Оценка взаимосвязи иммунного статуса и холестеринового профиля у пациентов с облитерирующим атеросклерозом артерий нижних конечностей

АРТЕРИОСКЛЕРОЗ ОБЛИТЕРИРУЮЩИЙИММУНИТЕТКОНЕЧНОСТЬ НИЖНЯЯХОЛЕСТЕРИ

Associations between pain thresholds for heat, cold and pressure, and Pain Sensitivity Questionnaire scores in healthy women and in women with persistent pelvic pain

Background The Pain Sensitivity Questionnaire (PSQ) is a self‐rating instrument developed as a time‐ and cost‐saving alternative to quantitative sensory testing (QST). The aims of the study were to assess (a) the associations between PSQ scores and QST in women with persistent pelvic pain and in pain‐free controls and (b) to what extent demographic variables and psychological distress influenced PSQ scores. Methods Fifty‐five healthy women and 37 women with persistent pelvic pain participated. All filled in the PSQ and Hospital Anxiety and Depression Scale and had QST (heat, cold and pressure pain thresholds) performed on six locations on the body. Information on age, body mass index, smoking habits and pain duration were collected. Principal component analysis and orthogonal partial least square regressions were used. Results The patients scored significantly higher on PSQ than the controls. Significant multivariate correlations between pain thresholds and PSQ scores were found only in the patient group. In the patient group, the heat and cold pain thresholds correlated more strongly with PSQ scores than the pressure pain threshold. Conclusions The PSQ score was significantly higher in pelvic pain patients, and correlations between QSTs and the PSQ were only found for patients. Significance The PSQ reflects pain sensitivity in women with PPP and can be used as a non‐invasive and painless way to assess this condition in clinical practice.Funding Agencies|Medical Research Council of Southeast Sweden; Swedish Research Council; County council of Ostergotland; Linkoping University; IMI Paincare</p

Altered neuromuscular control mechanisms of the trapezius muscle in fibromyalgia

<p>Abstract</p> <p>Background</p> <p>fibromyalgia is a relatively common condition with widespread pain and pressure allodynia, but unknown aetiology. For decades, the association between motor control strategies and chronic pain has been a topic for debate. One long held functional neuromuscular control mechanism is differential activation between regions within a single muscle. The aim of this study was to investigate differences in neuromuscular control, i.e. differential activation, between myalgic trapezius in fibromyalgia patients and healthy controls.</p> <p>Methods</p> <p>27 fibromyalgia patients and 30 healthy controls performed 3 minutes bilateral shoulder elevations with different loads (0-4 Kg) with a high-density surface electromyographical (EMG) grid placed above the upper trapezius. Differential activation was quantified by the power spectral median frequency of the difference in EMG amplitude between the cranial and caudal parts of the upper trapezius. The average duration of the differential activation was described by the inverse of the median frequency of the differential activations.</p> <p>Results</p> <p>the median frequency of the differential activations was significantly lower, and the average duration of the differential activations significantly longer in fibromyalgia compared with controls at the two lowest load levels (0-1 Kg) (p < 0.04), but not at the two highest load levels (2 and 4 Kg).</p> <p>Conclusion</p> <p>these findings illustrate a different neuromuscular control between fibromyalgia patients and healthy controls during a low load functional task, either sustaining or resulting from the chronic painful condition. The findings may have clinical relevance for rehabilitation strategies for fibromyalgia.</p

Foreword

Background: This study compares the levels of algesic substances between subjects with trapezius myalgia (TM) and healthy controls (CON) and explores the multivariate correlation pattern between these substances, pain, and metabolic status together with relative blood flow changes reported in our previous paper (Eur J Appl Physiol 108: 657-669, 2010). Methods: 43 female workers with (TM) and 19 females without (CON) trapezius myalgia were - using microdialysis - compared for differences in interstitial concentrations of interleukin-6 (IL-6), bradykinin (BKN), serotonin (5-HT), lactate dehydrogenas (LDH), substance P, and N-terminal propeptide of procollagen type I (PINP) in the trapezius muscle at rest and during repetitive/stressful work. These data were also used in multivariate analyses together with previously presented data (Eur J Appl Physiol 108: 657-669, 2010): trapezius muscle blood flow, metabolite accumulation, oxygenation, and pain development and sensitivity. Results: Substance P was significantly elevated in TM (p=0.0068). No significant differences were found in the classical algesic substances (p: 0.432-0.926). The multivariate analysis showed that blood flow related variables, interstitial concentrations of metabolic (pyruvate), and algesic (BKN and K+) substances were important for the discrimination of the subjects to one of the two groups (R-2: 0.19-0.31, pless than0.05). Pain intensity was positively associated with levels of 5-HT and K+ and negatively associated with oxygenation indicators and IL-6 in TM (R-2: 0.24, pless than0.05). A negative correlation existed in TM between mechanical pain sensitivity of trapezius and BKN and IL-6 (R-2: 0.26-0.39, pless than0.05). Conclusion: The present study increased understanding alterations in the myalgic muscle. When considering the system-wide aspects, increased concentrations of lactate, pyruvate and K+ and decreased oxygenation characterized TM compared to CON. There are three major possible explanations for this finding: the workers with pain had relatively low severity of myalgia, metabolic alterations preceded detectable alterations in levels of algesics, or peripheral sensitization and other muscle alterations existed in TM. Only SP of the investigated algesic substances was elevated in TM. Several of the algesics were of importance for the levels of pain intensity and mechanical pain sensitivity in TM. These results indicate peripheral contribution to maintenance of central nociceptive and pain mechanisms and may be important to consider when designing treatments.Funding Agencies|Danish Medical Research Council [22-03-0264]; Danish Rheumatism Association [233-1149-02.02.04]; Swedish Research Council [K2011-69X-21874-01-6]; Swedish Council for Working Life and Social Research [2010-0913]</p

