Aging with a Disability: Physical Impairment, Pain, and Fatigue

This article focuses on the role of pain and fatigue in aging people who have physical impairments and provides a brief summary of definitions, descriptions, and classifications of pain and fatigue; implications of these secondary conditions on the health and functioning; multidisciplinary assessment and treatment options; and critical gaps in knowledge and directions for future research. Central nervous system trauma, diseases of the nervous system, and degenerative muscle diseases often result in significant physical impairments and disability. People who are living and aging with these underlying medical conditions often experience pain and fatigue secondary to their physical impairment that may worsen over time, resulting in increased disability and decreased quality of life. Important areas for future research in persons who have physical impairments include identification of conditions that require age-specific considerations; identification of symptom clusters (eg, pain, fatigue, depression) and how they evolve over time; and development of interdisciplinary treatment protocols

Outbreak of Cryptosporidium hominis in northern Sweden : persisting symptoms in a 5-year follow-up

In 2010–2011, a waterborne outbreak of the parasite, Cryptosporidium hominis, affected approximately 27,000 inhabitants in the city of Östersund, Sweden. Previous research suggested that post-infectious symptoms, such as gastrointestinal symptoms and joint pain, could persist for up to 2 years after the initial infection. In this study, we investigated whether the parasite caused post-infectious sequelae for up to 5 years after the outbreak. Prospective cohort study. A randomly selected cohort of individuals residing in Östersund at the time of the outbreak was sent a postal questionnaire in 2011. Responders were sent a follow-up questionnaire in 2016 and completed items on whether they experienced a list of symptoms. We examined whether outbreak cases were more likely than non-cases to report post-infectious symptoms 5 years later. We analysed data using logistic regression and calculated odds ratios with 95% confidence intervals. The analysis included 626 individuals. Among the 262 individuals infected during the outbreak, 56.5% reported symptoms at follow-up. Compared to non-cases, outbreak cases were more likely to report watery diarrhoea, diarrhoea, swollen joints, abdominal pain, bloating, joint discomfort, acid indigestion, alternating bowel habits, joint pain, ocular pain, nausea, and fatigue at the follow-up, after adjusting for age and sex. Our findings suggested that cryptosporidiosis was mainly associated with gastrointestinal- and joint-related post-infectious symptoms for up to 5 years after the infection

Effects of repeated sensory stimulation sessions (electro-acupuncture) on skin temperature in chronic pain patients

Changes in skin temperature and haemodynamics were studied during experimentally administered electro-acupuncture before and after a 4-week period of electro-acupuncture (EA) treatments. Subjective pain intensity was evaluated using a pain questionnaire. Twelve patients with long-lasting nociceptive pain were included. Before clinical treatment, skin temperature tended to decrease after 30 minutes' stimulation. In contrast, a significant increase was seen after the clinical treatment. No significant changes were seen for blood pressure, heart rate or pain intensity before and after the clinical treatment. The data indicate that an increased skin vasoconstrictor sympathetic activity may be responsible for the decreased skin temperature during the electro-acupuncture in the initial test sessions, whereas an inhibition of skin sympathetic activity and/or a release of vasodilatory substances may be responsible for the increase in temperature after completed clinical treatment. Despite a small number of subjects and correction for multiple inference, the difference in temperature effects before and up to 3 months after acupuncture treatment was significant

Relations between experimentally induced tooth pain threshold changes, psychometrics and clinical pain relief following TENS. A retrospective study in patients with long-lasting pain

The present study investigates the relationships between clinical pain relief, physiological and psychological parameters. Out of 50 patients with long-lasting musculoskeletal neck- and shoulder-pain treated with transcutaneous electrical nerve stimulation (TENS), 21 were selected and classified as responders (n = 13) or non-responders (n = 8). Tooth pain thresholds (PT) were measured before and after an experimental TENS treatment and the relative change in PT following the stimulation was calculated. Three psychometric self-inventories were administered: Zung Depression Scale, Spielberger's Trait Anxiety Scale and the Multidimensional Health Locus of Control Scale. Responders (R) and non-responders (NR) differed significantly from each other in the PT measurements as well as on the psychometric scales. NR exhibited higher levels of anxiety and depression, a more pronounced powerful other orientation and no change or a decrease in PT following TENS compared to R. These findings indicate relationships and interactions between physiological and psychological factors in patients with long-lasting pain

Pain threshold responses to two different modes of sensory stimulation in patients with orofacial muscular pain: psychologic considerations

This study focuses on the influence of trait anxiety and mood variables on changes in tooth pain threshold following two similar methods of somatic afferent stimulation, one familiar (manual acupuncture) and one unfamiliar (low-frequency transcutaneous electrical nerve stimulation [low-TENS]). Twenty-one acupuncture responders, treated for long-lasting orofacial muscular pain but naive to low-TENS, were selected for the study. In an experimental session, acupuncture and low-TENS were randomly given during two periods separated by a rest interval. Tooth pain thresholds (PT) were measured before and after stimulation with a computerized electrical pulp tester. Trait anxiety and depression were assessed with psychometric forms before the experimental session in all patients, whereas momentary mood was assessed in 10 randomly selected patients with visual analogue scales during and after the two types of stimulation. Following acupuncture, the group average PT increased significantly, whereas no significant change was observed following low-TENS. Higher scores on trait anxiety correlated significantly with a low PT increase following low-TENS, and higher ratings of stress correlated significantly with a low PT increase following acupuncture. This indicates that the magnitude of analgesia induced by these methods may be modified by psychologic factors like anxiety and stress

Common data elements for spinal cord injury clinical research:a National Institute for Neurological Disorders and Stroke project

OBJECTIVE: To develop a comprehensive set of common data elements (CDEs), data definitions, case report forms and guidelines for use in spinal cord injury (SCI) clinical research, as part of the CDE project at the National Institute of Neurological Disorders and Stroke (NINDS) of the USA National Institutes of Health. SETTING: International Working Groups METHODS: Nine working groups composed of international experts reviewed existing CDEs and instruments, created new elements when needed, and provided recommendations for SCI clinical research. The project was carried out in collaboration with and cross-referenced to development of the International Spinal Cord Society (ISCoS) International SCI Data Sets. The recommendations were compiled, subjected to internal review, and posted online for external public comment. The final version was reviewed by all working groups and the NINDS CDE team prior to release. RESULTS: The NINDS SCI CDEs and supporting documents are publically available on the NINDS CDE website and the ISCoS website. The CDEs span the continuum of SCI care and the full range of domains of the International Classification of Functioning, Disability and Health. CONCLUSIONS: Widespread use of common data elements can facilitate SCI clinical research and trial design, data sharing, and retrospective analyses. Continued international collaboration will enable consistent data collection and reporting, and will help ensure that the data elements are updated, reviewed and broadcast as additional evidence is obtained