustration tolerance (beta = -0.49, t = -2.80, p = 0.006, R-2 change = 0.039). Specifically, post hoc analyses indicated that changes in pain intensity only correlated with changes in physical health when patients reported high frustration tolerance levels (r = 0.47, p = 0.006, M = 7, n = 32), but not when patients were intolerant to frustration (r = 0.28, p = 0.078, M = 17, n = 41). Conclusion: the results suggest that frustration tolerance may render adaptive by facilitating the positive effect that a reduction in pain intensity has on physical health status. The study findings are discussed in the context of personalized therapy with an emphasis on how to maximize the effectiveness of current interventions for pain

Acute Infection in Total Knee Arthroplasty: Diagnosis and Treatment

Infection is one of the most serious complications after total knee arthroplasty (TKA). The current incidence of prosthetic knee infection is 1-3%, depending on the series(.) For treatment and control to be more cost effective, multidisciplinary groups made up of professionals from different specialities who can work together to eradicate these kinds of infections need to be assembled. About the microbiology, Staphylococcus aureus and coagulase-negative staphylococcus were among the most frequent microorganisms involved (74%). Anamnesis and clinical examination are of primary importance in order to determine whether the problem may point to a possible acute septic complication. The first diagnosis may then be supported by increased CRP and ESR levels. The surgical treatment for a chronic prosthetic knee infection has been perfectly defined and standardized, and consists in a two-stage implant revision process. In contrast, the treatment for acute prosthetic knee infection is currently under debate. Considering the different surgical techniques that already exist, surgical debridement with conservation of the prosthesis and polythene revision appears to be an attractive option for both surgeon and patient, as it is less aggressive than the two-stage revision process and has lower initial costs. The different results obtained from this technique, along with prognosis factors and conclusions to keep in mind when it is indicated for an acute prosthetic infection, whether post-operative or haematogenous, will be analysed by the authors

Bloqueo de la articulación metacarpofalángica por osteofito de la cabeza del metacarpiano

Se presenta el caso de una paciente de 79 años de edad que acudió al Servicio de Urgencias de nuestro centro con un bloqueo de la articulación metacarpofalángica (MF) del dedo medio ocasionado por un osteofito en la cara cubital de la cabeza del tercer metacarpiano. El estudio radiológico permitió observar la presencia del osteofito y su extirpación permitió recuperar la normal excursión del ligamento colateral cubital de la art. MF y la extensión completa de la articulación.A 79 years old woman that presented her middle finger metacarpophalangeal joint blocked in flexion because and osteophite on the dorsal-ulnar aspect of the head of the metacarpal is presented. Diagnostic was stablished after radiological study. Resection of the osteophite allowed the ulnar collateral ligament come back to its normal excursion and complete extension of the joint was regained

Fracaso del cartílago costal en el tratamiento de defectos óseos experimentales: Estudio histológico y radiológico

Se realiza un estudio experimental para demostrar la utilidad del cartílago costal, fresco o criopreservado (autólogo y homólogo), en el tratamiento de defectos óseos cavitarios de huesos largos y observar si la radiología simple es fiable para la valoración de su incorporación. Para ello se implanta cartílago costal, sin pericondrio, en un defecto óseo cavitario de la metáfisis distal del fémur de conejo. Se utilizan dos tipos de injerto según su procedencia (antólogo y homólogo) y el procedimiento de conservación (fresco y criopreservado). Se trabaja sobre 3 grupos de 6 conejos cada uno. Se valora la incorporación del injerto mediante histología y radiología simple, a las 3, 6 y 12 semanas. Las conclusiones de este trabajo demuestran que el implante de cartílago costal no actúa como elemento osteoinductor; la radiología simple no es un método fiable para la valoración de la incorporación del injerto.An experimental study was carried out to demonstrate the utility of costal, fresh or cryopreserved cartilage (autologus and homologous), in the treatment of cavitary bone defects of long bones and to observe whether simple radiology is reliable for assessing of its incorporation. The study involved implanting costal cartilage, without perichondrial tissue, in a cavitary bone defect of the distal metafisis in rabbit femur. Two types of graft were used, according to their origin (autologus and homologous) and to the conservation procedure (fresh and cryopreserved). We workek on 3 separate groups of 6 rabbits. We assessed the incorporation of the graft by means of histology and simple radiology studies, at 3, 6 and 12 weeks. The conclusions of this work demonstrate that costal cartilage implants do not act as osteoinductor elements, and that simple radiology is not a reliable method for assessing the incorporation of the graft

El trasplante de células de la glía envolvente del bulbo olfatorio tras lesión de la médula espinal: Estudio experimental en ratas.

Objetivo Evaluar el efecto a largo plazo del trasplante de células de la glía envolvente (GE) del bulbo olfatorio tras lesión de la médula espinal. Material y método Se practicó una laminectomía dorsal T8, en 16 ratas adultas Sprague-Dawley, dejando al descubierto la médula espinal subyacente, la cual se bañó con rosa de Bengala durante 10 minutos, antes de lesionarla por iluminación con una fibra óptica acoplada a una lámpara halógena, durante 2,5 minutos. A la mitad de los animales se les inyectó 180.000 células de GE, en 10 μl de medio (grupo GE), y a la otra mitad sólo 10 μl de DMEM (Dulbecco's modified Eagle's medium) (grupo DM). Los animales se sacrificaron a los 90 días de efectuar la lesión y se evaluó el área de médula espinal preservada, la recuperación locomotora y la sensibilidad nociceptiva. Resultados Los animales del grupo GE mostraron un nivel de locomoción superior y retiraron antes la pata al estímulo nociceptivo que los del grupo DM. También hubo una mayor preservación de parénquima medular y más células p75 positivas en el grupo GE que en el DM. Conclusiones El trasplante de GE favorece la preservación de parénquima medular y evita la pérdida de funciones motoras y sensoriales en la rata

Cartilage Appearance Using an Environmental Scanning Electron Microscope.

Because of technical principles, samples to be observed with electron microscopy need to be fixed in a chemical process and exposed to vacuum conditions that can produce some changes in the morphology of the specimen. The aim of this work was to obtain high-resolution images of the fresh articular cartilage surface with an environmental scanning electron microscope (ESEM), which is an instrument that permits examination of biological specimens without fixation methods in a 10 Torr chamber pressure, thus minimizing the risk of creating artifacts in the structure. Samples from weight-bearing areas of femoral condyles of New Zealand white rabbits were collected and photographed using an ESEM. Images were analyzed using a categorization based in the Jurvelin classification system modified by Hong and Henderson. Appearance of the observed elevations and depressions as described in the classification were observed, but no fractures or splits of cartilage surface, thought to be artifacts, were detected. The ESEM is a useful tool to obtain images of fresh articular cartilage surface appearance without either employing fixation methods or exposing the specimen to extreme vacuum conditions, reducing the risk of introducing artifacts within the specimen. For all these reasons it could become a useful tool for quality control of the preservation process of osteochondral allografting in a bank of musculoskeletal tissues

Luxación recidivante de prótesis total de cadera

Más del 50% de los casos de caderas inestables se pueden resolver mediante la reducción cerrada de la luxación. Un intento sistemático para entender la causa de la inestabilidad, normalmente suele conducir a un tratamiento eficaz del problema cuando hace falta cirugía. Los componentes constreñidos o de retención han mejorado las posibilidades de resolver los problemas difíciles de inestabilidad, pero los efectos negativos potenciales de estos componentes deben tenerse también en cuenta. Los implantes tripolares, cuyos resultados clínicos en la literatura son muy alentadores, ocupan un lugar de elección en el arsenal terapéutico de la inestabilidad protética