Interdisciplinary Pain Rehabilitation Programs: Evidence and Clinical Real-World Results

Chronic pain conditions are influenced by and interact with physical, psychological, social, and contextual factors. These conditions are associated with psychological distress, poor health, sick leave, and high socio-economic costs. Therefore, modern clinical practice applies a biopsychosocial (BPS) framework. Interdisciplinary pain rehabilitation programs (IPRPs) for chronic pain distinguish themselves as well-coordinated complex interventions. This chapter describes the contents of such programs. We will briefly review the evidence for IPRPs and discuss problems when evaluating these complex interventions. Furthermore, we will report practice-based results from a large Swedish pain registry—the Swedish Quality Registry for Pain Rehabilitation (SQRP). The SQRP collects data from a relevant special clinical department in Sweden—i.e., real-life outcomes will be depicted. Characteristics of patients that benefit the most from IPRPs will be described and discussed. The indications for IPRPs will also be presented. Finally, we will discuss how to improve rehabilitation for chronic pain patients

Pain tolerance in chronic pain patients seems to be more associated with physical activity than with depression and anxiety

OBJECTIVE: To explore the associations between habitual self-reported physical activity, pain sensitivity and patient-reported outcomes (including pain intensity) in patients with chronic pain. DESIGN: Cross-sectional, experimental study. SUBJECTS: Patients (n = 78), age range 18–65 years, with different chronic pain conditions (> 3 months) were compared with age- and sex-matched healthy controls (n = 98). METHODS: Multivariate correlations between self-reported physical activity, pressure pain sensitivity, and patient-reported outcome measures were assessed. RESULTS: Lower perceived health status (p < 0.001, Cohen’s d = 2.34), higher levels of depression (p < 0.001, Cohen’s d = 1.77), and lower pain tolerance threshold (p < 0.001, Cohen’s d = 1.66) were the most prominent variables discriminating patients from controls. In patients, bivariate and multivariate analyses showed that higher pressure pain tolerance was associated with male sex, lower pain intensity and fewer painful regions, higher self-efficacy and more self-reported physical activity, but not with lower levels of anxiety and depression. CONCLUSION: Pain tolerance thresholds, as well as degree of depression and perceived health status discriminated between patients and controls, and there was an association between pain tolerance thresholds and level of self-reported physical activity in patients. This study highlights the importance of further research into how increased physical activity may improve pain sensitivity in patients with chronic pain

Reduced pain thresholds and signs of sensitization in women with persistent pelvic pain and suspected endometriosis

INTRODUCTION: Endometriosis is a gynecological disorder that may cause considerable pelvic pain in women of fertile age. Determining pain mechanisms is necessary in order to optimize the treatment of the disease. The objective of the study was to evaluate pain thresholds in women with persistent pelvic pain with and without confirmed endometriosis, and healthy, unaffected controls, and analyze how pain thresholds in these cohorts related to duration of pelvic pain, quality of life, and symptoms of anxiety and depression. MATERIAL AND METHODS: Pain thresholds for heat, cold and pressure were assessed with quantitative sensory testing on six locations on a reference group of 55 healthy women and on 37 women with persistent pelvic pain who had been admitted for diagnostic laparoscopy on the suspicion of endometriosis. Validated instruments were applied to assess quality of life and symptoms of anxiety and depression. Data were analyzed by means of uni- and multivariate analysis of variance and Spearman's rank-order correlation. RESULTS: The women with persistent pelvic pain had significantly lower pain thresholds compared with the reference women. In the women with pain, no differences were observed in pain thresholds between women with (n = 13) and women without (n = 24) biopsy-proven endometriosis. The duration of pelvic pain correlated significantly positively with reduced pain thresholds, ie, the longer the duration, the more sensitization. In the persistent pelvic pain group, pain thresholds for heat correlated significantly with the Short Form Health Survey 36 dimension of bodily pain, and thresholds for cold correlated with Short Form Health Survey 36 bodily pain and with symptoms of depression. CONCLUSIONS: Our results showed widespread alterations in pain thresholds in women with persistent pelvic pain that are indicative of central sensitization and a time-dependent correlation. Women with pelvic pain and suspicion of endometriosis should probably be treated more thoroughly to prevent or at least minimize the concomitant development of central sensitization.Funding agencies:  Medical Research Council of Southeast Sweden; Region Ostergotland; Linkoping University</p

Математическое моделирование производственной программы сельскохозяйственной организации как инструмент принятия управленческих решений

Материалы IX Междунар. науч.-практ. конф., Гомель, 26-27 ноября 2015